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.

A Short Open Letter To Jeremy Clarkson

Dear Jeremy

Before writing your column this week, was there perhaps some sort of incident involving petrol fumes?   I have to confess to being a tad concerned you're really rather confused about basic biology.

In your piece you compared breastfeeding with urinating, and how we do that in a private room.  Let's take a deep breath and cover the basics.

Urination:  Urine exits the body via the urethra which is located in the genital area - it's illegal to randomly expose one's genitals in a public place.  Urine contains bacteria that could be harmful to the health of others, particularly when eating.  Urinating in the middle of Claridge's restaurant (outside of the designated toileting areas) would not be acceptable, and would likely end in arrest.

Breastfeeding:  Milk exits the body via the nipples which are located on the front of a woman's body.  Men also have breast tissue, areolas and nipples located in the same area - but do not typically lactate.   A baby is eating, just like everyone else in the restaurant.  Breastmilk contains bacteria that kills harmful pathogens, and unlike taking a piss in public, the milk is delivered into the baby's mouth.  Asking a mum to stop breastfeeding is illegal, and can result in you being sued.

 To see how silly your comparison really is, try out the following sentence:
"The school children were given warm home-made cookies, and an ice cold glass of urine".
I think we should actually be making mothers as comfortable about breastfeeding as possible.

A 2012 report shows that for just five illnesses, moderate increases in breastfeeding would translate into cost savings for the NHS of £40 million and tens of thousands of fewer hospital admissions and GP consultations.

£40 million of tax payers money the NHS could save Jeremy.  To put that in perspective, it's over 200 Ferrari 458's, or more than 450 top spec Range Rovers.  You've often commented about hospitals, strikes and UK budgets in general, so best to factor this into the equation.

It's clearly not breasts generally you have a problem with, in fact you comment here "All the birds in England have great tits", and struggle to present properly when faced with a couple of pairs .  But I guess we shouldn't be shocked, after all you've previously told us that men see "funbags" as their toys, and like a sports car can't face letting baby "use" them - in fact men generally find breastfeeding "deeply disturbing".

The irony you wrote this for a paper that frequently objectifies women isn't lost on me, because the message I'm getting here Jeremy is breasts are cool, as long as they're out on show for you to leer at (quite literally), but not when a woman chooses to do something else with them.  I believe that's known as misogyny...

The trouble is your stance is actually quite illogical.  To use your analogy, it's a bit like buying yourself one of those sports cars, and then not taking all the precautions you could to look after it well.  A 2013 study found breastfeeding could delay the onset of breast cancer for 10 years, whilst another found not breastfeeding was linked with increased risk of aggressive subtypes.  So even from an entirely misogynistic perspective, that's 10 more years of enjoying those "funbags" - oh and potentially saving the life of your spouse.  So unlike in your analogy where the baby wrecks the sports car, breastfeeding is akin to them taking it out for a spin and throwing in a service and tune up.

And a wax and polish actually, because did you know Jeremy that having a baby and not breastfeeding, is linked with a faster rate of breast skin ageing?  And before we go there, it's a myth breastfeeding makes them sag too.

So come on Jerry you don't need to write controversial guff to desperately try and stay in the public eye.  If you really can't bear to see babies eating, maybe carry around a copy of that paper you write for - then should you stumble unexpectedly upon a nursing dyad,  you can quickly immerse yourself in a vetted, titillating alternative on page 3?

AA

I'm Banned from Facebook Again - Breastfeeding Images Apparently NOT Allowed...

Unless you're a cave dweller, you probably saw recent media coverage of Milli Hill and her bottom. Well not hers per se, but the birthing bottom she shared online.  Posting it on Facebook landed her with a ban, despite the fact Kim Kardashian was doing the rounds faster than you could say "oily backside".

I had no idea at that point, that today I would be following in her shoes and receiving my own three day ban.

You can see the offensive image I posted that apparently violated their policies here:

The caption I posted with it was:
"As bf pics are now allowed on fb, I thought (with full permission granted) I would share this lovely photo, taken at our feeding support centre today. This babe is immediately post tongue tie treatment, and I only wish we had taken a before photo"
I posted the image on two Facebook pages; the one that goes with this blog here, and my dedicated UK infant feeding support site, Milk Matters.  I then followed the post on Milk Matters, with a link as to how parents might be able spot indicators of tongue tie in their baby, a post which is still visible.

The photo remains on Armadillo, but the one on Milk Matters was removed, along with notification I had violated standards and thus was banned for 3 days.  I have previously received a ban for 24 hours, but for a thumbnail showing birth imagery, rather than breastfeeding photos.

According to Facebook their policy is as follows:
"Does Facebook allow photos of mothers breastfeeding?

Yes. We agree that breastfeeding is natural and beautiful and we're glad to know that it's important for mothers to share their experiences with others on Facebook. The vast majority of these photos are compliant with our policies.
Please note that the photos we review are almost exclusively brought to our attention by other Facebook members who complain about them being shared on Facebook."

Alrighty then, left hand please meet right.

I have since been asked, why I felt the need to share the image anyway - and I couldn't help but think what a bizarre question.  Would you ask a mechanic why they wanted to share an picture of a car engine, or a nail technician a photo of perfectly manicured nails?

Anyway, I thought I would answer here.


It was a breastfeeding image, posted on an infant feeding support page.  A relevant arena for what actually was a pretty educational image.  Google NHS breastfeeding, click images and then count how many photos of a deep breastfeeding latch you can spot.  You might want to grab a drink as it's going to take a while.

A large amount of the material shows breastfeeding from a distance, or the back of baby's head, like this image on the right.

The first few latch images are as follows:

Hmmm no deep latches there.

Hopefully they will get better, especially when we get on to the NHS results:


The first image shown by Peterborough and Stamford, may be functional and work for that dyad, we can't tell - but it's certainly not a great example of a deep latch.  The second looks to be a slightly older baby who has nodded off, so he may have had a great latch earlier, but now it's shallow.  The third I'm hoping is used with the intention of "if your breastfeeding looks like this, please contact us", as the word that springs to mind is "ouch!".

I got bored after 100 images.

I Googled again, this time just using "breastfeeding" as the search term.  The search results are no better, you can see them here.

I'm mid another blog post at the moment, discussing shallow latches; because what has become apparent in recent years is that parents often have no clue what a deep breastfeeding latch looks like.  What we are seeing as everyday imagery of breastfeeding, isn't accurate.

What's even more worrying is that a huge percentage of parents I see, have been told their baby's latch is good, often by several people and even if mum is in pain.   I observe a feed and instead see a baby in a shallow, suboptimal position, which means their milk transfer is compromised.  As a result baby wants to feed a gazillion times per day and mum is sore.   So are we actually in a position where some midwives, health visitors and breastfeeding workers can't consistently recognise a deep latch either?

I should say at this point (before someone else does), that latch doesn't have to look textbook to work.  If mum and baby are comfortable, baby is gaining weight and is settled (not writhing about with trapped wind, colic or reflux), then it doesn't really matter what it looks like.  However when a mum is telling you breastfeeding isn't working, recognising that the latch means mum's nipple is getting rammed up against her baby's hard palate, or he's sucking in buckets of air via the gaps at the corners of his mouth - is kinda significant.

What annoys me most about this whole brouhaha, is that someone felt a need to report the picture.  A photo that was taken on the spur of a beautiful moment, after the mum had struggled for eight weeks to breastfeed her baby. We were discussing how wide his mouth was open, mum said it felt great but couldn't see because of her large breast, so my colleague grabbed her iPad to capture how he looked.  He popped off milk drunk and blissfully settled, after previously fussing, crying and needing topping up by bottle after every feed. Something, I should add that mum had managed to do with expressed milk the entire time, despite having two other energetic children under four!
Jack Nicholson - stars added for "modesty"

So my question is, why on earth shouldn't we post photographs? It seems the complicated rules of breast coverage strike again.  It would be so much easier to support effective breastfeeding if men did the lactating, as we have no such social discomfort with their skin, nipples and breast tissue.

Women's areola and nipples however are positively scary, see here how this knickerless pouting contributor to "dailyboobs" covers them up, to make the image decent and fit for Facebook sharing.

See the problem here?  The very thing involved in feeding an infant is also considered sexually explicit and best left to the realms of pornography.  I've had women laughingly tell me their husband wants them to finish breastfeeding so he can "get his boobs back".  The objectification of women is such, it's spilling over into the feeding choices women make.

I've contacted Facebook via every reporting route I can find, but most just say "thanks for the report" and nothing further happens.  Using the "Report a violation of the Facebook Terms" I managed to get a case open, highlighting my problem. But it was almost immediately closed. I used the reopen button, attaching an image showing their guidance quoted re breastfeeding photos, but again after several hours it was closed.

The bigger problem is, aren't we setting parents up to fail?  There's lots of hot air about how it's "best" and everyone should do it, yet don't dare show what it should actually look like!  Add this to the other stack of information parents may not be told, the passive support, and the often lack of specialist help, and it quickly becomes clear that we are merely paying lip service.

Your Baby Week by Week - Consultant Paed Advocates Cry It Out?

Photo: This is from one of the top selling baby books in the UK at the moment.  I know this specific advice is in MANY books (e.g., Tizzie Hall).  I'm so so so sick of these "experts".  

Read more here: http://evolutionaryparenting.com/educating-the-experts-lesson-one-crying/

Update: This book is geared for the zero-six MONTH baby...Unless you've been living in a parenting cave the last few days, you can't have failed to see the image on the left which has been doing the social media rounds.

A baby book which appears to suggest that should a baby cry so hard they vomit, you can change the sheet half the cot at a time.  And resist any urge to comfort, cuddle or speak to baby as parents need to be strong minded.

I noticed when reading the discussions, some people claimed the snippet had been taken out of context. And they're right; the next line might read "don't ever do this!".  So I decided to take a look on Amazon at exactly what the book does and doesn't say.

Book Title: Your Baby Week by Week
Author: Dr Caroline Fertleman & Simone Cave
ISBN-13: 978-0091910556
Relevant Pages: 260+

Below you can find the sleep section in question:


My Amazon preview finished there, but a book owner copied the following conclusion to Facebook:
"and cry even harder. By all means try the popping-in technique, although you’ll probably find that it just seems as though you’re teasing him. Checking your baby will give you some reassurance that he’s still safe and well, despite being very upset, but leaving the room will be hard for both of you. So our advice is to check on your baby without him seeing you – perhaps through a crack in the door. The next day Your baby will wake up refreshed, be as cuddly and loving as ever and behave as though nothing happened. You’re bound to be feeling guilty, but see the programme through because you’ve made a decision to try controlled crying and it really won’t do your baby any harm.
What many first time parents reading this book may not be aware of, is that all the above is really rather controversial.  Whilst statements are written definitively ie "it really wont do your baby any harm", other specialists vehemently disagree with this opinion.

This makes it tricky.  A paediatrician, someone who many hold as the ultimate baby expert, is saying it absolutely won't do any harm to leave a baby crying so hard they vomit.

Firstly I would like to say that whilst the term "controlled crying" is used a lot, this book isn't advocating "controlled crying" (CC), but "cry it out" (CIO).  CC involves returning to the baby with ever extending gaps, CIO is basically just leaving them to cry, end of.

Let's start at paragraph one.

Five months is the recommended age to start.  I'm not sure why, ie who picked this date - it doesn't tie in with any research I've seen recently, and there are no references in the book to support the claims. According to all SIDS guidelines baby should still be in their parent's room at this stage right?

As a lactation consultant it's concerning, because many breastfed infants continue to need a night feed at 5 months - they haven't even started solids at this age.
Infants whose primary source of energy is breastmilk will often wake frequently to nurse, something that is essential for the breastfeeding relationship to continue (Ball, 2009).
The thing is, take the feeding out of the equation - and we know it's still biologically normal for infants of this age to wake regularly.  (Weinraub, Bender, Friedman, Susman, Knoke, Bradley, et al., 2012).  More about what is normal infant sleep here.

How can any parent of a 5 month old be sure their baby doesn't need milk, but that it's "just" a want?  To me it really highlights the formula feeding culture many health professionals live in.  That a bottle is simply calories and we can calculate whether they are deemed necessary.  It doesn't consider that the breast is a whole lot more than food.  Breastfeeding is recognised as an anaelgesic by the BMJ - therefore an infant in discomfort will often want to feed.  It releases relaxing, sleepy hormones to both mum and baby (often helping mothers themselves get back to sleep quickly after night wakings), helps baby pass any trapped wind (gas), and is the ultimate "comfort item".  It seems it's OK for babies to rely on bits of cloth or "loveys" as their comfort, but heaven forbid a baby derives comfort from its own mother.

We then have to warn the neighbours.  Seriously.  And apparently if you do this, they will be tolerant.   To be honest we clearly mix in different circles, as many of my friends would be horrified if their neighbours informed them of this, and would likely print off oodles of reading as to to the risks before dropping it round with an offer of babysitting!

You then basically need to book time off work, as you have to expect 4 nights of crying - right before they warn you will feel stressed as your baby howls.  

Dear readers this "stress" felt is called INSTINCT.  Many mothers can use their "stressed" feeling as an accurate gauge as to their baby's need.   There is the low pitched, almost moany non urgent cry, that many of us attend to - but we might pop to the loo en route calling out we are on our way.  It's the polar opposite of the high pitched scream that makes you want to sprint and stop that baby crying now.
"Don't stand unmoving outside the door of a crying baby whose only desire is to touch you. Go to your baby. Go to your baby a million times." - Peggy O'Mara
Next we check baby is well, presumably we're assuming onset of illness can't occur in the middle of the night.  We then have to add extra creams in case baby poops whilst crying.  Er why?  Are we seriously suggesting not changing the nappy if baby soils it?

The next paragraph about vomit, makes me feel like doing the same.  I have no words.

Whilst he's screaming we have to remind ourselves he isn't hungry or in pain.  Hmmm what about all the other emotions we humans have?  We are seriously limiting babies to two or three?

Oh no wait, it's ok because the next paragraph tells us he's probably not feeling abandoned or scared, because he isn't a teenager and only has basic needs.  Yep that's right, the basic need of a responsive caregiver.

If it all gets too much, watch a film, pop in some earplugs.  Forget your 5 month old is so desperate for you they're vomiting - because apparently whilst babies aren't mature enough to feel complex emotions, they're capable of a mastermind level of manipulation.

Wendy Middlemiss, Associate Professor of Educational Psychology at the University of North Texas decided to study exactly what does happen to babies who are left to cry.
"Saliva was sampled for mothers and infants at initiation of infants' nighttime sleep and following infants' falling to sleep on two program days and later assayed for cortisol. As expected on the first day of the program, mothers' and infants' cortisol levels were positively associated at initiation of nighttime sleep following a day of shared activities. Also, when infants expressed distress in response to the sleep transition, mother and infant cortisol responses were again positively associated. On the third day of the program, however, results showed that infants' physiological and behavioral responses were dissociated. They no longer expressed behavioral distress during the sleep transition but their cortisol levels were elevated. Without the infants' distress cue, mothers' cortisol levels decreased. The dissociation between infants' behavioral and physiological responses resulted in asynchrony in mothers' and infants' cortisol levels" here
What does this mean?  Basically it tells us that during the first two nights of sleep training, both mum and baby released increased levels of a hormone, indicating they were stressed at the "sleep training" taking place.  However by the third night, the baby stopped signalling this distress - the "result" that this book aims to achieve.

What is critical to note though, is that baby's saliva showed they were indeed still stressed - they just stopped signalling this distress to their caregiver.  Therefore mother's stress hormone dropped and for the first time during the study mother's and baby's cortisol was mismatched.

This also confirms that when mothers feel so incredibly stressed on nights one or two that they just want to go and retrieve their baby (which the authors acknowledge will happen) - he is feeling the exact same desperately overwhelming levels of stress too...

So what does cortisol, this stress hormone do to the brain when it's produced in excess? It has been linked to chemical and hormonal imbalances, a suppressed immune system, ADHD, and a negative impact on emotional development. Read full with references here

Darcia Narvaez is a Professor of Psychology at the University of Notre Dame and Executive Editor of the Journal of Moral Education agrees:
"With neuroscience, we can confirm what our ancestors took for granted---that letting babies get distressed is a practice that can damage children and their relational capacities in many ways for the long term."
She goes on to say:
When the baby is greatly distressed,it creates conditions for damage to synapses, the network construction which is ongoing in the infant brain. The hormone cortisol is released. In excess, it's a neuron killer but its consequences many not be apparent immediately (Thomas et al. 2007). A full-term baby (40-42 weeks), with only 25% of its brain developed, is undergoing rapid brain growth. The brain grows on average three times as large by the end of the first year (and head size growth in the first year is a sign of intelligence, e.g., Gale et al., 2006).
Darcia also believes there are other significant potential consequences, which are discussed fully in her article here.

Perhaps the most ironic thing, is that Penn State researchers recently suggested receptiveness is more important than routine.
Emotional availability of mothering at bedtime was significantly and inversely related to infant sleep disruption, and, although these links were stronger for younger infants, they were significant for older infants as well. 
These findings demonstrate that parents' emotional availability at bedtimes may be as important, if not more important, than bedtime practices in predicting infant sleep quality. Results support the theoretical premise that parents' emotional availability to children in sleep contexts promotes feelings of safety and security and, as a result, better-regulated child sleep.
The Australian Association for Infant Mental Health Inc (AAIMHI) in its 2002 position paper (revised in 2004) on controlled crying:
'AAIMHI is concerned that the widely practised technique of controlled crying is not consistent with what infants need for their optimal emotional and psychological health, and may have unintended negative consequences.' You can read the background to these concerns in a PDF document that can be downloaded from the AAIMHI's website .
I would like to conclude by thinking again about the advice to not interact, respond or communicate in anyway with baby when they are distressed.  I think this video clip highlights perfectly that whilst as non psychologists, emotional and psychological damage may not be easy to recognise - that doesn't mean it isn't happening.



Further reading:

Baby Taming, if it works does that make it right?

Evolutionary Parenting: Educating the Experts – Lesson One: Crying

Dear Paediatric Consultant

I wanted to drop you a line to discuss some of the babies I've worked with over the last few years. Although our roles are very different, I  believe ultimately we both want the same thing; happy, healthy, thriving infants.

I know how hard you work.  I saw first hand the dedication as you worked all night on the tiniest of premature babies in the NICU.  The calls you make can be critical to the lives of the most vulnerable members of society, and that must be a huge responsibility as parents hand over a piece of their heart to you. 

It's because of these parents I feel I have to write this letter.  Parents who have babies classed as "reluctant feeders" or labelled as "failure to thrive".  As an aside, it would be great if you could send an internal memo, advising staff this is now referred to as "faltering growth" - a lot of slow-gaining babies are developing normally and are happy and "thriving" apart from their smaller than typical weight gain.

I've seen the same thing play out so many times, that I've realised it's not an odd blip - but a significant flaw in the system, so I think it's time to speak up.

I don't work for the NHS, I'm independent - which means a large percentage of parents I see are pretty much at the end of their tether.   They've gone through the system, or are in it when we meet, and here is what I've found:

A large percentage of babies who don't gain weight, aren't drinking enough milk.

I know, it sounds so basic doesn't it?  We don't need med school to tell us that insufficient intake results in insufficient weight gain, surely if a baby isn't gaining weight, this is the first thing to assess?

It's not happening.

Instead babies are subjected to a battery of tests, readmission to hospital, costs to the NHS, distressed parents, increased workload for you - all because nobody is skilled enough to assess a feed properly.

Perhaps this has become an increasing problem as budget cuts have resulted in fewer infant feeding advisors in our hospitals?  Whilst we have armies of keen and valuable (yet ultimately minimally trained) supporters, perhaps it's inevitable. In a local hospital for a large city, we have gone from three qualified full-time advisors, to one part-time; so perhaps previously babies referred to you had been thoroughly assessed, but this isn't the case now.

When an infant drops two centiles, this (as you will know) usually triggers referral to you.

Before this significant drop, if mum is breastfeeding she may be advised to supplement extra milk.  Yet typically nobody has assessed how effective (or not) the transfer of milk is.  Thus nobody has established whether the top ups or "one bottle per day" are enough.  If a baby is transferring very little at the breast, they may be surviving solely on top ups; why would we expect weight gain?

If a midwife or health visitor has watched the baby feed and believes it to be good, the suggestion might be made to feed more frequently - but if two centiles are crossed, again they are referred.

Of course the converse is also true.  If someone can establish that actually baby is consuming sufficient milk and yet gain is slow, these babies can be referred more quickly.

Once they arrive with you, it seems the assumption a baby can feed well is taken as a given - so the investigation into other causes of slow growth start.

I know this isn't your fault because your long training doesn't cover assessing infant feeding, and even less about the technicalities of breastfeeding.  That you often have to rely on personal experience or take time from your hectic schedule to seek out additional training. I know in the medical environment of a hospital and in complex cases, something so obvious as the inability to drink enough, might be a wood for the trees situation.  Instead heart conditions are ruled out, urinary tract infections, reflux and so on - and when these tests come back negative, it must be difficult knowing where to go.

If we establish a baby simply can't feed well, the next question we have to ask is why?  But instead what often seems to happen is that this is overlooked for "symptom solving", ie purely finding a way for the baby to gain weight.

If why is considered and weight is slow but not worryingly so, a hypoallergenic formula seems on the menu - because it must be dairy intolerance.

One of your colleagues refused to continue treating a mum because she refused to give up breastfeeding, he said she was selfish that she wouldn't give her baby a lactose free milk.   You will be pleased to know after the baby's oral disorganisation was addressed, he gained weight rapidly at the breast.  He wasn't dairy intolerant. 

If the situation is more serious, dropping an NG tube to provide nutrition seems an obvious choice, even in an older baby with no history of medical problems.  Indeed I've seen three infants older than twelve weeks in the last two months, who were sporting NG tubes due to bottle refusal or barely taking any milk orally.

I know too that ankyloglossia doesn't feature heavily on your curriculum, whilst clefts of the lip or palate and conditions like laryngomalacia might get a look in, beyond a tongue tethered at the tip - it seems largely ignored.  Even then the quality of advice received seems to vary massively, please don't misunderstand - some paediatricians do know the ins and outs and spot a tongue tie within minutes.  But we have to acknowledge that a far greater number do not.

Perhaps this is why so many of your colleagues believe, and tell parents, that tongue tie doesn't impact on breastfeeding, and definitely not when bottle feeding?

A mum I saw this last weekend was told by her consultant that "There is no evidence tongue ties cause feeding problems".  

Let's just think about that statement for a moment.

There is no evidence that having your tongue anchored to the floor of your mouth, impacts on feeding - an
act that requires the tongue to cup, elevate and undulate.  Let's take a glance at the image on the right and consider how exactly that will happen?

There is no evidence that having a leg that wont bend properly will hinder the child's chances of becoming a gold medal runner at the Olympics either. Or that water is wet... 

I wonder if I could please ask, what evidence is there that all these problems are caused by food intolerances?  Or that hypoallergenic formula is an appropriate long-term solution?   Or that there aren't risks to cessation of human milk?  What is the evidence for prescribing Gaviscon or Ranitidine as a first-line response to suspected silent reflux?

So we have some of the NHS denying the existence of ankyloglossia and its impact on feeding, we have some that are treating only anterior ties, and others are treating both anterior and posterior ties - and the problem with that, in the age of social media, is parents talk.  They're confused when a midwife tells them their baby has tongue tie and this is the cause of their problems, only to receive a completely conflicting opinion from their paediatrician.  The read online, they discuss things with other parents - and the real risk is they lose faith in you.

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The irony is that there is ample evidence exploring ankylogossia so much so that NICE wrote guidelines.  I know you must be confused as to why 20 years plus of research, still hasn't hit the NHS at a working level, to such a degree that some think it doesn't exist.  I find this baffling too.

I saw a paediatrician last year who was struggling to feed her own baby.  When we found a tongue tie and started discussing the implications - it became obvious that when a baby was readmitted for weight gain issues, still nobody checked oral function and whether baby was organised and effective when feeding. Nobody checked for tongue tie.  Her husband, a doctor in a different field pointed out that this seemed "rather bizarre".

Quite.

It seems common in hospitals to refer babies who are identified with a feeding issue to a speech and language therapist, but guess what?  Tongue tie and breast/bottle feeding doesn't feature in their training either...

The baby this weekend used to feed from a bottle, but then started refusing - so it absolutely couldn't be a tongue tie the mum was told, otherwise how did the baby manage it before?  Taking a brief history revealed yes the baby had taken a bottle, but had leaked, spluttered, gasped and required small, frequent feedings. 

Upon examination there was a 100% tongue tie, that is the tongue was anchored right at the tip preventing the tongue lifting, lateralising or protruding -just like the photo above.  It was one of the most restricted tongues I had seen for months.

Even if nobody is 100% sure if this is the root cause of the problem, it's such a minor intervention compared to a NG tube, reflux medications that are difficult for breastfeeders to use and which may carry other longer- term risks or cessation of breastfeeding; that I have to ask why it isn't it even on the radar?

As you know, infants experience rapid growth in the first 6 months, if a baby has found an adequate compensation strategy when tiny - there is no guarantees this will continue to be feasible as the head grows and the mouth changes.  Babies also have personalities, and a slightly older baby might decide they don't want to do something stressful and that makes them feel like they're drowning, especially once the offer of solid food is on the table.

At least with bottle feeding infants, you can measure their intake - with breastfed babies it's even harder.  It requires someone to watch a whole feed, not just the first few minutes.

Shallow latch hinders transfer
When a baby latches to the breast, it's easy to stimulate the first milk ejection (or letdown).  The baby then really just has to hang on, drink, and try and keep up with the flow - whilst co-ordinating swallowing and breathing.  

After this, if baby is not deeply attached and performing the correct action with his mouth and tongue, he may fail to stimulate further milk ejections. The mouth and tongue may become tired from trying, the flow of milk becomes so slow the baby has a powernap; gradually transfer comes to a halt - yet a full feed hasn't been taken.

We see these same behaviours in bottle fed infants.  Whilst they may not need to latch as effectively as they would to the breast, bottles also require some semblance of an effective suck to deliver milk at an appropriate rate.  Some disorganised infants feed so slowly they have to take small amounts around the clock, others can't slow the flow and appear to gulp hungrily (often labelled "greedy") and occasionally practically drown.

The problem is people are busy, and so often they only observe the first couple of minutes of a feed, see good drinking, assume baby is feeding well and breastfeeding problems aren't the cause of poor weight gain.

Indeed around 75% of the mums I see have notes from someone in their red book stating "breastfeeding going well" - which is interesting when you consider they are seeing me for feeding problems.

This seems exacerbated if there is any other potentially obvious explanation for the problem ie if a baby was premature, it's assumed prematurity is responsible.  If they have a milk intolerant sibling, it must be dairy. Yet surely we all know when it comes to healthcare we can't assume the obvious?

So what would I like to see?

Babies either readmitted or referred to a paediatrician for weight gain issues, should always see a competent infant feeding specialist - either prior to their appointment (potentially massively reducing the number that need to come through to you) or at the very least at the same time.  Really this should be happening long before there is such concern for growth that referral is being discussed.

All pediatricians need to be educated about symptoms of feeding disorganisation, and the many ways to quickly and easily identify if the tongue and suck appears typical.  Pure strength is not indicative of an effective suck, there are no bonus points for sucking like a Dyson, and this in itself can indicate compensatory techniques in play.

Finally, and perhaps most importantly we should be listening to mothers.  I would estimate 95% plus of mums I see know there is a feeding problem, they just can't identify what it is - particularly if all around them are saying "latch looks fine".  Mums often know the baby keeps slipping of the breast, or leaks and can't seem to grasp the teat well - and often suspects baby isn't taking as much as they need.

I know your hours are long, your diary full and that these problems might be considered "fads".  I know at times you might wonder why a mum is even bothered when she could just give a bottle, and might struggle to understand the many emotions feeding evokes, beyond the medical benefits and the basics of nutrition.  

 The distress a mother feels if her baby is not doing the one key thing they need to do and grow is immense, when breastfeeding this can be magnified as mum feels solely responsible.

When some paediatricians are denying that how we eat, impacts on what we weigh - I can't help but feel that as things stand, everyone is being short changed.

AA

If you've enjoyed this article, please consider making a donation.  This money will be used to fund assessment/ frenulotomy (tongue tie release)/feeding support from an Independent Board Certified Lactation Consultant (IBCLC), for those who can't find help within the NHS and are otherwise unable to afford to access independent support.  Any and all amounts (however small) are gratefully received.

Poem: Kids & The Fat Trap

I heard on the news there's an obesity epidemic
we're all getting fatter and they really need to stem it
Cancers, heart disease, diabetes and more
to the extent that Social Services are knocking at the door

before obesity can kill them, they're going to get 'em out of there!

Nobody seems to give a damn about the overwhelming irony
that these kids are the end product of a hypocritical society

As a child it seems there's junk food lurking everywhere you go
at school, at youth club, Brownies too, I'm forever saying no

So tell me Mr Government, if you really care so deeply
why you're plying it behind the scenes whilst smiling oh so sweetly?

click to read
In fact those trying to get healthy seem to be the ideal market
as our leisure centre told me they have vending machine targets
Even at the hospital purpose built to help the sick
it seems all you really care about is trying to get rich quick

Pizza Hut, Burger King, KFC & more
adorn the streets and shopping malls
enticing through their door...

In response our lovely government gives us "UK Change4Life"

Hang on Mr Government 
I thought the plan was less not more?

At the start of the Olympics, McDonalds came to town
along with Coca-Cola and they passed free samples down

The Tour de France was Haribo
cos "kids and grown-ups love it so"
their happy world means cash to blow
in return for seeing profits grow

You see the marketing for children is there to be sucked up
with lots of money changing hands, adverts at the World Cup

British Heart FoundationThe British Heart Foundation
said parents are undermined
by sophisticated promotions, on TV and now online
They exploit all the loopholes in marketing regulations
insidious, pervasive tactics to con a whole new generation

Billions spent every year
Beyoncé advertising sodas
and the message is clear
junk food is fine
oh except when it's not
and know when to stop

The trouble as I see it with an obesity causing addiction,
is nothing can compare to it from natures own kitchen.

The more refined and processed foods pervade our normal diet,
the more deficient and sluggish we become which makes it harder then to fight it.

So junk surrounds us everywhere, with billions spent to lure us
then the government turns around and blames it on consumers?

Seriously?
For real?
Go on, tell us another...

But please sort this mess out before another child loses his mother.

Is Dr Ellie Off The Telly Really That Silly?

As I read this today - my thoughts were not unlike those of the author, Lorraine Candy. Except it wasn't the "vitriolic war" between mums I was hoping to escape, but articles like this one.  The ones that say "go on, give a bottle" - yet forget to mention that could carry negative health implications *oops*.

I discovered the risks post "just one bottle" and I can't lie, I was pretty peed. But hey it's an "opinion piece", so you can say whatever you fancy right?

Lorraine I can forgive, after all why would we expect a DM journo who writes primarily about non-topics like eating custard creams for breakfast, to have a clue? She probably has the best intentions, alongside the fact she might have considered that adding a bit of drama could be good for readership. She's probably right.

I don't however understand people like Dr Ellie, supposedly educated, intelligent health professionals, who seem to do an amazing job of failing to see the wood for the trees when it comes to infant feeding.

There are some formula users who are just as vicious as some breastfeeders.  You see some people are mean, that's how it is - and those mean people are going to fall either side of the "debate".

That doesn't mean it's representative of the vast number of "pro-breastfeeders".  Instead it's rather like claiming all Muslims are Islamic extremists and nicknaming them the Musapo.  Would UK Doctors casually throw that around?

Dr Ellie likes black and white.  Yes breastfeeding is best, if you can't do it don't feel bad, and don't let anyone else make you feel bad.  Yes I know we medical professionals usually spend our time telling you about the "benefits of breastfeeding", and that this time next week you will be reading (in this same newspaper) an article extolling the virtues of human milk; but hey if you can't do it - y'know we'll backtrack and say actually it's not important.  

PS don't feel bad if you can't eat a healthy diet or exercise either - I know we say they're key to being healthy too, but hey working mothers run out of hours, pressure to "provide the best" and guilt over ready meals or not increasing one's heart rate is uncalled for.  My sister was so stressed trying I told her, that undoes any benefits!  And she's the picture of health, despite never exercising and living off convenience food.

Oh no sorry, there are only certain health messages Doctors feel can be scrapped at their convenience.  I don't suppose we should tar all of them with the same brush, I'm sure a fair amount cringe when they see Dr Ellie heading up a column. 

I agree with her mothers are often the ones left feeling bad - so Ellie's pat on the back of "there, there it doesn't really matter", might provide some short term feel good factor.  Until next week's article that is.  The other problem is that given there's only a very small percentage of mothers still  breastfeeding after the first few months - that's an awful lot of people you need to reach and give your feel good message to.

I guess that's where the media comes in, which works well as Dr Ellie can appear the reasonable, caring, "middle ground" - compared to those "extreme lactivists", with the added bonus of a nice boost for book sales.  There was this in March, which just happens to tie in perfectly with this.

But before you shoot out and buy it, perhaps we need to ask - if Dr Ellie is such an advocate of mothers, and by her own admission those she sees distraught have tried really hard to feed.  Perhaps, random idea - it might be more helpful to effectively support these mothers and try and enable them to do so?  

By effective I don't mean a GP who has nothing but the bare minimum of infant feeding training - I mean someone appropriately qualified.  That can't be a difficult concept for a GP to grasp surely?  Ear problems get referred to an ENT, Alzheimer's symptoms referred to a neurologist - if there's one thing GP's aren't a stranger to it's signposting.

So, we get a mother with a lactation problem we refer to?

Nobody.  We tell her not to feel bad because formula is good enough.  

How many GP's even know what a lactation consultant (IBCLC) is?  Despite the fact many areas have an odd one or two employed.  Last week during a discussion with a paediatrician, I mentioned the IBCLC's (there are two) in his hospital.  He had never heard of them, nor their qualifications and didn't regularly work with them to support babies having feeding problems.  Right you are then.

Some areas don't have them at all, perhaps Dr Ellie's is one of them?  Bizarre isn't it, that the NHS promotes feeding intensively on the one hand, yet doesn't provide enough infant feeding supporters to help everyone?

But surely during her appointments with upset mothers, at some point she has pondered the support services?  Where are her vocal calls for improvement? Then instead of trying to convince mothers that actually breastfeeding doesn't matter, they could have a fighting chance at achieving their breastfeeding goals?

We're not talking about trying to convince anyone to breastfeed who doesn't want to.  We're talking purely about helping those that want to do it.  Or does Dr Ellie actually think so many UK women are fundamentally broken, they're simply unable to successfully breastfeed in such large numbers?

You see the trouble is Dr Ellie, breastfeeding isn't just about nutrition.  So you tell a distraught mum, it's OK, formula provides perfectly adequate nutrition, and expect her to be placated.  But you've failed to consider the deep primal drive many mothers have to feed their young; how not doing so can hurt some mums so deeply that "adequate nutrition", doesn't begin to cut it.  If a mum has had a great breastfeeding relationship with one child, has experienced it working - to be deprived of that with subsequent babies can provoke a grief so deep, I've seen grandmothers crying as they recall it.

Those for whom it doesn't work from the start, may never know what they're missing - until they have more babies of course.

Because if Dr Ellie chose to delve beyond the immediate knee jerk reaction of trying to make mums feel better, asked the right questions and listened, truly listened to stories like that in the link above - she would surely see that supporting mothers, has to go much further than platitudes.  Throwing them a bone might work in the short term, but it doesn't last.

To suggest someone is a "bad parent" for not breastfeeding is ridiculous; I too see what some mothers go through trying to feed their babies and I see why some can't continue.  I also meet mothers with issues that could have be easily resolved if only she had received effective support after three days and not three months. 

You see the trouble is, the same health establishment Dr Ellie represents, telling you not to feel bad - are the ones letting mothers down.

Why on earth should a mother feel guilty that her healthcare providers failed to provide her with adequate support?

If  I got in a car without taking a single driving lesson, just a 5 minute crash course in how to operate the mechanics of the vehicle, and then set off down the M1 - would you be surprised if it ended in disaster?  I had a driving instructor, but they were understaffed, so didn't have time to sit and work through the detailed stuff with me.

When I crashed they told me not to feel bad and said not everyone could manage driving, if I wanted to quit public transport was a perfectly acceptable method of getting around - oh and never let the smug drivers make you feel bad either. 

When I said I wanted to try learning to drive a bit longer, and that I thought my car might be damaged - I was told whilst the ideal would be to see a mechanic, a qualified driving instructor and some moral support from Jim who managed to get down the M1 last year.  Problem was they had cut the hours of the mechanics and instructors, they didn't work there half the week - but Jim would call me daily.

When things didn't improve, they said I had tried hard enough, and being happy was more important than being able to drive.  Being unhappy would undo any benefits of driving anyway, and they really needed to tick the box to say that at least one method of transportation was going well...

Unlike not learning to drive, not getting help to breastfeed carries health risks.  It's a hundred times more emotive and linked to depression and feelings of guilt - and yet we're not only accepting this level of care as adequate, we're going to try and pretend after the event that none of it matters?  

Whilst Dr Ellie might like to portray those who are actually passionate about improving care for women, as nutters.  I have my own message for mothers:

1.  Whether you chose to formula feed from the start, or tried breastfeeding and it didn't work - never, ever apologise for how you feed your baby.  Not to a doctor, a mum at a group, a health visitor, a family member - anyone.  I hate hearing mums say "they failed" at breastfeeding, because the vast majority of time they "were failed". 

There are some mothers who can't breastfeed - but with support these mums can understand why, or even choose other methods of feeding at the breast if they wish via a supplemental system.

2.  Ask yourself whether you received the information and support you needed in a timely manner.

3.  If you didn't, pass the blame back:  "I wanted to breastfeed for longer, but didn't receive adequate support to do so."  

Perhaps if more mums started saying this instead of "I couldn't breastfeed", other mums might realise they too were let down,  that it's not their fault.  Perhaps if GP's like Dr Ellie, start hearing facts instead of misplaced guilt from mothers - they might start listening.

The Day They Banned Me From Facebook...

So I guess the day had to come.  A third warning for "explicit" material shared on Facebook and thus a 24 hour ban.

I'm sure you're all dying to see the hardcore porn I shared, so here it is, hope you're sitting down:



Has anyone ever seen a thumbnail so explicit?  Are your eyes bleeding?

I didn't choose the image, it was auto selected when I linked to the article - and it was so small on my phone I didn't clock it.  At the time the first post was deleted it had received close to 600 likes.

Even if we click through to the article:

Image property of http://www.janemccraephotography.com
So we can clearly see it's a woman giving birth - but I fail to see what's offensive.  There is no vagina, vulva or anus on display?  There are breasts, pubic hair, inner thigh and a baby's head.

Which of these is the deal breaker?

My page (as it quite clearly states at the top), is about pregnancy, BIRTH and breastfeeding.  We're not even talking random birth shots appearing on peoples friend feed which have been discussed recently.  We are talking about over 13 thousand fans who have clicked to like my page and its topics.

The problem is we are inundated with the media's portrayal of how horrific birth is; women flat on their backs wailing, some choosing a C-section purely because they can't face the thought of it.

Perhaps what people actually find offensive, is a woman not only having a beautiful labour, but also clearly enjoying giving birth.

It's always interesting to watch people's reactions if the topic of orgasmic birth comes up.  Whilst this can mean everything from a pleasurable labour to literally having an orgasm, a super common response is "ew, that's a bit weird".  If an agonising toil is our cultural norm, then enjoying birth is I guess the polar opposite to that and weird to some, out of their comfort zone.

But the "ew" response, particularly from women, that is most interesting; that some are clearly uncomfortable with the thought of a woman enjoying delivering her baby.  

It reminds me of an extract I remember reading from an 1894 newsletter giving advice to "new brides" who of course weren't supposed to enjoy sex:
"At this point, dear reader, let me concede one shocking truth. Some young women actually anticipate the wedding night ordeal with curiosity and pleasure! Beware such an attitude!"

"On the other hand, the bride's terror need not be extreme. While sex is at best revolting and at worst rather painful, it has to be endured, and has been by women since the beginning of time, and is compensated for by the monogamous home and by the children produced through it."

"She will be absolutely silent or babble about her housework while he's huffing and puffing away. Above all, she will lie perfectly still and never under any circumstances grunt or groan while the act is in progress. As soon as the husband has completed the act, the wise wife will start nagging him about various minor tasks she wishes him to perform on the morrow."
Whilst we might have come a long way, even now there is more stigma with a female wanting or admitting to enjoying sex - and it seems birth too.  I can't help but wonder if it's not all about a bigger power play, and empowered women are almost as scary as *whispers* breasts.  Oh only female breasts though, those belonging to men are fine to be out on show, even when they're bigger than mine.

Why?  Because as Jane quite rightly pointed out in her article - C-section images are not considered explicit. They can be mid-surgery with baby pulled half way out and nobody bats an eyelid if that appears on their feed over their morning cornflakes.

It seems to me it's fine for women's bodies to be on Facebook if they're vajazzled or popping out of skimpy underwear, or if they're hanging off the arm of a rapper who is singing about his "ho".   But see a woman so clearly in control, showing her body without intent to titillate and suddenly nature becomes offensive.

Roll Up Roll Up, Come and Test Your Breastmilk...

Yes really.

This week I stumbled upon, or rather couldn't help but fall over - an advertisement for a test called "My Milk Count". The purpose? To check mum's breastmilk has adequate levels of DHA.

DHA or Docosahexaenoic acid, is one of the long chain polyunsaturated omega 3 fatty acids (LCPUFA) that people commonly refer to as "good fats".

It seems good old Bounty are advertising the test in their packs and via email, which is why the product (which actually launched in July last year) is suddenly in the spotlight.

Developed by Professor Gordon Bell and his team at Stirling University, mothers pay £99 and send off a milk sample, they then tell you whether it's "low, sub-optimal or optimal "in terms of DHA.

If levels are "sub-optimal", mothers are advised to improve their diets and take another £99 test a month later.

The website is a bit sketchy and thin on the ground as far as information goes, beyond telling you how important "optimal" levels are.   So I decided to contact Professor Bell, to ask some of the questions that you've all been asking this week.

I have to say he replied like lightening, he was out of office but Dr Tom Gilhooly, Clinical Director of Glasgow Health Solutions replied moments later.  He was extremely helpful and happy to answer my questions as you will see below.

Whilst waiting for a reply, I couldn't help but ponder what this all means for formula fed infants born pre 2000, who had absolutely no DHA in their early diet?  Perhaps we could identify those most severely affected by going through the readership of the Daily Mail (particularly those who feel compelled to add a comment)?

Before we even get on to the studies about DHA and whether supplementing is beneficial, let's start with the obvious:

1)  If you don't eat a 2-3 portions of oily fish per week, or take an appropriate supplement - and you haven't done for some time (ie your stores are reduced),  you're likely to find yourself in the suboptimal range.  And you don't need to pay me £99 :)  If this is the case either eat fish or spend some of the £99 you've just saved on a supplement. Simples. Well actually it's probably not give the polluted state of our oceans and the omega 6 rich diet of the fish farming industry, but hey ho - moving on.

2)  Milk composition changes constantly during periods as short as a breastfeed, and as long as the entire lactation period.  We know colostrum has more DHA than mature milk, and we also know the fat profile of breastmilk fluctuates in response to infant feeding; when the breast is fuller, milk has a lower fat content than immediately after a feed when the breast is emptier.

In addition to all that, a study recently found breastmilk expressed around 30 minutes after the end of a feed, was higher in fat than that expressed straight after a feed. This seemed to be related to the amount of milk removed, with larger volumes showing a more marked response. Read more here.

If amounts in breastmilk can be influenced by diet, what mum has eaten recently should be taken into account too?

So when it comes to expressing milk for "My Milk Count", how exactly does one pick an "optimal" time to check for so called "optimal levels"?  The same mum could surely have dramatically different results depending on which hour, day, week or month she expressed?

I decided to ask Dr Gilhooly, here is his reply:
"This is a very new test and we have not yet established when is the best time for expressing the sample. We are advising a sample in the morning prior to a feed."
The problem with this as discussed above, is that pre feed (when the breast is full) is likely to yield a low result, the first milk expressed ie before a feed would be more sugary first milk, unless an entire feed is sent off for sampling?  Even then a mother can typically only express around 50% of her milk without massage, compressions ie hands on techniques most aren't even told about.  Therefore the sample wouldn't be an accurate reflection of what a far more efficient baby would obtain in terms of fats?   Furthermore mothers are often most full in a morning if they've had a longer spell of sleep - which again would trigger a significantly different reading to say later in the day, half an hour after a feed.

3)  Breastmilk doesn't just contain DHA, it also contains precursors which the body can convert to DHA.  Whilst precursors alone don't increase the level in non breastfed babies like preformed DHA does, remember for breastfed infants this is in addition to the DHA already present in breastmilk, not instead of:
"Studies in modern humans and non-human primates show that modern infants consuming infant formulas that include only DHA precursors have lower DHA levels than for those with a source of preformed DHA." here
For any levels to exist in a formula fed infant only consuming precursors, it confirms conversion can and does take place to some degree.

This is confirmed by another study:
"Infants fed ALA-supplemented formula had significantly higher DHA levels than control infants." here
4)  How do we decide what "optimal" levels of DHA are for human infants?  We look at breastmilk right? The problem though is it's massively variable depending where mothers live - something one of the studies "My Milk Count" reference highlights.  Coastal regions who eat a lot of fish, unsurprisingly have higher levels than those inland who didn't.

However the study didn't examine whether these higher levels conferred any benefits  They just noted that eating more fatty acids increased the amount in breastmilk, ie it could be influenced by maternal diet.

They also noted:
"There is evidence that poorly nourished mothers conserve PUFAs and LCPUFAs in their breast milk at the expense of saturates. Breast-milk FA concentrations, therefore, vary with the lifestyle of the population of lactating mothers under study; thus, FA concentrations vary by region." here
I posed this question to Dr Gilhooly, here is his reply:
"The optimal levels are drawn from a paper on worldwide variation on breast milk levels of DHA. The optimal level we aim for is the Japanese level which we also do in the much better established Omega Blood Count test. The study is http://ajcn.nutrition.org/content/85/6/1457.full"
Japan is second only to the Canadian Arctic in terms of average DHA levels.  They're are extremely high compared to other countries, Click here to see the table.

Since we're not Japanese, and our diet isn't comparable to theirs - how do we arrive at the conclusion, (particularly if we consider epigenetics) that this is the level the UK mum should strive to achieve?  I've asked Dr Gilhooly and will update when he replies.

5)  We can't extrapolate data from formula fed infants and apply it to breastfed babies.  How well someone can make DHA from precursors partly depends not only on the other types of fat consumed, but also vitamin and mineral intake.  Breastmilk needs to be viewed as a whole product, not as individual constituents.

Absorption from synthetic sources rather than human, may also influence outcome and formula fed infants have a different gut profile because they receive a different source of nutrition - therefore any data needs to pertain to exclusively breastfed infants.

6)  They're not even sure it's lack of DHA that links to poorer neurocognitive outcome in non breastfed infants.  A 2013 review states:
"Over the years, many prospective observational studies have indicated that breastfed infants have a significant neurocognitive advantage over their formula fed counterparts. It has been theorized that this is due to the higher presence of DHA in breast milk, relative to formula milks.
They also note studies are confounded by the massively variable composition of breast milk (both within and between lactating individuals) as well as environmental factors such as maternal/infant bonding, or the act itself which may assist development (Morley et al., 1988). " here

In short DHA appears to have some impact but it's really not that simple.
"The proposal that DHA enhances neurocognitive functioning in term infants is controversial. Theoretical evidence, laboratory research and human epidemiological studies have convincingly demonstrated that DHA deficiency can negatively impact neurocognitive development. However, the results from randomized controlled trials (RCTs) of DHA supplementation in human term-born infants have been inconsistent." (1) here
They go on to say that in order to establish whether fatty acid intake is linked to outcome, several trials based on formula fed infants have taken place.  These typically compare DHA enhanced formula with placebo (un-supplemented formula).
"The majority of trials in healthy term infants have shown little or no consistent, beneficial effects on neurocognitive outcomes as a result of dietary LC-PUFA supplementation. However, infant LC-PUFA supplementation has resulted in no negative effects on growth, development or morbidity. There is, therefore, currently no compelling argument either for or against LC-PUFA supplementation in term infants with respect to neurocognitive outcomes. This conclusion has been re-iterated in three consecutive versions of the Cochrane review that have evaluated 9, 14, and 15 relevant RCTs, respectively"here
So even for infants who are receiving zero DHA as they're drinking unsupplemented formula, benefit in terms of outcome have not been established.

In contrast:
"Both DHA and AA have been found in all breast milks examined to date via appropriate methods." (here
 7.  Fats aren't a solo, they're a choir.  Ask any nutritionist and they will tell you that health is really not as easy as picking one fatty acid such as DHA and deciding that's the important one.  A balance of different fats is important, and the best way to deliver that is simply by eating a healthy balanced diet - however you feed your baby.

Prof Bell himself says:
"An excess of omega 6 may hinder children's brain development. This is because omega 6 and omega 3 compete with each other to be absorbed by the body, so excessively high levels of omega 6 can effectively block omega 3 from entering your system." here
So presumably the test looks at omega 6 too, and tells you to cut that down if it's high?  It doesn't appear so looking at the sample report, and omega 6 doesn't appear to get a mention on their website.  I asked Dr Gilhooly
"The test will look at omega 6 levels which are actually quite important for brain development at this stage. We are planning to only report DHA levels as this is where most research is."
Make what you will of that...

I have asked for clarification as to whether this means they are testing the levels but not reporting them back to mum, and also whether data collected will be used for research purposes.

8.  Milk banks don't test for adequate DHA,  yet numerous studies show better outcome for infants who are giving human donor milk compared to infant formula.
"We test for protein, carbohydrates and total solids. These are the important things, and we have found that all our samples are nutritionally sufficient, even for vulnerable premature babies"' spokesperson for Human Milk Bank at the Countess of Chester Hospital NHS Foundation Trust.
9.  You can have too much of a good thing.  In late 2013 a review suggested that "omega-3 fatty acids taken in excess could have unintended health consequences in certain situations, and that dietary standards based on the best available evidence need to be established."
“What looked like a slam dunk a few years ago may not be as clear cut as we thought,” said Norman Hord, associate professor in OSU’s College of Public Health and Human Sciences and a coauthor on the paper. 
“We are seeing the potential for negative effects at really high levels of omega-3 fatty acid consumption. Because we lack valid biomarkers for exposure and knowledge of who might be at risk if consuming excessive amounts, it isn’t possible to determine an upper limit at this time.”
Previous research led by Michigan State University’s Jenifer Fenton and her collaborators found that feeding mice large amounts of dietary omega-3 fatty acids led to increased risk of colitis and immune alteration. Those results were published in Cancer Research in 2010". Read more here
10.  Is it closing the door after the horse has bolted?  DHA demands rapidly increase during the last trimester of pregnancy, and the amounts in umblical cord plasma have been positively associated with higher cognitive scores for both mental and psychomotor performance at 11 months. Furthermore most studies have recognized a positive association between maternal intake of good fatty acids during pregnancy and neurocognitive development of offspring.  Here

So shouldn't we actually be testing pregnant mothers and ensuring their intake is "optimal" long before lactation if at all?

In fact given evidence suggest pre-conception diet can permanently influence DNA, perhaps those planning to conceive should be the target market?  And puberty, and childhood - remind me again exactly how much omega 3 can be found in the typical British school dinner?

11.  Because there's far better things to spend £99 on!.

Note:  I asked Dr whether the test was funded by the university, or whether outside funding was sought:
The development of the test has been jointly between Glasgow Health Solutions Ltd and the University .We have had a some assistance from Scottish Enterprise to help with marketing of it and two major pharmaceutical companies are also interested.
Many thanks to Michael @yournutritionmatters for the all the fatty acid discussion of late!