Dr. Nicole King Warns About Dangers of Baby-Friendly Hospital Initiative at USDA Dietary Guidelines Meeting

On August 11, 2020, Dr. Nicole King, Anesthesiologist, Critical Care Intensivist, Patient Safety Expert and Senior Advisor to the Fed is Best Foundation spoke at the USDA Scientific Report of the 2020 Dietary Guidelines Advisory Committee meeting warning of the dangers and patient rights violations of the Baby-Friendly Hospital Initiative. Watch her address below.

Good afternoon, my name is Nicole King and I am a mother and a physician.  As an anesthesiologist and intensive care physician, I am faced with life and death circumstances every day.  In no way did I ever consider breastfeeding my child would be as stressful as supporting a COVID patient through their critical illness.  Five years ago, I realized how wrong I was.

As a new mother who had had a breast reduction and a physician, I should have known better, but I did not. I fed into the same propaganda, misinformation and fervor around breastfeeding that has grown over the last 30 years as a result of the Baby-Friendly Hospital Initiative and the WHO’s Ten Steps [to Successful Breastfeeding]. I was not informed of its risks and followed the exclusive breastfeeding guidelines, and as a result, my newborn lost excessive weight and was readmitted for dehydration and jaundice.

The current USDA guidelines are filled with the same soft science riddled by confounding factors, that has led to the shaming of women who are unable to exclusively breastfeed for 6 months. The guidelines are an ableist and elitist narrative and read as an invitation to admonish women for failing to produce enough milk for her child. It blatantly ignores research that clearly shows that delayed lactogenesis of mature milk is common, found in up to 40% of first-time mothers and 22% of all mothers, even those who are motivated to exclusively breastfeed.  Never mind the 15% of women who are incapable of sustaining breastfeeding past the first month, even with lactation support.

If you are ill and in the hospital, nutritionists are there to calculate the calories needed to feed you in order for you to thrive and recover. Why then are we so easily fooled into thinking an infant who is building muscle, fat and brain cells can be sustained on far less than their caloric needs, purported by the Baby-Friendly policy? If the “biological norm” is put forth as a reason to exclusively breastfeed, then why are exclusively breastfed infants being admitted daily for dehydration, jaundice, and hypoglycemia? Why do we continue to insist on a policy that increases the risk of harm to infants while vilifying supplementation that prevents serious complications? Every day, I protect my patients with medications, machines and nutritional alternatives to overcome so many failures of the “biological norm.” I do this because I too am human and understand that we care and love for each other regardless of our ability to live up to a standard of perfection. Yet we allow babies to become seriously ill by pressuring mothers to achieve this standard of perfection that millions cannot safely achieve. If judicious and humane supplementation is the difference between a hospitalized and a safely breastfed child, then we have failed all mothers and infants in this country by disparaging its use.

The USDA draft policy continues to ignore these realities and thus fails to protect countless infants.  National guidelines should never encourage a policy that is directly responsible for the leading cause of rehospitalization of healthy term infants. And most importantly, as a national guideline, it should apply to all mothers, regardless of her ability to breastfeed, across all socioeconomic demographics.

As a mother who followed these guidelines and was led to rehospitalize her own infant, I beg you to consider the plight of all mothers and infants in this country. Every infant deserves to be protected from hospitalization and the complications of an exclusive breastfeeding policy.   And their mothers deserve to know that breast milk is but one way to best nourish their children.  The USDA is responsible for every child in the US and their policy should reflect this responsibility.


Dr. Nicole King, M.D. is a patient safety expert and Senior Advisor of the Fed is Best Foundation. She is a board-certified anesthesiologist and critical care intensivist.

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I See Myself in Other Mother’s Eyes: A Neonatologist’s Fed is Best Story

 by dr. Jessica Madden, M.D., Neonatologist

My oldest daughter, Grace, was born when I was 28 years old. She was our long-awaited first child, the one who I had postponed having for many years so that I could get through a good chunk of my medical training before becoming a mom.  I felt like I was prepared as much as one could possibly be to take care of and breastfeed a newborn.  I had spent years babysitting my siblings and neighbors and had over two years of intense pediatric/neonatal training under my belt. I had read every single “What to Expect” type of book, joined multiple online breastfeeding forums to learn from experienced mothers beforehand, and took all of the prenatal classes at the hospital where I delivered. I knew that breastfeeding was going to be difficult and exhausting at times, and that it might take several weeks for my baby and me to get into a “groove” with it, but I was ready to dive in headfirst.

“In my work as a neonatologist I have taken care of countless babies around the U.S. who have had to be admitted to the neonatal intensive care unit (NICU) for breastfeeding failures. The most common breastfeeding problems I encounter requiring hospital admissions are dehydration, hypernatremia (high sodium levels), hypoglycemia (low glucose levels), and jaundice (patients often have some combination of these 4 diagnoses).” Continue reading
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Breastfeeding, Supplemental feeding, Formula-Feeding, Fed is Best

Letter to Doctors and Parents About the Dangers of Insufficient Exclusive Breastfeeding

  (En español)

Dear Colleague and Parent:

My name is Christie del Castillo-Hegyi and I am an emergency physician, former NIH scientist, with a background in newborn brain injury research at Brown University, and mother to a 6-year-old child who is neurologically disabled. I am writing to you because my child fell victim to newborn jaundice, hypoglycemia and severe dehydration due to insufficient milk intake from exclusive breastfeeding in the first days of life. As an expectant mom, I read all the guidelines on breastfeeding my first-born child. Unfortunately, following the guidelines and our pediatrician’s advice resulted in my child going 4 days with absolutely no milk intake requiring ICU care. He was subsequently diagnosed with multiple neurodevelopmental disabilities.  Being a physician and scientist, I sought out peer-reviewed journals to explain why this happened. I found that there is ample evidence showing the links between neonatal jaundice, dehydration, hypoglycemia, and developmental disabilities. I wish to explain to you how I believe this could apply to my son and the many children whose care you are entrusted with. Continue reading

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