Infant feeding - what do you want your GP to know?

[user1498741230]

Hello, I'm writing some educational materials for GPs about infant and toddler feeding (milk, weaning, problems). What would you like your GP to know about these areas? Thanks for any helpful input.

Shouldn't GPs be getting advice from medical journals etc on formula feeding?

There are lots of things we do anecdotally that would be unfit to join the ranks of foral guidance, I hope I'm not coming across as rude and may have completely misunderstood your OP but I'm not sure exactly how we could advise best pracroce for formula feeding's that would be useful for GPs to pass on to others?

formal*

Indeed, but there is a huge amount of possible information and a finite space in the training modules, so just wondering what parents would prioritise. So, do you find GPs don't know enough about...
Different types of milk
When and how to wean
What to do if you can't / choose not to breastfeed
What to do with fussy eaters?

There must be another whole load of things I haven't thought of so I'm just doing some "consumer research" to see what others want us to focus on. I'm a GP and a mum but also trying to capture the wealth of experience on mumsnet.

I'd like them to know about tongue tie and how to spot it/refer to someone who can.
Also that both mother and baby need to be treated for thrush.

Bit worried not coming from a medical journal but
Knowledge of CMPA for breastfeeding & formula feeding signs, the amount of mother's who have gone to GP's who've missed this is astounding.
Decent advice for reflux.
Weaning - knowledge of gag reflex which can be sensitive/baby led weaning. How it's not a race.

CLUSTER FEEDING! Every first time mum seems shocked by this when breastfeeding, it is normal if the latch/weight/ baby is normal for baby to feed hours & hours in first weeks & around growth spurts.

Knowledge of allergies, how different food allergies present and suitable advise to share with parents. Also what Parents can/can't buy over the counter so you don't just recommend things parents then find they can't do.

But do parents get much info from GPs unless something has gone wrong? Would it be better to educate others who are talking to parents about these thing proactively e.g HV?

The modules will all be appropriately evidence-based (e.g. NICE for reflux, www.nice.org.uk/guidance/ng1/ifp/chapter/reflux-in-babies).

I find lots of the questions parents ask aren't well answered in the literature, hence the need for training materials that capture practicalities (making up bottles when travelling, volumes and frequency of feeds for those bottle feeding etc)

how to feed during tummy bugs ? extra water yes or no?

Medication and feeding.

You might want to look at the GP Infant Feeding Network, who are working on this - search on Facebook, they are very easy to find.

CMPI and soya Intolerance
Reflux
Cluster feeding
Exaggerated latch technique
Tongue tie especially posterior
Feeding lying down and safe bedsharing - and also it's correlation with successful breastfeeding
Frequency of feeds including overnight
Growth spurts and feeding frequency
Signs of readiness for solids and why the 4 months growth spurt / sleep regression doesn't indicate readiness.

That mastitis requires at least a 10 day course of anti biotics and the standard 7 day course is like to lead to reoccurrence (bitter experience)

wonderful.... personal experience (bitter or otherwise) very helpful.

Thanks guys .... keep it coming ....

I would say that most of your initial list would be the responsibility of mw and hv rather than gps. I would say gps are best of with a knowledge about thrush, mastitis, reflux and allergies. Cluster feeding and fussy eating? Health visitor with a referral to gp if they see fit.

Reading the NICE guidance on reflux made me so angry. I assume none of the HCPs we saw during the dreadful weeks and months of an infant screaming in pain six minutes into each and every feed and having to be coaxed patiently to feed at all had bothered to read the guidance and in particular the link to frequent otitis media. No, it was fine because it was silent reflux and because he was gaining weight his pain didn't matter.

He's now nearly six and getting him over his subsequent lifetime of food aversions has been awful. Even now his diet is very restricted and nowhere near as healthy as I'd like.

It's good you're doing this. I think knowing more about breastfeeding and potential breastfeeding issues in general would be helpful.

Plus also, remembering that mothers have physical impacts after pregnancy and birth, and it would be good to have these better understood or cared about by GPs.

Agree with more knowledge and understanding of allergies, particularly milk allergy. Ds's symptoms were only picked up on when we started weaning onto solids around 6 months: he developed large red hives on his face from mere contact with dairy. On visiting the doctor he didn't really recognise the severity of it and recommended I still try it different types of formula when I returned to work later that month as "some babies react to one but won't another"... despite the severe milk allergy symptoms... And at the time I didn't know that's what they were, so I gave him normal formula for the first time as per the doctor's recommendation. I had a very sick baby.

I don't blame the doctor really but he probably should have referred me elsewhere before giving that advice. Even to the health visitor as she turned out to be very knowledgeable on the subject, what with dealing with babies all the time.

Agree was going to say (but didn't want to spam your thread ) that GP's aren't going to be the first point of call for many of these problems and questions - it will be the health visitors on their home visits etc.

But the root of the problem with HV's from my personal experience is that there is a gap of knowledge or standard advice - when I was a first time mum with tiny newborn DD, I had massively conflicting advice from the same HV on between the first and second visit, which eroded any confidence I had in the information she provided me. It doesnt help when you then go online and every woman has received different advice. If it was presented as options or opinions that would be fine, but especially with your first you expect the HV to be a but of a fountain of knowledge, so take what they say to heart.

The training will be available for everyone working with babies and toddlers. Increasingly, professionals will be based out of children's centres so hoping this might be helpful for family support workers and the like as well.

Reflux, CMPA and allergies will all be covered.
The plan is for separate info on breast feeding, so very helpful to know what the gaps are on that topic too.

Thanks all. Feel free to post anything else that comes to mind....

What sort of training/literature is it op? The level of detail in a full morming/afternoon session would be very different to that in a leaflet.

It's all very well saying that some things are HV remit - but a lot of this comes up as a by the way during a routine 6 week check up and a GP needs to be aware....

More advice on formula feeding would be helpful. When I didn't bf I was pretty much left to get on with it, but advice on feeding technique, choosing formula, how much the baby should be eating (guides on formula boxes aren't helpful really), preparing bottles etc. would have been welcome. I just ended up terrifying myself with articles about chronobacter from medical journals. I became obsessed and even hallucinated at one point about feeding my baby dirty water (although I didn't realize it was a hallucination until a lot later). A bit of reassurance would have made a big difference.

We had no issues when we needed a reflux diagnosis and DS was better within days. I really appreciated that.

More information about how best to introduce potential allergens - I know the guidance has changed but I was worried because my baby has a bit of eczema and the dr told me to just give him peanuts anyway. I don't think that was the best advice (he's fine with peanut, thankfully, but has an egg allergy).

It is about an hour of training (online) so enough scope to cover common things, hence the need to prioritise.

SleepWhatSleep1 - indeed. GPs and other docs are often asked feeding questions and frequently feel less than confident in this area.

More training on the fourth trimester as a whole - seeing the whole picture rather than just feeding issues.

That exclusively expressing breastmilk is a long term option if you can't breastfeed but want to give breastmilk. Every HP I've told that I exclusively pump has looked at me like I've got two heads/has told me it won't last. 3 months in and still going strong with a freezer full of milk and 3 donations to a milk bank tells me otherwise!

Slightly different but I think it's worth impressing on the GPs that they really must be very careful prescribing any medication to Breastfeeding women. Twice I had my gp try to give me Prozac, which states very clearly that it should not be used by breastfeeding mothers. The first time she gave me a prescription and the only reason I didn't take it was because I did my own research.