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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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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My baby went hungry under the care of three IBCLCs, so I became an IBCLC to promote evidence-based lactation care


As a result of my traumatizing breastfeeding experience, I became an IBCLC. My goal as an RN and IBCLC is to help moms reach their feeding goals in a safe and evidence-based way and, most importantly, to ensure that babies are fed, not forced to go hungry, and to listen and believe moms when they say they are not making enough milk! After all, the number 1 rule in lactation is to feed the baby, but that rule no longer applies. The rule is to breastfeed exclusively, at all costs. That was the price my baby had to pay, and I am determined to change that. 

I was just beginning my career as a labor and delivery nurse when I became pregnant with my first child. According to our standard breastfeeding policies, all our patients were encouraged to breastfeed. It was common for patients to complain that they didn’t have enough milk, but we were taught this was “rare” as babies have small stomachs and need little colostrum. Because of this, I assured my patients that everything was fine. 


There is a myth regarding a newborn’s stomach size that perpetuates the underfeeding of EBF babies, and now it is beginning to infiltrate formula-fed babies as well.  The myth is found in every hospital and is not supported by current research.  According to seven research articles, the stomach size of a term 7-pound baby ranges between 20 and 35 ml.


Another myth is that colostrum is all your baby needs.  Note: One teaspoon of colostrum contains three calories. Feeding a newborn baby drops of colostrum is never enough for adequate feeding and fluids.

There is also a myth that low milk supply is rare. 


After my first baby was born, I immediately began breastfeeding her, and everything seemed to be going well with latching and nursing, but she cried a lot, which was unsettling to me as I couldn’t comfort her.  However, excessive crying was considered normal. (Note: Excessive crying is not normal) Gradually, my baby developed excessive jaundice, and the neonatologist was so concerned he recommended supplementing her with formula after nursing before we could be discharged. I tried to hand express, and all I could get was the tiniest clear drop, but the IBCLC said I probably didn’t respond to hand expression and told me I didn’t need to supplement because my baby’s  bilirubin level wasn’t “too high.” Sadly, I followed the advice of the IBCLC.  (Note: The IBCLC violated her Code of Professional Conduct and Scope of Practice, putting this baby in unsafe conditions without adequate nutrition and fluids and increasing bilirubin levels.)


That night, my baby did not sleep at all because she was crying. As I slept, my husband tried latching her onto my breasts as I was exhausted and falling asleep. In the morning, she was re-examined, and her bilirubin levels got worse, and she also lost a whopping 10 ounces! I was told by the neonatologist that I needed to supplement urgently.  

With terror in my heart, I trembled, and I began supplementing right away. My baby finally stopped crying and slept for the first time.

I nursed and supplemented her every 2 hours because she was so hungry. However, another IBCLC and the breastfeeding support group I was in told me that supplementing my baby would hurt my supply, so I slowly eased her off the formula and began EBF again at one month old.  (Note: supplementing does not decrease milk supply if adequate breast stimulation and milk removal are provided with every supplemental feeding.) 

Even though I was finally exclusively breastfeeding, my baby would nurse every 15 minutes, and I would have maybe one 15-minute break all day when my husband took care of her. She would cry the whole time. Whenever she fed, I told myself it was “cluster feeding.” Her continuous feeding was good for my supply; I should keep it up. 

Cluster feeding is another myth parents are taught when babies feed non-stop in the hospital. Find out what “cluster-feeding” really is here: cluster-feeding

I went to see another IBCLC, and she did a weighted feed. After feeding her, the weight didn’t change at all. The IBCLC said a mistake must have occurred, “that never happens.” She suggested I come back after another weighted feeding when my breasts were painfully full. At this weighted feeding, my baby had only gained one ounce, but I was only encouraged to continue exclusive breastfeeding because her weight was slowly going up. (Note: The IBCLC violated the Code of Professional Conduct and scope of practice.  The baby was placed in unsafe conditions because of inadequate feeding. The baby should have been supplemented, and a feeding plan should have been implemented to improve milk supply while supplementing.  Her pediatrician should have been notified; follow-up lactation appointments to monitor weight gain were essential.  

At nine weeks old, despite me constantly nursing her, her weight percentile dropped from the 76th percentile at birth to 7th. She had gone ten days without pooping; she even had a few brick dust diapers during the month of exclusive breastfeeding. At this point, I was at my breaking point. Both my baby and I were not thriving. I vividly remember reading the signs of HUNGRY on the Fed Is Best website in the middle of the night. I burst into tears knowing my baby had some of the symptoms and realized she was hungry! 

There was no way to describe the guilt I felt. The truth is no mother can believe she wasn’t giving her baby enough milk when she was doing the “right” thing by exclusively breastfeeding. The result was that I had to suffer through the depths of the worst mom guilt hell.


The fact that she ate all the time was not normal. Still, many breastfeeding support groups said it was all normal (cluster feeding, baby can go two weeks without pooping, percentile charts are not accurate for breastfed babies, and some babies are just smaller, etc.).

These breastfeeding support groups are harming babies every day, and I shudder to think about how many babies are suffering from hunger or worse. 

My pediatrician recommended I begin supplementing with formula again, and I finally decided I needed my baby to be happy and healthy.  I began following the Fed’s Best Supplementation Guide and supplemented with 15cc at a time after breastfeeding both sides and using a slow-flow nipple when supplementing her. She gained five ozs in two days, was finally content and happy, and began sleeping better. Her weight gain percentiles began CLIMBING rapidly, and I was so relieved.

I am here to tell you it’s possible to successfully combo-feed your baby; I successfully combo-fed my baby until she was a year old, with 1/3 of the milk from my breasts, and the rest was life-saving infant formula.


She has grown into a healthy, intelligent, beautiful girl in four years.  I have since had two more children, and I have combined breastmilk with formula from the start. I still sometimes feel a pit in my stomach, wondering what would happen if I continued exclusively breastfeeding. I am so grateful to Fed is Best Foundation for helping me see the evidence that my baby was hungry. 

Sarah F., RN, IBCLC

Dec 12, 2018 — The aim of this Scope of Practice is to protect the public by promoting that all IBCLC certificants provide safe, competent and evidence-based care

IBCLC Assessment, Diagnosis, and Referral

IBCLC Code of Professional Conduct

IBCLC scope of practice

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My Baby is Healthy (and so am I) and That’s All That Matters: A Pediatrician’s Perspective

I didn’t have the easiest pregnancy; for one thing, I was considered a geriatric pregnancy, given that medicine was my second career, and I waited until after residency to get pregnant. 

I also have a history of depression and anxiety; thankfully, my depression was under control during pregnancy, but my anxiety certainly wasn’t – it worsened when I learned I was diagnosed with gestational diabetes (likely due mainly to my advanced maternal age). 

In my mental preparations to have my baby, there was one thing I was always sure of: I would certainly attempt to breastfeed my child, but if it didn’t work out, that would be okay because, in my clinical experience, formula-fed babies did just fine. Furthermore, from the years of my struggles with my mental health, I learned the importance of choosing my battles, and it simply wasn’t worth it to me to agonize over breastfeeding if it didn’t come easily.   Continue reading