Starvation Jaundice and Bilirubin-Induced Brain Injury in Breastfed Newborns

Lecture Delivered by Dr. Lawrence Gartner, Chief Medical Director of Baby-Friendly USA

We have uncovered a lecture provided to lactation consultants at a prominent breastfeeding conference given by Baby-Friendly USA Chief Medical Consultant, Dr. Lawrence Gartner, who discussed the risk of brain injury from starvation-related jaundice, called kernicterus, 90% of which occurs to breastfed babies who lose excessive weight, according to his lecture. Yet despite this training, no information on the risk of preventable brain injury from starvation-related jaundice in breastfed newborns exists in patient-directed breastfeeding literature published by breastfeeding advocacy groups other than our own.





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Exclusively Breastfed Newborns Have Double the Risk of Being Rehospitalized

By Christie del Castillo-Hegyi, M.D.

This week, the journal Academic Pediatrics, published a study conducted by the Newborn Weight Loss research group led by Drs. Valerie Flaherman and Ian Paul, which consisted of 143,889 healthy, term and near-term newborns born at the Baby-Friendly Northern California Kaiser Permanente hospital system from 2009-2013.[1] They included newborns who were discharged from their birth hospitalization without requirement of intensive care, which includes newborns who developed jaundice before discharge. They looked at the effects of mode of feeding, namely exclusive breastfeeding and exclusive formula feeding during the birth hospitalization on the rates of rehospitalization and number of outpatient follow-up visits. In addition, they looked at the effects of percent weight loss on the same outcomes.

Overall, 6.2% (1 in 16) of the healthy term newborns studied were readmitted; 4% were vaginally delivered and 2.2% were Cesarean delivered. This represents 8921 newborns over the five year period, almost 5 babies per day. They showed that exclusively breastfed newborns had slightly more than double the risk of being rehospitalized, even when adjusted for gestational age, birth weight and maternal race/ethnicity. Exclusively breastfed newborns also had significantly more (32% more) outpatient visits in the first 30 days after birth compared to exclusively formula-fed newborns. The leading cause of readmission was for hyperbilirubinemia or jaundice and need for inpatient phototherapy. The purpose of phototherapy is to reduce blood bilirubin levels in order to prevent or limit brain injury, a complication of insufficient feeding and dehydration commonly found in exclusively breastfed newborns before the onset of copious milk production (lactogenesis II).

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Fed is Best Foundation Presentation to WHO Officials on Breastfeeding Complications, Hospitalizations, Brain Injury and Disability

Christie del Castillo-Hegyi, M.D., Co-Founder

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

This is a video of the presentation given to the WHO officials:

We believe all babies deserve to be protected from hunger and thirst every single day of their life and we believe that education on Safe Infant Feeding should be free. If you would like to make a donation to support the Fed is Best Foundation’s mission to teach every parent Safe Infant Feeding, please consider making a one-time or recurring donation to our organization.

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Thank you from the Fed is Best Foundation!



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Why the Academy of Breastfeeding Medicine Guidelines for “Medically Necessary” Supplementation Make the Baby-Friendly Hospital Initiative Unsafe

by Christie del Castillo-Hegyi, M.D., Co-Founder of the Fed is Best Foundation

On September 22, 2017, senior members of the Fed is Best Foundation met with the top officials of the World Health Organization (WHO) Breastfeeding Program. We learned that the WHO has never studied the complications of the WHO Ten Steps to Successful Breastfeeding and the Baby-Friendly Hospital Initiative (BFHI). We learned they have no studies commissioned to monitor the complications. Despite being presented data on the complications caused by allowing newborns to fast for days to achieve exclusive breastfeeding, they declined our offer to help make the guidelines safer and more ethical.  To watch the presentation given to the WHO officials, please go to this link. We learned that they have known about the risks of brain injury from exclusive breastfeeding and yet refuse to inform the public and health professionals. We learned that their provision for preventing brain injury consisted of telling health professionals to look out for “convulsions, lethargy and being unable to feed,” which are late signs of newborn brain injury. As a result, the WHO Ten Steps and the BFHI has created to an epidemic of infant feeding complications, hospitalizations, brain injury and disability in the developed and developing world. This constitutes one of the largest and most egregious violations of patient and human rights in the history of public health. They have asked for comments from the public regarding their draft revision of the breastfeeding guidelines, which make no changes to the recommendation, “give infants no food or drink other than breastmilk unless medically indicated,” while providing patients no information on the risks of avoiding supplementation. This is the official response of the Fed is Best Foundation to their request. Continue reading

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Donor Breast Milk – Is It Worth It?

Written by Hillary Kuzdeba, MPH

Many women in developed countries like the U.S. find that despite their best efforts, they are unable to exclusively breastfeed due to supply problems or other circumstances. They may feel pressured into finding some other way of ensuring their babies are exclusively breastfed, even though they cannot produce enough for baby. Adoptive parents may also feel pressure to provide breast milk. A lot of this pressure to provide breast milk comes from the over-exaggeration or misinterpretation of the benefits of breast milk on long term health outcomes, or from unfounded fears about infant formula.

Currently there are two types of donor breast milk available to moms in the US, but only one type that is supported and recommended by major medical bodies like the American Academy of Pediatrics (AAP)(1, 2) and by the Fed is Best Foundation. Donor milk obtained from a milk bank or hospital is a safe and healthy alternative to mom’s own milk.(2) Milk banks thoroughly screen their donor moms to ensure the safety of the milk and pasteurize it following strict food safety protocols to destroy bacteria that can make infants very ill. Milk banks are similar to blood banks. These organizations are designed to make sure human body fluids, whether breast milk or blood products, are screened and safe before they are used by vulnerable people like newborns and sick patients. This is because human body fluids, including breast milk, can pass transmissible infections like HIV from person to person.(3-5) For more information on the milk bank process, please visit Continue reading

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Dangers of Insufficient Breastfeeding Presented at the First Coast Neonatal Symposium

Dr. Christie del Castillo-Hegyi was invited to present her research on the brain- and life-threatening consequences of insufficient feeding of exclusively breastfed newborns at the First Coast Neonatal Symposium held by the Department of Neonatology at the University of Florida at Jacksonville on April 24, 2017.  Here is the video of the lecture presented.

Note: A segment of the lecture was excluded due to copyright laws and will be posted once permission is granted to publish it.

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The Lancet: Nonexistent Magic Breasts Could Save 800,000 Lives Per Year

Written by Brooke Orosz, PhD

In 2016, an article in The Lancet  claimed that increasing breastfeeding rates worldwide could save 800,000 children per year.  The first problem with this study is that the authors are somewhat overly optimistic in interpreting the evidence for breastfeeding.  The second is that, although the vast majority of those hypothetical lost lives are in poor countries, this study has been used as a club to shame women into breastfeeding in wealthy countries.

The biggest problem, however, is that the article assumes “near-universal” exclusive breastfeeding until 6 months, with complementary foods until at least 12 months. They provide no evidence that this goal is realistic or even possible, and all available evidence suggests it is not possible.

There are no societies, today or in the past, that have near-universal exclusive breastfeeding for six months. While it works for some individual babies, no one has ever made it work across an entire society, not without allowing a lot of babies to starve, anyway.

In fact, it’s not at all clear that six months is even the best age to introduce complementary foods.  Many babies outgrow their iron stores or their mother’s milk supply earlier, and they benefit from other foods at 4 to 5 months old. Earlier introduction of solids may even reduce the risk of food allergy.

Mothers in low and middle income countries do not fail to breastfeed because they are too stupid to know it’s important, they fail because breastfeeding doesn’t always work. Because women die in childbirth, or suffer complications so serious they are unable to care for the baby. With limited medical care, this is sadly commonplace. Because women are undernourished, which impairs their ability to produce milk. Because an unknown number of women across the population have insufficient glandular tissue and will not make enough milk under any circumstances. And because babies are born premature, sick, or otherwise unable to nurse effectively.

So, many women cannot breastfeed, even more cannot breastfeed exclusively, and even when breastfeeding is going well, there’s no reason to withhold solids until 6 months.

Sure, in a world in which mother and baby are always doing well after birth, and breastfeeding nearly always works out, then we can talk about “near-universal”. But it makes no sense to write public health goals based on completely unrealistic assumptions.



19396698_917437061753694_1008365497486792066_nBrooke Orosz, PhD is a professor of mathematics and the mother of a child who had to be hospitalized for dehydration due to insufficient breast milk intake. After her son’s crisis, she was stunned to learn that readmissions for nursing problems are commonplace, and that they are not tracked or penalized by health authorities. Since then, she has used her knowledge of statistics to study the problem and to advocate for evidence-based feeding protocols that put the baby’s safety and comfort first. Brooke will be delivering her second baby very soon, in a BFHI hospital again but she will be advocating and using our infant feeding plan to prevent accidental starvation–

Fed Is Best Infant Feeding Plan

Brooke’s story:


The hospital where he was born was Clara Maas. I cannot name one single staff member who was clearly negligent, I think it was more a case of him slipping through the cracks. The on-staff LC never checked on us after the first day, and I still don’t know exactly who knew what, when or who made which decision. Nevertheless, they allowed an at-risk newborn (37 weeks and Small-for-Gestational-Age) to go home without double-checking that he was safe or providing any special instructions for his care. Personally, I would not deliver another baby there.

Details of the incident have been reported to Clara Maas hospital in a formal complaint, and to the Joint Commission.

Do you need to know how to file a formal complaint to your hospital?  We can help you: Writing Your Hospital



The Religious and Cultural Bases for Breastfeeding Practices Among the Hindus

When Lactivism Kills

The influence of breast surgery, breast appearance, and pregnancy-induced breast changes on lactation sufficiency as measured by infant weight gain.

Some mothers can’t breast-feed There are physical reasons, and yet women get little help from most doctors, researchers

Markers of Lactation Insufficiency: A Study of 34 Mothers

Bust a Myth: Breastfeeding Advocates Need to Stop Using this Statistic!

Biological underpinnings of breastfeeding challenges: the role of genetics, diet, and environment on lactation physiology.

Early exposure to cow’s milk protein is protective against IgE-mediated cow’s milk protein allergy.

Introducing Highly Allergenic Solid Foods

Iron Supplementation in Pregnancy or Infancy and Motor Development: A Randomized Controlled Trial

The limits of intensive feeding: maternal foodwork at the intersections of race, class, and gender.


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

Written by Jody Segrave-Daly, RN, IBCLC

As a veteran NICU, nursery nurse and IBCLC, I have taken care of and fed thousands of babies over the years.  When working in the special care nursery, babies were always fed according to their weight and cumulative losses, to determine their caloric requirements for intake amounts and optimal growth.

That is contrary to a lot of non-clinical discussion you’ll read out there on the internet about an infant’s intake needs, which suggest it’s mostly based on stomach size. So what’s fact and what’s fiction?

Calories and Feeding Amounts for Breast Milk, Formula, and Colostrum

What science tells us is that mature breast milk averages around 20 calories per ounce (~30ml) and formula contains approximately 20 calories per ounce as well. Thus their per-milliliter (mL) calorie count is on average the same. Colostrum, a key substance that imparts passive maternal immunity to a newborn in the first few days of life if a mother breastfeeds, is lower in fat and carbohydrates than those two, and comes in around 17 calories per ounce (~30ml) (Guthrie 1989).

#2 Why Fed is Best- CaloriesColostrum(1)

With that knowledge in mind, current hospital feeding protocols for formula-fed babies range from feeding 10-30 ml for newborns less than 6 pounds’ every 2-3 hours and feeding newborns over 6 pounds 10-30 ml every 3 hours on the first day of life. Continue reading

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Keeping Your Baby Safe by Knowing Normal vs. Abnormal

by Christie del Castillo-Hegyi, M.D., Co-founder of the Fed is Best Foundation

In order to provide mothers and health professional a quick guide to preventing newborn brain injury in the first days of life, the following is a short slideshow on the scientific literature regarding the thresholds that predict newborn brain injury and developmental delay and disability in the first days of life related to insufficient feeding.

All complications of underfeeding, including jaundice, weight loss, hypernatremia, dehydration and hypoglycemia can be prevented with feeding sufficient milk before the complications occur. The scientific literature shows that by the time a child develops abnormal jaundice, hypernatremia or hypoglycemia, the brain injury that follows is irreversible and can result in long-term negative consequences to brain development, even when corrected.

We advise parents and health professionals to be knowledgable about what constitutes safe and unsafe lab values and weight loss so that all newborns can be protected.


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Response to Anna Almendrala’s editorial from Dr. Christie del Castillo-Hegyi, Co-Founder of the Fed is Best Foundation

Your recent article in the Huffington Post titled, “The Scary But Rare Risk Linked to Exclusive Breastfeeding,” is yet another example of the untruthful and unethical promotion of exclusive breastfeeding as an all-benefit, no-risk choice for mothers.  The hiding of the common and dangerous complications of the Baby-Friendly protocol including the risks of starvation from avoiding supplementation is a violation of patient rights and threatens the brains and lives of newborns.

First of all, you identified the Fed is Best Foundation as a “parent-led” non-profit founded to push back against the social pressure to exclusively breastfeed. That is an inaccurate representation of our credentials as the Foundation was founded by an emergency physician, former NIH scientist and a Newborn ICU nurse and IBCLC.  We are also joined by Neonatal Nurse Practitioners, NICU Nurses, Labor & Delivery Nurses, Physicians, Scientists, Public Health Advocates, Attorneys and a Statistician. Furthermore, we were created to speak out against the unsafe and unethical practices of the Baby-Friendly Hospital Initiative and the WHO exclusive breastfeeding guidelines, which has hospitalized more babies on this planet for starvation-related complications than any other policy in the history of public health. We were created to write ethical breastfeeding guidelines that respect the patient rights of mothers to honest information so that she can protect her child. Lastly, we were created to write safe and evidence-based breastfeeding guidelines that don’t endanger children’s lives.

Jaundiced newborns requiring phototherapy in Vietnam

While it is rare for a child to die from dehydration caused by exclusive breastfeeding, it is not rare to experience brain-threatening complications that require hospitalization. The reason why these hospitalizations occur is because mothers are taught that insufficient breast milk is rare and therefore the need for supplementation is rare, which even Dr. Alison Stuebe of the Academy of Breastfeeding Medicine admits in her own editorial is necessary in as many as 1 in 7 babies.  Furthermore, their own jaundice protocol says that 10-18% of U.S. exclusively breastfed newborns experience starvation jaundice from insufficient milk intake, which require extended or repeat hospitalization for phototherapy to prevent or limit brain injury. The scientific literature has shown by the time a child needs phototherapy, they already have markers of brain injury leaking into their blood.  

The latest data on rates of hypoglycemia in healthy, term exclusively breastfed newborns showed that 10% experience levels low enough (<40 mg/dL) to cause long-term cognitive declines by 6 hours of life. The scientific literature has also shown that by the time they reach a glucose of 40 mg/dL, they are also leaking markers of brain injury in the blood. Yet few EBF healthy, term newborns are monitored for hypoglycemia.

In addition, you misquote the Oddie study on hypernatremic dehydration and represent dehydration as rare and when dehydration as defined by weight loss of greater than 10% is actually common, occurring to 14% of newborns in the largest study done to date. In other countries, they have been reported as high as 25%. Lastly, while the rates of laboratory-diagnosed hypernatremic dehydration are reported as rare, the number of exclusively breastfed newborns who experience it are likely to be far greater since EBF newborns do not get blood work unless their starvation is detected. If you don’t look for it, then it appears rare. However, the data on neonatal hypernatremia shows that it occurs as early as 7% weight loss, which happens to half of all exclusively breastfed newborns. This is not surprising since the blood volume of a child is 8.5% of their body weight, a weight loss of > 7% is likely to result in severe dehydration synonymous with hypernatremia.

Sadly, hospitalizations for jaundice primarily caused by underfeeding from the Baby-Friendly protocol are common. In a paper published by a Baby-Friendly Hospital system, they revealed that 5.7-13% of all the babies born required hospitalization for phototherapy. Furthermore 12-20% experienced levels of hyperbilirubinemia that have been associated with multiple developmental and neurological disabilities.

The Baby-Friendly Hospital Initiative is 25 years old. It has no data on safety. Exclusively breastfeeding one’s newborn before having a full milk supply comes with an infinite-fold risk of underfeeding and excessive weight-loss, since recent data shows no supplemented or formula-fed newborn is at risk. It relies on the unproven notion that newborn babies can fast for 3 days without irreversible harm to the brain and vital organs. It operates with no knowledge of the number of calories colostrum can provide nor the true caloric requirements of newborns. Finally, it allows newborn babies to cry out of hunger for hours to days without sleep while withholding supplementation in the faulty belief that the torture of hunger they experience is worth the benefits of breastfeeding.

Landon crying and nursing continuously by the second day of life

So as you see, hospitalizations and complications from the exclusive breastfeeding guidelines are not rare and are in fact the leading causes of newborn hospitalization in the world. So not only are you falsifying that complications are rare in order to convince mothers to trust you with their children, you are hiding them at the risk of causing harm to a child that is severe and irreversible. While every mother is informed of the risks of formula, they are not informed of the risks of starvation; and the risks of starvation far exceed the risks of properly-prepared formula. Sadly, the only rare thing in breastfeeding is honesty in its promotion.

Lies killed Landon Johnson and lies are hospitalizing exclusively breastfed babies every single day.

#babyfriendly #fedisbest

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