Breast-feeding and Preventative Medicine

Sir.—Drs Gilmore and Rowland presented an interesting report concerning three cases of clinical malnutrition in breast-fed infants (Journal 132:885-887, 1978). As more women attempt to nurse their infants, this syndrome may become more common, so the role of preventive medicine in maternal and child health develops increased importance. Gilmore and Rowland's report could have dealt more fully with this aspect.

Breast-feeding is intimately involved with maternal physiology. The brief descriptions given of maternal medications and health were not sufficient to assess the situation. Was the mother on a special diet for breast-feeders or did she, as do many "upper-middle-class" women, greatly restrict caloric intake in the postpartum period to regain her figure? Was maternal fluid intake adequate? Was a sample of breast milk assessed? Did the mother receive a complete physical examination including breast examination? In case 3, how was the infant fed during the maternal illness and was