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.

Breastfeeding, Dispatches & Society - Can We Provoke Change?

As a flurry of breastfeeding related news hits the headlines in anticipation of the upcoming Dispatches documentary, "discussions" reach boiling point in some quarters and I have to wonder where do we even begin to provoke the paradigm shift needed?

In the documentary preview, we can see the a clearly distressed mum needs help breastfeeding, yet her nearest support group is now two hours away.  Budget cuts mean her local one was closed.

As I highlighted in 2015, parents are being failed on a spectacular scale. 

Not just because of the lack of funding for support in recent years, because let's not pretend that we had good breastfeeding rates before.  It's an area that's long been problematic; some groups headed up by appropriately trained staff and providing a first class service, others whilst well-intentioned but manned by those working beyond remit and with inadequate supervision.

Parents deserve appropriately qualified, timely, effective, appropriately funded support - but the problem is much wider reaching.  Celebrities, the media, medicine, scientists and society as a whole fails mothers.

We tell them to cover up, put it in a bottle, feed in a toilet and make babies independent ASAP (ideally in their own room, sleeping 12 hours per night and "self soothing").  We promote detachment, creating a non-breastfeeding culture and then blame those who are a product of the world they live in.

We can then throw in the "Mummy Wars", a concept created and marketed to mothers by formula companies.  This campaign also successfully resulted in a direct reduction of feeding related information shared across social media networks, the risk of provoking "guilt" - reducing support and overall information even further.

Nowadays someone ALWAYS brings guilt to the table and I tweeted my thoughts this week:

We also have formula companies pushing the "breast is best" message, a recognised marketing technique to induce sales.  As a result academics, highly respected scientists and doctors - talk about the "benefits" of a mammal consuming same species milk. 

They conduct studies that hold those not breastfed as the norm against which they compare the outcomes of those who are - creating the illusion of "benefit".

If we hold breastfeeding as the norm against which we compare the outcome of alternatives, we would find ourselves exploring risks.  Far more beneficial to medicine and science as a whole, but far less desirable when it comes to formula sales.

We have major supermarkets repeatedly breaking laws regarding the promotion of infant of formula milk - a collection of this weeks Tweets include Boots, Tesco, Sainsburys and Asda:

We have campaigns like "Fed is Best" - where retired doctors from completely unrelated fields (and some I suspect suffering their own trauma), wave their HCP status like a banner - right before gas-lighting mothers that how they feed their babies doesn't really matter anyway.

Yet mothers, grandmothers, sisters, aunts tell us it does.  Long before science extolled the "benefits", many mothers had a primal, instinctive drive to feed their young.  The emotion provoked as they unpack their breastfeeding grief, is proof alone that we need to support mothers whatever journey unfolds.

We have Baby Milk Action reporting as doctors like Ellie Cannon joined the Nestle payroll.  Turning next to the Daily Mail this week to tell people breast isn't best so "stop bashing" bottle feeders.

Cannon writes:
"Studies do show that five per cent of breast-cancer rates are attributable to not breastfeeding. So there is an effect – but it’s small and I don’t believe it poses enough of a risk to be a worry for my patients who do not breastfeed."
There are so many problems with this comment.

First, where is this statistic even pulled from?  There isn't a citation.

A 2017 review states:
"From the 13 [studies] that evaluated the effect of length of breast-feeding, the report finds that for every 5 months of breast-feeding duration, there is a 2 percent lower risk of breast cancer.
A rather different statistic to ponder as the WHO recommendation of at least two years would result in a reduction of almost 10%, double that quoted by Cannon.

Second whether that risk was significant for your patient would also surely depend on their other factors such as a family history and other health concerns?  Can we make sweeping generalisations about the health of individuals?

Third, shouldn't patients get to decide whether they feel it's enough of a risk to "be a worry"?  Don't they deserve unbiased advice?

After briefly mentioning asthma and obesity (two conditions from hundreds), we learn that a "study from Brussels" found as long as we add prebiotics, "the health benefits for infants could be almost identical to that provided by human breast milk".   There's no citation and try as I may I can't turn up any such study.

The Daily Mail also tells us in a separate article that "2/3rds of people think breastmilk and formula are "no different" anyway.  Despite science telling us otherwise, the general public aren't convinced!  Well I can't think why, can you Dr Cannon?

Perhaps we shouldn't be surprised given this week, UC Davis professor and researcher Dr Bruce German told us:
"There’s a simple reason we have missed the critical importance of breast milk for lifelong health. It’s because science has been completely focused on the diseases of rich, middle-aged white men. Heart disease, high cholesterol, high blood pressure – these are the ailments that science has been focused on treating since the 1950s.”
We have the volunteer breastfeeding organisations manned by unpaid staff, propping up the entire system - one in which highly paid healthcare professionals refer mums to volunteers donating their time for only minimal expenses.

Breastfeeding is competing with a multi-billion pound industry and it's a battle we're clearly not winning.

We can't pretend how we feed our babies doesn't matter, yet the alternative - to recognise it does and yet leave people with completely inadequate support is just as bad. Even with support, without society on board- we can only get so far.  Yet a huge chunk of society including many health professionals have themselves been failed and cognitive dissonance is the biggest barrier of all.

We need our government to step up and take the lead with funding, but we need to think much bigger and better to hope for it to be more than a drop in the ocean.

Do Babies Who Eat Solids Before 6 Months Sleep "Better"?

Better for whom?

The media had fun this week with a study that told us:
"The early introduction of solids resulted in small but significant improvements in infant sleep characteristics."
Not "changes" to infant sleep, but "improvements".  A "making better" of. 

Or in this case, a change reported as an improvement because of author bias that longer = better.

Human infants rouse and signal frequently when close to their caregivers.  As I cover in my book, there's a whole host of reasons they do this,  yet things can interfere with or even stop this normal communication entirely.  As an example (and as this study confirms) the further away from their parents babies are, the less they signal.  This is precisely why "baby tamers" are always keen to get baby in their own room despite safety guidelines. 

These behaviours are assumed to be desirable by the study authors, because it results in a longer sleep stretch for caregivers and result in them feeling their baby is more "normal".

Attempting to manipulate and shift infant sleep patterns to be more like those of an adult and thus more convenient for parents isn't new, in fact it sells very well. 

Whether it's comfort blankets (although nowadays we prefer to call them "transitional objects") to "condition" a baby to accept cloth over a caregiver, or cry it out so the baby realises signalling is futile - it's considered entirely normal in Western society.  As such we like to pretend there are no consequences or cost to the infant of doing so.

In biological terms if we explore animals generally, the more mammals "signal" - the healthier they and their relationship with their caregivers is considered to be.  As with anything, when we intervene to shift away from the biological norm- we have the potential for both risks and benefits.

If we examine the risk and rates of SIDS, studies show us that not hitting deep sleep levels and retaining the the ability to rouse and signal is the best protection infants under 6 months have.   We know for example some studies find non-breastfed infants are less rousable, whilst others also link not breastfeeding an increased risk of SIDS, when compared to those who are mix-fed or exclusively breastfed. 

What impact does introducing solids and reducing arousal ability further, have on SIDS?  

It would seem prudent to ask given the authors note:
"Following the early introduction of solids, infants in the EIG slept significantly longer and woke significantly less frequently than infants in the SIG."
Although this effect was only visible in babies around 5/6 months (despite some having food from 3), what impact does introducing solids before readiness have on rates of infection, longer term microbiome and overall health? 

They didn't explore that either.

The "significant" change referenced is an average of 15 minutes total sleep in these older babies - which let's be honest, in knackered parent land is but a snifter. 

As was highlighted on Twitter, it would take longer than this to give the food and deal with the solid poop that comes with it.  Yet authors noted 10% fewer arousals, which is huge in terms of a shift from the biological norm.

What also isn't clear from reading the media coverage is the data is from "parental questionnaires". 

Here tired new parent who barely has time to shower and eat some days, pick the baby sick from your hair and accurately recall your baby's sleep for the last week please.  Make sure you're entirely honest about how much breast and formula you're giving too (rather than putting what you think we want to hear or what you'd rather be doing); after all your answers are going to influence the nation!

Seriously?  Researchers have already established that this isn't a reliable method of data collection.

Although the study authors don't acknowledge this, they do comment:
"The commonly held belief that introducing solids early will help infants sleep better could have produced a reporting bias. Mothers, anticipating improved infant sleep, could have reported better outcomes."
Ya think?

Given we have numerous studies highlighting babies can and do reach for food and start eating when ready and that there are risks before this time, why are researchers even going there with sleep?

A quick glance and no conflict of interest is disclosed.  So I dug a little deeper:

First - you'll recognise the names from the EAT study:

Professor Gideon Lack states on his bio that he receives "Personal remuneration: Lectures (SHS Nutricia, Nestle, SHS International)"

Dr Michael Perkin says he receives "Personal remuneration: Lecture (SHS Nutricia)"

Next I checked out the author associations:
"The Population Health Research Institute, St George's, University of London, London, England."

I dug out their financial statement which outlines that they've received grants from a number of people including the "Wellcome Trust".  A quick click later and we can see the Wellcome Trust's financial statement shows they own profitable shares in Nestle...

A cynic might propose parents may not be the only ones with a bias, but when has that ever stood in the way of a good headline?

Aptamil Formula Changes - Comparison Vitamins/Minerals

Since the changes to Aptamil first milk recently, I've received lots of enquiries as to whether I know what the nutritional changes are.

I snapped the back of a can and checked with online stores and have compiled a chart comparing old and new standard first milk, plus the pro furtura.

First up - they've adjusted the Whey/Casein balance.  Previously it was 60/40 to mimic breastmilk, now it has shifted to 50/50.  This may be why some babies are finding it harder to digest.

They've shifted some of the levels around, but the other big difference seems to be the addition of neucleotides.

A 2010 randomised control trial concluded:
"Nucleotides could be conditionally essential for optimal infant growth in some formula-fed populations. Additional research is needed to test the hypothesis that the benefits of nucleotide supplementation for early head growth, a critical period for brain growth, have advantages for long-term cognitive development."
So let's cut to the chase - if indeed nucleotides are indeed important, aren't we actually saying "oops, we're realised we were missing something needed for optimal development, and without which babies may be at a cognitive disadvantage"?

So what about all the babies given formula prior to the addition of nucleotides?  And that's the nub of the problem with infant formula manufacturers.  We pretend it's close to breastmilk, until we discover the next new "essential" ingredient at which point we admit otherwise?

Click here for the PDF

Image: Ocado Website