I think the BF / FF statistics could be wrong

[shirleyhyypia]

I completed a survey for the NHS recently on how DS is fed. He is exclusively BF, however the day he was born he had a 7ml syringe of formula, to help him settle, as he was sucking and sucking at my (actually rather copius) colostrum, but was still starving.

The survey asked if DS had EVER had formula, even if it was only once, and then went on to ask loads of questions, assuming he was still having it? There was a comments box where I explained, but I have a feeling that they will just look at the numbers and see that in the eyes of the survey he wasnt "exclusively" BF.

Obviously it doesnt actually matter to me, but I cant help but think that this may have something to do with why Britains BF numbers are so low???

I know FF is the trend anyway, just saying the figures might be a bit off.

Two friends had DSs at the same time as me, one BF for a few months (inc the odd bottle of F) and one FF from birth. The girl in the bed next to me in hospital BF but also gave her DS formula once (obv i dont know what happened when she went home

So even though 75% of us BF, 100% of us had given formula at some point.....
(and the OFFICIAL NHS survey doesnt distinguish between once and full blown mixed feeding)

I agree. I'm in Scotland and after 6-8 weeks no one bothers to ask any more. At the 6 week review I was mix feeding (one bottle overnight). By 12 weeks I was exclusively b/f again but the stats don't reflect that cos nobody's bothered to ask! DD's 6 months today and still breastfed.

That's a really interesting point, and I'd be curious to know how the figures are skewed if this is the case. As a layman, looking at your situation I'd still think you are in the exclusively breastfed category (I mean, 7ml???) - hell, not even as a layman, I'd say that surely common sense means that you are

Well I'm in the NE which has some of the worst (or the worst) rates, and yet my 6-8 week status wasn't even recorded. So I bet in the figures I am down as ff. No wonder they're low.

Mine wasn't recorded either and am in NE too.

The indicator used to be based on initiation but is now based on prevalence at 6-8wks

Totally agree, and often bring this up on threads when the stats are mentioned. Because the stats that are usually used are the exclusively BF ones, and as you say, they exclude loads of people who are actually BF. My DD1 had a sip of formula at about 5 weeks (she didn't ever have any more, she didn't like it) and I BF her until 14 months. But on exclusive BF stats she would not show up.

There is a link with the figs I'l find it for you now.

here scroll down to the bottom

Key facts include:

Key facts

• Initial breastfeeding rates in 2005 were 78 per cent in England, 70 per cent in Scotland, 67 per cent in Wales, and 63 per cent in Northern Ireland. In England and Wales, Scotland and Northern Ireland the incidence of breastfeeding increased between 2000 and 2005.

• In 2005, 48 per cent of all mothers in the United Kingdom were breastfeeding at six weeks, while 25 per cent were still breastfeeding at six months. Between 2000 and 2005 there was an increase in the prevalence of breastfeeding at all ages up to nine months in both England and Wales and Northern Ireland. The pattern of fall out was broadly similar across all countries.

• In 2005, 45 per cent of all mothers in the United Kingdom were breastfeeding exclusively at one week, while 21 per cent were feeding exclusively at six weeks. At four months the figure was 7 per cent while at six months the proportion of mothers who were breastfeeding exclusively was negligible (<1 per cent).

So when you look at the ex bf rates I think it gives an unduly gloomy picture of what's going on. At 6 months - it's the difference between negligible (no-one) and 1 in 4 mothers, which is a hugely different picture. The initiation rates also show that most mothers give it a try - I think the reason rates are low is down to lack of support rather than anything else. The focus on pre-natal education here is wrong I think - women have got the message, they just aren't getting the support to follow through on it.

Where do these figures come from? I think I was asked at ds's 8 week check but no one has asked me since. At his 8 week check I wasn't asked if he had ever been given formula either (he had), just if I was breastfeeding.

From that report

"The survey is based on a representative sample of mothers who were selected from all births registered during August and September 2005 in the United Kingdom. Three stages of data collection were conducted with Stage 1 being carried out when babies were around four to ten weeks old, Stage 2 when they were around four to six months old, and Stage 3 when they were around eight to ten months old. A total of 9,416 mothers completed and returned all three questionnaires."

There is a difference between exclusive bf and mixed feeding. The theory is that anything other than breastmilk in the first weeks or earliest months can permanently affect the lining of the gut. OTOH in mixed feeding any amount of bm is beneficial, so the degree of mixing is not seen as particularly relevant.

Unless however that survey is going to be followed up with further health surveys, I don't see how knowing about strictly exclusive bfing is going to be helpful. If you fill out an unrelated survey in, say, 20y time about how you fed your baby, you will almost certainly say 'exclusive bf', as that is what it felt like to you, and probably what you will remember.

I don't see the point in asking whether you are bfing in the check-ups. The info isn't recorded anywhere other than in the red books, which no HCPs look at after about 3y anyway. Nurses have been surprised when I brought the books along to record pre-school boosters!

What about giving medicines? Does that also mean you are no longer exclusively breastfeeding? Thinking of the impact of 7ml formula versus 7ml calpol.

So in a way if you give anything other than BM for any reason - a bit of formula, calpol, whatever, then you have ballsed it up on the BF front. Their stomachs may be knackered. I didn't know that. They certainly don't tell you that in the BF leaflets.

What do the changes to the lining of the gut do to the baby?

actually i thought that any "damage" done to the virgin gut would heal itself in a few weeks if the baby was then exclusively breastfed?

in any case, a baby given some formula and then EBF is far better off than a baby completely formula fed.
every single bit of breastmilk helps, so it certainly isn't a case of if you've given something you've ballsed it up

the benefits of breastmilk are far more than just gut-related :)

medicine apparently doesn't have the same effect because it's the enzymes or proteins or something in formula or whatever else that affets the gut lining.

basically when your baby is born it has a unique gut flora (good bacteria etc). it thrives on breastmilk and forms a "lining" in the gut, stopping anything that shouldn't be there from passing through. I believe this is why breastfed babies are less likely to suffer from allergies for example

formula does the opposite. the bacteria in the gut will be altered dramatically, and the "lining" damaged allowing things to pass into the bloodstream.

btw, to answer the OP. I do see your point, but am not sure it's relevant

exclusive breastfeeding is just that! you can't say well i DID ebf, he only had a bit of formula. exclusive is exclusive

i agree that it's very different to mixed feeding on a lengthy basis, and perhaps the surveys need to be altered to change that.

but as it stands I think they are right to say that however much formula (or anything else) a baby has had it is NOT exclusively breastfed

there's a bit here in regard to starting solids, which explains the open gut thing and has links to the virgin gut

kellymom

Well the gut related thing sounds pretty concerning.

Would be good to know more about the damage done. One sip of formula FFS, I don't even know if she took any, she never had any again. Why the hell don't they tell you about the damage when they do the mountains of BF info at hospital? They all said "breast is best" but no-one pointed out that any formula whatsoever would damage the baby's gut.

thisisyesterday are you saying that babies who have had anything other than BM at all before 6 months are open to all of the risks that they list on that page?

well, the page i linked to was mainly in regard to starting solids, rather than having small amounts of formula, but it had a good diagram!

I suspect as with anything, the amount and frequency plays a huge part. I think if you read the article linked to, on the virgin gut, it does say that it would repair itself if the baby then was exclusively breastfed

so personally I wouldn't worry about a very small amount of formula very early on. I think the risks get higher if other substances are given regularly. and I presume (and this is only a presumption) that real foods would be different to formula only in as much as formula has been made easier to digest etc

So we're looking at:

• Immune system compromised
• Increased likelihood of allergies including anaphylaxis
• Increased likelihood of anaemia
• Increased body weight and fat (obesity) in later life

They really need to be telling women at ante-natal classes this.

There are official definitions, which well-organised surveys should follow.

Exclusive breastfeeding means just that - but medicines are not part of this so a baby who had nothing but breastmilk and he had medication would still be excl bf.

OP - of course 7 mls is not significant, but for survey purposes, you have to go down as not exclusive. In survey terms, your baby would be 'predomninantly' breastfed.

The surveys have to be collected like this, with consistent definitions, so comparisons can be made year on year and from region to region and country to country.

Who on earth is saying babies' stomachs are 'knackered' if they have medicine, or even a small amount of formula, and not excl bf?

The stats in the big Infant Feeding survey incl excl bf and any breastfeeding, as should most studies (I cant think of any that don't collect 'any breastfeeding'). This survey does not collect every bf experience - I think it's about 10,000 every five years, so the vast majority of people will not be surveyed.

PCTs are supposed to collect their own local figures via health visitor/GP returns but not everywhere is efficient at this.

The Infant Feeding survey collects the stats for formula given to bf babies in the maternity unit. This is an important figure to know about as mothers are in hospital for such a short time, and there is rarely any sound reason for supplementing with formula at this time - a high figure for hospital supplementation would suggest very poor bf support, and a figure that was dropping over the years would suggest maternity units are getting better at supporting bf.

Thisisyesterday is right, the damage may not be permanent and that it is mostly the protein content of non-bm that may affect the gut lining. I meant that the damage may be permanent as long as the baby is being given formula and has no period of exclusive bm.

Also, please bear in mind that 'damage' is a big scary word. 7ml of formula is not ripping holes in a newborn's gut. It may remove or change some of the mucus that lines a baby's delicate gut, thus letting the proteins come into contact with the gut wall itself, which at this stage is slightly porous, so non-human proteins may pass through it and may affect the baby now or in the future by being where they shouldn't be.

That's a lot of 'may's. There are still strictly ebf'd babies who develop allergies/diabetes/obesity/gastric illnesses, and fff'd babies who go on to be robustly healthy individuals with none of the above conditions. It's about an overall picture, rather than an individual prescription.

Absolutely, prettycandles. I really dislike this 'virgin gut' thing. Even a small amount of formula will affect the gut, but only a tiny number of susceptible babies will have long lasting effects.

Exclusive breastfeeding is the normal, physiological nutrition for young babies. Anything else should never be given casually or unthinkingly, and exclusive breastfeeding should be supported and enabled by all HCPs (not actively undermined and sabotaged as it is by some of them :( )

But if formula has been given already, for whatever reason, breastfeeding is a great way to repair any effects...and we can all move on!

prettycandles mentioned permanent adverse changes to the baby's gut.

So now the message is that damage may not be permanent, but of course it may be permanent, and how can anyone tell which baby is damaged and which is not.

Please can someone confirm whether the risks I listed are the correct ones, and whether there are any additional ones.

i think the question raised by that 7mls of formula is why were you advised to give it when BF was going well?

ISNT - I was a bit more emphatic than I should have been. AFAIK there is no absolute, incontrovertible proof for these statements. (And I do wonder how they could be proven, anyway. Gut biopsies on newborns? I doubt that would be given ethical approval or that any mother would give permission!)

They are theories based on current knowledge.

The only incontrovertible evidence AFAIK - Tiktok is the expert - is that overall health throughout life is better in breastfed babies than in formula-fed babies.ISNT - I was a bit more emphatic than I should have been. AFAIK there is no absolute, incontrovertible proof for these statements. (And I do wonder how they could be proven, anyway. Gut biopsies on newborns? I doubt that would be given ethical approval or that any mother would give permission!)

They are theories based on current knowledge.

The only incontrovertible evidence AFAIK - Tiktok is the expert - is that overall health throughout life is better in breastfed babies than in formula-fed babies.