quired immunodeficiency syn- suring physicians, nurses and othdrome as it is in protecting me ers that this situation carries an extremely low risk for infection by from little notebooks. blood-borne pathogens. NeedleLinda A. Robinson, MD, FRCPC stick injuries, the most common Ottawa, Ont. route of accidental infection for the health care worker, are not prevented by gloves. The ready availability of safe disposal containers and the practice of not To glove or not to glove recapping needles are more effective measures. It is true that in mass vacciT he Infectious Diseases and nation clinics health care workers Immunization Committee gloves for general sanihave worn of the Canadian Paediatric Society is very concerned about tary reasons when dealing with the implication of the picture on perhaps hundreds of people. This the cover of the Mar. 15, 1992, is questionable in terms of costissue of CMAJ. The picture de- effectiveness but somewhat reaspicts a physician wearing gloves suring to the public and staff. In and giving an injection to a child. the practice of family medicine a We support the promotion of well-child vaccination might be vaccination in children as well as better illustrated with adequately universal precautions. However, washed but ungloved hands. universal precautions apply to J. Walters, MD, CCFP procedures that place the caregiv- David Director er at risk of exposure to blood, Department of Health Care bloody body fluids or other fluids and Promotion (e.g., cerebrospinal, synovial and Canadian Medical Association pleural) that might contain bloodborne pathogens. Routine vacci- [We were, in fact, trying to illusnation is not deemed to be such a trate Charlotte Gray's article on procedure, and gloves are not in- mass vaccination during the recent dicated. The implication of this outbreak of meningococcal disease in the Ottawa area (see page picture is the opposite. We hope that CMAJ will 1033), as the top cover "teaser" more carefully screen the pictures indicated. Reassurance appeared selected for its covers to ensure to be an important element of the that they are compatible with cur- public health response to the outrently recommended practices or break. Drs. MacDonald and Walmake clear that they do not repre- ters are, of course, quite right that gloves are not necessary for routine sent an accepted practice. vaccination. - Ed.] Noni E. MacDonald, MD, FRCPC Chairman Infectious Diseases and Immunization Committee Canadian Paediatric Society Ottawa, Ont.
The message that the cover of the Mar. 15, 1992, issue presents is that family physicians and pediatricians should use gloves (on both hands) when vaccinating cooperative children. This may run counter to the major task that public health officials have had in reasSEPTEMBER I, 1992
In support of breast-feeding B5 ravo! The CMA's Council on Health Care and Promotion has issued a marvellous statement in support of breast-feeding, as reported in "CMA supports breast-feeding, 'condemns' contracts between for-
mula makers, hospitals," by Patrick Sullivan (Can Med Assoc J 1992; 146: 610-611, 613). The council's four points are right on the mark. Especially important is the characterization of bottle-feeding as an intervention. It is a measure of the power of advertising, among other things, that bottle-feeding has come to be viewed as the norm even by physicians, who should know better. Formula should be considered a drug - occasionally necessary, rarely lifesaving and never routine. To breast-feed or to bottlefeed is not a question of the mother's choice, since most people in our society have been conditioned from a very early age to think of bottle-feeding as the normal way of feeding infants. One has only to look at children's books, films and toys to see that the baby almost always has a bottle and not a breast in its mouth. Infants seen in public are rarely breast-fed. Once a woman becomes pregnant she get lots of information from formula companies that idealizes formula-feeding and undermines breast-feeding. This long-standing indoctrination will not be easy to reverse, but physicians should be in the forefront of change. Breastfeeding has to become, once again, the normal, obvious way of feeding children. The council's statement is a good start. An example of the neglect of breast-feeding by the medical establishment is in "Iron deficiency anemia in 1-year-old children of disadvantaged families in Montreal," by Francois Lehmann and associates, in the same issue of CMAJ (pages 1571 to 1577). The authors neglect to mention that the best way to prevent iron deficiency is for the mother to breastfeed her baby. Indeed, iron deficiency in the first year of life can generally be considered a problem of bottle-feeding. Breast-fed babies are protected against iron deficiency for at least 6 months and CAN MED ASSOC J
1992;
147 (5)
583
The message that the cover of the Mar. 15, 1992, issue presents is that family physicians and pediatricians should use gloves (on both hands) when vaccinating cooperative children. This may run counter to the major task that public health officials have had in reasSEPTEMBER I, 1992
In support of breast-feeding B5 ravo! The CMA's Council on Health Care and Promotion has issued a marvellous statement in support of breast-feeding, as reported in "CMA supports breast-feeding, 'condemns' contracts between for-
mula makers, hospitals," by Patrick Sullivan (Can Med Assoc J 1992; 146: 610-611, 613). The council's four points are right on the mark. Especially important is the characterization of bottle-feeding as an intervention. It is a measure of the power of advertising, among other things, that bottle-feeding has come to be viewed as the norm even by physicians, who should know better. Formula should be considered a drug - occasionally necessary, rarely lifesaving and never routine. To breast-feed or to bottlefeed is not a question of the mother's choice, since most people in our society have been conditioned from a very early age to think of bottle-feeding as the normal way of feeding infants. One has only to look at children's books, films and toys to see that the baby almost always has a bottle and not a breast in its mouth. Infants seen in public are rarely breast-fed. Once a woman becomes pregnant she get lots of information from formula companies that idealizes formula-feeding and undermines breast-feeding. This long-standing indoctrination will not be easy to reverse, but physicians should be in the forefront of change. Breastfeeding has to become, once again, the normal, obvious way of feeding children. The council's statement is a good start. An example of the neglect of breast-feeding by the medical establishment is in "Iron deficiency anemia in 1-year-old children of disadvantaged families in Montreal," by Francois Lehmann and associates, in the same issue of CMAJ (pages 1571 to 1577). The authors neglect to mention that the best way to prevent iron deficiency is for the mother to breastfeed her baby. Indeed, iron deficiency in the first year of life can generally be considered a problem of bottle-feeding. Breast-fed babies are protected against iron deficiency for at least 6 months and CAN MED ASSOC J
1992;
147 (5)
583
