Welcome to my first blog.
I have chosen to write my first blog on an area in which I have exerted a great deal of effort and time to be aware of the scientific evidence and also studied what actually works over many years and many thousands of families.
As you know, the whole area of breast- and bottle-feeding is cloaked in emotion, guilt, inconsistent advice and mythology. A key message from me is that there are many ways to succeed with your feeding. The strategies which I use have a very high success rate in achieving optimal growth for your baby and higher than average rates of continued breast feeding.
The Babysleep Doctor strategy aims to support you in your feeding choices and to protect you from those who wish to criticise you and make you feel guilty. As long as the baby is growing well I almost always support and respect a mother’s feeding choices.
In English speaking cultures in the last 30 years there has been a huge emphasis on breast feeding, particularly exclusive breast feeding. I have paid a large amount of attention to this area and went to the length of employing a scientist for two years to read the international literature on infant feeding. There are more than 9,500 academic papers in the literature. Because the literature is so vast, it is possible to argue every single case both for and against breast feeding and exclusive breast feeding. Perhaps one of the key messages from our review is that the large majority of the benefits of breastfeeding are achieved by the breast milk. There is no evidence that the benefits of breast milk are diluted or diminished by making breastfeeding partial rather than exclusive
Let’s make some things crystal clear from the outset.
- I support, encourage and promote breast feeding when it is possible.
- In terms of your baby being a happy, well balanced and healthy adult there are much bigger issues than how they were fed in the first weeks and months of life.
- The decision that you make is going to be quite OK in terms of your baby’s health, happiness and well-being as long as growth and nutrition are maintained.
- Every breast feed has benefits for mother and child
- I am very hesitant to push a mother in the direction of exclusive breast feeding.
- I strongly reject the concept that there can be one style of feeding which is universally appropriate or superior.
- All four of my children were breast fed for their first year of life.
- For many years, my advice for supporting breast feeding was strongly criticised by advocates for exclusive breast feeding. The principal criticism was my advice to use top-up bottles early in life and to start solids by 8-12 weeks.
As a result, I completed my first simple research study to find if the advice given to my patients was having an impact on their breast feeding success. The key element of the study was that babies were being given top up bottles of formula or 5% glucose in the first 72 hrs of life. The study found that that these patients were 50% more likely to be breast feeding at 12 weeks than the national average. In 2013, another study published by Stamford University, found almost exactly the same results; that a somewhat similar feeding strategy was able to increase breast feeding success rates at 12 weeks by about 50%. (Read the study at: http://www.jwatch.org/na31070/2013/06/12/can-limited-formula-newborns-improve-breastfeeding-rates)
As a result of this research, my review of the literature, my experience as a father and now having looked after breast feeding mothers for over 30 years, I feel confident in giving advice on this topic and provide the next few paragraphs with the view to helping you ensure optimal growth and health of your child:
- Breast milk is a biological fluid which varies between women like all other biological variables.
- Some women produce ‘skimmer’ and some ‘full cream’. This is genetically controlled and we can’t do anything about that.
- Some women produce larger volumes and some less. This will vary from day to day and feed to feed. Volume will reflect many variables in a woman’s day in addition to her genetic predisposition
- If you produce ‘full cream’ breast milk it is likely that your feeding will proceed well most days. For many women who produce large volumes of high energy milk, their babies grow wonderfully.
- If for genetic reasons your milk has a low energy value (‘skimmer’) I still aim to support you in breast feeding successfully; your milk contains important information about your immune system and every feed gives the babies immune system “passive” support. This means that antibodies which you have produced will pass into the baby’s blood stream and assist in his or her resistance to illness. For you as a mother, there are long term health benefits for continuing your lactation. However, if the baby becomes agitated about the feeds or fails to achieve good weight gain, mixed feeding is an important option. In families where the mother’s milk has a low energy density or butter fat there will be benefits from giving top up bottles of formula after some or many or sometimes every breast feed.
- Many mothers have been told that ‘supply equals demand’ and that her breasts will adjust to meet the babies milk needs if she keeps trying. While there is a degree of truth in this, it is a totally inadequate summary. We are complex biological mechanisms and for every single biological variable in the body there is a variation in what is normal. It is a biological truth that with the best will in the world some women will have small volumes of low energy milk. Other women will have large volumes of high fat milk. This is normal.
- While there will be some ability to increase volume on some days there is no ability to change the energy density of your milk as that is genetically determined.
- Almost all women can breast feed to some extent. In some women they will have 150% of their baby’s milk supply. In others they can supply 25% of their baby’s energy needs. What is important and ethical is to support a woman in feeding her baby in such a way as we meet that babies needs for growth and total nutrition. If that means exclusive breast feeding for some time that is great. If it means that the baby receives breast and bottles of formula that is also fine. In my experience, some women are able to exclusively breastfeed for some months. It is uncommon for women to be able to exclusively breastfeed for longer than approximately four months. There is very large variation in this field and a mother must judge when the total breast milk supply is no longer meeting her baby’s total needs for optimal growth.
- There are sometimes problems in attempting to increase supply. I have seen women who were told to breast feed every hour. The problem here is that the attempt to increase supply exhausts the mother and in fact over a period of days her supply goes down. It is my experience that introducing complimentary bottles while lactation is being established and then supporting the baby’s growth with complimentary solids after 8-12 weeks will support a mother’s breast feeding.
There is a little paradox about children who are breast fed very well and grow rapidly. Some will progress quickly in many ways. They sleep well, grow with amazing speed, advance through their percentiles rapidly and become very sociable. Logically we would all say that their milk feeds are so good that they can continue to be largely breast fed for a long time. My experience is that some of these children seem to need complementary solids early as well. They seem to be a little advanced in this area and particular in boys may outgrow milk as their only nutrition by 8-10-12 weeks. These babies may need some complementary solids fairly early in life. Girls tend to be more forgiving in this area and to remain content on just breast milk for a little longer.
Put very simply, there are multiple ways to achieve your baby’s optimal growth. This may be exclusive breast feeding for some time, it may be breast and bottle or it may be bottle. All are legitimate choices.
In terms of your baby being a health happy, well-balanced adult there are more important issues than the feeding choices in the first few weeks.
Your happiness, confidence and joy in parenting are more important to your baby’s wellbeing in my opinion.
All the very best to you and your baby or babies.
I invite you to provide feedback on this topic or on topics you would like me to discuss in future posts.
Dr Brian Symon
The Babysleep Doctor