Anyone tried scheduled as opposed to demand breastfeeding?

[jasper]

It seems most current experts on breastfeeding support demand feeding.
I consider myself to have been something of a failure on the breastfeeding front with my first two. The details are unimportant, but briefly, they would both suck for hours on end, I never once had the sensation of fullness in the breasts, never felt my milk " come in", never leaked...And this was with the most wonderful support from midwives and breastfeeding counsellors...Anyway I lasted about six weeks with number one, less with number two.This has made me wonder if perhaps demand feeding might work out where demand feeding had failed for certain mothers, eg. me.
I recently read Gina Ford's book with interest. She suggests scheduled feeding ( I think three hourly at first). I really do not want to open up the whole breastfeeding debate as I am sure demand feeding is best in some way, but having failed twice I really would like to hear from anyone who has succeded with scheduled breastfeeds where demand feeding failed.
Please don't suggest ways of making demand feeding work!

honeybunny - 20 weeks is quite a long time. Many women only b/feed for about 4 months anyway. Sounds like you never really got off to a good start and got your supply going. I'd have to know more about your difficulities and in any case I am not qualified. Hopefully as you say the experience and the knowledge you have gained since then will mean better luck next time.

Sorry, Robin, I am not sure what you are getting at. I did read that bit of the study, and yes, the mothers mainly intended not to bf exclusively - probably the same as mothers here. I don't think their intention is relevant to the outcome. The more quickly they introduced water and/or 'tea', the more quickly they introduced formula, and the less time they bf. It's been conceded here that measuring pacifier use and linking it to length of exclusive bf is problematic. The study, interestingly, raises yet another variable - the intensity of pacifier use, and whether or not the mothers had support for bf, and whether they had bf before.

The Sri Lankan study shows, once more, that babies do not actually need water. I have never labelled giving water as 'damaging' as a 'fact' . However, the research is clear - that bf is most likely to succeed when it is done on cue, as long as the feeding is effective, that is, the baby is suckling in a way that allows sufficient milk to be transferred from mother to baby.

I think we need to look at dummy use and bottles of anything as interventions in this process, and therefore the onus on people arguing for the intervention is to show that it does no harm. If bottles of anything are used to 'test' the baby, to see if he is 'really' hungry or not, then if this is to be put forward as a suggestion, it has to be demonstrably without risk.

Individual mothers and babies can do what they like, of course, and if they find that 'testing' the baby for hunger like this is useful to them, and that it doesn't have an impact on their bf experience, then they will continue to do it. But in the absence of research to show it positively supports bf, then it is best to think of it as an intervention in a process we know works best, for most, being allowed to happen on cue.

I looked at that article again robinw ? it doesn?t actually state that these women were using a dummy because they had decided to stop breastfeeding. (sorry I am repeating your comments tiktok). It says they are using the dummy to delay contact with the breast - ?a considerable group effectively used pacifiers to get their infants off the breast or to increase the interval between feedings? ? they did however recognise that this might shorten breastfeeding ? ie it was a consequence of pacifier user. It didn?t say they were deliberately trying to stop breastfeeding. Also I don?t think the study did actually strongly indicate cause and effect. Indeed this was examined but it was actually the ethnographic studies that revealed the more complex use of the dummy. I don?t think it is possible to look for cause and effect in the rigid way you would like in a complex process like breastfeeding. And in fact this study shows that a variety of research methods are necessary -?The combination of epidemiologic and ethnographic methods was essential for understanding the complex relations between pacifier use and breastfeeding.? Why do you think that studies that show cause and effect, i.e. are perhaps more ?scientific?/factual? or using quantitative methods are ?better? anyway? Is there no place for qualitative data in your opinion?

You say that you are looking for ?a good indication of what someone wishing to keep breastfeeding but exhausted by constant feeding will do?. Fair enough but that doesn?t mean that the studies you have quoted have no use ? no use to you perhaps in this specific context but they do indicate that dummies lead to problems with breastfeeding, and perhaps it may stop someone using one to ?solve? the problem of constant feeding. We have to remember that there is always a lack of funding for research and the few funds that are allocated have to be towards something worthwhile. I am sure that if it had been observed that a dummy had helped a mother with constant feeding difficulties then more research would have been carried out. It may just be the case that in light of these studies (and I am sure a lot of anecdotal evidence from health professionals) that dummies don?t solve breastfeeding difficulties and indeed may contribute towards them. It does make sense that what is going to solve a breastfeeding problem is the breast itself not a substitute and this is probably why research goes into the breastfeeding process itself rather than looking for solutions that don?t exist. (again similar comments to tiktok)

message withdrawn

No, Robin, that study is the ONS survey, and it looked at breastfed babies.....not babies who were bottle fed anyway. The ONS quinquennial survey shows that giving a bottle or bottles to a breastfed baby is associated with shortening the duration of breastfeeding. If you can get hold of the printed copy of the survey, the table and discussion is on page 57. 'One third of moters whose babies had been given a bottle [in hospital] had stopped bf at this stage [2 weeks] compared with 11 per cent of mothers whose babies had not been given a bottle.' This means that a breastfed baby who is given a bottle in hospital is three times more likely to not be having any breastmilk at all by 2 wks. This is not clear-cut cause and effect - as the survey says, 'this might reflect the proportion of women who are already having difficulties breastfeeding.' But the strong association is there, and it behoves supporters and professionals to be aware of it - the research that shows when bf is most likely to succeed and the physiological knowledge we have that effective sucking promotes good growth and good milk supply, should back up encouragement for exclusive bf.

No one should promote an intervention without being sure the intervention is safe - it is not up to research to prove the intervention is harmful before it is accepted as not desirable. I mean, I could say babies are best off on a diet of mashed potato alongside breastmilk from day 1. Many babies could have this without obvious harm, in fact. Are you then saying we need to have studies to prove it's not harmful?

Mothers who feel pressured because of frequent feeding and want to space out the feeds need a lot of support and info

• they need to know that frequent feeds are normal - most adults have something in their mouths every couple of hours!

• they need to know feeding is effective - correcting the positjining and attachment can make feeds more satisfying and often shorter and less frequent

• they need to know frequent feeding may not last

they need to know that if they give a dummy or water they may* be affecting their long-term bf....not that they will, but that they may

Still going? Eulalia the reason I said some studies are unethical is that they leap to conclusions not justified by the evidence. When you observe an association between two events it is not proof that one causes the other. In a well designed study you first identify what factors are known to influence the outcome (or may reasonably be expected to do so) and attempt to allow for/ adjust for them. If you are unable to do this then you must be cautious about what you have observed until better studies can be undertaken. Many medical studies are undertaken by people with minimal training in statistics and provide excellent examples of how not to conduct a trial. Medical journals are improving in what they include but there is still a lot published that is misleading.

As I have PCOS I am quite interested in research on the composition of breast milk and how that affects success. There isn't much of it. I have learnt that diabetics often have delayed lactation and that insulin levels in breastmilk affect intestinal maturation. It is possible to control insulin levels in adults by eating the right type of diet. It is possible that eating a diet which stabilises insulin levels would affect breastmilk. Since I know from the diet threads Jasper has lost weight on a low carbohydrate diet she might find eating low GI foods would improve her chances of breastfeeding. Eating every couple of hours may not be "normal" but a reaction to fluctuating insulin levels.

wendym- it's a good theory. As I've said on another thread I have insulin problems and my breastfed baby spent months with a 1 hour gap between feeds during the day and a maximum of 4 hours at night, average of 2 hours.
He refused bottles for a long time so continued to bf until he was 6 months, but I wanted to give up just because I was so tired!
If I have another I'll try to keep my food choices under control.

Jasper - I've been away, but going back to your original question, I did do a "sort of" scheduled feeding routine for ds when he was very young. This was at the recommendation of the midwife at the bf support group run by the maternity hospital as he was slow to gain weight. (Another example of "all babies are different"!).

Ds's "problem" was that he was slow to feed and also very sleepy (he'd had jaundice and light therapy in the first couple of days), so from 2 weeks, I was encourage to feed him every 2 hours during the day/3 hours at night, waking him if necessary (which I usually had to, especially at night). (The length of time gradually increased, and I have to admit that when the midwife said 3 hours at night, it tended to be closer to 4, 4 hours tended to be 5 and at 5 hours I just gave him a feed at around midnight and let him sleep through if he wanted to - this was at about 8 weeks). I was also encouraged to express (they lent me an electric pump to get started) and give him EBM, initially just as top-ups and for a while (as he continued to only gain weight extremely slowly) for every second feed.

Without wishing to open up a whole new debate(!), the midwife said that giving him the EBM would HELP ds to suck more productively! (My theory is that ds was a quick learner and had learnt that provided he used the "right" sucking motion - ie his jaw moving all the way up to his ear - then the "hassle" of cold cotton wool balls, water in the ears etc to encourage him to stay awake would stop! The problem was he wasn't actually swallowing anything).

He continued to gain weight extremly slowly till about 4 months or so (when I introduced solids). But he was NOT a "failure to thrive" - he was seen by the consultant paediatrician and it was patently obvious to everyone who saw him that he was thriving - happy, alert & contented. Every baby is different - as has been said before - and he was following his OWN growth curve, albeit a very flat one! And I knew from the EBM he was having that he was getting plenty from me. I continued to b/f for a full year, before gradually weaning on to milk. (and he is now cheery 17 month old, small in height/length, but on about the 40th centile for weight - not sure, as I no longer get him weighed!)

For me it helped that I was determined NOT to give him formula - but that was me. I DID give him a dummy after about 3 weeks, but only for very short periods, as he was keen on comfort sucking and it did give me some time in between feeding him and expressing! (he would sometimes take 40 minutes a side and want both sides,so there were times when it felt like I'd only just finished the last feed when the next one was due!). I also stopped the dummy when he was about 6 months old.

I know you're West of Scotland, but not sure which hospital you'll be delivering in - but the bf support group at the Queen Mum's is fantastic. I can't recommend it highly enough. (You don't have to delivered there to go to it). It's on a Thursday afternoon, about 1.30 to 3.30, in North Wing. The 2 midwives who run it are both very supportive and not at all dogmatic - if mixed feeding is what works for you, then that is better than no bf at all. And also you get support, advice and friendship from the other mums who go along - a bit like Mumsnet!

I've typed this offline so sorry again if I have repeated any of your comments tiktok as we seem to think along the same lines!

robin w - All mothers who try breastfeeding intend to breastfeed ? self evident isn?t it? If they decide to give up breastfeeding and want to use dummies/water then that is irrelevant to this issue and indeed would spoil any research that was done because the mother would be using other means such as giving formula for example. It is taken as read that we are discussing mothers who want to breastfeed. (And no those b/feeding studies where bottles are introduced don?t include bottle fed babies ? that is just patently silly. They want to look at the effect of bottles to breastfed babies.)

You say that none of the studies show ?damage? but it is unlikely that they would anyway. As I believe tiktok pointed out earlier ? no one is going to carry out a study that would potentially damage small children!

I am not sure what you mean by the term ?damage? anyway. What kind of damage to you expect? Something like a dummy wouldn?t of course cause immediate damage as any problems related to it tend to occur over a long time period ? perhaps even years (eg malocclusion for example). A bottle of water in itself is of course completely harmless but again if consistently administered instead of food then the baby would fail to gain adequate weight. No-one would attempt to research this and in any case it is so glaringly obvious that it would be a waste of time.

Using a dummy/bottle ?once? would obviously not show damage in an immediate sense. Therefore we have to look over a longer time period at say ?occasional use? And so how can one adequately determine when it is safe to adopt occasional use? For example a newborn needs to feed around every 3 hours and this is also necessary for the mother to keep her supply going. Missing even one feed (and hence the baby going say 4-5 hours without food) and replacing it with something artificial in the early weeks can interrupt the b/feeding process and cause problems with milk supply. This is simply because the mother?s body doesn?t have the sucking action (it is directed towards the artificial object). Again the ?damage? isn?t immediate but the whole effect is pervasive and eventually leads to the mother having an inadequate supply of milk and hence is likely to give up breastfeeding. You cannot find immediate damage in the sense you appear to be looking for simply because the effects are cumulative.

So dummies/water aren?t intrinsically damaging but used in conjunction with the early part of breastfeeding they tend to be. Once breastfeeding is established then I am sure they are absolutely fine. The baby is feeding more regularly and supply is established. However this wouldn?t address your original problem of using an artificial agent for soothing a constant feeder. There may just simply be no alternative for this kind of baby ? I am sure if someone had invented something to keep young babies quiet then we would all know about it! The studies show a difference between b/feeding mothers who exclusively b/feed and those who introduce something artificial ? therefore it is obvious that the artificial device has caused the problem or damage if you want to use that term.

To conclude: a dummy/water may cause damage to the breastfeeding process if it is administered to the extent where it would interrupt feeds and the stimulation of milk supply. If it DID not interrupt this process then they would be ?safe? to use. However as it is extremely difficult for a mother to judge when her supply DOESN?T need to be stimulated and/or the baby is hungry it is generally regarded that using dummy/water is risky and should be avoided in the first few weeks.

dm2 - I'm interested to hear from someone who's diabetic, didn't see the other thread. You may not know that women with PCOS are often insulin resistant. We have a higher risk of developing diabetes. (Just thought I'd explain my interest in food with low glycaemic indices and its possible influence on breastfeeding frequency.) I've also been through the frequent feeds so I understand why so many women give up breastfeeding.

dm2's and janz's stories are great examples of how decent knowledge of how bf works, a good source of informed support, and a motivated mother can overcome difficulties, and achieve her feeding goals. Yes, Janz, sometimes EBM can be really helpful with a baby who is gaining weight so s...l...o...w...l....y that there is concern....you get the calories in the baby in the EBM, and this aims to prevent the sleepy baby sleeping because he doesn't have the energy to wake and ask for feeds.

Wendy is right in stating that some bf research needs to be viewed critically, but there is a growing body of excellent stuff, which is perfectly respectable, and controls for all the variables. If you have a big enough sample, you can do this. There is a good overview of this in the current issue of Community Practitioner, which says 'although it has been suggested that these differences [in health and neurodevelopment] are related to confounding co-variables such as sociao-economic status or maternal education, several longitudinal studies of large (n>700) general child samples have shown that the apparent benefits of bf are resiliant to control for confounding.' There are 19 refs in this paper.

I also think it's helpful to remember that a baby normally doubles his body weight in about five months . If an adult had to do this for some reason (!), what would he/she do? Eat often/eat at night/ avoid drinking water instead of eating/make eating pleasurable....a bit like breastfeeding in those early months!!

Wendym - I'm another PCOS not diabetic - sorry!

I've typed this offline so sorry again if I have repeated any of your comments tiktok as we seem to think along the same lines!

robin w - All mothers who try breastfeeding intend to breastfeed ? self evident isn?t it? If they decide to give up breastfeeding and want to use dummies/water then that is irrelevant to this issue and indeed would spoil any research that was done because the mother would be using other means such as giving formula for example. It is taken as read that we are discussing mothers who want to breastfeed. (And no those b/feeding studies where bottles are introduced don?t include bottle fed babies ? that is just patently silly. They want to look at the effect of bottles to breastfed babies.)

You say that none of the studies show ?damage? but it is unlikely that they would anyway. As I believe tiktok pointed out earlier ? no one is going to carry out a study that would potentially damage small children!

I am not sure what you mean by the term ?damage? anyway. What kind of damage to you expect? Something like a dummy wouldn?t of course cause immediate damage as any problems related to it tend to occur over a long time period ? perhaps even years (eg malocclusion for example). A bottle of water in itself is of course completely harmless but again if consistently administered instead of food then the baby would fail to gain adequate weight. No-one would attempt to research this and in any case it is so glaringly obvious that it would be a waste of time.

Using a dummy/bottle ?once? would obviously not show damage in an immediate sense. Therefore we have to look over a longer time period at say ?occasional use? And so how can one adequately determine when it is safe to adopt occasional use? For example a newborn needs to feed around every 3 hours and this is also necessary for the mother to keep her supply going. Missing even one feed (and hence the baby going say 4-5 hours without food) and replacing it with something artificial in the early weeks can interrupt the b/feeding process and cause problems with milk supply. This is simply because the mother?s body doesn?t have the sucking action (it is directed towards the artificial object). Again the ?damage? isn?t immediate but the whole effect is pervasive and eventually leads to the mother having an inadequate supply of milk and hence is likely to give up breastfeeding. You cannot find immediate damage in the sense you appear to be looking for simply because the effects are cumulative.

So dummies/water aren?t intrinsically damaging but used in conjunction with the early part of breastfeeding they tend to be. Once breastfeeding is established then I am sure they are absolutely fine. The baby is feeding more regularly and supply is established. However this wouldn?t address your original problem of using an artificial agent for soothing a constant feeder. There may just simply be no alternative for this kind of baby ? I am sure if someone had invented something to keep young babies quiet then we would all know about it! The studies show a difference between b/feeding mothers who exclusively b/feed and those who introduce something artificial ? therefore it is obvious that the artificial device has caused the problem or damage if you want to use that term.

To conclude: a dummy/water may cause damage to the breastfeeding process if it is administered to the extent where it would interrupt feeds and the stimulation of milk supply. If it DID not interrupt this process then they would be ?safe? to use. However as it is extremely difficult for a mother to judge when her supply DOESN?T need to be stimulated and/or the baby is hungry it is generally regarded that using dummy/water is risky and should be avoided in the first few weeks.

Sorry about the repeated post - I hit 'refresh' on the computer and it posted the entire message again.

Wendym ? it is difficult for me to comment without seeing an example of a piece of research which you feel is unethical. It is rather damming though to say that some studies ?leap to conclusions? ? I have tended to find the opposite and in their summing up many authors use terms like ?this MAY cause/affect X or Y? and they often say things like more research is needed before an adequate conclusion can be reached. I do know all about how a well designed study should be carried out (having worked as a researcher myself!). Anyone with a higher degree (and generally speaking someone with at least a doctorate would only be able to publish) would have been taught the basic components of research methods. There is of course more to a good study than training in statistics as much research involves both qualitative and quantitative data. However I am probably also telling you things that you know already. There are obviously some studies which are better than others and there is always room for improvement but to say studies are ?unethical? is perhaps a little strong (after all a poorly designed study doesn?t cause anyone any harm ? it is probably at worst just a waste of time (and taxpayers money!).

Thanks JanZ. Yours is what I call a breastfeeding success story.
Good to hear favourable reports of the Queen Mums. My local hospital is Ayrshire central in Irvine and the support I received both from them and the local community midwives and HVs was wonderful.
Regards the water/dummy debate. I am a little lost here. The subject was raised as part of my original query and admission I had not done very well at bf. In reply RobinW said one "tip" which had worked for her and her baby was to give the occasional bottle of water. The important words were this had worked FOR HER snd therefore might be worth bearing in mind as something I might like to try.( and I intend to if necessary) If the suggestion had been to crush up custard creams in a bottle of cows milk or to mix a drop of vodka with expressed milk I would not have given that a try.( but then again...)
RobinW was not trying to rewrite the textbooks on establishing breastfeeding so I am at something of a loss as to why some of you are so keen to discredit her suggestion.It was just a suggestion from a fellow mum who had experienced difficulties with bf, and not an intuitively ridiculous suggestion by any means.
Also, Eulalia, with the greatest of respect, WendyMs comments on research trials is 100% correct. Many studies do indeed "leap to conclusions" not justified by the results.And these definately can and do cause damage.
Most pieces of research start with a hypothesis, which the research study is set up to try to prove. In a good study the design should not prejudice the outcome.Few studies set up a set of variables with the idea of " I wonder what will happen if..." - no, they have an idea that "I think such and such will happen and I will carry out a study to see if I can prove it".
Even more sisister is when results are deliberately massaged ( for example by leaving out certain results which don't support the hypothesis)to produce the result you are after. I have seen this happen first hand .
I don't mean to open up the MMR debate but it serves as an excellent example. If Andrew whatshisname's original research alleging the link with autism/crohns is as a result of a study which is methodologically flawed, as his critics say it is, think of the untold damage that has caused. If he was completely discredited, that would still never wipe out the "take home message " of his original paper, which was that MMR might damage children.This is what has percolated into the minds of many parents no matter what happens in the future. Even if he was to stand up and say "I faked the entire study, please strike me off the medical register" you still could not wipe out the notion from many peoples minds.
Remember I am using this as a hypothetical example, and not to open the MMR debate which I think the media are doing a great job of making a mess of!

Jasper - regarding research - as I say I'd have to see examples of said bad research. You state "Most pieces of research start with a hypothesis" - well not strictly true - anthropological research for example doesn't. Often this type of research starts with virtually nothing and employs a method known as 'emergent research theory' ... however I won't bore you with research methodology ... perhaps you/wendy were speaking only of medical research. However sometimes a hypothesis is the only thing that anyone can start with but enough said on this ...

Jasper - but it was robinw herself who wanted to know if it would be damaging for a baby to have water. We all know that it wouldn't hurt a baby to have an occasional bottle of water. robinw wanted proper research results on this and clearly research wouldn't be done on 'occasional bottles of water'. The debate thus became a discussion upon the merits/usefulness of research into widespread use of water and/or dummies.

I think I?ve about exhausted this subject but it seems that some, particularly robin seem to be starting from the position that it is intrinsically wrong/abnormal for a baby to want to suck a lot and that if the baby isn?t hungry then his sucking signals are ?false? or wrong and should or could be assuaged by something that is also false/artificial. In many societies frequent feeding is regarded as totally normal - babies are ?worn? next to the mother and they latch on and off as often as every 45 mins, rarely cry and don?t suck their thumbs.

Also as tiktok indicated it is not possible to separate hunger and comfort. Can we even do this as adults? We all enjoy eating and it is impossible to separate your enjoyment of the taste/sensation of eating from its strict nutritional benefits. Of course we have to learn not to comfort eat but you can?t expect this from a newborn. Therefore when a baby is feeding it is experiencing both pleasure and nutrition simultaneously. Interestingly breast fed babies rarely suffer from obesity despite their constant feeding they seem able to regulate their calorie intake to what they need (whereas bottle fed ones can be overfed).

To finish ? I don?t see how water or dummies can adequately work. If it were possible to determine that the baby was only hungry then he would still cry with a dummy and water would only delay the hunger pangs for a short time (and involve more work preparing and feeding the water in the first place). If he wanted comfort then it is hard to see how a bottle of water could work. What comfort can be gained from drinking water? Would you be happy being comforted with a glass of water! Also is a piece of cold silicone really comforting? Giving a dummy often involves much soothing of the baby at the same time (again just a lot more work). Why faff around and just use what nature provided - your breasts and avoid the potential problems that can arise with dummies (attract germs, baby becomes too attached to them, prevent communication etc etc) not to mention the already discussed effects upon breastfeeding as a whole.

Eulalia and Tiktok, thank you for all this incredibly interesting information, which mirrors my instincts about breastfeeding. Breastfeeding was as much about comfort as nutrition, for me, and one of the things that kept me going was the simplicity of being able to instantly comfort my baby. I couldn't imagine any other way that didn't involve a lot more effort.

Eulalia You worked as a researcher, you said - may I ask what training you had? The average medical researcher has a fairly short training in statistics - enough to learn how to use a statistical package but sadly not always enough to do so correctly. My training in statistics was considerably longer and at one time part of my duties involved commenting on whether research studies had been properly performed/ suggesting improved analyses of the data. I have personally had problems with researchers wanting to withhold part of the data because it did not fit their hypothesis. One in particular involved two extremely well qualifed and well respected doctors. To protect my own reputation I refused to have my name on the study until the statistical analyses were altered.

As for the studies on pacifiers - early studies of nonnutritive sucking suggested that it had beneficial effects for babies. Neeley CA, Effects of non nutritive sucking upon the arousal of the newborn showed that babies who sucked pacifiers were more alert and less irritable. Babies clearly suck for reasons other than nutrition since a fetus can be observed to suck and some babies suck their thumbs. The Swedish study showed no effect on breastfeeding from babies sucking their thumbs or from those where pacifier use had stopped by two months. Kramer MS in pacifier use, early weaning and cry/fuss behaviour showed that the observed high level of pacifier use in those ceasing to breastfeed disappeared when randomisation was used. The authors suggest that pacifier use was a marker of breastfeeding difficulties rather than a cause of them. There is not good evidence that use of a pacifier causes a reduced duration of breastfeeding. There is some evidence to suggest it has no effect.

Why do women cease to brestfeed? The reasons given frequently include that they were concerned about their milk supply, that the baby was always hungry and/or their nipples were sore. They may also have problems with tiredness and the needs of other family members. Women are told that frequent nursing is the way in which a baby builds up their milk supply. Therefore if they have a frequent feeder they may doubt the adequacy of their supply and cease feeding. If these mothers are encouraged to express milk after feeding they may find the supply is perfectly adequate and the baby was sucking for comfort. If comfort can be provided in other ways tiredness and nipple soreness can be reduced, the mother can attend to other children and the mother may continue feeding. Only a mother can breastfeed, other family members can be enlisted to comfort a baby who does not need a feed. In my experience a baby who is hungry will very rapidly reject a pacifier, a baby seeking comfort may not.

I realise that there are occasions when frequent feeding may be necessary to build up milk supply. There are also times when frequent sucking is not necessary to build up a supply. While some mothers may be happy with a baby permanently attched to their breast it discourages many mothers from breastfeeding. It is then in the long term interest of the baby to find an alternative that will encourage the mother to continue to feed. By arguing that pacifiers are best avoided you and tiktok may be reducing the duration of breastfeeding in mothers who simply need some reassurance that their supply is not inadequate. Expressing milk after feeding could either provide that reassurance or indicate that frequent feeding was necessary.

But I don't say that pacifiers are always best avoided - though I think we have enough evidence about how bf is likely to succeed to feel their use in the very early days isn't helpful, and with babies who are failing to thrive, we also know enough about sucking need to suggest that the mother reduce the use of the dummy and use the baby's sucking propensity at the breast.

I agree that sometimes, constant feeding is wearing to mothers. It's up to a supporter to work with the mother through this, and offering other forms of comfort (maybe via other people) may well help a mother continue to bf. I can assure you, I have talked with many mothers about this - sometimes the other comfort can come from a partner, or a grandmother, or a ride in the pram or the car, or yes, a dummy. If the baby is thriving and the milk supply is fine, then it is on a range of options.

But what good will expressing do (apart from providing milk for later use)? You may not be aware that expressing does not necessarily give an indication of what the mother can produce, or, crucially, what her baby can take. Expressing and pumping techniques differ in efficiency. The baby may be better than the pump at stimulating and taking milk. Conversely, a baby who is not sucking effectively may not be as 'good' as the pump.

What are you suggesting mothers look for when they express?

Wendym ? no-one has said that dummies and also thumbs which are included in ?non-nutritive? sucking (and indeed confusingly sucking at the breast is also included in this term) or any kind of sucking per se that is non nutritional is a problem IN ITSELF and if a dummy does pacify or comfort a baby then yes that is good. However if it interferes with his nutritional intake then that is not good.

I have found studies that have shown if a baby is given a pacifier when it is being given a heel prick for example then it is less distressed but this is just in a specific situation. Sometimes a child is given a sweet just after an injection but that doesn?t mean that sweets should frequently be given. As we all know life is not that simple and yes indeed pacifiers have their place and it is generally regarded that they are ?safe? after breastfeeding is established.

The discussion here was regarding replacing a dummy (and water) with frequent feedings at the breast. As frequent feedings take place in the early weeks and are usually as a result of the baby being hungry it makes sense for the mother to try to feed as much as possible and not run the risk of providing enough for the baby and/or establishing her milk supply. You state ?In my experience a baby who is hungry will very rapidly reject a pacifier? ? not true as not all babies cry when they need food ? some are very sleepy. Young babies can be difficult to read and a pacifier just complicates the messages that the baby provides. And my baby rejected a pacifier whether he was hungry or not! Conversely some may suck for awhile even though they really want something to eat (like the way chewing gum can keep your hunger at bay for awhile).

Of course there isn?t a clear cut causal effect of dummies=no breastfeeding. As indeed you state ?The authors suggest that pacifier use was a marker of breastfeeding difficulties rather than a cause of them? Yes indeed the dummies don?t directly relate to the breastfeeding difficulties because it is for example a reduced milk supply which is ACTUALLY the problem. But the fact is that it could be the overuse of the dummy that has prevented the baby from feeding enough to stimulate the supply. The mere association should be enough to put mothers off using them (in the early weeks).

You state ?By arguing that pacifiers are best avoided you and tiktok may be reducing the duration of breastfeeding in mothers who simply need some reassurance that their supply is not inadequate?. Sorry but I just don?t understand this ? me and tiktok are promoting the message that stimulating the supply is important and the aim is prevent it becoming inadequate in the first place. And what can tiktok say as a bf counsellor to a woman if her supply is indeed inadequate ? should she lie to them? And how would reassuring them make any difference to their supply and in what sense can using pacifiers help with the mother?s supply anyway?

Tiktok has provided examples of how to comfort a baby without needing to use a dummy. I'd say that even those who have used them 'successfully' would in retrospect try to do without them as there are often problems weaning babies off them.

Sorry I didn't answer your first question. I did very little 'hands on' research training as such - the qualifications I gained did however include some coursework such as a little statistics (not my strong point!) and 'research methods'. Most of the training was in doing the actual research itself ie in writing up my Masters dissertation. Here I obviously had to write up a research methodology and then apply that to my research issue with adequate conclusions. I also did one year of a PhD, for which writing just the proposal was in intself like a mini PhD. After receiving my qualifications I could do 'real' research but was of course supported by a professor. I generally found work in research enjoyable but exhausting (every statement I wrote had to be supported with evidence and a dozen references!) Also there was a feeling of 'ivory towerism' in that there was a distance between writing the research and the ultimate end product of actually helping people.

To go back to your earlier comments - I have a diabetic friend who has now moved to the States after receiving his PhD. It used to annoy him that some diabetics were irresponsible and used their condition as an excuse. Anyway I am really ignorant of how it does actually affect b/feeding.

I may have missed a bit. For balance, I feel it is reasonable to ask for wendym to clarify her statistical background.

I'd guessed you weren't too comfortable with statistics, Eulalia, but then not many people are If its still in print a good place to start is How to Lie with Statistics by, I think, Darrell Huff. Malmomum I have a degree with one third of the first two years in stats and the final year completely in stats. I was then employed as a statistician for quite a few years before doing other things and was a FSS (Fellow of the Royal Statistical Society). Actually the last bit doesn't mean a thing but it sounds impressive, doesn't it. I was entitled to join another professional body - the Institute of Statisticans - and that means a lot more.

The problem with babies who suck frequently is that its very hard to tell if they are sucking because they need food. As babies also suck in the womb/ suck their thumb clearly they do not always suck to feed. If breastfeeding mothers are told that sucking is always feeding and necessary to build up their supply then they begin to doubt whether their supply is adequate.

If you express milk after feeding you can see if milk was available to the baby. It doesn't tell you if the baby has trouble getting it out but it does mean that you are less likely to worry about an inadequate supply. If you are unable to express then you are no worse off because you were in effect being told your supply was inadequate anyway.

How do you know, Eulalia, when a mothers milk supply is inadequate? Is your evidence simply that the baby sucks a lot? How do you tell it isn't nonnutritive sucking? If a pacifier makes a baby more alert perhaps giving one for a few minutes before a feed would be beneficial if the baby is the sleepy type. Obviously you can look at weight gain but it takes a while to be sure about that and many breastfed babies gain weight more slowly anyway.

I haven't yet found a lot of research about diabetics and breastfeeding. Diabetics have delayed lactation, breastmilk has more insulin than formula, insulin affects gastrointestinal maturation - can't tell you much more at present. There is, however, a great deal of research about insulin levels in adults and their effect on what we eat. Insulin influences the way we metabolise foods, determines whether we burn fat or carbohydrate to meet our energy needs and determines whether we store fat in our body. It also has a significant effect on the desire for carbohydrate - why low carb diets are so popular at present. Diabetics have a particular problem with insulin but there are others who bodies do not respond well do insulin -they are called insulin resistant. There are reports of women with PCOS having breastfeeding problems too but not enough studies to say if it is a general problem. High levels of insulin in the body affect certain hormones so it is reasonable to suppose it has an effect on breastmilk.

The research on adults also suggests other things that may be relevant to frequent feeding - chromium deficiency, for example. There is a lot of scope for research on how a mothers eating habits and insulin levels affect her babies feeding pattern. Incidentally a high level of carbohydrate often makes adults sleepy - the sleepy baby may be getting milk with a higher carbohydrate content. If I was breastfeeding again and had a frequent feeder I'd eat a low GI diet and would try to avoid feeding the baby directly after eating myself as insulin levels are higher then.

Unfortunately research studies that leap to unwarranted conclusions can cause a lot of damage. The MMR fuss is an obvious example. Even if the vaccine had been shown to cause autism in some children then the number affected is likely to be less than the number who will suffer serious problems if they are not vaccinated. In fact the link is not proven. If you read the research and the editorial on the journal's website you'll get an idea of how such results should have been presented.

Impressed with your stats background, Wendy! : )

You say: 'As babies also suck in the womb/ suck their thumb clearly they do not always suck to feed. If breastfeeding mothers are told that sucking is always feeding and necessary to build up their supply then they begin to doubt whether their supply is adequate. '

If mothers are told this, without a fuller understanding, then no wonder they get confused. There is a notion that 'nutritive sucking' and 'non-nutritive sucking' are two highly differentiated states. They are not. Sometimes, it is obvious that the baby is enjoying sucking, but not swallowing a lot, and this is pobably NNS. But this can happen in the middle of a 'feed', and then the baby can start to do his NS again! NNS may well have a function in stimulating the breastmilk supply anyway....it certainly has a function in that it's enjoyable for the baby, and mothers can enjoy the peacefulness of it. There will be times when a mother has other things to do, and with confident, well-estabished bf there will be times when she knows she can take the baby off the breast and do these other tnings, without the baby protesting too much. If she wants to faff about with bottles of water to see whether the baby is 'really hungry' then that's her choice ; )

You also say:' If you express milk after feeding you can see if milk was available to the baby. It doesn't tell you if the baby has trouble getting it out but it does mean that you are less likely to worry about an inadequate supply.'

I'm not clear about this at all. Most mothers will get something - even a few drops - out of the breasts on expressing. Are you suggesting that mothers who are worried about their supply express to 'prove' they have milk? I suppose for some mothers it might help - but it is certainly possible to have a poor supply and to be able to express. It's also meaningless to express and 'prove' the existence of milk if the baby can't get it.

You add: ' If you are unable to express then you are no worse off because you were in effect being told your supply was inadequate anyway. '

So it just continues the undermining. A mother can think she has a poor supply, and be quite wrong. You think it would be helpful to be confirmed in a possible misapprehension because she can't express? I knew a mother who exclusively bf twins until six months, and she could never express more than a drop or two - and that was just squeezed out! She did worry about her supply because her twins fed a lot. She expressed because she was so worried - and got a couple of drops. In the end she decided to look at the babies and saw from their growth and development and behaviour that she did indeed have enough.

A mother's milk supply is best judged by looking at the baby. Is he happy, contented, thriving? In the early days, does he have plenty of poos? Are his nappies wet? Does he at least occasionally, come off the breast looking zonked, even if he wants feeding again shortly afterwards?

You say: 'If a pacifier makes a baby more alert....'

Does it? Most pacifiers are given to 'pacify' the baby, not to make them more alert. The study you quoted showed babies who used pacifiers were more alert and less irritable...not that the pacifier made them so, and not that the pacifier could be used therapeutically to waken a sleepy baby so he fed better.

You add: 'perhaps giving one for a few minutes before a feed would be beneficial if the baby is the sleepy type.'

'Perhaps' indeed. Studies? ; )

'The research on adults also suggests other things that may be relevant to frequent feeding'

But babies have to feed frequently to gain weight - to double their birth weight in just a few months, despite having a tummy that is no bigger than the size of the palm of their hand! It's got zip to do with chromium deficiency, surely. Why assume that frequent feeding is pathological?

(I agree with you about the MMR - but that's a different thread. )