鈥淏reast is best鈥�. This well-known slogan is meant to convey that babies should be fed exclusively with breast milk. The mantra is so ubiquitous it is widely assumed to be uncontroversial 鈥� even though many of the tenets of breastfeeding ideology are in fact contested.
While few would deny that breast milk has some health benefits over formula milk 鈥� including protection against infections such as diarrhoea 鈥� there is debate about their extent, and how they should be weighed against the mother鈥檚 well-being if breastfeeding goes badly, not to mention her right to do as she wishes with her own body.
Now there is another cause for concern: breastfeeding can sometimes have downsides for babies. It is becoming clear that an excessive focus on breastfeeding at all costs in the first few days after birth can have tragic consequences. 鈥淚 never imagined that anything like this would exist in medicine,鈥� says Christie del Castillo-Hegyi, a doctor whose baby son became dehydrated after she struggled to produce milk but was discouraged in hospital from supplementing with formula, lest it get in the way of breastfeeding. She was a factor in his later diagnosis with a seizure disorder. 鈥淚t goes against all the medical principles of 鈥楩irst do no harm鈥�,鈥� she says.
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Del Castillo-Hegyi began a campaign called 鈥淔ed is Best鈥� to highlight cases of other babies who went so hungry thanks to breastfeeding dogma they experienced serious harm 鈥� and bust some of the most damaging myths. But Fed is Best is not a rejection of breastfeeding promotion per se, only its anti-science excesses. Del Castillo-Hegyi says she wants a sane middle ground in which no ideology is 鈥減ushed鈥� at the expense of babies鈥� health.
鈥楤aby-friendly鈥� criteria
The idea that an over focus on breastfeeding could be bad for babies is darkly ironic given the history behind 鈥淏reast is Best鈥�. For many decades, formula makers claimed formula was better than breast milk, which must have led to countless infant deaths in developing countries, where the water used to make up formula can be contaminated. As a result, the World Health Organization recommended restrictions on how formula can be marketed, many of which have been adopted as law in 84 countries. Many hospitals strive to meet UN-approved 鈥渂aby friendly鈥� criteria that prioritise breastfeeding. Formula is shunned, partly because giving bottles can mean babies suck less at the breast, leading to a vicious circle of falling milk production and more formula use.
While new parents should be aware of this pitfall, they should also be told that the cycle doesn鈥檛 have to be inevitable. In fact, some research suggests that if breastfeeding isn鈥檛 going well, a little formula in the first few days after birth can lead to .
Why does breastfeeding need any intervention at all? One problem is that it takes women several days after birth to start producing much milk. Most get there in the end, but if it takes too long, the baby can be in danger of going short of calories, getting dehydrated or jaundiced.
In developing countries it is common for women to breastfeed each other鈥檚 babies while a new mother鈥檚 milk comes in 鈥� and if no wet nurse is around, they may resort to . In the growing number of UN-sanctioned baby-friendly hospitals, though, women and their babies now have little choice but to tough it out or face disapproval. In some US hospitals, parents must sign a 鈥渃onsent to formula feed鈥� form, in others formula is only available by prescription.
Last week the 鈥淔ed is Best鈥� site highlighted the story of aof starvation after his mother was unable to produce milk. She was assured that everything would be fine as long as she kept nursing. The baby went into cardiac arrest and died two weeks later. Breastfeeding advocates argue that insufficient milk is rare, but a study at a hospital in China found that a . Doctors there said that jaundice rates had risen since the hospital started promoting breastfeeding.
Stomach size
The Fed is Best campaign seeks to undo some of the more damaging distortions that have been put forward by breastfeeding advocates. For example, women who voice concerns they might not be making enough milk are often reassured that this is unlikely as a newborn鈥檚 stomach is just 5 millilitres in size. In fact, studies suggest it is . 鈥淲e are told their stomach is the size of a pea 鈥� while they get closer and closer to empty,鈥� says del Castillo-Hegyi.
Indeed, a whole range of merchandise has been created to convey the mythical small dimensions of a baby鈥檚 stomach. Del Castillo-Hegyi is now trying to get one such product 鈥� a lanyard depicting the circumference of a 5 millilitre stomach 鈥� taken off the market.
Another myth is that breastfeeding . There is no empirical evidence to suggest that bottle-fed children and their parents love each other any less.
Perhaps unsurprisingly, breastfeeding advocates are up in arms about the Fed is Best campaign, branding it . of King鈥檚 College London says a bigger priority is for health services to give more support for women who are struggling to breastfeed.
Del Castillo-Hegyi is a supporter of breastfeeding 鈥� but says we should give breastfed babies more checks in their first few days to ensure they are getting enough milk, and that they are not losing a dangerous amount of weight. 鈥淧romoting exclusive breastfeeding is a public health intervention that we haven鈥檛 asked enough questions about,鈥� she says. 鈥淐hildren are paying for it with their lives and their brains.鈥�
