If you follow along with Baby Food and Fun, you have likely heard about The Fed Is Best Foundation and their new book! This is one of the most comprehensive infant feeding books that I have ever read! They provide accurate and detailed information for breastfeeding, combination feeding, and formula feeding- all in
one book!! They have included resources, charts, sample schedules, and beyond for every feeding journey! It truly is one of the most complete infant feeding references I've ever seen!
+ They look at the shocking truth of infant feeding history and how we got to where we are today..
And when I say it is shocking and eye-opening... well, I truly mean that!
&& IN CASE YOU MISSED IT!!
Catch Baby Food and Fun LIVE with The Fed Is Best Foundation
talking all about their book and this mind-boggling information!!
Tune in to the replay here!
I want to touch on a few REALLY shocking things that all parents should truly know! The book was released on June 25 & is available online and in select stores!! Click the link below to learn more about the book, the authors, and order from their website!
Most Shocking Truth #1: The World Health Organization's '10 Steps To Successful Breastfeeding' ... don't actually lead to successful breastfeeding. & in some cases, simply cause more harm than good...
This is by far the most shocking, painful, and crazy fact to me, The 10 Steps To Successful Breastfeeding that have been endorsed by the WHO for over 30 years, have little evidence to support these recommendations. In fact, out of 10 steps, it was found that only 2.5 ACTUALLY help towards successful breastfeeding. TWO POINT FIVE. I think we can all agree that if a teacher gave a 10 question quiz, and you only got 2.5 correct... well, you'd fail. 25%. .....
Not only that, but evidence has shown that some of these '10 steps' are actually more harmful than beneficial in breastfeeding. & some of these recommendations could be potentially harmful to baby!
So what are the 2.5 helpful steps & what are the non-helpful steps?
Shown to be beneficial in successful breastfeeding:
Skin-to-skin! The caveat with this - we are often told that this is beneficial within the first hour, which is true! But it is also essentially as beneficial within the first 23 hours in general! Don't stress if you miss that 1 hour mark... cause, yeah, there is still time!
Teaching parents about and how to breastfeed. I mean, duh, lol
&& the point five? - don't give baby plain water. Because newborns do not need water, whether they are breastfed or formula fed.... so...
Early breastfeeding initiation within the first hour (provided that mom & baby are medically stable), also showed improved EBF rates by almost 25% at the 1 month when compared to bf initiation after 24 hours. But whether breastfeeding was initiated at hour 1, hour 10, or hour 26, it will likely, hardly make a difference at the 3 month mark (initiated before 23 hours = 5% ; after 24 hours = 6%)
Shown to be least beneficial & possibly even harmful?
Avoidance of pacifiers - this has 0 evidence that shows benefit and in fact, could be considered more of a risk as pacifiers are associated with a decreased risk of SIDS. This recommendation was actually dropped in 2017 due to lack of evidence supporting it.
Rooming in 24/7 - this 'step' shows high bf rates early on, such as 4 days in, however does not show evidence at the 3 or 6 month marks of 'successful breastfeeding'. Not giving new parents a chance to recover, especially after a long or traumatic birth, is again, not setting up for success. Of course it is of benefit for baby to be with parents as much as possible in those early hours and days, but the pros and cons need to be assessed. For many parents, these few days in the hospital may be some of the only opportunities to have help and support available. Discouraging the use of nursery care can lead to over exhaustion for new parents which can result in more accidents, falls, and even accidental suffocation. There is no evidence to say that 'if baby leaves mom's side for a few hours, everything is ruined!'. Take advantage of the nursery if you feel comfortable!
Avoiding supplementation - this is one recommendation that is potentially very harmful to baby AND the breastfeeding journey. In fact, early supplementation such as when waiting for milk to come in fully has shown either no significant impact on breastfeeding rates or it has shown to IMPROVE breastfeeding rates at the 1 and 3 month marks. This was the LEAST EFFECTIVE recommendation according to the true evidence when it comes to "successful breastfeeding". AND - if supplementation is truly needed yet not provided, this can lead to serious and even deadly medical complications for baby (ya'll, please read this book - it's important!!)
Like, HOW can this be the standard of care for so many... yet the research and evidence don't entirely support the recommendations provided?!
This book is JAW DROPPING in many ways, especially if you grew up, and lived in the 'exclusive-breastfeeding' era like I have.
5 More Crazy Facts & Topics:
How 'common' delayed milk can be! (delayed lactogenesis II) - we are made to believe that "all women can breastfeed, its the biological norm!" -- This has always been a strange 'argument' because I don't know of any human organ that UNANIMOUSLY works without flaw across the entire globe... but, Fed Is Best shows us how common this actually is & what it can mean!!!
The history of infant feeding in general is convoluted... and neither "side" is without "blame". (my words, not Fed Is Best)
Many signs and symptoms of inadequate feeding have been normalized and the thresholds are debatable - these weren't always so common (looking at you, jaundice)
"What did moms do before formula?" - well, let me tell ya! If mom had low supply or trouble breastfeeding, they would often 1) use another mom either actively nursing or to supplement breastmilk, 2) gave sugar water or something similar to bridge the gap until milk came in, 3) experienced poor outcomes with baby... the concerns that many face today are not entirely new. The status and safety of formula have evolved though over time!
Diaper counts in the first 24, 48, 72 hours.... (wet & dirty)...
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Well, it seems that I know and understand HOW this could be the case....
WHO.
The World Health Organization.
In fact, the World Health Organization so strongly promotes AGAINST formula, they have an entire folder of graphics and resources termed, "Exploitative Marketing". These resources and graphics take a hard dig at formula and formula companies, as well as healthcare providers and others who work with formula. Want to see?
Ouch.
What type of message is this sending to parents and families?
'Hey, don't trust your medical provider if they recommend medical nutrition therapy?'
That if a medical professional would recommend supplementation or combofeeding or anything along those lines... it's because they have been 'duped' by these formula companies and advertisements.
That is simply NOT the case....
Sure, there are plenty of healthcare providers who do not understand infant nutrition and/or infant formula. Or formula feeding in general! Or breastfeeding for that matter! But those who make their career in infant nutrition.. like, TRULY in this world, nobody is 'duped' by whatever advertisement is currently circulating by whatever formula company. We are talking about Doctors, Master's Degree holders, medical professionals who have practiced for YEARS. Those in this space have studied the science of it. Food science, nutrition, infant needs, biological aspects, you name it. Science is always evolving. Sure, we could learn something new at a point in time that could change the way I practice and such. But at this time, as you all saw above, the evidence for some of these practices is weak. Or nonexistent entirely. So, it is an extreme disappointment to see the World Health Organization publish such a degrading type of message regarding healthcare workers and beyond, when the reality is much more convoluted than that....
In order to understand just HOW convoluted and messy the recommendations for infant and newborn feeding can be, we need to take a little look at the history of infant feeding.
There has never been a population known where every single mother was able to exclusively breastfeed, by themselves (no wet nursing, no milk sharing, etc.), for extended time such as is recommended by the World Health Organization.. Mothers who could not nurse relied on wet nurses—women who breastfed other babies alongside their own. This practice, although common, was not always available to every family.
*Let me clarify: the WHO does not recommend against supplementation with breastmilk during the breastfeeding journey. They do recommend against supplementation with formula. That being said, it was a more common practice for mothers to help mothers "back in the day". In todays society, mothers are hardly given enough time away from work to heal and recover, let alone help other parents feed their babies... (& yes, I know there ARE some mothers who do donate breastmilk and aid in breastfeeding - ya'll are rockstars!!). Access to donor breastmilk can also be difficult to obtain for many healthy, term newborns and their families...
A 'common question' topic I hear often = "What did people do before formula? Actually, feed their babies themselves?" ; "How did babies ever survive without the convenience of formula?" ; "What did people do for centuries before formula was invented? Oh right, they breastfed." ; "How did babies ever make it without the 'modern miracle' of formula?"... Well, let's look at it:
In cases where a wet nurse wasn't an option, caregivers turned to alternative feeding methods. Some cultures developed early forms of animal milk-based substitutes, using goat, cow, or even donkey milk. These substitutes were sometimes mixed with water, honey, or bread to create a more digestible food for babies. However, these early formulas were not nutritionally balanced and could lead to various health issues. Pasteurization of milk was also not yet in play, so contamination of milk was more prevalent.
Another piece of the puzzle that is often overlooked: advancements in bottles and feeding tools!
The Fed Is Best book references a 1993 historical review, "In the early 19th century, the use of of dirty feeding devices combined with the lack of proper milk storage and sterilization, led to the death of one-third of all artificially fed infants during their first year of life."
The invention and creation of infant formula began to take place. In 1865, the first infant formula was created and patented. Although it lacked a variety of nutrients, it remained a better option than many alternatives noted above. Advances in infant formula began almost immediately, just like we continue to see today!
By 1929-1930, infant formula was coined as "Best for Babies", mostly by mistake. Formula companies, the Nestle Corporation in particular, intended to promote infant formula as the best ALTERNATIVE to breastmilk, given those options above as we mentioned. However this campaign was more so received as 'formula is best for babies.'. In the most infamous of cases, the Nestle Corporation promoted formula as 'best for babies', offering free samples and coupons. This campaign began to shift the general feeling toward formula.
Throughout the next decades, the percentage of families that were formula feeding continued to increase while the number of families breastfeeding continued to decrease.
By the 1970s, formula companies began advertising to low-income / lower-middle income countries. These ads continued with the 'best for babies' messaging. In addition, sales representatives were often dressed in healthcare attire, insinuating that this product is indeed 'best for babies' - because a "healthcare professional" endorses it!
Here is where things get extra .... As mentioned above, primary reasons for poor outcomes with formula feeding = poor storage conditions, poor sanitation, etc.
Advertising to low-income countries should be tailored very specifically as access to CLEAN WATER, sanitary prep conditions, bottles to feed with, etc. could be limited. These are examples of situations where formula contamination / illness could occur...
If a family believes that formula feeding is superior to breastfeeding, they will be more likely to strive to formula feed their child, despite financial circumstances. This of course could create a whole host of additional problems...
If families struggled to financially afford the formula, it was not uncommon for a family to dilute the formula for it to last longer or mix other ingredients in to help stretch the formula. (If you've followed me for a while, you know that diluting is a major no-no! It throws off the nutrient concentration and can lead to baby not getting enough nutrition!)
These scenarios led to an increase in infant deaths worldwide, given the circumstances where breastfeeding truly is the only SAFE option...
La Leche group formed in 1956 to help preserve the practice of breastfeeding. By the 1970s, a number of US advocacy groups for breastfeeding had popped up across the country to promote breastfeeding. These groups and public campaigns were successful in raising breastfeeding rates.
Meanwhile, in 1974, "The Baby Killer" was released, exposing concerns with the way infant formula companies were marketing their product, specifically in low-income countries. Infamously referred to as 'the Nestle Scandal', by 1977, a global awareness and boycott of Nestle ensued. This moment shifted the public opinion on infant formula yet again.. this time though, that shift would lead to lasting consequences..
The unethical marketing and advertising practices led to the creation and adoption of the International Code of Marketing of Breast-Milk Substitutes by the World Health Organization (WHO Code) in 1981.
This code specifies restrictions of the marketing of infant formula, bottles, and nipples. In addition, there should be no promotion of breast milk substitutes, bottles, nipples, or pacifiers by health facilities or healthcare providers. Free samples should also not be given.
In 1989, the World Health Organization and UNICEF adopted the "Ten Steps To Successful Breastfeeding". This states that healthcare facilities providing maternity and newborn care services should use these ten steps to guide parents towards successful breastfeeding. (Except, remember that problem I mentioned above...)...
In 1990, WHO and UNICEF adopted the Innocenti Declaration "to protect, promote, and support breastfeeding with the goal of promoting infant health and optimal nutrition". Both of these codes/declarations make it quite clear.. breastfeeding exclusively is the ONLY appropriate option. The Innocenti Declaration also makes various statements with the assumptions that mothers could breastfeed if they had the confidence and 'knew better'. It also undermines mothers and families who do express supply concerns, essentially stating this is a rare thing. (again, check my statements above...). Overall, these codes are pretty clear.. exclusive breastfeeding is the only acceptable way to feed you baby and if you aren't, you must simply, 'lack education, confidence, understanding, etc.'
In 1991, the "Baby Friendly Hospital Initiative" launched. This accreditation program teaches facilities to follow the "Ten Steps To Successful Breastfeeding" as mentioned above. Accreditations in hospital terms are like certifications, a 'hospital bragging right' aka 'marketing tool'.. (I mean, would you rather go to a Baby Friendly Hospital that has been "certified" or not?!)
The thing is though... as we mentioned... those Ten Steps aren't actually all science-based or proven...
& while we have seen an increase in breastfeeding rates overall, we've also seen more complications from underfeeding in general. Complications that likely would not occur if parents were actually provided the TRUE EDUCATION regarding infant feeding.. FULL education. a COMPLETE picture..
Just as these breastfeeding-promoting declarations claim, "parents don't know better" and "lack education", the irony is not lost on me.
Parents can NOT succeed in feeding their infant if they are not given the information. We do a disservice to all when we hide realities.
The real question I have though...
When is enough, enough?
Thanks for joining in that fun recap. I included the only graphic from the World Health Organization that I could actually 100% agree with from this campaign as the cover photo. Because this is true! In every sense and journey..!
Since the formula shortage has unfortunately continued on + we can clearly see how important total infant feeding education is, check out a resource I made-
I've updated my infant formula comparables guide which categorizes each formula based on nutrient breakdown and other special features! It also has common terms to know when it comes to formula feeding!
Get your FREE guide here!!
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Jessica Enderle, R.D., L.D.
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