To think breastfeeding has made no difference to my dd and is massively overrated in terms of benefits?

[Placeanditspatrons]

I've nearly driven myself to a breakdown feeding my dd. She is 16 months now and I'm still feeding. She has been ill more times and worse than my formula fed from four months son. She does not recover any faster and she catches anything I get and gets it worse, despite supppsedly the antibodies passing to her and either preventing or reducing the severity of the illness.

I know it's anecdotal and the studies say overall bf babies are healthier but how much healthier? I mean I we talking one less cold? One less ear injection? Statistically? Many of my friends have said similar. Again anecdotal but I can't help wondering - after the colostrum which is more important I guess - does it really make any noticeable difference?

Janet - BF babies being admitted for dehydration and/or low blood sugar is pretty common.

Tiktok...how do you know this? Genuinely interested..

My feeling (with nothing to back it up) is that in Norway mums are more likely to continue BFing a bit if they start to use formula, whereas in the UK the prevailing opinion is that once you're onto formula, that's it, there's no point BFing.

Janet, yes the baby got colostrum. At least I assume so, because that's all I could express until day 8 or 9 when it started to look more like milk. This was presumably nowhere near enough (it was tiny volumes) because it was clear from his bloods that he was very dehydrated. The paeds in the hospital told me that this kind of readmission is fairly common.

Alyosha I think there could be some truth in that. All the HCPs talk about breastfeeding or formula feeding, but rarely anything in between.

Janet it's really not common at all. But out of all the reasons for readmission after discharge it's the commonest, iyswim.

I'm an experienced bf counsellor, and a researcher with a special interest in maternity care and infant feeding. My knowledge of Scandinavian bf goes back a long time, to personal contacts and members of my family, and some close friends and academic contacts who have shared research and experiences with me. I've never actually lived there or had a baby there myself.

Supplementing with formula in the early days is far from unknown there, but at levels way below the uk. I can't remember the figures but something like half of all uk bf babies have formula in the first week.

I don't know where the idea that there is 'no point' in bf if a baby has some formula. I do hear this as a myth, but I have never actually heard an hpc say it (though I am sure you'll get the odd badly trained or stupid one saying it) and there is certainly nothing in any guidance or policy I know of. It makes no sense whatsoever. Breastmilk still remains breastmilk, breastfeeding still remains breastfeeding.

Some mums I know have been completely brainwashed and go on about virgin gut. i am talking about mums who refuse medication they desperately need because it may or may not pass through breast milk.
So they will not give formula, will not take the medication and are stuck breastfeeding babies against medical advice because formula will damage the virgin gut.
I am not making this up.

"I know it's anecdotal and the studies say overall bf babies are healthier but how much healthier? I mean I we talking one less cold? One less ear injection? Statistically? "

I'm quite interested in this and after much reading and searching the literature, have not managed to come up with much in terms of absolute risk reductions. (Statistically, an absolute risk reduction, is like saying, if 1000 men smoked 20 a day for 20 years, 100 of them would get cancer. if the same 1000 men didn't smoke at all, 1 of them might get cancer. A relative risk reduction is like saying you are 100 times more likely to get cancer if you smoke 20 a day for 20 years). nb, I'm making the actual numbers up just to make the point. (The actual data are the same for both presentations, but this shows how the same numbers presented differently can mislead).

In bf world, the benefits are generally represented with relative statistics - eg, roughly the reduction in risk of otitis media, upper respiratory tract infection or diarrhoea is (eg, 40%, 50% or whatever, with a baby optimally BF as compared to never BF. Those are vaguely the ball parks presented in the Lancet paper recently published which summarised it all. ps I think those 40/50%'s were mainly for developing countries, but it might be poss to get the equiv stats for developed - there is a review of BF benefits in dev countries. I will check it when I have more time.

But that is all pretty meaningless - we know that Joe Public doesn't grasp relative stats and most statisticians don't either. But we can interpret absolute risk reductions more easily, but this way of presenting the data is almost never given for BF. It matters, so we know what we are talking about 40% OF.

(As folks say, establishing BF can be a lot of work for some mums, and you need something to weigh it up against. Many mums face structural barriers, particularly low income mums who need to get back to work earlier etc).

Incidentally, I suspect that a lot of folks think BF is worth achieving for some long term benefits - but the health effects are most strongly shown for things that affect baby during the period they are BF and not beyond (otitis media, URTI, diarrhoea), and the longer term effects that are looked at in various studies, are not shown yet definitively to be causally linked.

But, you know, ear infections and diarrhoea are a pain in the arse (or ear) and nice to avoid, if you can.

Sorry, I would have loved to actually get you the numbers, but I couldn't (I suspect they are in a critical paper I was trying to get hold of, but I can't get the full text).

If anyone else has them, whack em in here?!

so Placeanditspatrons - I am really sorry you have had a tough time. But as so many people have said, it is totally your decision and no one else's what you decide to do about feeding your baby... I hope you are able to make things more comfortable and happier for you whatever the decision is. In terms of stats... the best I can do is roughly the below, but all these are a bit debateable and will differ between what study you look at. I'm going off the AHRQ systematic review of effects of BF/FF in developed countries only, since the effects seen in developing countries are vastly more stark. It was done in 2007. I'm only listing the outcomes for the most strongly-proven effects in term babies, ie, reduction in risk of otitis media (ear infection), diarrhoea, upper respiratory tract infection. I'm using this because they gathered together all the evidence from all the studies, so it's not biased by the flaws of any one individual study, and as I say, they used data from only the developed world - so mainly relevant to the UK.

Basically - for

Otitis media: they say 44% of babies get this in their first year (seems ridiculously high to me!) - and they say the reduction in odds for exclusively BF babies (3-6months) versus exclusively formula fed, is about 50%. PS odds is sort of the same, but not quite, as "risk" or "chance". So you are going from a roughly 1 in 4 chance of OM with BF baby, to 1 in 2 chance with FF. (This stat I was the most skeptical about).

Diarrhoea: they say average child under 5 has about 1 case of diarrhoea a year. They say the reduction in odds for BF babies is around 50% as compared to formula fed. (not sure about their definitions of BF/FF on this one). So you are "saving" half a case of diarrhoea with BF.

Upper resp tract infections: they say 3% of babies get hospitalised with this every year. they say the reduction in chance of being hospitalised with an URTI is about 2/3 for a baby exclusively BF for 4-6mo compared with exclusive FF. So you might be talking about 1% of BF babies hosp with URTI vs 3% of FF babies hosp with URTI.

That is the best I can do.. these are super hard to get.

But what matters for you, is your decision on how all these things square up in your life.

Good work, BMP :)

Some of my current involves presenting stats in understandable ways. I agree 100 per cent that 'X per cent reduction/increase' is meaningless.

From memory, the Quigley et all Millennium cohort study does something similarly useful, working out how many hospitalisations would be avoided if more babies were BF.

URTI are really common - it's mainly bronchiolitis, I think. Just in personal experience I've known loads of babies who've needed hospital treatment. Having said that I think those figures are prob a little high. However, URTI and gastro show up, consistently, as measurably less common in BF babies in cohort studies even after controlling for background, in developed countries.

Tiktok - OK, it would be interesting to know if the Norwegians ever get dehydrated babies & how they avoid this with their predominantly BF culture. It would also be interesting to know how people collect the stats in both countries!

I also think you're being a touch disingenuous re: mix feeding.

The idea that FF and BF can't go together is widespread, and I think it comes down to the following reasons:

1. Women are told just one FF will knock out their supply.

2. Women are told just one FF will cause nipple confusion.

3. Women are told that only EBF is the best way, so one FF - and you've lost all the benefits of breastfeeding.

I have quite literally 0 evidence to back this up, but my feeling is that the pro-BF groups, in their ardour to help women EBF, are actually harming BF overall as they have made it sound as if formula passes the lips of your baby that's the death knell for effective BFing.

BMP - what about hospital admissions for dehydration/low blood sugar?

That is less common than the other things you mention but probably has a higher hospitalisaton rate iyswim.

I'm on a few sciencey health groups on Facebook and the general information shared there is that breastfeeding is massively overrated in terms of immunity benefits. I am much less militantly pro breastfeeding since reading many reliable studies that have been posted on them. (Although I am still exclusively breastfeeding my youngest as it's been really easy this time.)

Shemozzle...Interesting you say that, any particular studies that stand out?

You mention BF being easy, my personal opinion is that the most effective way to increase BF rates in the UK would be to have a campaign along the lines of "BFing for 4 months would save you £x, enough for a holiday to...". Or some kind of "always have your babies milk with you, at the perfect temperature" campaign, rather than focusing on the health benefits, which though real, are really very modest.

Many mums find BF much less faff than FF and does seem one of the main benefits (none of that sterlising malarky). And of course, it's free.

I found a few studies suggesting that the incidence of neonatal hypernatremic dehydration is around 1-2%.

This paper suggests it's about 1.8% of neonates, and lists the frequency of associated adverse outcomes in that study:

www.ncbi.nlm.nih.gov/pubmed/23823259

Medscape states that the incidence of breast-feeding related hypernatremia is 1-2% in the US.

emedicine.medscape.com/article/907653-overview#a6

Readmission for neonatal hypernatraemic dehydration is not common in the UK. When babies are readmitted after discharge, it's unusual - a study which I will link to, published in 2013 found the incidence was between 7 and 9 per 100,000. Don't use US stats - their postnatal care is truly terrible compared to ours.

The same report found babies recovered well and quickly - no sequelae at all. Again, we have good care in hospital and the community.

Any baby readmitted to hospital because of dehydration, or serious weight loss (where dehydration has not actually occurred but might if the baby was left untreated) , has not been transferring milk well.

Exclusive breastfeeding does not cause dehydration. It's inadequate intake - and the people whose job it is to spot this, to let the mother know how to spot it, have not been doing their job if it happens. Maybe it's tongue tie; maybe it's poor positioning; maybe it's infrequent feeding; maybe the mother's milk is slow to come in; maybe the baby just looks like he's feeding well and he isn't....whatever, the problem can be averted before it's a crisis, with good maternity care.

In Norway there is no reason at all to think their higher rates of excl BF would cause a problem - quite the opposite. When staff are trained to support BF properly, when they see it all the time, when they know what normal healthy BF looks like and what to expect, and when they can communicate the good signs to mothers, and when they know how to watch for things that are not right, they can fix it more quickly and more easily.

Alyosha, I am sure some women are told these stupid and incorrect things....but not routinely, and it's certainly not part of normal maternity care, where many MANY women are supplementing when still in hospital.

The 'virgin gut' is not a mainstream idea. I bet if you asked 100 women, only a handful would have even heard of it. There is evidence that the newborn gut is not well served by formula, and that supporting BF without supplementing is a good thing, but no one sensible thinks that this should be done at all costs, with the baby remaining undernourished and underhydrated and his mother suffering from mental ill health. Even the virgin gut theorists understand that the gut integrity can be restored anyway.

Mothers whose babies are not breastfeeding well can be helped in the very early days without needing to use formula, if early difficulties are spotted and addressed before they get worse.

Of course this needs access to good care and knowledgable help. I expect this is one of the differences between the UK and Norway.

fn.bmj.com/content/98/5/F384

Link to UK report on incidence and sequelae of readmission for neonatal dehydration.

Note: this is severe dehydration, diagnosed and measured. It was treated and there were no long term effects. Obv it is best avoided, but the idea that in the UK at least babies are at risk of terrible permanent damage appears false.

I think one of the worst effects are likely to be the fear and distress to the new family - avoidable if BF difficulties are nipped in the bud.

For those who said I am insane and imagining that flavors of formula cause taste preferences.

www.google.com.hk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=4&cad=rja&uact=8&ved=0ahUKEwimq6jYptXTAhUBXrwKHTPdDOoQFgg4MAM&url=http%3A%2F%2Fwww.mdpi.com%2F2072-6643%2F9%2F2%2F107%2Fpdf&usg=AFQjCNEgPo4y-m1zLJ1wpllb6IBI7kM94g&sig2=Qj-K-eAdeJZ-lFoLRBCZSg

"The early flavor experience of formula-fed infants is markedly different from that of breast-fed infants. Exclusively formula-fed children do not benefit from the ever-changing flavor profile of breast
milk. Their flavor experience is more monotone and lacks the flavors of the foods of the mother’s diet. There are striking differences in flavors among the different types of formulas and brands of
formulas, and formula-fed infants learn to prefer the flavors of the formula they are fed and foods containing these flavors [11]."

Tiktok you say URTI are commen. How in any stretch of the imagination is 3% common? That is a tiny percentage.

You then just brush off babies being admitted for dehydration etc as just best to be avoided. It is more than that,it's horrific. Have you seen a severely hydrated baby or had one taken off you,seen staff working on it's tiny body,sticking needles in,worried about impact on it's brain..... It's an awful lot more than "best to be avoided".

Newbian you sound deranged.

Tiktok -- the oddie study did not do long or medium term follow up as far as I can see. So we don't know what the long term outcomes of hypernatremic weight loss are. I've not seen a study looking at this. Study lookin at long term outcomes after hypoglycaemia does show poorer cognitive outcomes.

"Any baby readmitted... not transferring milk well". I had thought that mums with delayed onset lactation were predictive their babies needing readmission. And the % of dol has been reported as pretty high in some cohorts even with very good lactation support. It's a physiological process that just doesn't go well in some - particularly primips etc.

Personally I feel we should be more aware of this and more willing to support supplementing where a risk of dol and in the end this will actually support bf. This isn't really politically correct at the mo.

Virgin gut - not many mums think this way but I've heard this said and believed by many in bf support. Who then reflect that belief in management of mums and babies even if they don't say it explicitly to mums.

I think it's a bit odd to say that EBF doesn't cause dehydration.

It's like saying formula doesn't give babies tummy bugs.

obviously if that baby was being BF there's a lower likelihood it would have got ill.

Likewise with BF, if the babies hospitalised with dehydration and low blood sugar had been FF, they wouldn't have been hospitalised.

In terms of negative long term outcomes, the UK has paid out large sums of money to parents of babies with low blood sugar who either died or had brain damage: www.theguardian.com/society/2012/apr/09/nhs-blunders-babies-brain-damage

"Virgin gut"?

Hahahahahahahaha

What will these mums do when their toddlers start eating dirt, snails and play doh?

😂

...and glitter

Badders there is such a thing you are coming across as truly ignorant.

Toddler different to baby - that's why we don't introduce solid food to baby before 4-6 months - their guts can't handle it.