tag:blogger.com,1999:blog-31021412878494078382024-03-12T22:34:22.167+00:00Analytical ArmadilloInfant Feeding & Early Parenting, Food For Thought...Analytical Armadillo IBCLChttp://www.blogger.com/profile/03829027807809292649noreply@blogger.comBlogger288125tag:blogger.com,1999:blog-3102141287849407838.post-71594198977717004492023-08-29T11:15:00.003+01:002023-08-29T11:45:00.102+01:00Iceland - It's not about the parking vouchers<p><b>Iceland boss Richard Walker claims overturning UK laws is best way to help parents cope with current cost of living crisis<br /></b></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgd9aDqL2cV_xcfH1AzhmUxrMY-iBPOCz-VA_-7jIInAXv__GffCdeYfZaR40hwTJpAwhwjskEzOzI7Sk9YIoX1JA8tehMKlPW_J-Vt_2QDSIJ2xOOMjAfN0jHUp-YFAa0QjUq2tR34WBPuQwYJ3E4U74IDsVEwZzs3oFB01gyBlScooCUV4nGdLbGUYTU/s600/parking.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="400" data-original-width="600" height="126" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgd9aDqL2cV_xcfH1AzhmUxrMY-iBPOCz-VA_-7jIInAXv__GffCdeYfZaR40hwTJpAwhwjskEzOzI7Sk9YIoX1JA8tehMKlPW_J-Vt_2QDSIJ2xOOMjAfN0jHUp-YFAa0QjUq2tR34WBPuQwYJ3E4U74IDsVEwZzs3oFB01gyBlScooCUV4nGdLbGUYTU/w165-h126/parking.jpg" width="165" /></a></div>This week has seen Iceland boss Richard Walker take to daytime telly, telling us he intended to break the laws around marketing infant formula. Presenting himself as an advocate for desperate parents everywhere, especially those who don't breastfeed and are purchasing baby milk (so the vast majority of parents). <p></p><p>We're apparently supposed to forget 2 months ago this same dood <a href="https://www.thegrocer.co.uk/iceland/icelands-richard-walker-latest-supermarket-boss-to-criticise-food-price-cap-proposals/680003.article" target="_blank">criticised the government's proposal</a> to help the most vulnerable, saying he felt capping the price of essentials like bread and milk was a bad idea as "<b>this would force them to apply more pressure on producers to reduce costs"</b>.</p><p>The ultimately aim of his media interview it seems, from the misinformation about parking vouchers to lamenting he couldn't accept reward points, <b>was to create an emotive response from viewers. </b></p><p><b>Why? </b></p><p><b>Apparently to urge parents to try and provoke changes to the very laws designed to protect them, ironically from companies like Iceland</b>. </p><p><a href="https://about.iceland.co.uk/2023/08/23/its-time-to-change-the-law-on-infant-formula/" target="_blank">His statement on Iceland's website</a> is titled:</p><div style="text-align: left;"><blockquote>"<i>It's time to change the laws on Infant formula</i>"</blockquote><p>The laws have nothing to do with the price of infant formula and everything to do with marketing and exploitation. Parents don't need the law to change, they just need the price cut - but supermarkets do <a href="https://www.chroniclelive.co.uk/news/cost-of-living/supermarket-price-war-aldi-asda-26700476" target="_blank"><b>if they want to engage in a price war</b>.</a> Infant formula is up there with essentials like bread and milk (so high, consistent demand) and it's become unaffordable.</p><p>Of course the majority of the British public and it seems even some media reporters, don’t understand the very basics of <a href="https://www.bflg-uk.org/the-code#:~:text='The%20Code'%20is%20an%20internationally,feeding%20bottles%20and%20teats%2C%20intended" target="_blank">The Code</a> - and that’s pretty understandable for parents.</p></div><p><b>So let’s check some facts.</b></p><p>First cutting the price of formula by 20% is entirely legal, providing it’s a long term discount and not a promotion. So Iceland can completely legally reduce the price at which they sell it.</p><p><b>But from a business perspective, to make the same profit they now need to either reduce their buy price, or sell more tins</b>.</p><p>What normally happens as Richard himself highlighted in <a href="https://www.thegrocer.co.uk/iceland/icelands-richard-walker-latest-supermarket-boss-to-criticise-food-price-cap-proposals/680003.article" target="_blank">The Guardian</a>, is when supermarkets cut prices, <b>they put pressure on the producer to cut buy price</b>. A report in Dec 2022 found <a href="https://www.grocerygazette.co.uk/2022/12/02/uk-farmers-supermarkets/#:~:text=The%20report%20suggests%20farmers%20received,soaring%20production%20costs%20and%20energy." target="_blank">UK farmers were making tiny profits as supermarkets boast record takings</a>.</p><p>Except formula companies are owned by multi billion pound conglomerates, the industry dominated by a handful of key players and with a <a href="https://www.wbur.org/onpoint/2022/05/19/the-corporate-monopolies-behind-americas-baby-formula-crisis" target="_blank">shortage of infant formula</a>, the producers hold all the cards. They aren't going to buckle to demand from UK retailers.</p><p>Richard highlighted in his statement that indeed infant formula manufacturers have increased their prices as much as 45% in the last two years. Let's also note the formula industry report profit margins have jumped from 11.6% in 2021 to an estimated 14.2% in 2022, the highest point since 2015, according to new IBISWorld data <a href="https://www.axios.com/2022/06/17/baby-formula-shortage-profit-margins" target="_blank">provided to Axios</a>.</p><div><b>This leaves retailers then with only one option, to market, advertise and sell more tins - and here's Richard's problem:</b></div><div><span style="background-color: white; color: #63636a; font-family: Montserrat; font-size: 15px;"><blockquote>"<i>What the law prohibits us from doing is telling anyone that we have done so. Which makes it pretty hard for us to get the message out to desperate parents that Iceland can now offer big savings on the products they need</i>."</blockquote></span></div><p>Pretty difficult? Has Richard forgotten social media exists? A 20% price reduction would likely go viral purely from parents sharing this, but this doesn't solve his actual problem.</p><p>So they take a 20% hit on profit, offset initially by more customers, but pretty soon other supermarkets are likely to follow suit, and how to engage in a price war, promote sales, deals and compete if you're not legally allowed to advertise and market to customers long-term?</p><p>As the price they're selling at reduces across the board, if they can't reduce buy price, they now need more consumers overall, more people using the product to make the same profit - and both formula manufacturers and retailers know this. It's precisely why the laws exist.</p><h4 style="text-align: left;"><b>Protecting Consumers</b></h4><p>The laws aren't there to try and force people to breastfeed or feel guilty if they don’t. They’re not there to try and force you to pay more for formula as a punishment - far from it. Retailers could reduce their formula to £1 per tin and providing this was a long term price change, it would be perfectly legal.</p><p>What we do know is without these laws, and often even with them, consumers aka <b>parents, are bombarded with misleading, inaccurate information and promotions which have a significant impact on feeding outcome</b>. Every single breastfeed is a loss of a formula milk sale and thus their profit.</p><p>Retailers frequently violate these rules and are fined, at the time of writing <a href="https://www.bbc.co.uk/news/business-66582141" target="_blank">the latest being Boots just 6 days ago</a>.</p><p>In April 2022, a report by the World Health Organisation revealed <a href="https://www.who.int/news/item/28-04-2022-who-reveals-shocking-extent-of-exploitative-formula-milk-marketing" target="_blank">the shocking extent of exploitative formula milk marketing</a>. The second report in a series, <b>showed parents, particularly mothers, were being insidiously and persistently targeted online.</b> </p><p></p><blockquote><p><i>They were “paying social media platforms and influencers to gain direct access to pregnant women and mothers at some of the most vulnerable moments in their lives.”</i></p><p><i>The global formula milk industry were targeting new mothers with personalized social media content that was often not recognizable as advertising.</i></p></blockquote><blockquote><p><i>Through tools like apps, virtual support groups or ‘baby-clubs’, paid social media influencers, promotions and competitions and advice forums or services, formula milk companies can buy or collect personal information and send personalized promotions to new pregnant women and mothers. <b>The report found evidence of how misleading marketing reinforces myths about breastfeeding and breast milk and undermines women’s confidence in their ability to breastfeed successfully</b>.</i></p></blockquote><p>A 2023 study in the Lacet entitled “Marketing of commercial milk formula: a system to capture parents, communities, science, and policy” found:</p><p></p><blockquote><p><i>“This Series paper describes the CMF marketing playbook and its influence on families, health professionals, science, and policy processes - w</i><i>e report how CMF sales are driven by multifaceted, well resourced marketing strategies that portray CMF products, with little or no supporting evidence, as solutions to common infant health and developmental challenges in ways that systematically undermine breastfeeding. Digital platforms substantially extend the reach and influence of marketing while circumventing the International Code of Marketing of Breast-milk Substitutes.”</i></p></blockquote><p><b>They engage in the above because it works</b>. And now suddenly in the face of several reports such as this, a giant like Iceland wants to call for us to scrap these laws under the guise this helps parents learn about price reductions?</p><p>Most of us can agree, permanently reducing the price of infant formula yes - permitting companies to circulate inaccurate information proven to negatively affect the likelihood of breastfeeding. No. This is what Richard is proposing.</p><p>So let’s be clear, this argument isn’t about being able to claim reward points on your formula or using food bank vouchers to pay for milk - it’s about massive changes to the law. This paves the way not to help parents, we know without doubt this marketing harms - but to protect and increase the profit margins of multi-million and billion pound companies by overturning laws that currently restrict them.</p>Analytical Armadillo IBCLChttp://www.blogger.com/profile/03829027807809292649noreply@blogger.com0tag:blogger.com,1999:blog-3102141287849407838.post-72660585568994047582020-04-06T19:39:00.004+01:002020-04-06T19:41:39.332+01:00CMPA in the Breastfed Baby & How Long Does Dairy Really Stay in Breastmilk?<div class="tr_bq">
It's not uncommon for parents to be told it takes 2-6 weeks for dairy to leave breastmilk (depending on the advice giver). This can naturally lead to some parents choosing to switch to a hypoallergenic formula, with the belief this will result in a more rapid removal of milk proteins for baby and thus relief of symptoms.<br />
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It's of course therefore that we're basing such a big decision on an evidence base, but this is actually where the problems begin.<br />
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"β-lactoglobulin (β-Lg), which is not expressed by humans, has often been monitored as a cow's milk marker. With specific concern to cow's milk allergens, exogenous β-Lg has been detected in only a limited number of mothers' milk samples, and its presence is not related to atopic or non-atopic conditions."</blockquote>
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The search for cow's milk allergens in breast milk has been the subject of fervent research. Human and bovine β-casein, αs1-casein, and α-lactalbumin share a medium to high degree of sequence homology (53, 31, and 73% homology, respectively) and, hence, a certain immune cross-reactivity" (1)</blockquote>
There's a lot more info on the link I'll drop below, but in short - the protein they were tracking, doesn't appear to be linked to symptomatic babies. Symptoms didn't correlate with the appearance or removal of this, and many mothers didn't consistently show it in their milk. Oops<br />
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Scientists of course got back on it, and identified peptides fragments - or teeny tiny bits of broken down proteins, which both appeared to correlate with consumption AND symptoms.<br />
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They found that peptides could be identified very rapidly after consumption, leaving milk quickly with a maximum of 6 hours recorded in a 2019 study. Authors established peptides, not proteins was a far more effective way of tracking a constituent via breastmilk and thus future studies can explore this further for other food groups. </div>
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<b><span style="color: red; font-size: large;">"Dietary peptides were already detected at 1 h (T1) after the consumption of cow's milk and peaked after 2 h, whereas none of them was detectable 6 h (T5) after the oral load." (1)</span></b><br />
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This means there is very little delay removing dairy when mum stops eating it.</div>
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<a href="https://www.myallergykitchen.com/2018/11/13/breastfeeding-food-allergies/" target="_blank">This blogger and mum of a baby with allergies, who also happens to hold a Ph.D. in Cellular and Molecular Biology</a> got digging when they were diagnosed:</div>
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"<b>What I found was SHOCKING.</b><br />
It typically takes 2-8 hours for breast milk to be clear of food allergens after ingestion.<br />
Ingested food allergens do not always make their way to breast milk. </blockquote>
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Mind. Blown. Scientists have conducted several studies of breast milk at different time intervals after ingestion by the mother. For instance, one lab gave 23 women a serving of peanuts. Only half of them ended up with detectable levels of peanut protein in their milk. The milk that did contain the allergen peaked in concentration between 1-2 hours and steadily decreased from there [1].</blockquote>
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<b>So why didn’t my doctor tell me this?</b></h3>
The question emerges: WHY would doctors say it takes 2 weeks? WHY would online articles spread this lie?<br />
I believe the answer is two-fold. First, scientific research explains that it may take up to 2 weeks for the infant to be clear of symptoms. This is the case whether the child is placed on hypoallergenic formula OR breastmilk in conjunction with an elimination diet (let’s call this hypoallergenic breast milk). So, while mothers may be clear of allergens, their infant will likely continue to show symptoms for a few more weeks."</blockquote>
<a href="https://www.myallergykitchen.com/2018/11/13/breastfeeding-food-allergies/" target="_blank">Her blog is great, well referenced and</a><a href="https://www.myallergykitchen.com/2018/11/13/breastfeeding-food-allergies/" target="_blank"> worth a dig around if you have a baby with allergies.</a><br />
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<b>Why do symptoms persist for 2 weeks if I slip up and have dairy then?</b><br />
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It can take up to 4 weeks for <span style="background-color: white; font-family: "times new roman" , "stixgeneral" , serif; font-size: 15.9991px;">the intestinal mucosa to heal after it has been exposed to an allergen. This may be more rapid in babies receiving breastmilk due to the growth factors and pre/probiotics, anti-inflammatory constituents etc (2,3)</span><br />
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<span style="background-color: white; font-family: "times new roman" , "stixgeneral" , serif; font-size: 15.9991px;">In practice if dairy is the issue, we see a very rapid response via breastmilk removal, which echoes the science above.</span><br />
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<span style="background-color: white; font-family: "times new roman" , "stixgeneral" , serif; font-size: 15.9991px;">This means parents can be confident that once they stop consuming dairy, their breastmilk is rapidly clear and they can continue breastfeeding if they wish.</span><br />
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<li><span style="font-size: xx-small;"><span style="background-color: white; color: #303030; font-family: "arial" , "helvetica" , "clean" , sans-serif;">Picariello G, De Cicco M, Nocerino R, et al. Excretion of Dietary Cow's Milk Derived Peptides Into Breast Milk. </span><i style="background-color: white; color: #303030; font-family: arial, helvetica, clean, sans-serif;">Front Nutr</i><span style="background-color: white; color: #303030; font-family: "arial" , "helvetica" , "clean" , sans-serif;">. 2019;6:25. Published 2019 Mar 12. doi:10.3389/fnut.2019.00025</span></span></li>
<li><span style="background-color: white; color: #303030; font-family: "arial" , "helvetica" , "clean" , sans-serif;"><span style="font-size: xx-small;">Brill H. Approach to milk protein allergy in infants. <i>Can Fam Physician</i>. 2008;54(9):1258–1264.</span></span></li>
<li><span style="background-color: white; color: #303030; font-family: "arial" , "helvetica" , "clean" , sans-serif;"><span style="font-size: xx-small;">Czerwionka-Szaflarska M, Łoś-Rycharska E, Gawryjołek J. Allergic enteritis in children. <i>Prz Gastroenterol</i>. 2017;12(1):1–5. doi:10.5114/pg.2017.65677</span></span></li>
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<br />Analytical Armadillo IBCLChttp://www.blogger.com/profile/03829027807809292649noreply@blogger.com0tag:blogger.com,1999:blog-3102141287849407838.post-44643922604895850062020-02-04T19:05:00.000+00:002020-02-04T19:05:19.092+00:00What Breastfeeding “Cluster Feeding” Is and Isn’t...<div class="p1" style="-webkit-text-size-adjust: auto; font-size: 22px; font-stretch: normal; line-height: normal; margin-bottom: 3px;">
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<span style="font-size: 17px;">Cluster feeding. </span><br />
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<span style="font-size: 17px;">We hear these words a lot in clinic. Sometimes, quite often in fact</span><span style="font-size: 17px;"> </span> <span style="font-size: 17px;">- what the person is describing is NOT cluster feeding; it’s a feeding problem that is being mislabelled and like an epidemic it’s spreading.</span></div>
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<span class="s2">First if you’re breastfeeding fine, you’re happy, baby is happy and they’re gaining normally - you don’t need to worry about this post at all.</span></div>
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<span class="s2">This post is for those who have either a baby who is growing much more slowly than expected, or who is gaining normally but consistently needs a million feeds per day to do so (outside of normal growth spurt behaviours which we’ll come onto). In short the pattern really isn’t sustainable.</span></div>
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<span class="s2">Cluster feeding is a process term, healthy babies who are gaining weight well - typically start (in my experience from around 3-5 weeks of age).</span></div>
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<span class="s2">Because breastmilk is rapidly digested, babies need to feed frequently - every few hours. If baby wants to sleep a longer stretch of say </span><span style="font-size: 17px;">5/6 hours, baby may need more food to last this long.</span></div>
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<span class="s2">Baby therefore takes several or more full feeds quite close together, often around early evening time, signalling again (typically) 20-30 mins after the last feed- before dropping into a longer sleep spell. This is thought to allow baby to fill their whole digestive system, so excess hunger doesn't occur during this longer gap.</span></div>
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<span class="s2">Babies tend to fall into two camps - those who cluster feed and have a longer sleep stretch, and those that don’t and keep to them same pattern during the day of 2-4 hours. I can once remember dad of newborn baby number 3 - asking when they started that cluster feeding so you get more sleep?!</span></div>
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<span class="s2">Cluster feeding can also occur during growth spurts. This tends to be more random, can happen any time of day or night but is short-lived. <span class="Apple-converted-space"> </span>If baby is feeding well, settled and suddenly has a day or two of crazy manic feeding before things settle again - this is often what people refer to as a “growth spurt”, as this behaviour drives up mum’s milk supply with more frequent and effective milk removal. Cluster feeding can also be comforting if baby needs some help to sleep, is unwell or just because.</span></div>
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<span class="s2">I don’t believe many babies not back at birthweight at the appropriate time (10-14 days for an average sized baby) cluster feed - these babies are feeding frequently to get a longer stretch, but in a bid to try and pull enough calories.</span></div>
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<span class="s2">They may fall asleep quickly, rouse when put down and for all their intense efforts they’re prone to getting the label “lazy”. Instead of clustering, these babies are interjecting their feeds with a <a href="http://www.analyticalarmadillo.co.uk/2018/02/when-breastfeeding-baby-falls-asleep.html?m=1" target="_blank">powernap</a>.</span></div>
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<span class="s2">Sure they may take a longer sleep stretch if they’re exhausted from very frequent feeding during the day, but this isn’t the same as that outlined above. It can however be difficult to tell apart, which is why ensuring your support team has at least one certified person.</span></div>
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<span class="s2">Feeding every 20-30 mins all day with the occasional hour gap IS NOT clustering. </span></div>
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<span class="s2">Not gaining enough to track a centile despite feeding frequently IS NOT clustering.</span></div>
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<span class="s2">Growing normally but with a feeding frequency day in and out that isn’t sustainable, IS NOT cluster feeding.</span></div>
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<span class="s2">I keep hearing parents fobbed off with the claim it’s just what breastfed babies do. Leaving parents feeling guilty they can’t sustain these intense demands. Since we’ve normalised a problem, the risk is mum things she’s not able to sustain what others clearly can.</span></div>
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I overheard a conversation recently in our waiting room between a mum who had called back for a quick check, and one who had just arrived with a feeding problem. As the new mum was outlining the problems they were experiencing, she kept diminishing with - but I’ve not had one before it’s probably just what babies do, or it’s probably something I’m doing or I probably just need to learn to wind him better and so on.</div>
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When the other mum said she’d had all those problems and then outlined what feeding was like now - the first replied it gave her such hope and she’d been told it was just was breastfed babies do, or perhaps he’d just “prefer” the bottle.</div>
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There are always the exceptions to the above, but you can seek support and chat it through with someone if you’re unsure or things feel unmanageable :)</div>
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Analytical Armadillo IBCLChttp://www.blogger.com/profile/03829027807809292649noreply@blogger.com0tag:blogger.com,1999:blog-3102141287849407838.post-92016782768375287792020-01-09T20:55:00.000+00:002020-01-10T11:59:25.365+00:00Response:Guardian Letter to a Lactation Consultant <div class="p3" style="font-stretch: normal; line-height: normal; text-size-adjust: auto;">
<a href="https://1.bp.blogspot.com/-btD3PSY_FOk/XhXLV1dbH0I/AAAAAAAAC0U/pCvTpYETYjwYeN0ZZr8zQ2posh3fW5WhwCLcBGAsYHQ/s1600/846-06112220en_Masterfile.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="450" data-original-width="352" height="320" src="https://1.bp.blogspot.com/-btD3PSY_FOk/XhXLV1dbH0I/AAAAAAAAC0U/pCvTpYETYjwYeN0ZZr8zQ2posh3fW5WhwCLcBGAsYHQ/s320/846-06112220en_Masterfile.jpg" width="250" /></a><span class="s2"><br />On Saturday <a href="https://www.theguardian.com/lifeandstyle/2020/jan/04/a-letter-to-the-lactation-consultant">The Guardian printed an anonymous “parent piece”</a> from a mother who has a bad experience with a “lactation consultant” and her tongue tied baby.<br /><br />Many aren’t aware that “Lactation consultant” is neither a recognised nor protected title. Your sister’s, friend Margaret who breastfed for half a day can call herself one. <br /><br />Similarly, there isn’t an NHS job titled “lactation consultant” either (unlike I believe in the US) - so who this person was or what their qualifications are is incredibly unclear.<br /><br /><a href="https://www.ilca.org/why-ibclc/ibclc">International Board Certified Lactation Consultant</a> (IBCLC) is a certified title (although not registered and so ultimately poorly protected) , yet 90% of the time when someone says “lactation consultant”, the person doesn’t hold this certified title.<br /><br />Unlike in the US, many hospitals in the UK don’t employ a certified IBCLC, even under a different title - although some do.</span>Parents therefore often refer to anyone who helps them breastfeed as the lactation consultant.<br />
<span class="s2"><br />As an IBCLC I cringed at the claims of what someone supposedly said, or perhaps implied.<br /><br />So this certified lactation consultant is going to add another perspective:</span></div>
<ol>
<li><span class="s2">No mum should be spending 12 hours a day feeding their baby. If someone feels overwhelmed, it’s important that the wants and needs of the parents are central to any “plan” established. I have seen plans set by some hospital staff with little breastfeeding experience, that have no gap for sleeping or eating. Instead two hourly feeding and pumping around the clock may be suggested, which is of course completely unsustainable.</span></li>
<li>Some mums want to use a hospital grade pump, other don’t. Some want to try a nipple shield, some don’t.</li>
<li>I’m unsure why a lactation consultant would ask a mum if she’s “fixed the tongue tie”, since this isn’t something a parent can do at home? If baby had a tongue tie diagnosed, when and by whom? Why is this "lactation consultant" not aware of if/when this is happening? It's all very confusing.</li>
<li>Frenugreek is a herb typically taken for low milk supply, which can follow a shallow latch associated with tongue tie. I’m not a huge fan personally, but some swear by it.</li>
<li>I’m not sure what poor garlic did wrong - a large study found that when breastfeeding mothers consumed garlic, their infants stayed at the breast and breastfed longer (1). And since an increase in breastfeeding can lead to an increase in the breast milk supply, this may be one of the reasons garlic can help breastfeeding mums make more breast milk.<span style="font-family: , "blinkmacsystemfont" , "helvetica neue" , "segoe ui" , "arial" , sans-serif;"><span style="font-size: 13px;">Which </span></span><a href="https://www.health-e-learning.com/resources/becoming-an-lc" style="font-family: -apple-system, BlinkMacSystemFont, "Helvetica Neue", "Segoe UI", Arial, sans-serif; font-size: 13px;" target="_blank">any certified IBCLC would likely know</a><span style="font-family: , "blinkmacsystemfont" , "helvetica neue" , "segoe ui" , "arial" , sans-serif;"><span style="font-size: 13px;">...</span></span></li>
</ol>
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<span class="s2" style="font-family: , "blinkmacsystemfont" , "helvetica neue" , "segoe ui" , "arial" , sans-serif; font-size: 13px;">S</span>o what appears to have happened here is mum has been discharged attempting to breastfeed a tongue tied baby, with the first mention of support being after a problem has arisen. <br />
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The shallow latch meant baby couldn’t pull a full feed, despite feeding at the breast and so was still hungry afterwards. To try and provide more milk for the still hungry baby, mum has expressed - yet many are not given appropriate guidance on how to drain their breasts effectively with a pump. This means mums can invest significant chunks of time, for little milk removal. Some mums struggle to express well even if they have oodles of milk - triggering the milk ejection reflex is a learnt art and even then, some mums don’t respond to a pump the way they do a baby.</div>
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As a result of the reduced milk removal though, mum’s supply may reduce further despite her dedication - rather like pushing a boulder up a hill. This can quickly become understandably overwhelming.</div>
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The next section again leads me to question whether this was a certified IBCLC:<br />
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“more lactation cookies, more mother’s milk tea, more essential oils, more water, more calories, more nutritious calories, more hand expression, more, more, more.”<br />
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Lactation cookies and tea aren’t on the whole evidence based, and certainly not routinely recommended in the UK (much more popular in the US) - they tend to have more popularity on parent to parent social media pages.<br />
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Essential oils aren’t within the remit of an IBCLC and so would never be suggested in the UK (unless presumably the practitioner is also a certified and insured aromatherapist). Any parent needs to drink normal amounts of water and consume normal calories - drinking and eating excessive amounts doesn’t link to milk supply, so again this is a rather bizarre statement from someone who has supposedly undertaken rigorous training.<br />
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There are good and bad in any profession, I saw an appalling GP for an emergency appointment for a relative recently - not that I’m sure the Guardian would be interested in that though.<br />
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What’s worse here, is we internationally certified lactation consultants get the flack for anyone and everyone who ever helps with breastfeeding! In the absence of knowing the title of the person that actually helped, lactation consultant is used.<br />
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I’m not sure whether this article originated in the UK as the guardian doesn’t specify - but I’m sure many parents can relate to unskilled support lacking appropriate counselling skills they often find themselves left with.<br />
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I won’t hold my breath for a guardian article that follows from a mother with a polar opposite experience, I suspect I’d be quickly turning blue.Analytical Armadillo IBCLChttp://www.blogger.com/profile/03829027807809292649noreply@blogger.com0tag:blogger.com,1999:blog-3102141287849407838.post-68297154662831609112019-09-12T13:27:00.001+01:002019-09-12T13:27:16.390+01:00No You Can't See Antibodies In Your Breastmilk - Myth Busted"My milk is really poor quality and doesn't have any antibodies anyway", said a mum during a phone call yesterday. She went to continue but I had to interject - sorry, wait, what?<br />
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Turns out mum had seen some photos on Facebook. One showing white milk and the other showing a rich golden yellow - with the claim because baby was sick, the yellow colour was all the antibodies, just like colostrum....<br />
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<a href="https://1.bp.blogspot.com/-Hhc9WerVS5g/XXom6VnlFjI/AAAAAAAACy8/jmhSNRU21w0dNAe1e0wVVVCPOwNvnJEGACLcBGAsYHQ/s1600/69964570_2307773229536559_412737595412316160_n.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="557" data-original-width="640" height="347" src="https://1.bp.blogspot.com/-Hhc9WerVS5g/XXom6VnlFjI/AAAAAAAACy8/jmhSNRU21w0dNAe1e0wVVVCPOwNvnJEGACLcBGAsYHQ/s400/69964570_2307773229536559_412737595412316160_n.jpg" width="400" /></a></div>
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Oh my days.<br />
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<b>YOU CAN'T SEE ANTIBODIES with the naked eye!</b> Any more than you can see vitamin D or harmful bacteria, antibodies do not colour breastmilk.<br />
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<a href="https://1.bp.blogspot.com/--k0gJE8jqw4/XXocBpS1QeI/AAAAAAAACyw/w5saZshv1wUf6-J8658-_TwPrMAYUvIoQCLcBGAsYHQ/s1600/download.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="183" data-original-width="275" src="https://1.bp.blogspot.com/--k0gJE8jqw4/XXocBpS1QeI/AAAAAAAACyw/w5saZshv1wUf6-J8658-_TwPrMAYUvIoQCLcBGAsYHQ/s1600/download.jpg" /></a><b>Colostrum is not coloured by antibodies</b>. The fact is colotrum can vary from mother to mother - it can be clear, pale and golden or bright orange like cordial! What's more, colostrum can vary in colour hour to hour, day to day from the same mother. The colour variation and orange tinge is because of carotenoids in the fat, NOT antibodies.<br />
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Eat enough beta-carotene rich carrots, squash, sweet potatoes etc and you can turn your whole self orange too, in a condition called "<a href="https://emedicine.medscape.com/article/1104368-overview" target="_blank">carotenemia</a>" (I kid you not).<br />
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Breastmilk is shown to be a dynamic fluid that changes moment to moment, hour to hour, day to day - to best meet the needs of that individual baby. This means the time of day she expresses, how long ago it was since her baby fed/she last expressed, how full her breasts were at the time - all can make a massive difference to how milk looks when milk is removed.<br />
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We can best see this difference if a mum who has full breasts expresses until they feel softer and a "full feed" volume of milk has been removed (or more if mum has oversupply/engorgement):<br />
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<a href="http://upload.wikimedia.org/wikipedia/commons/thumb/d/da/Human_Breastmilk_-_Foremilk_and_Hindmilk.png/250px-Human_Breastmilk_-_Foremilk_and_Hindmilk.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://upload.wikimedia.org/wikipedia/commons/thumb/d/da/Human_Breastmilk_-_Foremilk_and_Hindmilk.png/250px-Human_Breastmilk_-_Foremilk_and_Hindmilk.png" data-original-height="111" data-original-width="250" height="177" width="400" /></a></div>
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<a href="http://www.analyticalarmadillo.co.uk/2010/07/foremilkhindmilk-and-lot-of-confusion.html" target="_blank">As this post discusses</a> - when mum is full, the first milk is higher in lactose (to fuel brain growth and provide a "drink"). As the breast drains, we see the fat content increase. If mum was to express milk right at the end of a feed, when her breasts felt much less full and softer, we'd see a picture more like the right. However unless mum was extremely full and then got a superb expression with a pump, she'd be unlikely to notice such a distinct difference as above - it's a gradual transition, not a flipping switch. If stood in the frige, it typically <a href="https://kellymom.com/mother2mother/what-to-expect-when-pumping/" target="_blank">looks much more like this</a>.</div>
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What's even more ridiculous about the whole "visible antibodies theory", is it seems people can't even decide what colour they are!</div>
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Vaccines DID NOT turn her breastmilk green, or blue, depending on your point of view (maybe it's like <a href="https://www.iflscience.com/brain/explaining-perceptions-dress/" target="_blank">that dress where people saw different colours</a>?). The claim is her body thought it was sick from the vaccines, sent this signal to mother who made coloured milk!</div>
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What's far more likely is mum ate some green foods, drank some Gatorade, took a Spirulina supplement or something else that <a href="https://www.breastfeeding.asn.au/bfinfo/unusual-appearances-breastmilk" target="_blank">tinged her breastmilk</a>.</div>
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Mums are often worried their breastmilk doesn't look "right", or "nourishing" or that there isn't enough fat. This is purely because cow's milk proteins result in a yellowy/creamy hue (and typically the more cream the more golden/yellow). Yet human breastmilk as the norm has more of a white/bluey tinge unless the fat is separated out. What's more, even expressing with <a href="https://www.breastfeeding.asn.au/bfinfo/unusual-appearances-breastmilk" target="_blank">hands on techniques</a>, you're unlikely to remove as much milk (and thus fat) as a baby feeding well. If you just put the pump on and go without breast compressions, you typically remove less still. </div>
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Rest assured <i>your</i> milk is perfect for <i>your</i> baby.</div>
<br />Analytical Armadillo IBCLChttp://www.blogger.com/profile/03829027807809292649noreply@blogger.com0tag:blogger.com,1999:blog-3102141287849407838.post-25055294230087682412019-07-17T13:19:00.001+01:002019-07-17T13:41:09.923+01:00Toxic Breastmilk? <h3 style="text-align: center;">
<span style="font-size: large;">"'Cocktail of chemicals' found in UK mothers' breast milk due to home furnishings" </span></h3>
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The Telegraph</div>
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<span style="font-size: large;">Household chemicals blamed as UK mothers have highest levels of toxins in breast milk</span></div>
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Daily Express</div>
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And yet again I wondered who really funds these clickbait headlines.</div>
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The paper that provoked such a media response is an environmental audit called "<a href="https://publications.parliament.uk/pa/cm201719/cmselect/cmenvaud/1805/180502.htm" target="_blank">Toxic Chemicals in Everyday Life</a>". It explores the toxic contamination of our environment, the impact to wildlife, the food chain and society as a whole - with a particular focus on the aftermath of the Grenfell Tower fire. It discusses the levels of toxin exposure we face and how these can affect our health.</div>
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They note that toxins from fire-retardant sprays for home furnishing are at significant and worrying levels in everything they tested - from newborn cord blood to the urine of adults.</div>
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What's truly bizarre is that the media ran with the breastmilk angle - which is only noted briefly in one of the subsections, and frankly is a drop in the ocean in terms of the level of the problem.</div>
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The relevant section reads:</div>
<blockquote class="tr_bq">
"44. Flame retardants have been detected in air, soil, water, food, wildlife and humans.
They are present in homes and offices via dust and on surfaces including windows, floors
and carpets.151 Exposure occurs when additive flame retardants leach from goods into
the air, dust and surfaces.</blockquote>
So in short, flame retardants (PBDEs) have contaminated everything from the air in your home, to the soil your food is grown in. Oh and the formula you have to use if you don't breastfeed.<br />
<blockquote class="tr_bq">
"152 <b>Breast Cancer UK suggests the US and UK have the highest levels of flame retardants in human body fluids.</b>"</blockquote>
I dug out the Breast Cancer UK <a href="https://www.breastcanceruk.org.uk/uploads/Background_Briefing_Flame_retardants_21.9.17.pdf" target="_blank">briefing</a> which states:<br />
<blockquote class="tr_bq">
"In general, the USA and the UK have the highest recorded levels of flame retardants in human body fluids (36). <b>The highest concentrations of legacy PBDEs in mothers’ milk have been detected in American women</b>, and the second highest levels in those from the UK (37). Elevated levels of PBDEs have also been found in human blood serum in Californian children at 5 times the US average, and 10-100 times the European and Mexican average"</blockquote>
Oh, so hang on Daily Express - UK mothers don't have the highest levels, Americans do. <br />
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Reference 36 is a 2008 study exploring the <a href="https://www.ncbi.nlm.nih.gov/pubmed/18351120" target="_blank">US population</a> - it highlights that there are significant differences recorded depending on area and age.<br />
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Reference 37 is a 2009 review with particular focus on external exposure routes (e.g. dust, diet, and air) and the resulting internal exposure to PBDEs (e.g. breast milk and blood).<br />
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So let's pause a moment to consider that yesterday's headlines were in fact based on a TEN YEAR OLD study...<br />
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They note that fats contain higher levels of contaminants presenting an important exposure pathway for humans. This includes foods like fish, dairy products and breastmilk,<br />
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They state blood serum levels are 10 times higher in the US in their study than in Europe. Yet they couldn't find ten times the difference in the food chain.<br />
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But do you know where they did?<br />
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<b>Dust</b><br />
<blockquote class="tr_bq">
"The ingestion of dust conveys the highest intake of BDE-209 of all sources, possibly also of other PBDE congeners. The PBDE exposure through dust is significant for toddlers who ingest more dust than adults.<br />
Indoor air and dust concentrations have been found to be approximately one order of magnitude higher in North America than in Europe, possibly a result of different fire safety standards."</blockquote>
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To compare breastmilk, researchers searched for recorded data from different countries. We're not really comparing like for like, since not all data compared is from the same time period, nor using the same techniques or sample sizes. In the context of contaminants this is a significant flaw, because even within the same area, research highlights massive variations from sample to sample based on their immediate surroundings; some data pooled was samples from 10 people, some from 100, we have no idea what the ages of the sampled were (as the previous study highlights, the older we are - the higher our toxin level).<br />
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Everything tested recorded higher in the UK than other parts of Europe, in the one data sample we provided - blood serum, dust etc.<br />
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Peeing your pants about breastmilk, is like realising the entire second floor house is on fire, about to burn to the ground - and you make a public announcement your ashtray downstairs in the basement has just caught alight, distracting everyone from the actual imminent disaster.<br />
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What the media also fail to recognise - is that by scaremongering against breastmilk, not only will infants continue to be exposed (via the placenta, maternal blood flow, infant formula, the air they breathe and so on), but parents may wrongly believe it to be beneficial to their infant to not receive breastmilk.<br />
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In fact - this is like swapping the water you were pouring on the fire to cooking oil.<br />
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Exposure to environmental chemicals has been linked to <a href="https://rdcu.be/bKG3y" target="_blank">dysregulation of the immune and reproductive system, diseases like cancer - and are known to alter the gut bacteria</a> (microbiome).<br />
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Numerous studies have demonstrated that breastmilk is significant in terms of the developing microbiome, contains factors that assist regulation of the immune system and in short, assist the body in dealing with the effects of exposure (1-8).<br />
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It's time some media sources started sorting fact from fiction, before they write their headlines.<br />
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<ol><br />
<li>Pannaraj PS, Li F, Cerini C, et al. Association Between Breast Milk Bacterial Communities and Establishment and Development of the Infant Gut Microbiome. JAMA Pediatr. 2017;171(7):647–654. doi:10.1001/jamapediatrics.2017.0378</li>
<li>Van den Elsen LWJ, Garssen J, Burcelin R, Verhasselt V. Shaping the Gut Microbiota by Breastfeeding: The Gateway to Allergy Prevention?. Front Pediatr. 2019;7:47. Published 2019 Feb 27. doi:10.3389/fped.2019.00047</li>
<li>Alba Boix-Amorós, Fernando Puente-Sánchez, Elloise du Toit, Kaisa M. Linderborg, Yumei Zhang, Baoru Yang, Seppo Salminen, Erika Isolauri, Javier Tamames, Alex Mira, Maria Carmen Collado. Mycobiome profiles in breast milk from healthy women depend on mode of delivery, geographic location and interaction with bacteria. Applied and Environmental Microbiology, 2019; DOI: 10.1128/AE</li>
<li>Cacho NT, Lawrence RM. Innate Immunity and Breast Milk. Front Immunol. 2017;8:584. Published 2017 May 29. doi:10.3389/fimmu.2017.00584</li>
<li>Hsu PS, Nanan R. Does Breast Milk Nurture T Lymphocytes in Their Cradle?. Front Pediatr. 2018;6:268. Published 2018 Sep 27. doi:10.3389/fped.2018.00268</li>
<li>Laura M'Rabet, Arjen Paul Vos, Günther Boehm, Johan Garssen, Breast-Feeding and Its Role in Early Development of the Immune System in Infants: Consequences for Health Later in Life, The Journal of Nutrition, Volume 138, Issue 9, September 2008, Pages 1782S–1790S, https://doi.org/10.1093/jn/138.9.1782S</li>
<li>Molès, J‐P, Tuaillon, E, Kankasa, C, et al. Breastmilk cell trafficking induces microchimerism‐mediated immune system maturation in the infant. Pediatr Allergy Immunol. 2018; 29: 133– 143. <a href="https://doi.org/10.1111/pai.12841">https://doi.org/10.1111/pai.12841</a></li>
<li>Babak Baban, Aneeq Malik, Jatinder Bhatia, Jack C. Yu. Presence and Profile of Innate Lymphoid Cells in Human Breast Milk. JAMA Pediatrics, 2018; DOI: <a href="http://dx.doi.org/10.1001/jamapediatrics.2018.0148">10.1001/jamapediatrics.2018.0148</a></li>
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<br />Analytical Armadillo IBCLChttp://www.blogger.com/profile/03829027807809292649noreply@blogger.com0tag:blogger.com,1999:blog-3102141287849407838.post-57345975305972238822019-07-12T22:23:00.000+01:002019-07-12T22:23:53.255+01:00Babies 'don't need tongue-tie surgery to feed' - Rapid Response"Babies 'don't need tongue-tie surgery to feed" is today's BBC headline, which had reached my inbox before I opened my eyes this morning (thank you readers).<br />
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<a href="https://1.bp.blogspot.com/-cDWdbtHI-6U/XSj4QfWN_WI/AAAAAAAACxw/tS5jsDoqDyAXMmvbRwqE7JPOKMAM-zWRACLcBGAs/s1600/bf.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="466" data-original-width="700" height="213" src="https://1.bp.blogspot.com/-cDWdbtHI-6U/XSj4QfWN_WI/AAAAAAAACxw/tS5jsDoqDyAXMmvbRwqE7JPOKMAM-zWRACLcBGAs/s320/bf.jpg" width="320" /></a></div>
We know the media sensationalise studies, so you want to know what it really says right?</div>
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<br />
<b>Course you do, let's go.</b></div>
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112 babies who had been referred for tongue tie treatment, were assessed by "Speech and language pathologists, who examined the infants' ability to
breastfeed prior to a surgical consultation".</div>
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112? That's really one step beyond "large classroom experiment".</div>
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My next thought was:</div>
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Wow, do Speech and Language Therapists (SALTs) have breastfeeding training in the US?<br />
<br />
So I of course asked the man in the know, <a href="https://www.facebook.com/DrGhaheriMD/?ref=br_rs" target="_blank">Dr Ghaheri</a>. His reply:</div>
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"Er no".</div>
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Errrrrm ok then.<br />
<br />
He continues:<br />
<blockquote class="tr_bq">
"Their professional organization (ASHA) doesn’t recognize TT as being a problem in breastfeeding, solid foods or speech. They are not the practitioner of choice when it comes to breastfeeding pathology either."</blockquote>
</div>
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I want to clarify this early on (then probably repeat it 10 times throughout this piece for those who will still miss it) - NOT ALL BABIES WITH A TONGUE TIE NEED A RELEASE TO BREASTFEED WELL. At least I'm assured this is the case - people rarely ring an IBLC to say their baby has a tie but hey, they're feeding great and don't need our support. </div>
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This study is exploring infants who were diagnosed as tied and symptomatic with feeding problems, thus had been referred and recommended for release. This means anyone not experiencing a feeding problem from their tie, wouldn't be included in this study.</div>
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I pushed on. The SALTS then: </div>
<blockquote class="tr_bq">
"offered techniques for mothers to
address any feeding difficulties prior to surgical intervention was developed. Infants either
found success in feeding and weight gain through this program or underwent procedures."</blockquote>
<div>
Ok, that sounds fair enough right? Try other techniques such as improving attachment, positioning and so on. Indeed these interventions are listed. </div>
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<br />
Brace yourself.</div>
<blockquote class="tr_bq">
<b>"If sleep state regulation was determined to be the primary issue (with the baby falling asleep and transitioned to a nonnutritive sucking pattern causing maternal nipple pain/ injury/prolonged feeding), interventions included arousal actions such as applying a wet facecloth or tapping the infant’s foot."</b></blockquote>
I had to stop and take a moment here to suck air through my teeth.<br />
<br />
<span style="font-size: large;">News flash - </span><a href="http://www.analyticalarmadillo.co.uk/2018/02/when-breastfeeding-baby-falls-asleep.html" target="_blank">babies fall asleep when the flow of milk isn't worth staying awake for because their attachment is shallow</a>. Tapping a baby or applying a cold wet cloth, may temporarily wake the baby, who will take a few more sucks/swallows before nodding back off again.<br />
<br />
Next:<br />
<blockquote class="tr_bq">
<b>"If volume or rate of breast-milk flow (tongue clicking,
gulping, or pulling off the nipple) appeared to be the primary
issue, modifications included the following strategies to slow
the flow of milk: placing the mother in a supine position (gravity to slow flow), expressing milk prior to breastfeeding, and/or
placing the mother and baby in a side lying position."</b></blockquote>
If a baby is in a shallow latch, they will often perceive the breastmilk supply to be too fast. We can see video examples of that <a href="https://www.facebook.com/breastfeed/videos/1821166657928560/" target="_blank">here: with a tongue tie</a>. However with a deep latch, the flow is easily tolerated as we can see <a href="https://www.facebook.com/breastfeed/videos/1991474374231120/" target="_blank">here: post tongue tie release</a>.<br />
<blockquote class="tr_bq">
<b><span style="color: red;">"If previously-diagnosed reflux appeared to be the primary issue (eg,
arching, pulling off nipple), verbal reassurance to continue gastroesophageal reflux disease medication treatment was provided"</span></b></blockquote>
Woah woah woah. Wait a moment.<br />
<br />
First - pulling on and off the nipple and arching can mean many things. It can mean "hey the milk has stopped", "I have trapped wind/gas" (top or bottom end), "my mouth is sore" or "my neck is stiff in that position". Since when did the assumption these symptoms mean reflux become a given?<br />
<br />
Shallow latch and feeding technique can cause reflux (NICE) - indeed the baby in the clips above was symptomatic prior to release. It seems though we're just ignoring that in this study and carrying on with medications.<br />
<br />
<b><span style="color: red; font-size: large;">This is where my alarm bells really started ringing.</span></b><br />
<br />
The authors opened this paper with the statement:<br />
<blockquote class="tr_bq">
"Inpatient surgical release of lingual frenulums rose 10-fold between 1997 and
2012 despite insufficient evidence that frenotomy for ankyloglossia is associated with
improvements in breastfeeding</blockquote>
This is a rather confusing claim, since there are really quite a lot of studies exploring tongue tie and breastfeeding (1-15), my list isn't exhaustive. They consistently demonstrate breastfeeding improvement, none evidence any risk of significant harm and they include is comments such as:<br />
<blockquote class="tr_bq">
"No complications were reported with frenotomy."(2)</blockquote>
and<br />
<blockquote class="tr_bq">
"Ankyloglossia, which is a relatively common finding in the newborn population, adversely affects breastfeeding in selected infants."(4)</blockquote>
and<br />
<blockquote class="tr_bq">
"This review of research literature analyses the evidence regarding tongue-tie to determine if appropriate intervention can reduce its impact on breastfeeding cessation, concluding that, for most infants, frenotomy offers the best chance of improved and continued breastfeeding. Furthermore, studies have demonstrated that the procedure does not lead to complications for the infant or mother." (6)</blockquote>
and<br />
<blockquote class="tr_bq">
"Frenotomy is a safe, short procedure that improves breastfeeding outcomes, and is best performed at an early age" (7)</blockquote>
and<br />
<blockquote class="tr_bq">
"After lingual frenotomy, changes were observed in the breastfeeding patterns of the the tongue-tied infants while the control group maintained the same patterns. Moreover, all symptoms reported by the mothers of the tongue-tied infants had improved after frenotomy."(8)</blockquote>
and<br />
<blockquote class="tr_bq">
"Tongue-tie is not uncommon and is associated with breastfeeding difficulty in newborn infants." (10)</blockquote>
and<br />
<blockquote class="tr_bq">
This should provide convincing evidence for those seeking a frenotomy for infants with significant ankyloglossia.(15)</blockquote>
Apparently not.<br />
<br />
What we should perhaps also explore some other stats too.<br />
<br />
Prescriptions of a a child-friendly liquid formulation of a popular reflux medication (PPI), saw a 16-fold increase in use <a href="http://s188618569.websitehome.co.uk/resources/PPI+use+for+reflux.pdf" target="_blank">between 1999-2004</a>. Between 2006 and 2016, prescriptions of specialist formula milks for infants with cow’s milk protein allergy (CMPA) increased by nearly 500%. (16)<br />
<br />
If we want to talk about things lacking an evidence base - let's start here.<br />
<br />
<blockquote class="tr_bq">
"There was no significant difference for both outcome measures while taking either omeprazole or placebo. Compared with placebo, omeprazole significantly reduced esophageal acid exposure but not irritability." (17)</blockquote>
and<br />
<blockquote class="tr_bq">
"PPIs are not effective in reducing GERD symptoms in infants. Placebo-controlled trials in older children are lacking. Although PPIs seem to be well tolerated during short-term use, evidence supporting the safety of PPIs is lacking." (18)</blockquote>
and<br />
<blockquote class="tr_bq">
"As more extensively discussed below, the inappropriate use of acid suppressive drugs has been indeed associated with consistent modifications in the intestinal microbiota by inducing gastric hypochlorhydria, delaying gastric emptying and increasing gastric mucous viscosity [<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5578061/#B48-ijms-18-01671">48</a>]. In adults, chronic acid suppression has been linked to an increased risk of small intestine bacterial overgrowth (SIBO). Although not reaching statistical significance, a trend towards an increased risk of SIBO has also been recently observed in children under long-term PPIs therapy (6 months) [<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5578061/#B49-ijms-18-01671">49</a>]. Apart from SIBO, the chronic use of acid suppressive agents is a well-known risk factor for gastrointestinal (acute gastroenteritis, Clostidium difficile infection, candidemia and necrotizing enterocolitis) and extra-intestinal (lower respiratory tract infections, community acquired pneumonia) infections, particularly in infants." (19)</blockquote>
and<br />
<blockquote class="tr_bq">
"Several micronutrients require an acidic environment for optimal absorption. Iron, vitamin C, and vitamin B12absorption are dependent on the intestine's acidic environment. Several studies and case reports describe associations of omeprazole with altered calcium, magnesium, and vitamin B12 absorption. To date, there have been no prospective trials evaluating the effect of proton pump inhibitors (PPIs) on iron absorption.<br />
Conclusions:<br />
Existing data support the conclusion that the acid-suppressing effect of omeprazole can have important clinical implications for vitamin and mineral therapy. Clinicians should be cognizant of this issue in practice. Further studies exploring the relationship of PPIs and iron deficiency are warranted, especially in high-risk populations such as the elderly." (20)</blockquote>
And presumably infants.<br />
<br />
I won't bore you with however many more studies and turn this into a reflux post, if you're interested you can <a href="http://www.analyticalarmadillo.co.uk/2018/05/the-omeprazole-priloseclosec-epidemic.html" target="_blank">read more here</a>. The point is, there are recognised and potentially significant risks associated with reflux medications. As a result, current recommendations are to minimise use whenever possible, giving as a last resort not a first line response; it makes no logical sense as a preferred treatment pathway compared to frenulotomy.<br />
<b><br /></b>
<b>The question this study really asks is - can we breastfeed tongue tied infants ie, provoke weight gain and not suffer nipple trauma, even when the baby is tied.</b><br />
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We of course all know that a lot of the time - yes you can! 2/3rd of the time according to this study. We can employ multiple compensatory strategies. <br />
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Many do constantly jostle their babies awake and feed them 20 times per day to provoke gain or because it's the only way baby settled.<br />
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They may give reflux medications, keep baby upright an hour after feeds, use a specialist milk or undertake a restricted diet, at times completely unnecessarily:</div>
<blockquote class="tr_bq">
"Inappropriate elimination diets have been imposed on pregnant and lactating women and their infants to prevent allergies without scientific evidence proving their efficacy. Even when well indicated in infants and children diagnosed with an allergy, the type of dietary products to eliminate and the duration of such elimination are not always logical."(21)</blockquote>
They may accept their baby is "higher needs" and sleeps badly or has "wind" or is "fussy" as they won't be put down or settle for long.<br />
<br />
They may use techniques such as expressing before a feed, reclined feeding or catching the first "letdown" in a muslin.<br />
<br />
They may accept they won't take a bottle and feed hourly.<br />
<br />
Any family being offered tongue tie division should always be offered the option of doing nothing - to carry on managing the situation as they have been up until this point, with added tips and tricks for positioning, wind and colic management, expectations and so on.<br />
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The problem though is, especially in the patriarchal world of medicine - often the <i>only</i> things valued as markers of "successful breastfeeding" are weight gain and nipple pain. "Symptoms of reflux" are medicated rather than looking the resolve the problem and mothers are told to rub their baby with wet flannels to keep them awake.<br />
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These studies don't consider maternal satisfaction levels and overall well-being - is this sustainable in terms of getting through a day? Is this situation conducive to good mental health for family members?</div>
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As usual, social media comments sum things up best:</div>
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<b>Join us and share your view <a href="https://www.facebook.com/130161827020242/posts/2268859569817113?s=652351149&sfns=mo" target="_blank">here on our Facebook page</a>.</b></h3>
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<ol>
<li>Ghaheri BA, Cole M, Fausel SC, Chuop M, Mace JC. Breastfeeding improvement following tongue-tie and lip-tie release: A prospective cohort study. Laryngoscope. 2017;127(5):1217–1223. doi:10.1002/lary.26306</li>
<li>Srinivasan, A., Al Khoury, A., Puzhko, S., Dobrich, C., Stern, M., Mitnick, H., & Goldfarb, L. (2018). Frenotomy in Infants with Tongue-Tie and Breastfeeding Problems. Journal of Human Lactation. https://doi.org/10.1177/0890334418816973</li>
<li>Emond A, Ingram J, Johnson D, et al. Randomised controlled trial of early frenotomy in breastfed infants with mild–moderate tongue-tie Archives of Disease in Childhood - Fetal and Neonatal Edition 2014;99:F189-F195.</li>
<li>Messner AH, Lalakea ML, Aby J, Macmahon J, Bair E. Ankyloglossia: Incidence and Associated Feeding Difficulties. Arch Otolaryngol Head Neck Surg. 2000;126(1):36–39. doi:10.1001/archotol.126.1.36</li>
<li><span style="background-color: white; font-family: "minion w08 regular_1167271" , "times"; font-size: 17px; text-align: justify;">Elvira Ferrés-Amat, Tomasa Pastor-Vera, Paula Rodríguez-Alessi, Eduard Ferrés-Amat, Javier Mareque-Bueno, and Eduard Ferrés-Padró, “Management of Ankyloglossia and Breastfeeding Difficulties in the Newborn: Breastfeeding Sessions, Myofunctional Therapy, and Frenotomy,” </span><span style="background-color: white; font-family: "minion w08 italic"; font-size: 17px; text-align: justify;">Case Reports in Pediatrics</span><span style="background-color: white; font-family: "minion w08 regular_1167271" , "times"; font-size: 17px; text-align: justify;">, vol. 2016, Article ID 3010594, 5 pages, 2016. </span><a href="https://doi.org/10.1155/2016/3010594">https://doi.org/10.1155/2016/3010594</a>.</li>
<li>Edmunds, Janet & Miles, Sandra & Fulbrook, Paul. (2011). Tongue-tie and breastfeeding: a review of the literature. Breastfeeding review : professional publication of the Nursing Mothers' Association of Australia. 19. 19-26.</li>
<li>Sharma, S., & Jayaraj, S. (2015). Tongue-tie division to treat breastfeeding difficulties: Our experience. The Journal of Laryngology & Otology,129(10), 986-989. doi:10.1017/S002221511500225X</li>
<li>MARTINELLI, Roberta Lopes de Castro, MARCHESAN, Irene Queiroz, GUSMÃO, Reinaldo Jordão, HONÓRIO, Heitor Marques, & BERRETIN-FELIX, Giédre. (2015). The effects of frenotomy on breastfeeding. Journal of Applied Oral Science, 23(2), 153-157. <a href="https://dx.doi.org/10.1590/1678-775720140339">https://dx.doi.org/10.1590/1678-775720140339</a></li>
<li>BAXTER, R., HUGHES, L.. Speech and Feeding Improvements in Children After Posterior Tongue-Tie Release: A Case Series. International Journal of Clinical Pediatrics, North America, 7, jun. 2018. Available at:<<a href="https://www.theijcp.org/index.php/ijcp/article/view/295/254">https://www.theijcp.org/index.php/ijcp/article/view/295/254</a>></li>
<li>Sopapan Ngerncham, Mongkol Laohapensang, Thidaratana Wongvisutdhi, Yupin Ritjaroen, Nipa Painpichan, Pussara Hakularb, Panidaporn Gunnaleka & Penpaween Chaturapitphothong (2013) Lingual frenulum and effect on breastfeeding in Thai newborn infants, Paediatrics and International Child Health,33:2, 86-90, DOI: <a href="https://doi.org/10.1179/2046905512Y.0000000023">10.1179/2046905512Y.0000000023</a></li>
<li>Hogan, M. , Westcott, C. and Griffiths, M. (2005), Randomized, controlled trial of division of tongue‐tie in infants with feeding problems. Journal of Paediatrics and Child Health, 41: 246-250. doi:<a href="https://doi.org/10.1111/j.1440-1754.2005.00604.x">10.1111/j.1440-1754.2005.00604.x</a></li>
<li>Ankyloglossia: Assessment, Incidence, and Effect of Frenuloplasty on the Breastfeeding Dyad</li>
Jeanne L. Ballard, Christine E. Auer, Jane C. Khoury<br />Pediatrics Nov 2002, 110 (5) e63; DOI: 10.1542/peds.110.5.e63
<li>Shaul Dollberg, Eyal Botzer, Esther Grunis, Francis B. Mimouni,Immediate nipple pain relief after frenotomy in breast-fed infants with ankyloglossia: a randomized, prospective study,Journal of Pediatric Surgery,Volume 41, Issue 9,2006,Pages 1598-1600,ISSN 0022-3468,https://doi.org/10.1016/j.jpedsurg.2006.05.024.</li>
<li><a href="https://www.liebertpub.com/doi/abs/10.1089/bfm.2011.0030">A Double-Blind, Randomized, Controlled Trial of Tongue-Tie Division and Its Immediate Effect on Breastfeeding</a>. Janet Berry, Mervyn Griffiths, and Carolyn WestcottBreastfeeding Medicine 2012 7:3, 189-193</li>
<li>Efficacy of Neonatal Release of Ankyloglossia: A Randomized Trial Melissa Buryk, David Bloom, Timothy Shope Pediatrics Aug 2011, 128 (2) 280-288; DOI: 10.1542/peds.2011-0077</li>
<li>Van Tulleken Chris. Overdiagnosis and industry influence: how cow’s milk protein allergy is extending the reach of infant formula manufacturers BMJ 2018; 363 :k5056</li>
<li>Double-blind placebo-controlled trial of omeprazole in irritable infants with gastroesophageal reflux. Moore, David John et al. The Journal of Pediatrics, Volume 143, Issue 2, 219 - 223</li>
<li>Efficacy of Proton-Pump Inhibitors in Children With Gastroesophageal Reflux Disease: A Systematic Review. Rachel J. van der Pol, Marije J. Smits, Michiel P. van Wijk, Taher I. Omari, Merit M.Tabbers, Marc A. Benninga. Pediatrics May 2011, 127 (5) 925-935; DOI: 10.1542/peds.2010-2719</li>
<li>Rybak A, Pesce M, Thapar N, Borrelli O. Gastro-Esophageal Reflux in Children. Int J Mol Sci. 2017;18(8):1671. Published 2017 Aug 1. doi:10.3390/ijms18081671</li>
<li>Humphrey, M. L., Barkhordari, N., & Kaakeh, Y. (2012). Effects of Omeprazole on Vitamin and Mineral Absorption and Metabolism. Journal of Pharmacy Technology, 28(6), 243–248. <a href="https://doi.org/10.1177/875512251202800604">https://doi.org/10.1177/875512251202800604</a></li>
<li>Lifschitz, C. & Szajewska, H. Eur J Pediatr (2015) 174: 141. https://doi.org/10.1007/s00431-014-2422-3<div class="separator" style="clear: both; text-align: center;">
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Analytical Armadillo IBCLChttp://www.blogger.com/profile/03829027807809292649noreply@blogger.com0tag:blogger.com,1999:blog-3102141287849407838.post-49757226877703195332019-06-13T10:48:00.001+01:002019-06-13T10:48:12.275+01:00Boots UK Force Breastfeeders to Receive Baby Bottles?This week saw the launch of what can only be described as an utterly random marketing move from Boots UK. A move to include an obligatory "free gift" of a baby bottle when you purchase baby wipes. <br />
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I'm not sure whether they got their team from the 1950s, but in 2019 we're drowning in plastic. Not to mention the elephant in the room of course, from an environmental perspective - we really should be supporting those who want to breastfeed to do so.<br />
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Instead, not only is the bottle offered when someone is purchasing wipes, but there is no option to decline the free gift and remove it from the basket.<br />
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<tr><td style="text-align: center;"><a href="https://1.bp.blogspot.com/-ZhBwC7-pRTI/XQIPwIPyt_I/AAAAAAAACwE/5f52ovfBoTEGksbyb1RB7gPjChsiz4wQACLcBGAs/s1600/boots.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="559" data-original-width="709" height="504" src="https://1.bp.blogspot.com/-ZhBwC7-pRTI/XQIPwIPyt_I/AAAAAAAACwE/5f52ovfBoTEGksbyb1RB7gPjChsiz4wQACLcBGAs/s640/boots.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption">Image Emma Pickett <a href="https://twitter.com/makesmilk">@makesmilk</a> Twitter</td></tr>
</tbody></table>
Some Tweeters agreed:<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><img border="0" data-original-height="158" data-original-width="610" height="163" src="https://1.bp.blogspot.com/-4FJa_TVyYPU/XQIRELdx5WI/AAAAAAAACwM/K6BgsHFrVUs3htdgO2ayW1CJjLzwC37owCLcBGAs/s640/Screenshot%2B%25286%2529.png" style="margin-left: auto; margin-right: auto;" width="640" /></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><a href="https://twitter.com/kiityc/status/1138791086070083584" target="_blank">Twitter</a></td></tr>
</tbody></table>
<br />
I can't feel but this spectacularly misses the point. Why should someone who is trying to establish breastfeeding, have to find someone who needs a bottle to get rid of it - thus undertaking the bottle manufacturers' marketing for them? (it's still reaching a consumer in the hope they will purchase more of the same brand). <br />
<b><span style="color: red; font-size: large;"><br /></span></b>
<b><span style="color: red; font-size: large;">Why can't they decline the "gift"?</span></b><br />
<br />
Would Dr Cairns be equally as dismissive if mums were receiving free breastpads? I can only imagine the uproar, the outpourings from mothers who didn't want them and the claims of pressure to breastfeed.<br />
<br />
Other Tweeters noted this too:<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://1.bp.blogspot.com/-IbsbdyLKCzA/XQITJ3ueQMI/AAAAAAAACwY/xpL3vOaNkfgUcZJp-3gH_H7r5MDg4A9kwCLcBGAs/s1600/Screenshot%2B%25287%2529.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="75" data-original-width="614" height="76" src="https://1.bp.blogspot.com/-IbsbdyLKCzA/XQITJ3ueQMI/AAAAAAAACwY/xpL3vOaNkfgUcZJp-3gH_H7r5MDg4A9kwCLcBGAs/s640/Screenshot%2B%25287%2529.png" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><a href="https://twitter.com/LactivistSinger/status/1138787754366685184" target="_blank">Twitter</a></td></tr>
</tbody></table>
<br />
<br />
And of course the obligatory comments about how some people have to use bottles! (since 88% of babies are bottlefed by 4 months, I think the world is aware the MAJORITY of people are using bottles). <br />
<br />
However this <b>does not </b>justify the insidious, forced marketing to parents and carers who DO NOT WANT THEM.<br />
<br />
<b><span style="font-size: large;">Let's not even pretend this is all about breastfeeding</span></b>.<br />
<br />
Many who bottle-feed have a brand they use, or don't need or want more bottles either!<br />
<br />
Manufacturers know this - so they've clearly done a deal to force their product into your home, like it or not. Maybe if you try one, you'll love it and buy more! If not, it's used - then what?<br />
<br />
Perhaps the most ridiculous argument I read around the subject, was that anyone using these wipes (a single use product that is only 20% recyclable), can't possibly complain getting a free multiple use plastic item.<br />
<br />
Using that argument anyone who drives a car, gets on a plane or buys non-organic clothes, can't complain about anything ever.<br />
<br />
What if someone doesn't always have reliable access to facilities to wash reusable-wipes, nor safely prepare formula, thus they're trying desperately to establish breastfeeding to free up government tokens for fruit and veg instead? What if more than 50% of children were being raised in poverty - <a href="https://www.theguardian.com/society/2019/may/15/child-poverty-above-50-per-cent-in-10-uk-constituencies" target="_blank">oh no wait, that's right they are</a>. <br />
<br />
<br />
So let's flip this around.<br />
<br />
<br />
<span style="color: red; font-size: large; font-weight: 700;">Why can't they decline the "gift"?</span><br />
<span style="color: red; font-size: large; font-weight: 700;"><br /></span>
Anyone claiming they don't have a problem with this incentive is free to answer (on a postcard, or perhaps more effectively - in the comments below):<br />
<b><span style="font-size: large;">Why should parents <span style="color: red;">have</span> to receive an item that they do not want or need?</span></b>Analytical Armadillo IBCLChttp://www.blogger.com/profile/03829027807809292649noreply@blogger.com0tag:blogger.com,1999:blog-3102141287849407838.post-6049160584189466522019-03-19T23:10:00.000+00:002019-03-19T23:10:28.890+00:00What Channel 4 Dispatches Didn't Expose About the Infant Formula Industry<div class="tr_bq">
Many watched with interest last night as Channel 4 Dispatches exposed infant formula manufacturers and the insidious marketing tactics used. Top quotes from the programme included <a href="https://www.instagram.com/p/BvMBKWlAa2g/?utm_source=ig_twitter_share&igshid=gluiyjsskcmn" target="_blank">this</a>, <a href="https://www.instagram.com/p/BvMFLSjAG_P/?utm_source=ig_twitter_share&igshid=v46cb6fdnmxd" target="_blank">this</a>, <a href="https://www.instagram.com/p/BvMCYz9ARuP/?utm_source=ig_twitter_share&igshid=pscws0ei3zuf" target="_blank">this</a>, <a href="https://www.instagram.com/p/BvMBKWlAa2g/?utm_source=ig_twitter_share&igshid=gluiyjsskcmn" target="_blank">this</a> and <a href="https://www.instagram.com/p/BvMCYz9ARuP/?utm_source=ig_twitter_share&igshid=pscws0ei3zuf" target="_blank">this</a>.</div>
<br />
What Dispatches didn't cover though, is the further problem of retailers, consistently repeatedly flouting the law with seemingly little consequence. Week after week after week offences are repeatedly highlighted and reported on social media - despite retailers claiming their systems won't even allow illegal discounting on first milks...<br />
<br />
<b>I scanned Baby Milk Action's Twitter feed. Here are a sample of the breaches reported in the last month - it is by no means all as several report numerous violations:</b><br />
<b><br /></b>
<b>Waitrose:</b><br />
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<a href="https://3.bp.blogspot.com/-Ji-ur_Gkj2Q/XJFsKdPca4I/AAAAAAAACs0/98t0E2PuG1A2U3PucY3JhSmLFphmR2QGACLcBGAs/s1600/2019-03-19%2B%25286%2529.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="577" data-original-width="603" src="https://3.bp.blogspot.com/-Ji-ur_Gkj2Q/XJFsKdPca4I/AAAAAAAACs0/98t0E2PuG1A2U3PucY3JhSmLFphmR2QGACLcBGAs/s1600/2019-03-19%2B%25286%2529.png" /></a></div>
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<a href="https://2.bp.blogspot.com/-yz_250R3Dms/XJFsJqwlbLI/AAAAAAAACsw/v2j0ksbOuEMPNE03xHYJXJrEkd_HJeEnQCLcBGAs/s1600/2019-03-19%2B%25287%2529.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="366" data-original-width="602" src="https://2.bp.blogspot.com/-yz_250R3Dms/XJFsJqwlbLI/AAAAAAAACsw/v2j0ksbOuEMPNE03xHYJXJrEkd_HJeEnQCLcBGAs/s1600/2019-03-19%2B%25287%2529.png" /></a></div>
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<b>Amazon:</b></div>
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<a href="https://3.bp.blogspot.com/-emWZDc0sSfg/XJFyjGxPAmI/AAAAAAAACto/_o8f4fQLtRUCO28AFQXb5RdC8VrKn0ckACLcBGAs/s1600/2019-03-19%2B%25288%2529.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="529" data-original-width="586" src="https://3.bp.blogspot.com/-emWZDc0sSfg/XJFyjGxPAmI/AAAAAAAACto/_o8f4fQLtRUCO28AFQXb5RdC8VrKn0ckACLcBGAs/s1600/2019-03-19%2B%25288%2529.png" /></a></div>
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<b>Sainsburys:</b></div>
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<a href="https://4.bp.blogspot.com/-XRhqMsus6Vg/XJFykYtcRnI/AAAAAAAACts/zh03Nfa6olktYXcOXLTML35XcM-iuxJ9gCLcBGAs/s1600/2019-03-19%2B%25289%2529.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="465" data-original-width="582" src="https://4.bp.blogspot.com/-XRhqMsus6Vg/XJFykYtcRnI/AAAAAAAACts/zh03Nfa6olktYXcOXLTML35XcM-iuxJ9gCLcBGAs/s1600/2019-03-19%2B%25289%2529.png" /></a></div>
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<a href="https://2.bp.blogspot.com/-x8wKLTJ0OpY/XJFybHs8-hI/AAAAAAAACtE/KRbged6Z67gwbFKTMEoevOoUa-0zT4IBwCLcBGAs/s1600/2019-03-19%2B%252810%2529.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="352" data-original-width="577" src="https://2.bp.blogspot.com/-x8wKLTJ0OpY/XJFybHs8-hI/AAAAAAAACtE/KRbged6Z67gwbFKTMEoevOoUa-0zT4IBwCLcBGAs/s1600/2019-03-19%2B%252810%2529.png" /></a></div>
<b>Asda:</b><br />
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<a href="https://4.bp.blogspot.com/-o3_tRAOnFG4/XJFycw4RZCI/AAAAAAAACtM/ru9LvyPrPvApsNDCu7kpmczQbKhoBP5cwCLcBGAs/s1600/2019-03-19%2B%252812%2529.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="584" data-original-width="575" src="https://4.bp.blogspot.com/-o3_tRAOnFG4/XJFycw4RZCI/AAAAAAAACtM/ru9LvyPrPvApsNDCu7kpmczQbKhoBP5cwCLcBGAs/s1600/2019-03-19%2B%252812%2529.png" /></a></div>
<b> Boots:</b><br />
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<a href="https://1.bp.blogspot.com/-PYd6qI7eH9w/XJFybgn4zQI/AAAAAAAACtI/EMmDKbBi5TMmcVG_heqSs9bNOZO_-1daQCLcBGAs/s1600/2019-03-19%2B%252813%2529.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="545" data-original-width="519" src="https://1.bp.blogspot.com/-PYd6qI7eH9w/XJFybgn4zQI/AAAAAAAACtI/EMmDKbBi5TMmcVG_heqSs9bNOZO_-1daQCLcBGAs/s1600/2019-03-19%2B%252813%2529.png" /></a></div>
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<b>Tesco:</b><a href="https://3.bp.blogspot.com/-M1WIEi7T11c/XJFyijJO69I/AAAAAAAACtk/B156udzRRkwyM8lA7oogh0k8v365ccoFQCLcBGAs/s1600/2019-03-19%2B%252819%2529.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="531" data-original-width="525" src="https://3.bp.blogspot.com/-M1WIEi7T11c/XJFyijJO69I/AAAAAAAACtk/B156udzRRkwyM8lA7oogh0k8v365ccoFQCLcBGAs/s1600/2019-03-19%2B%252819%2529.png" style="cursor: move;" /></a></div>
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<a href="https://3.bp.blogspot.com/-xnLtre3ijWM/XJFyeG5tWEI/AAAAAAAACtQ/pMzorAb1moMzCGvprmK7NnvagTAKioggwCLcBGAs/s1600/2019-03-19%2B%252814%2529.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="391" data-original-width="526" src="https://3.bp.blogspot.com/-xnLtre3ijWM/XJFyeG5tWEI/AAAAAAAACtQ/pMzorAb1moMzCGvprmK7NnvagTAKioggwCLcBGAs/s1600/2019-03-19%2B%252814%2529.png" /></a></div>
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<a href="https://2.bp.blogspot.com/-QfYeJboZ_80/XJFyefw_dQI/AAAAAAAACtU/K4T0ZYa_UWUN7z7ygYEbUpfLt7crpPUdgCLcBGAs/s1600/2019-03-19%2B%252815%2529.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="336" data-original-width="519" src="https://2.bp.blogspot.com/-QfYeJboZ_80/XJFyefw_dQI/AAAAAAAACtU/K4T0ZYa_UWUN7z7ygYEbUpfLt7crpPUdgCLcBGAs/s1600/2019-03-19%2B%252815%2529.png" /></a></div>
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<b>Booths:</b></div>
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<a href="https://1.bp.blogspot.com/-g1ORgboPzac/XJFyfi3EVLI/AAAAAAAACtY/T5rYAieHracqMxBPkBubhYcs0YOCteTrgCLcBGAs/s1600/2019-03-19%2B%252816%2529.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="545" data-original-width="524" src="https://1.bp.blogspot.com/-g1ORgboPzac/XJFyfi3EVLI/AAAAAAAACtY/T5rYAieHracqMxBPkBubhYcs0YOCteTrgCLcBGAs/s1600/2019-03-19%2B%252816%2529.png" /></a></div>
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<b>Co-op:</b></div>
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<a href="https://2.bp.blogspot.com/-gGg5EZf-xBc/XJFyhjp1CFI/AAAAAAAACtg/x8T8r_jRHQ0Sl-GelLQ4hX7EtUL8BN8gQCLcBGAs/s1600/2019-03-19%2B%252817%2529.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="534" data-original-width="527" src="https://2.bp.blogspot.com/-gGg5EZf-xBc/XJFyhjp1CFI/AAAAAAAACtg/x8T8r_jRHQ0Sl-GelLQ4hX7EtUL8BN8gQCLcBGAs/s1600/2019-03-19%2B%252817%2529.png" /></a></div>
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<b>Wilkos</b></div>
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<a href="https://2.bp.blogspot.com/-D-SqFJbZMS0/XJFyhXLattI/AAAAAAAACtc/HVEFSJZvd00RsrcySIN53iRpFWvpN72-gCLcBGAs/s1600/2019-03-19%2B%252818%2529.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="318" data-original-width="523" src="https://2.bp.blogspot.com/-D-SqFJbZMS0/XJFyhXLattI/AAAAAAAACtc/HVEFSJZvd00RsrcySIN53iRpFWvpN72-gCLcBGAs/s1600/2019-03-19%2B%252818%2529.png" /></a></div>
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The <a href="http://www.legislation.gov.uk/uksi/2007/3521/contents/made" target="_blank">law came into force</a> over TWENTY years ago so retailers can hardly claim ignorance. When questioned all claim they adequately train staff, yet day after day new violations come to light. </div>
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Clearly the law is not rigorously enforced, to the point retailers clearly don't give a stuff about adhering to it.</div>
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This has been <a href="https://www.mirror.co.uk/news/uk-news/baby-milk-promotions-major-supermarkets-13176156" target="_blank">exposed by the media</a> and <a href="https://www.dailymail.co.uk/news/article-3964276/Supermarket-giant-Tesco-caught-breaking-law-reducing-price-baby-formula-milk-nearing-sell-date-just-2-20.html" target="_blank">Tesco highlighted as particularly problematic</a> here. </div>
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<a href="https://www.dailymail.co.uk/news/article-3964276/Supermarket-giant-Tesco-caught-breaking-law-reducing-price-baby-formula-milk-nearing-sell-date-just-2-20.html" target="_blank">Speaking to MailOnline</a>, Mike Brady from Baby Milk Action, said: <blockquote>
'The law prohibits the promotion of baby formula milk. But we have seen Tesco do this time and time again, year after year.<br />'They claim it was a mistake and that it won't happen again, but then it does. They are treating the law as a joke.<br />'We have been saying Tesco should be prosecuted for repeatedly breaking the law.<br />'Trading Standards Officers will sometimes visit stores but their numbers have been cut back drastically, so there are just a couple of officers trying to hold these massive companies to account which means no prosecutions are being brought.<br /> 'Tesco do seem to be the worst offenders when it comes to this.' </blockquote>
What this means is that virtually all safe-guards to protect the consumer (in this case babies) are being blatantly ignored. Companies are marketing to healthcare professionals, regulating themselves, providing the research and "evidence" and then ignoring laws regarding how it's sold.<br />
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How many documentaries and news reports do we need before something changes?Analytical Armadillo IBCLChttp://www.blogger.com/profile/03829027807809292649noreply@blogger.com0tag:blogger.com,1999:blog-3102141287849407838.post-43536954101270086392019-03-07T17:41:00.000+00:002019-12-08T15:41:43.737+00:00New Initiative - Colour Coded Hats on Newborns - No Thanks!<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">I felt a bit like I'd stepped back in time this morning, when I read the following Tweet from King's in London:</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
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<a href="https://2.bp.blogspot.com/-YnrDOwSK-rA/XIDceY7aTtI/AAAAAAAACro/neBDE3y-kyMK2Plpnwnmb_zMiRZXRgVHwCLcBGAs/s1600/2019-03-07.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: "trebuchet ms" , sans-serif;"><img border="0" data-original-height="582" data-original-width="578" src="https://2.bp.blogspot.com/-YnrDOwSK-rA/XIDceY7aTtI/AAAAAAAACro/neBDE3y-kyMK2Plpnwnmb_zMiRZXRgVHwCLcBGAs/s1600/2019-03-07.png" /></span></a></div>
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;"><span style="font-size: large;">I really thought we were well and truly over the idea of "hatting up" term newborn babies? It seems not:</span></span><br />
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<a href="https://1.bp.blogspot.com/-KJszHaVU-ww/XIDd0vzCQeI/AAAAAAAACrw/ur73VS9LkSoAHbcTTdhqUJxdOu_ynHjBQCLcBGAs/s1600/53643502_10155856749361150_2480130664666497024_n.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: "trebuchet ms" , sans-serif;"><img border="0" data-original-height="583" data-original-width="960" height="388" src="https://1.bp.blogspot.com/-KJszHaVU-ww/XIDd0vzCQeI/AAAAAAAACrw/ur73VS9LkSoAHbcTTdhqUJxdOu_ynHjBQCLcBGAs/s640/53643502_10155856749361150_2480130664666497024_n.jpg" width="640" /></span></a></div>
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">To be honest I'm even more confused, and the plan sounds more than a little flawed in a number of fronts:</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span><b><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">1) Studies show no temperature benefits to infants wearing a hat if held skin to skin</span></b><br />
<b><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">2) Hats may actually HINDER important newborn behaviours</span></b><br />
<b><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">3) Questionable infection control</span></b><br />
<b><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">4) Better alternatives </span></b><br />
<span style="font-size: large;"><b><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></b>
<span style="font-family: "trebuchet ms" , sans-serif;">Historically hats were used as way back in the 70s </span><span style="font-family: "trebuchet ms" , sans-serif;">as they were thought to prevent a dip in newborn body temperature. </span><a href="https://www.ncbi.nlm.nih.gov/pubmed/19912138" style="font-family: "Trebuchet MS", sans-serif;" target="_blank">Then we learnt about skin to skin</a>:</span><br />
<blockquote class="tr_bq">
<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">"Skin Contact is a powerful vagal stimulant, through sensory stimuli such as touch, warmth, and odor, which among other effects releases maternal oxytocin (Uvnas-Moberg 1998; Winberg 2005). <b>Oxytocin causes the skin temperature of the mother’s breast to rise, providing warmth to the infant</b> (Uvnas-Moberg 1996). In a study of infrared thermography of the whole body during the first hour post birth, Christidis 2003 found that <b>SSC was as effective as radiant warmers in preventing heat loss in healthy full-term infants</b>."</span></blockquote>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">Cochrane Database of Systematic Reviews,<a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003519.pub4/epdf/full" target="_blank">Early skin-to-skin contact for mothers and their healthy newborn infants (Review)</a></span></div>
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<span style="font-size: large;"><span style="font-family: "trebuchet ms" , sans-serif;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/30026787" target="_blank">Another 2018 paper</a> "The effect of mother and newborn early skin-to-skin contact on initiation of breastfeeding, newborn temperature and duration of third stage of labor" - found </span><span style="font-family: "trebuchet ms" , sans-serif;">separation hindered all areas and those kept close breastfed sooner, were warmer and their mothers had a more rapid third stage.</span></span></div>
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<span style="font-size: large;"><span style="font-family: "trebuchet ms" , sans-serif;">Focus shifted to "</span><a href="https://www.bellybelly.com.au/birth/7-benefits-undisturbed-first-hour-after-birth/" style="font-family: "Trebuchet MS", sans-serif;" target="_blank">the undisturbed hour</a><span style="font-family: "trebuchet ms" , sans-serif;">" after which babies don't need a hat. Even back in 2003 and the birth of my first, the midwives took the dinky hat I'd taken and placed it neatly back in my bag. Instead they tucked baby down my nightie and said after that, the ward was quite warm enough.</span></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">This seems logical right? If newborns needed a hat to survive those first few hours, surely they would pop out with their own built in hoodie? </span></span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">But alas no - I made a few calls and it seems hats are indeed back in fashion; in fact </span><span style="font-family: "trebuchet ms" , sans-serif;">mums are expected to have early skin to </span></span><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>skin WITH a hat, </b></span><span style="font-size: large;"><span style="font-family: "trebuchet ms" , sans-serif;"><b>and the colour coded initiative may be rolled out on a wider scale.</b></span></span><br />
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<a href="https://3.bp.blogspot.com/-038GsF5xn0Q/XIDgH1aK0YI/AAAAAAAACr8/RInJa4i1wF8gYrahPNZJWn_RnomBfi7xACLcBGAs/s1600/53720715_10155856755651150_5410526557976395776_o.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" data-original-height="496" data-original-width="1125" height="282" src="https://3.bp.blogspot.com/-038GsF5xn0Q/XIDgH1aK0YI/AAAAAAAACr8/RInJa4i1wF8gYrahPNZJWn_RnomBfi7xACLcBGAs/s640/53720715_10155856755651150_5410526557976395776_o.jpg" width="640" /></span></a></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">As a mum and an IBCLC, I have to say this is horrifying to me.</span></span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;"><span style="color: red; font-weight: bold;">The claim</span><b> </b>is the coloured hat enables them to identifying babies at risk of hypoglycemia (low blood sugars). All term babies apparently wear a hat for the first few hours to help maintain their temperature, including during skin to skin. This intervention it is proposed, reduces risks of separation of the dyad.</span></span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;"><span style="color: red;"><b>The reality</b></span> is somewhat different.</span></span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">First, the scent of her</span> <a href="https://www.frontiersin.org/articles/10.3389/fpsyg.2013.00597/full" style="font-family: "Trebuchet MS", sans-serif;" target="_blank">baby's head is extremely important</a> <span style="font-family: "trebuchet ms" , sans-serif;">to mum </span><span style="font-family: "trebuchet ms" , sans-serif;">during skin to skin and </span><a href="https://www.medscape.com/viewarticle/558124_1" style="font-family: "Trebuchet MS", sans-serif;" target="_blank">continuing into the early days for early bonding</a><span style="font-family: "trebuchet ms" , sans-serif;">. </span><span style="font-family: "trebuchet ms" , sans-serif;">I'm going to bet anyone who has sniffed their newly born baby's head knows exactly what I'm talking about - mothers often describe the scent as "addictive", which in turn encourages her to plant lots of kisses, </span><a href="http://www.newbaby101.com.au/motherbaby-sharing-pathogens-goes-viral-on-facebook/" style="font-family: "Trebuchet MS", sans-serif;" target="_blank">colonising her with any microbes on her baby</a><span style="font-family: "trebuchet ms" , sans-serif;">, enabling the tailor made production of antibodies, which are passed back via colostrum.</span></span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">The scent also prompts mum to release oxytocin (often called the bonding hormone), which in turn</span><span style="font-family: "trebuchet ms" , sans-serif;"> causes uterine contractions, forcing an instant constriction of the blood vessels that were running to the placenta. (Odent, 2013). </span><a href="https://academic.oup.com/jn/article/131/11/3012S/4686704" style="font-family: "Trebuchet MS", sans-serif;" target="_blank">Oxytocin is also important</a><span style="font-family: "trebuchet ms" , sans-serif;"> when it comes to breastfeeding, and as outlined above it generates heat for the baby - and so i</span><span style="font-family: "trebuchet ms" , sans-serif;">t all neatly comes full circle. </span></span><br />
<a href="https://4.bp.blogspot.com/-I46HuOwBbOI/XIEEujwYP5I/AAAAAAAACsc/daQk43C2mLse5bAJJ6tWz27STiC6_dn0wCLcBGAs/s1600/53208757_10155856897191150_8128300443190165504_n.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-size: large;"><img border="0" src="https://4.bp.blogspot.com/-I46HuOwBbOI/XIEEujwYP5I/AAAAAAAACsc/daQk43C2mLse5bAJJ6tWz27STiC6_dn0wCLcBGAs/s200/53208757_10155856897191150_8128300443190165504_n.jpg" /></span></a><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><br /></span><br />
<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">What's more, <a href="https://twitter.com/kajsabrimdyr?lang=en">Dr Kajsa Brimdyr</a>, researcher and expert in the field, covered at the UNICEF Baby Friendly Conference 2018, how hats can impede baby's "breast-crawling" reflexes after birth. </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;"><b>So, you'd think that if we're going to implement an intervention that has the potential to impact on all the above, plus hello, can you imagine skin to skin, half chewing on a pom pom instead of inhaling that delicious newborn scent? There must be some stonking evidence it helps. A lot. Right?</b></span></span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">Nup, not at all.</span></span><br />
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<span style="font-size: large;"><span style="font-family: "trebuchet ms" , sans-serif;">There's a paucity of studies on hat wearing at all, there's differences in terms of which hats are used (plastic, stockinette etc) and almost none in conjunction with skin to skin.</span></span><br />
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<span style="font-size: large;"><span style="font-family: "trebuchet ms" , sans-serif;">However a super amazing midwife, IBCLC friend of mine (thanks Marilyn!) </span><a href="https://www.ncbi.nlm.nih.gov/pubmed/29789445" style="font-family: "Trebuchet MS", sans-serif;" target="_blank">sent me a </a><span style="font-family: "trebuchet ms" , sans-serif;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/29789445" target="_blank">2018 study</a>, exploring the preterm baby and knits - in a rural setting where low cost interventions can be hugely beneficial:</span></span><br />
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<b><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">"Thermal Effect of a Woolen Cap in Low Birth Weight Infants During Kangaroo Care."</span></b><br />
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<span style="font-size: large;"><span style="font-family: "trebuchet ms" , sans-serif;">"The </span><span style="font-family: "trebuchet ms" , sans-serif;">use of a woolen cap was safe but <b>provided no advantages in maintaining LBWI in the normal thermal range while being in a KMC ward</b>."</span></span></blockquote>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">Again these babies are low birthweight and so far more challenged in terms of maintaining their own body temperature - even for them,<b> there was no advantage to a hat.</b></span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;"><b>Going back to the cochrane review above, we can see what did make a difference to hypoglycemia? Yep, skin to skin.</b></span></span><br />
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<li><span style="font-size: large;"><span style="font-family: "trebuchet ms" , sans-serif;">"Blood glucose mg/ dL at 75 to 180 minutes post birth Thresholds for low glucose vary from 40 mgto 50 mg/ dL</span> </span></li>
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<li><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">The control group mean blood glucose at 75 to 180 minutes post birth was 49.8 mg/ dL</span></li>
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<li><span style="font-size: large;"><span style="font-family: "trebuchet ms" , sans-serif;">The mean blood glucose mg/ dL at 75 to 180 minutes post birth in the intervention group was 10.49 mg/ dL more (8.39 more to 12.59 more)</span> </span></li>
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<li><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">The mean difference (MD) of 10.49 mg/ dL is clinically significant"</span> </li>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">When not in use the hat is kept "near the cot".</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">Now I love the NHS, I think midwives do a sterling job in the face of ridiculous demands - with most having developed the bladder capacity of a Shire horse. But seriously, now they have to ensure colour coded hats, that are likely to be rarely atop a head, stay with the right baby too? </span></span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">Even under normal circumstances the hats wouldn't be needed, but anyone who has spent any time in summer in a typical NHS ward, knows colour coded fans may have been more appropriate. The air-con sucks, the windows barely open and the thought of a chunky knit hat becomes preposterous.</span></span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;"><b>It's important to understand, I'm not questioning the the need to identify at risk infants - I'm questioning the implementation.</b></span></span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">Surely a large acrylic colour coded magnetic disk that sticks to the side of the cot would be a far more reliable and environmentally friendly indicator, one that doesn't interfere with mums and babies?</span></span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">9000 babies are </span><a href="https://www.kch.nhs.uk/news/media/press-releases/view/13559" style="font-family: "Trebuchet MS", sans-serif;" target="_blank">born in King's hospitals</a><span style="font-family: "trebuchet ms" , sans-serif;"> each year - imagine if all hospitals roll this out, acrylic yarn isn't sustainable nor is the production of hats via volunteers.</span></span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">The hat may in fact never even be worn - each baby gets a new hat for infection control reasons or it is burnt.</span></span><br />
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<span style="font-size: large;"><span style="font-family: "trebuchet ms" , sans-serif;">Now hold up here.</span></span><br />
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<span style="font-size: large;"><span style="font-family: "trebuchet ms" , sans-serif;">The knitter may be sat knitting in the grottiest conditions, smoking whilst knitting, coughing or sneezing on the item - that’s fine to put on a newborn head. Yet the moment the hat is officially allocated to a newborn, even if green and infection free - it must be burnt? </span></span><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">It also </span><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">surely raises the question from vegans (or anyone else who chooses to avoid animals based products) of - is that hat real wool or acrylic? (I asked and they think mainly synthetic, but they're donated so don't really know). </span><br />
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<a href="https://3.bp.blogspot.com/-PAqpjZxOp8s/XIDm_t0HpwI/AAAAAAAACsM/rFNAeNwzbH8Mj13ml5G_9jBAKsl-2ht6wCLcBGAs/s1600/skintoskin.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"></span></a></div>
<a href="https://4.bp.blogspot.com/-LepqMZ7D368/XIDm_ZrlnxI/AAAAAAAACsU/8iEidNc7gDIuG23se9-FULFP-zhBuPuxwCEwYBhgL/s1600/skintoskin2.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" data-original-height="600" data-original-width="600" height="200" src="https://4.bp.blogspot.com/-LepqMZ7D368/XIDm_ZrlnxI/AAAAAAAACsU/8iEidNc7gDIuG23se9-FULFP-zhBuPuxwCEwYBhgL/s200/skintoskin2.jpg" width="200" /></span></a><a href="https://4.bp.blogspot.com/-LepqMZ7D368/XIDm_ZrlnxI/AAAAAAAACsU/8iEidNc7gDIuG23se9-FULFP-zhBuPuxwCEwYBhgL/s1600/skintoskin2.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"></span></a><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">An alternative option which I think is at least worthy of consideration, is colour coded <a href="https://nuroobaby.com/product/short-sleeve-pocket-black/" target="_blank">kangaroo care carriers</a>. </span><br />
<span style="font-size: large;"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">These are carriers designed to protect </span><span style="font-family: "trebuchet ms" , sans-serif;">baby's airways during skin to skin (if mum falls asleep) and hold baby close when mum wants to be mobile. </span></span><br />
<span style="font-size: large;"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">This facilitates best practice <i>and</i> could provide a mobile visual indicator. </span></span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;"><b>The other benefit of carriers is they could further protect against newborn falls.</b></span></span><br />
<span style="font-size: large;"><span style="font-family: "trebuchet ms" , sans-serif;"><br /><a href="https://pediatrics.aappublications.org/content/143/1/e20182488?sso=1&sso_redirect_count=1&nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token" target="_blank">Paediatrics 2019 published</a> "</span><span style="font-family: "trebuchet ms" , sans-serif;">In-hospital Neonatal Falls: An Unintended Consequence of Efforts to Improve Breastfeeding". </span><span style="font-family: "trebuchet ms" , sans-serif;">The study claimed that in an effort to improve breastfeeding rates, rooming in rather than newborns in a nursery was putting babies at risk of falls. </span></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">Therefore surely the appropriate response is to identify and minimise risks?</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">When newborn nurseries were introduced, the problem of increased infection risk, mixing up babies or them being stolen, would all be higher than when babies weren't separated from their caregivers. As a result, tags and improved security systems followed. Hospitals have evaluated and adapted to visible risks based on separating babies from their primary caregivers. </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">Of course they didn't know then that <a href="https://jennifermargulis.net/babies-and-mothers-should-not-be-separated-after-birth-heres-why/" target="_blank">separation was a bad idea for mothers and babies</a>.</span></div>
<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><br />A <a href="https://www.biologicalpsychiatryjournal.com/article/S0006-3223(11)00639-1/fulltext">2011 paper</a> however highlighed:</span><br />
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<blockquote class="tr_bq">
<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">"The profound impact of maternal separation on the infant. We knew that this was stressful, but the current study suggests that this is major physiologic stressor for the infant."</span></blockquote>
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<span style="font-size: large;"><span style="font-family: "trebuchet ms" , sans-serif;">They didn't know then that separating mother and infants who need intensive care support and were sent to different units, forcing increased separation - <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3519169/" target="_blank">resulted in increased mortality</a></span><span style="font-family: "trebuchet ms" , sans-serif;">.</span></span></div>
<span style="font-size: large;"><span style="font-family: "trebuchet ms" , sans-serif;"><br />They didn't know then that Mother-Child Separation Causes <a href="https://www.psychologicalscience.org/publications/observer/obsonline/how-mother-child-separation-causes-neurobiological-vulnerability-into-adulthood.html" target="_blank">Neurobiological Vulnerability Into Adulthood</a> or that </span><a href="https://www.researchgate.net/publication/51549851_Separation_anxiety_disorder_increases_among_neonatal_intensive_care_unit_graduates" style="font-family: "Trebuchet MS", sans-serif;" target="_blank">scores and incidence of SAD were increased</a><span style="font-family: "trebuchet ms" , sans-serif;"> among children who were cared in the NICU and both were correlated with the duration of stay in the NICU.</span></span><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">These risks, whilst not as visible as dropping an infant, are far more common and wider reaching.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">Now hospitals know more - they need to re-evaluate and react according. Dr Nils Bergman (a prominent expert and kangaroo care proponont) has long-said mothers shouldn't be left alone. </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">The Paediatrics study noted:</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>All events</b> were associated with mothers falling asleep while feeding their infant, and all occurred between midnight and 6 am</span></blockquote>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">A <a href="https://www.nursingtimes.net/clinical-archive/patient-safety/reducing-the-risk-of-baby-falls-in-maternity-units/5087445.article" target="_blank">UK hospital explored their fall rate even further</a>. There they noticed:</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">"similarities in many of the circumstances in which the falls occurred. These were that the mother had:</span></blockquote>
<ul><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">
<li><span style="font-family: "trebuchet ms" , sans-serif;">Had a Caesarean section;</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;">A low haemoglobin level [anaemic];</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;">Restricted mobility, such as epidural or spinal anaesthesia.</span></li>
</span></ul>
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<blockquote class="tr_bq">
<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>The most common scenario was that the mother had restricted mobility, due to having had a Caesarean section, felt sleepy, and fell asleep with the baby in her arms. The baby then fell from her arms and onto the floor.</b></span></blockquote>
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<li><span style="font-family: "trebuchet ms" , sans-serif;">Simple interventions like open curtains and using bedside cots can reduce baby falls"</span></li>
</span></ul>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">These strategies brought about a marked reduction of baby falls and are now being established across all the maternity units across the trust.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">Bedside cots were so in demand they had to source more!</span></span><br />
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Kangaroo Carriers could reduce falls, protect airways and provided the additional colour coding re hypoglycemia. Either way - ditch the wooly pom poms and let mothers smell their babies.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>Edited to add:</b> A midwife friend raised an interesting theory this morning, that newborns (she felt) were at risk of becoming colder with a hat, particularly the babies with hair. Although wiped, their heads are still damp and a hat on a damp head can reduce temperature. Another interesting theory to throw into the mix!</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">Update Nov 2019 as the scheme has been rolled out nationally.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">Comments from Facebook readers:</span><br />
<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">This one really made me chuckle:</span><br />
<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">“</span> I just gave birth last week, and my baby was an amber hat--there was a picture of an amber hat stuck to the end of her cot. We never saw an actual hat 🙂”<br />
<br />
<br />
<span style="font-family: "trebuchet ms", sans-serif; font-size: large;">Maybe hats themselves have secret magical properties only the NHS knows about? Why not an amber circle or square, why is hat imagery essential? 🤷♀️😂</span><br />
<br />
<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">“</span> YES! Thank you The Analytical Armadillo, I've seen this shared so many times and every time I was thinking If there's a hat you can't sniff them!<br />
The idea that a green hatted baby is of lower concern, would set alarm bells off with me, because the nurses could completely unintentionally be a little complacent.<br />
Baffles me how this gains support within hospital walls, even ten years ago, after the birth (home) of our first, the midwives said, oooh no hat unless it's chilly out!”<br />
<br />
“ I’m not sure how I’d feel if my newborns had been made to wear red hats; marking them out as a concern? I think I’d probably feel like they were less than perfect or not as good as those in green hats in some way. This might sound a bit ridiculous but your hormones are all over the place and I was so worried about everything right at the start. It feels a bit dehumanising.”<br />
<br />
“ My little guy would have been in a red hat (resuscitated, suspected neonatal sepsis, 5 days of antibiotics). It's hard enough for a mother on an extended stay in hospital with a sick newborn without the constant visual reminder.”<br />
<br />
“ They're after them round us too, acrylic for 60 deg washing, sob. All that plasticky yarn on your beautiful new baby!”<br />
<br />
“ I always thought the hat ridiculous, particularly because I didn’t want to take it home and then heard it would be destroyed for infection control. What waste, on so many fronts. Now that I’ve read this article (so well evidenced, well argued, as always), I’m even more incensed. It’s a silly implementation of an otherwise sensible need - to easily identify babies in need of extra care.”<br />
<br />
“ I gave birth 5 months ago in July. My daughter was 9lb4. They put a hat on her and when i took it off to breastfeed (i couldnt see to get her to latch) i was told she had to wear it for 24 hours! Like something out of the 1970s.”</div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><br />Further reading: </span><br />
<ul><span style="font-family: "trebuchet ms" , sans-serif;">
<li><span style="font-family: "trebuchet ms" , sans-serif;"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1948089/" target="_blank">Care Practice #6: No Separation of Mother and Baby, With Unlimited Opportunities for Breastfeeding</a></span></li>
<li><a href="https://www.rcm.org.uk/news-views-and-analysis/analysis/keeping-mothers-and-babies-together-%E2%80%94-breastfeeding-and-bonding" target="_blank">RCM Keeping mothers and babies together — breastfeeding and bonding</a></li>
</span></ul>
</div>
</div>
</div>
</div>
Analytical Armadillo IBCLChttp://www.blogger.com/profile/03829027807809292649noreply@blogger.com0tag:blogger.com,1999:blog-3102141287849407838.post-29573527453987054442019-02-27T19:29:00.000+00:002019-02-27T19:29:08.849+00:00Infant Feeding - Massive Straw Men with Ambivalence & Gaslights<blockquote class="tr_bq">
<i>"A straw man is a common form of argument and is an informal fallacy based on giving the impression of refuting an opponent's argument, while actually refuting an argument that was not presented by that opponent. One who engages in this fallacy is said to be "attacking a straw man."</i></blockquote>
When it comes to discussing infant feeding, we cover bodily autonomy a lot; mothers and their families have the right to decide how to feed their babies. Nobody should be pressurised into breastfeeding and similarly no mother should be pressurised into not breastfeeding. It sounds pretty simple and yet it's not.<br />
<br />
Infant feeding and discussion of, is fuelled by sleep-deprivation, hormones and significant <a href="https://www.nursingcenter.com/journalarticle?Article_ID=446527&Journal_ID=54035&Issue_ID=446521" target="_blank">cognitive dissonance</a> - tangled up with complex emotions and a healthcare system that has now lost valuable skills.<br />
<br />
Ultimately we know that many fail to receive adequate support when it comes to feeding their baby, leaving a wake of mothers failed by the system, society or both.<br />
<br />
The perhaps most vocal response to this recently, is to claim that it doesn't really matter how we feed our babies anyway.<br />
<br />
You can see how this happens - a mum wanted to breastfeed, couldn't and thus relays her story of the difficulties she's faced. Human nature to many when it comes to hearing pain/distress in others, is to attempt to "fix" it. To provide a solution which will relieve, however temporarily, the discomfort another is feeling.<br />
<br />
To hear, acknowledge, to agree that not everyone can or wants to breastfeed or to help her unpick what happened may not <i>feel</i> enough - particularly when so many lack the skills to enable the latter.<br />
<br />
So follows the response is that she shouldn't worry - as it doesn't really matter anyway...<br />
<br />
The mum's words often read as though it mattered to her. Whether expressed as anger, guilt, sadness or in any other form, the one emotion that doesn't provoke a heated response is ambivalence. Thus we can safely say mum is feeling something. To dismiss her desires or needs as unimportant seems the ultimate act of anti-feminism.<br />
<br />
If a mum is telling you she wants to breastfeed, trying to convince her she's wrong and that it doesn't matter, or that she probably can't do it, that she's selfish and just doing it for herself, would really not be OK in any other discussion than how we feed our babies.<br />
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<a href="https://1.bp.blogspot.com/-EzuCtmB7OXc/XHbjwwFQx8I/AAAAAAAACrI/A7lIodKjKsQ10lVH9LhvvVkkxbWR2n4KgCLcBGAs/s1600/straw.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="512" data-original-width="768" height="213" src="https://1.bp.blogspot.com/-EzuCtmB7OXc/XHbjwwFQx8I/AAAAAAAACrI/A7lIodKjKsQ10lVH9LhvvVkkxbWR2n4KgCLcBGAs/s320/straw.jpg" width="320" /></a></div>
This is also when we typically see the Straw Man rear his head.<br />
<br />
When it comes to infant feeding, the biggest clue is that the writer will often use made up terms to address imaginary groups of people - for example "lactivists".<br />
<br />
Strangely enough this term doesn't appear in the recognised dictionaries, but we can turn to the urban dictionary for this definition:<br />
<blockquote class="tr_bq">
"A lactivist is a lactation activist: <b>someone who considers him/herself an advocate for breastfeeding, whether or not s/he's nursed.</b> Lactivism comes in many forms: choosing to breastfeed, choosing to breastfeed for an extended period of time, choosing to breastfeed in public, choosing to smile at a breastfeeding woman, encouraging other women to breastfeed, educating the public on the benefits of breastfeeding, lobbying for pro-breastfeeding legislation, etc. Maybe you're already a lactivist, and didn't know it." </blockquote>
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That would seem to cover rather a large demographic - anyone who considers<br />
himself an advocate, anyone who has breastfed, anyone who smiles at someone breastfeeding?<br />
<br />
One article someone screenshot recently stated that "lactivists promote inadequate weight gain in babies by saying it's acceptable".<br />
<br />
<b>This is the <i>classic</i> straw-man, a technique to derail discussion by refuting an argument that has never been made. </b><br />
<br />
There is no statement from the "world leader of lactivists", representing all lactivists worldwide making any such statement - they didn't ask me, did they ask you? Who exactly are the "lactivists" referenced?<br />
<br />
If<b> </b> specific people are making the claim babies don't need food, addressing them directly would seem more effective than an open letter to a fictional collective.<br />
<br />
"Lactation consultants" are another group readily attacked in a similar way. <br />
<br />
Recently I read suggestion that "lactation consultants claim a single bottle of formula can destroy supply."<br />
<br />
I'm an International Board Certified Lactation Consultant (IBCLC) and I don't claim this, so is my colleague Debs and neither does she. My friend Helen in Canada is also an IBCLC and similarly makes no such claims, neither does Jo in the US. Our regulatory body didn't make this statement - so perhaps what is actually meant is one person, somewhere, calling themselves a lactation consultant, said it?<br />
<br />
We often see similar tactics employed by far-right groups, but they're often much more easily identified than when it comes to infant feeding.<br />
<br />
Instead this anti-breastfeeding agenda is promoted as merely a reasonable middle ground - a place where no infant feeding method is considered superior to another, because this is really what many want to hear right? Pat pat women on the head, don't fret dear...<br />
<br />
Imagine this in any other area of health - does what adults eat matter or will my GP be promoting beige ready meals and chips next? If so at what age does it shift from not mattering to being the cornerstone of health?<br />
What about an active lifestyle, is there really enough consistently convincing evidence we need to move?<br />
<br />
The next time someone tells you how a mother feeds her baby doesn't matter, blow out the gaslight and listen to the mothers telling you it does.Analytical Armadillo IBCLChttp://www.blogger.com/profile/03829027807809292649noreply@blogger.com0tag:blogger.com,1999:blog-3102141287849407838.post-36911359380383960552019-02-25T19:23:00.000+00:002019-02-25T19:23:41.413+00:00All Tongue Tie Providers Now Need to Register with the CQC - Outcome & Implications for Parents<a href="https://2.bp.blogspot.com/-NoKo-HDfYRY/XHPql3E05uI/AAAAAAAACq8/HNovI9MpCzkfqYTuh17LvTeuBPmnwc38wCEwYBhgL/s1600/tt.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-family: Verdana, sans-serif;"><img border="0" data-original-height="300" data-original-width="500" height="192" src="https://2.bp.blogspot.com/-NoKo-HDfYRY/XHPql3E05uI/AAAAAAAACq8/HNovI9MpCzkfqYTuh17LvTeuBPmnwc38wCEwYBhgL/s320/tt.jpg" width="320" /></span></a><span style="font-family: Verdana, sans-serif;">Many people still don't truly understand the whole hoo-ha with the CQC. The confusion I think is the result of a number of factors; the embellishment of whispers, passed along morphing into a "ban" and resulting in a rather bizarrely worded <a href="https://www.facebook.com/sarahoakleylactation/posts/2202471293150769?comment_tracking=%7B%22tn%22%3A%22O%22%7D" target="_blank">petition to "reinstate providers</a>" - so I've tried to form an analogy that might help give a better understanding.</span><br />
<span style="font-family: Verdana, sans-serif;"><br /></span>
<span style="font-family: Verdana, sans-serif;">In your local area is a private road that connects a housing estate to a busy working area. Nobody really knows who the road belongs to, only that some have permission to use the road and some don't need permission. There's a list of prohibited activities that can't be undertaken on the road - for example dancing and shouting, but walking isn't mentioned.</span><br />
<span style="font-family: Verdana, sans-serif;"><br /></span>
<span style="font-family: Verdana, sans-serif;">The police don't do anything about people walking on the road, since it isn't causing anybody any problems. The risks to the public of people walking down the road are minimal, because only people who work at the end of the road are carefully walking down it, and in 20 years, there's been no</span><span style="font-family: Verdana, sans-serif;"> problem; all "walkers" are trained in road safety and their regulatory body ensures they follow standards, to use roads in a safe and responsible manner. A local group check on two occasions if they can use the road and the police reply that they can.</span><br />
<span style="font-family: Verdana, sans-serif;"><br /></span>
<span style="font-family: Verdana, sans-serif;">One day, a member of aforementioned local group contacts the police call centre independently to ask if he needs permission to use the road. The call handler (who has no idea about the road in question as they haven't heard of it before), gives the standard response which is to have a look at the local maps, ownership deeds and decide for themselves.</span><br />
<span style="font-family: Verdana, sans-serif;"><br /></span>
<span style="font-family: Verdana, sans-serif;">The person takes this back to the local group - concerned they now don't have permission to use the road. The local group contacts the police again, asking for confirmation they legally have express permission to use the road. The call handlers again say it's up to them to decide - there isn't a blanket rule as when it comes to roads, some need permission and some don't..</span><br />
<span style="font-family: Verdana, sans-serif;"><br /></span>
<span style="font-family: Verdana, sans-serif;">The group hires a barrister to ask the police for a definite yes or no answer - can we walk down this road without permission? Who owns this road? Is it technically illegal to trespass? If so can you give us permission to trespass until we've planned an alternate route? If we are acting illegally, will you, the police take action to stop any of us?</span><br />
<span style="font-family: Verdana, sans-serif;"><br /></span>
<span style="font-family: Verdana, sans-serif;">The police state that the road is privately owned, which can be in no doubt if we look at the deeds. The law states most need permission to walk down it - and no they can't give permission without application, because they don't own the road and can't break the law themselves.</span><br />
<span style="font-family: Verdana, sans-serif;"><br /></span>
<span style="font-family: Verdana, sans-serif;">They state if someone is acting illegally, of course they may take action to stop them, <b><span style="font-size: large;">however</span></b> if those who have always walked that way, choose to continue walking that way until they find an alternate route, they can consider each person passing on their own merits. For example, if they're from the area and are in the process of applying for permission to pass, are governed by the road safety regulatory body, following the rules and are insured to be in the area - the police can choose not to take any further action.</span><br />
<span style="font-family: Verdana, sans-serif;"><br /></span>
<span style="font-family: Verdana, sans-serif;">Frenulotomy has been undertaken by midwives and nurses in the UK for 20 years. Ironically the only fatality reported <a href="https://www.bbc.co.uk/news/uk-england-essex-22081044">is at a CQC regulated hospital</a>. There seems to be confusion that registering with the CQC makes practices safer - and there are some areas of healthcare where this is true. However tongue tie has historically always been performed by sole registered, insured, healthcare professionals, with an absence of significant adverse effects. If you have a complaint, you contact the healthcare provider's regulatory body (NMC, GMC etc) - this is still the case when CQC registered.</span><br />
<span style="font-family: Verdana, sans-serif;"><br /></span>
<span style="font-family: Verdana, sans-serif;">The CQC is designed to regulate hospitals, GPs, Care homes and suchlike - "to monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety". The OFSTED of healthcare, they are body bound to act in the interest of the public.</span><br />
<span style="font-family: Verdana, sans-serif;"><br /></span>
<div>
<span style="font-family: Verdana, sans-serif;">Hospitals, clinics etc employ a lot of staff, not all are HCP, they need to know places are following safety protocols and have ways of monitoring satisfaction in the setting. If we <a href="https://www.cqc.org.uk/what-we-do/how-we-do-our-job/fundamental-standards">look at their fundamental standards</a> - how many even apply to a self-employed midwife treating 3 tongue ties per week in someone's home? </span><br />
<span style="font-family: Verdana, sans-serif;"><br /></span>
<span style="font-family: Verdana, sans-serif;">When it's one or two people working alone as registered healthcare professionals, their own training and insurance ensures fundamental standards of quality and safety are met -they're not bloody Bupa!</span></div>
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<div class="separator" style="clear: both; text-align: center;">
<a href="https://1.bp.blogspot.com/-qYDImRHaMfs/XDIMy5y0-8I/AAAAAAAACpo/1JRt8ysP4TwA3YKZJh8pQmcFETCORi2DwCPcBGAYYCw/s1600/catpigeon.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="394" data-original-width="600" height="210" src="https://1.bp.blogspot.com/-qYDImRHaMfs/XDIMy5y0-8I/AAAAAAAACpo/1JRt8ysP4TwA3YKZJh8pQmcFETCORi2DwCPcBGAYYCw/s320/catpigeon.jpg" width="320" /></a></div>
<span style="font-family: Verdana, sans-serif;">As soon as the ATP started pinning down the CQC, some members (including the chair herself) started completing their CQC applications. - knowing they would have little choice but to deem tongue tie a surgical procedure. By virtue of the law and their own guidance, when backed into a corner, they had little choice but to require registration.</span><br />
<span style="font-family: Verdana, sans-serif;"><br /></span></div>
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<b><span style="font-family: Verdana, sans-serif;">The question is, what happens next?</span></b></div>
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<span style="font-family: Verdana, sans-serif;"><br /></span></div>
<div>
<span style="font-family: Verdana, sans-serif;">The costs of preparing and maintaining CQC registration are huge (the application form alone takes weeks to complete, in part again because it's really designed for larger organisations with "staff policies", not a "one-man band"). No doubt some who just did a few here and there will decide not to continue in practice - and for those who do register, these costs will likely be passed on to parents. Many who ceased practicing before Christmas as advised by the ATP, may have already had such an impact to their business and earnings from which it could be difficult for them to recover.</span></div>
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<span style="font-family: Verdana, sans-serif;"><br /></span></div>
<div>
<span style="font-family: Verdana, sans-serif;">This is likely to make tongue treatment less attainable to those least able to afford it, leading the way for larger clinics and hospital treatments over the personal one to one service many have valued for so long.</span></div>
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<span style="font-family: Verdana, sans-serif;">------------------------------------</span></div>
<div>
<span style="font-family: Verdana, sans-serif;">I spoke with the CQC 18.2.19 and clarified the following (posted initially on the <a href="https://www.facebook.com/groups/tonguetie/" target="_blank">Infant UK tongue tie group</a>)</span><br />
<div style="background-color: white; color: #1d2129; font-size: 14px; margin-bottom: 6px; margin-top: 6px;">
<span style="font-family: Verdana, sans-serif;"><br /></span></div>
<div style="background-color: white; color: #1d2129; margin-bottom: 6px; margin-top: 6px;">
<span style="font-family: Verdana, sans-serif;">1) Since pressed legally, the CQC now really have little choice but to r<span class="text_exposed_show" style="display: inline;">egulate frenulotomy. They recognise that it's low risk, has been practiced for years and so on, and as such wasn't an area of interest to them; however, legally it's impossible for them to argue that scissors, a frenulum and blood isn't surgical. Therefore, when asked to define the legal position - they've had to concede pin holding HCPs need to register. The CQC don't write the laws (parliament do), they interpret and enforce them.</span></span><br />
<span style="font-family: Verdana, sans-serif;"><span class="text_exposed_show" style="display: inline;">.</span></span><span style="font-family: Verdana, sans-serif;"><span class="text_exposed_show" style="display: inline;">2) The only exemptions in terms of "practicing privileges" apply to doctors with GMC registration (as outlined in numerous pieces of legislation). Petitioning parliament would be the only way to potentially extend this exemption to other HCPs. Similarly if people wanted to propose frenulotomy should be on the list of exempt procedures (like toenails for example), they'd need to do the same.</span></span><br />
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<span style="font-family: Verdana, sans-serif;"><div style="margin-bottom: 6px;">
3) They didn't/don't automatically expect midwives/nurses who are certified/insured and co-operating with the CQC, to stop practicing privately whilst applications are completed/processed. Under the law they cannot give permission for a "grace period", however they do decide who they do/don't prosecute and any action has to be in the public interest. Note - THERE IS NOT A BAN as some have claimed.</div>
<div style="margin-bottom: 6px; margin-top: 6px;">
4) The CQC ONLY regulate registered healthcare professionals. In this RA osteopaths will require registration, however they do not regulate lay healthcare professionals eg IBCLCs, thus they will not be required to register.</div>
<div style="margin-bottom: 6px; margin-top: 6px;">
5) If contacting the CQC, please remember those that answer are call handlers. Please ask to speak to the registration team for detailed information.</div>
<div style="margin-bottom: 6px; margin-top: 6px;">
6) ETA: For the avoidance of doubt, frenulotomy does not fall under the regulated activity ‘maternity and midwifery services’, even where it is carried out by a midwife. Tongue-tie is a condition that is usually picked up in infancy, as a difficulty to breast feed and attach to the breast. Older children or adults may require the treatment related to speech difficulties and, where this is the case, the condition is treated by other healthcare professionals. Treating it is not part of midwifery care. It is post-natal care (see NICE interventional procedures <a data-ft="{"tn":"-U"}" data-lynx-mode="asynclazy" href="https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.nice.org.uk%2Fguidance%2FIPG149%3Ffbclid%3DIwAR2vEVLTjVmk1YkrdudGuIWWfV42OcLrKvlWQfhS1SUgWKXYELDc00KmNEc&h=AT24OD5Z7EoDLZvdbpTUUXT1km_MO8HpgVzmU4ZZDHZciIngIinAnpbb20xymKUc5AIM_7nlrfHpq_qE0UePZzwLkmxOyPppUQm-xGi0F_sZBXRHVXwkHMIMsUz4TLqQiGEzF10ngB0mKIJo7MGc1tvZdrjUZ2u8erE" rel="noopener nofollow" style="color: #365899; cursor: pointer;" target="_blank">https://www.nice.org.uk/guidance/IPG149</a>).</div>
</span></div>
<a href="https://docs.google.com/document/d/1bcSnItk9Z6vGUg-l3VB2kl0HCmKLXx5JOC7zPlDtNno/edit?usp=sharing" target="_blank"><span style="font-family: Verdana, sans-serif;">Click here for Letter ATP received from the CQC and sent to ATP members</span></a><br />
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Analytical Armadillo IBCLChttp://www.blogger.com/profile/03829027807809292649noreply@blogger.com0tag:blogger.com,1999:blog-3102141287849407838.post-52370691692777063912019-01-06T21:51:00.002+00:002019-01-07T10:58:41.938+00:00The UK, Frenulotomy, Private Services & the CQC - Separating Fact from Fiction<div class="separator" style="clear: both; text-align: center;">
<a href="https://4.bp.blogspot.com/-qYDImRHaMfs/XDIMy5y0-8I/AAAAAAAACpk/BvwHxlcaOQ8h8XXWa_Q6ejNVegrlFArlACLcBGAs/s1600/catpigeon.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="394" data-original-width="600" height="209" src="https://4.bp.blogspot.com/-qYDImRHaMfs/XDIMy5y0-8I/AAAAAAAACpk/BvwHxlcaOQ8h8XXWa_Q6ejNVegrlFArlACLcBGAs/s320/catpigeon.jpg" width="320" /></a></div>
<span style="font-family: "trebuchet ms" , sans-serif;">The UK "tongue tie world" was thrown into chaos j</span><span style="font-family: "trebuchet ms" , sans-serif;">ust before Christmas, when the Association of Tongue Tie Practitioners (ATP) sent an email to all their members in private practice.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">They reported that confusion had arisen over whether the Care Quality Commission (CQC - regulators of health and social care in England), considered tongue tie a surgical procedure that required CQC registration.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">The ATP states that in both 2011 and 2013, the CQC had reassured them registration wasn't required. However recently, they've received reports that practitioners who contacted the CQC independently, have been advised it’s up to them to establish whether they need to register using the framework published. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">Further communications between at ATP and CQC, have so far not resulted in obtaining the blanket guidance for all practitioners that the ATP seek.</span><br />
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<a href="https://3.bp.blogspot.com/-FdxY_AeYGTU/XDIZ3azIbBI/AAAAAAAACpw/tqdgBDWrYZsU8tUjtOnKnwaOZzSCF8GjACLcBGAs/s1600/2019-01-06.png" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://3.bp.blogspot.com/-FdxY_AeYGTU/XDIZ3azIbBI/AAAAAAAACpw/tqdgBDWrYZsU8tUjtOnKnwaOZzSCF8GjACLcBGAs/s1600/2019-01-06.png" /></a><span style="font-family: "trebuchet ms" , sans-serif;">As a result the ATP sought legal advice. Whilst this was under investigation over Christmas, the ATP warned </span><span style="font-family: "trebuchet ms" , sans-serif;">if practitioners were not registered, yet it turned out they needed to be - they could face a hefty fine and even prison. </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">The ATP of course would be neglectful not to share the legal information gleaned with their members. Since they formally provide guidance regarding registration, they're quite rightly likely to be concerned about potential litigation issues that could arise as a result of any advice they give. </span><span style="font-family: "trebuchet ms" , sans-serif;">They recommended this course of action for all healthcare practitioners that were not CQC registered.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">Since it may take months for applications to the CQC to be processed, they also provided a suggested letter members could use to inform others why their frenulotomy services had temporarily ceased. </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">This information was disseminated to members, some of whom ceased practice.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">As updated guidance from the CQC has been published since 2013, th</span><span style="font-family: "trebuchet ms" , sans-serif;">is could mean, as the ATP highlighted in their email, that a good chunk of practitioners have potentially been misadvised - resulting in them practicing without the appropriate registration for years. Concern</span><span style="font-family: "trebuchet ms" , sans-serif;"> was also raised the CQC could take retrospective legal action if and when members applied.</span><br />
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<b><span style="color: red;">What hasn't happened:</span></b></span><br />
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I've heard all sorts of rumours over the last couple of weeks - that the ATP had forced suspension of services, that the government?! had decided nobody was regulating frenulotomy and so had banned private practice, through to claims anyone practicing without CQC registration was acting illegally!</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">Clearly some forgot that all healthcare providers with a pin are already really rather regulated - so unless your friend's non-registered uncle is having a bash down the pub, we were always far from the worryingly unsafe situation some are now suddenly purporting.</span><br />
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<b><span style="color: red; font-family: "trebuchet ms" , sans-serif;">Who are the ATP?</span></b><br />
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We should clarify as there has been some confusion recently online, <b>the ATP is <span style="color: red;">not</span> a governing body or regulatory in nature</b>. The ATP was formed by a group of tongue tie practitioners and is a committee run, member organisation. They're perhaps best known for the UK directory, or list of their members who provide tongue tie services - although their scope is larger than this as they state they aim to increase tongue tie awareness, support parents to obtain safe, effective care and so on. All practitioner members of the ATP must submit evidence of training and insurance. </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;"><b>Tongue tie providers can therefore choose to become a member, but there is no requirement to do so. Similarly of course, </b></span><span style="font-family: "trebuchet ms" , sans-serif;">both members and non-members can choose to follow guidance from the ATP, or seek their own legal counsel.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">Several providers I know (including ours), had already made contact with the CQC independently, typically when setting up their practice or moving to a clinic base. <b>All seem to have been advised (as per recent reports), that the onus was on them to read the guidance and establish whether registration was required.</b></span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">Because the framework is complex and different exemption pathways exist, for example <a href="https://www.cqc.org.uk/sites/default/files/documents/ra_11_maternity_and_midwifery_services.pdf" target="_blank">here</a> and <a href="https://www.cqc.org.uk/sites/default/files/20150428_scope_of_registration_independent_medical_practitioners_working_in_private_practice.pdf" target="_blank">here</a> (with further details and caveats in other sections and sub-sections), some providers have already separately sought legal advice long before this recent news from the ATP.</span><br />
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<span style="color: red; font-family: "trebuchet ms" , sans-serif;"><b>Some practitioners have already faced investigation and answered to the CQC.</b> </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">I was notified early in 2018 that </span><span style="font-family: "trebuchet ms" , sans-serif;">IFS (Milk Matters) were under investigation for unlawfully undertaking "Tre</span><span style="font-family: "trebuchet ms" , sans-serif;">atment of disease, disorder or injury" and "Surgical Procedure".</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">We probably shouldn't have been surprised as after I made <a href="https://www.facebook.com/breastfeed/posts/1728038207241406" target="_blank">THIS Facebook post here</a>, I received this (</span><span style="font-family: "trebuchet ms" , sans-serif;">ironically a year ago to the day!)</span><span style="font-family: "trebuchet ms" , sans-serif;">:</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">After providing all the required information/evidence about our setup, practitioner and so on (including offering to register ASAP if required) - the complaint was dismissed with no further action needed. </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">Our legal guidance received since the ATP email therefore, is that we have already satisfactorily addressed this issue direct with the CQC. </span></div>
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<b><span style="font-family: "trebuchet ms" , sans-serif;">The latest legal advice the ATP shared with members, in response to some continuing to practice, can be found in the form of an email from their barrister:</span></b></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">"I am afraid it (frenulotomy) is registerable as far as independent practitioners are concerned and an offence to carry it out without registration (<b><span style="font-size: large;">subject to the medical practitioner exemption, explained in the advice</span></b>)<b>."[sic]</b></span></blockquote>
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<span style="font-family: "trebuchet ms" , sans-serif;">Their opinion is frenulotomy is registrable and if you don't meet the required exemptions, to not do so would be an offence. Logical. This however is not the same as saying <b><i>all</i></b> providers need to register.</span></div>
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<b><span style="color: red; font-family: "trebuchet ms" , sans-serif;">It also makes the next move by the ATP yesterday incredibly confusing.</span></b></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">The chair Sarah Oakley writes:</span></div>
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<a href="https://4.bp.blogspot.com/-e8jDvsfozcI/XDDtena0pKI/AAAAAAAACpE/8lUjLlUWA8or5UKDbbC3UPHL_iS27G-TACLcBGAs/s1600/49479640_407679559975514_3344719916497371136_n.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: "trebuchet ms" , sans-serif;"><img border="0" data-original-height="899" data-original-width="640" src="https://4.bp.blogspot.com/-e8jDvsfozcI/XDDtena0pKI/AAAAAAAACpE/8lUjLlUWA8or5UKDbbC3UPHL_iS27G-TACLcBGAs/s1600/49479640_407679559975514_3344719916497371136_n.jpg" /></span></a></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">Why, I wonder, do parents need to ensure a provider is CQC registered? </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><b>The onus is not on patients to ensure their healthcare professional holds appropriate CQC registration, because they can't be expected to be aware of exemptions or the laws surrounding registration. Despite what has been suggested recently - parents visiting a non-registered CQC provider are NOT "colluding in an illegal act". Providers who fail to register when they need to however, can face prosecution.</b></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">What are the benefits of using a practitioner that is CQC registered </span><b style="font-family: "Trebuchet MS", sans-serif;">rather than exempt from needing to register</b><span style="font-family: "trebuchet ms" , sans-serif;">? </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">The ATP may need to expand further and provide evidence supporting their rationale, should they be challenged legally regarding this recommendation. I can't imagine paying members (who have been advised by their own solicitor they are exempt from needing to register) will be massively impressed at this point.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">It's even harder to understand the recommendations in terms of benefits to parents, as this leaves us for the most part with surgeons and dentists - the very group from which parents on the </span><a href="https://www.facebook.com/groups/tonguetie/?ref=br_rs" style="font-family: "Trebuchet MS", sans-serif;" target="_blank">UK Infant Tongue Tie Group</a><span style="font-family: "trebuchet ms" , sans-serif;"> report the lowest satisfaction levels, when it comes to frenulotomy and infant feeding.</span></div>
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<span style="color: red; font-family: "trebuchet ms" , sans-serif;"><b>More about the CQC</b></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">Given what I've read in recent days, I think there is much confusion about what the CQC actually does - <a href="https://www.cqc.org.uk/what-we-do/how-we-do-our-job/fundamental-standards" target="_blank">Here you can see what CQC fundamental standards are.</a></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">Despite what many seem to think, the CQC won't undertake complaints from those dissatisfied with their private care (<a href="https://www.cqc.org.uk/contact-us/how-complain/complain-about-service-or-provider" target="_blank">as outlined here</a>). </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">"</span><span style="font-family: "trebuchet ms" , sans-serif;">We cannot make these complaints for you or take them up on your behalf. </span><span style="font-family: "trebuchet ms" , sans-serif;">That may seem confusing but it’s because we don’t have powers to investigate or resolve them."</span></blockquote>
<span style="font-family: "trebuchet ms" , sans-serif;">The CQC </span><span style="font-family: "trebuchet ms" , sans-serif;">inspect and ensure the provider is qualified, that general clinical standards are met and so on, but s</span><span style="font-family: "trebuchet ms" , sans-serif;">hould someone be unhappy with a treatment received - whether CQC registered or not, complaints would be addressed to the relevant governing body eg the General Medical Council, Nursing and Midwifery Council or General Dental Council.</span><br />
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<b><span style="color: red; font-family: "trebuchet ms" , sans-serif;">One might argue - why doesn't everyone just register with the CQC anyway, even if they don't need to, surely this is win win all round?</span></b></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">The problem with this is the vast majority of tongue tie providers work alone or with a colleague - yet the CQC is setup to regulate large hospitals, care homes and suchlike.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">If a provider has 2 bases (working say half a day from each), the annual cost for registration to the CQC is in the region of <b>£4000</b>. </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">In addition to this, sources quote anywhere between forty and hundreds of staff hours are needed to apply for and prepare for an inspection (rather like when Ofsted at inspecting schools). If we pitch that even at forty hours (which would likely be unrealistically low for someone with no experience of the process), that's around a further <b>£2500.</b></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">If we then consider the insurance to undertake tongue tie independently is already expensive (as you might imagine), plus other "hidden costs" like accountancy fees, ongoing CPD hours to keep up to date with current practice, conferences and re-certification costs for IBCLCs and so on) - many may soon find it's not financially viable to practice.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><b>It would also be very difficult to argue any benefits in terms of safety, of everyone blindly registering with the CQC even if they're eligible for exemption.</b> </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">Frenulotomy has been performed extensively in the UK since the 1990s and is considered an extremely safe procedure which can be performed</span><span style="font-family: "trebuchet ms" , sans-serif;"> in the home (like a heel prick/neonatal blood-spot or blood test) - complications are considered very rare </span><span style="font-family: "trebuchet ms" , sans-serif;">(NICE: Division of ankyloglossia (tongue-tie) for breastfeeding). </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">Independent nurses and private health visitors in any great number are relatively new in terms of private UK services, from the perspective of member interests - an urgent dialogue regarding clarifying current and possible further exemptions with the CQC would seem prudent before issuing guidance. </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">Assistance for different types of provider in navigating the exemptions seems necessary - yet instead we're seeing </span><span style="font-family: "trebuchet ms" , sans-serif;">recommendation every private practitioner in the UK should race to register or be deemed "legally unsafe" and avoided by parents. </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">This seems both reactionary and </span><span style="font-family: "trebuchet ms" , sans-serif;">unnecessary</span><span style="font-family: "trebuchet ms" , sans-serif;"> to many I've discussed this with, leaving both practitioners and parents stuck. One health professional I spoke with who is CQC registered for other activities, said they'd expect practitioners to explore all routes thoroughly for CQC exemption, offering yourself up for regulation unnecessarily they felt was madness. Whilst unfortunately nobody was prepared to speak "on the record", this is clearly a large can of worms lacking a lid.</span></div>
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Analytical Armadillo IBCLChttp://www.blogger.com/profile/03829027807809292649noreply@blogger.com0tag:blogger.com,1999:blog-3102141287849407838.post-91972208158848462822018-11-28T18:56:00.000+00:002018-11-28T21:18:54.616+00:00Baby Landon - is Breastfeeding to Blame?Many of us are familiar with the tragic case of baby Landon, for those that aren't you can get the lowdown that most commonly circulates <a href="https://fedisbest.org/2017/02/given-just-one-bottle-still-alive/" target="_blank">here</a>.<br />
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As LA makes all autopsy results public, a reader suggested I may be interesting in taking a look. It can be easy for memory and recall to change over time and I wondered whether it was possible one bottle of formula could have saved him. Whilst these cases are traumatic and difficult to discuss. It's vital we do so in order to minimise the risks of this happening to another child.<br />
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It's not exactly easy to pick this story apart, because errors appear to be present in the autopsy report:<br />
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<li>Page 15 and the opening summary, states baby's birth weight was 7lb 7 ounces (3.36 kg). It states in this same paragraph is records his <b>discharge weight as 6lb 5 ounces (2.86 kg)</b></li>
<li>Page 17 also states his <b>discharge weight was 6lb 5 ounces (2.86 kg)</b></li>
<li>Page 18 states that<b> his discharge weight was 3.03 kg (6lb 11oz)</b></li>
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<b>This is a significant discrepancy. </b>The first gives a loss of 15%, the second a loss of 9.8% at day 4.<br />
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But what happened before then?</div>
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<b>"Fetal intolerance to labor" </b></h4>
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Labour progressed typically until epidural meds were given, at which point baby's heartbeat decreased. This didn't improve with maternal positioning and thus they ruptured mum's membranes to enable them to attach a monitor to baby. This showed baby still had a slow heartbeat and thus they moved to cesarean section.</div>
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<b>Once Landon was born:</b><br />
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<li>Page 16, based on an interview with a doctor reviewing the case: </li>
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He states baby was <b>born dehydrated</b> "but the explanation for that term was not provided in the documentation he reviewed". It says baby was given fluids and transferred to NICU because of "a history of a poor transition". <br />
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Note: Dehydration at birth isn't typical and is commonly associated with infant blood loss.<br />
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<li>Page 17, based on maternal interview:</li>
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This states that parental understanding was baby's heart rate was slow to increase after birth (<b>bradycardia</b>) and <b>oxygen was administered for 15-20 minutes plus a 35 ml bolus of fluid was given through a scalp vein</b>. Parents were advised baby was dehydrated and he was transferred to NICU.<br />
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<li>Page 18, <span style="color: red;">based on official medical records</span> </li>
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This states baby was born with Apgars of 8 and 9, but then experienced transient <b>tachypnea</b> (<span style="background-color: white; font-family: Arial, "Helvetica Neue", Helvetica, sans-serif; font-size: 17.5px;">v</span>ery fast or labored breathing) and thus was admitted to NICU. It states baby was treated with CPAP<b> </b>(continuous positive airway pressure - presumably the inflation breaths given at birth) <b>and given saline IV for <span style="color: red;">hypovolemia</span>.</b><br />
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<a href="http://www.winchesterhospital.org/health-library/article?id=849013" target="_blank">Hypovolemia is</a> a low level of fluid in the body (presumably the dehydration discussed). Lower levels of blood make it difficult to get nutrients and oxygen to the entire body. Hypovolemia will affect the entire body but certain organs are at higher risk of damage. <b>Organs that are very active like the heart, kidney, brain, and liver may be affected the mos</b>t.<br />
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<b>Causes of Hypovolemia are:</b><br />
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<li>Blood loss–from an injury or illness</li>
<li>Problems absorbing fluids in the digestive tract</li>
<li>Trouble feeding</li>
<li>Illness with vomiting or diarrhea</li>
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Clearly since he was just born - feeding and vomiting etc can't apply. </div>
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All reports agree that just 2 hours later, Landon was discharged from the NICU to room in with his mother for the next four days.<br />
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They were taken to the maternity ward:<br />
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"She [mum] had concerns because he was fussy, she thought he would sleep and eat more".</blockquote>
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"During the hospital stay, baby appeared to be nursing, but mum raised concerns she didn't have enough milk due to a history of PCOS". <b style="color: red;">The infant produced few wet diapers.</b><br />
<br />
On day 4 baby was discharged at 3pm despite the fact <b>baby had produced ZERO wet nappies that day and as we explored above, had a loss of either 10 or 15% at that point.</b><br />
<b><br /></b>
Once home Landon fed continuously. Mum states she was advised that this was normal as baby was cluster "feeding".<br />
<br />
The report becomes a tad contradictory:<br />
<ul>
<li>Page 16 reads: the baby was home for 8-10 hours and was not feeding well. The father states the child had poor skin turgor. On the night in question they had called the hospital for advice and nobody suggested supplementation. The child was not doing well and <b>so they were going to take him hospital.</b></li>
<li>Page 18 reads: It was reported that the <b>mother fell asleep breastfeeding </b>the infant at 02:00 hours (no hospital visit). She woke 30-40 minutes later to find him blue and not breathing.</li>
<li>In contrast <a href="http://www.analyticalarmadillo.co.uk/2017/03/part-2-shame-on-british-media-what.html" target="_blank">posts online from mum</a> recount how he slept in the car and then "they had fun playing with him that evening" yet awoke to find him unresponsive.</li>
</ul>
</div>
<div>
<b>Rushed to hospital:</b></div>
<div>
Baby was resuscitated, readmitted and rehydrated with IV fluids (noted by the pathologist to be visibly swollen due to the volume), at this point baby was 9.3% below birth-weight.<br />
<br />
Medical professionals I've discussed this with have said if baby was discharged with a 9.8% loss, you'd typically expect a significant positive shift following IV fluids, particularly if baby looks oedematous. As we know from what happened to <a href="http://www.analyticalarmadillo.co.uk/2016/10/fed-is-best-infant-dehydration.html" target="_blank">Dr Christie del Castillo-Hegyi</a> of "Fed is Best" - we start seeing these dangerous sequale unfold when we start hitting these very large losses.</div>
<div>
<div>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://3.bp.blogspot.com/-CPep6QNxvkU/W_fJFLZEkOI/AAAAAAAACn4/KAkVcgPTVyQu1GnTKTjnjWd1VBpcx5LawCLcBGAs/s1600/16699706_10209897006436462_2020190930_n.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="144" data-original-width="171" height="336" src="https://3.bp.blogspot.com/-CPep6QNxvkU/W_fJFLZEkOI/AAAAAAAACn4/KAkVcgPTVyQu1GnTKTjnjWd1VBpcx5LawCLcBGAs/s400/16699706_10209897006436462_2020190930_n.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Images show signs of excess weight/fluid loss visible on baby's hands.</td></tr>
</tbody></table>
<br /></div>
<div>
Tragically Landon didn't survive:<br />
<br />
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<a href="https://4.bp.blogspot.com/-1u0saX4-Vfk/W_fLWqWV-JI/AAAAAAAACoE/iNlmqy748l4IfZnEDnpue8DkEn1VbVj_gCLcBGAs/s1600/2018-11-23.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="161" data-original-width="673" src="https://4.bp.blogspot.com/-1u0saX4-Vfk/W_fLWqWV-JI/AAAAAAAACoE/iNlmqy748l4IfZnEDnpue8DkEn1VbVj_gCLcBGAs/s1600/2018-11-23.png" /></a></div>
<b>Discussion</b><br />
<b><br /></b></div>
<div>
The picture painted by the media and groups trying to use this story to promote a formula feeding agenda - is so far away from reality, it's at best misleading and at worst lies intended to manipulate. Instead of a term, healthy baby apparently feeding well, with normal output and yet suddenly struck down (ie it could happen to anyone!), the reality is very different.</div>
<div>
<br /></div>
<div>
Baby Landon was <b>dehydrated at birth with no explanation as to why since no excessive blood loss is noted. </b>Following his NICU stay and subsequent rooming in, there are persistent warning signs this was a compromised baby unable to transfer enough colostrum to sustain himself. First mum states she thought baby was fussy and would have fed more - given this baby had just been discharged from NICU for dehydration, fussiness (which expends energy and suggests something is wrong) along with lack of feeding should surely have raised a red flag?</div>
<div>
<br /></div>
<div>
The report states during the hospital stay baby "appeared" to be feeding, yet mum was unsure if she was producing adequate milk and had concerns over PCOS and potential insufficient glandular tissue. What this tells us is mum's instincts are baby wasn't feeding well, yet it seems no action was taken by doctors caring for Landon to ensure he now remained adequately hydrated and able to feed well during his stay. </div>
</div>
</div>
<div>
<br /></div>
<div>
Babies can fail to latch effectively for a number of reasons but those most at risk of problems are babies in Landon's position. In fact on day 4, after continuing to lose weight during his stay, a dehydrated baby without adequate urine output was discharged from hospital. No feeding plan or safeguarding protocols were implemented and just hours late his mother fell asleep with him in arms. </div>
<div>
<br /></div>
<div>
If the baby had been bottle fed and mum had kept handing back full bottles of unused formula, would staff have been OK with this too? If not, it clearly demonstrates staff NEED the skills to identify when a baby is drinking well. They need to check and double check infants who have left NICU following dehydration (of all things!), weighing baby to plot against nomograms if needed </div>
<div>
<br /></div>
<div>
They NEED to listen to mothers who state their baby doesn't appear to be drinking well, is fussy, is never satisfied - these things are NOT normal!</div>
</div>
Analytical Armadillo IBCLChttp://www.blogger.com/profile/03829027807809292649noreply@blogger.com3tag:blogger.com,1999:blog-3102141287849407838.post-67474354887841330052018-09-17T17:22:00.000+01:002018-09-17T17:22:03.479+01:00Why Are Some Media Outlets So Reluctant To Use Qualified Infant Feeding Advisors?<div class="separator" style="clear: both; text-align: center;">
</div>
There has been much discussion this week surrounding the "experts" presented in the media to proffer infant feeding support.<br />
<br />
"<a href="https://www.bristolpost.co.uk/news/health/new-mums-breastfeed-live-morning-2002419" target="_blank">This Morning</a>" did a breastfeeding feature that <a href="https://you.38degrees.org.uk/petitions/itv-start-using-ibclc-lactation-consultants-in-your-breastfeeding-segments-on-daytime-tv" target="_blank">resulted in a petition</a> demanding those providing their infant feeding advice, <a href="http://www.ilca.org/main/why-ibclc/ibclc" target="_blank">hold a qualification in infant feeding</a>.<br />
<br />
It seems crazy to me we're even having this discussion, but as it stands those of us in practice have to squirm uncomfortably as mothers are advised to shake their breasts to change their nipple shape and express to check their supply, by "experts" who <a href="http://www.analyticalarmadillo.co.uk/2012/05/claire-byam-cook-in-times-say-what.html" target="_blank">compare breastmilk to coca-cola</a>.<br />
<br />
This isn't the first time there has been social media uproar over the infant feeding advice given, so why are the media so keen to choose the "experts" they do?<br />
<br />
They say a picture speaks a thousand words:<br />
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<a href="https://2.bp.blogspot.com/-PuO3E1_53Bk/W591EZC1cfI/AAAAAAAACmI/ZFKsQWawQAkjCLiilxWlWy0I4i5PZ110wCLcBGAs/s1600/41807190_1832719760097765_577653134009040896_n.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="497" data-original-width="518" src="https://2.bp.blogspot.com/-PuO3E1_53Bk/W591EZC1cfI/AAAAAAAACmI/ZFKsQWawQAkjCLiilxWlWy0I4i5PZ110wCLcBGAs/s1600/41807190_1832719760097765_577653134009040896_n.jpg" /></a></div>
<br />
Midwives, International Board Certified Lactation Consultants, Breastfeeding Counsellors, Health Visitors are all bound to a code of practice which includes lack of commercial association along with working from an evidence base:<br />
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<tr><td style="text-align: center;"><a href="https://3.bp.blogspot.com/-07mQW0alMrE/W591ZSFCvoI/AAAAAAAACmc/2QOELtooQaEDLyz88-1mnNy2hn8LGJ9RwCEwYBhgL/s1600/41911526_1893573270724606_6020907961256247296_n.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="308" data-original-width="1242" height="156" src="https://3.bp.blogspot.com/-07mQW0alMrE/W591ZSFCvoI/AAAAAAAACmc/2QOELtooQaEDLyz88-1mnNy2hn8LGJ9RwCEwYBhgL/s640/41911526_1893573270724606_6020907961256247296_n.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Midwives Code of Conduct</td></tr>
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<tr><td style="text-align: center;"><a href="https://3.bp.blogspot.com/-4YOJPPGfZg8/W5932DnPsII/AAAAAAAACmk/Vi1rdJ-JuPANftt2SwygP4XnOmXhoEOEwCEwYBhgL/s1600/2018-09-17%2B%25281%2529.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="97" data-original-width="632" src="https://3.bp.blogspot.com/-4YOJPPGfZg8/W5932DnPsII/AAAAAAAACmk/Vi1rdJ-JuPANftt2SwygP4XnOmXhoEOEwCEwYBhgL/s1600/2018-09-17%2B%25281%2529.png" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">International Board Certified Lactation Consultant Code of Conduct</td></tr>
</tbody></table>
Evidence base is a tricky thing when it comes to infant feeding and the media.<br /><br />We need to keep the majority of viewers happy, but statistics show us the majority of viewers aren't sustaining breastfeeding. Evidence based isn't the same as "<a href="https://www.spectator.co.uk/2015/08/the-biggest-heretic-in-baby-feeding-and-why-i-like-her/">audience pleasing</a>".<br />
<a href="https://www.spectator.co.uk/2015/08/the-biggest-heretic-in-baby-feeding-and-why-i-like-her/" target="_blank">This article</a> is a great example of us liking "what we want to hear":<br />
<blockquote class="tr_bq">
<span style="background-color: white; color: #333333; font-family: "times" , "times new roman" , serif; font-size: 20px;">"</span>The La Leche League, the NCT, the Association of Breastfeeding Mothers and the National Breastfeeding Helpline try hard these days not to sound too judgmental. They do not like being nicknamed ‘the Breastapo’, although some of the NCT’s bossier members can be terrifyingly dogmatic. </blockquote>
<blockquote class="tr_bq">
‘We support all mothers, however they decide to feed their baby,’ they insist. But their websites also explain that if you choose formula rather than breast milk, your baby is more likely to suffer from gastroenteritis, diarrhoea, respiratory, urinary, gut and ear infections, asthma, pneumonia, diabetes, obesity, leukaemia and a low IQ. Anna Burbidge, a spokesperson for La Leche League, quoted a recent Unicef survey saying that a baby will be more likely to be hospitalised during its first year if not exclusively breast-fed for the first six months."</blockquote>
So supporting mothers means withholding the evidence base so as not to appear "terrifyingly dogmatic"?<br />
The rest of the article makes it clear the author really would like to believe it doesn't matter how we feed our babies and feels this is what we should be telling parents...<br />
<br />
I had this discussion recently with another practitioner in the field of infant feeding. The reality is, some parents may not want the evidence on which to base an informed choice, particularly if this causes cognitive dissonance (ie, when the information contradicts what someone already believes to be true). We can encourage informed choice - but we can't force it and nor should we.<br />
<br />
By the time mums get breastfeeding support, some (understandably) have had enough. Sometimes we want "permission to stop" - for someone to say, maybe you're just not built for this?<br />
<br />
Alongside this, marketers have worked hard to create a "militant" edge to anyone who works in the field of infant feeding. Breastapo, Breastfeeding Nazis, dogmatic, judgmental, will push you to breastfeed at any cost.<br />
<br />
In reality lactation consultants and breastfeeding counsellors are all trained in precisely the opposite, a non-judgmental approach to facilitate the parents to make choices. But those who profit from the majority of parents purchasing formula, don't want mothers seeking help in their droves, that would never do in terms of profit margin. <br />
<br />
Creating a divide so parents are poised to perceive information as judgment is a <a href="https://www.facebook.com/analyticalarmadillo/posts/did-you-fall-for-the-marketed-mummy-wars-since-1968-the-effie-awards-have-honore/1152918458077902/" target="_blank">crucial part of the picture</a> in terms of restricting what parents share and who they reach out to.<br />
<br />
Being seen to be supportive of breastfeeding, whilst also people pleasing can be a delicate line to tread - perhaps this is why so many media outlets are so keen to stick to what they know? The Bruce Forsyth of breastfeeding.Analytical Armadillo IBCLChttp://www.blogger.com/profile/03829027807809292649noreply@blogger.com0tag:blogger.com,1999:blog-3102141287849407838.post-77639248260867641802018-09-06T19:02:00.000+01:002018-09-06T19:02:20.487+01:00Leah from Leeds, Dying to be Perfect<blockquote class="tr_bq">
<span style="font-family: "verdana" , sans-serif;">"<b>When women are reduced to their physical appearances, all the things that make them beautiful on the inside, like kindness and intelligence, come to seem less important</b>. <b>They waste time and energy perfecting their appearances that could be spent developing their careers, bonding with their loved ones, and making the world a better place.</b>"</span></blockquote>
<span style="font-family: "verdana" , sans-serif;">Last week I <a href="https://www.independent.co.uk/news/uk/home-news/cosmetic-surgery-death-turkey-bum-lift-towie-british-woman-dies-butt-lift-leah-cambridge-a8512186.html" target="_blank">heard the devastating news</a> a local mum had tragically died undergoing Brazilian Butt Lift (BBL) surgery in Turkey. </span><span style="font-family: "verdana" , sans-serif;">Leah Cambridge felt body-conscious after having three smalls and the foreign clinic </span><span style="font-family: "verdana" , sans-serif;">seemingly offered an attractive alternative to the the UK. </span><br />
<span style="font-family: "verdana" , sans-serif;"><br /></span>
<span style="font-family: "verdana" , sans-serif;">The BBL procedure takes fat from elsewhere (such as your stomach, via liposuction), before it is re-injected into your butt. Whilst the procedure seems to be marketed as safer than implants or fillers, there's still a risk </span><a href="https://www.cosmeticsurg.net/blog/2017/12/19/brazilian-butt-lift-risks-pulmonary-fat-embolism/" style="font-family: verdana, sans-serif;">of the injected product ending up somewhere it shouldn't</a><span style="font-family: "verdana" , sans-serif;"> - for example your heart or lungs:</span><br />
<div>
<div>
<blockquote class="tr_bq">
<span style="font-family: "verdana" , sans-serif;">“If somebody injects fat into the wrong place and goes deep into the muscle, then the chances of the patient getting muscle necrosis – muscle death – and fat going into the vascular system (which you can die from) are increased."</span></blockquote>
<span style="font-family: "verdana" , sans-serif;">The Plastic Surgery Group in London reports that, during the second half of 2016, they saw a staggering <b>500 PER CENT</b> increase in consultations for the BBL. </span><br />
<span style="font-family: "verdana" , sans-serif;"><br /></span>
<span style="font-family: "verdana" , sans-serif;">The cosmetic surgery and procedure market size was valued at over <b>$26.3 US billion</b> in 2016 and is expected to reach <b>$43.9 US billion</b> by 2025, according to a new report by Grand View Research, Inc.</span><br />
<span style="font-family: "verdana" , sans-serif;"><br /></span>
<span style="font-family: "verdana" , sans-serif;">The photographs and <a href="https://www.facebook.com/100000554622441/posts/2288597044502094/" target="_blank">clips published of Leah</a>, show a young (29), vibrant, beautiful, engaging mother with an already model-like figure and a contagious laugh. </span><span style="font-family: "verdana" , sans-serif;">We learn about her long-term relationship with a man she planned to marry, how they were building a business and a future as a family. In the blink of an eye her family are now planning a funeral and three children are left without a mother.</span><br />
<span style="font-family: "verdana" , sans-serif;"><br /></span>
<span style="font-family: "verdana" , sans-serif;">The </span><span style="font-family: "verdana" , sans-serif;">news coverage highlighted how other young, glamorous celebrities have also used the clinic - leaving many asking why.</span><br />
<b><span style="font-family: "verdana" , sans-serif;"><br /></span></b>
<b><span style="font-family: "verdana" , sans-serif;">Why are so many young women who seemingly have it all, tempted to risk going under the knife for the perfect butt, boobs or nose?</span></b></div>
<blockquote class="tr_bq">
<span style="font-family: "verdana" , sans-serif;">"The substantial increase in the volume of cosmetic procedures <a href="https://www.businesswire.com/news/home/20170821005426/en/Global-Cosmetic-Surgery-Procedure-Market-Analysis-2014-2025" target="_blank">can be attributed to</a> the popularity of digital photography, <b>rising demand by consumers to boost self-esteem, </b>introduction of self-monitoring apps, and increasing affordability of cosmetic surgeries in developing countries."</span></blockquote>
<span style="font-family: "verdana" , sans-serif;">Dr Jack Duckett Senior Consumer Lifestyles Analyst at <a href="http://www.mintel.com/">Mintel</a> studies surgery trends in the UK:</span><br />
<blockquote class="tr_bq">
<span style="font-family: "verdana" , sans-serif;">“Our research shows that women are much more likely to be unhappy with areas of their appearance than men, <b>reflecting the high level of pressure many women feel to look a certain way</b>” says Jack.</span><br />
<span style="font-family: "verdana" , sans-serif;">“Much of this pressure comes from the advertising industry, with the continued emphasis on photoshopped models promoting unachievable aesthetic goals. But there can be no doubt that social media is also playing an important role in exacerbating many women’s self-image doubts.”</span></blockquote>
<span style="font-family: "verdana" , sans-serif;">A recurrent theme reading around the topic is </span><span style="font-family: "verdana" , sans-serif;">pressure to look a certain way, objectification (treating a person as an object or thing) and sexualisation (</span><span style="font-family: verdana, sans-serif;">when a person's value comes only from her or his sexual appeal or behaviour, to the exclusion of other characteristics,</span><b style="font-family: verdana, sans-serif;"> </b><span style="font-family: "verdana" , sans-serif;">and when a person is portrayed purely as a sex object)</span><span style="font-family: "verdana" , sans-serif;"> result in </span><span style="font-family: "verdana" , sans-serif;">low self-esteem. </span><br />
<span style="font-family: "verdana" , sans-serif;"><br /></span>
<span style="font-family: "verdana" , sans-serif;">Advertising, "Photoshopping" and now social media - w</span><span style="font-family: verdana, sans-serif;">hether you have a girl, boy, nieces, cousins, sisters - we all need to be aware of what's happening around us.</span></div>
<div>
<br />
<span style="font-family: "verdana" , sans-serif;"><span style="font-size: large;">Reports show a trend for these pressures to now start at a disturbingly young age</span>.</span><br />
<span style="font-family: "verdana" , sans-serif;"><br /></span>
<span style="font-family: "verdana" , sans-serif;">In 2010 the Home Secretary</span><span style="font-family: "verdana" , sans-serif;"> </span><a href="http://webarchive.nationalarchives.gov.uk/+/http:/www.homeoffice.gov.uk/documents/sexualisation-of-young-people.pdf" style="font-family: Verdana, sans-serif;" target="_blank">commissioned an independent report</a><span style="font-family: "verdana" , sans-serif;">:</span><br />
<blockquote class="tr_bq">
<span style="font-family: "verdana" , sans-serif;">“How have sex, sexiness and sexualisation gained such favour in recent years <b>as to be the measure by which women’s and girls’ worth is judged</b>?</span></blockquote>
<blockquote class="tr_bq">
<span style="font-family: "verdana" , sans-serif;">While it is not a new phenomenon by any means, there is something different about the way it occurs today and how <b>it impacts on younger and younger girls</b>.”</span></blockquote>
<blockquote class="tr_bq">
<b style="font-family: Verdana, sans-serif;">The evidence collected in this report suggests these developments are having a profound impact, particularly on girls and young women.</b><span style="font-family: "verdana" , sans-serif;">" </span></blockquote>
<blockquote class="tr_bq">
<span style="font-family: "verdana" , sans-serif;">As children grow older, exposure to this imagery leads to body surveillance, or the constant monitoring of personal appearance. <b>This monitoring can result in body dissatisfaction, a recognised risk factor for poor self-esteem</b>, depression and eating disorders.6 </span></blockquote>
<blockquote class="tr_bq">
<span style="font-family: "verdana" , sans-serif;">Indeed, <b>there is a significant amount of evidence</b> that attests to the negative effects of sexualisation on young people in terms of mental and physical health, attitudes and beliefs.7"</span></blockquote>
<iframe allowfullscreen="" class="YOUTUBE-iframe-video" data-thumbnail-src="https://i.ytimg.com/vi/_WjLG4c5sD8/0.jpg" frameborder="0" height="266" src="https://www.youtube.com/embed/_WjLG4c5sD8?feature=player_embedded" style="clear: left; float: left;" width="320"></iframe><br />
<div>
<span style="font-family: "verdana" , sans-serif;">If you haven't seen it - this presentation from a high school student is a good introduction to sexualisation many may not even be aware of.</span><br />
<span style="font-family: "verdana" , sans-serif;"><br /></span>
<span style="font-family: "verdana" , sans-serif;"><span style="font-family: "verdana" , sans-serif;">The early sexualisation of girls has become such a concern, in 2014 a task force from the American Psychological Association (ASA) was established to </span><a href="http://news.bbc.co.uk/1/hi/health/6376421.stm" style="font-family: Verdana, sans-serif;" target="_blank">examine its effects</a>:</span><br />
<blockquote class="tr_bq">
<span style="font-family: "verdana" , sans-serif;">"<b>Sexualisation can lead to a lack of confidence with their bodies </b>as well as depression and eating disorders.".</span></blockquote>
<br />
<span style="font-family: "verdana" , sans-serif;">At the United Nations CSW58 in 2014, Dr. Shari Miles- Cohen from the American Psychological Association (APA) explained:</span><br />
<blockquote class="tr_bq">
<span style="font-family: "verdana" , sans-serif;">"<b>the inappropriate portrayal of women and girls in the media is not only negatively affecting women, but is also contributing to the misperception many men have about the female gender</b>."</span></blockquote>
</div>
<div>
<span style="font-family: verdana, sans-serif;">Outside of TV, music videos and advertising - even in toddlerhood clothes for girls are cut smaller and shorter. By the time they reach tweenhood, getting a pair of shorts that covers their butt seems a challenge in itself, particularly if they're above average height. If you succeed with that, finding a top that isn't cropped, cold shoulder or so tight it makes anything active uncomfortable becomes your next challenge. My daughter frequently bought jeans and shorts designed for boys, because they were so much comfier and designed for movement. And, they had pockets! </span></div>
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<span style="font-family: "verdana" , sans-serif;"><br /></span></div>
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<span style="font-family: "verdana" , sans-serif;">Last year <span style="background-color: white;"><span style="color: #111111; font-family: "indy" serif , serif;"><a href="https://www.independent.co.uk/news/business/news/clarks-shoes-sexism-dolly-babe-girls-leader-boys-gender-identity-a7892441.html" target="_blank">Clarks shoes sparked a sexism row </a>after naming a girls' shoe range "Dolly Babe" while the boys’ equivalent was called "Leader". The tough, robust boys' shoes made for action! The girls' range often can't withstand even a puddle due to the low cut fronts and flimsy soles.</span></span></span></div>
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<span style="font-family: "verdana" , sans-serif;"><span style="background-color: white;"><span style="color: #111111; font-family: "indy" serif , serif;"></span></span><br /><span style="background-color: white;"><span style="color: #111111; font-family: "indy" serif , serif;"></span></span></span></div>
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<tr><td style="text-align: center;"><a href="https://scontent-lhr3-1.xx.fbcdn.net/v/t1.0-9/12734123_645301225610447_976345801088367752_n.jpg?_nc_cat=0&oh=889f6d95bb71a33d2d610b528f70806d&oe=5C299D63" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="560" data-original-width="800" height="224" src="https://scontent-lhr3-1.xx.fbcdn.net/v/t1.0-9/12734123_645301225610447_976345801088367752_n.jpg?_nc_cat=0&oh=889f6d95bb71a33d2d610b528f70806d&oe=5C299D63" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">"Let Clothes be Clothes" highlights the problem</td></tr>
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<span style="background-color: white;"><span style="color: #111111; font-family: "indy" serif , serif;"><span style="font-family: "verdana" , sans-serif;">Merchandise for boys tells them to be adventurous, a muck magnet, brave, a leader, think big.</span></span></span><br />
<span style="background-color: white;"><span style="color: #111111; font-family: "indy" serif , serif;"><span style="font-family: "verdana" , sans-serif;"><br /></span></span></span>
<span style="background-color: white;"><span style="color: #111111; font-family: "indy" serif , serif;"><span style="font-family: "verdana" , sans-serif;">Hit the girls' aisle and the pink will knock you over. Flowers, sparkles and sprinkles with little call to think big. Leader becomes "bossy" and terms focussing on appearance - beautiful, perfect, pretty etc are in abundance. Even if these slogans are not emblazoned on the front - the fabric, cut, colour and style fill in the gaps. </span></span></span></div>
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<span style="background-color: white;"><span style="color: #111111; font-family: "indy" serif , serif;"><span style="font-family: "verdana" , sans-serif;"><br /></span></span></span></div>
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<span style="background-color: white;"><span style="color: #111111; font-family: "indy" serif , serif;"><span style="font-family: "verdana" , sans-serif;">"Princess Pamper Parties" for girls as young as three can now be booked for birthdays - an age where there is SO much more fun to be had than what your face looks like.</span></span></span><br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://3.bp.blogspot.com/-9CIzi3ndomI/W46Q_ggWjuI/AAAAAAAAClM/JOSPx4mqEe4KwdPonQIJtcllVF1Bt0mVwCLcBGAs/s1600/2018-09-04.png" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><span style="font-family: "verdana" , sans-serif;"><img border="0" data-original-height="405" data-original-width="271" height="200" src="https://3.bp.blogspot.com/-9CIzi3ndomI/W46Q_ggWjuI/AAAAAAAAClM/JOSPx4mqEe4KwdPonQIJtcllVF1Bt0mVwCLcBGAs/s200/2018-09-04.png" width="133" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: "verdana" , sans-serif; font-size: small;">Old Snow White</span></td></tr>
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://1.bp.blogspot.com/-iboQ8KyuuPc/W46StW04kDI/AAAAAAAAClc/9nqKoNUjvtIYV8FLZu7w8CB_ePeRVADuACLcBGAs/s1600/Snow_White.png" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><span style="font-family: "verdana" , sans-serif;"><img border="0" data-original-height="1200" data-original-width="852" height="200" src="https://1.bp.blogspot.com/-iboQ8KyuuPc/W46StW04kDI/AAAAAAAAClc/9nqKoNUjvtIYV8FLZu7w8CB_ePeRVADuACLcBGAs/s200/Snow_White.png" width="140" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: "verdana" , sans-serif; font-size: small;">Snow White 2018</span></td></tr>
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<span style="font-family: "verdana" , sans-serif;"><span style="background-color: white;"><span style="color: #111111; font-family: "indy" serif , serif;"><br /></span></span>
<span style="background-color: white;"><span style="color: #111111; font-family: "indy" serif , serif;"><a href="https://www.thesun.co.uk/fabulous/6655857/primark-disney-princess-eyelashes-cinderella-ariel/" target="_blank">Disney market "princess" fake eyelashes</a> and alongside the fact most princesses are saved by their beauty, they've consistently made their princesses </span></span><span style="background-color: white; color: #111111;">thinner and more provocative.</span></span><br />
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<span style="font-family: "verdana" , sans-serif;">Worryingly "A study published in 2012 by psychologists in America found that <b>girls as young as six were beginning to think of themselves in sexual terms</b>. They were offered two paper dolls, one dressed in sexy, revealing gear, one in trendy, loose-fitting clothes. Asked which one they wanted to look like or thought would be popular, overwhelmingly </span><a href="https://www.telegraph.co.uk/women/mother-tongue/11051917/Curse-of-the-sexy-Disney-princesses.html" style="font-family: Verdana, sans-serif;" target="_blank">they chose the “sexy” doll</a><span style="font-family: "verdana" , sans-serif;"><span style="color: #111111; font-family: "indy" serif , serif;"><span style="font-size: 19px;"><span style="background-color: white; color: #282828;">."</span></span></span></span><br />
<span style="font-family: "verdana" , sans-serif;"><span style="background-color: white;"><span style="color: #111111; font-family: "indy" serif , serif;"><span style="color: #282828;"><br /></span></span></span>
<span style="color: #111111;"><span style="background-color: white;">The same messages are echoed via toys - as the campaign "<a href="https://www.facebook.com/lettoysbetoys/" target="_blank">Let toys be toys</a>" highlights. Science, mechanical, engineering, space are all typically marketed at boys. </span></span></span><br />
<span style="color: #111111;"><span style="background-color: white; font-family: "verdana" , sans-serif;"><br /></span></span>
<span style="color: #111111;"><span style="background-color: white; font-family: "verdana" , sans-serif;">Historically toys (and often clothes) were suitable for anyone, as this advert from the 1970 shows:</span></span><br />
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<a href="https://2.bp.blogspot.com/-ZnUexLpP4YI/W46TvguaAcI/AAAAAAAAClk/Nr9WKpYHlYoVpFhZaiVVfktCMUjfGYtyACLcBGAs/s1600/lego.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: "verdana" , sans-serif;"><img border="0" data-original-height="370" data-original-width="560" height="420" src="https://2.bp.blogspot.com/-ZnUexLpP4YI/W46TvguaAcI/AAAAAAAAClk/Nr9WKpYHlYoVpFhZaiVVfktCMUjfGYtyACLcBGAs/s640/lego.png" width="640" /></span></a></div>
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<tr><td style="text-align: center;"><a href="https://3.bp.blogspot.com/-Ti-XctJI57I/W46UNQ-WyWI/AAAAAAAAClw/x_FxhKM8_MsVVez3mU5C-x8_TyL052nrQCLcBGAs/s1600/lego2.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><span style="font-family: "verdana" , sans-serif;"><img border="0" data-original-height="371" data-original-width="624" height="118" src="https://3.bp.blogspot.com/-Ti-XctJI57I/W46UNQ-WyWI/AAAAAAAAClw/x_FxhKM8_MsVVez3mU5C-x8_TyL052nrQCLcBGAs/s200/lego2.jpg" width="200" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: "verdana" , sans-serif;">Modern Lego advert</span></td></tr>
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<span style="color: #111111;"><span style="background-color: white; font-family: "verdana" , sans-serif;">Just like rinse and repeat doubled the sale of shampoo, gender specific doubles the same of clothes and toys in many households.</span></span><br />
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://1.bp.blogspot.com/-pgVh4VPLWDA/W40q5zrQVgI/AAAAAAAACk8/_yEetnkoBLsZUqaAKHQdzmgnwywa6qQqACLcBGAs/s1600/primark-lashes-3.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="591" data-original-width="594" height="198" src="https://1.bp.blogspot.com/-pgVh4VPLWDA/W40q5zrQVgI/AAAAAAAACk8/_yEetnkoBLsZUqaAKHQdzmgnwywa6qQqACLcBGAs/s200/primark-lashes-3.jpg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Disney Princess "Eyelashes"</td></tr>
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<span style="color: #111111;"><span style="background-color: white; font-family: "verdana" , sans-serif;">I decided to search toys for boys and toys for girls on Amazon via Google.</span></span><br />
<span style="font-family: "verdana" , sans-serif;"><span style="color: #111111;"><span style="background-color: white; font-size: 19px;"></span></span></span><br />
<span style="font-family: "verdana" , sans-serif;"><span style="color: #111111;"><span style="background-color: white; font-size: 19px;"></span></span></span>
<span style="color: #111111;"><span style="background-color: white; font-family: "verdana" , sans-serif;">Here are the search results (in order displayed)</span></span><span style="color: #111111;"><span style="background-color: white; font-family: "verdana" , sans-serif;">
</span></span><br />
<span style="color: #111111;"><span style="background-color: white; font-family: "verdana" , sans-serif;"><br /></span></span>
<span style="color: #111111;"><span style="background-color: white; font-family: "verdana" , sans-serif;">Toys for girls:</span></span><br />
<ul>
<li><span style="font-family: "verdana" , sans-serif;">Toy Electronic Washer</span></li>
<li><span style="font-family: "verdana" , sans-serif;">Learning Resources Pretend & Play School Set</span></li>
<li><span style="font-family: "verdana" , sans-serif;">John Adams Chocolate Lolly Maker</span></li>
<li><span style="font-family: "verdana" , sans-serif;">Toy Ironing Set</span></li>
<li><span style="font-family: "verdana" , sans-serif;">Learning Resources Time Tracker 2.0</span></li>
<li><span style="font-family: "verdana" , sans-serif;">Wooden Kitchen Accessory Set</span></li>
<li><span style="font-family: "verdana" , sans-serif;">Secret Safe Diary</span></li>
<li><span style="font-family: "verdana" , sans-serif;">Pretend & Play Doctors Set - Multi-Coloured</span></li>
<li><span style="font-family: "verdana" , sans-serif;">Standing Art Easel - Dry-Erase Board, Chalkboard, Paper Roller</span></li>
<li><span style="font-family: "verdana" , sans-serif;">Pink Vintage Play Kitchen. Wooden vintage style kids play kitchen.</span></li>
</ul>
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<span style="font-family: "verdana" , sans-serif;">Toys for boys:</span></div>
<span style="font-family: "verdana" , sans-serif;"><a href="https://www.amazon.co.uk/Learning-Resources-Pretend-Original-version/dp/B000E8S8XO/ref=lp_2174085031_1_6?s=kids&ie=UTF8&qid=1535973294&sr=1-6"></a></span></div>
<ul>
<li><span style="font-family: "verdana" , sans-serif;">Face and Body Paint Mini Starter Kit</span></li>
<li><span style="font-family: "verdana" , sans-serif;">Black/Yellow Twin Pack Walkie Talkie With Upto 3 km Range</span></li>
<li><span style="font-family: "verdana" , sans-serif;">Swingball Pro All Surface</span></li>
<li><span style="font-family: "verdana" , sans-serif;">Pizza Party Wooden Play Food Set With 54 Toppings - Multicolour, 266141</span></li>
<li><span style="font-family: "verdana" , sans-serif;">Tool Carrycase</span></li>
<li><span style="font-family: "verdana" , sans-serif;">Snakes and Ladders Ludo Game Set</span></li>
<li><span style="font-family: "verdana" , sans-serif;">Balance Bike - Red</span></li>
<li><span style="font-family: "verdana" , sans-serif;">Articulate for Kids</span></li>
<li><span style="font-family: "verdana" , sans-serif;">3-D Planets in a Tube Glow-in-the-Dark</span></li>
<li><span style="font-family: "verdana" , sans-serif;">Bosch Tool Belt</span></li>
</ul>
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<span style="font-family: "verdana" , sans-serif;">Crafts, learning resources and lots of "homewares" dominate the girls' list, in contrast fun and adventure, games and "tools" dominate the boys'. </span></div>
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<span style="font-family: "verdana" , sans-serif;">Is it coincidence then that girls outperform boys on all 17 learning indicators in the early years? Yet by teenagehood, maths and sciences are male dominated to the extent <b>80% of physics A Level students are male</b>.</span><br />
<span style="font-family: "verdana" , sans-serif;"><br /></span>
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<span style="font-family: "verdana" , sans-serif;">
"<a href="https://www.telegraph.co.uk/education/secondaryeducation/9929672/Why-dont-more-girls-study-physics.html" target="_blank">The boys at Redland Green can explain the imbalance</a>":</span></div>
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<blockquote class="tr_bq">
<span style="font-family: "verdana" , sans-serif;"> “Boys are naturally adapted to be better at maths and space stuff, whereas girls are better at language and communication,” says one. “Which means – logically, according to science – boys should have a natural ability to understand physics a bit better.”</span></blockquote>
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<div>
<div>
<span style="font-family: "verdana" , sans-serif;">Yet the reality in fact is that <a href="https://venturebeat.com/2015/01/27/study-girls-outperform-boys-in-math-and-science-all-over-the-world/" target="_blank">a 2015 study found</a> when girls do study choose to study maths and science, they outperform boys all over the world.</span><br />
<span style="font-family: "verdana" , sans-serif;"><br /></span>
<span style="font-family: "verdana" , sans-serif;">The </span><a href="http://webarchive.nationalarchives.gov.uk/+/http:/www.homeoffice.gov.uk/documents/sexualisation-of-young-people.pdf" style="font-family: Verdana, sans-serif;" target="_blank">2010 report</a><span style="font-family: "verdana" , sans-serif;"> noted this too:</span></div>
<blockquote class="tr_bq">
<span style="font-family: "verdana" , sans-serif;">"Although the original intention of the
review was to focus on how sexualisation
is affecting girls, it quickly became evident
that we could not talk about girls without
acknowledging the concomitant impact
on boys and the hyper-masculinised
images and messages that surround them. "</span></blockquote>
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<span style="font-family: "verdana" , sans-serif; font-size: large;"><a href="https://www.ted.com/talks/reshma_saujani_teach_girls_bravery_not_perfection?language=en" target="_blank">W</a><a href="https://www.ted.com/talks/reshma_saujani_teach_girls_bravery_not_perfection?language=en" target="_blank">e don't teach girls to be brave, we teach them to be perfect.</a></span></div>
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<span style="font-family: "verdana" , sans-serif;"><br /></span></div>
<span style="font-family: "verdana" , sans-serif;">In 2014 <a href="https://youtu.be/lNlKjUfmaUA" target="_blank">a project collected all images of both genders</a> featured in The Sun, and stuck them side by side to compare how men and women are represented in <a href="https://www.huffingtonpost.co.uk/2014/12/01/madonna-topless-photos-interview-magazine-drugs-new-album_n_6249110.html?utm_hp_ref=uk">the paper</a>:</span><br />
<blockquote class="tr_bq">
<span style="font-family: "verdana" , sans-serif;">"The men are nearly all active, doing things. Not posed. <b>The women are passive. It's all about how they look. When I look at the men's side, I see real life. But when I look at the women's side it doesn't seem real.</b> <b>It's all manufactured</b>. </span></blockquote>
<blockquote class="tr_bq">
<span style="font-family: "verdana" , sans-serif;">"This is a newspaper renowned for sport. And there's not a single picture of a woman doing sport... not one. The only older women on there are a woman on a mobility scooter, The Queen and Mrs Brown. <b>There's a range of emotions on the men's side. The women are mainly smiling or pouting.</b>"</span></blockquote>
<span style="font-family: "verdana" , sans-serif;">When women sportspeople <i>are</i> interviewed, they're often faced with questions about their appearance or personal life. I'm sure many of us can remember the interview with </span><span style="font-family: "verdana" , sans-serif;">Serena Williams,</span><span style="font-family: "verdana" , sans-serif;"> when she was asked why she wasn't smiling when she had won! Commenters noted that in previous interviews male winners weren't smiling and yet were asked about their achievement not their face. </span><a href="https://www.cbc.ca/news/trending/serena-williams-interview-smiles-1.3224139" style="font-family: Verdana, sans-serif;" target="_blank">Yet this isn't an isolated example</a><span style="font-family: "verdana" , sans-serif;">.</span><br />
<blockquote class="tr_bq">
<span style="font-family: "verdana" , sans-serif;">"Serena Williams has often been called an “ape” and “gorilla” across the dark caverns of social media; her body has been described in language not unlike the kind you’d find in old timey slave auction advertisements or <a href="https://en.wikipedia.org/wiki/Saartjie_Baartman">Old English freak show exhibits</a>.</span> </blockquote>
<blockquote class="tr_bq">
<span style="font-family: "verdana" , sans-serif;">In 2014, a high-ranking Russian tennis official snarkily referred to Serena and her sister Venus as “<a href="http://thinkprogress.org/sports/2014/10/20/3581934/womens-tennis-association-suspends-russian-official-for-calling-venus-and-serena-williams-brothers/">the Williams brothers</a>”.</span> </blockquote>
<blockquote class="tr_bq">
<span style="font-family: "verdana" , sans-serif;">In 2012, Williams’ fellow competitor Caroline Wozniacki <a href="http://www.nydailynews.com/sports/more-sports/wozniacki-impersonates-serena-article-1.1217680">stuffed her top and skirt</a>, doing her best Serena imitation by mocking her shapeliness.</span> </blockquote>
<blockquote class="tr_bq">
<span style="font-family: "verdana" , sans-serif;">As far back as 2009, a sports columnist <a href="http://web.archive.org/web/20090709162516/http://msn.foxsports.com/tennis/story/9757816/Serena-could-be-the-best-ever,-but-">wrote a scathing editorial</a> about Williams’ body, likening her derriere to food and complaining that she wasn’t attractive enough to him because of her size.</span> </blockquote>
<blockquote class="tr_bq">
<span style="font-family: "verdana" , sans-serif;">Her latest Wimbledon win <a href="https://twitter.com/jk_rowling/status/619886370081869824">was</a> <a href="http://www.huffingtonpost.com/entry/serena-williams-policing-of-black-bodies_55a3bef4e4b0a47ac15ccc00">no</a> <a href="http://mic.com/articles/122186/serena-williams-just-won-her-21st-major-so-why-are-we-still-talking-about-her-body">different</a>." <a href="https://www.theguardian.com/commentisfree/2015/jul/14/serena-williams-female-athletes-femininity-police" target="_blank">here</a></span></blockquote>
<span style="font-family: "verdana" , sans-serif;">And it's not just Serena, as <a href="http://www.sportbible.com/other/news-this-guy-probably-regrets-body-shaming-these-olympic-gymnasts-20160824" target="_blank">these Olympic gymnasts</a> can testify.</span></div>
<div>
<span style="font-family: "verdana" , sans-serif;"><br /></span>
<span style="font-family: "verdana" , sans-serif;">We're asked if we're "bikini ready", our bodies are constantly </span><br />
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<span style="font-family: "verdana" , sans-serif;"><a href="https://2.bp.blogspot.com/-UxrfxlHuSYE/W5EPx1jDRbI/AAAAAAAACl8/oWhktzqJOIczJkaJtahWoGHXDejQP0AAACLcBGAs/s1600/southern-comfort-hero-700x539.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="924" data-original-width="532" height="320" src="https://2.bp.blogspot.com/-UxrfxlHuSYE/W5EPx1jDRbI/AAAAAAAACl8/oWhktzqJOIczJkaJtahWoGHXDejQP0AAACLcBGAs/s320/southern-comfort-hero-700x539.jpg" width="184" /></a></span></div>
<span style="font-family: "verdana" , sans-serif;">judged and shamed - too fat, too thin, boobs too big, boobs too small, boobs too saggy, makeup too much, not enough makeup, making too much effort, not making an effort. Clothes too tight, too revealing, not revealing enough.</span><br />
<span style="font-family: "verdana" , sans-serif;"><br /></span>
<span style="font-family: "verdana" , sans-serif;">Women are so conditioned to only think skin deep, they're often just as critical and cutting about how others look. Body shapes go in and out of fashion like hemlines and w</span><span style="font-family: "verdana" , sans-serif;">omen are told to </span><a href="https://www.mnn.com/lifestyle/arts-culture/blogs/why-men-tell-women-smile" style="font-family: Verdana, sans-serif;" target="_blank">cheer up and smile</a><span style="font-family: "verdana" , sans-serif;"> by random strangers!</span><br />
<span style="font-family: "verdana" , sans-serif;"><br /></span>
<span style="font-family: Verdana, sans-serif;">Society consistently and persistently delivers the message that our worth is measured by our appearance. It reinforces the message you aren't enough if your boobs are too small or your leggings show off your "love handles".</span></div>
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<span style="font-family: Verdana, sans-serif;"><br /></span></div>
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<span style="font-family: Verdana, sans-serif;">Being caring, thoughtful, generous, kind or being an amazing mother - aren't revered by the media in the way your hair, makeup, shape or "on trend" outfit is; yet L</span><span style="font-family: verdana, sans-serif;">eah's children wont remember how taut or toned their mother was - they'll long for her warm embrace, her love, laughter and as they grow her wisdom.</span><span style="font-family: "verdana" , sans-serif;"><br /></span>
<span style="font-family: "verdana" , sans-serif;">The one sexist clothing range, heavily gendered toy or debate about "wolf-whistling" alone may seem an insignificant "snowflake" moan. </span><span style="font-family: "verdana" , sans-serif;">The problem though is that when enough snow falls at once, you can quickly find yourself facing a blizzard and stuck in a drift.</span></div>
Analytical Armadillo IBCLChttp://www.blogger.com/profile/03829027807809292649noreply@blogger.com0tag:blogger.com,1999:blog-3102141287849407838.post-32950451230496851672018-07-30T19:18:00.001+01:002018-07-30T19:18:16.266+01:00Breastfeeding, 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?<br />
<br />
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.<br />
<br />
<a href="https://www.facebook.com/analyticalarmadillo/videos/831094806926937/" target="_blank">As I highlighted in 2015</a>, parents are being failed on a spectacular scale. <br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
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We can then throw in the "Mummy Wars", <a href="https://www.facebook.com/analyticalarmadillo/posts/did-you-fall-for-the/1152918458077902/" target="_blank">a concept created and marketed to mothers by formula companies</a>. 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.<br />
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Nowadays someone ALWAYS brings guilt to the table and I tweeted my thoughts this week:<br />
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We also have formula companies pushing the "breast is best" message,<a href="http://www.analyticalarmadillo.co.uk/2010/07/breast-isnt-best.html" target="_blank"> a recognised marketing technique to induce sales</a>. As a result academics, highly respected scientists and doctors - talk about the "benefits" of a mammal consuming same species milk. <br />
<br />
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".<br />
<br />
If we hold breastfeeding as the norm against which we compare the outcome of alternatives, we would find ourselves exploring risks. <a href="https://www.researchgate.net/publication/230673320_'Voldemort'_and_health_professional_knowledge_of_risks_of_not_breastfeeding_Poster_presentation" target="_blank">Far more beneficial to medicine and science</a> as a whole, but far less desirable when it comes to formula sales.<br />
<br />
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:<br />
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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.<br />
<br />
<a href="https://www.amazon.co.uk/Why-Breastfeeding-Matters-Pinter-Martin/dp/1780665202/ref=as_li_ss_il?ie=UTF8&linkCode=li2&tag=iwantmymum-21&linkId=e7fde44932d3b19b71a058d073f80beb&language=en_GB" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;" target="_blank"><img border="0" src="//ws-eu.amazon-adsystem.com/widgets/q?_encoding=UTF8&ASIN=1780665202&Format=_SL160_&ID=AsinImage&MarketPlace=GB&ServiceVersion=20070822&WS=1&tag=iwantmymum-21&language=en_GB" /></a><a href="https://amzn.to/2vksmdZ" target="_blank">Yet mothers, grandmothers, sisters, aunts tell us it does</a>. 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.<br />
<br />
We have <a href="http://www.babymilkaction.org/archives/8851" target="_blank">Baby Milk Action reporting as doctors like Ellie Cannon joined the Nestle payroll</a>. Turning next to the Daily Mail this week to tell people <a href="https://donotlink.it/g1RN" target="_blank">breast isn't best so </a><a href="https://donotlink.it/g1RN" target="_blank">"stop bashing" bottle feeders</a>.<br />
<br />
Cannon writes:<br />
<blockquote class="tr_bq">
"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."</blockquote>
There are so many problems with this comment.<br />
<br />
First, where is this statistic even pulled from? There isn't a citation.<br />
<br />
<a href="https://www.medicalnewstoday.com/articles/318788.php" target="_blank">A 2017 review states:</a><br />
<blockquote class="tr_bq">
"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.</blockquote>
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.<br />
<br />
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?<br />
<br />
Third, shouldn't patients get to decide whether they feel it's enough of a risk to "be a worry"? Don't they deserve <b>unbiased</b> advice?<br />
<br />
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.<br />
<br />
The Daily Mail also tells us in a separate article that "<a href="https://donotlink.it/9Yyp" target="_blank">2/3rds of people think breastmilk and formula are "no different" anyway</a>. Despite science telling us otherwise, the general public aren't convinced! Well I can't think why, can you Dr Cannon?<br />
<br />
Perhaps we shouldn't be surprised given this week, <a href="https://www.theguardian.com/commentisfree/2018/jul/21/breast-milk-lifelong-health-benefits" target="_blank">UC Davis professor and researcher Dr Bruce German told us</a>:<blockquote class="tr_bq">
"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.”</blockquote>
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.<br />
<b><br /></b>
<b><span style="font-size: large;">Breastfeeding is competing with a multi-billion pound industry and it's a battle we're clearly not winning.</span></b><br />
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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.<br />
<br />
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.Analytical Armadillo IBCLChttp://www.blogger.com/profile/03829027807809292649noreply@blogger.com0tag:blogger.com,1999:blog-3102141287849407838.post-35662438319645461832018-07-10T15:56:00.000+01:002018-07-10T15:56:13.005+01:00Do Babies Who Eat Solids Before 6 Months Sleep "Better"?<b>Better for whom?</b><br />
<b><br /></b>
The media had fun this week <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2686726" target="_blank">with a study</a> that told us:<div>
<blockquote class="tr_bq">
"The early introduction of solids resulted in small but significant <b>improvements</b> in infant sleep characteristics."</blockquote>
Not "<i>changes"</i> to infant sleep, but "<i>improvements"</i>. A "making better" of. <br />
<br />
Or in this case, a change reported as an improvement because of author bias that longer = better.<br />
<br />
<a href="https://1.bp.blogspot.com/-JAVrZj3UZps/W0TGARTAdtI/AAAAAAAACjg/KOI6TwZQYLYBW2E4urpshI-y3SQYNzqRgCLcBGAs/s1600/36268045_462277887518461_2683690356192575488_n.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="915" data-original-width="523" height="320" src="https://1.bp.blogspot.com/-JAVrZj3UZps/W0TGARTAdtI/AAAAAAAACjg/KOI6TwZQYLYBW2E4urpshI-y3SQYNzqRgCLcBGAs/s320/36268045_462277887518461_2683690356192575488_n.jpg" width="182" /></a>Human infants rouse and signal frequently when close to their caregivers. As I <a href="https://amzn.to/2ukKQdL" target="_blank">cover in my book</a>, 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. <br />
<br />
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".<br />
<br />
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. <br />
<br />
Whether it's comfort blankets (although nowadays we prefer to call them "transitional objects") <a href="https://sarahockwell-smith.com/sarah-recommends/" target="_blank">to "condition" a baby</a> 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.<br />
<br />
In biological terms if we explore animals generally, the more mammals "signal" - <a href="http://www.analyticalarmadillo.co.uk/2012/01/non-breastfed-babies-are-happier-news.html" target="_blank">the healthier they and their relationship with their caregivers is considered to be</a>. As with anything, when we intervene to shift away from the biological norm- we have the potential for both risks and benefits.<br />
<br />
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 <a href="https://www.isisonline.org.uk/how_babies_sleep/sleep_training/considerations/" target="_blank">is the best protection infants under 6 months have</a>. We know for example some studies find non-breastfed infants <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1755888/" target="_blank">are less rousable</a>, whilst others also link not breastfeeding an <a href="http://www.analyticalarmadillo.co.uk/2010/08/breastfeeding-sids-guilt-at-what-cost.html" target="_blank">increased risk of SIDS</a>, when compared to those who are mix-fed or exclusively breastfed. <br />
<br />
<b>What impact does introducing solids and reducing arousal ability further, have on SIDS? </b><br />
<br />
It would seem prudent to ask given the authors note:<br />
<blockquote class="tr_bq">
"Following the early introduction of solids, infants in the EIG slept significantly longer and woke significantly less frequently than infants in the SIG."</blockquote>
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? <br />
<br />
They didn't explore that either.<br />
<br />
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. <br />
<br />
As was highlighted on <a href="https://twitter.com/An_armadillo" target="_blank">Twitter</a>, 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.<br />
<br />
What also isn't clear from reading the media coverage is the data is from "parental questionnaires". <br />
<br />
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!<br />
<br />
Seriously? <a href="https://www.sciencedirect.com/science/article/pii/S1389945718303204" target="_blank">Researchers have already established that this isn't a reliable method of </a><a href="https://www.sciencedirect.com/science/article/pii/S1389945718303204" target="_blank">data collection.</a><br />
<br />
Although the study authors don't acknowledge this, they do comment:<br />
<blockquote class="tr_bq">
"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."</blockquote>
Ya think?<br />
<br />
Given we have <a href="https://bmjopen.bmj.com/content/2/1/e000298" target="_blank">numerous</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/23201835" target="_blank">studies</a> highlighting babies can and do reach for food and start eating when ready and that <a href="http://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding" target="_blank">there are risks before this time</a>, why are researchers even going there with sleep?<br />
<br />
A quick glance and no conflict of interest is disclosed. So I dug a little deeper:<br />
<br />
First - you'll recognise the names from the EAT study:<br />
<br />
<b>Professor Gideon Lack</b> <a href="https://www.blogger.com/Personal%20remuneration:%20Lecture%20(SHS%20Nutricia)" target="_blank">states on his bio</a> that he receives "Personal remuneration: Lectures (SHS Nutricia, Nestle, SHS International)"<br />
<br />
<b>Dr Michael Perkin</b> <a href="https://www.blogger.com/Personal%20remuneration:%20Lecture%20(SHS%20Nutricia)" target="_blank">says he receives</a> "Personal remuneration: Lecture (SHS Nutricia)"</div>
<div>
<br /></div>
<div>
<b>Next I checked out the author associations:</b></div>
<div>
"The Population Health Research Institute, St George's, University of London, London, England."</div>
<div>
<br /></div>
<div>
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 <a href="https://wellcome.ac.uk/sites/default/files/wellcome-trust-annual-report-and-financial-statements-2017.pdf" target="_blank">financial statement shows they own profitable shares in Nestle</a>...</div>
<div>
<br />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?</div>
Analytical Armadillo IBCLChttp://www.blogger.com/profile/03829027807809292649noreply@blogger.com1tag:blogger.com,1999:blog-3102141287849407838.post-44586068672918800892018-07-09T18:20:00.002+01:002018-07-09T18:44:09.082+01:00Aptamil Formula Changes - Comparison Vitamins/MineralsSince the changes to Aptamil first milk recently, I've received lots of enquiries as to whether I know what the nutritional changes are.<br />
<br />
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.<br />
<br />
First up - <b>they've adjusted the Whey/Casein balance</b>. Previously it was 60/40 to mimic breastmilk, now it has shifted to 50/50. This may be why some babies are finding it <a href="http://americanpregnancy.org/first-year-of-life/whats-in-breastmilk/" target="_blank">harder to digest</a>.<br />
<br />
They've shifted some of the levels around, but the other big difference seems to be the addition of <a href="http://pediatrics.aappublications.org/content/126/4/e946" target="_blank">neucleotides</a>.<br />
<br />
A 2010 <a href="http://pediatrics.aappublications.org/content/126/4/e946" target="_blank">randomised control trial</a> concluded:<br />
<blockquote class="tr_bq">
"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."</blockquote>
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"?<br />
<br />
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?<br />
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<h2>
<a href="https://drive.google.com/file/d/1CwoGZfIKiDM8XRSXZIa7XQ2fsqn0SblP/view?usp=sharing" target="_blank">Click here for the PDF</a></h2>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://1.bp.blogspot.com/-_chlrMzbUdg/W0OZMl8GXSI/AAAAAAAACjE/002Cu4EBHQI9FVsWA78cYp6_-T1lFe4YgCLcBGAs/s1600/AptamilOcado.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="640" data-original-width="640" height="320" src="https://1.bp.blogspot.com/-_chlrMzbUdg/W0OZMl8GXSI/AAAAAAAACjE/002Cu4EBHQI9FVsWA78cYp6_-T1lFe4YgCLcBGAs/s320/AptamilOcado.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Image: Ocado Website</td></tr>
</tbody></table>
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Analytical Armadillo IBCLChttp://www.blogger.com/profile/03829027807809292649noreply@blogger.com0tag:blogger.com,1999:blog-3102141287849407838.post-13438236596583090582018-06-13T23:02:00.002+01:002018-06-13T23:02:44.884+01:00Clickbait Headlines as the Media Fails Mothers (again)It's been a clickbait fest over the last 48 since the Royal College of Midwives (RCM) launched this <a href="https://www.rcm.org.uk/news-views-and-analysis/news/rcm-publishes-new-position-statement-on-infant-feeding" target="_blank">press release</a>, sending the tabloids into a bullshit frenzy.<br />
<br />
First prize (you may need to sit down in shock) goes to the Daily Fail (who I'm not even sure bothered to even read the whole press release) with:<br />
<blockquote class="tr_bq">
<b><i>"End of the breastfeeding shaming: Midwives ordered not to judge new mothers who choose to bottle feed."</i></b></blockquote>
I've found myself becoming increasingly angry as all I've heard bandied about is that women must have a choice and we must respect that choice.<br />
<br />
Well shut the front door! Grown adults should make a choice and it should be respected - whatever next? The right to vote? Letting women work outside the home? I can see why <i>that</i> made the headlines in 2018. <br />
<br />
<a href="https://2.bp.blogspot.com/-tINI-uLW2TQ/WyGBox_fr6I/AAAAAAAACi0/XN4nMMFO_6wwyenLqaZmo_kM88J5ag5_ACLcBGAs/s1600/illusion.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="500" data-original-width="600" height="265" src="https://2.bp.blogspot.com/-tINI-uLW2TQ/WyGBox_fr6I/AAAAAAAACi0/XN4nMMFO_6wwyenLqaZmo_kM88J5ag5_ACLcBGAs/s320/illusion.jpg" width="320" /></a>Except of course it's all absolute nonsense, because for the most part <a href="https://amzn.to/2JSS5n4" target="_blank">as I discuss in my book</a>, mothers don't really get to make a choice at all; they have but the illusion of choice, which unsurprisingly leaves mothers pretty damn angry.<br />
<br />
RCM Chief executive Gill Walton <a href="https://www.theguardian.com/lifeandstyle/2018/jun/12/breastfeeding-womans-choice-must-be-respected-midwives-told" target="_blank">said</a>:<blockquote class="tr_bq">
“<b>If, after being given appropriate information, advice and support on breastfeeding</b>, a woman chooses not to do so, or to give formula as well as breastfeeding, her choice must be respected.”</blockquote>
First, there's no obligation for the mother to accept "appropriate information and advice" to earn the right to have her choice respected. We can promote informed choice, but we absolutely have the right to make an uninformed choice if we wish, or to seek education from "inappropriate" sources and <i>still</i> have that choice respected.<br />
<br />
Second, it has to actually be a viable choice for any decision to affect outcome. For example I can make a choice to amputate my leg, but if I can't find a surgeon to agree to lop it off - I have no choice but to keep the leg and my "decision" becomes a moot point. I can make a choice to live off dried African tree bark, but if I can't find a stockist to send it to me - my decision is irrelevant.<br />
<br />
Women can make a choice to breastfeed, but if they can't find anyone to help them do in a way that's sustainable (ie without pain, without feeding 19 out of 24 hours because the baby can't ever be put down, with appropriate weight gain etc) - she may find herself left with no choice as something has to give.<br />
<br />
A survey I ran found <b>EIGHTY FIVE</b> <b>percent </b>of over 1000 mothers surveyed said they <b>DID NOT receive the help they needed to succeed</b>. Yet the choice about feeding according to the RCM is a woman's right! So why then prey tell have <a href="https://happiful.com/new-parents-let-down-by-government-cuts-to-breastfeeding-support-services/" target="_blank">funding cuts left mothers with even less support than ever before</a>? <a href="https://www.theguardian.com/society/2017/feb/14/new-mothers-midwife-new-study-nct" target="_blank">Why are tens of thousands of women even unable to get hold of a midwife</a>?<br />
<br />
Aren't we trying to use pretty wallpaper to cover up the crumbling walls?<br />
<br />
The Daily Mail touch on this with:<br />
<blockquote class="tr_bq">
"Those who want to breastfeed, but are unable to, are up to two and-a-half times more at risk of post-natal depression." </blockquote>
Random idea - perhaps if we helped those women to succeed, we wouldn't have to worry about trying to assuage their guilt at a later date? <br />
<br />
Yet suddenly we only seem to care if the choice of a mother who chooses NOT to breastfeed is respected? There's a right to bottle feed but no right to breastfeed.<br />
<br />
Who will deliver all the "appropriate information" on which mothers will base their informed choice? It would have to be a pretty long chat given most parents have virtually zero knowledge prior to pregnancy. <br />
<br />
What format will this take? Because the problem is it's incredibly difficult for midwives to both give evidence based feeding material AND yet not simultaneously be perceived as applying pressure <a href="http://www.analyticalarmadillo.co.uk/2010/08/breastfeeding-sids-guilt-at-what-cost.html" target="_blank">as this post explores</a>. If a midwife tells a mother the risks of not breastfeeding her baby - given mothers typically want the best for their child, this information in itself could easily be perceived as pressure or a "guilt trip" if they didn't plan or want to do so.<br />
<br />
I've learnt over the years in practice, that mothers will blame themselves and feel guilty for almost<i> <b>anything</b> </i>relating to their baby. Even if it's something that you'd have needed a degree in medical science or the gift of second sight to know - mothers will still utter the words "I should have known" or "I should have done...". <br />
<br />
This happens so much, I've now taken to asking dad (or her significant other) - do you feel guilty or to blame? It's fascinating it if only for the momentary look of confusion. I've yet to meet one who does - why would you feel guilty about something you didn't know or couldn't change? Yet mothers do. <br />
<br />
Gill Walton continues:<br />
<blockquote class="tr_bq">
"We would focus on the risks and benefits of both breastfeeding and formula feeding – and help them do that – rather than say “Oh, this mother’s decided to formula feed, we’re not going to help her”.</blockquote>
A dire quote if verbatim but regardless, listing the risks and benefits of breastfeeding is notoriously problematic for a healthcare system - since there are no health benefits to not breastfeeding, no area in which formula confers an improved outcome. This means we're realistically going to give a heap of information to a mother which tells her lack of breastfeeding can impact negatively in the long-term. Surely it's an unrealistic expectation that they won't then feel <i>something </i>if they can't or choose not to do so. <br />
<br />
The reality as social media repeatedly highlights, is far many more mothers are told by their healthcare providers (including doctors and other senior medical professionals) to introduce formula, give a bottle or restrict breastfeeding - often because their lack of training and ignorance means they simply don't understand lactation. But I guess that's not a convenient narrative.<br />
<br />
Yet the media seems to forget women can read and think - instead others must be <i>making</i> these mothers feel guilty (their magic guilt inducing powers must be useless on dads since they don't get a media mention when it comes to feeding their offspring). But given I recently saw a mum express guilt in the face of a research study, it would seem these recommendations are about as doable as rotating your hands and feet in different directions at the same time (it's really tricky, try it ;))<br />
<br />
The media is selective in what is "problematic pressure" for women. Lose the baby weight, "get your life back" (but not too much), work (but not too much), stay at home (but not too much), mother enough (but not helicopter parenting), cook nutritious food, have just the right number of after school activities. Be yummy but not too slummy and on and on and on.<br />
<br />
I'm still undecided whether we as mothers are conditioned via society to put up with this constant dialogue of drivel trickling into our daily lives. That men aren't subject to this constant appraisal is spectacularly highlighted by the <a href="https://twitter.com/manwhohasitall?lang=en" target="_blank">"Man who has it all" Twitter account</a>. If men were breastfeeding would we pat them patronisingly on the head and tell them not to feel guilty that resources had been cut so much there was no help and as such they were failed in feeding their child how they wanted?<br />
<br />
I very much doubt it.<br />
<br />
<br />
<br />Analytical Armadillo IBCLChttp://www.blogger.com/profile/03829027807809292649noreply@blogger.com1tag:blogger.com,1999:blog-3102141287849407838.post-8681148236243937342018-06-11T22:04:00.001+01:002018-06-12T10:40:22.301+01:00The Probiotic, Prebiotic Pacifier (Dummy)<span style="font-family: "courier new" , "courier" , monospace; font-size: large;"><span style="color: red; font-weight: bold;">Probiotic</span><b>, </b><span style="color: #274e13; font-weight: bold;">Prebiotic</span> <span style="background-color: white;"><span style="color: blue;"><b>Pacifiers</b></span></span>™</span> or <span style="font-family: "courier new" , "courier" , monospace; font-size: large;"><b>PPP</b>™</span> as we like to call them, are finally <span style="font-size: large;">here</span>. We asked parents what they wanted from a paci, we added extras they didn't even know they wanted and <b><span style="font-family: "trebuchet ms" , sans-serif; font-size: x-large;">*</span></b><b><span style="font-family: "trebuchet ms" , sans-serif; font-size: x-large;">BOOM*</span><span style="font-family: "courier new" , "courier" , monospace; font-size: large;"> </span></b><span style="font-family: "courier new" , "courier" , monospace; font-size: large;"><b>PPP</b>™</span> was born.<br />
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<a href="https://4.bp.blogspot.com/-EEdSI5yoCmE/Wx7lpXMYSOI/AAAAAAAACio/gOtNdL2FO5Qt6gy371Bpc8MTf5kMuWiFQCLcBGAs/s1600/2376337_s%2B-%2BCopy.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="847" data-original-width="565" height="200" src="https://4.bp.blogspot.com/-EEdSI5yoCmE/Wx7lpXMYSOI/AAAAAAAACio/gOtNdL2FO5Qt6gy371Bpc8MTf5kMuWiFQCLcBGAs/s200/2376337_s%2B-%2BCopy.jpg" width="133" /></a></div>
<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">With all the hype about your infant's microbiome (the crew of bacteria hanging out in your baby's body), imagine a pacifier that delivers both pre and probiotics with each and every suck? Imagine no longer, PPP™ is here!</span><br />
<ul>
<li><span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">Unique, patented "never drop" function*</span></li>
<li><span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">Now Cleaning Dummies is Not Advised (ncDNA) thanks to our Bioclens flora technology™, making sterilising a thing of the past. The pacifier doesn't even need soap! A rinse is all that's needed to keep the PPP™ at its best.</span></li>
<li><span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">9 out of 10 mothers said their baby preferred PPP ™, even if they refused all other dummies on the market.</span></li>
<li><span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">Suitable from birth through to weaning for both breast and bottle fed infants.</span></li>
</ul>
<div>
<span style="font-size: xx-small;"><span style="font-family: "georgia" , "times new roman" , serif;">*Never drop function means the PPP</span><span style="font-family: "georgia" , "times new roman" , serif;">™ will never drop away from the owner's body. No throwing it out of the pram, crawling under the cot trying to find it at 2 am</span></span></div>
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<span style="font-size: xx-small;"><span style="font-family: "georgia" , "times new roman" , serif;"><br /></span></span></div>
<div>
<b><span style="font-family: "times" , "times new roman" , serif; font-size: large;">And if that wasn't enough. THERE'S MORE!!!</span></b></div>
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<span style="font-family: "georgia" , "times new roman" , serif;"><br /></span></div>
<div>
<span style="font-size: large;"><span style="font-family: "georgia" , "times new roman" , serif;">The PPP is <b><a href="https://www.ncbi.nlm.nih.gov/pubmed/26140303" target="_blank">CLINICALLY PROVEN</a></b> to assist in the development of your baby's jaw and teeth! </span><span style="font-family: "georgia" , "times new roman" , serif;">Reduce risks of malocclusion (<span style="background-color: white; color: #222222;">misalignment of the two dental arches when they approach each other as the jaws close), </span>teeth crowding and decay.</span></span></div>
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<span style="font-family: "georgia" , "times new roman" , serif;"><br /></span></div>
<div>
<span style="font-family: "times" , "times new roman" , serif; font-size: large;"><b>Why does my baby need bacteria from their binky anyway?</b></span></div>
<div>
<span style="font-size: xx-small;"><span style="font-family: "georgia" , "times new roman" , serif;"><br /></span></span></div>
<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4681407/" target="_blank">According to researchers</a>:<br />
<div class="sec sec-first" id="S1" style="clear: both;">
<blockquote class="tr_bq" style="background-color: white; font-family: "times new roman", stixgeneral, serif; font-size: 19.9989px; margin-bottom: 0.6923em; margin-top: 0.6923em;">
"Beginning at birth, the microbes in the gut perform essential duties related to the digestion and metabolism of food, the development and activation of the immune system, and the production of neurotransmitters that affect behavior and cognitive function."</blockquote>
<span style="font-family: "times new roman" , "stixgeneral" , serif;"><span style="background-color: white; font-size: 19.9989px;">What that actually means is the bacteria perform an essential job when it comes to digesting and absorbing food, how the immune system develops and how well it responds.</span></span><br />
<span style="font-family: "times new roman" , "stixgeneral" , serif;"><span style="background-color: white; font-size: 19.9989px;"><br /></span></span>
<span style="font-family: "times new roman" , "stixgeneral" , serif;"><span style="background-color: white; font-size: 19.9989px;">These bacteria can even affect how you act and how you think, act and feel, a "</span></span><a href="https://www.sciencedirect.com/science/article/pii/S0022395615000655" target="_blank">Collective unconscious</a>" - your bacteria communicate directly with your brain.<br />
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<span style="font-size: 19.9989px;"><br /></span></div>
<div style="background-color: white; font-family: "times new roman", stixgeneral, serif; font-size: 19.9989px;">
<span style="font-size: 19.9989px;">Studies also warn </span><a href="https://blogs.scientificamerican.com/guest-blog/shortchanging-a-babys-microbiome/" style="background-color: transparent; font-size: 19.9989px;" target="_blank">we may be short changing our baby's biome</a><span style="font-size: 19.9989px;"> increasing risks of </span><a href="https://www.nature.com/articles/s41467-017-02573-2" style="font-size: 19.9989px;" target="_blank">asthma</a><span style="font-size: 19.9989px;"> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5378446/" target="_blank">allergies</a>.</span></div>
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<div style="background-color: white; font-family: "times new roman", stixgeneral, serif; font-size: 19.9989px;">
PPP<span style="font-family: "times new roman"; font-size: small;">™ brings not only the big guns of good bacteria to the party (probiotics), it brings their favourite snacks (prebiotics). Helping <i>your</i> baby's biome to thrive like a newly seeded garden in spring.</span></div>
<div style="background-color: white;">
<span style="font-family: "times new roman"; font-size: small;"><br /></span>
<span style="font-family: "times new roman"; font-size: small;">Many probiotics you buy have a few strains, some have ten or eleven. The PPP</span><span style="font-family: "times new roman"; font-size: small;">™ responds to your baby's environment and has been found to deliver up to </span><span style="font-family: "courier new" , "courier" , monospace; font-size: large;"><a href="https://www.sciencedaily.com/releases/2013/01/130104083103.htm" target="_blank">SEVEN HUNDRED</a></span><span style="font-family: "times new roman"; font-size: small;"> different bacterial species.</span><br />
<br />
<span style="font-family: "verdana" , sans-serif;">However you feed your baby, PPP™ is suitable. Offer after a breastfeed to help your baby nod off, or whilst preparing a bottle to calm your baby - a godsend at 3am!</span><br />
<span style="font-family: "verdana" , sans-serif;"><br /></span>
<span style="font-family: "verdana" , sans-serif;"><b>Look down and you'll find your complimentary pair.</b></span><br />
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Analytical Armadillo IBCLChttp://www.blogger.com/profile/03829027807809292649noreply@blogger.com0tag:blogger.com,1999:blog-3102141287849407838.post-42612090180743724282018-05-08T16:51:00.002+01:002018-05-08T19:04:24.233+01:00The Omeprazole (Prilosec/Losec) Epidemic & Infant Reflux - Risks & BenefitsMany infant feeding practitioners have observed an exponential increase in the number of babies diagnosed with reflux and given hypoallergenic formula/and or reflux medication. It's something I've <a href="http://www.analyticalarmadillo.co.uk/2016/06/infant-reflux-nice-guidance-is-current.html" target="_blank">blogged</a> about <a href="http://www.analyticalarmadillo.co.uk/2014/07/dear-paediatric-consultant.html" target="_blank">before</a>.<br />
<br />
We have a situation whereby some babies are suffering with severe digestive issues, yet mums feel their concerns are not taken seriously (and I say mums intentionally, as many comment their concerns are taken more seriously should they take baby's dad with them or if he takes them). In contrast others simply presented at A&E with an infant crying, were diagnosed immediately with "reflux" and given a host of medications and milks.<br />
<br />
Today thought I'd specifically like to explore Omeprazole. <br />
<br />
I've heard parents feel confident Omeprazole makes a huge difference to their babies, whilst others feel there is little to no change at all; or maybe some improvement but still symptomatic enough to be seeking further help.<br />
<br />
It isn't without risk of side effects, therefore it's surely key to ensure that the medication is needed, effective and ultimately providing more benefit than risk - this decision will be unique to each baby and situation.<br />
<br />
<b>Omeprazole belongs to a class of drugs called "<a href="https://en.wikipedia.org/wiki/Proton-pump_inhibitor" target="_blank">proton pump inhibitors</a>" or PPI's. Unlike say ranitidine which aims to neutralise the acid, omeprazole actively works to reduce it being produced in the first place.</b><br />
<br />
<strong><span id="dscexpitem_-1880508617_2">The National Institute for Health and Care Excellence (</span>NICE) & PPIs:</strong><br />
<blockquote class="tr_bq">
<strong>1.3 Pharmacological treatment of GORD</strong><br />
Consider a 4-week trial of a PPI or H2RA for those who are unable to tell you
about their symptoms (for example, infants and young children, and those with a
neurodisability associated with expressive communication difficulties) who
have overt regurgitation with 1 or more of the following:<br />
<ul>
<li>unexplained feeding difficulties (for example, refusing feeds, gagging or choking)</li>
</ul>
<ul>
<li>distressed behaviour</li>
</ul>
<ul>
<li>faltering growth.</li>
</ul>
1.3.4 Assess the response to the 4-week trial of the PPI or H2RA, and consider
referral to a specialist for possible endoscopy if the symptoms: </blockquote>
<blockquote class="tr_bq">
<ul>
<li>do not resolve or</li>
</ul>
</blockquote>
<blockquote class="tr_bq">
<ul>
<li>
recur after stopping the treatment. </li>
</ul>
</blockquote>
I decided to give NICE a tweet to ask for the studies that formed this guidance, and in the meantime scoured journals for studies. I'll list them in date order, oldest first:<br />
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<a href="https://2.bp.blogspot.com/-nuS1HYAAZ2I/Vynjhr_MAjI/AAAAAAAACHU/qxdVJ7Yce9sdEFNHYBUyhLYdZQN30rjUwCLcB/s1600/omep.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://2.bp.blogspot.com/-nuS1HYAAZ2I/Vynjhr_MAjI/AAAAAAAACHU/qxdVJ7Yce9sdEFNHYBUyhLYdZQN30rjUwCLcB/s400/omep.jpg" width="385" /></a></div>
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</blockquote>
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<br />
<div>
<br />
<div>
Next we have a teeny tiny study from 1993 of just <b>15</b> children ranging from 8 months - 17 years:</div>
<blockquote class="tr_bq">
"Mildly elevated transaminase values in 7 patients and elevated fasting gastrin levels in 11 patients were present; <b>in 6 of the 11, gastrin levels were 3 to 5.5 times the upper limit of normal.</b>"</blockquote>
<blockquote class="tr_bq">
"We found omeprazole to be highly effective in this group of patients with severe esophagitis [insert: irritation or inflammation of the oesophagus]. <strong>Omeprazole appears to be safe for short-term use, but further studies are needed to assess long-term safety because the significance of chronically elevated gastrin levels in children is unknown</strong>."</blockquote>
So in short, it worked to soothe an irritated or inflamed oesophagus, however it resulted in high gastrin levels, the impact of which is unknown and as such needs further investigation. Gastrin is a hormone that is produced by ‘G’ cells in the lining of the stomach and upper small intestine; dring a meal, gastrin stimulates the stomach to release gastric acid. It also however acts as a disinfectant and kills most of the bacteria that enter the stomach with food.</div>
<div>
<br />
I then decided to directly search for safety studies. The first thing I pulled up was a site called http://www.choosingwisely.org. Choosing Wisely is an initiative of the ABIM <a href="http://abimfoundation.org/who-we-are/staff">Foundation, which was </a><a href="http://abimfoundation.org/who-we-are/staff">created by the </a><a href="http://www.abim.org/">American Board of Internal Medicine</a> (ABIM) in 1989 with a mission "to advance the core values of medical professionalism as a force to improve the quality of health care."</div>
<br />
Their goal via Choosing Wisely, is "advancing a national dialogue on avoiding wasteful or unnecessary medical tests, treatments and procedures". They provide evidence based information and are supported by <a href="http://www.choosingwisely.org/partners/">over 70 partners</a> including the American Academy of Paediatrics and The American Academy of Family Physicians<br />
<div>
<br /></div>
<div>
One of their publications is entitled:</div>
<div>
<h3 style="text-align: center;">
<b><a href="http://www.choosingwisely.org/wp-content/uploads/2015/02/SHM-Pediatric-Choosing-Wisely-List.pdf">Five Things Physicians and Patients Should Question</a></b></h3>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://1.bp.blogspot.com/-UoW0vrxtKSs/Vynvio4jI2I/AAAAAAAACH8/K-F96loy7ukQcAdoV99zJE1FywYng6UmQCLcB/s1600/omep4.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="99" src="https://1.bp.blogspot.com/-UoW0vrxtKSs/Vynvio4jI2I/AAAAAAAACH8/K-F96loy7ukQcAdoV99zJE1FywYng6UmQCLcB/s640/omep4.jpg" width="640" /></a></div>
<div>
<br /></div>
<div>
This was released in 2013, still stating a lack of effectiveness and lack of exploration of potential adverse effects.</div>
<div>
<br /></div>
<div>
NICE then kindly tweeted back telling me I could find the supporting evidence <a href="http://www.choosingwisely.org/wp-content/uploads/2015/02/SHM-Pediatric-Choosing-Wisely-List.pdf">here</a>. So off I went:</div>
<blockquote class="tr_bq">
Under A.3.3 Analysis it says: " <strong>The literature search found no trials evaluate the effectiveness
of PPIs in children</strong> and therefore there is not sufficient evidence to include these treatments
in an economic model." </blockquote>
<blockquote class="tr_bq">
A.3.4 Resource use and costs: "<strong>No studies were identified that looked at the comparative cost effectiveness of medical
therapy for GORD in children, either comparing different drug regimens or comparing
medical management with surgical management. The comparative evidence of efficacy is
poor.</strong>" </blockquote>
<blockquote class="tr_bq">
A.3.5 Conclusion: " Therefore, no comparison of the cost effectiveness of medical
management and surgical management was possible for this guideline".</blockquote>
I then ran through the studies listed under "I.8 Effectiveness of medical management (H2RAs, PPIs and prokinetics) in GOR or GORD", picking out those that examined omeprazole and infants.<br />
<br />
The first I found on the list was the study quoted in the purple box above, concluding irritability was not improved.<br />
<br />
The second study they list is the study quoted in the pink box above, concluding safety had yet to be addressed.<br />
<br />
I then got excited when I found a new study I hadn't yet found. <br />
<blockquote class="tr_bq">
Efficacy and Safety of Once-Daily Esomeprazole for the Treatment of Gastroesophageal Reflux Disease in Neonatal Patients, AAP 2013</blockquote>
</div>
<div>
The similarities between omeprazole and esomeprazole outweigh the dissimilarities. Some claim esomeprazole is even more effective, although this doesn't appear to be supported <a href="http://www.differencebetween.com/difference-between-omeprazole-and-vs-esomeprazole/" target="_blank">by evidence</a>.</div>
<div>
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Oh.<br />
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The second paragraph is particularly interesting "the signs and symptoms traditionally attributed to acidic reflux were not significantly improved by esomperazole"<br />
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And does well tolerated mean no potential long-term adverse effects?</div>
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I <a href="https://www.nice.org.uk/guidance/ng1/evidence/appendix-i-1784560">scanned the rest</a> of the papers and couldn't find any others relating to omeprazole and infants under 12 months.</div>
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<b>So we have it seems, very little evidence demonstrating omeprazole is effectively resolving the symptoms parents seek help for, even if acid levels are reduced in a lab.</b></div>
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<b><span style="color: red;"><br /></span></b></div>
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<b><span style="color: red;">What about undesirable side effects?</span></b></div>
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If we look at the bigger picture than just babies, a paper entitled "<a href="http://www.medicinesoptimisationacademy.com/wp-content/uploads/2015/04/McGinn_2015_Optimisation-review-in-patients-taking-PPIs.pdf">Outcomes of a medicationoptimisation review inpatients taking proton pumpinhibitors</a>" for the QUIPP (Quality, Innovation, Productivity and Prevention) agenda reads:</div>
<blockquote class="tr_bq">
"Proton pump inhibitors (PPIs) are one of the most
commonly prescribed groups of drugs.1–4 <strong>Although PPIs
are generally well tolerated, long-term use has been associated
with adverse effects such as increased risk of bone fracture, 5–8
nutrient deficiency,9–11 Clostridium difficile infection, 12–15 and
pneumonia.</strong>16–18 Because of these risks, the lowest effective dose
of PPI should be used.19-21"</blockquote>
<blockquote class="tr_bq">
"<strong>Proton pump inhibitors may trigger the very symptoms
that they are designed to treat because of compensatory
mechanisms</strong>.23,24 Studies have shown that patients can suffer
from rebound gastric acid hypersecretion following PPI
withdrawal,25–27 which may make it difficult to maintain step
down/off.28 In our experience, many healthcare professionals
(HCPs) and patients are unaware of the risk of rebound
symptoms and how best to manage them"</blockquote>
In particular problems observed include<a href="http://www.fda.gov/Drugs/DrugSafety/ucm245011.htm" target="_blank"> magnesium deficiency</a> and <a href="http://jamanetwork.com/journals/jama/fullarticle/1788456" target="_blank">B12 deficiency</a>. Furthermore these studies are of adults, with increased risks to the elderly - what about babies?</div>
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<b>In 2013 <a href="http://circ.ahajournals.org/content/128/8/845">a study</a> linked PPIs to constriction of blood vessels. </b></div>
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"We found that PPIs interfere with the ability of blood vessels to relax," said Ghebremariam, a Houston Methodist molecular biologist. "PPIs have this adverse effect by reducing the ability of human blood vessels to generate nitric oxide. Nitric oxide generated by the lining of the vessel is known to relax, and to protect, arteries and veins."</blockquote>
There is concern ""<a href="https://www.sciencedaily.com/releases/2013/07/130710114225.htm">If taken regularly</a>, PPIs could lead to a variety of cardiovascular problems over time, including hypertension and a weakened heart. In the paper, the scientists call for a broad, large-scale study to determine whether PPIs are dangerous." </div>
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I asked Dr. Flanders, a paediatrician in Canada for his thoughts about young infants:<br />
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He also suggested we check out an article from <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576942/">Canadian Family Physician 2013</a>:<br />
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<b>So what does all this mean?</b><br />
<b><br /></b>
It seems clear that PPIs <b>should not be widely prescribed for most babies</b>.<br />
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Omeprazole appears well tolerated in the short term, but guidance suggests this is reviewed and reduced/removed ASAP to minimise potential side effects. If tests demonstrate babies are at risk from acid damage or have an inflamed oesophagus, omeprazole appears in the short term to be effective.<br />
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It means we also have a huge overlap of symptoms and so we need to be extremely thorough in assessments - because it's also clear from studies that many babies we think have "acid reflux", don't improve with medication that tests show is effectively working. <br />
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For example the <a href="https://www.nct.org.uk/parenting/what-reflux">NCT state</a>:<br />
<blockquote class="tr_bq">
"If your baby shows discomfort when feeding, such as arching away, refusing to feed and crying, it can be a sign of reflux. She may also frequently vomit or spit up (more than normal posseting, which is only about a teaspoon) and cough a lot, including at night, with no other sign of a cold.</blockquote>
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Other symptoms include:<br />
<ul>
<li>Waking often at night</li>
<li>Comfort feeding to help alleviate pain</li>
<li>Weight loss or poor weight gain</li>
<li>Excessive crying or irritability during or after feeding</li>
<li>Regurgitation"</li>
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Yet a baby with a feeding problem such as difficulty latching or using a teat well will arch, refuse to feed and cry. They will often vomit if they gulp down air and <a href="https://pdfs.semanticscholar.org/a3e3/ab4a4dfb376b8e98545c37da5c55160b8fce.pdf" target="_blank">can develop symptoms of reflux</a> as a result.<br />
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They may feed little and often appearing to "comfort feed" as a result and may struggle with poor weight gain too. Babies generally not transferring enough milk also wake often at night.<br />
<br />
A shallow latch can also cause aspiration (<span style="font-family: "calibri" , sans-serif; font-size: 10pt;">Catherine
Genna Watson, Sucking Skills)</span> and thus a persistent cough and so none of the symptoms are exclusive to reflux.<br />
<br />
Tesco baby club have <a href="https://www.tesco-baby.com/baby/baby-health/has-my-baby-got-reflux/">an almost identical list</a>, as do <a href="http://www.babycentre.co.uk/a567208/reflux-and-silent-reflux">Babycentre</a> - it's hardly surprising parents are visiting doctors in their droves.<br />
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<span style="color: red;"><b>The problem is, we risk losing the babies suffering GORD, those who are most at risk of significant complications from their reflux, in all the noise of misdiagnosis. </b></span><br />
<span style="color: red;"><b><br /></b></span>
<span style="color: red;"><b>The babies who can suffer "An apparent life-threatening event" (ALTE), breathing difficulties, or experience damage to their oesophagus, experience recurrent aspiration pneumonias, persistent coughs and have a constant hoarse voice and acidic breath. </b></span><br />
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<a href="http://www.analyticalarmadillo.co.uk/2016/06/infant-reflux-nice-guidance-is-current.html" target="_blank">NICE guidance clearly states</a> infants should have their feeding fully assessed before any medications are prescribed, yet we know this isn't happening. Parents please push to see if someone can identify why your baby is refluxing, or why it's to such a degree they need medicating - rather than just symptom shooting.<br />
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<ol>
<li><a href="http://abimfoundation.org/who-we-are/staff">http://www.ncbi.nlm.nih.gov/pubmed/12970637</a></li>
<li>http://www.ncbi.nlm.nih.gov/pubmed/17204951</li>
<li>http://www.ncbi.nlm.nih.gov/pubmed/21464183</li>
<li>http://www.sciencedirect.com/science/article/pii/S0022347605815616</li>
<li>http://www.gastrojournal.org/article/S0016-5085(09)00780-X/pdf</li>
<li>http://circ.ahajournals.org/content/128/8/845</li>
</ol>
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Analytical Armadillo IBCLChttp://www.blogger.com/profile/03829027807809292649noreply@blogger.com0tag:blogger.com,1999:blog-3102141287849407838.post-82254743421623484812018-02-25T22:03:00.000+00:002018-02-25T22:09:35.528+00:00When The Breastfeeding Baby Keeps Falling Asleep Before They're Full<h3>
<span style="font-family: "trebuchet ms" , sans-serif;">AKA "The Power nap"</span></h3>
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">We all know it's totally normal for breastfeeding babies to fall asleep when they've finished their dinner. We know that in the first few days after birth it's also not unusual for baby to "forget" what they're were doing and take a quick snooze mid-feed, particularly if they're a little jaundiced or have had a more tiring delivery.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">But what about when baby is consistently falling asleep before they're full?</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">It tends to go like this - baby drinks the first milk ejection or letdown, a nice suck/swallow ratio can be seen and this tends to be the part of the feed everyone watches.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">As this naturally slows down, instead of pausing and then starting to drink with a regular swallow pattern again - baby adds more and more sucks for each swallow, becoming slower and slower until they're asleep. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">Except they're not. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">If you try and move them they will suddenly spring back into action. Eyes open, hand comes back to mouth - rooting ensues. Baby was taking a power-nap whilst waiting for more milk, they were <b>not</b> ready to leave the restaurant thank you very much.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">I hear lots of solutions to resolve this. Strip the baby down, blow on them, use a cold wet cloth to rouse them (yikes!), change a nappy. Much doesn't tend to work for long though and so it goes like this:</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">mum blows on baby</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;">baby takes three sucks</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;">baby goes back to sleep</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;">mum blows on baby</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;">baby sucks a few more times</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;">baby goes back to sleep</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;">mum blows on baby</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;">baby ignores blowing</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;">mum blows AND tickles hands</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;">baby suck a few more times</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;">baby falls back asleep</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;">mum undoes baby grow a bit, blows and tickles hands</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;">and so on and so forth</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">It's probably easier to ask the question -<i> <b>why</b></i><b> is the typical term, healthy baby persistently falling asleep before they're full?</b></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">A big reason babies fall asleep at the breast or bottle, is when the flow (for whatever reason) becomes too slow to be worth staying awake for. Lots of sucking without swallowing lots of milk, isn't a sensible idea for a small human with limited energy supplies - they want bang for their buck.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">We know this as if we take a "power-napper" and increase milk flow, baby's eyes spring open! Oh we're back in action? Nice one, I'll wake up then...</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;"><a href="http://ibconline.ca/wp-content/uploads/2017/08/Lactation-aid-short.mp4?_=1" target="_blank">WATCH THIS CLIP</a> - when additional milk is given, we can see the shutters ping open.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">Of course, in a symptom solving society the answer seems obvious - increase milk flow, breast compress and switch feed. Indeed short-term this can help, particularly for the sleepy newborn or baby who is a little early/small and simply running out of energy too soon.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<b><span style="font-family: "trebuchet ms" , sans-serif;">A common reason for many "breast hangers" is a shallower than optimal latch, resulting in reduced milk transfer. </span></b><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">I had an interesting discussion last week over on "Occupy Breastfeeding". <a href="https://www.facebook.com/OccupyBreastfeeding/posts/1393723560731693" target="_blank">This was the stunning image posted</a>. Mum looks radiant but oh my days look at that teeny latch.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">I love seeing breastfeeding in all sorts of positions and attachments, I'm not for a second suggesting we only show "optimal" images - this mum has clearly overcome a difficult time getting baby latched and feeding well and the resulting photo is glorious. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">I do though think we have to acknowledge when a latch <i>is</i> shallow - because we seem to have a nation of people who can't recognise the difference or who believe it doesn't matter and I don't think it's really helping anyone. If we saw a heap of well attached babies, the odd shallow latch wouldn't need a mention - but we see so few breastfeeding images and we've lost so many skills around feeding...</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">Perhaps this baby had just fallen asleep at the end of a lovely feed and slipped shallow as mum moved to take the pic? Who knows, it doesn't really matter as long as we can acknowledge that whilst it's a stunning picture, that latch as we see it won't work for many.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">To some a shallow latch won't be a huge deal, particularly in the early days. Some can compensate well, especially when demands are small and milk supply is abundant. Some mums are happy to feed half hourly day and night as baby gets older, or hold them upright or sling-wear to compensate for the colic, wind or reflux. We're re-framing this as "normal", but for some mums, tapas style eating around the clock isn't always sustainable. Some will experience mastitis from the regularly ineffective breast drainage, whilst for others the tiny mouth causes problems for baby if not for mum. From reducing the transfer, to gulping air a myriad of symptoms can follow. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">I'll take it as a compliment to be accused of "being very big on latch" (I'm still not entirely sure whether the pun was intended, but I chuckled anyway). I think we underestimate mothers to suggest they're going to stop breastfeeding en-mass because whilst they believed until now everything was completely fine, someone pointing out it doesn't quite look like a textbook may prompt them to abandon the breast and reach for the bottle. If whatever your doing is working for you and your baby, run with it! </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">I propose though, mums are more likely to stop breastfeeding when despite telling everyone they have some concerns, they're pacified that it's just a (never ending) growth spurt, or their baby is fine with a teeny tiny mouth and perhaps she just has insufficient glandular tissue or baby has an allergy?</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">The Global Beastfeeding project has uploaded some great clips, <a href="http://ytcropper.com/cropped/WV5a9310e25da59" target="_blank">including exploring why latch matters for many.</a> Here is a still from their clip showing a deep latch versus shallow latch or "nipple hanging".</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">In action this means we can't see the corners of baby's mouth:</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">The problem I think is the myth that refuses to die. <b>The pain myth</b>. How often do we hear the two key questions? </span></div>
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<li><span style="font-family: "trebuchet ms" , sans-serif;">Are you in pain?</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;">Is your baby gaining weight? </span></li>
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<span style="font-family: "trebuchet ms" , sans-serif;">As though these are the only markers of effective feeding.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><b>***Newsflash: Babies can have an incredibly shallow latch and not cause pain.***</b></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">These babies will typically have slower gain, and/or feed super frequently or for long periods to compensate. Not all though, sometimes mum has so much milk, baby is full after drinking the milk that pours out with the first milk ejection (lactose rich milk) resulting in typical or above average gain.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">In order to cause damage a baby has to to:</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">a) Have enough of something in their mouth to damage it</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">b) Be doing a compensatory action that causes damage. Whether that's pushing the nipple up to the hard roof of their mouth, pinching and trapping it, rubbing their tongue against it or sucking extra hard like a vacuum cleaner. </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">Sometimes a baby's suck is so disorganised they don't generate enough suction to cause pain to anything - it's weak and ineffective, like a sock in a washing machine. These babies may also have initial early latching problems and trouble staying on the breast (lack of effective suction). Sometimes mum is show positions to try and compensate for this which gets baby on, but not necessarily transferring milk as well as they could.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">All of this also fails to recognise that the very mechanics of breastfeeding, mean that even if a baby doesn't latch "optimally", the act of suckling (creating a seal and rippling the tongue) - will assist in shifting them in to a deeper latch.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">Normalising the weeny latch as "fine" doesn't really I suspect help many beyond the early weeks - we need to up our game in terms of breastfeeding education to help parents recognise when their baby is latched and drinking well, versus hanging out eating tapas style.</span></div>
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Analytical Armadillo IBCLChttp://www.blogger.com/profile/03829027807809292649noreply@blogger.com3tag:blogger.com,1999:blog-3102141287849407838.post-28092913965308724362017-12-24T12:16:00.001+00:002017-12-24T15:02:37.562+00:00Why "Modest" & "Discreet" Shouldn't Be in Your Breastfeeding Vocab<div class="separator" style="clear: both; text-align: right;">
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I hear so often about how hard women try to breastfeed discreetly or modestly. I mean it's not as as though the shift to caring for a small person 24/7 isn't quite enough to be dealing with; apparently they should also be mindful and take care to ensure not an inch of flesh is exposed.<br />
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Random ignorant members of the public who seemingly can't use their neck or eyes to filter their environment - trump the rights of either mum or baby.<br />
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Young babies who are feeding well tend to be still and focused due to the ongoing transfer of milk, particularly at the start of a feed; others however pop on and off, turn their head, kick their feet, giggle, cry, arch or any combination of the above.<br />
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A baby who has really trapped wind can wriggle and writhe, all limbs flailing. One mum described it as akin to trying to feed the cartoon " Tasmanian Devil", another that surely it would be more practical for them to grow arms at a later stage when they needed them - they can't control the ones they have and they really just get in the way if baby gets into a tizzy.<br />
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We often end up laughing, however for some mums it's far from funny. They may avoid feeding in public because in addition to the embarrassment felt that their baby's struggling to feed, the risk of exposing "their whole boob" can be unsettling.<br />
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I think all over the country there are mums who simply avoid putting themselves in that position and so stay at home - which in turn means we continue only to see the model standard of the "perfect feed" whilst others are stuck isolated<br />
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Why should anyone be panicking they're being judged when feeding their baby? - when many experience hiccups and bumps in the road. Breasts are located smack bang on the front of a person, which makes hiding them really quite difficult.<br />
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Men get to remove their tops without the world ending, modesty is a female only thing. In fact it did <a href="https://www.stuffmomnevertoldyou.com/blogs/how-american-men-won-the-right-to-go-topless.htm" target="_blank">used to be just as taboo for men to expose their chests, until they protested</a> and they're not even revealing their nipples to do something useful like keeping someone alive.<br />
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Let me be clear, I have absolutely no problem with mums who choose to cover up. It's<i> your </i>body and if you want to wear a row of structured nursing covers to build yourself a tent - go right ahead.<br />
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What I take issue with is the suggestion this is discreet or modest breastfeeding.<br />
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<li><b>Modest:</b></li>
</ul>
<ol>
<li>(of a woman) dressing or behaving so as to avoid impropriety or indecency, especially to avoid attracting sexual attention.</li>
<li>free from ostentation or showy extravagance: a modest house.</li>
<li>having or showing regard for the decencies of behavior, speech,dress, etc.; decent:</li>
</ol>
<b>Synonyms:</b> pure,virtuous. demure. Modest implies abecoming shyness, sobriety, and proper behavior: a modest, self-respecting person<br />
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<li><b>Discreet:</b> </li>
</ul>
<ol>
<li>careful and prudent in one's speech or actions, especially in order to keep something confidential or to avoid embarrassment.</li>
<li>modestly unobtrusive; unostentatious:</li>
</ol>
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The further problem with language is when we label one way of feeding "discreet", anyone who chooses not to cover to the same degree or shows more flesh is potentially "indiscreet".</div>
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<li><b>Indiscreet:</b></li>
</ul>
<ol>
<li> having, showing, or proceeding from too great a readiness to reveal things that should remain private or secret. </li>
<li>An act or remark that is indiscreet, <b>especially one that is not morally acceptable.</b></li>
</ol>
<ul>
<li><b>Immodest</b></li>
</ul>
<ol>
<li>not modest in conduct, utterance, etc.; bold, indecent; shameless.</li>
<li>indecent, esp with regard to sexual propriety; improper</li>
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We need to think about the words we use and the impact they can have. They're just breasts <a href="https://www.youtube.com/watch?v=-dw2XHMUnyE" target="_blank">and as the Sparrow Folk highlight they're really not that scary</a>. Babies need to feed and we need to give new mums the support and confidence to feed their babies wherever they are.</div>
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Analytical Armadillo IBCLChttp://www.blogger.com/profile/03829027807809292649noreply@blogger.com1tag:blogger.com,1999:blog-3102141287849407838.post-53701328974286422682017-10-10T19:28:00.005+01:002022-03-13T21:31:42.321+00:00A Gain is Not a Gain. Faltering Growth in Breast & Formula Fed Babies.We've been running our weekly <a href="https://www.facebook.com/breastfeed" target="_blank">infant feeding clinic</a> in Yorkshire for years now, and during that time it's been fascinating to note the changing trends when it comes to feeding babies. <h4>Book your infant feeding assessment with AA at Milk Matters Infant Feeding Solutions: ifs.as.me</h4>
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When we first started, a common problem was parents were advised their baby needed additional milk when they didn't. This happened because their growth was plotted on charts based on the growth patterns of formula fed babies, resulting in the breastfed babies older than a few months, appearing not to grow adequately. We spent so much time reassuring parents that their babies were growing perfectly well for a breastfed baby and didn't need coaxing to take additional milk.<br />
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Many believe formula fed babies gain weight more rapidly than their breastfed peers; however initially the reverse is actually true. The non-breastfed baby typically gains weight more slowly in the first four months, it's after this the shift occurs and they start to gain weight more rapidly compared to those who are breastfed.<br />
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Thus historically on the old charts, many breastfed babies appeared to have suboptimal gain and as a result the UK growth charts were updated to reflect the typical growth patterns of those exclusively breastfeeding.<br />
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In our clinic in the last couple of years, things have definitely shifted. Now it's rare we see an over-supplemented baby, instead we've observed a steep increase in actual cases of "faltering growth" - that is babies who aren't a little underweight, but chronically so.<br />
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What's perhaps most surprising is both these babies above were under the care of and regularly seen by healthcare professionals.</div>
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In the case of the first baby, they were eventually referred to a paediatrician. I completed a new growth chart for them to take, so weight trend was clearly visible. Baby had a tongue tie and we can see when the supplement plan was initiated at 7 weeks. Mum however was reluctant to give extra milk as her group online had warned her it would impact her supply (untrue, a baby not transferring milk will do that) and that anyone suggesting formula wasn't truly supportive of breastfeeding. This meant additional milk was given (provoking gain), withdrawn (resulting in the same amount gained lost again) and re-introduced again - creating the static pattern at the end.</div>
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Note the growth trend - how far away from that bottom curve are the dots (the minimum typically expected weight) and we can see there's a consistent pattern of faltering growth resulting in a 38% deficit based on expected weight.</div>
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It was a cold winter's day when they attended their paediatric review and baby was dressed in a fleece snowsuit. The paediatrician didn't feel it necessary to undress the baby, instead they unzipped the suit enough to listen to baby's chest with a stethoscope. They asked if he was peeing and pooping and said they weren't concerned about weight as we had plotted the chart wrong....</div>
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They said that although baby was 38 weeks when born and a typical weight of over 7lb, they felt a premature chart should be used (designed for babies born before 37 weeks and of a lower weight), and so adjusted the baby's chart in his red book notes to reflect this:</div>
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The bold dot and arrow indicate where the consultant felt the dot should be with this adjustment. Baby was a couple of days shy of 8 weeks at the last weigh in, (as you can see from the original dot now marked with the arrow), yet the new mark is plotted at 5 weeks. This results in an almost 3 week adjustment...<br />
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I can still recall the exact words the mother said to me when I expressed surprise at the consultant's nonchalance and checked additional milk was going to be continued : "You're the only one who is concerned about my baby's weight, everyone else thinks he's fine". A relative expressed she felt I was causing the mum unnecessary concern and worry, when clearly "those in the know" were happy with his gain.<br />
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If parents find their baby is struggling to gain weight, they can soon find themselves on the receiving end of contradictory recommendations and conflicting advice. They may be told by some just to "feed, feed, feed" or take baby to bed and "baby-moon" (both of which of course assume effective milk transfer when baby is feeding, rather than just burning yet more calories), whilst others are expressing concern and suggesting additional milk is needed alongside identifying the original issue that has led to growth faltering.<br />
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<b>A further problem is many don't really understand the charts, sometimes the graph isn't even completed by healthcare providers. This means at a glance nobody can even see the growth pattern, let alone know if the baby is tracking an appropriate curve.</b><br />
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First we need to understand they're based on averages. If we take a huge group of healthy, term, breastfeeding infants - we can identify the typical maximum and minimum rate of growth they undertake. That's not to say every baby outside this range absolutely has an issue, only that its atypical enough (when compared to the masses) to warrant further investigation.<br />
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If we use this data of healthy babies to create a chart - the heaviest infants will of course sit around the top and the lightest infants will sit near the bottom. We can also calculate the "average" - which would be the 50th percentile line (so half the babies will sit above this line and half below). This range allows for genetics, stature, build and so on.<br />
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It isn't desirable to sit on a particular place on the charts - in fact that's really quite illogical. We wouldn't take a group of adult females and identify their average weight is 7-13 stone, then tell everyone their optimal weight was 10 stone. We'd expect the weight of someone who was 5ft and of petite stature, to be less than someone who was 6ft and of broader stature?<br />
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<b>The same is true for babies.</b><br />
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Once on the chart, we can similarly expect different levels of gain from those at the top and bottom too - and we know that typical healthy young babies gain roughly 5-8 ounces per week (140-225g), after the first few days and doing so will result in them returning to birthweight by around day 10 and tracking a curve on the chart.<br />
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Babies may sometimes plot slightly above or below a line, it doesn't have to be an exact track of a centile but should be thereabouts.<br />
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Below we can see the growth chart of a twin baby girl born at 38 weeks, weighing 5lb (2.27kg) and with a tongue tie. Baby was readmitted at a week old with significant weight loss and you can see on the chart where the hospital implemented a "top up" plan. The next jump up the charts is when the tie was released:<br />
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If babies don't gain the expected amount as outlined above, instead if following a curve we see a flatter line appearing as they slide down the charts. Crossing two centiles triggers referral to a paediatrician to rule out underlying and potentially significant causes. Thus the saying "a gain is a gain" is ridiculous; I've heard this said when babies have gained 30g per week, the amount expected per day - that somehow as they haven't lost all is well. Considering nobody seems to check intake before this referral - it also seems a costly exercise too.<br />
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When babies are underweight not only can they lack the energy to take a full feed, but they become disorganised and less effective - creating a catch 22 situation. If this continues week after week, the energy and weight deficit often simply continues to get bigger, rather like you trying to run a marathon when you've just spent a month with Bear Grylls on a desert island.<br />
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<b>What evidence are people working from that they feel a very underweight baby is better than one who is supplemented?</b><br />
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The first choice of course would always be mum's own breastmilk, however if baby feeds very frequently due to not transferring enough per feed, finding time to express may be difficult. If baby has been taking less than they needed for weeks, mum's body similarly may have reduced production and supply may need additional stimulation.<br />
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Donated milk may be an option depending on accessibility and more mums are using and sharing donor milk, both informally and via their local <a href="http://www.ukamb.org/milk-banks/" target="_blank">milk bank</a>; but for many it will mean considering infant formula. The concern is that formula disturbs the microbiome, which is of course true - but we surely have to ask whether we believe there are no risks to inadequate food at a time of rapid growth when energy demands are high. <br />
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Not enough calories also means potentially not enough vitamins and minerals either. This could be a whole new discussion in itself, but let's pick one we know is important for the immune system, zinc:<br />
<blockquote class="tr_bq">
"Infants and toddlers are vulnerable to zinc deficiency due to their rapid growth rate and high demand for tissue synthesis, neurological development; immune function and tissue growth (<a href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD012561/full#CD012561-bbs2-0002">Aggett 2000</a>; <a href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD012561/full#CD012561-bbs2-0016">Friel 1994</a>; <a href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD012561/full#CD012561-bbs2-0025">Krebs 2014</a>). Cells with rapid turnover demand the highest concentrations of zinc, notably skin, gastrointestinal, immunological, neurological, and, in the developing infant, skeletal cells.</blockquote>
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<blockquote class="tr_bq">
"Mild to moderate zinc deficiency is characterised by stunted growth, deficits in immune function, and<span style="color: red;"><b> altered integrity and function of the gastrointestinal tract</b></span> (<a href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD012561/full#CD012561-bbs2-0025">Krebs 2014</a>). Zinc deficiency may be associated with deficits in attention, and motor and cognitive development in children<span face=""open sans" , "arial" , "helvetica" , "lucida sans unicode" , sans-serif" style="background-color: white; color: #333333; font-size: 16px;"> (</span><a href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD012561/full#CD012561-bbs2-0007">Black 1998</a>" <a href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD012561/full">here</a></blockquote>
We International Board Certified Lactation Consultants, often the only ones trained in infant feeding - can frequently find ourselves undermined by a whole range of people.<br />
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The twin baby above as an example was on a feeding plan - as she had a tie, combined with the fact mum hadn't received adequate advice on protecting her milk supply prior to our visit, this meant at the point we saw them baby couldn't physically transfer enough and the increased demand now exceeded supply.<br />
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Despite this a consultant in a different unrelated field (who works with multiples), saw fit to advise the parents to drop all the supplements and just feed her babies. Thankfully the mother contacted us confirming this wasn't correct, but I do wish people would consider the implications of their lack of specialist knowledge and how parents feel when they receive this conflicting advice, from someone absolutely not in a position to be giving it.<br />
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We hear sometimes of underweight babies who seem happy and settled - they sleep long periods, yet surely if they were hungry they'd wake and cry? The reality is that hungry babies cry, very hungry babies who've experienced consistently reduced intake don't have the energy to expend crying. On the contrary, they often sleep longer spells to conserve calories and don't signal too much (which again burns energy) if the feed intake is less than they'd like. Some will feed very frequently yet never really seem "milk drunk" or full and that's without considering that persistent weight gain concerns can be a huge cause of maternal anxiety.<br />
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It's really difficult for parents who are with babies to accurately gauge gain in their newborns based on visual appearance. Babies change a lot in the early weeks and when with someone a lot it's harder to notice subtle or gradual changes - which is precisely why we weigh newborns. It's what we do with this information that counts, the earlier a problem is spotted - the more rapidly it can be resolved. Reassuring people things are ok when they're not, in the longterm doesn't help anyone.</div><div><br /></div><div><h4 style="text-align: left;">Book your infant feeding assessment with AA at Milk Matters Infant Feeding Solutions: ifs.as.me</h4>
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Analytical Armadillo IBCLChttp://www.blogger.com/profile/03829027807809292649noreply@blogger.com0