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Several skeptical parenting blogs I read have talked about the Fed is Best Foundation. The Fed is Best Foundation advocates for greater awareness of women who can’t produce adequate milk and fights against overzealous pushing of breastfeeding.

Of course, I agree that many breastfeeding advocates have gone beyond the science in pushing the benefits of breastfeeding. Breastfeeding has small but clear health benefits in the first year of life, and may increase your child’s IQ; all other alleged “benefits” have not been shown to be true by high-quality evidence. Babies can be raised to happy, thriving adulthood on formula, breastmilk, or a combination. Support for breastfeeding parents must never pass into pressure to breastfeed– particularly for women who, for medical reasons, are incapable of producing enough milk. Guilt about not breastfeeding is entirely unjustified and it is wrong for people to make formula-feeding mothers feel guilty.

However, the Fed is Best Foundation goes beyond the science as well.

In the open letter explaining her position, Dr. del Castillo-Hegyi, the founder of the Fed is Best Foundation, writes:

My son was born 8 pounds and 11 ounces after a healthy pregnancy and normal uneventful vaginal delivery.  He was placed directly on my chest and was nursed immediately.  He was nursed on demand for 20-30 minutes every 3 hours.  Each day of our stay in the hospital, he was seen by the pediatrician as well as the lactation consultant who noted that he had a perfect latch.  He produced the expected number of wet and dirty diapers.  He was noted to be jaundiced by the second day of life and had a transcutaneous bilirubin of 8.9.  We were discharged at 48 hours at 5% weight loss with next-day follow-up.  We were told by the lactation consultant before discharge that he would be hungry and we were instructed to just keep putting him on the breast.  Upon getting home, he became fussy and I nursed him longer and longer into the night.  He cried even after nursing and latched back on immediately.  He did not sleep.  By the next morning, he stopped crying and was quiet.  We saw our pediatrician at around 68 hours of life (end of day 3).  Despite producing the expected number of wet and dirty diapers, he had lost 1 pound 5 ounces, about 15% of his birth weight. At the time, we were not aware of and were not told the percentage lost, and having been up all night long trying to feed a hungry baby, we were too exhausted to figure out that this was an incredible amount of weight loss.  He was jaundiced but no bilirubin was checked.  Our pediatrician told us that we had the option of either feeding formula or waiting for my milk to come in at day 4 or 5 of life.  Wanting badly to succeed in breastfeeding him, we went another day unsuccessfully breastfeeding and went to a lactation consultant the next day who weighed his feeding and discovered that he was getting absolutely no milk.  When I pumped and manually expressed, I realized I produced nothing. I imagined the four days of torture he experienced and how 2 days of near-continuous breastfeeding encouraged by breastfeeding manuals was a sign of this. We fed him formula after that visit and he finally fell asleep. Three hours later, we found him unresponsive. We forced milk into his mouth, which made him more alert, but then he seized. We rushed him to the emergency room. He had a barely normal glucose (50 mg/dL), a severe form of dehydration called hypernatremia (157 mEq/L) and severe jaundice (bilirubin 24 mg/dL).  We were reassured that he would be fine, but having done newborn brain injury research, knowing how little time it takes for brain cells to die due to hypoglycemia and severe dehydration, I did not believe it, although I hoped it.

At 3 years and 8 months, our son was diagnosed with severe language impairment, autism, ADHD, sensory processing disorder, low IQ, fine and gross motor delays.  He was later diagnosed with a seizure disorder associated with injury to the language area of the brain.

By implication, of course, del Castillo-Hegyi’s son’s hypernatremic dehydration caused his autism.

Of course, there is absolutely no evidence that delayed feeding causes intellectual or developmental disability. No one has ever done an actual peer-reviewed study. Circumstantial evidence suggests that it probably doesn’t: as mentioned above, a randomized controlled trial found that increased breastfeeding increases IQ, and breastfeeding appears to reduce the rates of autism or have no effect on it, depending on the study. This would be very very strange if, as the Fed is Best Foundation suggests, delayed feeding is putting thousands of children at risk of developing an intellectual or developmental disability.

When a child gets diagnosed with an intellectual or developmental disability, particularly one like autism, where the causes are poorly understood, many parents search for a reason why this happened to them. Many, in desperation, latch upon pseudoscience like mercury poisoning or vaccines. del Castillo-Hegyi is the latest in a long line of autism parents to comfort themselves with etiologies that aren’t backed up by the facts, although I guess at least she’s creative.

Skeptic parenting blogs would never ever run an article by an autism parent claiming that their child got a vaccine, then got autism, and therefore we shouldn’t be giving babies vaccines. Why is it acceptable to run an article by an autism parent claiming that her child was dehydrated, then got autism, and therefore we should be encouraging fewer women to exclusively breastfeed?

del Castillo-Hegyi fails to present the evidence in a remotely balanced way. In her discussion of transient newborn hypoglycemia, del Castillo-Hegyi dishonestly presents statistics from a study of high-risk infants as if they were from the general population. She also cites a single study in which transient infant hypoglycemia is linked to worse performance on fourth grade achievement tests, failing to note that the study itself says it goes against expert opinion and that policy should not be changed until the study is further validated. She points out that exclusive breastfeeding leads to an elevenfold increase in rehospitalization for dehydration, without mentioning that hospitalization for dehydration is not very common to begin with and that serious sequelae of dehydration are rare. (Modern medicine is awesome.)

Again: this is the exact quality of evidence that lead lactivists to make inflated and inaccurate claims about the benefits of breastfeeding. Skeptic parenting blogs quite rightly call lactivists out on making claims that aren’t backed up by the evidence. Why do they turn around and promote a woman who so distorts the evidence on exclusive breastfeeding?

Unfortunately, the Fed is Best Foundation’s tendency to favor emotional manipulation over statistics does not stop at that essay. Consider this recent blog post, If I Had Given Him Just One Bottle He Would Still Be Alive. I empathize with the author; the death of a child is one of the worst experiences anyone can go through. I understand that her grief makes her want to help other parents not suffer like she did.

Of course, no doubt a similar grief is felt by the mother whose baby died of cronobacter infection from contaminated formula. Or the father whose baby died when he propped the bottle and fell asleep, allowing his baby to choke. Or the many parents whose children died of sudden infant death syndrome, the risk of which may be reduced by breastfeeding. (Unfortunately, I am not aware of a randomized controlled trial or sibling study which examines the effects of breastfeeding on SIDS, and thus have to use lower-quality evidence which may overestimate the effects of breastfeeding.)

This is why we cannot rely on single cases, however much they tug at our heartstrings. In a world of seven billion people, something with a one in a million chance will affect seven thousand people, which is enough for as many heart-wrenching stories as you please.

I was not able to find exact numbers about how many babies die of dehydration in developed countries each year. In the United States, dehydration is not one of the top ten causes of infant death, which collectively account for seven out of ten infant deaths. About 0.4% of hospitalized newborns in a Scottish study were hospitalized for hypernatremic dehydration, suggesting that it is fairly uncommon. I also note the study cited above which says that serious sequelae of dehydration are rare; death is, presumably, a serious sequela. My guess is, therefore, that as tragic as her child’s death of dehydration is, the mother who wrote that article can comfort herself that very few other children will suffer a similar fate.

I empathize with this mother, who feels tremendous guilt. Her child appeared healthy except for crying a lot, and then turned out to be seriously ill in a way no one could have predicted. But her guilt is irrational: most babies who cry a lot do not turn out to have a fatal health condition. And we should not prey on the irrational guilt of mothers who have suffered tragedies to feed the guilt of other parents.

Many parents feel irrational guilt about their parenting choices, and of course I support alleviating that guilt. And there are a lot of people telling lies about how parenting works, and parents need evidence-based guidance to cut through the bullshit. But you don’t magically join the side of Yay Evidence, Boo Guilt the second you say something nice about formula.

Instead, you join the side of Yay Evidence, Boo Guilt if you nonjudgmentally and calmly give parents enough information to make their own decisions based on their own values, paying attention to the quality of evidence and base rates and so on. You need to completely avoid misrepresenting studies and claiming that things cause autism when they don’t. Your posts should contain things like “numbers” and should not contain things like “horrible stories about babies dying of dehydration which will cause every prospective parent reading it to panic that THEY ARE GOING TO MURDER THEIR BABY WITH BREASTFEEDING.”

Unfortunately, the Fed is Best Foundation appears slightly confused about these things. But in the meantime actual skeptics can avoid citing them like they’re not science deniers who happen to be wearing a different team jersey color.

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