Blog
15 January 2012
A study in Cambridge has found that breastfed babies cry more, laugh less, and generally have "more challenging temperaments" than formula-fed infants. But such behaviour is normal, and mothers should learn to cope with it rather than reach for the bottle, according to the researchers. The study also concluded that bottle-feeding was akin to "comfort eating" - producing quieter and apparently more content babies who may be over-nourished and putting on weight too rapidly.
The study authors wrote in the online journal Public Library of Science ONE: "In particular, compared to formula-fed infants, breastfed infants were reported to show greater distress, less smiling, laughing and vocalisation, to be slower to calm down following distress or excitement, and more difficult to soothe by care givers."
This study has been portrayed in the media as meaning that all breastfed babies will be less happy than their bottle-fed counterparts, and any mother reading the words above will probably interpret it the same way.
I feel that the conclusions of this study are extremely misleading and will no doubt cause a lot of confusion amongst new mothers who will now be wondering whether it really is best to breastfeed their babies. I find it really surprising that this study has been published with so little medical evidence to back up its claims. For example, did the researchers study the weight gain of the bottle fed babies? If they have done this and noted that the majority of them were putting on too much weight, then they would be able to state as fact that the more content babies were indeed overfeeding. But if their weight gain was normal, it would show that they were happy simply because they were getting enough to eat. Similarly, did they weigh the breastfed babies and if so, were they all gaining the correct amount of weight or were some of them are underweight and clearly not getting enough milk? In addition, did they investigate whether the miserable babies had undiagnosed medical problems which might have been the cause of their distress rather than the fact that they were being breast-fed?
In my experience, the only time I see breastfed babies who are unhappy and unsettled is when breastfeeding is going wrong or when the baby has a medical problem such as reflux. Most of these babies will then become totally happy again once the problem has been resolved.
So my message to all the mothers out there is this: if your baby is happy, settled and gaining the right amount of weight, then Breast is clearly Best. But if your baby is not happy, please don't assume that this is normal. Instead, try & identify the problem by doing this simple test: at the end of the normal breastfeed, offer your baby extra milk from a bottle. If he drinks some and then settles perfectly, hunger is the problem rather than discomfort. If he rejects the milk and but still won't settle, you should seek medical advice to get a proper diagnosis.
25 November 2011
I have written blogs before about mothers suffering from low milk supply and I have now been inspired to write another one following an article about gorillas (!) in the Daily Mail on Saturday, 19th November. The heading of this article is "How a British zoo worker adopted a dying baby gorilla and nursed him back to health in her own home". The article describes how a six-month-old gorilla named Okanda became increasingly listless and unwell and tests showed the cause of his problems was that the quality of his mother's milk wasn't good enough. Okanda wasn't getting the nutrients he needed and his keepers said “If we had kept him with his mum he would have died”. He was nursed back to health by a combination of tube-feeding and bottle-feeding, using baby formula milk.
The reason I find this article so interesting is because it shows, yet again, that nature doesn't always get it right. Most mothers are told that their breasts will always supply the amount of milk their baby needs, providing they are eating a healthy diet and feeding on demand, but every week I see mothers who have not found this to be the case. In many cases, their baby has lost more than 10% of his birth-weight and/or is still not back to his birth-weight after several weeks of following the standard advice of endless feeding, skin-to-skin contact etc. These mothers always find it reassuring when I point out to them that they are not a failure and that many other mothers have similar problems...... and so do animals!
Nonetheless, I do worry that they have come to me for breastfeeding advice and sometimes there is nothing I can do to help them other than to explain that they need to supplement with formula for their baby's happiness and well-being. It is therefore very comforting when I hear back from clients saying that they recognise that I was acting in their best interest. Last week I got this lovely letter from one such mother, which I have printed in its entirety to make the point that not only was the mother happy with my advice, but she is also recommending me to her friends and family - even though I didn't sort out her breastfeeding problems. I have changed their names to protect their privacy.
Dear Clare,
I wanted to very belatedly get in touch and thank you for your help and advice when James was born. At the time I found it very hard to accept that I wasn’t able to produce enough milk but your straight forward, honest approach made it much easier to deal with. James is now 12 weeks old and is still happily having an aperitif of breast milk followed by a main course of formula! It has worked, and continues to work, very well for us and he is thriving. I am very grateful to you for making me face reality and encouraging me to do the right thing for James rather than struggling on with exclusively breast feeding. It enabled me to get on with getting to know him and enjoying him rather than endlessly agonising about feeding. You asked me to let you know if I tried Domperidone; I did try it for 8 weeks and it had a small but not particularly significant effect. However, to begin with it helped me psychologically to feel as though I was doing something and hadn’t just given up.
My sister is due to give birth soon and I have been singing your praises to her. I hope it is O.K to have passed on your details and I think she is likely to be in touch once her baby has been born.
Thanks again
With best wishes,
Sarah
15 May 2011
Breastfed babies are "better behaved" than formula- fed babies.
A study by researchers at Oxford University has shown that babies who were breastfed for at least four months were 30 per cent less likely at the age of five years to show behavioural issues such as anxiety, clinginess, hyperactivity, lying and stealing than babies who were formula-fed. However, Maria Quigley who led the study has admitted that “we don't know whether it is because of the constituents in breast milk which are lacking in formula, or the interaction with the mum that accounts for this difference”. In other words, there is no scientific evidence that there is anything in the breast milk that will create a better behaved baby. So, to all the mothers out there who were/are unable to breastfeed their baby and are sobbing into their cornflakes after reading yet another study that highlights how much they have ‘failed’ - please don't worry. Babies who are given plenty of time, love and attention throughout their childhood will still grow up to be healthy and happy even if their mother was unable to breastfeed.
On another point ......I cannot understand why so much time and money is wasted on studies such as this. Everyone from health professionals to mothers is already well aware of the benefits of breastfeeding and yet despite endless campaigns, the breastfeeding rates in Britain have not improved and remain amongst the lowest in Europe. Approximately 30% of mothers do not even try to breastfeed and roughly 50% of mothers who do try find it too difficult and give up within a matter of weeks.
Surely it would be better to do a study to discover why we cannot persuade more mothers to breastfeed despite the obvious health benefits and to examine what can be done to help the mothers who are finding it too difficult. This is to my mind would produce far more interesting results than yet another study that simply highlights the benefits of breastfeeding.
20 October 2010
Millie came to see me about five weeks ago with her two-week old son Max, whom she had been bottle-feeding since his birth with expressed breast milk because she had been unable to get him to latch on and suck effectively. When he was a week old, Millie saw a lactation consultant who diagnosed tongue-tie as being the cause of his inability to suck on the breast and arranged for it to be clipped. Sadly, this did not resolve the problem so she came to see me. I was also unable to get him to latch on but it immediately became apparent that he had a very poor sucking action and he was using his tongue to push Millie's breast out of his mouth, rather than to suck it in. He also did this when we tried using a conventional nipple shield so I tried him on a very old-fashioned shield (a Portia nipple shield which is available from Bray Healthcare) and this worked perfectly. Millie had plenty of milk with a very fast letdown and Max sucked so effectively that he was able to get a full feed from the breast - and he continued to do that at every feed from then on. Millie was delighted!
The less good part of this story is that Millie rang me three weeks later to tell me that she had experienced extremely negative reactions from several midwives and health visitors and even some of her breastfeeding friends, all of whom told her that she should not use the shield because it would create nipple/teat confusion and reduce her milk supply. When she pointed out that she was only using the shield because she couldn’t latch Max on without it, not one of them offered to help her latch him on but they still continued to tell her that she shouldn’t use it. In addition, not one of them was interested when she pointed out that she had been using the shield for three weeks with no adverse affects to either her milk supply or baby, who was happy, settling well and gaining weight.
To me, this is another example of health professionals toeing the party line rather than learning by experience. If they had taken the time to talk to Millie (rather than simply criticise her) they would have learnt that nipple shields can and do work for some mothers - and rather than being detrimental to breastfeeding they might be the tool that enables them to continue breastfeeding.
PS. Bray Healthcare is developing a new prototype of the Portia nipple shield, which should be available soon. In the meantime, anyone wanting to try the current shield should call Mandy Ball on 01367 240736
01 July 2010
Lesley Backhouse, chairman of The Breastfeeding Network is blaming the 'breast is best slogan' for the fact that so few mothers in Britain breastfeed their babies. I am really amazed if she seriously thinks that women don't bother to breastfeed simply because they are unaware of the health benefits and think it is more normal to bottle feed.
All the mothers I see are desperate to breastfeed and will (and do) continue to breastfeed once they are shown how to do it correctly. Every mother I have seen this week has felt very upset by the lack of help available to them when they had experienced problems and were all scathing about the suggestion that changing the slogan would have made any difference to them.
Take for example, Mary who had an eight-day-old baby that she couldn't get to latch on to the breast. At least nine midwives in the hospital had tried and failed to get her baby to latch on. The hospital then sent one of their breastfeeding specialist midwives to visit her at home - but the midwife chose to visit at a time when the mother had already said her baby would be asleep and not ready to feed. As a result, she, too, was unable to latch the baby on but she did not offer any constructive advice and then sat down to fill in the paperwork to say that she had visited. She did not offer to visit again. Mary told me that "she seemed to be more interested in ticking boxes than actually helping me".
It took me less than two minutes to latch the baby on and then not much longer to teach Mary to do it. The following day Mary left a message on my answerphone to say that feeding was still going brilliantly and that her baby had needed no further bottles of either breast milk or formula. Job done!
On 22 June I wrote a letter to the Daily Mail expressing my views on the subject. When the letter was published on 25 June, I was horrified to see that they had changed and edited some of the content - including printing it under the headline "when bottle is best". This made it look as though I was saying that it is better to bottle feed than to breastfeed, which is most definitely not what I was saying. Below is the full letter that I sent in:
Changing slogans won't improve breastfeeding rates. Lesley Backhouse, chairman of The Breastfeeding Network (Mail) is naive in the extreme if she thinks that the Breast-is-Best slogan is "harming the cause". The reality is that approximately 50% of mothers give up breastfeeding because they find it too painful or difficult. They do not give up breastfeeding because they are unaware of the benefits and I would imagine that most of these mothers (who are already feeling a failure) will be outraged at the suggestion that they gave up simply because the breast-is-best slogan did not encourage them enough.
If Lesley were to speak to these mothers, I think she would hear that the main reason they give up is because they cannot find anyone to help them resolve their breastfeeding problems. If they could find expert help (that actually works!) these mothers would carry on breastfeeding. But the reality is that many of them are told that it is normal to get sore nipples, that it is normal for a breastfed baby to need to feed up to 20 times a day and that every mother has enough milk - none of this is of much help to a mother who is in agony at every feed and whose baby won't stop crying because he's hungry.
When breastfeeding goes well it is a wonderful experience for both mother and baby and all mothers should be encouraged to give it a go. But it is unrealistic to expect more mothers to breastfeed whilst the perception (and sometimes the reality) remains that breastfeeding is more difficult than bottlefeeding.
I am hoping that the Daily Mail will publish an apology so that anyone who read my letter on 25th of June will get to see what I actually wrote. But in case they don't, I do hope that this blog will be noticed by at least some of the people!
23 May 2010
Oliver James is a well-respected psychologist and I am sure that his forthcoming book, "How Not to F*** Them Up" will be as successful as his previous books. I agree with his views that parenting in the early years makes us what we are and I agree that bad parenting could lead to lifelong insecurity, bad relationships, depression etc.
However, I really do take issue with Oliver James criticising Gina Ford's methods where he is quoted as saying "The organiser is the kind of mother to adopt Gina Ford, to want the baby to adapt to her; the hugger is totally baby-focused to the exclusion of others and the flexi- mum is a combination of the two”.
I don't know whether these are Oliver James's exact words or whether he has been misquoted but I think this statement misrepresents the whole concept of Gina Ford. Far from a Gina Ford mother wanting (and forcing) the baby to adapt to her, a Gina Ford mother is taught that she must put her baby's needs before her own and adjust her lifestyle to fit in with the requirements of a new baby. Gina Ford explains that babies (like toddlers) are generally more secure, contented and relaxed when all their needs are met at the correct time, so they do not have to cry to attract attention. I am in full agreement with her on this.
I regularly see mothers who are at their wits end because their baby won't stop crying unless they spend all day and night feeding and cuddling them. Both mother and baby are sleep deprived and neither is happy. These mothers are doing their best but have no idea what a baby is meant to do and most of these mothers simply can't work out why their baby is crying and not settling.
Once we have sorted out the feeding and sleeping problems, the baby naturally gets into a better routine and everyone is happier. This is usually achieved by giving the baby more milk and making sure the baby is put down to sleep before he becomes over-tired - it does not involve ignoring the baby and leaving him to cry for hours on end. This is not what Gina Ford recommends mothers to do either.
I think it is a great shame that so many people think/say that Gina Ford does not have the baby's interests at heart, when this could not be further from the truth. I am not saying that all babies can and should follow a strict routine, nor am I saying that every mother should follow a Gina Ford routine - but there is no doubt in my mind that many mothers need more (not less) guidance on how to meet their baby's needs. Currently, most mothers are discharged home from hospital with their brand-new baby with the simplistic advice to "feed on demand and trust your motherly instincts". This is fine if the baby naturally feeds and settles well but is a recipe for disaster when things go wrong.
So, whilst agreeing with many of Oliver James's views, I would point out that many, many mothers (my own niece being one of them) have found their baby to be more, not less secure when put onto some kind of a routine.
Ultimately, the important thing is to do what works best for you and your baby and not to condemn others who choose to go down a different route – providing that route really is in the best interests of the baby.
28 April 2010
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Yet again the whole debate about feeding on demand versus routine and/or controlled crying has been sparked off by Penelope Leach's new book, in which she says that babies that are left to cry may end up being brain-damaged - and I would wholeheartedly agree with that. But, even though Penelope Leach makes it clear that babies are only at risk of damage if they are left to cry for prolonged periods over a number of days and weeks, this book is now being interpreted by many as saying that a baby should never be left to cry, even for five minutes.
In my view, there is a big difference between a baby who is crying for a reason and a baby who is crying because he needs to go to sleep, but cannot settle himself. It's all very well to say that you should never leave a baby to cry, but does anyone consider the damage that is done to mothers and babies when they suffer sleep deprivation for months on end? Instead of simply telling mothers that they should never leave their baby to cry, it would be far better to help mothers to distinguish between their baby's cries, so they can learn what he is trying to tell them and react accordingly.
When I visit a mother who has been up all night feeding and trying to settle her baby, it is very obvious that her baby is just as tired as she is and they both need help to solve the problem. I would never advocate simply leaving her baby to cry, but I do think it is important to discuss with the mother all the various reasons why her baby might be crying rather than simply saying she should cuddle him and take him into bed with her. In most cases, it is clear that the baby is either hungry, cold or suffering from a medical problem such as gastro-oesophageal reflux - which needs medical treatment, not just cuddles.
Whenever controlled crying is discussed, many think that this involves leaving a baby to cry (regardless of why he is crying) for hours on end and with no end goal in sight. This is clearly wrong and I don't think anyone does or would advocate doing this; but I'm equally clear that some babies need to learn to settle themselves at night and they can't do this if the mother is always picking her baby up every time he cries a 'I need to go to sleep' cry. I compare this situation with an adult who is tossing and turning a night and whose partner keeps turning on the light and asking what is wrong, offering to make a cup of tea, have a chat etc - this quickly becomes irritating rather than helpful!
It is also a shame when the 'feed on demand, routine is bad' brigade say that any book that recommends a routine for a baby is putting the mother's needs before that of her baby - whereas in fact the the opposite is true. Books such as mine, Gina Ford's & Tizzie Hall's are written to explain to mothers that they need to put the baby first and make sure that he is having his feed and sleep times when he needs it rather than when it suits the mother.
I am glad that Penelope Leach's new book (which I am sure is full of excellent advice) has highlighted the need to be a good, caring mother but sadly I would imagine that any mother who thinks it is okay to leave her baby to cry endlessly is unlikely to read her book ......or indeed any other!
25 March 2010
I regularly see mothers who don't have enough milk even though they have done all the standard things (feeding on demand, eating, drinking and resting as much as possible) to try and improve milk production. These mothers will usually feel a complete failure when they resort to giving formula milk to help their baby settle and gain weight. Then, to make matters worse they are often told that their milk supply is bad because they've given formula rather than everyone recognising that these poor mothers have only given the formula milk because their supply was already bad.
I explain to these mothers that a low milk supply can affect animals as well as humans and that nature doesn't always get it right. This was perfectly illustrated in the recent BBC programme 'Lambing Live' when the farmer explained to the viewers about ' wet adoption '. If the mother does not have enough milk to feed her newborn lamb they take the lamb and give it to another ewe, smothering the lamb in the amniotic fluid from its adoptive mother to fool her into thinking it's her own lamb. The ewe then feeds this lamb as well as her own.
Bearing in mind that sheep have not made a conscious decision as to whether they want to breast or bottle feed their baby it does make it pretty clear that resorting to ' wet-nursing ' is done through necessity rather than choice.
So, if a mother finds that she doesn't have enough milk to feed one baby while her friend is happily breastfeeding twins, she should feel comforted by the fact her friend is lucky to have so much milk and she is unlucky - it is not a question of who is the best mother or who is trying the hardest.
28 January 2010
I just want to make it clear to anyone who may have watched this morning's GMTV with Lorraine that I am pro-breastfeeding - even if this did not come across in the programme.
I was invited on to the programme to discuss Ann Sinnott's new book "Breastfeeding older children", in which she advocates breastfeeding children up to the age of six years and beyond. In the book she says that a child who has been breast fed to their hearts content has a basic sunny aspect to their nature and is amazingly self confident and outgoing. In my opinion, Ann can (and should) breastfeed her children for as long as she wishes but I object to her implying that mothers who don't breastfeed for years on end will have less happy or healthy children. This is the view I wanted to impart to anyone watching the programme.
My brief from GM TV was to discuss whether it was nutritionally beneficial in a civilised country to continue to give children breast milk as opposed to cows milk beyond the age of two years. They did not want me to get sidetracked into extolling the virtues of breastfeeding because we were all agreed that "breast is best" and we wanted to focus on the subject in hand- which was extended breastfeeding.
Unfortunately, with time being so limited I think this was not made clear at the outset and some people watching the programme may have got the impression that I was dismissing the benefits of breastfeeding any baby whatever their age.
I want to make it absolutely clear that I am very pro-breastfeeding and also that I think it is the mother's decision as to how long she wishes to continue and it is not up to me or anyone else to set a limit on this. The reason I agreed to do this program was because I wanted the opportunity to reassure all the mothers who have not managed to breastfeed their children for years on end that they will have happy and healthy children.
Re my comments about breastmilk damaging teeth: it is a medical fact that anyone with teeth (from toddlers through to adulthood) should avoid snacking on sugary foods or drinks in between meals as this can cause tooth decay. This is one of the reasons why mothers who are bottlefeeding are advised to start weaning their baby onto a cup from the age of about six months and to avoid giving their baby a bottle last thing at night after their teeth have been brushed. The same applies to breastfeeding. Although breast milk is "good" it is still full of natural sugars which may cause dental decay just like any other sugary drinks which are given too often. I also think it is wrong to suggest that a child needs to be comforted and settled by being given a breastfeed - a hug and a cuddle should be enough for older children.
16 January 2010
Most of the mothers who consult me because their babies won't settle after feeds tell me that breastfeeding is going well but say they need my help because their baby is suffering from colic. It never occurs to them that their baby might still be hungry after a feed because they have been taught in their antenatal classes that every mother has enough milk. Moreover, many of them have been told that it's no good offering a baby a top-up bottle after a breast feed to check to see whether the baby is hungry because breastfed babies will always drink extra milk from a bottle - even if they're not hungry.
I find it amazing that anyone (especially health professionals) can think that a breastfed baby will always drink more milk whenever he is offered it, Because his stomach is exactly the same as a bottle fed baby's stomach. When a bottle fed baby is full he won't drink any more milk even if you keep offering him more, so common sense says that a breastfed baby will also refuse to drink extra milk if he's full!
A good example of this muddled thinking is a mother I saw this week. Her five week old baby had been crying after every feed but had become much more settled after her health visitor had diagnosed colic and recommended that she started using Colief. Watching the mother feed her baby I was convinced that the problem was low milk supply rather than colic, but the mother assured me that her baby had improved dramatically as soon as she started using the Colief. On further questioning it turned out that the baby was being given the Colief in 60 mls of formula milk immediately after each feed. When I pointed out that maybe it was the extra milk that was settling their baby rather than the Colief, the father thought this made complete sense - especially as he'd noticed that their baby settled even better when they gave the Colief in 120 mls of formula!
So, my tip for all mothers with unsettled babies is to rule out hunger before you start assuming your baby has colic. If you offer your baby extra milk (preferably using expressed breast milk rather than formula) immediately after a feed and he drinks it and goes to sleep, he does not have colic. But if he refuses it or drinks only a tiny bit and is still unsettled, he is more likely to be suffering from colic or reflux than hunger.