A bit of fact checking today. Breastfeeding or bottle is an issue that always causes much discussion and often in a very polarized way- it seems the internet is full of either the ‘breastfeeding brigade’ or the ‘fed is best’ team and neither the twain shall meet. But today I am going to attempt to provide what I hope is a balanced view.
A very prominent celebrity Midwife Cath recently posted “trust your baby and trust your instinct, a baby who is constantly unsettled after breastfeeding or is constantly nursing is hungry. If breastmilk is not enough, supplementation can protect your child’s life and brain”. Midwife Cath is great, she has all sorts of amazing helpful advice for new parents, but her advice around giving a bottle before bed (either formula or expressed milk) as a standard routine from the get go (not for use in special circumstances, or with certain health issues, or just because nothing else is working and you are going insane), seems out of step with many other health professionals, not to mention breastfeeding methods followed for thousands of years.
I know is so hard for parents because they feel like they get different messages from everywhere. But I would say this what works for one mum and baby, may not work for another. So some flexibility is required, and a bit of trial and error or different strategies, from reputable sources is worth a shot. So why the fuss?
Well we know breastfeeding is so beneficial for both mum and baby, and helps prevent so many illnesses and chronic diseases both in the short and long term. Exclusive breastfeeding in the early months is particularly beneficial. So encouragement to give bottles of formula early on maybe doing a disservice to mums and babies, who are otherwise doing just fine with breastfeeding. Now there are all sorts of genuine reasons why mums may choose not to, or are not able to exclusively breastfeed – so you need not feel guilty is you cannot. They include reasons relating to mums or babies physical health (which may impact breastmilk supply or ability of baby to latch and suck well), mental health and social circumstance. But most women can breastfeed effectively with help and support, and they can produce enough milk to adequately nourish baby- routine milk supplementation for all babies is not required. Even when there are difficulties with breastfeeding often with expert help and support from a lactation consultant these can be overcome.
But back to fact checking…
Firstly the best indicator of adequate breastmilk supply and intake is lots of wet nappies and normal adequate growth. Babies will naturally lose a bit of weight in the week after birth – up to 10% is considered normal, and will regain this by day 14. From then ongoing growth is required. A health professional experienced in infant health for example a Midwife, child and family Nurse, GP, Paediatrician, Lactation Consultant, or Paediatric Dietitian can help you monitor your babies’ growth on a WHO growth chart and be able to advise if your baby is growing appropriately and gaining enough weight. Growth over several time points is the best indicator, a one off weight and length measure is less accurate, so take along baby’s health book where previous weights are recorded, so they can track the rate of growth over time.
Secondly there are all sorts of reasons why a baby might be unsettled, crying or frequently feeding. Too hot, too cold, sensory overload, colic, wet nappy, reflux, tummy pain, illness, constipation, over- tired, they want a cuddle, they want more milk, food allergy, comfort etc etc. Mostly it is not medical or health related but just normal baby behaviour (babies do cry and mothers do naturally respond to that crying in a nurturing way), these interactions are thought to be important for babies development. Obviously if you have any concerns that it is health related, than you should trust your instincts and get a medical assessment to rule out medical causes. One reason for frequent feeds in the early days and weeks after birth, maybe indeed be to help increase your breastmilk supply – nature’s way to help your body increase milk making. This is a good thing!
If your baby is NOT growing well, and if there is a decrease in wet nappies (a sign of dehydration), you may have breastmilk supply issues or a baby who is unable to feed effectively – this can be caused by many health and physical reasons). You will need medical assistance by GP, paediatrician or emergency department – urgently if you have concerns about dehydration, as this can be very serious in infants. And you will also benefit greatly by seeing a Lactation Consultant. Depending on the specific issues often other health professionals that can help with that issue are also be required, for example a Paediatric Dietitian or a Paediatric Speech Pathologist or a Psychologist specializing in maternal health. Each of these professionals will hopefully work collaboratively to look after you and your baby. There are many strategies to help nourish and hydrate your baby adequately (they may involve supplementation- either in the short term or for a longer period), and also many strategies to help overcome breastfeeding issues. It is essential for baby to get enough nutrition to protect their health- including the brain.
So whilst it is true that in some circumstances mixed feeding and supplementation can protect your babies life and brain, this is only in rare circumstances for babies who are really not getting enough – as indicated by inadequate growth and poor hydration status. Supplementation IS NOT required as a routine recommendation for all mothers of crying babies (that would be almost all mothers). Interestingly one benefit of breastfeeding is superior brain development and cognitive performance in the child (on average- there will still be brilliant formula fed babies and low IQ breastfed babies but on average kids who are breastfed tend to do a little better), so unless the baby is truly not getting enough nutrition, giving formula may have the opposite effect when it comes to the brain.
So fact check end. Let me know if you see any other nutrition claims for pregnancy or babies that you want me to fact check.
Some great resources for new parents include ‘The Australian Breastfeeding Association’ website, Lactation consultants – see ‘Lactation Consultants Australia and New Zealand’ to find fully qualified lactation consultants in your area (if you’re an Aussie or Kiwi), your GP or Pediatrician. If you are still pregnant getting ready to breastfeed by reading about it and talking to breastfeeding mums and attending courses by lactation consultants during pregnancy is a really helpful thing to do. Our book on pregnancy nutrition does also cover some information about looking after your own and Baby nutrition in the ‘fourth trimester’ i.e. the first weeks after birth. I have also previously recorded a video about feeding in the first six months which you make like to check out here