One new mother I know wrote something about liking the fact that formula could be measured. I sent a reply reminding her that breastmilk has little waste product and is used more efficiently than formula. Even the stools are different. Since they don't supply the same nutrition, "measuring" really tells us very little.
The real measurement for breastfed babies is their output and growth pattern.
Kitty Frantz, a nurse practitioner and lactation consultant, has developed an app to help moms figure out how much expressed breast milk to leave with the sitter. It calculates amount by a reverse sort of method. You can check it out at the link below.
https://itunes.apple.com/us/app/breast-milk-calculator/id348623986
One problem with the calculator is that it does not measure the caloric content of the milk, which can differ from feeding to feeding and from mother to mother. One baby maybe ingesting more milk with fewer calories and another may be ingesting milk with higher calories at any given feeding.
Dr. Jack Newman, whom I have mentioned in a few previous posts, wrote this article a couple of years ago and reprinted it recently.
"The futility of “breastfeeding by the numbers”
Once upon a time, mothers breastfed their babies without “numbers” and
it almost always worked. Then, at the end of the 19th century,
“scientific” infant feeding was born and everything changed. The
medical speciality of paediatrics actually developed as the “science of
infant feeding”. “Formulas” were developed by paediatricians and were
called formulas because they were both complicated and “scientific”.
Paediatricians taught mothers how to take x amount of whole milk, y
amount of sugar in some form, and z amount of water. (INSERT NOTE: My baby book lists Carnation evaporated milk and Karo corn syrup (high fructose corn syrup) as the ingredients for the "formula" the doctor gave my mother.) The amounts
changed with the weight of the baby. Babies were fed by the numbers, so
many minutes on each side every so many hours. Straying from the
“scientific” road was frowned upon and not following the straight and
narrow advised by paediatricians would lead to “spoiled” children and
even, eventually, to juvenile court (this is not a joke, parents were
told this by paediatricians). Mothers were strongly urged that even if
they foolishly wanted to breastfeed instead of using the “scientific”
milks, they should follow “scientific” guidelines.
Then it
got better for a while, but only for a while. La Leche League and other
mother to mother groups and many mothers realized themselves that
feeding the baby when the baby wanted to feed made more sense than to
let the baby cry for 30 or 60 minutes until the 3 or 4 hours had passed.
And now we are back to “scientific” breastfeeding.
Numbers on demand in 2013
Although we no longer, usually, say to mothers to feed by the clock in
the same was as before, we have too often only changed the way we say
the same thing. For example, “Feed the baby on demand, but don’t let
the baby go more than every 3 hours without feeding and make sure you
don’t feed the baby more than every two hours, because your breasts
won’t have filled up”. We also say such things as “make sure you feed
the baby at least 20 minutes on each side so the baby gets the
‘hindmilk’”.
“Dehydration”
Now we have become
panicked that breastfed babies become “dehydrated” and have imposed such
rules as “the baby cannot lose more than 10% of his birth weight” (or
5% or 7%, take your choice since there is no evidence for any of the
numbers). Basing whether a baby is breastfeeding well or not or is
dehydrated on % weight loss makes no sense at all. First of all, in
most hospitals, babies are weighed on two different scales. The birth
weight is usually determined on a scale in delivery. The next weights
are determined in postpartum. Scales can sometimes weigh differently.
We have seen anywhere from 80 to 400 grams difference between two
electronic scales. Even if a baby is weighed on the same scale, errors
are often made in transcribing the weights to the baby’s medical record.
However, modern obstetrics usually fills women in labour up
with very large amounts of intravenous fluids. Some of the fluid also
goes to the baby so the baby is born “extra heavy” and loses extra
weight after birth simply by peeing out the extra water and so the
weight loss does not necessarily mean that the baby is getting
dehydrated, only less overhydrated.
Even if % weight loss
actually meant something, the approach should be to help the mother and
baby breastfeed better. That’s not what is usually done; what is
usually done is automatically to give the baby formula which I believe
is a very wrong approach.
(This is added today --12/10/13 -- added for clarity. In an article
in a pediatric journal published in December 2013, a group of "experts"
now say that losing 5% in the first 24 hours was a marker for poor
breastfeeding. I am shocked that someone could write and the journal
could publish such an article.)
Pediatricians add their own numbers
Recently, pediatricians have decided that the serum sodium
concentration tells us if the baby is dehydrated or not. If the serum
sodium concentration is elevated, then the baby is dehydrated.
Nonsense! We don’t know what a normal serum sodium is in a 3 day old
baby, say, who is breastfeeding well and exclusively, so how can we say
what “elevated” means? After all, the exclusively breastfed newborn of
three days is not getting large amounts of fluids as is a child of 1
year or an exclusively formula fed newborn of three days. The latter
two might be expected to have “normal” serum sodiums, though I would
argue that the exclusively formula fed newborn of 3 days is not feeding
normally (they are getting too much) and thus cannot be used as the
standard. Incidentally, it would be a very easy study to measure the
serum sodium of 2 or 3 day old babies who are exclusively breastfeeding
and see what the normal sodium is.
These are just a few of the
absurdities dressed up as science with regard to breastfeeding in the
year 2013. To the above I could add weighing babies before and after a
feeding and many other bits of breastfeeding by the numbers. But don’t
expect it to get better soon because the problems all stem from the fact
that many, the majority I dare say, health professionals don’t have the
faintest idea of what a good latch is or how to observe a baby at the
breast and know if he is drinking well from the breast or not. If they
did, we would be miles ahead. Don’t ask how many miles, please.
Videos showing babies drinking well at the breast or not drinking well
can be found at at our website (click “online info”). The videos have
explanatory texts in 13 different languages.
The real measurement for breastfed babies is their output and growth pattern.
Kitty Frantz, a nurse practitioner and lactation consultant, has developed an app to help moms figure out how much expressed breast milk to leave with the sitter. It calculates amount by a reverse sort of method. You can check it out at the link below.
https://itunes.apple.com/us/app/breast-milk-calculator/id348623986
One problem with the calculator is that it does not measure the caloric content of the milk, which can differ from feeding to feeding and from mother to mother. One baby maybe ingesting more milk with fewer calories and another may be ingesting milk with higher calories at any given feeding.
Dr. Jack Newman, whom I have mentioned in a few previous posts, wrote this article a couple of years ago and reprinted it recently.
"The futility of “breastfeeding by the numbers”
Once upon a time, mothers breastfed their babies without “numbers” and it almost always worked. Then, at the end of the 19th century, “scientific” infant feeding was born and everything changed. The medical speciality of paediatrics actually developed as the “science of infant feeding”. “Formulas” were developed by paediatricians and were called formulas because they were both complicated and “scientific”. Paediatricians taught mothers how to take x amount of whole milk, y amount of sugar in some form, and z amount of water. (INSERT NOTE: My baby book lists Carnation evaporated milk and Karo corn syrup (high fructose corn syrup) as the ingredients for the "formula" the doctor gave my mother.) The amounts changed with the weight of the baby. Babies were fed by the numbers, so many minutes on each side every so many hours. Straying from the “scientific” road was frowned upon and not following the straight and narrow advised by paediatricians would lead to “spoiled” children and even, eventually, to juvenile court (this is not a joke, parents were told this by paediatricians). Mothers were strongly urged that even if they foolishly wanted to breastfeed instead of using the “scientific” milks, they should follow “scientific” guidelines.
Then it got better for a while, but only for a while. La Leche League and other mother to mother groups and many mothers realized themselves that feeding the baby when the baby wanted to feed made more sense than to let the baby cry for 30 or 60 minutes until the 3 or 4 hours had passed. And now we are back to “scientific” breastfeeding.
Numbers on demand in 2013
Although we no longer, usually, say to mothers to feed by the clock in the same was as before, we have too often only changed the way we say the same thing. For example, “Feed the baby on demand, but don’t let the baby go more than every 3 hours without feeding and make sure you don’t feed the baby more than every two hours, because your breasts won’t have filled up”. We also say such things as “make sure you feed the baby at least 20 minutes on each side so the baby gets the ‘hindmilk’”.
“Dehydration”
Now we have become panicked that breastfed babies become “dehydrated” and have imposed such rules as “the baby cannot lose more than 10% of his birth weight” (or 5% or 7%, take your choice since there is no evidence for any of the numbers). Basing whether a baby is breastfeeding well or not or is dehydrated on % weight loss makes no sense at all. First of all, in most hospitals, babies are weighed on two different scales. The birth weight is usually determined on a scale in delivery. The next weights are determined in postpartum. Scales can sometimes weigh differently. We have seen anywhere from 80 to 400 grams difference between two electronic scales. Even if a baby is weighed on the same scale, errors are often made in transcribing the weights to the baby’s medical record.
However, modern obstetrics usually fills women in labour up with very large amounts of intravenous fluids. Some of the fluid also goes to the baby so the baby is born “extra heavy” and loses extra weight after birth simply by peeing out the extra water and so the weight loss does not necessarily mean that the baby is getting dehydrated, only less overhydrated.
Even if % weight loss actually meant something, the approach should be to help the mother and baby breastfeed better. That’s not what is usually done; what is usually done is automatically to give the baby formula which I believe is a very wrong approach.
(This is added today --12/10/13 -- added for clarity. In an article in a pediatric journal published in December 2013, a group of "experts" now say that losing 5% in the first 24 hours was a marker for poor breastfeeding. I am shocked that someone could write and the journal could publish such an article.)
Pediatricians add their own numbers
Recently, pediatricians have decided that the serum sodium concentration tells us if the baby is dehydrated or not. If the serum sodium concentration is elevated, then the baby is dehydrated.
Nonsense! We don’t know what a normal serum sodium is in a 3 day old baby, say, who is breastfeeding well and exclusively, so how can we say what “elevated” means? After all, the exclusively breastfed newborn of three days is not getting large amounts of fluids as is a child of 1 year or an exclusively formula fed newborn of three days. The latter two might be expected to have “normal” serum sodiums, though I would argue that the exclusively formula fed newborn of 3 days is not feeding normally (they are getting too much) and thus cannot be used as the standard. Incidentally, it would be a very easy study to measure the serum sodium of 2 or 3 day old babies who are exclusively breastfeeding and see what the normal sodium is.
These are just a few of the absurdities dressed up as science with regard to breastfeeding in the year 2013. To the above I could add weighing babies before and after a feeding and many other bits of breastfeeding by the numbers. But don’t expect it to get better soon because the problems all stem from the fact that many, the majority I dare say, health professionals don’t have the faintest idea of what a good latch is or how to observe a baby at the breast and know if he is drinking well from the breast or not. If they did, we would be miles ahead. Don’t ask how many miles, please.
Videos showing babies drinking well at the breast or not drinking well can be found at at our website (click “online info”). The videos have explanatory texts in 13 different languages.
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