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.

Big Thumbs Down For Dr Ellie

Dr Ellie off the Telly decided to add her two penneth to the whole "feeding older babies" debate this weekend.  For those who haven't had the pleasure, Dr Ellie is a bit like a female version of Dr Christian Jessen; her website confirms she:
"Works in a busy inner city NHS practice as well as a private practice. She has a very family-orientated practice, specialising in children health from newborns to teenagers."
It's never promising when the publisher is the "Daily Mail", but as Dr Ellie specialises in infants and children - she will surely have her facts straight right?

Errrrrrrrrrrrrrrr hmmmmmmmmm
"Women who breastfeed their older children argue they are doing nothing wrong, and that each mother should be free to do what is right for their child, whether not to breastfeed at all or continue indefinitely.
But as a doctor, I must advise there is little benefit and possibly harm to be done by the latter."
Yikes, right!

Best read on!

Dr Ellie acknowledges the WHO recommendation to breastfeed for two years before adding:
"But there is little evidence of any health benefits beyond the age of one. ."
But hang on,
"WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends."

So why would they recommend at least two years if actually only a year mattered?  Does Dr Ellie have evidence there aren't health benefits beyond a year?

I could re-write the reply to Clare-Byam Cooking in my last blog post - but as it was only yesterday, I will go for a copy and paste!

Dewey in 2001 found:
"Breast milk continues to provide substantial amounts of key nutrients well beyond the first year of life, especially protein, fat, and most vitamins.”
From Kellymom:

In the second year (12-23 months), 448 mL of breastmilk provides:
29% of energy requirements
43% of protein requirements
36% of calcium requirements
75% of vitamin A requirements
76% of folate requirements
94% of vitamin B12 requirements
60% of vitamin C requirements
Furthermore breastmilk isn't just about nutrition is it? Even if we take this out of the equation, what about immunological implications?

The American Academy of Family Physicians note:

"Children weaned before two years of age are at increased risk of illness (2008).
Again from Kellymom:
“Antibodies are abundant in human milk throughout lactation. In fact, some of the immune factors in breastmilk increase in concentration during the second year and also during the weaning process. (Lawrence & Lawrence 2011, Goldman 1983, Goldman & Goldblum 1983, Institute of Medicine 1991)."
If we think about what's in breastmilk, there is protein that cause cell suicide in over 40 types of cancer, stem cells that develop into many different cell types in the body, serving as an internal repair system. Lymphocytes that kill infected cells directly or mobilise other components of the immune system, enzymes, immunologlobulins and a whole lot more, that actively seek out and destroy harmful pathogens, sweeping them from the body and regulating immune response. Anti infective factors, hormones, growth factors, anti-inflammatories and more. Why on earth would we assume that this is of no benefit after 12 months when we know a child's immune system doesn't mature fully until much later? Where is the evidence supporting this frankly archaic statement?

We can go a step further and remove the nutritional and immunological reasons to breastfeed after a year, and there is still a whole plethora of reasons to continue! Kellymom again covers this in great detail with references here, so I see little point reinventing the wheel; but numerous implications are "dose related" - ie the longer it happens the bigger the "benefit" (or if you want to word things accurately, the earlier it ceases the more increased the risk).

Dr Ellie doesn't stop there though:
"But in my opinion, breastfeeding your child up until three or even later is unnecessary"
Right so is that Dr Ellie's professional or personal opinion?  At least there is clarification it's opinion and not fact.

Dr Ellie then moves on to Sears:
"Every cry from an infant is a cry for help and should never be ignored, he says. Dr Sears even claims that allowing a baby to cry for too long can cause them brain damage."
The "even" implies the comment outlandish, but what Dr Ellie fails to mention is this isn't some far fetched ideal Dr Sears has come up with.  It's one supported by evidence. A 2002 paper entitled "Infant Crying: Nature, Physiologic Consequences, and Select Interventions" states:
"Documented immediate and long-term sequelae of crying include increased heart rate and blood pressure, reduced oxygen level, elevated cerebral blood pressure, initiation of the stress response, depleted energy reserves and oxygen, interrupted mother-infant interaction, brain injury, and cardiac dysfunction. Caregivers are encouraged to answer infant cries swiftly, consistently, and comprehensively."
In fact I would suggest Dr Ellie takes a look at this article as a matter of urgency to bring herself up to date with the latest research surrounding infant crying given her "day job".   Darcia Narvaez, Ph.D. provides an excellent referenced run down on the topic.

Anyway, back to the article:
"The attachment parenting crowd argue this is the way parents have been doing things for thousands of years. I’m not an anthropologist, but I do know that we’re living in an era when these things are not the norm"
Well I think the "AP crowd" probably argue that because it makes anthropological sense?  I appreciate Dr Ellie acknowledges she isn't an anthropologist, so if you would like to hear from someone who is and read an educated opinion  - click here.  Nope it's not the norm, that doesn't therefore make it wrong though does it?
"And breastfeeding until a child goes to school is fulfilling a mother’s needs, not a child’s. It is self-indulgent and possibly narcissistic. Children are at the centre of our world but it doesn’t mean we need to be at the centre of theirs."
Woah backup the truck Dr Ellie, we're definitely into "personal opinion" territory now right?  I know Dr Ellie confessed to no training in anthropology, but surely she can recognise that "appropriate nursing duration" is based on social norms not biological?

Dr Ellie then states that many psychologists worry that "extreme breastfeeding" (perhaps whilst parachuting?) hinders normal child development and indulges the mother with attention and purpose.

I would suggest any such concerned psychologists explore the numerous cultures where children are often nursed until older such as Mongolia, are they a country full of narcissistic needy mothers caring for developmentally delayed children?

Or perhaps some existing research?

In 2010 a study set out specifically to evaluate whether breastfeeding duration predicted later psychosocial development.     Researchers found the opposite of the concerns Dr Ellie raises, and that breastfeeding duration was a positive predictor of future psychosocial development (using an index shown previously to predict school readiness) measured in late childhood, concluding:
""These findings add to growing evidence that breastfeeding could provide lasting economic and social benefits" (Am J Hum Biol. 2010 Nov-Dec;22(6):725-30.)
The American Academy of Paediatrics state:
“Increased duration of breastfeeding confers significant health and developmental benefits for the child and the mother… There is no upper limit to the duration of breastfeeding and no evidence of psychologic or developmental harm from breastfeeding into the third year of life or longer.”(AAP 2012)"
 The Academy of Breastfeeding Medicine state:
“The average age at weaning ranges anywhere from six months to five years… Claims that breastfeeding beyond infancy is harmful to mother or infant have absolutely no medical or scientific basis".
Just to throw a few in to start with...


Back to Dr Ellie:
"Children go to nursery aged three, so they need to be able to cope without their parents."
Um, children don't always go to nursery at three; some go much earlier and others not at all.  But I don't see the link between the "need to be able to cope without their parents" and breastfeeding?  Does Dr Ellie really think toddlers who are breastfed when at home with their mother, can't go to nursery and cope without?

That because they choose to still feed at the breast, this is comparable to feeding a newborn who cannot be left or that the toddler will choose to stay home just because the breast is there?  The mind boggles as to what Dr Ellie thinks feeding a toddler is like!

A bizarre comparison is then made to continuing breastfeeding and not allowing a child to move on from nappies or a pushchair.   As though continuing to provide a child with milk of their own species rather than swapping to that from a cow was directly comparable to these acts.  Perhaps I'm wrong but my radar detects "personal baggage" sneaking into the mix here...

The next comment is the one I find most disturbing:
Toddlers & Tiaras
"Children are sexually aware from a young age. They become interested in body parts and what they do. Breastfeeding a child old enough to walk over to his mother and open her shirt creates a confusing message about personal boundaries and our bodies."
Dr Ellie is attributing sexual traits to a toddler?  For real?  Yikes, I've no idea where Dr Ellie lives but I can assure you that my toddler was not sexually aware!  He still isn't at 6 although he self weaned several years ago, but he does understand breasts are there for the purpose of nourishing (regardless of what else he goes on to appreciate them for as he matures!).

Perhaps I'm the only one that finds it disturbing to hear a Doctor making such links?  For those interested in the culture of sexualising our toddlers, this may be of interest.  But my children could walk over to me and lift my shirt at 10 months and a year respectively, should I have weaned them then despite the evidence highlighting the risks of doing so?

So to conclude, a statement from the American Academy of Family Physicians about GPs and lactation:
"Family physicians should be knowledgeable regarding the ongoing benefits to the child of extended breastfeeding, including continued immune protection, better social adjustment, and having a sustainable food source in times of emergency. The longer women breastfeed, the greater the decrease in their risk of breast cancer.” (AAFP 2008)"
It seems some still have rather a long way to go...

27 comments:

  1. Please tell me the author of this has a phd in something if not then by god you should. this is an outstanding well informed well structured response to a seemingly uneducated woman's ramblings (a so called Dr). I will be sharing this with everyone as it is fantastic.

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  2. *also applauds* was hoping you'd write about this..

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  3. agree with doctor ellie completely!

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    1. you agree with her? you think that breastfeeding is not important after a year? that moms just do it for some weird sexual reason?

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    2. Wow!

      I agree with the personal opinion that flies in the face of all the facts and science presented here-in and all the loads and loads more supporting extended bfing that could not be included? I thought I'd post here to make sure everyone knows I prefer personal bias over educated opinion.

      Well then, now we know. Congrats on remaining ignorant, Shell.

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  4. Thank you AA. Your post has saved me from clicking on the Daily Mail. In times of need, Daily Mail makes good kindle. If you can get it for nowt.

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  5. Wow - I find it scary that a qualified professional who is likely influencing the lives and attitudes of many mothers, would feel the need to speak from such an uninformed and influenced perspective!

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  6. All my 4 kids have 'extended' breastfed ( between 2 and 4 years). The idea that this stems from MY needs or there is a sexual element is just laughable. Toddlers definately don't think of it this way!! It is just comfort, a (very healthy) snack, and lots of cuddles. For me it is a chance to cuddle my otherwise hugely active toddler, have a bit of down time, while knowing that he is benefiting from my milk. Disturbing that a so-called 'professional' should get things so very wrong. Maybe SHE wasn't breastfed long enough?

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  7. Most of this is just personal preference, but how can condemn a doctor for her personal opinion but readily use your own. When the only aim of this blog is to promote your own website and the mothers milk marketing board. How much are they paying you and why should anyone take you seriously?

    Have a very long look in the mirror tonight. If you mums want to breast feed, if they don't then leave them be as well. There are bigger issues in the world. So get over yourself.

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    1. Why bother replying to this if only to slate AA? Pointless post.

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    2. Gaw, have you read it? At least AA has backed her PoV with research and evidence. Your reply is almost laughable, and I suspect not wholly innocent.

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    3. The difference is that the newspaper article isn't just being stated as opinion, but medical opinion - there's a big difference there. And to make it worse, she provides no evidence to back up her assertions, while AA provides reliable sources like the WHO. In addition, the article goes out to everyone who reads the daily mail, while this is seen only by people who actively go looking for it. Finally, the view espoused by the article is the common opinion in our society. I don't see anything wrong with AA providing an alternative perspective. Or do you think it's fair that only one side of the argument is heard?

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    4. Because when doctors go on shows representing themselves as DOCTORS, the implication is expert, not just another personal opinion. Because AA didn't just tell us her opinion, she presented facts and science. Because when lies and misinformation is put forward to the public as if it were fact, it needs to be countered so that women can make INFORMED choices. It seems that it is the mums who want to breast feed who aren't being left alone to do so. They are being told they are selfish and even sexually abusing their children. So, why is it this doctor, the media, society as a whole is spending so much time trying to shame the few moms who bf past a year into stopping? They are the ones who just won't let other moms be.

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  8. Superb article as always! It's so astonishing (I find myself surprised everytime!) how misinformed ''professionals' are. Well done xx

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  9. QUOTE but how can condemn a doctor for her personal opinion but readily use your own

    Did you even read the piece?

    MMMB don't pay me anything and nobody has to take me seriously, they can read the piece, look at the EVIDENCE and form their own opinions - that's kinda the point of the blog ;)

    Why exactly would you like me to look in the mirror? Is that a known technique to improve tolerance to nonsense? How did you shift from the above blog post to "if they don't then leave them be as well" when it has no relevance?

    Thanks to all coherent replies :)
    AA

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  10. Oh brother. being a mum = damned if you do, damned if you don't. Children need love and affection - they need to bond. If snuggling up to mum and soothing at the breast - a perfectly natural response - doesn't help, then wtf!!

    Erm - what did they do 100s of years ago before formula was invented......?

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  11. It makes me so happy to read this article! My mom and I were discussing the article in TIME. I was pro she was against, but I could not make a solid argument. This is so helpful! THANK YOU!!!

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  12. A really wonderful post, thank you so much.

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  13. Dr Ellie is not good for my health, she makes my blood pressure go up. When I mentioned to her on Twitter that her article is ignorant, she blocked me, as if I was going to ever write to her again. I found her feature insulting, offensive and judgemental. A shame she is doing a weekly feature, some trusting people might listen to her.

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  14. wow.
    this reminds me of my family doctor who told me that my BFing my 18 month old was selfish and my milk is no more than water.
    Lucky me that I knew better.

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  15. I too was told by my GP just last week that there was not nutritional reason to 'still be' bfing my 13 month old. Needless to say, we are 'still' breastfeeding.

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  16. I was told by my child's gastro that I wasn't likely "doing too much harm" bfing my 2 year old but that he wanted me to stop feeding her during the day altogether. I told him he was an idiot and ignored him and guess what, once she was able to be comfortable getting enough fluids from a cup or straw, she cut down on her nursing on her own. From 6 times a day to 3 in just 2 months once her swallow issues resolved. She was thirsty, just like I told him, and her swallow issues made cup drinking difficult. He'd have dehydrated her. Idiot.

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  17. It astounded me how thoroughly stupid these so-called "professionals" are. Believe me,I am not "still" feeding my 11 month old son for my benefit. I could do with keeping the weight,and I'm sure I'll have to trade in my nipples for new ones once he self weans. How ridiculous for people to take her OPINION as factually correct,just because she's a doctor. Well done AA,another wonderfully written piece,well needed when the pressure to give up has started.

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