F.U., S.V.U.: NBC show links not breastfeeding to SIDS, inappropriately

I want to kick the writers of Law & Order Special Victims Unit (SVU) in the overpaid shins.

First, they get rid of my beloved Stabler. Then they confuse the partner dynamic by bringing on not one, but two new detectives. And then, they give us last night’s episode, an astonishingly offensive example of mommy-blame (and confusion of correlation and causation) in all it’s glory.

I stayed up late to watch the DVR’d new episode of my (formerly) favorite show, which last night centered on a couple whose baby “supposedly” went missing after their car was stolen on the mean Manhattan streets. It’s pretty obvious from the start that something is fishy; the mother of the missing infant is seen in a convenience store buying diapers for her baby, all the while looking anxiously out the window at where her car is parked (apparently with the baby still inside).

Cut to the scene where the SVU detectives are taking her statement. The mother mentions that her baby is on soy formula due to “lactose intolerance” (she tells the detectives this because the person who snatched her baby won’t know that he needs a special formula.) At this point I knew she had to be guilty, because what kind of mother wouldn’t be breastfeeding? Probably one that was also shown smoking like a chimney, and left her child unattended in a running car.

Ultimately, it turns out that the baby died accidentally, while co-sleeping with the loving, but inherently flawed, parents. In terms of the storyline, we are supposed to feel sorry for the couple, who thought that the death was their fault (thus causing them to come up with the elaborate ruse which cost the city tons of money and energy trying to find a “carjacked” 3-month-old); the detectives are quite adamant that the cause of death was SIDS, and therefore 100% blame-free.

Or was it? (Cue the dramatic music)

See, I’m a little confused here. Near the end of the episode, we see the medical examiner in the process of making the cause of death diagnosis. As the idea of SIDS floats into her mind, she stops, pauses for effect, and says to the detective – “Wait – we know this baby wasn’t breastfed… is the mother a smoker?” The detective answers affirmatively, and viola, the M.E. has her answer. SIDS, obviously. Because everyone knows not breastfeeding and smoking cause – err, I mean, are correlated with – SIDS.

The minute the “not breastfed” line was out of the actress’s mouth, I turned to Fearless Husband and groaned. “You’re f-ing kidding me,” I yelled at the television. What was the point of bringing either of those things up? First of all, smoking – actually, prenatal smoking has the most significant correlation, and I don’t recall them addressing whether the mom smoked while pregnant – is far more significant a risk factor than not breastfeeding (and for that matter, how the hell did she “know” that this baby “wasn’t breastfed”? Maybe the mom nursed for 2.5 months and had just switched to soy formula in the past week or so; the studies say that any breastfeeding has a protective effect against SIDS, so this is relevant) and even bringing that up irked me. If the point of the episode was that the death was no one’s fault, it seems awfully suggestive to me that they brought up these “risk factors” which were completely controllable; both things that if the mom had been a “better” mother, could have been avoided.

This episode was indeed ripped from the headlines, like most of Law & Orders are. Just this week, a big article on CNN.com mentioned how a reduction of SIDS risk is just one more reason we “should breastfeed”. (It also talked about the risk factors of bumpers, and not vaccinating. Actually, it’s worth a read, because the way they talk about bumpers feels like a spoof on formula… they are actually asking retailers to stop selling bumpers because it can be “confusing” to see bumpers laid out so prettily in stores, as they are instruments of death, and all…)

The episode also hinted that co-sleeping was a risk factor (since the baby was sleeping in the same bed as the parents when he died), but in such a vague way that it barely registered. Plus, we all know that co-sleeping is only dangerous if you are formula feeding, so why bother to even discuss that association?

The sad truth is that we DO NOT REALLY KNOW what causes SIDS. Breastfeeding may indeed have a protective effect, but that doesn’t mean that not breastfeeding is so significant a risk factor that it would be the first thought in a medical examiner’s mind. (Unless she shares my infuriating Twitter feed.) There are things that are associated with SIDS deaths – sleep position, bumpers, too much stuff in the crib, not breastfeeding, maternal prenatal smoking, low socioeconomic status (that’s one that nobody brings up – what kind of uproar would there have been if that M.E.’s line had been “Wait – we know this baby had poor, uneducated, working class parents!! It must be SIDS!”), and apparently “not vaccinating”, according to CNN (which is weird, because why the hell would vaccinations protect against SIDS unless the death was caused from that particular diseases being vaccinated against? That recommendation puts my conspiracy theory cockles up, and makes me think that the AAP is using some vague research to cajole parents into vaccinating. Which doesn’t make me think too highly of the other recommendations. It’s also odd because if you look at the groups where not vaccinating is common practice, they tend to fulfill other “healthy” criteria – well educated, upper middle-class, non-smoking, organic-eating, breastfeeding-friendly types; since vaccines are free through public health programs, presumably the only other folks not vaccinating their kids are “negligent” parents who do not attend well-baby visits where these innoculations are given. Two markedly different groups. So I really have to wonder what controls were used in the research on this SIDS/not vaccinating correlation…. if they did control for socioeconomic status, how many non-vaxing parents do not breastfeed? I’m sure there are some, but if the blogosphere is any indication, this would be a rarity. Color me confused… is breastfeeding protective, but not protective if you don’t vaccinate??)

Anyway, back to SVU. Considering bringing up the risk factors of smoking and formula feeding threw blame on the mother, I have to believe that the writers had some sort of agenda here. It didn’t make sense plot-wise to insinuate that it was the mom’s fault. For the purposes of the story, we need to feel like the death was NOT anyone’s fault, otherwise we don’t feel any pity for the parents, which makes us question why the detectives wouldn’t at least prosecute them for putting the city through hell (which is brought up, but then a detective implores that the parents are “being punished enough already”). It seems that the writers wanted to send a message, that SIDS is preventable, if you are unselfish enough to breastfeed.

Now, if that were true, it’s one thing. But to throw that kind of meme into the court of public opinion? Guilty as charged, SVU. You guys suck. And seriously, bring back Stabler.

About the Author:

Suzanne Barston is a blogger and author of BOTTLED UP. Fearless Formula Feeder is a blog – and community – dedicated to infant feeding choice, and committed to providing non-judgmental support for all new parents. It exists to protect women from misleading or misrepresented “facts”; essentialist ideals about what mothers should think, feel, or do; government and health authorities who form policy statements based on ambivalent research; and the insidious beast known as Internetus Trolliamus, Mommy Blog Varietal.

Suzanne Barston – who has written posts on Fearless Formula Feeder.


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100 thoughts on “F.U., S.V.U.: NBC show links not breastfeeding to SIDS, inappropriately

  1. Have you emailed your outrage to the network?

    I agree that you can't pin SUDI on one or two things. If we could, it wouldn't be called 'unexplained' death, now would it?

    We have the maddening situation here (New Zealand) where coroners are going on and on and on about how unsafe bedsharing is, but aren't necessarily bleating on about the other very obviously unsafe practices that are present in the cases trotted out by the media. (bed sharing with siblings, sleeping on soft bedding, recliners, couches, smoking parents, drunk parents, drugged parents….) They get mentioned as a sort of 'oh, by the way' but the headlines scream things as nasty as 'Baby dies after parents fail to follow medical advice.' Yet, in the same week, there is a news item about a toddler drowning in a bucket, and the piece is extremely sympathetic – it is a tragic accident. (despite the fact that it is well known that buckets of water shouldn't be left around a property where there are small children present.)

    Either way, for families, it is a tragedy. Demonising them won't bring their babies back.

    As far as public health messages as a whole go, yes, the whole package is a good idea (back sleeping, proximity sleeping, breastfeeding, not smoking) but every individual case is different, and parent blaming after the fact is not helpful.

  2. Hmm…I'm concerned my point was lost – because it does look like parent blaming..! I guess what I meant was that it can be *perceived* that one particular thing caused something bad to happen, when it can be a combination of factors. For example, back sleeping in isolation isn't going to prevent SUDI, but may reduce risk. Just like a bucket of water on a property isn't guaranteed to drown a toddler – but you get rid of it just in case. And sometimes, if that hasn't happened, something bad may happen. :( Not really a case of neglectful parenting as just bad luck, IMO.

  3. It's sad…but something I've noticed lately is many blogs, companies, tv shows, commercials, using breastfeeding as way to get ratings to spike.

    It's like not a lot of thought goes into it, but they know it's a hot topic, so they're just going to throw it out there. And sure enough, everyone's talking about it, blogging about it, fb-ing about it, tweeting, etc. the next day. It's exactly what they want. Hey, negative publicity is still publicity.

    In their carelessness & irresponsibility, though, the message is about parent blaming, obviously. The message here, is that if mom had breastfed, not co-slept, and not been a smoker…the baby would not have died of SIDS.

    But as a mother who breastfeeds a very active 2 1/2 year old, stays at home, practices non-conventional ways of raising my children (daycare, what's that? what do you mean my child will become anti-social?), I have developed a bit of a thick skin when it comes to these things.

    I assume most people don't agree with my method of parenting. I nearly expect to hear misinformation from the media (as well as from my pediatrician)…and when I do, I tend to shrug it off. Of course being 43 helps.

    My hope is that young mothers are not easily impressioned by this sort of stuff. And good for you & all the bloggers that counter this type of ignorance.

  4. Another good example of television shows “demonizing” formula-feeding is the Mad Men episode where Betty Draper is preparing to leave the hospital with her newborn. Anyone who watches the show knows that the producers characterize Betty as a somewhat indifferent, negligent mother (some of this is a nod to the time period in that she smokes and drinks while pregnant…but she is made out to be a self-centered mother in other ways on the show). Anyway, there is a scene where she's at the hospital talking to a nurse who asks her something along the lines of “Will you be giving the baby the breast?” And Betty kind of sneers at her and says “No” with that “What? Are you crazy?” sort of tone. No reason to have that included in the episode! It automatically appeared to me to be the producers using the fact that Betty would be formula feeding as another way to make her appear uncaring (although formula use was common at the time…the fact that there was no good reason to bring that up in the show raised my own hackles a bit). Linking formula feeding to uncaring, negligent Betty Draper only makes it seem that much more “selfish” and wrong in the audience's eyes.

  5. As Donna mentioned, SIDS/SUDI generally implies the cause of death is unknown. It is at least highly suspected that the back-to-sleep campaign, no bedding/no bedsharing/no bedsharing with smokers, heavy sleepers or parents who are medicated recommendations made such a difference because smothering deaths were prevented. If the baby died from asphyxiation because it's parents rolled on it while they bedshared, the death is not SIDS, but asphyxiation. though maybe it woudl be considered SIDS unless an autopsy was done?

    As for BFing, why is that considered a bonus wrt to SIDS? I always thought it was because the BFing mother often has the baby in the room with her (hopefully in bassinet thing I guess) and has to be up every couple of hours all night long, giving ample opportunities to a)check on the baby b)not squish it because you are feeding it and c)never be able to fall into that deep heavy sleep that is so bad if you are bedsharing. Please let me know if there are other reasons.

    Formula/bottle feeding in and of itself should pose no threat, unless the same risk factors (heavy sleepers, etc) are present. Like FFF says, it almost seems like FFing is associated (erroneously) with other practices that might be risk factors. Like the vaccinating…what? Honestly, from what I've seen online, there is a huge contingent of militant BFers who DON'T vaccinate (some of them believe that their babies are immune to everything due to the magical breastmilk), and that a decent portion of these bedshare. Maybe the BFing cancels out the bedsharing/non-vaxxing risks?

    Ultimately, I agree…while most of the risk factors seem like good sense (baby sleeping on stomach, too much bedding, bedsharing esp.with heavy sleepers, people under the influence,etc), I can't fathom how the BFing, FFing and vaccination status could be strong contributors in their own right to SIDS risks. I guess since once smothering is ruled out, but babies are still found dead for (at least initially) no explicable reason, people start to pull stuff out of their asses to find a reason. See Jenny McCarthy for a good example—so far, the cause of autism is still unknown, but some parents of autistic children can't accept “unknown” and have to find something to blame (vaccines, the phase of the moon, Big Pharma, whatever).

  6. wow. another reminder why i don't watch tv. GUH. Women are to balme for everything. The next episode the mom will be breastfeeding, but a druggie and the drugs she took will have killed the baby. Sometimes I feel like its more than just an attack on women about breastfeeding or not–its just an attack on women period >:(

  7. AmyM: I understand how hurtful it must feel when formula-feeding is associated with neglectful parenting, but it doesn't do mothers and babies any good to ignore the research findings and summarily dismiss the *possibility* that formula-feeding increases the risk of SIDS. Formula feeding is a significant risk-factor for SIDS and it needs to be talked about. I've never seen a PSA that mentions this risk factor, much less a popular TV show. Smoking and back-sleeping, yes, but why leave out another important aspect of infant care that parents (sometimes!) have control over? One study found a 50% reduction in SIDS deaths among 1 month old babies who were exclusively breastfed (http://www.ncbi.nlm.nih.gov/pubmed/19254976) another meta-analysis also showed a significantly reduced risk for breastfed babies (http://pediatrics.aappublications.org/content/early/2011/06/08/peds.2010-3000)

    Some reasons why ffing might be a contributing factor: formula-fed babies are less rousable (wake less often and sleep more deeply) than their breastfed counterparts. James McKenna has spent years researching mother-infant sleep (with videotape, not notoriously unreliable self-reporting of sleep patterns) and he has found significant differences in how sleeping dyads respond to each other depending on feeding method. Breastfeeding mothers are more aware of their baby's body when bedsharing and position themselves much differently in relation to their baby's body. Does this automatically make formula-feeding mothers 'bad'? Of course not, and it stands to reason that a blog that intends to provide mothers with accurate information on ffing in order to make a truly informed decision, straight talk about SIDS should be included.

  8. LosAngelesMom–ok, I didn't realize FFing was actually a real risk factor, thank you for the info. I agree, it should be mentioned. Also, I think the sleep study is very interesting, but since another risk factor is bedsharing, what if the breastfeeding mother puts the baby in a separate sleeping space? (not being facetious, really want to know) Does that affect the numbers any?

  9. I'm curious about this hypothesis that FF infants sleep more soundly because it has not been the case for us or for anyone else I know and I always put it down to an old wives' tale. Correlation does not equal causality as we all know, so I would want to see whether confounding factors for FFing and SIDS were taken into account. Your links for the studies both say “content not found,” btw, perhaps they are wrongly typed. I would reserve judgement on this causal mechanism because it sounds far-fetched.

  10. Newborns cortisol levels, which are anxiety indicators, when not with/on the body of their mothers. This is a new study and one of the authors, Dr. Bergman, is the advocate of Kangaroo Care for premies in places in the world where there are no NICU units. Good stuff.

    Biological Psychiatry
    Volume 70, Issue 9 , Pages 817-825, 1 November 2011

    Subject: “Should Neonates Sleep Alone?”

    by Barak E. Morgan, Alan R. Horn and Nils J. Bergman:

    http://www.biologicalpsychiatryjournal.com/article/S0006-3223(11)00639-1/abstract

  11. It makes TOTAL sense that vaccinating would decrease risk of SIDS, BTW!!! Vaccines mean less illness – means less gunk from the illness in baby's nose and mouth to choke on.

  12. Interesting theory, Joe, but I'm not sure it follows. SIDS deaths are usually ruled as such because there is no known cause of death. If the child choked on a snotball, I assume that would come up in autopsy??
    Fwiw, I am entirely pro-vaccine, and I'd buy that vaccines can prevent deaths from disease. But it seems that for the sake of the SIDS argument, this recommendation is used more to counter some obscure but internet-prevalent theories that infant vaccines lead to SIDS deaths.e

  13. We know that gastric emptying times are slower for formula-fed babies: the stomach is half-empty on average after 65 minutes from the last feed as opposed to 47 minutes for a breastfed baby. It stands to reason that a breastfed baby would wake up more frequently if the milk digests more quickly. Plus, a breastfed baby takes in much more variable amounts of food if fed on cue. Formula-fed babies should be fed on cue too, but they tend to be scheduled.

    Also, you've got to remember that any given baby can fall way outside the trends seen in the research. Hence the 3 week old thriving breastfed baby that sleeps 12 hours (ha!) vs. the every-two-hour formula-feeder.

  14. Sorry about the links. Try these:

    http://tinyurl.com/bfingSIDSmeta
    http://tinyurl.com/GermanSIDSstudy

    The first one is a meta-analysis that threw out any questionable studies, which gives much more data than any one study can provide. The second study had a age-matched control group and did (if I remember correctly) take confounding factors into account. They did tease out a difference in risk for partially and exclusively breastfed babies. This German study is relatively large (over 300 SIDS subjects and over 900 controls) considering how few babies actually die each year.

    Another thought: a breastfed baby might rouse more frequently if right next to mom because of her smell and proximity. This frequent rousing may be part of the protective mechanism. Breastfeeding mothers are more likely to bedshare than formula-feeders (despite the usual rec to NEVER share a sleep surface with your baby, many mothers do it at one point or another).

  15. I'm not aware of a study that includes feeding method and sleeping location in the data…have to look into that!

    According to McKenna, no baby under the age of 6mos should sleep alone in a room. This applies to breastfed babies too. One theory is that babies don't regulate well at all and hearing mom breathe helps to remind them to breathe too. Also, if you are *right there* it's much, much more likely that you would respond to anything odd happening in the co-sleeper or crib (or next to you if bedsharing). Monitors just don't cut it apparently. As much as parents want babies to sleep through the night, you WANT them to be light sleepers (they naturally are) and to rouse frequently for their own safety. McKenna does NOT recommend co-bedding for formula-fed babies, but the risk of SIDS in terms of location only increases when baby is sleeping alone in a separate room. Definitely made me think about naps!

  16. Right, but I was asking (not clearly, sorry), since you said a bedsharing, BFing mother is more aware of her infant, if the BFing mother puts the infant in a cosleeper, she wouldn't be any more aware of it than anyone else who is not bedsharing, no?

  17. Actually, whether it is a risk factor or not is far from settled. The AAP statement on Breastfeeding states that breastfeeding may protect against SIDs (but states that this is not clear and further research is needed), while their SIDs statement says that the evidence is conflicting and that breastfeeding itself is unlikely to be protective against SIDs since the effect disappears as confounding factors are considered. http://aappolicy.aappublications.org/cgi/reprint/pediatrics;116/5/1245.pdf

  18. First I've heard about gastric emptying times – do you have a citation for that? Perhaps it's because my baby fed on a highly pre-digested formula due to protein intolerances but he was just as hungry just as fast on formula as on breastmilk (did both, with more BM for about 5 months). As for formula fed babies “tending to be scheduled” I don't think that holds true any more. The medical advice is all against scheduling and has been for decades. Certainly I never scheduled mine nor have my two friends who have had to FF.

    I see how some of these arguments might be plausible but I've heard them repeated without real evidence before and I'm very sceptical about “tend to be” and “we know that” arguments.

  19. I don't know a single formula-feeding mom who “schedules” feedings, and certainly my son was always fed on demand. And I wish I had one of those (possibly mythical) formula fed babies who actually slept more – my kid was up every 1.5-2 hours to eat for more than a year, and didn't sleep through the night until after 2 years. And we did bedshare (safely – no quilts or soft beddings, etc), and I was continually aware of where he was in relation to me all night – not that I ever had any really deep sleep, see “up every 1.5 hours”, above. Frankly, I really treasured our bedsharing that first year, since I felt that the extended skin to skin contact it facilitated was very beneficial precisely because I couldn't breastfeed and was looking to do anything I could to facilitate that close physical bond. Those night lying together and breathing in tandem together are my most favorite early memories.

  20. Here's the gastric emptying study: http://www.ncbi.nlm.nih.gov/pubmed/10400103

    Title is “Gastric emptying in formula-fed and breast-fed infants measured with the 13C-octanoic acid breath test” (I'll bet you can't wait for the TV movie LOL…)

    I don't know what kind of formula was used and the sample size is pretty small fwiw.

    Sorry to presume that ff babies are still scheduled…no evidence here as you suspected.

  21. Great question–I don't know! A breastfeeding mom might be woken up b/c of engorgement as it comes time to feed the baby. So many variables here. I'm sure James McKenna talks about this in his research b/c his rec is clear: breastfeed=baby in bed or in the same room on a different surface, ffeed=baby in the same room on a different surface ONLY. I need to look at his rationale again, because how awful to deny ffeeding mothers the opportunity to share a bed with their baby : (

  22. Ariel–sorry about my ignorance re: scheduled feeds. I know it's possible to overfeed a baby via bottle and that baby-paced techniques should be followed. I don't always see this happening out in the world, though. I hear you–if I had not been able to breastfeed and been told to not bedshare with my precious babies I would have been heartbroken…it is delicious!

  23. I know what you mean. There is a tendency to blame moms when their kids have medical problems. If they had just done this or that, their LOs would be all right. Maybe, maybe not. Having had medical problems of my own, I have noticed to tendency to blame me/ assume I must have certain unhealthful habits (esp. in terms of diet and exercise.) Doctors are people too. Sometimes I think blaming the parents/ patients is easier than saying, “I don't know.”

    It also seems to me that extreme BFing advocates are always looking for another reason to BF, oftentimes with questionable research to back it up. Why not stick to better documented arguments? Breastfeeding is associated with slightly lower rates of ear and gastrointestinal infections, not needing to prepare bottles, more portability (IF mom and baby go out together), can be more economical (IF nursing doesn't mean too much lost wages, extra childcare, special gear, LC appointments, etc), can be a bonding experience (IF mom and/or baby don't have too much difficulty and enjoy BFing), etc. Those are all good reasons to BF. I think a lot of moms would choose BFing for those reasons alone. But nursing would not look like an imperative. If formula was a better choice for a given family, no biggie. The cynical little voice in my head says that certain BFing advocates want nursing to be viewed as important– not just a good option in many cases. This is where I get confused. Why would the latter mentality be so bad, unless these extreme lactivists really believed that BFing was vastly better for babies/ formula was bad? Oh wait, they do. *Sigh* Why do they think this? I kind of understand from an intuitive standpoint. Human milk would probably be better than a substitute that was developed in a lab. However, studies have found little difference between people who were BFed and FFed. Most babies do fine on formula. And they turn into healthy, intelligent, well-adjusted adults. So do most breastfed babies. I thought that was the end goal. Why does the infant feeding method used to achieve it matter so much? How did the breast vs. bottle debate get so blown out of proportion?

  24. Well, I guess I will confess to being one of those horrible moms who feeds her child on a schedule. I was taught to do this at the hospital, while BF and in all honestly I don't see what the big deal is. Knowing that she needed to eat every x hours was a good thing and helped prevent meltdowns. Of course if she was obviously hungry I was not going to wait until x time to feed her, but I guess I am also one of those horrible moms who has a hard time reading baby's cues because it seemed to me that she showed no signs of hunger until screaming. Things just went more smoothly when she was fed at regular intervals. She thrived on having a predictable routine and it was good for my sanity as well. It's pretty much impossible to get her to eat more than she wants, so I'm not really concerned about overeating either. All babies are different and this is what worked for us.

  25. It's precisely because there are so many variables that I am very skeptical of such claims. If there is a correlation between formula feeding and SIDS, it is just that: a correlation. What other factors were involved? I think it's *very* dangerous and patronizing to tell parents (but who are we kidding… mothers will be the ones getting the blame) “formula feeding is linked to greater risk of SIDS” and leave it at that.

  26. I also don't see what's so bad about scheduling. It's often tossed around as an example of “bad” parenting… but if it's what WORKS for a family, what is so bad about it? Sure, if someone is depriving their obviously hungry baby of food because it's not 3:00 yet, then that's a problem… but that seems like a pretty obvious strawman (or strawmom!) to me. To me, the bottom line is finding what works for your family. This will obviously be different for everyone.

  27. Depending on the nipple and how a caregiver holds a bottle and responds to baby's need for breaks, a baby can have much less control over the intake via a bottle. Some bottles dribble milk into a baby's mouth regardless of whether or not they are sucking (this can happen with bfeeding too if mom has a crazy MER, but it won't be so consistent as the flow of milk from breast to baby is much more variable and dependent on how the baby suckles, degree of breast fullness, etc.) You cannot cajole or force a baby to feed from the breast. A bottle, with help from gravity and poor technique from a caregiver can result in overfeeding. Past the newborn stage, the stomach can be overstretched with too much milk. Not likely at all with breastfeeding as the baby usually has to do more work (esp. at first to stimulate the MER which shoots milk from the alveoli to the duct openings at the nipple) to transfer milk from the breast.

  28. Scheduled feedings may work for some dyads, but can also be disastrous and lead to a tanked milk supply. One major factor is the mother's storage capacity in her breasts (doesn't correlate neatly to breast size, btw). Storage capacity varies a LOT from woman to woman and even from one breast to the other in same woman. Ack–I can't find my reference atm, but in one study the range of milk storage capacity among the subjects was something like 3oz to 17oz!!!! A woman with small storage capacity can make just as much milk as woman with more over the course of a day, but she'll need to drain the breast more frequently (the more empty the breast, the *faster* milk is produced). This storage capacity issue also relates to whether the baby takes one or both breasts at a feeding.

  29. ALL of the risk factors for SIDS are based on correlation. Same goes for autism, heart disease, cancer, etc. Health outcomes tend to be too complicated to be linked to a definite cause and to do a double-blind randomized trial assigning feeding method would be practically and ethically impossible. I would counter to say it would be dangerous to NOT let parents know that ffing (and everything else) is correlated to a higher incidence of SIDS.

  30. Actually, I'm not sure that's entirely accurate, although I appreciate the argument. While human experiments are deemed unethical, we have no problem doing awful things to animals, unfortunately. And there have been numerous controlled studies on rats, monkeys, etc in regards to cancer. Not sure about autism as it is less understood as a disease and perhaps harder to diagnose/evaluate in animals. But I do not know of any experiments on animals which attempt to prove a biological superiority of breastmilk. This is something I have advocated for- less pointless studies showing correlation to better outcomes and more studies about how breastmilk operates on a chemical, biological level to confer these benefits.

  31. I'm pretty sure the M.I.N.D. Institute at U.C. Davis has worked with monkeys/apes in terms of autism. The last I read (a few years ago), they were able to isolate a maternal antibody through those studies.

  32. I found it impossible to overfeed my FF baby – he was a slow eater, he was a “snacker” in that he only liked to drink a little at a time, on a more frequent basis and the one or two times I tried to get him to eat more than he wanted to – he promptly upchucked all over me. He hates any kind of “fast flow” nipples and we used the newborn ones until he switched to cups at 15 months. I worked on understanding his cues and letting him lead the way with respect to feeding. He's now a very lean preschooler who won't overeat, and continues to eat in very much the same way (small frequent meals, that change according to his current needs, growth spurts, etc.) – and we continue to allow him to lead the way.

  33. Correct bottle-feeding technique has become a major pet peeve of mine so I always advocate for it… most people DON'T know the correct way to bottle-feed a baby. This is why I always say that all those supposed bad things that are linked to bottle-feeding are actually linked to *improper* bottle-feeding. That said, I am doubtful of claims of overfeeding… if a baby gets too much, he or she will spit it up. There are other problems associated w/ incorrect bottle-feeding technique, such as increased risk of ear infection due to milk backing up into the ear. But overfeeding doesn't strike me as a major problem.

  34. Totally agree about technique–it's important! Adults eat too much all the time and don't spit up, so I don't agree that we can assume that a baby can't be overfed. I'll have to look and see if there's any research on this.

  35. Granted, I took stats a few years ago. But under 30 is not even a statistically significant sample. Before you chide a great resource like FFF for not including what you consider to be sound research, perhaps you ought to assess whether your belief that this is good research is, itself, biased beyond what is truly helpful.

  36. Allow me to bust the stereotypes like Ariel did. My baby is 18 months and still doesn't sleep through the night. The second her breathing changes, I'm awake. She is in a very low percentile of weight (high for head size, average height) and was FF from 6 weeks onward. We co-slept for a while–when it was clear that she needed it–and stopped when it was clear she didn't. Whether she was in bed with me or not, for the 10 months she shared a room with us, I pretty much didn't get a solid hour of deep sleep the whole time. This notion that FF babies are more prone to SIDS because the mothers aren't as attuned to them is complete bullcrap to me, and I fail to be convinved by a handful of studies with low sample size or any of the other myriad reasons breastfeeding studies are typically inherently flawed.

    She has always eaten as much as she wants and has always made it clear exactly when she will eat nothing more. She was fed on HER schedule–which was pretty regular. I let her establish the schedule, but I looked at the clock at 2 pm and figured I'd better get the bottle ready because sometime within the next 10 minutes, she'd be hungry. And surprise surprise, she was. Because infants need to eat often. I don't care what you're fed, if your stomach is the size of a golf ball, you need to eat often.

    All of this “no scheduled feeding” and “overfeeding” snobbery that arises out of some breastfeeding activists really needs to stop, before they start out-and-out advocating starving babies out of fear of obesity. When I was dead set on breastfeeding I was told that even if my baby was not showing signs of hunger, a newborn HAD to eat every two hours, and you were a horrible mother worthy of having child services called on you if you didn't do this. Round the clock, whether the child was sleeping or not. This was also the only way to maintain supply. This was by a certificed nurse-IBCLC instructor at a very good hospital in my area. If that isn't feeding on a schedule, what is? Was I booby trapped by Big Formula? NO. I was booby trapped by Big Breastfeeding. Furthermore, do you get forced into the Bad Mommy club if your baby puts herself on a rough feeding/sleeping schedule? Baby-led is baby-led.

    My point? Babies aren't robots. They're people too, and none of us have exactly the same tastes and habits when it comes to food. It's time to stop treating people like they're clones of each other just because they're too little and helpless to knock some sense into the adults.

  37. I have never talked to someone who feeds on a schedule who has ever said she denies feeding if the baby is hungry before usual. My baby scheduled herself. I tend to think a LOT of kids do this because there's only so far a tiny stomach can go before it needs to be filled. If your baby likes the schedule, are you a bad mom for going with that schedule, or are you a bad mom for not doing baby-led feeding? Ah, that's the ticket–some folks are just out to make people feel like bad moms, no matter what they do. The only people who win in no-win situations like this are the bullies. It's very telling…

  38. See, when I hear “scheduled feeding”, I assume that baby gets fed on a schedule even if she/he's hungry before then. I have a cousin (who actually BFs) who was following some book that mandated strict schedules from something like 4 weeks onward, and listening to that poor kid wail for an hour because he wasn't “scheduled” to eat was excruciating. It seriously made MY boobs hurt and I didn't even have any milk! When you say that you feed your kid when she's hungry, but that she tends to get hungry on a predictable schedule, or that you need to feed a preemie/newborn/low weigh kid frequently even if they don't seem hungry, that seems totally different to me than when I think of as “scheduled feeding.”

  39. Adults eat all the time and don't spit up – err, babies are not adults. Any ped will tell you that if a baby is fed too much s/he will throw up and this happens even when Bfing – e.g. my baby was reflux-y and had intolerances so had stomach pain and would want to feed all the time (I was BFing at the time with about 20% formula feeds) and because baby was eating for comfort and then throwing up the docs suggested spacing out the feedings more (feeds were every hour, seriously, for about half an hour). You get guidelines when FFing for how many oz a day the baby needs and most babies will turn their heads away when they've had enough. Babies are not stupid whether BF or FF and they can reject excess food. I've done both feeding methods and baby actually gained better on the breast and never downed more than expected with the bottle. A lot of the stuff you're citing on formula fed babies sounds like a set of negative assumptions about FFing, sorry to say.

  40. When I hear “scheduled feeding” I think of those books from the 70s that our moms read that told you to get your child on a four-hour schedule as early as possible, and I think perhaps some of that advice is still out there – i.e. discipline your child for your own convenience – that is BS for ages newborn to about three months. Thereafter I think most babies develop schedules of their own and by about 8-9 months certainly one can predict when they will be hungry so that's another kind of scheduling. I think it's good to be clear on what we are referring to, and and what age, when we say scheduling though.

  41. Perhaps LosAngelesMom means well. But I've seen far too many examples of late of breastfeeding activists starting out all nice and supportive, when their true agenda is a sneaky subterfuge of bottle-feeding parents. It's the bottle-feeding equivalent of booby trapping. Instead of raising a knife dramatically and stabbing it into our hearts, instead it's a more quiet, subtle shivving between the ribs from behind. So please forgive me if I'm suspicious, here.

    http://www.fearlessformulafeeder.com/2011/07/venus-fly-booby-trap.html

  42. I think it could be possible to overfeed a formula fed baby, but I also think it is possible to overfeed a breastfed baby, as I've done it. I think all parents should be taught to be responsive to a baby's cues for hunger and fullness, and to develop a routine that works for both them and their baby around the baby's natural rhythms.

  43. Babies have immature gastric sphincter muscles, which is why they spit up. http://www.mayoclinic.com/health/infant-acid-reflux/DS00787/DSECTION=causes
    So not really like adults then. Up to 50-70% of infants do spit up to some degree. More so with premature infants. In addition reflux babies, either breast fed or formula fed, will frequently overeat to soothe their throats. Sometimes tongue ties (which have their own set of BF issues) can exacerbate reflux symptoms.

  44. Sounds like a whole lot of mother blame. I haven't watched SVU for some time now, most TV's writing is too fantastical/wacky/outlandish for my tastes these days. Not to mention poorly scientifically based. Wonder if SANDS has a statement on the show?

    This is my favored theory on SIDS/SUDI http://www.brianpalmerdds.com/sids_otitis.htm My take on it: proper oral development (which can, but may not always be, provided by breast feeding) allows appropriate development of the mouth. Inappropriate development of the mouth (caused by various factors) can lead to obstruction of the infant airway during sleep.

  45. Yes, I'm out to get all of you…geesh…I'll continue to read the blog so I can better serve the mothers and babies I try to help, but it's clear to me that many of the posters here are not interested in any real discussion and often succumb to confirmation bias (see http://en.wikipedia.org/wiki/Confirmation_bias) at any mention of the risks that might be associated with formula feeding (and yes, I admit I have my own biases, but I am willing to allow them to be challenged).

    Bottlefeeding technique IS important for many reasons (airway safety, baby's ability to stop eating when done, balanced eye development, eg). With all the bottle-propping of NEWBORNS I've seen out in the world, the message is not being sent or maybe just not received.

  46. Granted this is a survey that relies on self-reporting, but http://www.ncbi.nlm.nih.gov/pubmed/20004633 found that over 50% of the mothers surveyed thought they should “always make babies finish the bottle.” I'd like to see research that addresses your theory that a baby will simply refuse or spit up any extra milk and that overfeeding via bottle (or breast!) is impossible or even a rare occurrence.

  47. Mine scheduled themselves too…initially, we were told to wake them every 3hr to eat because they were a little preemie and would sleep instead of eating and lose too much weight. After 2wks, we simply waited for their cues (fussing/crying) and both of them generally went 3-3.5hrs between meals for the first 3mos. They would stop eating when full too…sometimes the bottles would be finished, sometimes not. They've never risen above the 5th percentile in weight/height, so we're not real concerned about obesity at this point.

  48. Mothers thinking they SHOULD make babies finish a bottle is not the same as babies finishing a bottle. I don't know if you've ever bottle fed a baby but they do push it away. Others here can probably weigh in too. My pediatricians who see hundreds of babies a month and every ped I have seen will confirm that. Of course mothers have their own interpretations of when a baby is full and advice will vary (e.g. old school ped I went to first said no more than ten minutes of nursing per side which was totally wrong). One study of one narrow population of mothers in which 50% said they felt they should make their babies finish the bottle doesn't say much about whether the babies do.

  49. In what capacity have you seen bottle-propping of newborns? You said you were not aware that bottle feeders did not necessarily schedule feeds. Some of your arguments are extrapolated from narrow specific studies and then use a “we all know that…” argument to make a case for why FFing may be a risk factor for infant deaths. It's fair to ask, I think, what your position is here – are you a lactation consultant? Have you fed a child? Multiple children? What is the motivation to make this rather tenuous connection between SIDs and FFing?

  50. The James McKenna study is about cosleeping primarily. You seem to be jumping from one variable to another. Are there studies that specifically deal with FFing and SIDs risk without being primarily concerned with other variables? The only scientific assessment of the correlation between SIDS and BFing/FFing I've seen (courtesy this blog) shows that the argument for increased deaths is totally unrelated to feeding. http://stats.org/stories/breast_feed_nyt_jun_20_06.htm

  51. FWIW I followed the links to the AAP's recommendations on avoiding SIDS and read some of the studies and they also say bed-sharing can increase the risk of SIDS by up to 50%; the studies you cite however suggest that bed-sharing may have a protective effect. I am agnostic on this but wonder what you all think about that. If studies are divided on cosleeping but you enjoy it and have every reason to believe it's safe, you'd still do it, and I would still support everyone's right to; but on FFing the vaguest of correlations gets everyone worried.

  52. So first of all, that study doesn't really say anything about bottlefeeding mothers at large because it's only Latino WIC mothers, second it demonstrates that the belief that a bottle must be finished is more widespread among those of foreign birth and those who lack a high school education. All this tells us is that some women are in need of more education on bottlefeeding particularly if they were born outside the US or lack education in general.

    I'm not saying that no baby can ever be overfed, but I do object to the notion that a breastfed baby can NEVER be overfed (I've heard this many times) but that overfeeding is a risk for all bottlefeeding babies. I suspect that babies are as varied as older human beings and some of them will steadfastly refuse more food than they want, some will spit it up, and some will continue eating because they find it comforting or because they still feel hungry or whatever other reason humans eat when they don't technically need more calories. The problem is the generalizations. My daughter has been a slow gainer and sometimes she eats very little formula which scares me. There are times when I would like to get her to eat more but I can't because I can't force her to eat when she doesn't want to. I do not think my daughter is unique in this regard.

  53. Ah sorry I just saw these links, got buried under new comments. The German study looks decent; the meta study says there were too many confounders and they rule the correlation is inconclusive.

  54. I don't think formula fed babies “tend to be scheduled”. I think formula fed parents get a lot of conflicting information on how to bottle-feed correctly and are misinformed that they need to treat feeding like a science experiment by care providers trying to impart a negative image of bottle feeding in comparison to the beautiful, magical act of nursing. We are told that we need to be careful not to overfeed our newborns while simultaneously being admonished to “learn to read feeding cues”. Which is it? The only way to be sure we aren't overfeeding is to follow vague, one-size-fits-all prescriptives which tell us that every 2-3 hours we should give 1-2 oz or what have you. This may lead to scheduled feeds, but I think it could be argued that for many families, this is a direct result of the pressure put on bottle-feeders (including exclusive pumpers, of which I was one, and was told that I was “overfeeding” my IUGR baby) to not overfeed.

    In terms of the gastric emptying, it's an interesting theory. But a difference of around 15 minutes shouldn't make THAT much of a difference in rousability, should it? I don't know enough about the correlation between SIDS and rousability to weigh in on this one, but I would be hesitant to base any recommendations purely on the work of one man who is admittedly a breastfeeding and cosleeping advocate, and thus has a heavy bias coloring his work.

  55. Yes, but as I sarcastically pointed out in the post, McKenna has made it his personal mission to tell formula feeding parents not to co-sleep as co-sleeping is only dangerous if you aren't breastfeeding. So even if we WANT to co-sleep, we are warned not to.

  56. I don't think you're “out to get us” and I think overall, this discussion has been informative, interesting, and respectful. You've shared studies, readers have voiced their opinions. I don't believe this is a case of confirmation bias, but more that the readers of this blog tend to be rather well educated and well-versed in reading scientific literature in a critical way. I know that in my case, my experience in studying the particular issue of BF vs FF outcomes- one RIFE with confirmation bias, ironically- has made me skeptical of all research, especially as reported by the media. For example, there was a recent study linking vitamin supplements with earlier death. The first thing I thought was “I wonder if they considered that the folks who were loading up on these supplements may have been in poor health to begin with or had a family history of disease and therefore wanted to pop vitamins as a preventative measure?” (Haven't had the time to look at this study, so I hope that they did control for these things, but I have no idea). A few years ago, I probably would've thrown out my One-a-Day's in a panic.

    Anyway, point is, things get heated when we are talking about something like SIDS which is a highly emotional topic for most parents. And I think some of us are on edge since we have endured our fair share of breastfeeding advocates who come on here pretending to be interested in a friendly debate and turn ugly when people begin challenging their assumptions. I do not think you are intentionally antagonizing anyone and I appreciate your willingness to listen and learn. I hope you'll stick around, because I think it's wonderful to have someone challenging us and making us dig a little deeper to find factual confirmation for our assumptions (and I hope the same is true on your end)!

  57. Confirmation bias goes both ways. With the SIDs research, you're right that most of what we know is correlative, but for some of the items there is much stronger reason to suspect a causative connection. Breastfeeding is not one of those areas, and the actual text of the new AAP statement is actually pretty conservative in the “breastfeed to prevent SIDs” recommendation. Compare the language on breastfeeding to the other language in the statement.

    I see as much bias towards research on the pro-breastfeeding side as on the “it doesn't matter that much” side. An individual study means little outside of the overall context of the research, which very often is a mixed bag. I continue to see benefits of nursing promoted which are actually believed by most researchers to not be benefits at all, such as higher IQ.

    I am actually a breastfeeding mom, trying to convince my 3 month old that he actually likes the taste of soy formula, so I can wean him and get back on meds I need for my mental health. He is my fifth nursling, the others were all breastfed over a year. I see bias on all sides.

  58. My SIL bottle props for her new baby, just turned two months, and has for some time, because she has too much to do to sit and feed him. Bad feeding technique is out there, but it is only going to get worse if we can't talk about the healthy way to bottle feed, because we can only talk about how much worse bottlefeeding is than breastfeeding.

  59. It's also just a little bit confusing when someone cites a somewhat inconclusive study to show a frightening correlation (FF and SIDS) and then hops on to other variables as reasons why FF babies may be more at risk (tanking out on overfeeding/mothers can't read their cues/look at all the ways in which FFers do things wrong) but doesn't address the fact that some of these studies are actually warning us against practices other than FFing, mainly bed-sharing. If you want to start out with studies that show risk factors for SIDS and consider what we can do to lower the risk, that's one thing, but when you emphasize studies and recommendations selectively (e.g. ignoring AAP's rec to discourage bed-sharing just as much as encourage BFing to lower SIDS risk) that sounds like cherrypicking evidence to make a very specific case against FFing rather than addressing the relative contribution of feeding practices as a risk factor among the several other factors for SIDS.

  60. Not sure if the data actually supports the conclusion in the meta-analysis, but they do state that “Breastfeeding is protective against SIDS, and this effect is stronger when breastfeeding is exclusive.” I'm not sure where you're seeing the inconclusive correlation.

  61. So the study has no relevance because the subjects are “only Latino WIC mothers”? 15% of the U.S. population is Hispanic and 50% of all American women with newborns receive WIC benefits–not exactly insignificant in my book. I agree that correct and safe bottlefeeding needs to be taught, but I'd like to see the evidence that you propose: only poor, uneducated, foreign, etc. etc. mothers coax a baby to take the entire bottle. And even if only THOSE women do it, it IS happening and will impact outcomes.

  62. I've seen bottle-propping many, many times in strollers and bucket seats around town. No data, of course, just observation. I am a volunteer breastfeeding helper and both of my children were/are breastfed. I often talk to mothers who are combo-feeding and/or wanting to breastfeed (relactate, bring baby back to the breast) so I need to know about bottle-feeding too. That is why I am here.

    As for the tenuous connection btween ffing and SIDS, I am going to hark back to the original subject for a moment: SVU and media portrayal of SIDS wrt infant feeding. In terms of the public message about SIDS, every PSA I've ever seen talks about “back to sleep” and ABSOLUTELY NO BEDSHARING. I have never seen breastfeeding mentioned in relation to SIDS and even one reader here was surprised that a correlation had been found. Looking at the German study, it seems very, very important that people are aware of the correlation (just as with smoking, etc.) I wasn't trying to ignore the bedsharing issue at all, but the convo was looking at ff and SIDS and so I presented a study that showed a correlation.

    We can poke holes in studies all day, but isn't our job as critical readers to see the limitations AND the possible truths contained within a study? I'm new to reading research and would be happy to read well-done studies that don't find a correlation btween ffing and SIDS, but that stats link you posted doesn't seem to be referenced (maybe I'm missing something) and those writers make tons of claims that I'd like to see backed up.

  63. I absolutely agree that it matters, but I think it is a valid and important point that Ariel makes – ethnicity and socioeconomic status are significant, classic confounding factors. The problem with so many formula-related studies is that it's difficult to separate behavior from feeding method… so these things do matter. The readers of this blog are from a wide variety of countries, ethnicities, and income brackets, but most of us are fairly well-educated, even if that education is of the self-taught kind. We also are mothers (and once in a while, some fathers) who care enough about good parenting practices and health to be on a blog talking about social and health issues. So I think we get frustrated that we have to be “schooled” or warned about things like bottle-propping…

    As the bulk of the exclusive breastfeeding set is older, highly educated, and upper-class (and predominately white, at least in the US), this also means that your “camp” gets the folks with the best food, the best healthcare, the best jobs, etc. Whereas we need to be lumped with people who could give two sh_ts about what their kids are fed. (BTW I am in no way referring to the study in question – the only confounders that should matter in that case are cultural and socioeconomic norms, IMO…) So that kind of skews the overall outcomes for our “population” of formula feeders. It gets frustrating explaining that we do not need special help in basic nurturing skills just because we are bottle feeding.

    As for this study, I think Ariel's point was more that all the research proves is that bottle propping is prevalent in this one subset of parents. Doesn't prove anything about the prevalence of bottle propping over a large population, considering it only used one particular group as a sample. So I would agree that within this particular group, there should be some education about the dangers of bottle propping for newborns.

    One last point – many busy daycares (the kind where I expect a lot of these kids whose parents are on WIC have to go to, as they can't afford private nannies or small exclusive in-home daycares) do bottle prop out of necessity. Not sure if they discussed this in the study or not, but it would certainly alter the results. I'd be interested in the dynamics of childcare in this sample, b/c if one caretaker is in charge of many infants, bottle propping may be a necessary evil.

  64. I was not trying to do a lit review here! The original blog post and some comments made me do a search on PubMed and I posted a few findings. Then most of my findings were shot down as biased, insignificant, etc. Other than that puzzling stats article you linked to, I've yet to see anyone post research for us to sink our teeth into and discuss that finds that there *isn't* a correlation between SIDS and ffing. It's probably out there; my cursory look (there are only so many hours in the day LOL) didn't find them, but maybe others will have more luck. The only reason I “ignored” the other contributing factors in SIDS is because I thought we were discussing feeding method and SIDS specifically.

  65. Here's a few that claim that the correlation is too weak to make it a good public health move to promote breastfeeding as protective or say that the correlation wasn't significant, etc- don't wanna pay the fee to download the whole thing for any of these, so I'm just going off the abstracts (not a good way to do things, but I'm rather skint at the moment). Granted, these are all rather old, so I am aware that there is new research out there that might counter these findings. But still, since you asked, this is what a 10-minute search turned up:

    http://onlinelibrary.wiley.com/doi/10.1046/j.1440-1754.1998.00225.x/abstract

    http://www.pediatricsdigest.mobi/content/100/5/835.short

    http://ije.oxfordjournals.org/content/18/1/113.short

    I'd also like to bring up the fact that pacifier use has been shown to be a significant tool in reducing SIDS risk, and yet this message has been ignored due to fears that pacifier use will discourage breastfeeding. I'd like to call “bullshit!” on that one, as my high school group of friends used to say…;)

    http://pediatrics.aappublications.org/content/117/5/1755.short

  66. Oh wow, i never knew about the tongue tie effecting reflux. Tongue tie runs in my family (i am severely tongue tied) and so is my (was, shes not anymore) refluxy daughter. I wonder how much this had to do with it.

  67. I was quite shocked to see a photo of a friend's 3 month old baby on facebook with her bottle propped. It's one of those prejudices that I have – that educated women don't do that, and my friend definitely doesn't fall into that category.

  68. The study is relevant to the group which it studied. It is not appropriate to say that 50% of bottlefeeding mothers, in general, think babies should finish their bottle when the study only found that 50% of Latina WIC mothers in a certain region do so. That is misappropriating the study's findings. I did not say “only” uneducated, foreign mothers coax a baby to finish a bottle. I was merely restating the findings from the link you provided: “Pressuring feeding style was associated with foreign maternal country of birth (adjusted odds ratio [AOR] 3.05; 95% confidence interval [CI], 1.66-5.60) and less than a high school education (AOR 1.81; 95% CI, 1.12-2.91).”

  69. I've bottle propped, and I can assure you that my son is no worse for it. He was a very independent child and preferred to hold his own bottle. And he only ate until he was full. I think that it's equally as dangerous and presumptive to assume that one method of bottle feeding is “right” for all families and every other way is “bad.”

  70. Fair enough – I suppose the part that confused me was the jump from “there is evidence that BFing is protective against SIDS” to “the causal link is probably all the stereotypically negligent stuff FFers do, like overfeed their children/schedule them/etc.” Other than the German study there isn't really one that adjusts for other risk factors and I still don't see a plausible causal link between FFing and SIDS (other than the suggested one of FFed babies sleeping more deeply which is just not true in the case of pretty much everyone i know, sadly – wish it were!) When there are other pretty well established risk factors with plausible causation like smoking, bedding, ear imbalance that stops a baby from adjusting position when suffocating and so on, it seems less important to me to focus on feeding.

    The STATS article, btw, was about a much publicized study that claimed to show FFed infants were more likely to die, period. Turned out to be a bit of an exaggeration to say the least and was debunked by a bunch of scientists.

  71. I'm curious about this Brooke b/c my baby wanted to hold his own bottle at around 8 months but before that really wasn't in a position to and I was told the risk was for babies who are too small/weak to be able to turn their heads away when full. I understand “propping” to be “not the baby holding the bottle but something else holding it up so the baby can't push it away” – is that the generally understood usage?

  72. Me either, Kate! I am going to look into this… FC was tongue tied, but we got it fixed and he never had reflux… but Fearlette had major reflux and wasn't tongue tied, far as I know (she latched perfectly at the hospital, at least). Hmm. Interesting….

  73. I was going to come on and ask the same thing. In my mind, “bottle propping” is something done with babies who cannot hold their own bottles, usually by wedging something in to hold the bottle in place – the risk being that the baby may not be able to turn his head away which could lead to overfeeding at best, choking at worst. Bottle HOLDING is a different thing, and one which I fully encourage. If your baby wants to hold his own bottle, more power to him. You can still hold him and play with his cute little feet, hands free. ;) And there is NOTHING wrong with encouraging independence. I think we could all stand to do a little more of that with our kiddos these days!

  74. I see it a lot here in LA too. I also see a lot of people feeding fruit punch or Coke in a bottle which makes me nutty.

    But I think we might have a warped idea of what “bottle feeders” are, living where we do. The LA area is a place where breastfeeding is the “norm” for white, upper-middle-class, educated parents. I also see many lower-income Hispanics and Asians (where I live, these two groups are the majority) breastfeeding. Most of the folks I see bottle feeding are young, often teenage parents, or parents with like 10 kids, usually a few of which have bottles. I would assume that these folks do quite a few things that would be considered “taboo” to most of the greater LA parenting community. Hell, a lot of what I do is contrary to the greater LA parenting community, but when I go back to the Midwest, everyone thinks I'm all crazy-California. Things really do vary by ethnic group, social class, and geographic area.

  75. Yeah I think bottle propping is different than letting the baby hold their own bottle. I have never seen anyone propping a bottle in public. The only person I know of who has sort of bottle propped is a lady with triplets. She has these little slings that hook on to their infant seats and hold the bottles. But I don't think this would work for a newborn. Anyway, I can hardly blame her considering I have no idea how I would be able to meet the needs of triplets while maintaining my sanity.

  76. Kellen was kind of a Herculean kid, so he held his bottle early. But even so, I know that I propped it at times. It wasn't in an attempt to be neglectful but rather because I was sick and trying to manage in any way I could. He still managed to push the bottle away when he was done if I remember correctly. And he pretty much spit up everything he ever consumed anyway.

  77. This is a very important point: what does “bottle propping” really mean? As far as I can tell, it's pretty much another avenue to attack bottle-feeding parents based on outdated information or one-size-fits-all ideals.

  78. It's more commonly associated with posterior tongue ties. The research on tongue ties is incredibly poor as it is, and posteriors even more so. Most of the relevant work comes from dentists. Dr. Lawrence Kotlow has written a few articles I believe.

  79. Becky (with apologies to everyone else, because I know this is going OT), that theory of Brian Palmer's has a couple of massive holes in it.

    Firstly, the timing is wrong. He cites a 1977 paper which says that the epiglottis descends from 4 – 6 months and that this corresponds to the peak in SIDS incidence, from 3 – 5 months. Now, obviously, even those figures don't quite match up, because that would have the SIDS incidence peaking just ahead of the age that the epiglottis is descending. But more recent statistics give an even earlier peak age for SIDS, around 2 months – see the first graph at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;116/5/1245, under the introduction. According to those figures, the incidence of SIDS has peaked and dropped considerably again prior to the age of epiglottal descent, and continues to drop steeply during the age range in which the epiglottis would be descending. So that's against his theory.

    Secondly, if his theory were correct then pacifiers would be expected to be a risk factor for SIDS. In fact, a meta-analysis shows a strong association between pacifier use and reduced SIDS risk (it's online at http://pediatrics.aappublications.org/content/116/5/e716.long). Interestingly, Palmer obviously realises that this blows a pretty awkward hole in his theory – elsewhere on his site he's got another presentation claiming to challenge the recommendation to use pacifiers to prevent SIDS, which is, frankly, downright dishonest in the way he presents the evidence. Rather than discuss the study on which the recommendation was based, he claims that it was based on various 'assumptions' that the AAP have made, none of which were in fact the basis for the recommendation and some of which don't even correctly represent what the AAP has said on a particular subject. Very slimy – I lost all respect for him after reading that.

    (Sorry again, everyone. I'm supposed to be doing tax-return-related stuff and am absolutely desperate for any kind of a distraction. As you can see.)

  80. If you go to the SIDS statement I posted above, from the AAP, and you read their discussion on breastfeeding, you can see that they talk about and cite studies which show a correlation between breastfeeding and lower SIDs rates and studies that don't. That's why I pointed out that the technical report on the new recommendations wasn't published yet — because there will be discussion of the findings that will almost certainly be more nuanced than “breastfeeding prevents SIDs.”

  81. Did you read the discussion in the AAP statement on SIDs, the one I linked? Unfortunately, the discussion for the new statement isn't available.

  82. I had understood that bottlepropping means when the bottle is not being held by a parent but the baby and bottle are propped up on objects and the parent may not even be in the same room. My SIL I mentioned above swaddles her baby, places him on his side in a curved pillow, and uses a stuffed animal to prop a bottle in his mouth. He naps and eats, and she cleans or cooks etc., not necessarily in the same room.

  83. Hmm, so interesting.
    Because I'm tongue tied and bottle fed from birth we never even bothered getting their tongue ties dealt with (sidenote: I get asked weekly why i don't just chop mine now by the way, hmm well besides the challenge and joy of learning to talk again… whats the point?) but evie was so refluxy when she was a babe, I wonder if this had anything to do with it.

  84. Thanks for that. I certainly don't take his theory as gospel, nor do I agree with all his points (for one I believe I've read a hypothesis that pacifiers reduce SIDS risk because the act of sucking keeps the baby from dropping into a deeper sleep. No citations for that off the top of my head). So if I did believe that pacifiers were causing slight oral malformations, less of an issue with all the orthodontic ones currently on the market I'd imagine, then the benefit of the sucking action likely supersedes any risk from oral malformation). I'm actually kind of surprised I agreed with what he wrote at all as I have an aversion to websites that give off a crackpot vibe, but some of the anatomy points do make sense and indicate to me that oral development could be a strong, but not only, factor in SIDS. However, I don't believe that SIDS (or autism or various other things) has any one cause and is most likely a agglomeration of factors that interact with the individual child's personal biology.

  85. Becky – just saw the full text of the meta-analysis and the discussion/recommendations section has so many caveats about confounders that it has left me confused. They note that most of the studies were done to look for correlations between all kinds of things + SIDs, not BFing + SIDS per se and it's difficult to remove other variables. The conclusion was more emphatic than the discussion suggested it should be. I actually wondered why they wrote any conclusion at all given how ambivalent they were in the discussion.

  86. I understand that you are trying to help in your own way but I think you also have to realize that basically all of us on here have been attacked even subtly by people who insisted that they were just trying to help us.
    After being attacked so many times by a lot of strangers and even some family I have to be honest I'm not the most trusting person at all of people trying to give me ANY benefits to breastfeeding because they've been used as a weapon too often or anyone using the word dyad to tell you the truth(I've always thought it made a child sound like an appendage). So forgive us if we're a little paranoid or touchy about it at this point.
    Get what I'm saying?

    Could we maybe come to an agreement that if improper technique is that much of a problem in low-income mothers that maybe offering a bottle feeding class at WIC might be a good idea? I'm on WIC and have found while they will bend over backwards for the breastfeeding moms all they have is shame for the bottle feeding moms and being the first in my family to bottle feed since the 1960's would have found it really handy(assuming they are capable of doing it without it being about shame).

  87. My son liked having his bottle propped sometimes and started holding it at 4 months because he's also independent.
    It just works for some kids because some don't want to be held.

  88. Great post! Ive seen this blame-hot topic-trendy-controversial edgy writing scheme used in a variety of dramas, and even sitcoms, and I barely watch tv. And by barely, I mean I dont have cable, satellite, digital, internet,…no tv reception of any kind now for about the last 9 years. And yet I notice it too. The writers throw stuff in there, I believe, without any agenda other than they want to take the latest controversy and sort of toss some random conventional wisdom based “facts” into the dialoge to make people say, “what a trendy, controversial, edgy show! Lets watch again next week!” This is how myths get circulated via “i saw it on tv somewhere so it has to be true” and become common “knowledge,” as in, “Everybody knows that if you do/dont _______ your baby, the baby will _______!” Unfortunately, the 100th monkey effect works with misinformation as well as fact. And it has caused me to stop watching a former favorite series as well. So, I sympathize. Side note: Japan stopped giving vaccines under 2 and their SIDS rate dropped to almost zero. I read about it years ago. Im going to look it up online next after posting this.

  89. Is this really a thing to get outraged about? Good lord. a) its a tv show and b) there is an actual correlation between formula feeding and sids. This wasnt invented to offend you. It’s just true. Don’t make other formula feeders look defensive and stupid with this rubbish.

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