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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Baby-Friendly USA Acknowledges Their Mistakes; Are They Going To Make Real Changes In The New Year Or Are They Providing Lip Service To Mothers?

Dear BFUSA,

Thank you for your long-overdue public acknowledgment endorsing what the Fed Is Best Foundation has been fiercely advocating for over the past 3 years. 

According to your recent blog post you now agree with us that:

1. Delayed onset of copious milk production is common. 

BFUSA: “Delayed lactogenesis is actually increasingly common because the risk factors for it are potentially increasing,” Dr. Rosen-Carole says. “When a baby is born into that situation, the goal is to closely monitor what the baby is doing, instead of giving a bottle right away. “If the baby is hungry and they’re not getting enough milk out of the mother’s breast, then they need to be supplemented,” she says. 

FIBF: We have been passionately educating parents about safe breastfeeding since the beginning of our advocacy over 3 years ago with the current scientific studies that have confirmed over and over again that delayed onset of milk production and low milk supply are common.  We question why it took you so long to acknowledge this deadly and 100% preventable consequence of insufficient breastfeeding? Does this mean you will ban the belly bead stomach models that do not reflect the current science?

Will you please apologize to the thousands of mothers who bravely told their stories of accidental starvation?  You have previously tried to discredit their stories, called them “‘anxiety-provoking,” and characterized our foundation as BFHI detractors— simply because we offer a social media platform for mothers to be heard by you. Have you ever heard a mother break down and scream in horror when she learned her baby was starving to death because she followed your breastfeeding education and protocol?  We have—over and over again, and it is the most haunting sound. It’s what drives us to fiercely advocate for safe breastfeeding because no other health organization is doing so.

BFUSA: Dr. Bobbi Philipp agrees. “If you see signs that the mother’s milk is insufficient, you need to feed the baby,” she says. “And if the mother is really committed to breastfeeding, you’ve got to bridge the gap in a way that you support her, feed the baby, and don’t undermine the breastfeeding. It’s that simple.”

FIBF: Now that you are acknowledging delayed onset of milk is common, something that we have been passionately writing and speaking about for years, we expect that you will stop calling us “fibbers.” Name-calling is what a child having a temper tantrum does, not what a professional organization should do; the appropriate response to being called out and held accountably, is to take responsibility and revise your guidelines based on current research and patient feedback. Continue reading

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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!

 

 

 

 

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Baby-Friendly: Failure and the Art of Misdirection

By Alex Fischer, PhD Candidate, Brooke Orosz, PhD, Jody Segrave-Daly, RN, IBCLC and Christie Del Castillo-Hegyi, M.D.

Any good magician will tell you that the secret to their trade is misdirection—making the audience look one way while doing something the other way. And even knowing this, most of us are still baffled by a magician’s tricks. So it’s no wonder that Baby-Friendly USA (BFUSA) has tried to employ that same tactic in their statement titled “Fact vs FIB: The Impact of Baby-Friendly on Breastfeeding Initiation Rates.”  In this statement written by an anonymous author representing BFUSA, they attempt to dispute the findings of a recent study published in Journal of Pediatrics, “Outcomes from the Centers for Disease Control and Prevention 2018 Breastfeeding Report Card: Public Policy Implications” by Bass et al. This study examines the impact of statewide breastfeeding initiation rates as well as the impact of BFHI facilities on continued breastfeeding after hospital discharge (exclusive or combination). The Fed is Best Foundation read this study and agreed: “Baby-Friendly does not work.” These five words are the instigators of the entire statement by BFUSA and its misrepresentation of a very robust scientific study.  Continue reading

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U.S. Study Shows Baby-Friendly Hospital Initiative Does Not Work

by Christie del Castillo-Hegyi, M.D.

On October 14, 2019, the Journal of Pediatrics published astonishing findings regarding the effects of the Baby-Friendly hospital certification on sustained breastfeeding rates as defined by the 2020 Healthy People Goals of: 

  1. any breastfeeding at 6 and 12 months
  2. exclusive breastfeeding at 3 and 6 months. 

They did so by measuring the relationship between statewide breastfeeding initiation rates data and the above breastfeeding rates. They then measured the contribution of Baby-Friendly hospital designation on these same breastfeeding outcomes.

According to the study authors, the increase in hospital designation in the Baby-Friendly Hospital Initiative (BFHI) began in 2011 when the U.S. Surgeon General issued a call to action for maternity care practices throughout the U.S. to support breastfeeding. The Centers for Disease Control (CDC) became involved in promoting the BFHI policies in hospitals and health facilities, as breastfeeding was thought to be associated with lower rates of childhood obesity. The assumption was that by increasing breastfeeding rates through the BFHI, there would be a concomitant decline in childhood obesity. Upon initiation of this program, the CDC initiated surveillance of state-specific data on breastfeeding outcomes after discharge including BFHI designation rates. This data is made available to the public through the CDC Breastfeeding Report Card, which provides annual reports from 2007 through 2014 and biennial reports from 2014.

As expected, they found that states with higher breastfeeding initiation rates had higher rates of these sustained breastfeeding outcomes. You cannot have high breastfeeding rates unless mothers are given education and successfully initiate breastfeeding. However, when they measured the effects of Baby-Friendly certification, this is what they found.

“Baby-Friendly designation did not demonstrate a significant association with any post-discharge breastfeeding outcome (Figures 1, B and 2, B). There was no association between Baby-Friendly designation and breastfeeding initiation rates.” Continue reading

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National Women’s Health Advocate Describes How A Baby-Friendly Hospital Starved Her Baby

Sarah Christopherson is a mother and the Policy Advocacy Director at the National Women’s Health Network, a non-profit advocacy organization in Washington, D.C. She talks about her breastfeeding experiences and her recent experience in a Baby-Friendly hospital where her child became severely dehydrated and lost 15% of her birth weight while in the hospital. She discusses how policies can negatively affect patient health and how systemic change is needed to support positive patient health outcomes and prevent patient coercion.

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Two Physicians Describe How Their Baby-Friendly Hospital Put Their Newborn in Danger

John and Kristen are both surgical residents who recently had their first child. This is their story.

By John and Kristen Waters

Let me start by saying we are one of the lucky ones. Our first-born was born at term on July 25th, 2019 at 9:43 p.m., a healthy 7 lb, and 10oz. My wife – a general surgery resident – was planning on beginning to breastfeed right after birth. My wife had undergone a bilateral breast reduction about 15 years ago, so issues with breastfeeding were on our radar. Immediately after birth, we were taken from the delivery room to the postpartum unit, where at 2 a.m. my wife and I were given a pile of paperwork and instructions on breastfeeding practices. All the while both of us were seeing double from the long day and night of laboring and delivery.

Over the course of the next 12-24 hours, our baby attempted to latch and breastfeed, continuing to have issues with falling asleep while on the breast. We spoke with a lactation consultant and multiple nurses who stated that things were going fine and that everything was normal. Over this time the rate of wet diapers continued to decrease and our baby did not have a bowel movement.

As we got into our second night of life, our child began to cry hysterically.

Continue reading

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We Were Awarded A Malpractice Financial Settlement Because My Baby Suffered From Starvation In A BFHI Hospital

By A Mother from the Fed is Best Community who wishes to remain anonymous

This is my baby girl in NICU. She developed a high fever, jaundice, and dehydration with a 10.1% weight loss 56 hours after birth while exclusively breastfeeding in a ‘Baby-Friendly’ hospital.

During our stay, the hospital pediatrician saw my baby twice a day but he failed to inform us she had a 7.2% weight loss in the 30th hour of life. Hence, we were not given the information to decide if we should supplement with formula.

According to a review published in the Journal Of Family Practice in June 2018, “exclusive breastfeeding at discharge from the hospital is likely the single greatest risk factor for hospital readmission in newborns. Term infants who are exclusively breastfed are more likely to be hospitalized compared to formula-fed or mixed-fed infants, due to hyperbilirubinemia, dehydration, hypernatremia, and weight loss.” They estimated that for every 71 infants that are exclusively breastfed, one is hospitalized for serious feeding complications.

She was always furiously latching and my nipples were cracked and bleeding from constant nursing. She became very sleepy and now I know she was lethargic. Naively, I continued to breastfeed as instructed, and we told everything was fine until she developed a high fever just before discharging. They suspected bacterial infection and my poor baby endured a spinal tap, blood tests, IV glucose, and prophylactic IV antibiotics while waiting for results to come back. There was a very concerned NICU nurse that told me it’s time someone questions the strict exclusive breastfeeding practices of the BFHI. She was the one that told me to look at the weight loss when I was shocked and confused wondering how on earth my little girl caught a bacterial infection. Continue reading

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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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What Have We Done To Support Breastfeeding Parents When “Breast Is Best” Support Is Letting Them Down?

By Jody Segrave-Daly, MS, RN, IBCLC

We. listened. to. them.

We validated their stories and offered them compassionate and judgment-free support. We didn’t blame them when they were struggling with their breastfeeding journey.  Instead, we apologized for what happened and found a way to help parents breastfeed/chest-feed their babies safely, with confidence and with love. We helped them heal in a safe place while lactivist zealots vehemently judged them and blamed them for not having the right breastfeeding support, the right breastfeeding education, the right nurse, doctor, LC, or hospital. They even blamed mothers for not recognizing HUNGRY signs when their babies were starving while under the trusted care of lactation professionals.

Today begins World Breastfeeding Week 2019.

 I want to bring awareness to what we do every day to support breastfeeding parents successfully at the Fed Is Best Foundation. Our goal is to bring awareness to lactation professionals to inform them of what parents are telling us they need to successfully breastfeed because they tell us no one is listening to them. Continue reading

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