The other weekend in my pediatric clinical (which is at an excellent children's hospital) I took care of a poor little 5 month old with RSV bronchiolitis. It's the common cold virus, but an infant's upper respiratory tract is so relatively close to their bronchial tree, which means what would be the common cold for you or I might travel down to their lungs very quickly. This poor girl was completely clogged from nostrils to lungs with the thick, tenacious mucus characteristic of RSV. I spent all of Sunday suctioning her and sitting her upright with her mom, but it helped keep her out of the PICU which is where the respiratory therapist and nurse thought she might be headed. One of our lecturers said that RSV infections before one year of age is correlated with a much greater incidence of asthma. She thought it has to do with oversensitizing the respiratory immune system.
I can't help feeling like breastfeeding would've prevented this. She was formula-fed. I mean, I don't know what the mom's situation is, so I didn't really say anything to her. Maybe I should've. But think about it: we are all exposed to RSV. I think I can safely assume the mom is actively immune to many forms of the common cold virus. And the antibodies which are produced in breastmilk——immunoglobulin type A—are chiefly antibodies of the mucus membranes, including the respiratory tract. (They also heavily protect the gut from unpleasant visitors like E. coli and rotovirus.)
So why would we not recommend the mother begin breastfeeding? Why aren't there breastmilk donor banks to help treat these children? Except there are, but I don't know if they're equipped for treating every RSV and gastroenteritis case that comes along. Why doesn't the government offer financial incentives for breastmilk donation?
Another of my instructors told us about the time her entire family came down with salmonella diarrhea—except her infant who she was breastfeeding. Apparently while she battled salmonellosis herself she had developed enough antibodies not only to fight her own enteric infection but to protect her infant. She said the day after she stopped breastfeeding, her infant spiked a 103 temp and began diarrhea. I don't know why she didn't resume—instead she went to Pedialyte mixed with formula—but the lesson seems clear.
I have a four month old. I was afraid of bringing RSV home to her after taking care of this poor infant. RSV is extremely communicable—it transmits easily from hand to mucus membranes, and can live for days on dry surfaces. I scrubbed my hands & arms within an inch of their life and used alcohol foam. Even thought about using chlorhexidine wipes like they use presurgically! But on the other hand, she is breastfed. I wouldn't play games with that, but I don't think it was as great a risk as I felt it was at the time.