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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.
Franklyn said:
I think you’ve missed the mark here. Getting hung up on whether brain damage secondary to neonatal starvation and dehydration causes autism is absolutely missing the forest for the trees. Maybe it doesn’t; maybe autism is entirely determined by genetic and in utero factors (I actually have no idea what the current state of science is) and maybe autistic brains are not damaged in any way at all. So maybe this baby started out autistic and she shouldn’t have lumped the autism diagnosis in with the others.
But if neonatal starvation and dehydration (and come on, “transient hypoglycemia” is not an accurate description of what happened to this baby) do cause brain damage*, that damage might very well cause “severe language impairment, […] ADHD, sensory processing disorder, low IQ, fine and gross motor delays [… and] a seizure disorder associated with injury to the language area of the brain.”
So it is really not a wild claim that her baby’s neonatal starvation and dehydration caused him neurologic problems later on.
The argument that it can’t be true because incidence of learning delay is not higher amongst breastfed infants is not a good argument. Studies of the outcomes of breastfeeding vs formula feeding tend to divide the categories based on whether babies were exclusively (I think maybe in some cases predominantly, but more usually exclusively) breastfed until an endpoint like 3 or 6 or 12 months. Babies who are readmitted to the hospital because they’ve lost >10% of their body weight attempting to subsist on inadequate or nonexistent breastmilk generally do not go on to be exclusively breastfed for 6 months. They eat formula then and thereafter, are binned in the “formula fed” category, and may even account for some of the purported IQ gap (though I think that’s a stretch).
I’m also not sure why it would matter that dehydration due to lactation failure is not among the most prominent dangers American infants face right now. It is definitely at least A danger, and one that is probably growing. It’s hard to say, but it’s becoming more and more mainstream for first-time parents-to-be to be getting advice from for instance prenatal yoga teacher doulas or back-to-nature Christians who incorrectly but fervently believe (and tell everyone) that every mother can make enough milk for her baby, that feeding formula even once will somehow ruin a baby’s life and is a shameful failure, that babies don’t even need more than a marble’s worth of milk because their stomachs are tiny, that if breastfeeding is not working it’s because she’s not trying hard enough. Actual lactation consultants say this stuff. I live in a conservative mid-sized city in flyover country and I hear it all the time. And whether or not dehydration and starvation (and secondary outcomes like brain damage, kidney damage, and death) are an objectively relatively large risk, these are also risks that are 100% unnecessary. Like the risk can be completely eliminated with the better information that there’s no reason not to feed formula in the first few days; maybe milk will come in and maybe it won’t, but meanwhile nobody will starve.
*It’s not true that there is no evidence that this happens. There will never, ever be a controlled clinical trial showing this in people (for reasons that I hope are obvious) but there are some suggestive studies, e.g.:
http://onlinelibrary.wiley.com/doi/10.1111/j.1442-200X.2007.02313.x/full
Moreover, the finding of “changes in and damage to the brain occurring from sodium derangement and changes in body water balance” is exactly what we would expect based on knowledge of physiology; sodium is quite tightly regulated. It would require strong evidence to make me think it doesn’t happen.
I’m a veterinarian not a physician, but in all of the mammal species I have dealt with it is well known (like, it’s in the textbooks) that major changes in sodium are expected to cause at least short-term neurologic problems. I have also seen this happen with my own eyes, both in neonates and in adults. Treatment may reverse the changes, but long-term neurologic problems would not be an unexpected outcome. It would be weird if people were somehow different.
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ozymandias said:
PROBIT– from which the information about IQ comes– is a randomized controlled trial of breastfeeding which randomized women either to an intervention modeled on the Baby-Friendly Hospital Initiative or treatment as usual. The experimental group is all children who received the intervention (regardless of whether their parents wound up breastfeeding). So, yes, children who suffered from dehydration due to breastfeeding would be included, and even so children randomized to the breastfeeding intervention as a group had higher IQs than children who had treatment as usual.
As I’m sure you’re aware, colostrum (produced in the first few days of breastfeeding) contains antibodies which are not present in formula, and the antibodies in colostrum are believed to be one of the causes of the small but real health benefits of breastfeeding within the first year. Therefore, there is not “no reason” not to formula-feed in the first few days.
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Jsfik Xujrfg said:
Also milk production is stimulated by feeding. That is one reason why the nurses encourage new mothers to breastfeed, and if that is not working to express milk manually and then by pump.
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Jason said:
This was also my wife’s experience with breast feeding our newborn (except the last paragraph which is horse shit). We ended up going back to the hospital just 2 days after he was born. He was jaundiced, with low bilirubin, lost 20% of his weight, had to stick him in one of those plastic tanning beds by himself overnight. Before the hospital, I was practically in tears begging my wife to pump and bottle feed him but she was terrified of being reprimanded by the lactation consultant (who actually turned out to be very nice and non militant). My wife’s mother had to get involved and basically command my wife to start pumping and she still refused.
Anyways, I know this is all kinda orthogonal to the point of your post but just wanted to share. Our baby’s fine now. 4 years old and healthy. Not sure how common or uncommon our version of the story is but I also think it’s okay to share personal stories and experiences even if they’re not necessarily representative so long as you don’t follow them up with bogus science (like claiming that dehydration leads to autism).
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ozymandias said:
I’m sorry about what happened and I’m glad your baby is all right. And of course I agree that it is more important that the child be fed than that they be fed breastmilk; the benefits of breastmilk are relatively small and easily outweighed by, you know, not starving.
With regards to sharing her story: of course she can share her story, but I think when you’re writing an article, it makes sense to contextualize it and say “hey, how likely is this to actually happen to any individual parent, is this something it makes sense for people to be worried about?” I think things like that would have benefited your wife as well– if she’d had access to nonjudgmental discussion of breastfeeding, then maybe she would have been more willing to go “yeah, this obviously isn’t working.” The last thing parents need is more stuff to freak out about going wrong!
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Jason said:
Is this something individual parents should be worried about? I do think that not being able to produce any or enough milk in the first few days or weeks is a common issue. Not sure how often that leads to dehydration though as I think in most cases the Mom will figure out that they’re not producing, the baby’s crying continuously and losing weight and begin to bottle feed either formula or pumped milk. The more you know!
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beautyboozeandbudgeting said:
I agree that both sides can go as far as to figment “truths” in order to suit their agenda, however, I still believe that fed is best. I truly, truly, truly hope to breastfeed! It’s a strong desire of mine, but as a woman with PCOS, it’s been said we have a harder time producing. 😦 I definitely won’t be hesitating to formula feed if my baby is hungry. But that’s a FTM for ya! 🙂
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tcheasdfjkl said:
Took me several tries to figure out what “FTM” meant here.
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christiedch said:
I’m so sorry but you clearly have not read anything about the consequences of hypoglycemia, hyperbilirubinemia and hypernatremia from starvation caused by insufficient breast milk intake. I don’t really see that you have any credentials like going to medical school or being a newborn brain injury scientist to know anything about newborn brain injury and developmental disabilities. You may study a small sampling of the literature I have read on brain injury and all the above complications. Basically every physician and brain injury scientist in the world would agree with me that starving a newborn causes brain injury and permanent disability. https://fedisbest.org/2016/09/the-scientific-evidence-on-the-effects-on-accidental-starvation-on-the-newborn-brain/
Dr. Christie del Castillo-Hegyi
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christiedch said:
By the way, neonatologists see starved, jaundiced, dehydrated, hypoglycemic and hypernatremic newborns into their ICUs every single day. They are the leading causes of newborn hospitalizations in the world. If you were actually a neonatologist, or anyone who has actual expertise in what you are talking about, instead of a mommy-blogger, then you would know that.
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trentzandrewson said:
This post has been up for several hours and nobody yet has pointed out how bizarre and reality-orthogonal it is to call Ozy a mommyblogger, so I’m going to take one for the team.
I’m not even saying this in a negative way, it’s just a bewildering statement.
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Kasey Weird said:
I suspect it’s someone who got here from some tag they follow, and they didn’t even bother to check what the blog they’re commenting on even is.
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trentzandrewson said:
Given as it’s the person the OP talks about, I’m suspecting she googled her own name.
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ozymandias said:
I also linked to her so she might have noticed the hits in google analytics.
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loki said:
I don’t remember whether Ozy settled on a ‘mommy’-equivalent word for when they do become a parent but if they did I think we all need to make thatwordblogger a term when it happens
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trentzandrewson said:
I accidentally read through the entire parenting tag on their tumblr once and they settled on ‘baba’, but before that they were thinking ‘zaza’ and I strongly endorse zaza because the logical older-child-shortening of it is Zaz and the idea of a parent called Zaz is my new favourite thing.
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loki said:
#zazzyblogging. I see it.
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Aapje said:
My Zaz has sass and is into jazz.
Works for me.
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Alizarin said:
I support Fed is Best not because I think that injuries from exclusive breastfeeding are common but because people need to be aware that injuries from exclusive breastfeeding are a thing that can happen. I’m in nursing school doing my OB unit right now and we learned about cord prolapse and amniotic fluid embolisms even though those are very rare, because we need to be able to recognize the signs just in case. However, my instructor never said anything about insufficient breast milk.
I also looked up the teaching documents for the Baby-Friendly Hospital Initiative and they basically said any woman can breastfeed her baby if she tries hard enough. They also had a case study where a baby had lost 12% of her body weight due to an improper latch, and the correct intervention was to teach the mother proper feeding technique and check back in in a few days.
I agree that breastfeeding is great – most of the time. People should be aware of things that can go wrong though.
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Aapje said:
I was really confused by this headline until I realized that Fed didn’t refer to the federal government, and that Fed Is Best isn’t a pro-big government foundation.
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jossedley said:
I went a step farther and assumed Ozy was doing some econblogging.
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Devin Lee said:
As a family physician who routinely sees babies right after birth, in the hospital and outside in clinic, what I found much more concerning was the bilirubin. I think there was something she didn’t share about that – because those levels (especially the 24mg/dL) are high enough for phototherapy, and might have been enough to cause kernicterus, or basically, direct toxicity to the brain because of bilirubin. The majority of problems listed could be directly linked to that damage. I didn’t have the energy to read her website, or source-check or see if she discussed those possibilities, but I do hope so. If you want to know more about what can cause those elevated levels, just let me know!
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jdbreck said:
I’m really glad that Fed Is Best is around, and I wish they’d been around when I had my first child. If they’d been around then, maybe I wouldn’t have waited so long to give my oldest formula.
The slogan “Breast is best” is so pervasive, so ubiquitous, so completely unavoidable. Just having a counter-slogan in existence in the public eye helps to counter a tiny bit of the incredible pressure.
Being a mom in our culture is isolating and terrible. We’re expected to perform perfection, and that perfection includes being able to overcome any limitations of our bodies, (need to sleep? need some alone time? have trouble making enough milk? you should feel shame, all the shame).
I say good on the Fed Is Best people.
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Patrick said:
Somewhat off-opic: Ozy, can you recommend some of those sceptical parenting blogs? I’m a soon-to-be father and I find the mainstream parenting blogs to unscientific and irrational. I really loved your book posts on parenting books. Especially “Expecting Better” was a very interesting and helpful book, so thank you for these recommendation!
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