U.S. Study Shows Baby-Friendly Hospital Initiative Does Not Work

by Christie del Castillo-Hegyi, M.D.

On October 14, 2019, the Journal of Pediatrics published astonishing findings regarding the effects of the Baby-Friendly hospital certification on sustained breastfeeding rates as defined by the 2020 Healthy People Goals of: 

  1. any breastfeeding at 6 and 12 months
  2. exclusive breastfeeding at 3 and 6 months. 

They did so by measuring the relationship between statewide breastfeeding initiation rates data and the above breastfeeding rates. They then measured the contribution of Baby-Friendly hospital designation on these same breastfeeding outcomes.

According to the study authors, the increase in hospital designation in the Baby-Friendly Hospital Initiative (BFHI) began in 2011 when the U.S. Surgeon General issued a call to action for maternity care practices throughout the U.S. to support breastfeeding. The Centers for Disease Control (CDC) became involved in promoting the BFHI policies in hospitals and health facilities, as breastfeeding was thought to be associated with lower rates of childhood obesity. The assumption was that by increasing breastfeeding rates through the BFHI, there would be a concomitant decline in childhood obesity. Upon initiation of this program, the CDC initiated surveillance of state-specific data on breastfeeding outcomes after discharge including BFHI designation rates. This data is made available to the public through the CDC Breastfeeding Report Card, which provides annual reports from 2007 through 2014 and biennial reports from 2014.

As expected, they found that states with higher breastfeeding initiation rates had higher rates of these sustained breastfeeding outcomes. You cannot have high breastfeeding rates unless mothers are given education and successfully initiate breastfeeding. However, when they measured the effects of Baby-Friendly certification, this is what they found.

“Baby-Friendly designation did not demonstrate a significant association with any post-discharge breastfeeding outcome (Figures 1, B and 2, B). There was no association between Baby-Friendly designation and breastfeeding initiation rates.” Continue reading

World Health Organization Revised Breastfeeding Guidelines Put Babies at Risk Despite Pleas from Experts—Informing the Public “Not a Top Priority”

By the Senior Advisory Board of the Fed is Best Foundation

A key recommendation of the 1989 World Health Organization Ten Steps to Successful Breastfeeding which guides the Baby-Friendly Hospital Initiative (BFHI) is: “give infants no food or drink other than breast-milk, unless medically indicated.” This has led to serious complications from accidental starvation of babies, including dehydration, hyperbilirubinemia (jaundice) and hypoglycemia (low blood sugar) — known causes of infant brain injury and permanent disability. Last week, the WHO issued draft revised breastfeeding guidelines, failing to revise this recommendation. These guidelines define the standard of care for breastfeeding management in all healthcare facilities worldwide. Nearly 500 U.S. hospitals and birthing centers and thousands more worldwide that meet the criteria of the BFHI are certified as Baby-Friendly, adhering to the application of the WHO’s Ten Steps.

On Sept. 22, 2017, senior members of the Fed is Best Foundation, and guests including a neonatologist from a leading U.S. tertiary care hospital and a pediatric endocrinologist, Dr. Paul Thornton, M.D, from Cook Children’s Hospital Fort Worth, lead author of the Pediatric Endocrine Society’s newborn hypoglycemia guidelines, met via teleconference with top officials of the WHO Breastfeeding Program: Dr. Laurence Grummer-Strawn, Ph.D., Dr. Nigel Rollins, M.D. and Dr. Wilson Were, M.D. to express their concerns about the complications arising from the BFHI Ten Steps and to ask what, if any, monitoring, research, or public outreach the WHO has planned regarding the risks of accidental starvation of exclusively breastfed newborns. The Foundation members who attended were 1) Christie del Castillo-Hegyi, MD, Co-Founder, 2) Jody Segrave-Daly, RN, IBCLC, Co-Founder, 3) Julie Tibbets, JD, Partner at Alston & Bird, LLP, Pro-Bono Attorney for the Foundation, 4) Brian Symon, MD, Senior Advisor, and 5) Hillary Kuzdeba, MPH, former quality improvement program coordinator at a children’s hospital, managing infant feeding projects and Senior Advisor.

Emails confirming meeting between the WHO and the Fed is Best Foundation available here.

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If I Had Given Him Just One Bottle, He Would Still Be Alive.

by Jillian Johnson with commentary from Dr. Christie del Castillo-Hegyi

Landon would be five today if he were still alive. It’s a very hard birthday–five. It’s a milestone birthday. Most kiddos would be starting kindergarten at this age. But not my little guy. I wanted to share for a long time about what happened to Landon, but I always feared what others would say and how I’d be judged. But I want people to know how much deeper the pain gets.

I share his story in hopes that no other family ever experiences the loss that we have.

Jarrod and I wanted what was best for Landon, as every parent does for their child. We took all of the classes. Bought and read all of the books. We were ready! Or so we thought….every class and book was geared toward breastfeeding and how it’s so important if you want a healthy child. Landon was born in a “Baby-Friendly” hospital. (What this means is everything is geared toward breastfeeding. Unless you’d had a breast augmentation or cancer or some serious medical reason as to why you couldn’t breastfeed, your baby would not be given formula unless the pediatrician wrote a prescription.)

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Frequent Feeding VS Cluster Feeding: How to Know If Your Baby Is Being Adequately Breastfed Before Lactogenesis II

Frequent breastfeeding and cluster feeding are often used interchangeably, creating confusion for parents. This educational blog will help parents clarify the differences between the two.

What are the differences between frequent breastfeeding and cluster feeding before lactogenesis II for newborns?

Frequent Feeding-Newborn babies feed frequently (every 2-3 hours) before lactogenesis II, the onset of copious milk production. Frequent feeding is expected and normal. 

Cluster Feeding-Cluster feeding occurs after the arrival of lactogenesis II and is defined as a series of short feeding sessions lasting 2-3 hours daily. 

The Academy of Breastfeeding Medicine supplementary feeding protocol states cluster feeding before lactogenesis II requires a prompt evaluation to determine if the baby is getting enough colostrum. 

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The Fed Is Best Book: Protecting Infants and Empowering Choices

Sandra Stephany Lozoya combo-feeding her babies

In a world filled with parenting advice and conflicting messages, there emerges a beacon of wisdom and support – the upcoming release of the Fed Is Best book. Set to hit the shelves June 25, 2024, this transformative guide promises to navigate the intricate landscape of infant feeding choices, empowering parents with knowledge and judgment-free support. This highly anticipated book will reshape the conversation around infant nutrition, offering a comprehensive, science-backed, and inclusive perspective on the myriad ways families can safely and optimally nourish their babies.

Fed Is Best Book

What is the difference between this book and so many other breastfeeding manuals? The goal of the book is not to convince to feed your baby in one way or discourage you from feeding another by painting one type of feeding as ideal and the other as suboptimal or undesirable. The goal is to help you find the best way to feed your baby that fits your biology, your ability to produce milk, your baby’s needs, and the many social, economic, psychological, and practical factors that define what “best” infant feeding looks like for your family—which is different for every single family.

For too long, parents have had to accept a monolithic message that only exclusive breastfeeding provides the best for their infants. Mothers have been told that if they “perceive” that their milk is not enough, they are likely mistaken, under-educated, doing it wrong, or simply not trying hard enough. Little do they know that scientific research has shown that when measured by objective means, true insufficient milk supply is actually quite common. As a result, the message that insufficient milk is rare and supplementation is rarely necessary is putting many infants at risk and many mothers at risk postpartum mental health problems due to the faulty message that low milk supply is their fault. Little do parents know that health professionals have been witnessing a rise in complications of insufficient feeding of exclusively breastfed infants, like jaundice, dehydration, hypoglycemia, and failure to thrive, for as long as parents have been receiving this message.  And the most common victims are those who have diligently followed the guidelines they have found in parenting and breastfeeding manuals yet found that their milk supply was truly too low to safely exclusively breastfeed.

This comprehensive and compassionate guide gives you the raw truth of about breastfeeding and formula feeding, dissects the history and science of breast- and bottle-feeding, and helps you prepare to reach your feeding goals in a safe and practical way. It does this by teaching you how to be flexible and respond to problems while working towards your goal, whether it be exclusive breastfeeding, exclusive formula feeding, or combination feeding.

This groundbreaking work is divided into two distinct parts, each addressing crucial aspects of infant feeding.

Fed Is Best Book

Part 1: The History and Science of Infant Feeding

The first section of the book lays a solid foundation by exploring the complex history and science behind infant feeding practices. It starts with Chapter 1, delving into the evolution of breastfeeding, the role of supplemental feeding, and the development of infant formula, providing readers with a broad context to understand how current practices came to be.

In Chapter 2, the book challenges prevalent beliefs surrounding breastfeeding, debunking harmful myths and shedding light on inconvenient truths that often go unspoken in the discourse on infant nutrition. This chapter aims to foster a more nuanced understanding and encourage critical thinking about the information often presented to new parents.

Chapter 3 addresses the polarizing debate between breastfeeding and formula feeding, questioning the notion of a singular “best” method of infant feeding. It presents evidence-based insights that highlight the benefits and considerations of each method, promoting a balanced view that respects individual circumstances and needs.

The final chapter of this section, Chapter 4 defines optimal infant feeding through a scientific lens, arguing why “Fed Is Best” is a principle that supports the health and well-being of all infants, regardless of the feeding method chosen by their families.

Part 2: The Fed Is Best Guide to Safe and Optimal Infant Feeding

Transitioning from the why to the how, the second part of the book serves as a practical guide for expectant and new parents. Chapter 5 discusses preparations before birth to ensure that parents are equipped with the knowledge and resources needed for optimal infant feeding from day one.

Chapter 6 focuses on the critical first few days of an infant’s life, offering guidance on how to protect against insufficient feeding and ensure that newborns receive adequate nutrition for a healthy start.

Subsequent chapters delve into the specifics of various feeding methods. Chapter 7 through Chapter 11 cover breastfeeding, pumped milk feeding, formula feeding, combination feeding, and bottle feeding, each chapter providing detailed advice, troubleshooting tips, and support for the respective feeding method. The book emphasizes the importance of honoring and supporting all families and their chosen safe infant feeding practices in Chapter 12, advocating for a non-judgmental and inclusive approach to infant nutrition.

The “Fed Is Best” book promises to be an essential resource for parents, caregivers, and healthcare professionals alike, promoting a more informed, compassionate, and inclusive approach to infant feeding. By combining historical context, scientific evidence, and practical guidance, this book aims to empower families to make informed decisions that best suit their needs and circumstances, ensuring that every infant is fed with love and care. Click the button below to pre-order your copy.

Fed Is Best Book

Are Ounces Counted Before Or After Mixing Powdered Formula With Water?


The answer is yes; ounces are counted after mixing the water and powdered formula.  Let’s talk about why.

Calculating accurate total volume intake is important for all babies.

  • Parents need to know how much their baby consumes to be sure they are trending accurately on their growth charts.
  • If a parent is not calculating the formula mixture properly, they may unintentionally overfeed their baby, thinking they need more formula intake.
  • Babies requiring careful intake calculation, such as preemies or medically complex babies, must account for accurate caloric intake for optimal growth and development.

Regarding nutrition, infant formula and human milk have an 87 percent water content, a very important part of your baby’s diet. In a powdered formula recipe, both the water and the powdered formula contribute calories and fluids. 

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What Does Fed Is Best Mean?

The phraseology of Fed is Best is frequently misinterpreted, and we want to clarify what it means to our readers. Nutritionally speaking, “fed” refers to the absorptive state or the first stage of nutrition, in which a baby receives adequate nutrition to maintain optimal bodily functions and achieve healthy growth and development. 

Fed is best means a baby can achieve this fully fed state required to thrive from two clinically-approved sources of nutrition. One is human milk, and the other is infant formula.

Source: Science Simplified, May 13, 2020, Biology/Physiology, Video focused on details of Fed State of Metabolism.

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Breastfeeding pressure is real, and research suggests it’s linked to mental health conditions in mothers

Families are under enormous pressure to exclusively breastfeed from major health organizations such as the WHO, Baby-Friendly USA, CDC, AAP, ACOG, WIC offices, and the majority of US  hospitals.  

The “Breast is Best” public health campaign has permeated US culture and influenced hospital policies; even though US families face impossible barriers to breastfeeding exclusively, the pressure remains, and it is up to families to meet the unattainable guidelines for the majority of families.

By the way, there is no evidence that Baby-Friendly policies are effective for increasing long-term breastfeeding rates.

It has been shown in ample research that exclusively breastfeeding can cause serious complications for infants experiencing insufficient milk intake, a concern we discuss daily. The same pressure to exclusively breastfeed has now been linked to mental health complications, according to a recent research paper published in Research Psychiatry.

Breastfeeding pressure even has a pseudonym, “BRESSURE,” but it’s not funny. 


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