Intro

All content of this blog is my own opinion only. It does not represent the views of any organisation or association I may work for, or be associated with. Nothing within this blog should be considered as medical advice and you should always consult your Doctor.

Is my breastfed baby getting enough? (and things you can do if not)

I sometimes feel that advice for breastfeeding mums swings like a giant pendulum, rarely stopping in the middle.  Years ago when I started breastfeeding, the big focus was breastfed babies not gaining enough weight - when in reality their weight was being plotted on charts more suited to non breastfed infants.  Mums were under pressure from health professionals to supplement and we (breastfeeding supporters) used to have to focus on reassuring mothers their infant's gain was fine, health professionals don't always understand normal growth patterns and that not all infants are robots that gain to a set pattern.  But the important thing to note is that this information applies to infants older than a couple of months who are following an appropriate growth curve, NOT newborns.  Young breastfed infants do not gain less weight than those formula fed - the difference become apparent in the second half of the first year and beyond.

Now, perhaps with the increasing popularity of Internet support,  things seem to have veered in entirely the opposite direction - and I read a worrying amount of forum posts where babies are clearly not taking enough milk and gaining well below expected levels of weight, but are told by other mums to "ignore the midwife or health visitor'" and follow their instincts.  "As long as he's weeing and pooing, he's fine" one mum stated recently, with no mention of the amount of poo or wee we expect to see in a baby consuming enough.  These posts are often backed up with anecdotal evidence from other mums of low gaining babies - how their baby didn't gain well, took six weeks to regain birth weight and was fine! they are all different!  Some mums wrongly feel if a newborn isn't getting enough they would be "unsettled" - some newborns will be, others wont.  Some also feel that baby wouldn't have long awake periods if not taking enough - again, this is not reliable as some infants need to be really struggling before this happens. Some believe breastfed babies don't poo regularly - in fact they should stool at least several times per day before 5-6 weeks, after which it is quite common for them to become more infrequent.

Output and weight together, are by far the most reliable indication of whether a newborn is receiving enough. 

I have no doubt mothers sharing the advice mentioned genuinely believe it to be true - they have perhaps read something pertaining to the first scenario and applied it to a younger infant.  But in reality reassurance is short lived if things continue to go downhill day after day and pressure mounts from those caring for mum.  Even if things pick up a little and don't appear quite as dire, if intake isn't up where it should be, it can really hit again at around 4 months - because not enough prolactin receptors were developed in the early weeks ready for when prolactin levels drop.

Unfortunately poor breastfeeding support from health professionals also plays a massive part - the midwife or health visitor sees a baby ticking a "red flag" box or two and because many are simply not equipped to help, threaten formula will be required if weight doesn't improve soon.  The mother then posts upset online, confused and unsure of what to do and those that reply are trying to support her, and trying to protect breastfeeding.

What should happen is that if a midwife or health visitor is supporting a mum whose baby isn't gaining weight or giving output as expected, a full feeding evaluation should be done - observing a feed, asking lots of questions and supporting mum with techniques she can use to ensure her baby is receiving enough ie nipping any potential issues in the bud early.  Feedback from mums online suggests this doesn't happen far more often than it does.  There is absolutely no reason why any infant should need readmitting to hospital with dehydration - this only happens when vital signs have either not been recognised, or have been ignored.

There will always be babies who lose slightly more weight than normal, but are stooling and urinating as expected, and appear alert and hydrated - for example many midwives suggest those born at the later end of typical ie 42 weeks plus often lose more weight than others, or if mother and baby are retaining water/fluids for any reason (some state this is more common following an epidural).  Then there will be those who gain weight fantastically but poo slightly less often and when they do a larger amount - if urine and all other signs are fine this may be the norm for a small group of infants.  When both weight and output is suffering, further checks should take place - if urine suffers parents should seek medical assistance straight away.

So what should happen weight wise?

It is normal for infants to lose weight in the first 3/4 days postpartum: once milk "comes in" this should start to turn around, and so any baby who continues loosing is a red flag for further checks to ensure feeding is going well.  For this reason many recommend a weight check on day 3, followed by weekly until six weeks and then monthly until six months.  Once breastfeeding is shown to be established and baby gaining well, more frequent weighing can result in unnecessary concern.
Losing more than 10% of birth weight : there seems to be some confusion over this guideline with some believing loss or slow gain going on beyond day 5 is ok providing it is less than 10%.  This is not the case!  a loss of more than 10% indicates baby and breastfeeding should be evaluated immediately as one study published in the European Journal of Paediatrics, found 60% of these infants had some degree of hypernatraemic dehydration which can be extremely serious - this does not mean as discussed that a smaller but sustained loss is therefore ok.

By 10 days - 2 weeks baby should be back at birth weight : if not this is another sign feeding should be evaluated.  There are exceptions to this guideline, perhaps mum has had a lot of problems in the first week and so the loss period was greater or longer than standard - which may mean even if these issues have now been resolved with support and baby is gaining well, they may run behind with catching up.  Similarly if baby has been ill or is prem, gain can be slower to take off; but on the whole the vast majority of infants where mum isn't experiencing problems should be back at birth weight, or well on the way by around 2 weeks.  Weight gain should always be measured from the lowest point.

The normal rate of gain for a newborn is around 5-8 oz per week: much less than this and again, breastfeeding should be evaluated.  At this age of course there is still a range of "normal", but it is a smaller range than for an older infant.  In the early weeks gain should be 5-8oz or more per week - with many health professionals and breastfeeding supporters more comfortable when this is 6-7oz upwards. Whilst it may be normal for some infants to gain nearer 4oz (perhaps some Asian mothers with a very petite frame) the vast majority will gain within the range above in the earlier weeks.

There also seems to be a misconception that babies are either "thriving", or (to use a bit of an out of date term) "failing to thrive".  In reality there are a whole host of shades of grey in between, and babies can limp along with minimal to moderate gain, without it ever becoming so serious they could be described as "failing to thrive".  Similarly some can output as expected, develop as expected and still have much smaller than average growth which is why the term has been changed to "faltering growth" from "failure to thrive".  The current charts are such that all babies should sit somewhere on here and follow that appropriate curve (note they will NOT all sit in the same place, nor should they!  it is an average) sometimes a few tweaks can make a big difference to weight gain, and ensure baby fulfills their genetic potential.

Common causes of weight gain problems.

Not feeding frequently enough: A young baby needs to feed 10-12 times per 24 hours.  This (obviously) equates to every two hours day and night at the latter end of the scale.  A slightly longer sleep means even more frequent feeding when awake.  In the first couple of days, some feed frequently whilst others are tired and less interested.  If birth was unmedicated, baby is more likely to rouse when hungry - if baby was exposed to opiates such as pethidine, they are more likely to be unusually tired and perhaps need encouragement to feed.  There is a fine line between ensuring baby has enough, and pushing the breast so much it potentially leads to breast refusal. Aiming for every couple of hours (more often if your baby's cues indicate), with a maximum gap of around four hours, and watching your baby and his output (ie whether nappies are transitioning as they should) can help.

Missing hunger cues: crying is a late sign of hunger, often by this point very young infants may then become too uncoordinated to milk the breast as well as they could.  Early cues include smacking or licking lips, the "goldfish impression" (opening and closing mouth) and finger/hand sucking.  If not offered the breast, this progresses to "rooting" (turning head looking for breast) fussing and squirming.  Finally baby will begin frantic head turning, fast breathing and squeaking/crying.

Offering one breast: because there has been confusion over fore and hind milk, some mothers are advised to stick to one breast per feed, and feeding roughly every two hourly as described above.  However, whilst we know women can produce the same mean amount of breastmilk per 24 hours, what is available at each sitting can vary enormously from women to women; some babies will thrive taking one breast every two hours, others won't - if only taking one breast they may need to feed hourly.  I always suggest mums consider offering the second breast, because then baby can choose to not have any, have some or have all!  Of course breastfeeding is also about convenience so if you just want to "push baby on" until you get somewhere, offer one and if happy offer the other when you get there!

Positioning & Latch: Often if baby isn't latched as well as possible mothers experience sore nipples, but this isn't always the case; latch can be good enough to not cause pain, but still not be "optimum".  Often infants in this position will take a long time to feed, because it's comparable to sucking through a straw that is squished - yes you get liquid, but your mouth aches and it burns more calories due to effort.  Sometimes it can be a tweak in positioning that is required - perhaps baby is latched well but is straining slightly to reach the breast and so tires sooner than he would if positioned a bit better.  He may be full enough to settle and sleep, but not as satiated as he may be if he could have carried on longer.  Some will appear to enter a light sleep whilst at the breast, but will wake and resume rooting if removed; not ever reaching the truly satiated "drunk" stage.

Oral difference such as high palate or tongue tie:  both can make it more difficult for baby to feed effectively, with an outcome the same as the point above - positioning and latch.  Baby can simply tire before becoming truly satiated, resulting in smaller gain or static weight.

Scheduled feeding and clock watching:  Limiting feeds to a clock or swapping baby after x minutes can cause some to receive insufficient fatty milk to gain weight well.

Pacifiers: some babies who are hungry will spit the dummy and object, others will happily suck the pacifier.  Even if you want to introduce one, waiting until breastfeeding and weight gain are established is important.  This not only ensures baby doesn't suck a replica when hungry, but also that mum's breasts receive enough stimulation to produce an adequate supply.

Tips to improve weight gain.

Ensure baby is latched & positioned well:  Visit a breastfeeding group, breastfeeding counsellor or lactation consultant if you are unsure; this ensures all sucking efforts produce maximum milk.

Ensure milk is transferring well: whilst there is a lot of focus on latch, many mums are never shown how to tell if baby is actually drinking lots of milk!  I think the best way to demonstrate this is using a couple of clips by Dr Jack Newman

The first clip below shows "nibbling" or ineffective feeding: Baby is doing almost no drinking. A baby who breastfeeds only with this type of sucking could stay on the breast for hours and still not get enough milk. Something needs to be done here and if achieving a better latch, using compression doesn’t help, the baby almost certainly needs to be supplemented (Newman).




Now compare this to the clip below, where baby is doing some really good drinking: The pauses are very long (this is the mouth filling); this baby could spend a very short period of time on the breast and still be getting plenty of milk (Newman)




It's also worth noting the difference in positioning in these clips.  In the first baby is meeting the breast almost vertically - with nose, mouth and chin meeting the breast at the same time.  As you can see the baby's nose is pressed against the breast, potentially making it difficult for him to feed well and breathe easily   In the second clip baby's head is flexed and the chin meets the breast first, the nose is then well clear from the breast tissue - allowing him to milk the breast easily.

Skin to skin: this not only increases the levels of hormones involved with milk production, but also allows baby to find the breast the moment they are hungry!  babies held skin to skin feed more frequently and gain weight better than those who are not.

Breast compression: when baby is sucking, but not actively feeding, compressing the breast can increase the amount of fat available to baby.  Even with a less than brilliant latch, with breast compression and unrestricted access to the breast - baby can often do much better until things are resolved.




Switch nursing: when baby works for letdown on one side, the other side also lets down - meaning there is an instant reward for baby as soon as they swap.   As mums have multiple letdowns per feed, switching baby to the other side as soon as baby stops effectively feeding, snoozes, or come off the breast, can help to increases intake.   For babies that are sleepy at the breast, a combination of breast compression and switch nursing can dramatically increase intake.

Frequent offering: Not all newborns will always give hunger cues when hungry, therefore being proactive in offering either one breast hourly or both every couple of hours- can ensure not only that baby takes enough, but that mums breasts receive adequate stimulation to maximise supply.  To boost supply offering both breasts hourly along with other techniques mentioned can also be very effective.

If baby needs milk NOW
The first rule when supporting a mum is to "feed the baby".  If there are concerns over whether baby is adequately hydrated or loosing weight and is clearly very hungry even after a feed, ensuring baby gets milk is the first priority.  If at all possible mums own milk should be used, so as to protect the infants gut - however, if baby is displaying as described and mum is struggling to express enough, or with support an effective feed can't be achieved - risks of formula are outweighed by the need for nourishment; not providing food is a far bigger risk.

Many mums find in the very early days hand expressing (links to video clip) is the most effective way to express, and some choose to express straight into the sterilised cup they plan to feed from. For increasing and maintaining supply an electric pump is often recommended and double hospital grade pumps are shown to be particularly effective - you can hire these from around £40 per two weeks.

Either cup or finger feeding is preferable to introducing an artificial teat to the baby already having problems.  Another option is a supplementary nursing system, so baby can take his supplement at the breast.  Mum's health professional should be able to help with which is best for your baby, if not contact a local breastfeeding counsellor, group or lactation consultant.

If a breastmilk substitute is required, liquid formula is sterile (unlike powder) and so reduces risk of infection for the very young.  Expressing alongside this is also important to ensure supply doesn't dip further and instead is boosted, so mum can progress to replacing the substitute supplement with breastmilk.  Once baby is gaining and any problems are resolved, mum can then feel confident her body is already producing the right amount of milk to meet baby's needs, making the transition back to exclusive breastfeeding easier.  Both breastfeeding and expressing boost supply.

In some cases where baby is gaining less than desired but isn't critical, supplementation may still be suggested - depending upon how long the problem has been ongoing and whether mums supply has suffered from baby not taking enough milk (this is the cue mum's body uses to know how much to produce)  the individual situation the best course of action varies.  For some it may be that whatever was causing the issue is easily resolved and so very frequent feeding for a few days to give supply a boost and transfer lots of milk is enough.  For other mums expressing and giving a supplement may be needed - perhaps doing so every couple of hours during the day to provide a supplement before bed.  If using a breastmilk substitute it is just as important not to over supplement!  Giving a top up too big will result in baby feeding less frequently, again reducing supply further - your health professional should be able to help, if not contact a breastfeeding counsellor, group or lactation consultant.
Other things to consider:

Scales: Time, clothing, scales and floor surface can all make a big difference. If a clinical weight is required due to concern over growth digital scales that are regularly calibrated are essential.  Always weigh the baby on the same scales.

If supply is low, consider a galactagogue to increase milk supply ie: fenugreek, fennel or domperidone

Diet: is mum eating and drinking enough?  Some studies have linked  consuming less than around 1700 calories per day with reduced supply.  This seems to be particularly the case if calorie intake dips significantly from the norm.  You can read more here.

Does baby sick up a lot? Could he have reflux?

If baby isn't interested in extra feeding, try something different – maybe feed lying down or in the bath.
Is baby feeding enough at night? Night feeds are very important for maintaining and increasing supply.

If a breast pump is required to boost supply, a hospital grade double breast pump is more effective than an ordinary hand pump. You can hire pumps from:
http://www.ardomums.co.uk/shop/purchase/Hospital-Grade-Dual-Electric-Breast-Pump-for-Hire
http://www.nct.org.uk/shop/hire-services/breast-pump-hire
Sometimes your health visitor or midwife may be able to arrange for you to borrow one from your local hospital, or alternatively contact your local La Leche League, NCT or Association of Breastfeeding Mothers counsellor to enquire about pump hire.

Did the baby have a very difficult birth? perhaps long or resulting in intervention or csection.  Some mums are also surprised to hear a very fast birth can also impact with both potentially resulting in a disorganised suck.  If so exploring cranial osteopathy can often have amazing results.

Has tongue tie been ruled out?

Remember:
Breastfeeding is about protecting your baby from allergies, illness, obesity, diabetes, childhood cancers, SIDS and normal oral and dental formation. It also protects mums from various cancers and osteoporosis.  Formula feeding is about putting on weight and that’s it.

Note:
For some reason, many health professionals still insist on placing baby in the "stranded beetle" position, or half on one side.  Whilst this suits an older infant, with a newborn the result is often as seen in this photo!  Consider placing your baby prone, as per the image at the top of the page.  You can also place a blanket on the scales, zero them and then wrap your baby snugly in that blanket for weighing.  If the house is cold, warming the blanket may ease the transition further for those that are premature, or more sensitive to undressing and handling.

RELATED POSTS: Effective feeding, it's not all about the latch...

15 comments:

  1. Interesting article and I don't doubt that what you say about some babies, who really are not gaining sufficient weight for whatever reason, are missed by HPs/parents. However. My first gained very slowly. Lost less than 10% and was back to birth weight within two weeks but after that only gained a couple of oz a week (with no change to feeding pattern etc). The HVs etc went into a panic and I was bullied into topping up with formula (which made no difference to weight gain). No dummy used, plenty of wet and dirty nappies and feeding was fine on demand, she fed very regularly day and night, never more than 2 hours between feeds, usually a lot less. Even the Paediatrician we were referred to commented on how well she was developing etc but they just could not get past the slow gain. She remained petite for years. My second was exactly the same in terms of frequency of feeding, amount of wet/dirty nappies, sleep pattern etc but piled on the weight. Their 12 month weights were the same.

    Not quite sure what the point of this was but I felt myself bristle when reading your post (and I'm a huge huge fan of your blog) because it sounds as though you believe that slow gain in a young baby ALWAYS means there is an issue that needs to be addressed, but after my experience with my first child (who went on to breastfeed for nearly 3 years) I really don't believe this is the case. Maybe most/some of the time, but not always.

    ReplyDelete
  2. QUOTE
    I felt myself bristle when reading your post (and I'm a huge huge fan of your blog) because it sounds as though you believe that slow gain in a young baby ALWAYS means there is an issue that needs to be addressed, but after my experience with my first child (who went on to breastfeed for nearly 3 years) I really don't believe this is the case. Maybe most/some of the time, but not always.

    Hiya and thanks for your feedback :)
    No I'm not trying to suggest there's always a problem - I suggest it always needs evaluating to check there isnt a problem. I do also say that some infants will stool as expected but have small gain, perhaps if mums has a petite frame - but this is the exception rather than the norm and so to ensure every child can reach their full genetic potential (both physically and mentally) ensuring they ARE ok and normal for them is important? As also mentioned gain and stools are both important considerations and one is far less reliable without the other.

    I do believe it is the exception as we are able to improve gain so much of the time (without supplementing formula!)

    AA

    ReplyDelete
  3. Outside of the internet breastfeeding world that most people reading this will be in, any baby with slow weight gain but no other issues is more likely than not to be monitored by a health professional with limited/outdated/poor breastfeeding knowledge and/or mum may well be given the usual "your milk isn't enough" type advice from well meaning friends/family. End result? Straight to formula. Several people I know stopped breastfeeding very early on citing "baby wasn't gaining weight" as the reason. They aren't the type of people who will ring a BFC, nor are they likely to be familiar with the really good breastfeeding information sources online, but they do believe the myths that are so commonly spouted on the breastfeeding issue.

    I have wondered (and it is just a musing) that maybe babies with no other health problems/feeding issues but gain weight slower than is expected may be more common than "the exception" when you take into account that the majority of breastfed babies who have slow weight gain are probably on formula pretty quickly. Just a thought.

    ReplyDelete
  4. Hi Catherine
    Yep mums getting told to give formula is common, as outlined in my post - it seems evaluating feeding doesn't happen often :(

    I'm not sure really what you mean by the last paragraph - yes slow gaining infants may be more common due to poor breastfeeding management; but in terms of norm "expected" weights are based on healthy breastfed infants. We know when breastfeeding is going well, this is how the majority of breastfed infants should gain in the early weeks. Is that what you meant?

    ReplyDelete
  5. That'll be cos I explained myself very badly! That's what happens when trying to post, feed a wriggly toddler and cook tea at the same time!

    I will try again! My own child was a "healthy breastfed infant" but gained weight at a much slower rate than you said a baby "should". Had I not spoken to LLL and discovered breastfeeding information online my breastfeeding journey would have ended at 3 months. Many mums are not this lucky and the baby ends up on formula. How many of these slow gaining breastfed babies are like my child and are actually fine? They are feeding well, taking in plenty of milk etc etc but, because many MW/HVs seem to go into a panic the minute a baby doesn't follow the charts, it is assumed there must be a problem and formula is recommended. In most cases, breastfeeding management is not even presented as an option, and other signs that a baby is thriving are not looked at - formula is the one and only solution to the "problem". My point is, were this not the case, perhaps it would be more common for "healthy breastfed infants" to gain weight at a slower rate than the 5-8oz per week you mentioned.

    It's not a huge issue and obviously doesn't change the fact that a baby who isn't gaining because of a feeding/health issue should be monitored. It's just something I've wondered as I was criticised because I didn't just put my baby onto formula full-time when the weight gain pattern was so different to the norm. From what I can gather, most people in that situation do and I wonder if that skews the figures (in terms of how common it is for a baby to gain weight slower) somewhat. Did that make sense?

    ReplyDelete
  6. QUOTE My point is, were this not the case, perhaps it would be more common for "healthy breastfed infants" to gain weight at a slower rate than the 5-8oz per week you mentioned.

    Yes I see what you're saying - but the average gain doesn't come from taking a group of infants gaining what we expect, with those supplemented skewing figures? It comes from numerous studies into healthy breastfed infants over the years, and the new growth charts.

    More is explained here: http://www.rcpch.ac.uk/doc.aspx?id_Resource=4605

    with the "harcore" long version here:
    http://www.who.int/childgrowth/standards/Chap_2.pdf

    There is also evidence looking at average gain of those feeding well - v those with variations, such as this:
    http://www.internationalbreastfeedingjournal.com/content/4/1/13

    I understand what you are saying - my two were opposite ends of the spectrum weight and gain wise, with my second falling off the charts at times - he is "fine", but I'm still not convinced things were optimum. I was reassured a lot at the time he was - but from working with mothers since who have also been in this situation, I've found it IS incredibly rare not to find something to tweak that increases gain. One lady who springs to mind is a recent one who had a frequently feeding baby (often hourly) output was on the low side of fine ie only one to two stools a day, baby developing normally but was torn as had HV concerned over gain and lots of breastfeeding support telling her it was fine! everything looked fine.

    The only thing after much discussion we could see a difference with was intake - mum went all out to ensure she ate enough (she often didn't!) and drink enough - plus added porridge for breakfast - gain shot up and her baby naturally spaced feedings further apart.

    It is of course important too that we are only talking about the early weeks - beyond that gain can have larger variations of "typical".

    Of course this isn't the case for all and there ARE exceptions, but there isn't anything evidence wise suggesting it's common. It's also difficult to guage if a low gaining infant is developing "fine" or "optimally" ? because there is no direct comparison for each child - so on what basis do we tell mothers something is "fine" versus "not" iyswim?

    ReplyDelete
  7. Really good to see this blog. As one of those who's baby was readmitted at 4 months, it all rings true - and I too have been concerned at the - 'no need to worry' posts online. Switch feeding helped get us back on track, alongside loads of pumping and an sns - would have been far easier to put it right at 6 weeks than 16 weeks.
    Cathi

    ReplyDelete
  8. I have seen plenty of inappropriate reassurance given to mothers by hvs who are supportive of bf but not knowledgeable. I meet too many mothers who are given poor advice by their midwives about how to increase weight gain. Some of these mothers are following advice that will reduce their supply. I am sure you are right and there are many babies who could be gaining more although there will be some who are outside of the norm but fine. Actually I don't believe that Asian women have babies with lower gain, I don't think this is true of any ethnic group.

    The majority of mums I meet whose babies have lower weight gain do fewer feeds. Some mums discuss low weight gain whilst re doing the dummy and rocking their crying baby who is 'tired'.

    Have met more mums who have been blandly reassured than ones asked to top up.

    ReplyDelete
  9. Hiya Anon
    Yes I think that's exactly it - supportive but not knowledgeable.
    I've also supported mums who have had low gain, then told to feed from one breast for x hours to ensure baby reaches "hindmilk" (as you say a known technique to reduce supply) when the mum is still struggling no doubt she will feel she tried but simply couldn't make enough - she was just one of that precentage that can't bf.

    Re Asian group - I was thinking of a chinese lady I supported as a PS years ago. She was so tiny that she and actually the rest of her family too, had really beyond petite childlike frames - indeed she used to wear childrens shoes and clothes!

    Her HV was fretting over gain (despite lots of wee/poo and a very active/alert/forward baby who had strength beyond her size!) and I'm sure in the end she located a growth chart aimed at chinese mums, and took into account mothers height and weight. Wish I could remember more about it now -but as a PS I wasn't heavily involved beyond a supportive ear.

    I seem to meet a big mix of reassurance/top up - I wonder if it depends on what the areas bfi targets are like?

    ReplyDelete
  10. Spoke with a UNICEF trained worker today who told me that she couldn't remember the course content at all but just reassures the mums and tells them to follow their baby. Maybe the targets and ethos change are a stage we have to get through?!

    Some of our local HVs have changed their default position regarding acceptable weight gain over recent years. They better match their newer team leader but and it is great that top ups aren't the first suggestion but they frequently give out the advice above. Frustrating stuff.

    I do see what you are saying about frame/family size - course it is relevant but I seem to remember Magda Sachs saying that when they crunched all the data for the charts their was no difference in gain for different ethnic groups. It surprised me so I remembered it-not necessarily correctly though:)

    Great blog.

    ReplyDelete
  11. wow@ UNICEF trained worker! I will sleep easy tonight knowing they are so on the ball :| yes I wonder re a stage to endure!

    I totally forgot about Magda! I will drop her a line as it would be great to know her views.

    ReplyDelete
  12. I'm a bit disappointed that in an otherwise excellent post you recommend cranial osteopathy, saying it "can often have amazing results."

    There's no credible evidence that it's anything more than a placebo (and yes, placebo does happen in babies). I'm sorry, but it's quackery.

    Normally you seem to be pretty good on the evidence, but you're mistaken on this one.

    ReplyDelete
  13. Hi Colin
    If a placebo can stop a baby severely refluxing in one session, can curve flat patches on a baby's head, can transform a baby with an unco-ordinated suck into an organised feeder, plus a lot more that both myself and other lactation workers have observed first hand. Then I'm all for placebos!

    I've seen an infant that would barely open their mouth to feed (even when finger feeding), approach the breast with a nice wide gape following a session and I know many lactation consultants have also seen similar results including palate shape changes. In cases of TT, HAP, BP etc the results seem most striking.

    My own experience is from taking a child who didn't ever sleep more than a few hours in a row (aged 2!) the osteopath perfectly described my labour (from what she could feel) and explained what was causing the problem - after which my daughter slept 14 hours straight! we were advised as she grew in BIG spurts, she would probably need a top up session around this time until a bit older. Sure enough her sleep would go AWOL and I would notice her trouser legs were half masts lol a session later and sleep was restored!

    Given the feeding nerves run through the head and the oral cavity and neck are all intricately linked - I don't think it's that "out there"?

    There are a few studies:
    http://archpedi.ama-assn.org/cgi/content/full/157/9/861

    http://news.bbc.co.uk/1/hi/health/157585.stm

    http://www.originalosteopathy.com/osteopathic/

    ReplyDelete
  14. I am sorry, it could be my mistake. Maybe my patchy connection ate my post, or maybe I just had a brain fart and didn't submit when I thought I did, then got paranoid when I came back to see it wasn't there. As far as I can remember it, the post went as follows:

    Given the complexity of the human brain and nervous system, the idea that it's somehow possible to nudge bits of it back into alignment using head massage seems a little far-fetched. Granted, it's probably quite pleasant and relaxing for a child, which of course is a valuable outcome in itself, but for it to be marketed as a genuine medical treatment capable of curing illnesses (with a price tag to match) really there should be some proper evidence that it's effective. Anecdotes won't do, I'm afraid. How do you know that the perceived effect wasn't caused by something else? How do you know your expectations of the treatment aren't colouring your perception of its outcome? Also, some conditions clear up by themselves, especially with babies, who grow and develop so fast.

    Ok, I've looked at the three links you've provided above.

    The first is a link to a small study (57 patients) with results that aren't statistically significant.

    The second, the BBC article, is simply an anecdote. The cranial osteopath interviewed mentions research, but the piece doesn't link to it, tell us where we might find it, or even examine it.

    The third link cites three trials with supposedly positive results. I've checked the references:
    One is the 57-patient trial I've already discussed.
    The next is a trial of spinal manipulation in adults with lower back pain, NOT cranial osteopathy at all.
    The last trial compares osteopathy with acupuncture. Yes, acupuncture. And the numbers don't add up. All that trial tells us is that some children who were unwell got better.

    If this is the most compelling evidence in favour of cranial osteopathy (I've had a look on pubmed myself, and quite frankly I didn't find much), it's a bit of a poor show.

    That's the only part of the post I have a problem with, btw. I applaud you for the work you do supporting breastfeeding; my wife breastfeeds our 3-month-old and she's found your blogs very useful.

    ReplyDelete
  15. This comment has been removed by a blog administrator.

    ReplyDelete