Tag: Fed is Best

Fed is Best Foundations Statement to USDA Healthy People Goals 2030

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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 Objectives Baseline (%) Target (%)
Increase the proportion of infants who are breastfed (MICH 21)
Ever 74.0 81.9
At 6 months 43.5 60.6
At 1 year 22.7 34.1
Exclusively through 3 months 33.6 46.2
Exclusively through 6 months 14.1 25.5
Increase the proportion of employers that have worksite lactation support programs (MICH 22) 25 38
Reduce the proportion of breastfed newborns who receive formula supplementation within the first 2 days of life (MICH 23) 24.2 14.2
Increase the proportion of live births that occur in facilities that provide recommended care for lactating mothers and their babies (MICH 24) 2.9 8.1
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

 

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

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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.

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

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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. Continue reading →

Please Support Fed is Best on #GivingTueday!

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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!

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

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

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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]

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