Fed is Best Foundations Statement to USDA Healthy People Goals 2030

Christie del Castillo-Hegyi, M.D.

From December 2018 to January 2019, the Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 published the proposed Healthy People 2030 Objectives for public comment. Of note, the proposed Healthy People 2030 objectives saw a marked change from the 2020 objectives, namely a reduction of the breastfeeding objectives from 8 goals to one, namely, “Increase the proportion of infants who are breastfed exclusively through 6 months” (MICH-2030-15 ). Among the objectives that were dropped from the list were:

  1. MICH-23 – Reduce the proportion of breastfed newborns who receive formula supplementation within the first 2 days of life.
  2. MICH-24 – Increase the proportion of live births that occur in facilities that provide recommended care (i.e. Baby-Friendly Hospital Initiative-certified hospitals) for lactating mothers and their babies.
Healthy People 2020 ObjectivesBaseline (%)Target (%)
Increase the proportion of infants who are breastfed (MICH 21)
Ever74.081.9
At 6 months43.560.6
At 1 year22.734.1
Exclusively through 3 months33.646.2
Exclusively through 6 months14.125.5
Increase the proportion of employers that have worksite lactation support programs (MICH 22)2538
Reduce the proportion of breastfed newborns who receive formula supplementation within the first 2 days of life (MICH 23)24.214.2
Increase the proportion of live births that occur in facilities that provide recommended care for lactating mothers and their babies (MICH 24)2.98.1
We applaud the removal of the last two objectives as patient safety issues have emerged from those two objectives, namely increased rates of neonatal jaundice, weight loss, hypoglycemia and dehydration readmissions. We have submitted the following statement regarding the Healthy People Goals for 2030 requesting for a revision of the current proposed objective and the addition of two new objectives.

Exclusive breastfeeding at discharge is a major risk factor for severe jaundice and dehydration. Both conditions can require in-hospital treatment and can result in permanently impaired brain development. Photo Credit: Cerebral Palsy Law

 

Revision of MICH-2030-15 calling for “Increase in the proportion of infants who are exclusively breastfed from birth to 6 months” to the following:

Increase the proportion of infants who are primarily breastfed through 4-6 months who have received sufficient nutrition to ensure optimal growth and brain development and to prevent feeding complications (e.g. hyperbilirubinemia, hypernatremia, dehydration, excessive weight loss, hypoglycemia and failure-to-thrive).

We have requested the following additions to the 2030 Healthy People Goals:

New Proposed Objective #1: Reduce the proportion of infants who require treatment and/or extended or repeat hospital admission for insufficient feeding-related hyperbilirubinemia, hypernatremia, dehydration, excessive weight loss, hypoglycemia and failure-to-thrive.

New Proposed Objective #2: Increase the proportion of parents who have made the informed choice to partially- or exclusively-feed formula to provide safe and sufficient nutrition to their infants to prevent feeding complications (e.g. hyperbilirubinemia, hypernatremia, dehydration, excessive weight loss, hypoglycemia and failure-to-thrive) and optimize growth and brain development.

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Breast Milk Production in the First Month after Birth of Term Infants

by Christie del Castillo-Hegyi, M.D.

One of the most important duties of the medical profession is to make health recommendations to the public based on verifiable and solid evidence that their recommendations are safe and improve the health of nearly every patient, most especially if the recommendations apply to vulnerable newborns.  In order to do this, major health recommendations require extensive research regarding the safety of the real-life application of the recommendation at the minimum.

Multiple health organizations recommend exclusive breastfeeding from birth to 6 months as the ideal form of feeding for all babies under the belief that all but a rare mother can exclusively breastfeed during that time frame without underfeeding or causing fasting or starvation physiology in their baby. In order to suggest that exclusive breastfeeding is ideal for all, if not the majority of babies, one would expect the health organizations to have researched and confirmed that all but a rare mother in fact produce sufficient milk to meet the caloric and fluid requirements of the babies every single day of the 6 months without causing harmful fasting conditions or starvation. There have been few studies on the true daily production of breast milk in breastfeeding mothers.  Only two small studies quantified the daily production of exclusively breastfeeding mothers including a study published in 1984, which measured the milk production of 9 mothers, and one in 1988, which measured it in 12 mothers.  After extensive review of the scientific literature, it appears the evidence that it is rare for a mother to to not be able to produce enough breast milk to exclusively breastfeed for 6 months is no where to be found. In fact the scientific literature has found quite the opposite.

In November 2016, the largest quantitative study of breast milk production in the first 4 week after birth of term infants was published in the journal Nutrients by human milk scientists, Dr. Jacqueline Kent, Dr. Hazel Gardner and Dr. Donna Geddes from the University of Western Australia. They recruited a convenience sample of 116 breastfeeding mothers with and without breastfeeding problems who agreed to do 24 hour milk measurements through weighed and pumped feedings between days 6 and 28 after birth and were loaned accurate clinical-grade digital scales to measure their milk production at home. The participants test weighed their own infants before and after breastfeeding or supplementary feeds and recorded the amounts of breast milk expressed (1 mL = 1 gram). All breast milk transferred to the baby, all breast milk expressed and all supplementary volumes were recorded as well as the duration of each feed.

These were the results…

13 mothers perceived no breastfeeding problems while 103 mothers perceived breastfeeding problems.  The most common problem was insufficient milk supply (59 mothers) followed by pain (11 mothers),  and positioning/attachment (10 participants).  75 mothers with reported breastfeeding problems were supplementing with expressed breast milk and/or infant formula.

Of the mothers with reported breastfeeding problems, their average weighed feeding volumes were statistically lower than the mothers who did not report breastfeeding problems with an average feed volume of 30 mL vs. 63 mL in the mothers who reported no breastfeeding problems (p<0.001).  The daily total volume of breast milk they were able to transfer (or feed directly through breastfeeding) were also statistically lower than those who did not report breastfeeding problems. The moms without breastfeeding problems transferred an average of 693 mL/day while those that reported breastfeeding problems transferred an average of 399 mL/day (p<0.001).  The study defined 440 mL of breast milk a day as the minimum required to safely exclusively breastfeed. This is the amount of breast milk that, on average, would be just enough to meet the daily caloric requirement of a 3 kg newborn (at 70 Cal/dL and 100 Cal/kg/day). Babies of mothers with no reported breastfeeding problems were statistically fed more milk than those with breastfeeding problems, 699 mL vs. 567 mL per day (p = 0.007). All 13 mothers who perceived no breastfeeding problems produced and transferred more than the study’s 440 mL cut-off as the volume required to be able to exclusively breastfeed.  What this data shows is that a mother’s perception of breastfeeding problems is associated with actual insufficient volume of breast milk fed to her child.

Based on the 440 mL cut-off for “sufficient” breast milk production, some mothers who report their babies not getting enough in fact produced more than 440 mL.  However, since 440 mL is the amount of milk that is needed to meet the minimum caloric requirement of a 3 kg newborn, if the mother had a newborn weighing > 3 kg as they would expect to be past the first days of life if growing appropriately, many of the mothers reporting breastfeeding problems may be producing more than 440 mL but are still in fact producing less than the amount to keep their child satisfied and fed enough to grow.  A supply of 440 mL would actually be just enough milk to cause a 3 kg newborn to be diagnosed to fail to thrive at 1 month since they would not gain any weight if fed this volume of milk. Failure to thrive has known long-term consequences including lower IQ at 8 years of age.  So their conclusion that some mother’s perception of insufficient breast milk may in fact be inaccurate as a volume of 440 mL is in fact “not enough” for most newborns weighing > 3 kg.

The figure below shows the daily production of breast milk by breastfeeding mothers over the 4 week course. The crosses showed the total breast milk production of mothers without reported breastfeeding problems and the dots reflected the mothers with reported breastfeeding problems. Unfortunately, the figure did not distinguish whether the reported problems were due to poor positioning and attachment or pain while breastfeeding versus breast milk supply. The study found that 2/3rd of mothers in this study did not produce the minimum milk 440 mL they defined to exclusively breastfeed safely between days 11 and 13 of life.  Between days 14 and 28 of life, 1/3rd of mothers did not produce the minimum 440 mL. While the study population were disproportionately made up of mothers who reported breastfeeding problems, the study suggests that there is actual association between “perceived” breastfeeding problems and actual problems with milk supply.

As it stands, the number of women who report breastfeeding problems due to insufficient milk supply is much larger than what mothers are taught through their breastfeeding education sources.  According to a review of the peer-reviewed literature by Human Milk Scientist Dr. Shannon Kelleher, Ph.D., the number of mothers who have insufficient breast milk supply may be much larger that what is commonly taught.  Currently, it is the most common reason reported by mothers who do not exclusively breastfeed for the first 6 months of life.  The Infant Feeding Practices Study II (IFPS II) was drawn from 500,000 households in the United States. Approximately 4,900 pregnant women ages 18 and above participated, and of those, 2,000 received questionnaires throughout the first year of their infant’s life between May 2005-2006 (Li et al, Pediatrics 2008).

  • Although 75% of new mothers intend to breastfeed, not all women are able to breastfeed their infants exclusively for the first 6 months of life, as recommended by the American Academy of Pediatrics and the World Health Organization;
  • It is estimated that the prevalence of women who overtly fail to produce enough milk may be as high as 10–15%  and can quickly lead to hypernatremia (high blood sodium levels)  nutritional deficiencies, or failure to thrive;
  • The prevalence of lactation “insufficiency” may be much higher, as 40–50% of women in the US and 60–90% of women internationally cite “not producing enough milk” or that their baby was “not satisfied with breast milk” as the primary reasons for weaning prior to 6 months.

It is therefore important to do objective measurements of breast milk supply through 24 hour diaries of test weighing as well as supplemented and pumped breast milk volumes as well as routine weighing of breastfed babies to prevent newborn starvation and failure to thrive.  A mother showing concerns that her child is not receiving enough should receive more than reassurance and encouragement and should receive objective testing to measure her child’s actual daily intake and daily growth in order to protect the brain and vital organs.

Discussion

What this means is if a mother says her breast milk supply is not enough, she is likely correct.  She may be able to get additional milk through pumping but for many mothers in the first month of life, supplementation will likely be necessary to keep her child from going hungry and experiencing fasting conditions. Babies who receive too little milk can experience starvation-related complications including injury to the brain and vital organs.  If you are a breastfeeding mother who is worried about your child not getting enough though breastfeeding, both your baby and your breastfeeding need evaluation by a pediatrician and a qualified breastfeeding professional.

Because of the belief that need for supplementation is rare, breastfeeding advocacy organizations as recently as this month have restated their recommendation that health professionals should aim to avoid supplementation unless a child is experiencing true metabolic complications associated with underfeeding and starvation as defined by their supplementation guidelines.  It is not sufficient for a child to be showing obvious signs of hunger like crying or hours of nursing to be offered supplementation while they are losing weight and receiving a fraction of their caloric and fluid requirement.

The studies typically included few mothers and others did not actually quantify the volume of milk produced and actually fed (or transferred) to the baby.  The remaining studies on breast milk sufficiency only reported on “perceived” milk insufficiency, which much of the literature dismisses are related to poor confidence, misinterpretation of baby’s crying and are largely viewed as inaccurate and not an actual measure of true milk sufficiency.


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

  1. Join the Fed is Best Volunteer group to help us reach Obstetric Health Providers to advocate for counseling of new mothers on the importance of safe infant feeding.
  2. 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.
  3. 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 resources to expectant moms that you know. Share the Fed is Best campaign letter with everyone you know.
  4. Write a letter to your health providers and hospitals about the Fed is Best Foundation. Write them about feeding complications your child may have experienced.
  5. Print out our letter to obstetric providers and mail them to your local obstetricians, midwives, family practitioners who provide obstetric care and hospitals.
  6. Write your local elected officials about what is happening to newborn babies in hospitals and ask for 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.
  7. Send us your stories. Share with us your successes, your struggles and every thing 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.

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.

Donate to Fed is Best

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I Chose to Formula Feed and I Don’t Owe Anyone An Explanation

By Alix Dolstra

I never realised there was a war between breastfeeders and formula feeders until I became pregnant and suddenly my breasts became everyone’s business. I found this rather odd as, outside of pregnancy, it’s usually seen as a form of harassment when others start commenting on your breasts, but I digress.

Very quickly after the “congratulations” came the “will you be breastfeeding?” I very openly admitted that I’d be formula feeding, unaware that I had metaphorically stepped in dog poo and wiped it on the clean carpets in the eyes of shocked onlookers. Apparently, I’d said the wrong thing. I couldn’t understand why, and that’s because I hadn’t actually said anything wrong in the first place.

I planned on formula feeding. I have absolutely no interest in breastfeeding. I support breastfeeding but I won’t do it myself. It has always been that way and I don’t feel like I owe an explanation. Though, quite often, I’d found myself being asked very personal and confronting questions about my body.

It made me feel… invalid — like somehow I owed it to them to have my personal space invaded.

When my brothers and I were children in the 90s, my mother formula fed us, while our neighbour breastfed her children. There was never an argument. We’d visit each other and it was normal. Some of us breastfed and some of us didn’t and that was okay. It was all the same to me. The babies were fed and happy. Breastfeeding was normal and so was formula feeding and that was the harmony in my mind when it came to my decision. It was quite a shock to find that it was a different world for me when I got pregnant.

Very quickly you learn that you are no longer seen as a human being with feelings and preferences. You’re an incubator that must meet societies ever-changing, sanctimonious expectations and you can never please everyone because there’s always someone who will strongly oppose and shame you. Through reading, I found that even if I had chosen to breastfeed, I would likely have been shamed and labelled a harlot for breastfeeding in public. You simply can’t win… at least, you can’t win if you’re always trying to please others. In reality, whatever choice you make, you’re likely winning as long as you’re not feeding your newborn soft-drink and coffee.

While I was buying the bottles, the steriliser and the prep machine and lovingly creating a “formula station” in the kitchen and neatly lining up the tin of formula until everything looked picture perfect, I was being compared to a drunk-driver because “feeding rat-poison formula to your baby is as irresponsible as driving drunk because you’ll ruin their lives”. That was a real thing someone had said to me.

I’d also had my mental health questioned, told that I was being lazy, that my child would be dumber in school and fall behind, that she’d be sick all the time and it’d be all my fault for not “loving her enough”.

Pregnancy wasn’t fun. I had Hyperemesis Gravidarum and pregnancy was just one, big argument over what I should do with my boobs. I never swayed as I knew that I was doing the right thing for my family.

People that know me may know that I am scared of needles. I don’t like them. I had a drug-free birth and avoided that monstrous-looking needle that was the epidural. I simply do not like needles. I shudder at the thought. When my daughter was born she came out with her arm as well as her head and I needed A LOT of needles before getting stitches. That is the last thing I wanted when I was already pretty sore.

The midwife had taken my husband out, helped him make a bottle (bless supportive hospitals!) and guided him back to the birthing suite to give our daughter her first feed. One of the most precious first memories I have of my daughter was watching her from the chaos that was my bed, all bundled up in the arms of her loving father, he cried tears of joy as he fed her her first bottle and gently greeted her between sobs. It was so precious and it took my mind completely off the mess I was in. Every time he fed her, that memory was there and brought me joy. That he could look after her in times when I would be unable to was very reassuring and he’s been a fantastic father for it. We do things 50/50, even feeds. We slept in shifts and both of us, though still exhausted, were rested enough.

Formula feeding, for us, really connected us all as a family unit. No one felt pushed out. Not everything was dumped on me like society had expected it to. We were a team from the very start and that was important for us.

Everyone tries to scare you and tell you that you won’t connect with the baby and if you claim that you did connect and bond, they’ll claim that it wasn’t as much as they did with their babies but that always sounded weird and competitive. How would they even know? We lovingly made our daughter a bottle and talked to her, sang to her and adored her little features, blown away that we made the most perfect baby in all the world. To us, she was our treasure and we treasured those times. We’d hover over her as she slept, whispering to each other about her cute expressions and wondered who she’s going to be when she grew up. Every time she looked at us and smiled and laughed, our hearts melted. She would do this cute little dance whenever she could hear the prep machine making her a bottle and it was part of our routine. All of it.

That bond that others threatened we’d never have? We had it. It’s no competition and it’s not up for speculation or debate.

She was also rarely sick, slept well, very smart and ahead in her age group. All the things that I was told would happen didn’t happen. I honestly wasn’t surprised.

I’d always strongly believed that genetics and environment played a big part in the overall outcome of our children’s development and reading the article, The Case Against Breastfeeding by The Atlantic, I learned that a lot of what I’d been told wasn’t entirely accurate at all and it was all based off groups who made a profession out of making mothers guilty. I felt even more relaxed in my decision and I’m going to be formula feeding my next baby from the start as well.

To me, it does not matter whether you breastfeed, formula feed or tube feed. We are all doing a spectacular job and if we can just leave the sanctimonious tripe at the door, and stop trying to outdo each other, I’m sure we’d have a more powerful village of mums supporting mums.

Fed is best, always!

—Alix Dolstra, Australia


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 the Fed is Best Volunteer group to help us reach Obstetric Health Providers to advocate for counseling of new mothers on the importance of safe infant feeding.
  2. 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 the cost of creating and publishing educational material. All the work of the Foundation is achieved via the pro bono and volunteer work of its supporters.
  3. 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 resources to expectant moms that you know. Share the Fed is Best campaign letter with everyone you know.
  4. Write a letter to your health providers and hospitals about the Fed is Best Foundation. Write them about feeding complications your child may have experienced.
  5. Print out our letter to obstetric providers and mail them to your local obstetricians, midwives, family practitioners who provide obstetric care and hospitals.
  6. Write your local elected officials about what is happening to newborn babies in hospitals and ask for 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.
  7. Send us your stories. Share with us your successes, your struggles and every thing 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.
  8. 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.

Donate to Fed is Best

Thank you so much from the Founders of the Fed is Best Foundation!

 

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Please Support Fed is Best on #GivingTueday!

We are making preparations for #GivingTuesday! This year, Facebook and Paypal are joining to match up to $7 million of donations made to non-profit organizations through Facebook. Please consider logging on to our Facebook page at midnight on November 27, 2018 to make your donation to Fed is Best. Put it on your calendar!

Donate to Fed is Best

This year, we are extending our campaign to hospitals and health officials. We have developed our information for hospitals page on the Fed is Best website and are developing our Fed is Best Foundation hospital guidelines for Safe Infant Feeding. We also plan to send our health professional advocates to Washington, D.C. to raise awareness on the safety issues that insufficiently fed newborns face on a daily basis.

Please help us in our mission. For those who would like to donate today or on a monthly basis, please consider going to our new donation page.

Thank you to all our supporters! #FedisBest

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Fed is Best Foundation Response to U.S. Delegation Actions at the World Health Assembly

Jody Segrave-Daly, RN, IBCLC and Christie del Castillo-Hegyi, M.D.

The Fed is Best Foundation is dedicated to ensuring safe infant feeding for every single child, a goal that can be achieved with exclusive breastfeeding, combination feeding, exclusive formula feeding and tube-feeding. We have no political affiliation. We support all mothers to help their infant thrive with safe, sufficient and sustainable feeding in order to protect their health and optimize brain development. Recent news has broken about the U.S. delegation at the 71st World Health Assembly opposing the first draft of the Infant and Young Child Feeding resolution. We have provided a line-by-line break down of the first draft of the resolution, which was set to be proposed by delegates from Ecuador, as well as the proposed draft submitted by the U.S. delegation along with our interpretation of the lines that the U.S. delegates opposed.

In an editorial published in the New York Post, two pediatricians, Dr. Alma Golden and Dr. Brett Giroir,  who were key members of the U.S. delegation attending the 71st World Health Assembly, wrote about the rationale for the U.S. opposition of the first draft:

As pediatricians, US representatives at this year’s World Health Assembly in Geneva and supporters of breastfeeding throughout our professional careers, we were shocked to read recent headlines, in the New York Times and elsewhere, claiming that the administration has somehow called into question the importance of breastfeeding for infants.

The administration fully endorses breastfeeding, and the agencies where we work — Health and Human Services and USAID — communicate this unequivocally…We don’t just affirm these priorities in formal conference rooms in Geneva. For years, the US government…has invested millions of dollars to promote breastfeeding both at home and abroad.

All of which is to say: Breastfeeding wasn’t in dispute in Geneva. Rather, we raised objections to an early draft of the resolution we eventually supported, which made references to a controversial 2016 guidance document. The underlying policy goal of this guidance is unsupported by US nutrition guidelines and inconsistent with the practice of most families in our country…

In particular, the guidance recommends that countries impose stringent new regulations on the marketing of any commercially produced foods suggested for children between 6 months and 3 years old. Such restrictions, in our view, prevent parents from having access to all the factual information they might need. The guidance even advocates for the prohibition of free samples of formula — including in countries and conflict zones where supplies of formula could help save babies’ lives.

Most important, there are good and valid reasons, both medical and personal, why some mothers cannot breastfeed, or choose not to breastfeed exclusively. This is particularly true in situations where displacement, other trauma or malnutrition have made it impossible for mothers to breastfeed their children, and these babies’ lives are at risk without formula or other nutritional supplementation. Parents in these dire situations need all the information and choices available.

The issue of child malnutrition occurring in war torn countries has been reported on by CNN reporter Gayle Lemmon in her article, “Don’t make babies rely on breast milk in war zones,” where she interviewed members of Doctors Without Borders who reported taking care of many infants suffering from severe malnutrition as a result of the strict restrictions of the World Health Organization and UNICEF on formula donations.

‘Over the past couple of weeks we’ve seen an increase in the number of malnourished children needing treatment,” Doctors Without Borders’ Iraq country director Manuel Lannaud said in an interview released on the group’s Web site.

The surprising thing is that Lannaud and his colleagues at the humanitarian aid group didn’t place the blame for these underfed little ones just on war and the fact that the city was under siege. They also put the blame on other international organizations and policies that seek to do good.

“It isn’t a problem of access to food. The malnutrition we see here is primarily due to the scarcity of infant formula,” Lannaud wrote. “International organizations like UNICEF and the World Health Organization (WHO) promote breastfeeding … and provide infant formula, but only by prescription. We believe that distributing infant formula in a conflict situation like Iraq is the only way to avoid children having to be hospitalized for malnutrition.”

Doctors Without Borders says it agrees that breastfeeding promotion is a priority, but one that comes after dealing with the immediate crisis of a baby’s survival. Says Lannaud, if mothers “need formula, we give it to them.”

The mothers who need it are those facing down life-and-death situations each day, often while caring for multiple children in the shadow of war. That giving infant formula to them is so controversial speaks to a policy tripwire few outside the humanitarian realm even know exists: global “breastfeeding first” policies.

The WHO breastfeeding policies are not without flaws and aggressive promotion of exclusive breastfeeding has resulted in harm, namely an epidemic of newborn hospitalizations for jaundice, dehydration and hypoglycemia, known causes of brain injury and developmental disability, in the U.S. and across the globe. In addition, there has been a rise in accidental suffocation of newborns, called Sudden Unexpected Postnatal Collapse, from prone positioning during to skin-to-skin care and breastfeeding, made worse by maternal exhaustion from 24/7 rooming-in, practices encouraged but the WHO Ten Steps and by Baby-Friendly policies. The promotion of exclusive breastfeeding from birth has contributed to an epidemic of neonatal jaundice in the developed and developing world, which has contributed to an epidemic of perinatal brain injury and cerebral palsy particularly in the developing world, where few health care resources are available to monitor and treat exclusive breastfeeding complications. Promoting exclusive breastfeeding from birth over the local, traditional practices of supplemented breastfeeding (with wet nursing, animal milk or sugar water) until the onset of copious milk production has discouraged a practice that breastfeeding mothers used to prevent hunger and starvation-related complications like jaundice, dehydration and hypoglycemia, which now are the leading causes of newborn rehospitalization in the world.

Incidence of severe neonatal jaundice (bilirubin ≥ 20 mg/dL) in Low- and Middle-Income countries. The data reported correspond to hospital statistics. [Greco, et al, Neonatology 2016;110:172-180]

Continue reading

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Moms Thank The Fed Is Best Foundation For Safe Infant Feeding Support

Every day we hear stories from parents who were able to feed their babies safely and confidently with our help.  These stories are the fuel that fills our hearts and motivates our volunteers and advocates to continue our important work to teach parents and healthcare providers about safe infant feeding, and giving babies what they need to thrive and have the best possible start.

#fedisbest #safebreastfeeding #thrivingisbest  #fedismaximum

Read on for their words of thanks and encouragement:

Do you have a #fedisbest story? We’d love to hear from you. Send us your stories.

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

  1. Join the Fed is Best Volunteer group to help us reach Obstetric Health Providers
  2. Make a donation to the Fed is Best Foundation.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.
  3. 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 resources to expectant moms that you know. Share the Fed is Best campaign letter with everyone you know.
  4. Write a letter to your health providers and hospitals about the Fed is Best Foundation. Write them about feeding complications your child may have experienced.
  5. Print out our letter to obstetric providers and mail them to your local obstetricians, midwives, family practitioners who provide obstetric care and hospitals.
  6. Write your local elected officials about what is happening to newborn babies in hospitals and ask for 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.
  7. Send us your stories. Share with us your successes, your struggles and every thing 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.
  8. 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.
  9. Shop and Fed is Best Foundation will earn cash back! We hope to develop our online safe infant feeding classes with these funds.
  10. If you need support, we have a private support group – Join

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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Fear NOT Facts Contained in Baby-Friendly Formula Feeding Waiver Forms

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

The primary reason why newborns experience starvation-related complications every single day as a result of the Baby-Friendly protocol is because the complications associated with the protocol are hidden from mothers who seek to breastfeed.  The primary objective of the Baby-Friendly Hospital Initiative is high exclusive breastfeeding at discharge.  Unfortunately, because the rates of insufficient breast milk and delayed lactogenesis II are high among mothers, the necessary consequences of hospital policies that seek high EBF at discharge rates are higher starvation-related complications like hyperbilirubinemia, hypernatremia, dehydration and hypoglycemia, all of which can cause newborn brain injury and permanent disability.  Below is an example of the way mothers are made to fear formula supplementation while the risks of NOT supplementing are hidden.  This is a waiver form published on the California Department of Public Health Website to provide an example of a model formula waiver form for hospitals.

Here are examples of FEAR not FACTS contained in formula feeding waiver forms that Baby-Friendly hospitals require moms to sign before they allow a newborn to be formula-fed.

1. FEAR: Supplementation CAUSES delayed milk production.

FACT: The known risk factors for delayed milk production include being a first-time mom, cesarean delivery, flat or inverted nipples, higher BMI > 27, prolonged stage II of delivery (when a mom pushes to deliver), having a large baby, excessive blood loss, being an older mom > 30, PCOS, diabetes, hypothyroidism, insufficient glandular tissue, retained placenta to name a few. While supplementation may be ASSOCIATED with delayed milk production, supplementation is in fact a REFLECTION of the need to supplement a baby who is being underfed due to delayed copious milk production.  (Pediatrics 2003, 112 (3 Pt 1): 607-19)

2. FEAR: Not exclusively breastfeeding puts my child at risk of jaundice.

FACT: Exclusive breastfeeding is among the highest risk factors for excessive jaundice requiring phototherapy admissions according to the American Academy of Pediatrics and 10-18% of exclusively breastfed newborns experience starvation jaundice from insufficient milk intake according to the Academy of Breastfeeding Medicine. Exclusively breastfed newborns are at higher risk of jaundice than supplemented and formula-fed newborns due to the smaller volumes of milk they receive as milk helps the baby pass bilirubin into the stool. In fact one of the ways jaundice is treated and prevented is through supplemental milk feeding.
Pediatrics, July 2004, VOLUME 114 / ISSUE 1, BREASTFEEDING MEDICINE, Volume 5, Number 2, 2010

3. FEAR: Not exclusively breastfeeding will cause my baby to be underfed

FACTS: In the largest studies of supplemented/formula-fed vs. exclusively breastfed healthy, term newborns from a large Baby-Friendly Hospital system, the exclusively breastfed babies lost almost twice as much as the supplemented/formula-fed babies. 10% of vaginally-delivered and 25% of cesarean-delivered EBF newborns lost excessive weight of >10% while NONE of the formula-fed newborns experienced this complication. In fact, exclusive breastfeeding at discharge is associated with an 11-fold higher risk of rehospitalization for dehydration and underfeeding.

Early Weight Loss Nomogram of Formula-Fed Newborns. Hospital Pediatrics May 2015, VOLUME 5 / ISSUE 5

Early Weight Loss Nomogram of Exclusively Breastfed Newborns.  Pediatrics January 2015, VOLUME 135 / ISSUE 1

Rehospitalization for Newborn Dehydration. Arch Pediatr Adolesc Med. 2002;156:155-161

4: FEAR: Supplementing will CAUSE low blood sugar and colostrum protects my baby from it.

FACT: In a study of newborns fed antenatally expressed colostrum along with direct latch feeding of colostrum when compared to those who did not receive expressed colostrum, the babies fed expressed colostrum in fact had higher rates of hypoglycemia requiring admission.  Lancet 2017, 389: 2204-2213

So NO, colostrum does not protect against hypoglycemia. In fact in the most recent study of EBF newborns, 10% had blood glucose levels low enough to increase risk of lower long-term academic achievement. An even older study on low blood sugar in EBF newborns, 53 out of 200 or 26.5% developed low blood sugar within the first 6 hours of life. What protects against hypoglycemia is providing a child their full caloric requirement, which is 100-120 Cal/kg/day to prevent them from running out of caloric reserve.

Study of Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life Journal of Clinical and Diagnostic Research. 2015 Sep, Vol-9(9): SC07-SC10
Association Between Transient Newborn Hypoglycemia and Fourth-Grade Achievement Test Proficiency: A Population-Based Study JAMA Pediatr. 2015;169(10):913-921.
Nutritional management of newborn infants: Practical Guidelines. World J Gastroenterol 2008 October 28; 14(40): 6133-6139      

5. FEAR: Introduction of cow’s milk will lead to cow milk protein allergy.

FACT: In a study of over 13,000 children, earlier introduction within the first 2 weeks of life of cow’s milk REDUCED their risk of cow milk protein allergy by 19-fold.

Early exposure to cow’s milk protein is protective against IgE-mediated cow’s milk protein allergy.  J Allergy Clin Immunol. 2010 Jul;126(1):77-82.e1.

6. FEAR: Exclusive breastfeeding is the ideal way of feeding every baby and there are no risks associated it, only risks of NOT doing it.

FACT: The most significant risks to a newborn’s life and brain come from the fasting conditions imposed by exclusive breastfeeding before full milk production and these risks are hidden from mothers to gain compliance with exclusive breastfeeding.

A review of 116 cases of breastfeeding-associated hypernatremia in rural area of central Turkey. J Trop Pediatr. 2007 Oct;53(5):347-50. Epub 2007 May 12.

Hypernatremic Dehydration in Breastfed Term Infants: Retrospective Evaluation of 159 Cases. Breastfeed Med. 2017 Jan/Feb;12:5-11.

Long-Term Neurodevelopmental Outcome of Neonates with Hypernatremic Dehydration. Breastfeed Med. 2017 Apr;12:163-168

Of Goldilocks and Neonatal Hypernatremia. Academy of Breastfeeding Medicine Blog.

7. FEAR: Just one bottle will ruin my child’s future health.

FACT: Just one bottle can save a child’s life and save them from a lifetime of disability.

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

Letter to doctors and parents about the dangers of insufficient exclusive breastfeeding

#FactsnotFear #FedisBest #BFHIShowMeYourFacts


The Fed is Best Foundation is dedicated to the prevention of newborn and infant starvation from insufficient exclusive breastfeeding. We do so by studying breastfeeding stories sent by mothers and the scientific literature on breastfeeding complications that lead to infant brain injury and death. Since the beginning of our campaign almost two years ago, we have received tens of thousands of newborn and infant starvation stories leading to the complications of hyperbilirubinemia, dehydration, hypernatremia,  hypoglycemia and failure to thrive. These complications occur because the current breastfeeding guidelines have not been studied for safety, operates with little awareness of the caloric and fluid requirements of newborns nor the amount transferred to babies until complications have already occurred. “Just one bottle” can save a child from these tragedies as it is often a mother’s first clue that a child is in fact starving from exclusive breastfeeding.

If your baby is experiencing distress and signs and symptoms of starvation, we encourage you to advocate for your child. We encourage mothers to notify hospital administrators if you are being pressured to avoid supplementation to alleviate your child’s hunger. You have the right to feed your child and your child has the right to be fed. No one but your baby knows how close they are to empty. The only way they can communicate distress is by crying. Listen to your baby and listen to your instincts.

Our message is simple. Feed your baby. Feed them as much as they need to stay safe and satisfied. Only they know what they need.

#FedisBest
Click on the infographic below to print for your reference.

For more information on how to protect your baby from feeding complications due to early exclusive breastfeeding, please read and download the Fed is Best Feeding Plan, a way to communicate your feeding choices to your health care providers.

In addition, please read and download the Fed is Best Weighing Protocol to prevent newborn dehydration and failure to thrive.

Lastly, for more detailed information, please watch our educational videos on Preventing Feeding Complications.

Our full list of parent resources can be found on our Resource Page.

If you wish to help parents learn how to protect their newborns from accidental starvation, please share this story and sign our petition to demand that the CDC, the AAP, the U.S. Surgeon General and the WHO/UNICEF Baby-Friendly Hospital Initiative warn parents about the dangers of newborn and infant starvation from insufficient exclusive breastfeeding. Go to https://fedisbest.org/sign-our-petition/.

 

 

 

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Just One Bottle Would Have Prevented My Baby’s Permanent Brain Damage From Hypoglycemia

Written by Holly Lake

I wish I had known about the Fed Is Best Foundation before my 1st son was born. I felt enormous pressure to exclusively breastfeed at my hospital. My son was born at 37 weeks, weighing 5 pounds,13 ounces and he struggled to latch-on and breastfeed at each feeding. When I told the midwife, she came back with a leaflet which described how to hand express. She told me to express 1 mL of colostrum into a syringe and feed that to my baby whenever he struggled to latch.  I asked her if 1 mL was enough and she said it was because his tummy was very small and this amount would be fine until my milk came in. Note: 1 teaspoon equals 5 ml.

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StomachSize

I was discharged hours later not feeling confident my baby was getting enough colostrum.  A midwife came out to see me at home on day 3 because I said I was worried about his feeding. He became extremely yellow (jaundiced), not very responsive (lethargic) and would let out random high pitch screams and would sleep all of the time and never wanted to feed by this time.  He also would have random body spasms which doctors shrugged off as normal baby reflexes (later we found out different).  The midwife said I could wait and see how he did overnight or go to hospital.  I chose to take him to hospital. When arriving, we found that he had lost 12% of his body weight and his blood sugars levels dropped dangerously low to 0.2 mmol/L (4 mg/dL) and was he was jaundiced. Continue reading

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My Daughter Starved Because of My Determination to Exclusively Breastfeed and Lack of Knowledge on How to Supplement

By Jamie Nguyen

As new parents, my husband and I relied on professionals: doctors, nurses, lactation consultants to guide us in providing the best care for our newborn. But what happens if most of these professional have bought into a dangerous lie? The lie that all moms, except in very rare cases, are able to produce enough milk for a newborn baby.

After a long unmedicated labor that lasted over 36 hours, my daughter Noemie was born on November 2nd 2016. She was perfectly healthy and weighed 7 lbs 3.5 ozs. My goal was to exclusively breastfeed and the staff at the Baby-Friendly hospital were very supportive. Noemie lost 4% of her weight in the first 24 hours and we were told that it wouldn’t be anything to worry about until it got to more than 7%. However, she had become very fussy and inconsolable, but as we were new parents we just assumed that this was normal baby behavior. Having taken a breastfeeding class, I simply trusted that my body would make enough milk for her. I had been told that not being able to make enough milk was very rare. I asked to see a lactation consultant as I had previously had breast surgery to remove a benign lump from my right breast. The lactation consultant told me that I should have no problem breastfeeding from just my left side. She reassured me that my milk would “come in” sometime over the weekend at day 4 – 5. We were told to get a weight check at the pediatrician’s office on day 4.

Born healthy at 7lbs 3.5 ozs.

Continue reading

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Questions to Ask Your Health Providers to See if They Believe that Fed is Best

Mothers have reported feeling unprepared for their birth and postpartum experiences and that their newborns experienced complications from underfeeding due to excessive pressure to exclusively breastfeed.  It is important to know your health providers, their perspectives on infant feeding, supplementation and keeping your baby safe from complications and hospitalization.  These are a list of questions to ask your health provider to see if they and their hospital believe that Fed is Best.

 

What do I do if my milk does not come in and my child is not getting enough milk?

If they are unwilling to discuss this possibility and are unwilling to tell you how to protect your child from complications, then they are not being honest with you and are violating a basic ethical obligation required of all health providers. They should be able to tell you that supplementation with formula or safe, tested donor breast milk can protect your child from complications if your breast milk is not enough.

 

Continue reading

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