Infants born at a very low birth weight can greatly benefit from pasteurized, donated breast milk, but families should avoid feeding babies unpasteurized breast milk acquired through the internet or other informal networks because of the risks of contamination, according to a new policy statement from the American Academy of Pediatrics.
"The use of donor breast milk has become a lot more common in recent years and that's because of the increasing scientific evidence of its benefits, especially for high-risk babies," says Dr. Steven Abrams, one of the statement's lead authors and a professor in the pediatrics department at The University of Texas at Austin's Dell Medical School.
Health care providers should discourage families from procuring milk online regardless of whether it is sold or donated, according to the Academy, "because of the increased risks of bacterial or viral contamination of nonpasteurized milk and the possibility of exposure to medications, drugs, or other substances," such as pesticides or mercury.
The U.S. Food and Drug Administration also recommends against feeding babies breast milk acquired directly from individuals or via the internet, citing similar concerns about possible contamination.
The Academy's statement, published Monday in the journal Pediatrics, draws a clear line between donated milk acquired through a human milk bank and milk procured through informal networks.
It says brick-and-mortar milk banks have developed safe and effective methods to obtain, pasteurize and dispense breast milk for use in neonatal intensive care units and other settings. It says there are no reported cases of pasteurized, donated human milk causing a hepatitis or HIV infection.
There is a much higher risk with online exchanges that facilitate the donation or selling of breast milk to families of healthy babies, according to the Academy.
While some internet-based groups do screen milk donors, the pediatricians' organization cautions that unpasteurized, donated milk could contain bacterial contamination and transmit hepatitis or HIV.
A 2013 study in the journal Pediatrics found 74 percent of the breast milk researchers purchased online contained staph, strep or other bacterial species.
A follow-up analysis in 2015 found one out of every ten of those samples wasn't 100 percent pure mother's milk. Instead, the donor milk contained added cow's milk or milk-based formula, the study said, adding that the cow's milk was in high enough concentrations "to rule out minor, incidental contamination, suggesting some sellers unintentionally or intentionally added to human milk a significant amount of a cow’s milk product."
Maria Armstrong, a volunteer with a leading breast milk-sharing website, Eats on Feets, expressed disappointment with the Academy's recommendations.
The service provided by online sharing exchanges such as Eats on Feets "fills a big void in feeding infants and babies breast milk," she said, calling it "an unstoppable phenomenon."
Since families are going to acquire breast milk in this manner, the Academy should focus on educating the public on "how you do it safely," said Armstrong.
"Those are the kind of guidelines that I think that organizations like the [Academy] should put out, as opposed to saying it’s not safe," she said. "Because it is safe."
Eats on Feets' press kit acknowledges that milk sharing does have risks, including "exposure to dangerous viruses, exposure to bacteria from improper handling, unwanted contact from adults who seek milk for non-medical reasons," or "harassment by [a] donor or recipient."
But the organization says it is unaware of any "documented cases of disease transmission or bacterial infection associated with informed milk sharing at this point."
Milk sharing "can be done safely as long as all the parties involved practice informed choice making," according to Eats on Feets. It counsels parents "to look through the research available to them and apply it to their personal situation."
Eats on Feets has strongly disputed the 2013 Pediatrics study's findings, questioning its methodology, analysis, context and ethics.
Armstrong also took the Academy to task for lumping together websites that facilitate breast milk donation with those that serve as exchanges for the selling of milk.
Eats on Feets "fervently opposes the selling of breastmilk (sic)," according to one of its fact sheets. "It is our firm belief that the selling and buying of breastmilk (sic) carries undue medical and ethical risks."
There are some similarities between online sites that oversee sharing and selling.
Eats on Feets and a major site that offers breast milk for sale, Only The Breast, both support stovetop pasteurization at home, arguing that it's safe and easy.
Only The Breast did not respond to a request for comment on the Academy's recommendations.