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Breast milk mix-ups at daycare facilities

Cases of babies receiving the wrong breast milk at daycare facilities are not rare.

Many breastfeeding mothers who return to work utilize daycare providers to care for their breastfed babies. Those who want to exclusively breastfeed their babies will need to plan for the transition ahead. In some circumstances the mother can come into the daycare facility to breastfeed at arranged times. But many mothers do not have this option and will need to provide pumped breast milk to the daycare facility to feed the baby.

Surprisingly, cases of babies receiving the wrong breast milk at daycare facilities are not rare. A recent Internet search revealed six cases highlighted in the media over the past five years where babies received another mother's breast milk while in the care of a daycare provider. Additional stories can be seen on various parenting forums. In all likelihood, there are more cases that have not been made public, or in some incidences, never brought to the parents' attention.

Breast milk is not only an excellent source of nutrition for babies, but it also contains important antibodies and other protective substances to help babies defend against illness. However, breast milk can also contain pathogens associated with dangerous diseases such as human immunodeficiency virus (HIV), hepatitis A, hepatitis B, and hepatitis C. While some sources suggest that breast milk can transmit these bloodborne pathogens to babies, other sources suggest the risk of a baby getting an infection from the milk is very low. Specifically, transmission of HIV from breast milk is not only low, it's never been documented. The risk is low because chemicals present in breast milk act, together with time and cold temperature, to destroy HIV present in breast milk. However, the Centers for Disease Control and Prevention (CDC) recommends treating breast milk the same as other bodily fluids (e.g., blood, urine) that may transmit diseases.

Aside from the risk of transmitting diseases from breast milk, there are other factors to consider if a baby receives the wrong breast milk. Breast milk may contain illicit drugs, alcohol, or prescription and non-prescription medications that the mother has taken. These may cause problems for babies, particularly if they have never been exposed to these substances previously. Another consideration is the potential for contamination of the breast milk due to the normal bacterial flora of the mother or improper pumping and storage of the milk. As most parents would agree, the anxiety of learning your baby has ingested another mother's milk can be significant.

Studies that have investigated breast milk mix-ups have found that incorrectly labeled breast milk, difficult to read handwritten labels, mistaken identification of babies, and problems with the way milk is stored are the most common causes of breast milk mix-ups.

Discuss with your daycare provider what policies and procedures are in place to prevent breast milk mix-ups. Be sure you are comfortable with the process used for storing the milk and identifying the correct infant. Ideally, the breast milk will be stored at the daycare facility in labeled, separate storage bins in the refrigerator or freezer for each breastfed baby. You can also help prevent mix-ups by clearly labeling the breast milk you provide for your baby. Consider these recommendations when labeling the breast milk:

  1. Use a moisture-resistant ink to label the breast milk container.

  2. Include on the label your baby's full name and the date and time the milk was expressed, and the date and time the milk was thawed if applicable.

  3. Print the label information or prepare a computer-generated label. Do not use cursive writing, which is more likely to be misinterpreted than printed information.

  4. Secure (perhaps with invisible tape) the label to the breast milk container. Be sure it cannot fall off.

  5. Apply the label to the container in such a way that it would need to be viewed and considered when opening the breast milk container.

  6. Inspect the label for accuracy and complete information before providing the breast milk to the daycare provider.

If your baby receives another mother's breast milk, ask the daycare provider how the milk was expressed and handled prior to giving it to your baby, and inform your child's pediatrician. The CDC suggests that your child should undergo a baseline HIV test as a precaution despite the low risk of being infected. Your child's pediatrician will decide if baseline testing should also occur for other diseases such as hepatitis B, hepatitis C, and HTLV. Hopefully, your baby was vaccinated against hepatitis B at birth as well as subsequent doctor visits to complete the series.

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