The answer is 2, 3, 4. The AAP does not endorse any form of sharing or selling/purchasing of unpasteurized human milk.Milk Mob Comment by Anne Eglash MD, IBCLC, FABMBefore reading further, first understand that I applaud this policy’s attention to and endorsement of PDHM for vulnerable infants. Let’s hope that in this new year, 2017, we can kiss goodbye the administration of artificial food to infants who are at risk for a lifetime of disability because of poor early nutrition.

However, I strongly disagree with the AAP’s recommendations on the use of unpasteurized human milk. The AAP’s policy recommends no unpasteurized donor human milk use, but does not clarify if they are referring to high risk infants in the NICU, or any healthy term infant, inpatient or outpatient, at any age.

Because of this lack of clarification, the policy could be interpreted as anti-milk sharing in any and all situations where unpasteurized milk is involved.

It is a FACT that millions of families in the USA and other countries milk share. From what basis would we conclude that a healthy 6-month old who romps and plays with other infants and toddlers on the floor with dogs and cats, sharing saliva, eating old food particles on the floor, breathing in dust and dirt from grandpa’s shoes after he comes in from the barn, ought not to be exposed to the germs in mother’s friend’s milk? A friend who she has grown up with, who she knows does not have HIV? The same friend who happens to have a cold and a bit of diarrhea, and who kisses the child anyway? What argument is used to determine that her breastmilk is taboo for this child, the same child who just drank out of the dog’s water bowl? This child’s mother, who for some reason suffered a drop in milk supply, knows that providing her friend’s unpasteurized milk optimizes her child’s health. Didn’t she read something about how breastfeeding for a year is best for her baby?

By placing a taboo on all unpasteurized milk, the AAP is sanctioning formula as the only alternative to mother’s own milk FOR ALL INFANTS, unless the family has access to PDHM at approximately $5.00/ounce, or about $100/day minimum.

Let’s use Common Sense

• Yes, donor milk for high risk infants should be screened, pasteurized, and retested according to the Human Milk Banking of North America guidelines.
• I agree that some milk sharing strategies are dangerous. Selling one’s own donor milk introduces all sorts of conflicts of interest, such as dishonesty in one’s health status, diluting the milk to increase volume, etc. This practice is actually outlawed in some countries.
• It is NOT reasonable to expect most families to purchase PDHM at $5.00/ounce (~$100/day). IF this is the only recommendation that the AAP has to offer, then millions of infants are relegated to inferior health by being placed on artificial food.
• Safe milk sharing is not rocket science – our ancestors have been doing it for the last 25 million years. It is only in modern times that we have developed a chemical substitute for human milk, and we know that it pales by comparison.
• Unpasteurized milk is no ‘dirtier’ than the sandbox outside, the grocery cart, or kitchen floor in many people’s homes. It fulfills breastmilk’s role in building the gut microbiome. Formula’s contribution to a child’s microbiome? Contamination.
• We need a professional medical organization to endorse a policy that gives safe guidance for families who only want the best for their children. A policy that outlines how to minimize risk of milk sharing, which would enable unlimited access to human milk for all infants regardless of race, ethnicity and socioeconomic status. This would go a long way in reducing disparity in health.