Why it’s Time to Stop Teaching Parents Paced Bottle Feeding and Teach Responsive Feeding As Recommended by the AAP

Paced bottle feeding is a wildly popular bottle feeding technique that is promoted as the best way to feed babies who are breastfed. When I did a google search for paced bottle feeding, there were a whopping 572,000,000 results! What’s more, definitions of paced bottle feeding techniques varied significantly, often contradicting each other,  and there were many unproven claims to promoting paced feeding. 

As a 30-year NICU nurse and lactation consultant, I’m mystified why paced feeding for healthy term babies has become the norm. Pace feeding is a therapeutic feeding technique primarily used for medically complex and premature babies whose suck, swallow, and breathe (SSB) reflex is not coordinated or matured, which is essential to bottle-feed without aspirating milk into the lungs.  

The American Academy of Pediatrics (AAP) and global infant feeding guidelines advocate and promote responsive feeding, which is uniquely different from paced feeding.  Full-term, healthy babies are born with their SSB coordination fully developed and can responsive bottle feed safely.

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Is Breastfeeding Twelve or More Times a Day Normal? Not Always

A meme posted by an IBCLC states that breastfeeding 12 or MORE times a day is “normal” with no further education on when it can be a sign of newborn hunger, poor feeding, inadequate milk transfer, or failure to thrive. 

Overly simplistic memes like this are irresponsible, confusing and in some cases are the reason why parents miss red flags that require medical attention and lactation assessment to be sure the baby is receiving adequate nutrition and fluids when nursing. (Source of meme to the left, Facebook, Lucy Ruddle, IBCLC)

Here at the Fed Is Best Foundation, we receive messages frequently from families who tell us they were repeatedly assured by trusted health professionals that nursing 12 or more times a day is completely normal. 

But is it always normal?

No, it’s not.  Continue reading

Trouble Breastfeeding? It’s Not Your Fault  

by Heidi Bitsoli, Sunshine Behavioral Health 

If there’s one thing pregnant women get in spades, it’s advice. From your relatives to your neighbors to your coworkers to strangers in line at the grocery store, everyone has an opinion on how to best care for the child you’re about to birth.

And one of the most common pieces of advice you’re likely to hear is how important breastfeeding is, for both mother and baby. But what all those opinionated folks won’t tell you is how hard it is for some women.

The truth is, that your mental and physical health is just as important as your baby’s. If you have trouble breastfeeding, or simply decide it’s not for you, you are not alone. You also aren’t a failure as a parent if you have difficulties breastfeeding or decide against it.

How Common Are Breastfeeding Difficulties?

Breastfeeding difficulties are extremely common. One study conducted by Nutrients followed mothers who were breastfeeding when they were discharged from the hospital, within 72 hours of delivery. At the time of discharge, 95% of the mothers were breastfeeding exclusively.

After one week, 81% were still breastfeeding exclusively. The majority of these women continued with complementary breastfeeding. At one month, only 73% were exclusively breastfeeding. 19% still provided breast milk complementary feedings, and 7% had transitioned to exclusively formula feeding. Continue reading

Dear pediatricians, watch your language; infant bonding happens with a present loving parent not the way they are fed

 

Dear Pediatrician, 

I am writing this letter to open my heart to all pediatricians. I’m hoping that sharing my story will encourage them to watch their language when talking to parents about infant feeding.

As a parent, we naturally want to make sure our children thrive. We entrust pediatricians to care for our children with unbiased and evidence-based information. We rely so heavily on your assurance that we are doing right by our children. We need the “you’re doing great” or “maybe try doing this instead” to help guide us through the ups and downs of parenting these little ones that did not come with an instruction manual. 

Recently, I was at a pediatrician appointment with my second baby, who happens to be exclusively breastfed. Breastfeeding was easier for me the second time around, and my mental state is in a much better place. 

My pediatrician began to examine him. He starts to cry as he does with everyone that isn’t mommy, daddy, or big sister. She looks at me and laughs and says, “yup, he is definitely in the stranger-danger phase now. And I bet it’s even stronger because he is breastfed. Breastfeeding just creates this unexplainable bond.”

I stood there dumbfounded and in disbelief. My pediatrician knows my daughter was formula-fed, and she knows how emotional I was when switching her to formula. But even putting that aside, she is supposed to be a trained professional and understands that breastfeeding doesn’t create “an unexplainable bond” —bonding happens with an emotionally healthy, loving parent, not by the way a baby is fed. I don’t feel a stronger bond with my son than I do with my daughter. They are both my babies, and I love them both equally and unconditionally. 

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How To Prepare For Supplementing When Breastfeeding Your Baby In The Hospital

Mothers who experienced delayed onset of milk production or experienced low milk supply with their first baby often contact us for support to try breastfeeding again. They typically have anticipatory anxiety, because they have lost trust in their lactation professionals and hospital staff and are unwilling to attempt breastfeeding again without supplementation. They want to know how to supplement their baby until their milk supply becomes sufficient to feed their baby safely while providing proper stimulation to their breasts for optimal milk production.

The most common concerns expressed:

 

  • Fear of the pressure to exclusively breastfeed
  • Fear of failing to breastfeed again
  • Fear of advocating for themselves and their babies while in the hospital
  • Fear of being shamed by hospital staff when wanting to supplement until their milk comes in
  • Fear of being denied formula or not receiving it in a timely manner
  • Triggers from the previous negative breastfeeding experience, such as being touched without consent

Monica writes: “I lost confidence in breastfeeding because I didn’t make enough milk for my first son, who required hospitalization for severe jaundice and a 13% weight loss. I was devastated and furious when the neonatologist told me he was starving. In my birth hospital, my son had been forced to cry from hunger, and I was told my body would make enough milk for him by every lactation consultant and nurse in the hospital. I trusted them. They were wrong! I no longer trusted breastfeeding and decided to pump and bottle feed to ensure he got enough milk. I purposely delivered my second baby at a hospital that didn’t force me to breastfeed exclusively. After starving my son,  I was not taking any chances, and I supplemented my daughter after every breastfeeding session. My breastfeeding experience was the opposite of my son’s, and I remember tearing up several times because she was so peaceful and never cried.  Thankfully I supplemented her because it took five days for my milk to come in. Supplementing saved my breastfeeding journey, and we are still breastfeeding 19 months later.”

 

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What Kind Of Water Is Safe For Mixing Formula Powder For My Baby?

Written By: Jody Segrave-Daly, MS, RN, IBCLC

Great question! Educational resources that parents have access to often give them mixed messages about safe formula preparation.  To answer the many questions we receive, we developed an up-to-date evidence-based resource guide for parents about safe formula feeding. We start with water sources available to parents in the United States, specifically. 

Public Water

The United States has one of the safest public drinking water facilities in the world, and it is strictly regulated by the Environmental Protection Agency known as the EPA. Your community’s public water system is routinely tested for safe consumption. The EPA sets legal limits on over 90 contaminants in drinking water. The Environmental Protection Agency’s Safe Drinking Water Hotline is  1-800-426-4791.

Private Well Water

It is estimated that more than 13 million households rely on private wells for drinking water in the United States. According to the EPA, private well owners are responsible for the safety of their water. This website educates well owners on wells, groundwater, and information on protecting their health.   Continue reading

Is My Baby’s Weight Loss Normal Or Excessive?

The Newborn Weight Loss Tool can provide an answer.

Parents are taught that it’s normal for babies to lose 7–10% of their body weight in the first few days after birth, but is this true? Well, that depends. According to the AAP, a baby who loses more than 7% of his body weight may be losing excessive weight and requires a comprehensive lactation evaluation to rule out delayed onset of copious milk production, primary lactation failure, and/or infant oral anomalies that prevent adequate colostrum/milk transfer.

From the American Academy of Pediatrics HealthyChildren.org website. Breastfed newborns should lose no more than 7 percent of birth weight in the first few days after birth before starting to gain weight again. (Accessed July 16, 2020)

Weight loss has typically been assessed using simple percentages, but now there is a much more precise and accurate way to track excessive weight loss in newborns and many hospitals, pediatricians, and lactation consultants are adopting this method for greater accuracy in making clinical recommendations. The Newborn Weight Tool, or NEWT, is an online tool, the first of its kind, to help pediatricians determine whether exclusively breastfed newborns have lost too much weight in the first days of life. The tool was developed at Penn State College of Medicine through research conducted jointly with University of California, San Francisco. It was developed using a research sample of hourly birth weights from more than 100,000 breastfed newborns. For a quick synopsis of this tool from the lead investigator and one of developers of the tool, Dr. Ian Paul, watch the video below.

Source: Penn State Health News

In this video, Dr. Ian Paul, professor of pediatrics and public health sciences at Penn State College of Medicine and pediatrician at Penn State Hershey Children’s Hospital, talks about how NEWT fills an important void.  Determining whether an exclusively breastfed newborn is losing excessive weight is important because higher weight loss almost always reflects suboptimal milk intake. It is also associated with increased risk of medical complications such as low blood sugar, jaundice, and dehydration, which can result in the need for medical interventions and future health and developmental problems. This weight-loss tool shows that how quickly babies lose weight is just as important as how much they lose.

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Nurses Talk About Delivering, Feeding, And Caring For Babies Following The AAP Guidelines When A Mother Is infected With The COVID-19 Virus

 

We know everyone’s anxiety level is very high right now because of the uncertainly of delivering your baby during the COVID-19 pandemic. Our goal is to provide real-life experiences of nurses who are taking care of people in labor and postpartum so that parents can have an idea of what to expect when delivering their babies.

The most recent guidelines released by the AAP, CDC, and ACOG apply to babies in the U.S.A.

Since these guidelines are different from the WHO guidelines and parents have been receiving mixed messages and are asking for clarification. We want to clarify the recommendations for parents so they can be fully informed of their choices. Generally speaking, parents who live in developed countries such as the USA have access to breast pumps, clean water, masks, cleaning supplies, and formula. The science-based recommendations are based on these choices.

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Guidelines for Pregnant and Breastfeeding Mothers During the Coronavirus Pandemic

Photo Credit: Shutter Stock

By the Fed is Best Foundation Health Professional Team

We have summarized the current recommendations by the Centers for Disease Control  for Pregnant and Breastfeeding Mothers in the wake of the Coronavirus Pandemic (COVID-19). The American College of Obstetricians and Gynecologists have also endorsed the CDC recommendations. This information is intended to inform health care professionals and pregnant mothers who are confirmed positive for COVID-19 or persons under investigation (PUI) for COVID-19 in the hospital and postpartum settings.

The symptoms of coronavirus for pregnant and lactating mothers and infants are the same as those of the general population, which include but are not limited to:

  • Fever 
  • Cough
  • Shortness of Breath
  • Fatigue
  • Poor appetite
  • Sputum production 
  • Body aches

The United States is currently has the highest number of coronavirus cases in the world, particularly in New York, New Jersey, California and Washington State. See the current world distribution of Coronavirus cases here. Continue reading

Relactation: A Science Based How To Guide

by Jody Segrave-Daly, RN, IBCLC and Lynnette Hafken, MA, IBCLC

Our goal is to ensure you have the accurate information you need for the best chance of success, with adequate attention to your mental and physical health and well being.

Before you start, it is important to manage your expectations. The limited research we have shows that while most mothers can produce some milk, developing a full milk supply is often not the case, especially under these very stressful pandemic circumstances. Please be very gentle to yourself throughout the process, because all sorts of feelings can come up. This study talks about those feelings. 

In considering relactation, mothers need to consider the big picture.  There are cons…:
  • time spent pumping that takes time away from other important things, such as interaction with baby, sleep, and caring for other children
  • less free time for mom, which is important for mood and stress levels
  • potentially disappointing results
  • mental health considerations 
…as well as pros:
  • another source of milk for the baby
  • passive immunity from breast milk*
  • for mothers who enjoyed breastfeeding, an additional way to spend more one-on-one time with baby
  • feeling a sense of agency in a time when we have little control over our lives

*Since COVID-19 is caused by a novel coronavirus (SARS-CoV-2), no one has antibodies to prevent infection unless they have either been exposed to it or recovered from it. Once a mother is exposed and starts developing antibodies, it takes around two weeks to build up antibodies to have a clinical impact as passive immunity protection.   Continue reading