Your recent article in the Huffington Post titled, “The Scary But Rare Risk Linked to Exclusive Breastfeeding,” is yet another example of the untruthful and unethical promotion of exclusive breastfeeding as an all-benefit, no-risk choice for mothers. The hiding of the common and dangerous complications of the Baby-Friendly protocol including the risks of starvation from avoiding supplementation is a violation of patient rights and threatens the brains and lives of newborns.
First of all, you identified the Fed is Best Foundation as a “parent-led” non-profit founded to push back against the social pressure to exclusively breastfeed. That is an inaccurate representation of our credentials as the Foundation was founded by an emergency physician, former NIH scientist and a Newborn ICU nurse and IBCLC. We are also joined by Neonatal Nurse Practitioners, NICU Nurses, Labor & Delivery Nurses, Physicians, Scientists, Public Health Advocates, Attorneys and a Statistician. Furthermore, we were created to speak out against the unsafe and unethical practices of the Baby-Friendly Hospital Initiative and the WHO exclusive breastfeeding guidelines, which has hospitalized more babies on this planet for starvation-related complications than any other policy in the history of public health. We were created to write ethical breastfeeding guidelines that respect the patient rights of mothers to honest information so that she can protect her child. Lastly, we were created to write safe and evidence-based breastfeeding guidelines that don’t endanger children’s lives.
Jaundiced newborns requiring phototherapy in Vietnam
While it is rare for a child to die from dehydration caused by exclusive breastfeeding, it is not rare to experience brain-threatening complications that require hospitalization. The reason why these hospitalizations occur is because mothers are taught that insufficient breast milk is rare and therefore the need for supplementation is rare, which even Dr. Alison Stuebe of the Academy of Breastfeeding Medicine admits in her own editorial is necessary in as many as 1 in 7 babies. Furthermore, their own jaundice protocol says that 10-18% of U.S. exclusively breastfed newborns experience starvation jaundice from insufficient milk intake, which require extended or repeat hospitalization for phototherapy to prevent or limit brain injury. The scientific literature has shown by the time a child needs phototherapy, they already have markers of brain injury leaking into their blood.
The latest data on rates of hypoglycemia in healthy, term exclusively breastfed newborns showed that 10% experience levels low enough (<40 mg/dL) to cause long-term cognitive declines by 6 hours of life. The scientific literature has also shown that by the time they reach a glucose of 40 mg/dL, they are also leaking markers of brain injury in the blood. Yet few EBF healthy, term newborns are monitored for hypoglycemia.
In addition, you misquote the Oddie study on hypernatremic dehydration and represent dehydration as rare and when dehydration as defined by weight loss of greater than 10% is actually common, occurring to 14% of newborns in the largest study done to date. In other countries, they have been reported as high as 25%. Lastly, while the rates of laboratory-diagnosed hypernatremic dehydration are reported as rare, the number of exclusively breastfed newborns who experience it are likely to be far greater since EBF newborns do not get blood work unless their starvation is detected. If you don’t look for it, then it appears rare. However, the data on neonatal hypernatremia shows that it occurs as early as 7% weight loss, which happens to half of all exclusively breastfed newborns. This is not surprising since the blood volume of a child is 8.5% of their body weight, a weight loss of > 7% is likely to result in severe dehydration synonymous with hypernatremia.
Sadly, hospitalizations for jaundice primarily caused by underfeeding from the Baby-Friendly protocol are common. In a paper published by a Baby-Friendly Hospital system, they revealed that 5.7-13% of all the babies born required hospitalization for phototherapy. Furthermore 12-20% experienced levels of hyperbilirubinemia that have been associated with multiple developmental and neurological disabilities.
The Baby-Friendly Hospital Initiative is 25 years old. It has no data on safety. Exclusively breastfeeding one’s newborn before having a full milk supply comes with an infinite-fold risk of underfeeding and excessive weight-loss, since recent data shows no supplemented or formula-fed newborn is at risk. It relies on the unproven notion that newborn babies can fast for 3 days without irreversible harm to the brain and vital organs. It operates with no knowledge of the number of calories colostrum can provide nor the true caloric requirements of newborns. Finally, it allows newborn babies to cry out of hunger for hours to days without sleep while withholding supplementation in the faulty belief that the torture of hunger they experience is worth the benefits of breastfeeding.
Landon crying and nursing continuously by the second day of life
So as you see, hospitalizations and complications from the exclusive breastfeeding guidelines are not rare and are in fact the leading causes of newborn hospitalization in the world. So not only are you falsifying that complications are rare in order to convince mothers to trust you with their children, you are hiding them at the risk of causing harm to a child that is severe and irreversible. While every mother is informed of the risks of formula, they are not informed of the risks of starvation; and the risks of starvation far exceed the risks of properly-prepared formula. Sadly, the only rare thing in breastfeeding is honesty in its promotion.
Lies killed Landon Johnson and lies are hospitalizing exclusively breastfed babies every single day.
#babyfriendly #fedisbest
Thank you. I had to demand that the hospital give me formula for my baby by threatening to send my husband to the store. I got tired of hearing, “Her sugar levels are within normal range” and “she’s getting the colostrum you’re self-expressing, her belly is tiny, and that’s all she needs right now.” I truly believe, because of this, my child had a complete aversion to the breast to begin with. The odds were stacked against me and my child before we had a chance. Luckily, the nurses caved and gave her formula.
I completely agree with your comments Christie, as a mother and Family Doctor doing obstetrics for over 25 years. Administrators create these ideals with no options and the Nurses and Doctors have to ” buy in” to be part of supporting breastfeeding. Hmmm- where have we seen this before? Thank God for social media to express the views that we constantly think and are too afraid to say. They are afraid to loose power and persuasion in the vulnerable young mothers group. They are talking about “fed is best” website Christie and are worried!!!! What does that say! Maybe there will be less developmental issues in this world- cause the rise of this coinciding with exclusive bf ( only breastfeeding- I say). They are taking notice and what I love is that they have to read the hundreds of mothers comments along with professionals like myself who have witnessed this too long. Congratulations for helping thousands of mothers and especially babies who cannot vocalize what is happening to them. The site will continue to be a place that threatens those who use denial to cope with decisions they have perpetuated for themselves or others. I feel sorry for those babies under their care.
Dr. Heather McLeod
MD FCFP
I don’t know why anyone reads Huffington Post. They’ll print anything, facts aren’t researched. Please continue to set the record straight.
FED is best!
Dr. Castillo-Hegyi’s pediatrician missed a monumental warning sign at an early pediatric visit, i.e., that her baby had lost 15% of birth weight. That was the first of several problems. Breastfeeding was not the problem; the problems were lack of awareness, critical analysis, and ignorance.
From what I have read, every case involves some provider ignorance; it isn’t breastfeeding that is the problem. It is lack of attention to risk factors (Example: “Dear mamma, you have PCOS and had a cesarean section, so we will have to monitor your baby and breastfeeding more closely.”) that stands out.
Healthy term babies are born with built-in resources to get through the first couple of days while lactation is being established. When I see a baby where insufficient milk supply is the issue, those babies have lost a pound by day 5 or 6, and they need help right away. . . and, they don’t collapse on Day 3. After reading that heartbreaking story, I wondered (as a healthcare professional since 1971) what else was going on with that baby?
Yes it is true that not every mother will make enough milk, just as not every mother can conceive, or carry a baby to term, or birth a baby without surgery. We need to build a system that recognizes and supports, rather than discarding anything. . . except maybe, ignorance.
This is the time for collaboration and cooperation and changes in policy. Some countries don’t send the dyad home until breastfeeding has been proved to be working.
When a new mother goes home to no reliable source of practical advice and supervision, when 23% of mothers are returning to work by 2 weeks postpartum, when most providers are undereducated and overworked by a factory approach to care, the scene is set for disaster
The problem is this, mothers should be honestly informed that their children can starve until they are brain injured or dead. At 15% weight loss, it is too late. A child has massive amount of brain injury after 3 days of no eating according to cases of 15% weight loss identified in the literature. What would have saved my son and Landon was HONESTY from health professionals in breastfeeding classes and books. I would have supplemented from the start like millions of moms did before the WHO guidelines made breastfeeding dangerous. So no, I don’t plan to collaborate with people who are willing to lie at a baby’s great peril to push their agenda on unsuspecting mothers. If you are willing to admit that it is unethical and criminally negligent to lie to mothers that their crying and constantly nursing newborns aren’t starving and asking for more milk, I might be willing to consider your opinion. Otherwise, the Foundation plans to set up a new infant feeding credential that only uses people with nursing degrees. Feeding is life and death and the WHO and the supporting organizations have made it a game where babies are put at risk.
Thank you. Newborn weight loss is a complicated topic. What do you think of this study? Or this one, ?
What does the newborn really weigh after a mother has had a prolonged period of IV hydration? There are many studies identifying that the duration and rates of IV hydration influence newborn weight loss.
I agree that we have to be honest about milk making, as I said in my comment above. Reproductive process can fail at any step of the way. The solution is knowledgeable and timely support, again identified in the literature.
The new born weight loss study has no data on clinical outcomes. You don’t know how many of those babies experience brain injury from hypoglycemia, hypernatremia, hypotensive dehydration or hyperbilirubinemia. For all we know, half of those babies could have experienced brain injury.
The links to the studies I found didn’t show up. . . what can I do about that?
Which study?
J Pediatr. Author manuscript; available in PMC 2008 Aug 1.
Published in final edited form as:
J Pediatr. 2007 Aug; 151(2): 127–133.e1.
doi: 10.1016/j.jpeds.2007.03.009
PMCID: PMC2233705
NIHMSID: NIHMS28070
FIVE YEAR NEURODEVELOPMENTAL OUTCOME OF NEONATAL DEHYDRATION
Gabriel J. Escobar, MD,1,2 Petra Liljestrand,1,3 Esther S. Hudes, PhD,3 Donna M. Ferriero, MD,4,5 Yvonne W. Wu, MD, MPH,4,5 Rita J. Jeremy, PhD,5 and Thomas B. Newman, MD, MPH1,3
Objective
To determine the long-term outcome of neonatal dehydration.
Study design
We identified 182 newborns rehospitalized with dehydration (weight loss ≥12% of birth weight and/or serum sodium ≥150 mEq/L) and 419 randomly selected controls from a cohort of 106,627 term and near-term infants ≥2000 g born from 1995 through 1998 in Northern California Kaiser Permanente hospitals. Outcomes data were obtained from electronic records, interviews, questionnaire responses, and neurodevelopmental evaluations performed in a masked fashion.
Results
Follow-up data to the age of at least two years were available for 173/182 children with a history of dehydration (95%) and 372/419 controls (89%) and included formal evaluation at a mean (±SD) age of 5.1±0.12 years for 106 children (58%) and 168 children (40%) respectively. None of the cases developed shock, gangrene, or respiratory failure. Neither crude nor adjusted scores on cognitive tests differed significantly between groups. There was no significant difference between groups in the proportion of children with abnormal neurologic examinations or neurologic diagnoses. Frequencies of parental concerns and reported behavior problems also were not significantly different in the two groups.
Conclusions
Neonatal dehydration in this managed care setting was not associated with adverse neurodevelopmental outcomes in infants born at or near term.
This also shows that you didn’t read the whole paper because in the body of that paper, the dehydrated newborns were more likely to fail the fine motor test, had parents that expressed concern about language delay, were more likely to be described as “shy,” “allergic,” and “disabled.”
Interesting too, that the cases had insignificantly higher IQs than the controls.
Specifically, “Only one of the 12 individual items differed between the two groups; children in the dehydration group were more likely to fail the ‘copy shapes’ item (a test of fine motor skills) (40% versus 30%; P=0.04).”
However, no one wants infants to get in trouble. The focus of our work should be creating providing thorough education to providers, being honest about breastfeeding in the prenatal period and the hospital, and providing support (accurate information and encouragement) to all mothers.
Parents had concerns about speech delay; the speech pathologists examinations found no significant difference between groups.
There were no speech evaluations! They weren’t speech pathologists that evaluated them. They were child psych and neurology that evaluated. No speech eval. That is called burying data.
You see how lying is endemic in Baby-Friendly hospitals? Even the research that comes out. They showed no evidence of actual standardized speech evaluations on the paper and child psychiatrists and neurologists do not do speech evaluations.
Who are you and the Baby-Friendly hospitals trying to protect? Babies or yourselves?
There was ONE. That does not make a pattern. You cannot make a pattern with one when the entire scientific literature on neonatal hypernatremia shows that it causes brain injury, developmental delay, disability and intellectual decline and death. Brain injury also causes savant skills in a RARE child. But the majority are disabled.
Original article
Severe neonatal hypernatraemia: a population based study FREE
Sam Joseph Oddie1, Vanessa Craven2, Kathryn Deakin3, Janette Westman4, Andrew Scally5
Author affiliations
Abstract
Aims To describe incidence, presentation, treatment and short term outcomes of severe neonatal hypernatraemia (SNH, sodium ≥160 mmol/l).
Methods Prospective, population based surveillance study over 13 months using the British Paediatric Surveillance Unit. Cases were >33 weeks gestation at birth, fed breast or formula milk and <28 days of age at presentation.
Results Of 62 cases of SNH reported (7, 95% CI 5.4 to 9.0 per 1 00 000 live births), 61 mothers had intended to achieve exclusive breast feeding. Infants presented at median day 6 (range 2–17) with median weight loss of 19.5% (range 8.9–30.9). 12 had jaundice and 57 weight loss as a presenting feature. 58 presented with weight loss ≥15%. 25 babies had not stooled in the 24 h prior to admission. Serum sodium fell by median 12.9 mmol/l per 24 h (range 0–30). No baby died, had seizures or coma or was treated with dialysis or a central line. At discharge, babies had regained 11% of initial birth weight after a median admission of 5 (range 2–14) days. 10 were exclusively breast fed on discharge from hospital.
Conclusions Neonatal hypernatraemia at this level, in this population, is strongly associated with weight loss. It occurs almost exclusively after attempts to initiate breast feeding, occurs uncommonly and does not appear to be associated with serious short term morbidities, beyond admission to hospital.
http://dx.doi.org/10.1136/archdischild-2012-302908
Like I said, laboratory-diagnosed hypernatremic dehydration is rare because EBF newborns are not tested for it. But hypernatremia occurs by 7% weight loss, which half of all EBF newborns experience. Other neonatal hypernatremia studies have showed than over half of the baby has abnormal development by 12 months of age.
J Matern Fetal Neonatal Med. 2007 Jun;20(6):449-52.
Moderate hypernatremic dehydration in newborn infants: retrospective evaluation of 64 cases.
Uras N1, Karadag A, Dogan G, Tonbul A, Tatli MM.
Author information
Abstract
OBJECTIVES:
This study was carried out to assess the incidence, presenting complaints, risk factors, and methods for prevention of hypernatremic dehydration among term and near-term breastfeeding infants.
METHODS:
We retrospectively evaluated term and near-term (> or =35 weeks of gestation) neonates admitted to our neonatology department, during a four-year period with serum sodium concentrations of > or =146 mEq/L. A detailed maternal and infant history and examination including presenting complaints, risk factors, feeding problems, and weight loss, if present, were registered.
RESULTS:
Among 1150 neonates admitted to our unit, 64 (5.6%) had serum sodium concentrations of >145 mEq/L, in whom 43 of them had sodium concentrations of >149 mEq/L. The most common presenting complaint was jaundice in 30 patients (48%). Forty-one (95%) of the 43 patients described a more than 7% weight loss and there was a positive correlation between serum sodium and urea and creatinine concentrations, and a negative correlation between serum sodium and glucose concentrations in these patients (p < 0.05). There was no difference between patients with sodium >149 mEq/L and <149 mEq/L with respect to maternal age, parity, educational level, hospital stay, type of delivery, and anesthesia and also with respect to seasons (p > 0.05).
CONCLUSIONS:
Weight loss in an infant of greater than 7% from birth weight increases the risk of hypernatremia, a weight loss limit that is lower than the previously reported 10%. This indicates possible breastfeeding problems and requires more intensive evaluation of breastfeeding and possible interventions to correct problems and improve milk production and transfer.
The study you quoted did not do developmental testing on these children. So they might have looked normal upon discharge but perinatal brain injury is invisible because newborns don’t do much.
A Review of 116 Cases of Breastfeeding-Associated
Hypernatremia in Rural Area of Central Turkey
by Esad Koklu, Tamer Gunes, Mehmet Adnan Ozturk, Mehmet Kose, Selim Kurtoglu, and Fatih Yuksel
Department of Paediatrics, Division of Neonatology, School of Medicine, Erciyes University, Kayseri, 38039, Turkey
Summary
We aimed to assess the incidence, neurologic and neurodevelopmental outcome of breastfeedingassociated
hypernatremic dehydration among hospitalized neonates in rural area of central Turkey.
A retrospective study was conducted at Gevher Nesibe Hospital over a 6-year period, to identify
otherwise healthy term and near-term (35 weeks of gestation) breastfed neonates (<29 days of age)
who were admitted with serum sodium concentrations of >150 mEq/l and no explanation for
hypernatremia other than inadequate milk intake. The incidence of breastfeeding-associated
hypernatremic dehydration among hospitalized term and near-term neonates (n¼5592) was 2.1%,
occurring for 116 breastfed infants. More than one half of the infants admitted with breastfeedingassociated
hypernatremia exhibited abnormal development at 12 or more months of age. Increased
efforts are required to establish successful breastfeeding.
“Of 90 infants with known outcomes,
19 had severe adverse outcome, three died (at home)
and 16 had severe impairment and microcephaly at
12 or more months of age. Of 13 infants with severe
quadriplegia, two had cortical blindness and five
were deaf; none of the 13 was able to undergo
developmental testing with the Bayley Scales of
infant development. Three infants with moderate
cerebral palsy had moderate global developmental
delay on Bayley testing at 18–21 months of age. Of
the remaining 71 infants, 44 were considered normal,
18 had mild cerebral palsy and normal Bayley scores
and nine had no cerebral palsy and moderate
developmental delay on Bayley testing. No infant
with mild or no cerebral palsy had severe developmental
delay.
Follow-up information was not available for
65 infants in control group. Of 51 infants with
known outcomes, 49 were considered normal and
two had moderate developmental delay on Bayley
testing at 21 months of age.”
Here’s a link to that article with the highlighted text showing the developmental delays and “disability” that the authors buried in the paper. It also comes out of a Baby-Friendly hospital system whose bias is to produce papers to distract the public about the developmental and neurological harm of the Baby-Friendly protocol.
https://drive.google.com/open?id=0B0_MbXCqYazzOFFjRFhtVEo5SzA
Here’s a link to that article with the highlighted text showing the developmental delays and “disability” that the authors buried in the paper. It also comes out of a Baby-Friendly hospital system whose bias is to produce papers to distract the public about the developmental and neurological harm of the Baby-Friendly protocol. https://drive.google.com/open?id=0B0_MbXCqYazzOFFjRFhtVEo5SzA
I like what is done in Finland, where mothers stay in hospital until breastfeeding is well established. A Finnish patient of mine told me about this.