Will Breast Milk Protect My Baby From Getting Sick? Passive Immunity 101

Written by Jody Segrave-Daly MS, RN, IBCLC

As a veteran neonatal nurse and lactation consultant, I am often asked by parents to explain how the antibodies found in breastmilk work to protect their babies. Published research on immunology is extremely technical and difficult to understand, and unfortunately, the information that is readily available (especially on social media) contains a lot of false and conflicting information. So I’m here to share evidence-based information about this very important topic in a way that is easier for most parents to understand.

How does the immune system work?

Our immune system is very complex, but generally speaking, it is responsible for fighting off both germs that enter our bodies from our environment, and also for protecting us from diseases like cancer that occur within our bodies.  I will be focusing on how the immune system fights off germs, which it does by producing antibodies.

What is an antibody and what does it do?

An antibody is a protein that is produced by the body’s immune system when it detects the surfaces of foreign and potentially harmful substances, also known as pathogens. Examples of pathogens are bacteria, fungi, and viruses, which are all microorganisms. The antibody response is specific; it will seek out and neutralize the microorganism and stop the invasion. There are five classes of antibodies: IgM, IgG, IgA, IgD, and IgE.

There are two ways babies acquire and develop immunity:
  • The first way is through passive immunity (temporary)
  • The second way is through active or acquired immunity (lifelong) 

Note: Antibody types and where they are acquired from are denoted by color throughout the blog.

 

Passive Immunity During Pregnancy

The first way for a baby to acquire immunity is called passive immunity, and it occurs during pregnancy.  Over a mother’s lifetime, she is exposed to many different pathogens, and her immune system develops the ability to produce a large catalog of antibodies that can act against them. During pregnancy, these antibodies are transported across the placenta to the fetus’s blood supply. These types of antibodies are called immunoglobulin G, or IgG. They are the only antibody type that passes through the placenta to the growing fetus. They are called passive maternal IgGs, because of how they are transferred to the baby.

IgGs are the most common type of antibody in our bodies. They help protect us, as well as our unborn babies, from viral and bacterial illnesses. Human babies are born with all of the passive maternal IgG antibodies their mother has during pregnancy.  

To provide additional, critical passive IgG antibodies that will pass from the placenta directly to the baby’s bloodstream, mothers should strongly consider following the vaccination recommendations during pregnancy.  This will help protect the baby from infections such as pertussis (whooping cough), influenza, and other illnesses ahead of their scheduled childhood vaccinations and before their immature and vulnerable immune system begins to produce its own antibodies. 

 

Women vaccinated during pregnancy pass protective antibodies to babies (CDC.gov)

 

Maternal IgG antibodies are temporary though, and they gradually disappear within four to six months after birth. Fortunately, immediately after birth, the baby begins to make their own IgG antibodies in response to viruses and bacteria in their environment and through childhood vaccinations. The immune system is constantly maturing, but children under two are most vulnerable. By five years of age, children have been exposed to many viruses and bacteria and have also received many important vaccinations; therefore they are less vulnerable to serious infections. Premature babies are particularly vulnerable, as they don’t receive the 40 weeks gestation time to receive the full maternal passive immunity that a term baby does. (Most antibodies are transferred in the last four to six weeks of pregnancy.) Maternal IgG antibodies passed through the placenta are very effective in protecting neonates and infants against most infectious diseases. This is why term human babies can be fed properly prepared formula and thrive without the passive immunity that breast milk provides. Evidence has shown, however, that human breast milk, whether through direct breastfeeding, expressed breast milk or human donor milk is critical to preterm babies as it reduces the risk of developing a deadly infection called necrotizing enterocolitis, which affects a baby’s intestines.

 

Passive Immunity Through Breastfeeding

The other way a baby can acquire passive immunity is through breast milk. Colostrum is the first milk a woman produces when she begins to breastfeed, and it contains a large number of antibodies called secretory immunoglobulins ( over 90% are IgA; IgM and IgG are present in tiny amounts) You’ll see this abbreviated as IgA. (First we discussed passive IgG; now we will discuss IgA.) These IgA (mucosal) antibodies in human milk line the mucous membranes in the baby’s mouth, upper airway, throat, ears and intestines; here they guard against germs entering the mucosal lining, which is the first port of germ entry, by neutralizing the pathogen. Secretory IgA antibodies can survive being broken down by gastric acid and digestive enzymes in the stomach and intestines. Human babies are not able to absorb these passive maternal antibodies from colostrum or breast milk directly into their bloodstream. Instead, the IgA antibodies protect against infections by working inside the baby’s gastrointestinal tract and respiratory system. 

This passive breastfeeding IgA immunity is dose-dependent, meaning the more breastmilk your baby receives, the more protection they have.  The dose-dependent protection continues until the baby is weaned. This passive immunity is invaluable for premature newborns and newborns born in impoverished countries where there is limited access to clean water for safe formula preparation, often leading to severe diarrhea and death. 

Breast milk immunity offers protection from respiratory and gastrointestinal illnesses; this does not mean prevention. This population-based study in the Netherlands found that exclusive breastfeeding for 4 months was associated with a reduction of severe respiratory and gastrointestinal morbidity in infants. However, breastfed babies can still get sick, because young children get lots of colds, some as many as eight to ten each year, before they turn two years old.

For mothers who don’t plan on breastfeeding exclusively for the first 6 months, breastfeeding during the first months is still beneficial, because this is when the baby’s immune system is the most vulnerable. Human milk also contains infection fighting components that are not antibodies. (*see the full description below )

The second way a baby develops immunity is by ACTIVE OR ACQUIRED IMMUNITY (germ exposure and vaccination) 

 A baby’s immune system is at its most vulnerable right after birth. Since passive immunity from both IgG and IgA forms of maternal immunity is temporary, and breast milk antibodies can only protect the respiratory and GI tracts while breastfeeding is occuring, these measures are not enough to fully protect a baby from infectious diseases. At six months, a baby’s IgG antibodies that were acquired passively from their mother are gone. Their immune systems have started to produce their own IgG antibodies from the germs they are encountering in their world and through vaccinations. This is known as active or acquired immunity, the type of immunity that the body develops after germ or vaccination exposure. To continue the process of protection, babies need to acquire vaccine-induced immunity, and fortunately, vaccination is a safe and effective way to achieve it by boosting immature immune systems without getting the disease. Active immunity is long-lasting, and sometimes lifelong.

 Did you know breastfed babies produce higher levels of antibodies in response in response to some immunizations?

Vaccines are tested again and again to be sure they are safe for children and nursing mothers. If you are concerned about whether or not a particular vaccine is safe to receive while breastfeeding, check the CDC’s list of vaccines that are safe for nursing mothers and babies.  Because breastfeeding provides passive antibodies to a baby, breastfeeding is not a substitute for immunization. During the first months prior to receiving vaccinations, babies are counting on their parents, family, friends, caregivers, doctors, nurses, lactation consultants and anyone else around them, to protect them from diseases they may not be able to fight off. Everyone being up to date with their recommended vaccines is the best way for a community to support a newborn’s health.

A common question I receive is: “Can I breastfeed while I am sick with the flu?”

The answer is yes, even if you are taking Tamiflu. The flu is not transmitted through breast milk. Breastfeeding can continue while taking precautions to avoid spreading the flu to the baby. The CDC has excellent guidelines about breastfeeding while having the flu.

If a mother is sick from an illness, how long does it take for the antibody to be produced in her breast milk?

This picture is one of many popular memes floating around on social media. Unfortunately, the information is incorrect and misleading about the timeline for antibody production.

To be fully informed and to take proper precautions, a mother should know there is a delay between the first exposure to the pathogen and the acquisition of immunity. This process, called the primary response, can take up to fourteen days for optimal antibody production. If a person is exposed to the same pathogen again later, the response is much faster and stronger; this is called a secondary response. 

To provide additional protection for your baby, hand-washing is an excellent way to help prevent the spreading of germs. According to the CDC, “Regular hand-washing, particularly before and after certain activities, is one of the best ways to remove germs, avoid getting sick, and prevent the spread of germs to others.” It’s quick, it’s simple, and it can keep us all from getting sick. Hand-washing is a win for everyone—except the germs.

Hand-washing is a win for everyone—except the germs.

Another social media post that went viral is a picture of the color changes of pumped breastmilk from a mother who said her baby was sick. Can this be true?

This study found leukocytes increase when a baby has an active infection but does that mean a color change occurs?  It’s not very likely.  Color changes in breast milk are from colorful foods, stages of breastmilk, medication, vitamins and sometimes from cracked nipples.

What about the back-wash idea in which a baby’s saliva is sucked into valves within the nipple and the mother’s body produces an immune response that is secreted in her breastmilk.  

The idea that a baby’s saliva can trigger changes in breast milk was popularized in 2015, and several mothers have posted viral images and claims similar to the above, but even scientists who study breastmilk say the idea that baby saliva changes breast milk is still a hypothesis that needs to be proven or disproven with high-quality research. 

*Please Note: Human milk also contains the following protective components:

  • Oligosaccharides and mucins that adhere to bacteria and viruses to interfere with their attachment to host cells.
  • Lactoferrin to bind iron and make it unavailable to most bacteria.
  • B12 binding protein to deprive bacteria of needed vitamin B12.
  • Bifidus factor that promotes the growth of Lactobacillus bifidus, normal flora in the gastrointestinal tract of infants that crowd out harmful bacteria.
  • Fibronectin increases the antimicrobial activity of macrophages and helps repair tissue damage from infection in the gastrointestinal tract.
  • Gamma-interferon, a cytokine that enhances the activity of certain immune cells.
  • Hormones and growth factors that stimulate the baby’s gastrointestinal tract to mature faster and be less susceptible to infection.
  • Lysozyme to break down peptidoglycan in bacterial cell walls.

Jody is a champion for debunking pseudoscience in the breastfeeding community because parents need to be truly informed when making parenting decisions. She is also a staunch advocate for protecting underfed breastfed babies and is the reason why she co-founded the Fed Is Best Foundation. She provides parents with the most up to date scientific resources and includes her extensive neonatal nursing knowledge and infant feeding clinical experiences, to help parents make the best infant feeding decision that works for them.

Additional references:

Immunity Types

An Introduction to Active Immunity and Passive Immunity

 Natural Passive Immunity

Human milk: Defense against infection. 

Infant gut immunity: a preliminary study of IgA associations with breastfeeding.

Chapter 50 Immune Defenses

Mucosal immunity: integration between mother and the breast-fed infant

Breastfeeding after maternal immunisation during pregnancy: Providing immunological protection to the newborn: A review

Breast Milk as the Gold Standard for Protective Nutrients

Cells of human breast milk

Evolution of the immune system in humans from infancy to old age

https://microbiologynotes.com/differences-between-primary-and-secondary-immune-response/

Influenza (Flu)

Changes in immunomodulatory constituents of human milk in response to active infection in the nursing infant 

Future Research in the Immune System of Human Milk

https://fedisbest.org/2019/03/an-evaluation-of-real-benefits-and-risks-of-exclusive-breastfeeding/

Feed Your Baby—When Supplementing Saves Breastfeeding and Lives

The Newborn Stomach Size Myth: It is NOT 5-7 mL

What is “Cluster Feeding” and Is It Normal?

The ‘Second Night Syndrome’ is Abnormal and This is Why

Dear Parents, Did You Know Just 2 Teaspoons Of Supplementation Can Protect Your Baby And Your Breastfeeding Journey?*

Mothers Describe Their Triple Feeding Experiences And The Impact It Had On Their Mental And Physical Health

 

 

 

 

 

 

 

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Mothers Describe Their Triple Feeding Experiences And The Impact It Had On Their Mental And Physical Health

Written by The Fed Is Best Foundation Lactation Consultant Team

Part 1: What is “triple feeding?” 

Triple feeding originated in the NICU and was used for premature infants. It is now being used for full-term babies, especially in home environments. Triple feeding is a breastfeeding plan in which, for every feeding, a mother feeds her baby at the breast, followed by immediate pumping, and then giving any expressed milk (and/or formula supplement) to the infant by a bottle, cup, syringe, or through a tube at the breast. Triple feeding requires a considerable amount of effort and time, and there is little time between feedings for the mother to take care of her own basic needs, such as sleep, eating, and hygiene.

Many mothers who have followed this regimen say that they were given little guidance on how long to triple feed and when to stop.  As a result, these mothers have endured the equivalent of caring for triplets (feeding a baby at the breast, “feeding” the pump, then feeding a bottle). In addition, there are pump parts to wash up to eight times a day, and sometimes other children to care for.

“I didn’t eat or drink for days because of the time constraints of triple feeding. By the time my baby was admitted to the hospital on day 5 of life, I lost consciousness and then broke down in the corner of his room from profound exhaustion. I’m a doctor and had done surgical and anesthesia residency. I’m used to sleep deprivation. Those five days were hell on earth. Not only did it not work, I unknowingly starved my baby under the care of lactation professionals.  They knew I had a breast reduction, but I was told to triple feed without a back up plan. That week of my life lives over and over in my head all the time.” —Dr. N. King 

Why is the triple feeding strategy recommended by medical and lactation professionals?

The common reasons for prescribing triple feeding are:

  • Poor latching, lack of sustained suckling, oral anomalies, and insufficient milk removal.
  • Delayed onset of full milk production and excessive infant weight loss or failure to gain weight.
  • Chronic low milk supply for poor breastfeeding management, hormonal insufficiency, insufficient mammary physiology, and unknown mammary dysfunction.
The theory behind triple feeding is based on the first two rules of lactation management: feed the baby and maximize the milk supply.  
  1. When a baby is not transferring milk effectively, he is not stimulating his mother’s milk-making hormones adequately, and milk remains in the breast. This causes a reduction in her milk supply and does not provide a full feeding for the baby.
  2. Giving the baby frequent opportunities to breastfeed despite the low milk transfer is thought to help the baby improve his latching and milk transfer skills, and avoids bottle preference.
  3. Pumping after nursing will remove most of the milk from the breasts, thus helping to increase the mother’s milk supply to a sufficient level (a full milk supply is about 25-32 oz/day).  When successful, this will allow her to gradually wean the baby from supplementing and return to fully feeding at the breast. 
  4. Immediate supplementation is necessary to provide the baby’s full feeding, as babies have caloric, nutritional, and hydration needs that cannot wait until the breast milk supply potentially increases. 

Unfortunately, triple feeding has become the default method that is recommended by medical and lactation professionals for a large number of breastfeeding challenges, with no regard to the maternal complications that will eventually occur, or the likelihood of it solving the problem of low milk supply. It is imperative for all mothers to know that triple feeding is not sustainable for longer than five to seven days, and it cannot be recommended unless the mother has a full-time helper. If triple feeding is working, there will be evidence with increased milk supply/volume. This is how we know it is working. If there is no increase, triple feeding will not work for this mother, and her breastfeeding plan will require changes. Most likely it will be a combo-feeding plan. 

Before triple-feeding is recommended, medical and lactation professionals must make careful considerations because of the daunting amount of time that is necessary for every feeding. The things that need to be considered are:

  1. Does the mother have full-time in-house help?
  2. Does she have any preexisting history of mental illness?
  3. Does she have the best mammary physiology and general health profile to sufficiently increase her milk production?  (The word “sufficient” is subjective and is determined by both the baby’s needs and the mother’s goals.)
  4. Does she have a high-quality electric breast pump?
  5. Does the proposed triple feeding plan allow for sufficient sleep, nutrition, and self-care to support her basic physiological needs?

Of course, every mother and baby have unique needs and require individualized breastfeeding management and support. The plan must also be flexible enough to meet unexpected needs. It is very important for the health care professional involved to inform parents that they may find themselves unable to follow the triple feeding plan perfectly. A backup plan should be provided until changes can be made that the parents are confident they can follow. Mothers need to know they can stop at any given time, and that there is no guarantee triple feeding will provide the results they are looking for. This is part of informed consent. 

Complications of triple-feeding: mental health, bonding and preventing accidents

Jessica Montgomery talks about how triple feeding stole her ability to enjoy her baby and did not increase her milk supply.

Literally everything I read about breastfeeding said that undersupply was rare. After she was born, my milk didn’t come in right away. When it did, it was not enough, and she lost weight and had to be re-hospitalized for jaundice, dehydration, and hypoglycemia. 

I was willing to do anything to increase my supply and hoped to eventually be able to exclusively breastfeed. I saw two lactation consultants (IBCLCs) and both gave me different versions of the “triple feeding protocol” to try. I was supposed to complete the following three steps every 2-3 hours around the clock:

  1. Breastfeed baby for at least 10-15 minutes per breast, using breast compressions.
  2. Supplement baby pumped breast milk, and then formula if pumped milk is not enough. If the baby is able to latch, use a supplemental nursing system, to supplement at the breast, with a tube placed and taped next to my nipple. If she wouldn’t latch, I was supposed to finger feed, cup feed, or use a slow flow bottle.
  3. Pump for 15-20 minutes with a double pump or for 15-20 minutes on each side if using a single pump or hand expressing. If the baby didn’t empty my breasts I was supposed to do this right away, and if not, I was supposed to wait an hour after nursing to pump. 

Triple feeding was my life for months, and my mental health seriously suffered. I couldn’t keep up and that made me feel so guilty, and honestly, it didn’t really do much for my supply. I lost so much time being with and bonding with my baby.

After my second baby was born, I met with a breastfeeding medicine physician who told me that triple feeding was too exhausting for most moms, and it wouldn’t fix my low supply issues because I was diagnosed with insufficient glandular tissue (IGT). I stopped pumping, ditched my SNS, and started combo-feeding my baby. It was amazing for my mental health and literally changed my life. 

Bethanne talks about having a psychotic break from severe sleep deprivation while triple feeding her daughter.

I was a first-time mother and was 100% committed to exclusively breastfeeding.  She was born at 36 weeks and was very sleepy. She latched poorly, so the LC prescribed triple feeding. I had plenty of help at home and thought everything was going well. I was profoundly exhausted because I didn’t sleep in the hospital at all. I didn’t recognize my mind was shutting down. I became confused and wasn’t eating or drinking much. I began hallucinating. My husband called my OB who told him to bring me to the hospital. I was admitted for observation, and the psychiatrist diagnosed me with severe sleep deprivation and anxiety. I had IV fluids and sleep medication and slept for 8 hours straight. When I woke up, my milk was in, but I was very frail and kept crying. I decided I would become a pumping and formula feeding mother so I could get some sleep. I tell every mother I know not to triple feed because of the hell I lived through. My OB filed a formal complaint about the LC who prescribed triple feeding to me.

According to Dr. Marianne Neifert, “the rigors of a triple feeding schedule aren’t for every woman: some are too exhausted or have too many other responsibilities to devote the necessary time and energy to this demanding regimen. Dr. Neifert states, “if a mom’s emotional well-being is at risk because she keeps trying and trying and it’s still not a rewarding experience, we have to assess whether it’s realistic for her to exclusively breastfeed. Many moms who are having a great deal of trouble and are ready to quit will breastfeed longer if they see it as doable for them” — doable, in other words, by combining breast- and bottle feeding.

Sleep deprivation has very serious consequences. As health professionals, we need to protect maternal mental health when developing complicated breastfeeding plans. Very serious sleep deprivation conditions while triple feeding has resulted in postpartum depression, anxiety, psychosis, deteriorating physical health, and serious accidents.

In Part 2 of this blog, we will share stories from mothers describing how a modified triple feeding plan worked for them. It’s important to recognize that every infant feeding situation requires individualized care for the best outcomes.

 


HOW YOU CAN SUPPORT FED IS BEST

There are many ways you can support the mission of the Fed is Best Foundation. Please consider contributing in the following ways:

  1. Join us in any of the Fed is Best volunteer and advocacy, groups. Click here to join our health care professionals group. 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 send an email to Jody@fedisbest.org  if you are interested in joining any of our volunteer groups. 
  2. If you need infant feeding support, we have a private support group– Join us here.
  3. If you or your baby were harmed from complications of insufficient breastfeeding please send a message to contact@fedisbest.org 
  4. 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, 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 the work of the Foundation is achieved via the pro bono and volunteer work of its supporters.
  5. Sign our petition!  Help us reach our policymakers, and drive change at a global level. Help us stand up for the lives of millions of infants who deserve a fighting chance.   Sign the Fed is Best Petition at Change.org  today, and share it with others.
  6. 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 that you know. Share the Fed is Best campaign letter with everyone you know.
  7. Write a letter to your health providers and hospitals about the Fed is Best Foundation. Write to them about feeding complications your child may have experienced.
  8. Print out our letter to obstetric providers and mail them to your local obstetricians, midwives, family practitioners who provide obstetric care and hospitals.
  9. 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 of mother’s rights to honest informed consent on the risks of insufficient feeding of breastfed babies.
  10. 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 safely feed her baby. Every voice contributes to change.
  11. Send us messages of support. We work every single day to make infant feeding safe and supportive of every mother and child.  Your messages of support keep us all going.
  12.  Shop at Amazon Smile and Amazon donates to Fed Is Best Foundation.

Or simply send us a message to find out how you can help make a difference with new ideas!

For any urgent messages or questions about infant feeding, please do not leave a message on this page as it will not get to us immediately. Instead, please email christie@fedisbest.org.

 Thank you and we look forward to hearing from you!

Click here to join us!

 

 

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Dear Parents, Did You Know Just 2 Teaspoons Of Supplementation Can Protect Your Baby And Your Breastfeeding Journey?*

Written by: The Fed Is Best Foundation IBCLC Team

There have now been six studies showing that in some infants, a little bit of supplementation with two teaspoons (10 mL) of formula or donor breast milk after nursing had no effect on long-term breastfeeding. One study showed it prevented hospital readmissions in all of the supplemented newborns. Another showed it actually helped breastfeeding! 

 Why aren’t medical and lactation professionals recommending this intervention?

Many medical and lactation professionals believe that a tiny amount of formula will contaminate the baby’s gut, causing lifelong health problems. They refuse to admit that formula supplementation can be helpful, and they have baseless concerns that temporary formula supplementation will become routine for all babies.  According to Baby-Friendly USA, “donor [breast] milk takes the fight out of this.” What they mean is that the few babies who are born in a hospital with donor milk can be fully fed, while the vast majority of babies who are born in hospitals without donor milk just have to tolerate hunger and thirst so as to avoid a few teaspoons of formula.  

Did you know two teaspoons of formula or donor milk has seven calories?  

They argue that formula will change the beneficial bacteria in the baby’s gut, but this change is safe and only temporary—and pales in comparison to the risks of potentially life-threatening complications from insufficient colostrum, like jaundice, low blood sugar, and dehydration, which can be caused by acute starvation.   What about sensitizing the infant’s gut to cow’s milk protein?  There is no evidence that early limited formula supplementation has any impact on babies’ future health. If someone has this evidence, please come forward.  In addition, if anyone has is concerned about cow’s milk formula, there are formulas that have those proteins broken down (hydrolyzed) that can also be used. The fact that lactation and medical professionals have not promoted and implemented this life-saving solution shows that the real issue is bias against formula use, pure and simple.  Do they hate formula products so much that they don’t care if your baby suffers from hunger?

The question is, how many randomized, controlled studies support Step 6 of the WHO’s Ten Steps to Successful Breastfeeding to avoid supplementation from birth in order to improve breastfeeding outcomes? None. Absolutely none.

In the meantime, parents and health care professionals can be assured that if a baby shows signs of persistent hunger after breastfeeding, just a few teaspoons of formula or donor milk (if available) can satiate the baby’s unrelenting hunger, will not cause breastfeeding problems, and even reduces the risk of re-hospitalization due to the baby not getting enough milk.

As long as the mother’s milk supply is protected by the baby breastfeeding at least eight times a day, or in some cases adding milk expression to the feeding plan, the baby can return to exclusive breastfeeding when the mother’s milk comes in.

Supplementation does not destroy mothers’ confidence in their bodies; it gives them the confidence to know they can care for their babies no matter what happens, and it gives them the knowledge they need to support their milk supply until it increases to meet the baby’s needs.  

Do you want to be successful with breastfeeding while protecting your baby from hunger?  Follow your instinct and your baby’s cues, and don’t be afraid of giving your baby a little extra nutrition until your milk comes in!

The Fed Is Best Foundation IBCLC Team

#JustTwoTeaspoons   #FedIsBest  #SafeBreastfeeding

*Only some infants were supplemented. Babies received 10 mL of formula by syringe after breastfeeding if they met the following criteria: >75th %ile  weight loss for age, irritability such as crying and hungry behavior, and if their mothers requested it. Mothers were instructed to stop supplementing after their milk came in.

Note: if a baby is still showing hunger cues after those 10 mL, you can repeat with another 10 mL until the baby is satisfied. 


Resources

Feed Your Baby—When Supplementing Saves Breastfeeding and Lives

The Newborn Stomach Size Myth: It is NOT 5-7 mL

Fed is Best Feeding Plan – Updated 2018

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

WHO 2017 Revised Guidelines Provide No Evidence to Justify Exclusive Breastfeeding Rule While Evidence Supports Supplemented Breastfeeding

HOW YOU CAN SUPPORT FED IS BEST

There are many ways you can support the mission of the Fed is Best Foundation. Please consider contributing in the following ways:

  1. Join us in any of the Fed is Best volunteer and advocacy, groups. Click here to join our health care professionals group. 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 send an email to Jody@fedisbest.org  if you are interested in joining any of our volunteer groups. 
  2. If you need infant feeding support, we have a private support group– Join us here.
  3. If you or your baby were harmed from complications of insufficient breastfeeding please send a message to contact@fedisbest.org 
  4. 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, 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 the work of the Foundation is achieved via the pro bono and volunteer work of its supporters.
  5. Sign our petition!  Help us reach our policymakers, and drive change at a global level. Help us stand up for the lives of millions of infants who deserve a fighting chance.   Sign the Fed is Best Petition at Change.org  today, and share it with others.
  6. 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 that you know. Share the Fed is Best campaign letter with everyone you know.
  7. Write a letter to your health providers and hospitals about the Fed is Best Foundation. Write to them about feeding complications your child may have experienced.
  8. Print out our letter to obstetric providers and mail them to your local obstetricians, midwives, family practitioners who provide obstetric care and hospitals.
  9. 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 of mother’s rights to honest informed consent on the risks of insufficient feeding of breastfed babies.
  10. 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 safely feed her baby. Every voice contributes to change.
  11. Send us messages of support. We work every single day to make infant feeding safe and supportive of every mother and child.  Your messages of support keep us all going.
  12.  Shop at Amazon Smile and Amazon donates to Fed Is Best Foundation.

Or simply send us a message to find out how you can help make a difference with new ideas!

For any urgent messages or questions about infant feeding, please do not leave a message on this page as it will not get to us immediately. Instead, please email christie@fedisbest.org.

 Thank you and we look forward to hearing from you!

Click here to join us!

 

 

 

 

Please follow and like us:
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FAQs Part 3: Do You Believe Exclusive Breastfeeding is a Good Goal to Promote?

FREQUENTLY ASKED QUESTIONS

Our goal is to respond to the many statements that have been made about the Fed is Best Foundation and to answer questions we receive about what the Foundation stands for. Unfortunately, our #FedIsBest phrase has been used incorrectly by others, and it’s important that we clarify what it means and doesn’t mean. Our mission statement has evolved over time and reflects what our parents tell us they need to support them. Click here and here for FAQs part 1 and 2, respectively.

7. Do you believe exclusive breastfeeding is a good goal to promote?

 We do if a mother wants to exclusively breastfeed and they are fully informed about their individualized risk factors for delayed onset and or potential low milk supply. We promote and educate families about safe exclusive breastfeeding because no other health organization informs parents about the risks of insufficient feeding complications and how easy they are to prevent. To be fully informed, parents must be educated about both the benefits and risks of exclusive breastfeeding. Currently, they are only taught about the benefits and not the risks. Continue reading

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Neonatal Nurse Practitioner Talks About Excessive Newborn Weight Loss And Maternal IV Fluids While Exclusively Breastfeeding

By C. Faust

As a neonatal nurse practitioner in a community hospital, I see babies in the postpartum unit every day and make decisions about their discharge criteria.

The average length of stay after birth is 24-48 hours for a vaginal delivery and 48-72 hours for cesarean delivery.  A lot of information about breastfeeding, newborn care, and post-partum care must be conveyed in that short time, often to new parents who are exhausted and overwhelmed. In an ideal world, every mother-baby dyad would be well suited for breastfeeding. Many women are able to breastfeed without difficulty, but for some, it’s a struggle.  The majority of mothers are discharged before their milk comes in, which is why discharge criteria include pediatrician follow-up within 24-48 hours and why weight check appointments are critical so that all breastfeeding babies are protected from inadequate milk intake.

 “Days two to five are critical days for normal newborns to be seen by their pediatrician,” said Dr. Vicki Roe, M.D., a pediatrician at North Point Pediatrics in Indiana. “They are still losing weight and their jaundice levels could be increasing. A healthy baby can become a very sick baby quickly, and we must monitor them closely to prevent complications.”

Many of us work in “Baby Friendly” hospitals.  Requirements for the Baby-Friendly designation include displaying the WHO/Unicef Ten Steps for successful breastfeeding and adhering to these recommendations.  It is important to note that Baby-Friendly does not prohibit supplemental feeding in the case of medical necessity; nevertheless, both medical staff and nursing staff often report that they are afraid to violate  the Baby-Friendly “rules.”  I find it effective to specifically document the condition I am treating when I order supplemental feedings. This makes the plan of care transparent and easy to communicate, ensures accountability, and meets the requirements of certification. The exclusively breastfed baby with excessive weight loss (EWL) requires careful assessment.

Question: Would you consider laboratory testing if a baby has excessive weight loss and the mother’s milk is not in yet to meet discharge criteria?

A weight loss of 7-10 % certainly prompts further feeding evaluation.  A physical exam should be performed, looking for clinical signs of dehydration.  I would consider ordering a Basal Metabolic Panel (BMP) to evaluate for dehydration, hypernatremia, and hypoglycemia. In some situations, the decision to supplement based on excessive weight loss may be met with pushback; laboratory evidence of dehydration adds weight to the decision and may forestall disagreement.  In our facility, we usually do bilirubin (jaundice) screening using a transcutaneous meter at around 24 hours of life; if I were concerned about weight loss, particularly if there were visible jaundice or risk factors, I would repeat the screening.  And of course, if the infant’s clinical appearance were of concern, for instance, if the infant were hypotonic or lethargic, a CBC or complete blood count and blood culture would be of paramount importance to check for infection.

Question: Do you take into consideration the mothers’ risk factors for delayed onset of milk when considering supplementation? 

Absolutely. The considerations I have outlined below are drivers in assessing not only readiness for discharge but also whether there is an indication for supplementation.  A healthy infant born at term and appropriate size for gestational age with no complications can endure a couple of days of low volume colostrum feedings while mother’s milk is coming in. I use the analogy of a bear storing up for hibernation when I speak to parents about prenatal stores and normal expectations for breastfeeding. Maternal considerations and infant health status inform the decision of whether supplemental feeding is needed.  A lactation consultant may be of assistance if lactogenesis is delayed and can implement interventions such as pumping or adjusting the infant’s latch and positioning. It is important to work as a team; LCs can offer valuable input into the plan of care, but they can’t make decisions without consulting with the pediatrician. When a medical need for supplemental feeding is recognized, an appropriate plan of care must accurately be conveyed and followed by everyone involved in the care of the dyad.

Question: If a mother has IV fluids during labor, do you think babies who have excessive weight loss can lose more weight than the current guidelines from the AAP?

It has been posited that the administration of IV fluid in the intrapartum period can affect neonatal weight loss.  The assertion is that IV fluid “plumps up” (i.e., causes edema) of the fetus, leading to an artificially inflated birth weight.  Diuresis after birth then causes apparent significant weight loss.  But babies are not diuresing after birth, as evidenced by their low wet diaper output in general.

 A 2011 study published in Pediatrics (Chantry et al.) sought to examine potentially modifiable factors in excessive weight loss (EWL) in predominantly breastfed newborns.  This was a relatively small study of 316 infants with gestational ages between 32 and 40 weeks. The authors looked at a number of factors, including prenatal feeding plan, supplemental feeding, onset/delay of lactogenesis, nipple type, nipple pain, and interventions during labor, including IV fluid administration. They defined excessive weight loss as ≥10% of birth weight by three days of age.   Overall, 18% of infants who were exclusively breastfed or received minimal (defined as <60 ml total) supplemental formula had EWL. 19% of exclusively BF infants had EWL; 16% of minimally supplemented infants had EWL, and only 3% of infants who had supplemental feeds of >60 ml total had EWL. To greatly simplify the statistical analysis, the initial analysis showed a number of factors associated with EWL, including higher maternal age and education, hourly intrapartum fluid balance, postpartum edema, delayed lactogenesis, fewer infant stools, and birth weight. Further analysis found only two significant factors:  intrapartum fluid balance and delayed lactogenesis. EWL occurred in 30% of EBF/minimally supplemented infants whose mothers had high hourly intrapartum fluid balance, and 10% of those whose mothers had low hourly fluid balance. Around the issue of delayed lactogenesis (defined as not “feeling noticeably fuller” by 72 hours), 35% of EBF/minimally supplemented infants with mothers who reported delayed lactogenesis had EWL; for women who reported no delay in lactogenesis, 8% of EBF/minimally fed infants had EWL. 

I can’t help but wonder whether this study failed to see the forest for the trees. A higher fluid balance may be a marker for longer labor and labor complications, which in turn would certainly affect postpartum recovery, fatigue, and lactogenesis.  The authors relied on subjective perception by primigravidas as a definition of delayed lactogenesis and reported it as 42%, a much higher prevalence than the usual estimate of 15%. Indeed, the title of this article could have been “Excess weight loss in the first-born breastfed newborns relates to delayed lactogenesis”—not nearly as exciting. The authors themselves advise caution in interpreting weight loss and state that EWL should not be assumed to be fluid loss alone but may indeed represent insufficient feeding.

A later study by Elroy et al. (2017) also sought to examine whether there is a relationship between EWL, type of fluid (colloids + crystalloids or crystalloids alone), and IV fluid dose.  This was a larger study, involving 801 dyads. EWL was defined as >7% of birth weight. In this case, the authors did not find a difference in the rate of EWL associated with the type of fluid given, nor did they find a dose-response relationship between the amount of fluid and EWL.  As an aside, they mention the confounding variable of maternal hypotension, which of necessity would require fluid administration, but which could lead to impaired uteroplacental perfusion and fetal acidosis, affecting the vigor of the infant.

So do I think that a 7-10% or greater weight loss is grounds for concern?  Absolutely. Ascribing excessive weight loss to maternal IV fluid is disingenuous at best. 

While IV fluid may contribute to perceived weight loss, this relationship is by no means established, but the relationship between poor feeding and weight loss is.  With the exception of critical infants with certain prenatal conditions, I do not see infants born with perceptible edema.  

A comprehensive exam for every breastfeeding dyad will include:  
  • Maternal health.   In the aggregate, women giving birth today are older, have higher BMIs, and are more likely to have underlying chronic health conditions or pregnancy complications than women in previous generations. Delayed childbearing means that women may be having children after the age of 35. Older mothers are more likely to have pregnancy and childbirth complications.  The obesity epidemic has affected people of all ages and socioeconomic strata; obese women may have underlying chronic health problems such as diabetes and hypertension and may have more difficulty with mobility and healing.  Long or complicated labor may contribute to fatigue, which can delay(link) onset of milk production and can also increase the risk of (link)accidental suffocation of the infant. No mother plans to fall asleep with her baby in the bed, but if parents are awake for 36+ hours, their risks for falling asleep while breastfeeding or holding their baby increases.
  • Substance use.  About 10% of babies in our facility are affected by maternal substance use; about half of these are affected by opioids, whether illicit drugs, prescription drugs, or medication-assisted treatment (MAT) drugs such as methadone and buprenorphine.  We can and do support breastfeeding in women who are stable in recovery, even if on MAT, but we recognize that these women may have unique stressors that may make breastfeeding more difficult. Infants who are experiencing withdrawal often have disorganized feeding.  Hunger can exacerbate withdrawal, and weight loss is a symptom of withdrawal. These infants do stay in the hospital longer for observation; my threshold to start supplemental feedings is lower since they are at risk for significant weight loss.
  • Breast anatomy.  A history of augmentation or reduction surgery may impact milk production or transfer.  Wide-spaced, “tubular” breasts may be an indicator of insufficient glandular tissue. Flat or inverted nipples may present difficulty with latching; a breast shield may help, but the use of a shield should prompt careful follow up of feeding, milk transfer, and weight gain.
  • Feeding assessment.  Every breastfeeding dyad should have an evaluation of feeding by a lactation consultant or clinician with expertise.  Latch, nipple pain, and evidence of transfer, such as audible swallowing, are one part of the assessment. Can the mother get the baby on independently or does she require assistance?  If the nurse has had to get the baby latched for every feeding, the dyad is not ready for discharge.
  • Anatomy of the infant’s mouth.  Tongue ties and other anatomical considerations may present specific challenges to feeding.  (Link) Frenulotomy and lysis of lip ties have become common. Infants who may be at risk for feeding difficulty should be followed very closely, whether or not they have surgical intervention.
  • Timing of weight assessment.  A 7% loss has different implications depending on the day/hour or age. If the weight was done 16 hours earlier on the evening shift before the morning of discharge, I request a repeat weight.
  • Gestational age.  Late preterm (LPT) infants are often cared for in the well-baby setting and may masquerade as healthy term infants, but they are not. LPTs may have excessive weight loss; readmission rates for weight loss, jaundice, and other complications are up to three times higher than for term infants.  In our facility, late preterm infants are observed in the hospital setting for a minimum of 72 hours. Our protocol for the care of the LPT follows the recommendations of the Academy of Breastfeeding Medicine: we initiate supplemental feedings for a weight loss of ≥3% by 24 hours or ≥7% by day 3 or, of course, sooner if there is evidence of hypoglycemia, dehydration, jaundice or poor feeding.
  • Birth weight.  We assess weight loss by percentage since babies come in many sizes…however, a 7% weight loss in a baby who weighed five pounds at birth looks different than the same percentage in a large infant who has more reserves of fat and glycogen.
  • Output.  Passage of urine and stool are unreliable indicators of intake, but no or very low output suggests poor intake.  A breastfed infant may have only 1-2 wet diapers per 24 hours in the first day or two, but as mother’s milk comes in, the output should increase because of colostrum amounts increase.  I always discuss watching output at home and contacting the pediatrician promptly if the infant is not producing urine or dirty diapers. 
  • Experience.  Is this a first baby or has the mother successfully breastfed other children? Did she try breastfeeding before and stop?  If so, what were the issues?
  • Exam.  A physical exam includes assessment of hydration status:  fontanels, skin turgor, mucous membranes, as well as general well-being, suck, activity level.     

So would I discharge a baby with a greater than 7% weight loss and no supplemental feedings? It depends on the complex thought process that goes into discharge planning. Every mother-baby dyad is unique and requires individualized care.  An EWL baby can decline rapidly in 24 and It’s important to teach parents about what signs to look for insufficient breastfeeding so that they can safely supplement until they have their next day follow-up pediatrician appointment.  Weekends pose particular concerns. Discharging a baby on a Monday with an outpatient appointment the following day is a very different scenario than discharging on a Friday of a holiday weekend with no possibility of follow up until Tuesday.  In certain cases where risk factors are present, such as LBW or prematurity, I may order outpatient weight checks for a few weeks. As well, follow up with a lactation consultant can be invaluable for the mother who needs support.   

 


                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
 Resources:                                                                                                                                                                     Boies, E.G., Vaucher, Y.E. & the Academy of Breastfeeding Medicine (2016).  ABM Clinical Protocol #10: Breastfeeding the late preterm (34-36 6/7 weeks of gestation) and early term infants (37-38 6/7 weeks of gestation, second revision 2016.  Breastfeeding Medicine, 11 (10).Chantry, C.J., Nommsen-Rivers, L.A., Peerson, J.M., Cohen, R.J. & Dewey, K.G. (2011).  Excess weight loss in first-born breastfed newborns relates to maternal intrapartum fluid balance.  Pediatrics, 127, e171-9.Eltonsy, S., Blinn, A., Sonier, B., DeRoche, S., Mulaja, A., Hynes, W., Barrieau, A. & Belanger, M.  (2017). Intrapartum intravenous fluids for caesarian delivery and newborn weight loss: a retrospective cohort study.  BMJ Paediatrics Open 2017 (1).

WHO 2017 Revised Guidelines Provide No Evidence to Justify Exclusive Breastfeeding Rule While Evidence Supports Supplemented Breastfeeding

Weight Loss is Not Caused by IV Fluids: The Dangerous Obsession with Exclusivity in Breastfeeding:

FAQs: Does The Fed Is Best Foundation Believe All Exclusively Breastfed Babies Need Supplementation?

 

Informed Consent Regarding Risks of Insufficient Feeding

 

HOW YOU CAN SUPPORT FED IS BEST

There are many ways you can support the mission of the Fed is Best Foundation. Please consider contributing in the following ways:

  1. Join us in any of the Fed is Best volunteer and advocacy, groups. Click here to join our health care professionals group. 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 send an email to Jody@fedisbest.org  if you are interested in joining any of our volunteer groups. 
  2. If you need infant feeding support, we have a private support group– Join us here.
  3. If you or your baby were harmed from complications of insufficient breastfeeding please send a message to contact@fedisbest.org 
  4. 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, 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 the work of the Foundation is achieved via the pro bono and volunteer work of its supporters.
  5. Sign our petition!  Help us reach our policymakers, and drive change at a global level. Help us stand up for the lives of millions of infants who deserve a fighting chance.   Sign the Fed is Best Petition at Change.org  today, and share it with others.
  6. 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 that you know. Share the Fed is Best campaign letter with everyone you know.
  7. Write a letter to your health providers and hospitals about the Fed is Best Foundation. Write to them about feeding complications your child may have experienced.
  8. Print out our letter to obstetric providers and mail them to your local obstetricians, midwives, family practitioners who provide obstetric care and hospitals.
  9. 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 of mother’s rights to honest informed consent on the risks of insufficient feeding of breastfed babies.
  10. 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 safely feed her baby. Every voice contributes to change.
  11. Send us messages of support. We work every single day to make infant feeding safe and supportive of every mother and child.  Your messages of support keep us all going.
  12.  Shop at Amazon Smile and Amazon donates to Fed Is Best Foundation.

Or simply send us a message to find out how you can help make a difference with new ideas!

For any urgent messages or questions about infant feeding, please do not leave a message on this page as it will not get to us immediately. Instead, please email christie@fedisbest.org.

 Thank you and we look forward to hearing from you!

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Weight Loss is Not Caused by IV Fluids: The Dangerous Obsession with Exclusivity in Breastfeeding:

By Dr. Christie del Castillo-Hegyi, M.D.

The Fed is Best Foundation has written about countless cases of serious complications caused by poor standards of breastfeeding management established by multiple exclusive breastfeeding advocacy organizations. The primary causes of these poor outcomes are:

    • the persistent denial of the seriousness of newborn weight loss
    • the lack of transparency about the consequences of insufficient feeding complications in patient education and health professional training
    • and the dangerous obsession with exclusivity in breastfeeding.

Exclusive breastfeeding, according to the WHO, means “the infant receives only breast milk. No other liquids or solids are given – not even water – with the exception of oral rehydration solution, or drops/syrups of vitamins, minerals or medicine.” While breastfeeding is a positive thing to support, the obsession with exclusivity in breastfeeding promotion results in approximately 190,000 newborn admissions a year in the U.S. alone, mostly from complications of jaundice and dehydration caused by underfeeding. This article will discuss the actual reason why exclusively breastfed newborns lose weight and why newborn weight loss is not due to IV fluids given to mothers before delivery. This is to address a commonly circulated unsafe recommendation by exclusive breastfeeding advocates and lactation professionals suggesting we increase the AAP recommended maximum weight loss threshold of 7% and to weigh infants at 24 hours, which would likely increase newborn insufficient feeding complications, hospitalizations, and brain injury.

Part 1: Why a Newborn Loses Weight in the First Days

Let’s start the conversation off with why newborns lose weight in the first days of life. Exclusive breastfeeding advocates have hypothesized that infant weight loss is caused by fluid shifts and “diuresis” or elimination of fluid through urination. Diuresis is defined as overproduction of urine caused by excess body fluid, which should be at least 6-8 wet diapers a day, the normal urine production of a hydrated newborn. In fact, exclusively colostrum-fed newborns, only produce 1-2 wet and dirty diapers a day the first 2 days of life, which is lower than the normal number of wet diapers a day for a hydrated newborn. Therefore, weight loss is not in fact caused by fluid loss. 

Here are some basic facts about newborn nutrition:

  • The caloric requirement of a newborn from birth through the first weeks of life is 100-120 Calories/kg/day, a figure that is determined by the number of living cells a baby has to keep alive. 
  • The fluid requirement of a newborn is more variable, which can be affected by how much fluid reserve they are born with. But according to the pediatric literature it is approximately  60-80 mL/kg/day the first 2 days then 100 mL/kg/day thereafter. 
  • That means a 3 kg newborn needs 300 to 360 Calories per day and 180-240 mL of fluid for the first 2 days and 300 mL thereafter. 

Continue reading

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A Fully Fed Baby is the Biological Ideal

Abridged Comment Presented on July 11, 2019 at the USDA Dietary Guidelines Committee Meeting in Washington, DC

My name is Dr. Christie del Castillo-Hegyi, Co-Founders of the Fed is Best Foundation, a non-profit organization of health professionals and parents whose mission is to research and advocate for safe breastfeeding practices. We do this to prevent the complications of infant dehydration, excessive jaundice, and hypoglycemia from insufficient feeding, all known causes of brain injury, disability and rare deaths. I have come here representing over 700,000 supporters to raise awareness regarding these complications for the DGA committee as they prepare the infant nutrition guidelines.

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Feed Your Baby—When Supplementing Saves Breastfeeding and Lives

Jody Segrave-Daly, RN, MS, IBCLC

Mothers are taught that it’s rare to not produce enough milk to exclusively breastfeed in nearly every breastfeeding book, mommy group, and hospital breastfeeding class. The truth is, we have limited studies that provide an accurate percentage of the number of mothers who can produce enough milk for their baby for the recommended 6 months. Although actual rates of adequate milk production are unknown, there are estimates that range from 12-15 percent or more.  

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WHO 2017 Revised Guidelines Provide No Evidence to Justify Exclusive Breastfeeding Rule While Evidence Supports Supplemented Breastfeeding

Christie del Castillo-Hegyi, M.D.

The WHO health policy that has been responsible for millions of preventable hospital admissions of newborns for insufficient feeding complications is Step 6 of the Ten Steps to Successful Breastfeeding: “Give no additional food or fluid other than breast milk unless medically indicated.” Complications of insufficient feeding from exclusive breastfeeding before copious milk production are now among the leading causes of newborn extended and repeat hospitalization, namely jaundice (hyperbilirubinemia), dehydration and hypoglycemia.

In 2017, the World Health Organization published its guidelines updating its recommendations for “Protecting, Promoting and Supporting Breastfeeding in Facilities Providing Maternity and Newborn Services,” which outlines the evidence for the WHO recommendations on breastfeeding support for newborns in health facilities based on the Ten Steps to Successful Breastfeeding. Here is the evidence presented to justify the recommendation to avoid supplementation in breastfed newborns.

The WHO guidelines authors went on to conclude the following:

How did very low quality of evidence turn into moderate-quality evidence for exclusive breastfeeding particularly when the evidence showed improvement of breastfeeding rates in supplemented breastfed newborns? Continue reading

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The ‘Second Night Syndrome’ is Abnormal and This is Why

Written by Jody Segrave-Daly, MS, RN, IBCLC

As a NICU/nursery nurse and IBCLC who has worked with newborn babies her entire nursing career, I was mystified when I first heard the phrase “second-night syndrome.” When I began to research where the phrase came from, it became clear that this phrase is not based on any scientific research, but rather based on a theory that describes the behavior of exclusively breastfed newborns on their second day of life. I think it is a frightening phrase for new parents to hear, as the word “syndrome” is defined as a group of signs and symptoms that occur together and characterize a particular abnormality or condition. 

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The truth is, the “second night syndrome” is a theory that describes abnormal newborn behavior.

Babies can go into a very deep, recovery sleep period after the first 2 hours from birth. This period can range from 8-12 hours after birth and is often a time that babies may not wake up on their own to feed every 2-3 hours. Babies often need gentle encouragement from their parents to wake them up for feeding sessions. Some babies will nurse for 5 minutes or suckle on a bottle for 5 minutes or less and fall back asleep. It’s well known that babies are fasting during this time and if they have enough caloric reserves, they may tolerate this fasting period without complications. Nursery nurses are quite skilled in performing clinical assessments of babies to ensure they are stable. They are looking for signs of hypoglycemia or low blood sugar levels, jaundice and other abnormal clinical markers.  Ten percent of healthy, full-term exclusively breastfed newborns develop hypoglycemia in the first days of life and may require specialized care until they are stable.  All babies are transitioning from intrauterine to extra-uterine life and need skilled observation from the nurse while they are bonding with their parents in their room.

Yellow with Grayscale Photos Photographer General Media Kit (20)

Risk factors for delayed onset of full breast milk production

After babies begin to ‘wake-up’ from their deep recovery sleep period on their second day of life, they will begin to exhibit stronger hunger cues to nurse or bottle-feed, every 2-3 hours and they become much more alert. This is a new opportunity for parents to bond because their babies become alert again, opening their eyes while gazing at their parent’s adoring faces. Some babies are a bit demanding during this time because they are very hungry. Newborn babies are very easy to console after their feeding by being held and snuggled. Every nursery nurse will tell you if a baby is not content after feeding, something is wrong. I suspect this is where the word “syndrome” came from, which describes abnormal infant behavior. Continue reading

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