我叫Christie del Castillo-Hegyi，是一名美國急救醫師，之前是NIH研究院的科學家，在布朗大學時我曾做過關於新生兒腦損傷的研究。我也是患有神經功能疾病6歲孩子的母親。我寫這封信是因為我的孩子在剛出生不久就因為母乳餵養不足而成為新生兒黃疸、低血糖和嚴重脫水的受害者。作為一名準備的新媽媽，我學習了所有關於母乳餵養的指導知識去迎接我的第一個孩子。不幸的是，遵循了這些指導以及兒科醫師的意見，卻導致我的孩子經受了為期4天無奶水攝取而進入加護病房。隨後，他被診斷為多重神經發育障礙。作為一名醫師和科學家，我找到了一些同行評議期刊來解釋為何會出現這樣的情況。我發現有充分的證據可以顯示新生兒黃疸、脫水、低血糖和發育障礙之間的聯繫。我希望解釋這個聯繫怎麼可能對我的兒子和你們所照顧的許多其他孩子有重大的影響。
As mothers, we always want the best for our babies and we worry what we do is never enough. 6 years ago, I had my first child when emergency C-section delivered her. She was 8 pounds 12 ounces and healthy. I was immediately told by my OB-Gyn to supplement her since she was such a large baby for 37 weeks. The hospital had LCs and we requested to see her several times but she was a no show. We figured out fast we were on our own with breastfeeding, however we did take our OB-Gyn’s advice and started supplementing right at the start to maintain her glucose levels. She never perfected her latch, so I exclusively pumped and she got everything she needed and we both liked our routine.
6 years later, I delivered my son early for pregnancy complications at 36 weeks but he was much smaller weighing 6 pounds 11 ounces. This time breastfeeding protocols were very different. Formula was considered evil and no one could supplement their babies and exclusive breastfeeding was the only way to breastfeed my baby. However, after day one things gradually started going downhill. My son latched very well and it was determined he was nursing perfectly. He nursed every one to two hours and we even had the second night “cluster” feedings we were informed about.
Little did I know, he was starving and not cluster-feeding and I had no idea! But as you can see in this photo- he. was. starving!
I wish I had known about the Fed Is Best Foundation before my 1st son was born. I felt enormous pressure to exclusively breastfeed at my hospital. My son was born at 37 weeks, weighing 5 pounds,13 ounces and he struggled to latch-on and breastfeed at each feeding. When I told the midwife, she came back with a leaflet which described how to hand express. She told me to express 1 mL of colostrum into a syringe and feed that to my baby whenever he struggled to latch. I asked her if 1 mL was enough and she said it was because his tummy was very small and this amount would be fine until my milk came in. Note: 1 teaspoon equals 5 ml.
I was discharged hours later not feeling confident my baby was getting enough colostrum. A midwife came out to see me at home on day 3 because I said I was worried about his feeding. He became extremely yellow (jaundiced), not very responsive (lethargic) and would let out random high pitch screams and would sleep all of the time and never wanted to feed by this time. He also would have random body spasms which doctors shrugged off as normal baby reflexes (later we found out different). The midwife said I could wait and see how he did overnight or go to hospital. I chose to take him to the hospital. When arriving, we found that he had lost 12% of his body weight and his blood sugars levels dropped dangerously low to 0.2 mmol/L (4 mg/dL) and he was jaundiced. Continue reading →
As a veteran NICU, nursery nurse, and lactation consultant, I have cared for and fed thousands of babies over the past 32 years. When working in the special care nursery, babies are fed according to their weight and cumulative losses to determine their caloric requirements for intake amounts and optimal nourishment. For example, term babies admitted to the NICU from complications of hypoglycemia (low blood sugar) are immediatelyfed based on their weight, usually about 60-80 ml/kg/day (typically 15-30 ml) every 2-3 hours. Newborns fed 15-30 ml will likely have their insufficient feeding complications stabilized and demonstrate feeding satisfaction and comfort because the newborn stomach is at least four times larger than what is taught.
First, we should review the anatomy of the newborn digestive system.
Newborn digestive system. Photo credit St. Luke Hospital System, KS
Gastric emptying is a continuous movement into the small intestine, accommodating milk volume of more than 5-7 ml every 2-3 hours. The stomach is a muscular and very stretchable organ. Its biological function is to expand to hold food and fluids while churning with digestive enzymes before entering the duodenum or small intestine. A full-term baby swallows 500-1000 ml of amniotic fluid every day. Ultrasound can confirm the stomach’s size and measure when the baby swallows amniotic fluid. The newborn’s stomach does not magically or suddenly grow after day one, as taught to parents. My concern as a long-time NICU nurse, infant feeding specialist, and IBCLC has always been why mothers are taught their exclusively breastfed newborn baby’s stomach capacity is only 5-7 mL on day one, which is false.
The Myth of the Newborn Stomach Size: Where Did it Come From?
I started my research with my non-clinical hat on and turned to Google since this is where my patients typically go first. When I did a Google search for newborn stomach sizes, there were over 868 thousand links! I was led to a plethora of visual images depicting newborn stomach size. Some of the most popular images were thebelly ball modelsthatlactation consultants wear on their lanyards to visually educate new mothers about how big their ‘newborn’s stomach size is.’
I was in absolute disbelief knowing our most trusted lactation consultants were selling, wearing and using, proudly I might say very inaccurate, dangerous and non-evidence based tools that are used in hospitals. I quickly began to understand that ‘belly bead’ models are lucrative merchandise to sell!
Marble/ball models are often used to represent newborn stomach capacity; however, their accuracy has not been determined:
“Measurement of infant stomach capacity has been attempted for over 100 years. Exact volumes cannot be standardized, but data suggest that anatomic and physiologic stomach capacity vary widely.” In addition, “It is important to note that because a wide range of feeding volumes on day one (1-20 mL) and day three (13 to 103 mL) has been reported, and the reasons for these variances are unclear, it may be best to simply acknowledge that feeding volumes vary widely and like stomach capacity, do not lend well to the visual representation given our current knowledge.”
This research was published in 2008 in the Journal of Human Lactation and yet, not a single lactation professional is practicing what the evidence says. How can this be?
New moms are inundated with images of a series of bottles filled with milk depicting the size of an infant’s stomach according to each day after birth, sometimes compared with fruit or different-sized marbles and balls. A mother sent this picture to us, which was in her hospital room after the birth of her baby. She also received inaccurate education about the newborn stomach size and thought herformula-fed baby only needed 5 ml at each feeding.
This information is FALSE and based on research from 1920.
“There is insufficient evidence on optimal neonatal feeding intervals, with a wide range of practices. The stomach capacity could determine feeding frequency. A literature search was conducted for studies reporting volumes or dimensions of stomach capacity before or after birth. Six articles were found, suggesting a stomach capacity of 20 ml at birth.”
Dr. Bergman states, “There is reasonable consensus on the amount of milk that human term newborn infants need per day; figures given vary from 150 to 160 mL/kg/day.”
This means an average 3 kg or 6.6 lb newborn requires 450-480 mL or 16 ounces of milk daily. At 66 Calories/dL, this would roughly be 100-106 Cal/kg/day, which is thepublished daily caloric requirement for a newborn. This total volume can be given in smaller volumes more frequently or larger volumes less frequently, 2 ounces every 3 hours or 1.3 ounces every 2 hours.
His article poses the hypothesis that the feeding interval should be 20 mL every 1 hour, assuming that every mother produces 20 ml of colostrum every hour.
However, thereal-life hypothetical clinical application of his suggested feeding interval would quickly lead to maternal and newborn exhaustion from lack of sleep and increased risk of postnatal depression, breastfeeding cessation, and even suffocation from a mother falling asleep with her newborn during breastfeeding. In addition, his feeding interval does not consider that the stomach actually empties during feeding; therefore, a newborn’s feeding capacity is higher than 20 mL. The clinical expertise of neonatal health professionals has shown that even one-day-old newborns are able and do comfortably tolerate 15-30 MLS per feeding every 2-3 hours.
Additional newborn stomach size research
The most popular breastfeeding education resources for new parents also refer to false information by teaching that the stomach size is 5-7 ml on day one. This picture is from a mother who delivered in a Baby-Friendly Hospital this week. Imagine her confusion when her baby required 30 mL of supplemental milk to treat hypoglycemia.
No one could explain to her why her baby could comfortably tolerate more milk than what she was taught in this hospital education resource booklet.
Dr. Gomez, a neonatologist, explains why hypoglycemic babies (low blood sugar) need more than 5 ml of milk despite being told their baby’s stomach can only hold 5 ml.
“We don’t have any strong evidence as to the size of the stomach for each baby. However, we do have significant scientific evidence that hypoglycemia and under-hydration cause damage to the brain of the infant.
We have solid evidence that feeding babies 10-20 mls when they are born is adequate to keep the blood glucose levels up in most babies. Some will still need some other interventions, but 10- 20 ml feedings are enough most of the time.
There is no evidence that feeding 10 to 20 ml of milk to a baby causes “stretching of the stomach,” and we don’t have ANY evidence that this is detrimental to the baby.”
We have evidence that judicious supplementation helps babies and does not impact breastfeeding rates.
So the question is, are we hurting babies by supplementing? NO. Are we hurting babies by not supplementing and allowing them to have hypoglycemia or dehydration? YES.
According to the Academy of Breastfeeding MedicineSupplementation Protocol,they suggest exclusively breastfed babies are fed 2-10 ml per feeding, and they reference the infant’s stomach size according to outdated studies (1992 and 1920) to reflect intake volume. They also say there is no definitive research available, and the amount of supplement given should reflect the normal amounts of colostrum available, the size of the infant’s stomach, and the age and size of the infant.
Unfortunately, this information contributes to additional confusion that already exists for parents. What they do say is research is necessary to establish evidence-based guidelines on appropriate supplementation volumes for specific conditions and whether this varies for colostrum versus infant formula.
But why don’t we already know this if an infant feeding protocol has been implemented in hospitals? Protocols are supposed to be peer-reviewed for scientific accuracy.
Speaking of HUNGER cues and feeding your baby to satisfaction, here are signs that your newborn baby needs immediate attention:
We have been talking about the newborn stomach size, but what about calories? How many calories do human milk, infant formula, and colostrum contain in 5-7 MLS?
What research tells us is :
Mature breast milk averages around 20 calories per ounce (~30 mL)
and infant formula contains 20 calories per ounce as well.
Colostrum is lower in fat and carbohydrates and comes in at around 17 calories per ounce (~30ml) (Guthrie 1989).
How many calories do term newborns need to ensure Cell Survival?
As you can see, exclusively breastfed newborns cannot thrive on three calories per 5 ml (1 teaspoon) of colostrum at each feeding.
Some exclusively breastfed babies are fasting after birth if they are not receiving enough colostrum. 1 in 5 new mothers can experience delayed onset of copious milk production due to various risk factors. This puts these babies at risk for developing complications from insufficient colostrum intake while breastfeeding.
1 in 71 exclusively breastfed babies are rehospitalized for life-threatening complications from insufficient colostrum intake. As lactation and neonatal medicine professionals it is imperative to update our educational resources and identify the babies who may need timely supplementation before the onset of copious milk production. For mothers who desire to exclusively breastfed, donor milk should be made available for them to use if supplementation is needed. In order for babies to receive the full benefits of breastfeeding, they need to be safely fed at every feeding.
So, how often should exclusively breastfed babies eat?
There is no single correct answer to this question because each baby has a different weight and unique caloric requirement. Babies should be fed according to their hunger cues and to satisfaction, along with other clinical observations such as excessive weight loss, low blood sugar, excessive jaundice, or dehydration. We have a feeding plan that you can follow to determine how well your baby is feeding. (currently being updated.)
If your baby is crying and crying after breastfeeding, an immediate medical exam is necessary to be sure the baby is not suffering frominsufficient intake of colostrumwhile exclusively breastfeeding. If a medical evaluation is not immediately available, especially before the milk has come in, supplementation may be urgently needed to feed your hungry baby before medical evaluation is available to prevent serious complications of insufficient feeding.
A mother writes: “Because of this stupid belly bead, my baby was discharged from the hospital despite not eating enough breastmilk. He had a seizure at home and was taken back to the hospital by an ambulance for dehydration.”
As you can see, It’s time to ban the false belly bead models and update our breastfeeding education resources immediately. Our babies are counting on us to keep them well-fed, meeting their metabolic needs with sufficient milk, and using the best and most current infant feeding practices possible. Too many babies are being harmed by this flawed product.
Was your baby harmed by the belly bead lanyard product?
To file a formal complaint about the belly bead lanyard company, click here.
If your baby was harmed from insufficient feeding related to this lanyard, click here for legal counsel.
Jody Segrave-Daly’s 32-year nursing career has been dedicated to caring for healthy and medically fragile babies in the nursery and NICU. When she began her community-based infant feeding practice 12 years ago, she was unprepared to see the significant numbers of babies suffering from accidental starvation complications. The stories she heard were the same —distressed mothers were being told never to supplement their crying, sleepy, jaundiced, and dehydrated babies — or risk ruining their breastfeeding relationship and milk supply. She has comforted countless mothers worldwide who believed it was rare to under-produce breast milk and often felt betrayed by their lactation and healthcare teams, their bodies, and the social pressure that insisted “Breast Is Best.” Now a staunch advocate for the Fed Is Best movement, Jody works to debunk those myths while supporting families to breastfeed, mix-feed, pump-milk-feed, formula-feed and tube-feed their babies. She uses evidence-based science and her years of clinical experience to support SAFE infant feeding. She also prioritizes perinatal mental health when counseling parents about their feeding options. Ultimately, every family has different needs and deserves individualized, unbiased, inclusive, and shame-free support. If you need help, please join our support group or contact her directly at jody@fedisbest.org. If you need infant feeding support, we have a private support group–Join us here.
There are many ways you can support the mission of the Fed is Best Foundation. Please consider contributing in the following ways:
Send us your stories. Share with us your successes, your struggles, and everything in between. Every story saves another child from experiencing the same and teaches another mom how to feed her baby safely. Every voice contributes to change.
If you need infant feeding support, we have a private support group– Join us here.
If you or your baby were harmed from complications of insufficient breastfeeding, please send a message to contact@fedisbest.org
Make a donation to the Fed is Best Foundation. We are using funds from donations to cover the cost of our website, our social media ads, and our printing and mailing costs to reach health providers and hospitals. We do not accept donations from breast- or formula-feeding companies, and 100% of your donations go toward these operational costs. All of the Foundation’s work is achieved via its supporters’ pro bono and volunteer work.
Share the stories and the message of the Fed is Best Foundation through word-of-mouth, by posting on your social media page and by sending our FREE infant feeding educational resources to expectant moms you know. Share the Fed is Best campaign letter with everyone you know.
Print out our letter to obstetric providers and mail it to your local obstetricians, midwives, and family practitioners who provide obstetric care and hospitals.
Write your local elected officials about what is happening to newborn babies in hospitals and ask for the legal protection of newborn babies from underfeeding and for the mother’s rights to honest, informed consent on the risks of insufficient feeding of breastfed babies.
Join us in any Fed is Best volunteer and advocacy groups. Click here to join our group of healthcare professionals. We have: FIBF Advocacy Group, Research Group, Volunteer Group, Editing Group, Social Media Group, Legal Group, Marketing Group, Perinatal Mental Health Advocacy Group, Private Infant Feeding Support Group, Global Advocacy Group, and Fundraising Group. Please email Jody@fedisbest.org if you want to join any of our volunteer groups.
Send us messages of support. We work daily to make infant feeding safe and supportive of every parent and child. Your messages of support keep us all going.
I have three beautiful children: one nearly three year old boy, and one set of boy/girl twins, who are just three weeks old.If I could go back and change my eldest son’s first feeding experiences on this earth, I would. I would have been happier and my baby healthier if he had just been fed while attempting to exclusively breastfeed.
When I was pregnant with my eldest boy, I fully intended to breastfeed him. We were delivering in a Baby-Friendly Hospital. I had never heard the term “Baby-Friendly” before becoming pregnant, but when my husband and I attended the hospital tour, we were told that the Baby-Friendly label meant that the hospital had achieved what was considered the gold standard in breastfeeding support. We attended the available lactation, birth, and parenting courses at the hospital. Whenever I was asked if I was planning to breastfeed my son, I proudly said, yes, I would. I was 34 years old, and I had never really considered infant feeding practices before becoming pregnant. From the information presented, it was obvious that breastfeeding was optimal.
I was told that babies did not need very much food in the first days of life. I was told that I would always make enough to feed the baby. I believed that the information I was receiving in these courses was truly the gold standard.
My son was born naturally after an unmedicated labor. He was placed on my bare chest, latched and I was told that we were doing great. I would nurse him and then he started screaming after each nursing session. Later, I learned that newborns aren’t meant to continuously scream after attempting to feed. They are meant to be satisfied and then sleep. The crying and screaming means something is wrong. I did not realize that my colostrum might not be enough to keep him fully fed before my milk came in. If I was informed that different babies have different caloric requirements at birth, and that my colostrum might not be enough right away, I never would have consented to not feeding my newborn for any period of time. Continue reading →
