Breast-feeding has advantages in terms of psychosocial aspects, maternal considerations, and infant factors.1-3 Within these same broad areas, I want to address circumstances in which reservations about breast-feeding should be considered.

In terms of infant conditions, galactosemia is clearly an absolute contraindication to breast-feeding. Breast milk is a rich source of lactose, and the very survival of infants with galactosemia is dependent on their receiving a non-lactose-containing formula. Of course, galactosemia is a rare disorder, occurring in approximately 1:60,000 births.

Phenylketonuria is often mentioned as another contraindication to breast-feeding. Breast milk, however, has relatively low levels of phenylalanine; in fact, infants who are exclusively breast-fed may receive a phenylalanine intake near the amount recommended for treating phenylketonuria.4

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