Two sides to every story – except when you’re talking about breastfeeding

I’m starting to wonder if the health journalism community needs some lessons in scientific reading comprehension, or if we’re all just so convinced of the benefits of breastfeeding that we read every study with rose colored glasses. Either way, the discrepancies in the reporting of a group of new infant feeding studies are so alarming that I don’t even know where to start.

You know what? I do know where to start. How about the studies themselves.

Source: www.encognitive.com

Source: www.encognitive.com

All come from a special supplement published in the journal Pediatrics, using evidence from the 2005–2007 IFPS II (Infant Feeding Practices Study II) and follow-up data collected when the children were 6 years old.

A couple articles from this publication are specifically making headlines, the first being Breastfeeding and the Risk of Infection at 6 Years. The results:

The most common past-year infections were colds/upper respiratory tract (66%), ear (25%), and throat (24%) infections. No associations were found between breastfeeding and colds/upper respiratory tract, lung, or urinary tract infections. Prevalence of ear, throat, and sinus infections and number of sick visits differed according to breastfeeding duration, exclusivity, and timing of supplementing breastfeeding with formula (P < .05). Among children ever breastfed, children breastfed for ≥9 months had lower odds of past-year ear (adjusted odds ratio [aOR]: 0.69 [95% confidence interval (95% CI): 0.48–0.98]), throat (aOR: 0.68 [95% CI: 0.47–0.98]), and sinus (aOR: 0.47 [95% CI: 0.30–0.72]) infections compared with those breastfed >0 to <3 months. High breast milk intensity (>66.6%) during the first 6 months was associated with lower odds of sinus infection compared with low breast milk intensity (<33.3%) (aOR: 0.53 [95% CI: 0.35–0.79]).

Translation: No link between breastfeeding for any duration and the risk of colds/upper respiratory infections, lung infections, or UTIs. Babies breastfed for any amount of time had lower risk of ear, throat and sinus infections, and babies primarily breastfed for the first 6 months had lower odds of sinus infections.

The second one to cause a stir is Infant Feeding Practices and Reported Food Allergies at 6 Years. The researchers found:

In this cohort of 6-year-old US children, socioeconomic (higher maternal education and income) and atopic (family history of food allergy and infant eczema) factors were significant predictors of pFA (probable food allergy). Our analysis did not find a significant association between pFA and feeding practices at established dietary milestones in infancy. However, among children who did not have pFA by age 1 year, exclusive breastfeeding of ≥4 months was marginally associated with lower odds of developing pFA at age 6 years. This potential benefit was not observed among the high-risk atopic children, which suggests the need to separate children according to atopic risk when studying preventive benefits of exclusive breastfeeding on food allergy.

Translation: Kids in higher socioeconomic demographics, kids with higher-educated moms, and those with family history of food allergies were at higher risk for food allergies by the age of 6 than their peers. The only time breastfeeding or not seemed to make a difference was in kids with none of the risk factors I just mentioned, who had been breastfed at least 4 months.

A slew of other studies were also included in this supplement, and were summarized by a team of AAP researchers:

The first set of articles examines child health outcomes at 6 years of age. The study by Li and colleagues demonstrates that longer breastfeeding and later introduction of foods or beverages other than breast milk are associated with lower rates of ear, throat, and sinus infections in the year preceding the survey. However, they find no associations with upper or lower respiratory or urinary tract infections. Luccioli and co-workers find no significant associations between exclusive breastfeeding duration or timing of complementary food introduction and overall food allergy at 6 years old. Pan and colleagues examine childhood obesity at 6 years of age and show that consumption of sugar-sweetened beverages by infants doubles the odds of later obesity. Lind et al describe how breastfeeding is associated with various aspects of psychosocial development. They show a protective relationship between duration of breastfeeding and emotional, conduct, and total psychosocial difficulties, but these relationships become statistically nonsignificant after other confounding factors are controlled for. Though certainly not conclusive, these studies demonstrate that infant feeding is predictive of some later health outcomes (eg, some infectious diseases and childhood obesity) but not others (eg, food allergy and psychosocial development).

The American Academy of Pediatrics reported these findings, publishing an entry on its website called “How infant feeding practices affect children at age 6: A follow up.” Great, neutral, accurate title. Here is what they report:

The longer a mother breastfeeds and waits to introduce foods and drinks other than breastmilk, the lower the odds her child will have ear, throat, and sinus infections at 6 years of age.
Children who breastfeed longer consume water, fruit, and vegetables more often at 6 years of age and consume fruit juice and sugar-sweetened beverages less often.
When children drink sugar-sweetened beverages during the first year of life, this doubles the odds that they will drink sugar-sweetened beverages at 6 years of age.
When children eat fruit and vegetables infrequently during the first year of life, this increases the odds that they will continue to eat fruit and vegetables infrequently at 6 years of age.
Study authors conclude the data emphasize the need to establish healthy eating behaviors early in life, as this could predict healthy eating behaviors later in life. For more information about the IFPS-II and the IFPS-II follow-up study, visit www.cdc.gov/ifps.

Pretty clear, right? 

Apparently not.

From ABC News: Breastfeeding May Influence Kids’ Eating Habits at Age 6

“Childhood nutrition experts not involved with the study said the findings provide additional weight to the importance of shaping a child’s diet early. Dr. David Katz, editor-in-chief of the journal Childhood Obesity and director of the Yale University Prevention Research Center, said the findings serve to underscore the long-established relationship between breastfeeding and health in mothers and children.

 

“The question we need to be asking is not ‘Why should mothers breastfeed?’ but, ‘Why shouldn’t they?’” Katz said. “For all mammals, our first food is breast milk.”

For the love of god. At least now we know about the publication bias of Childhood Obesity. 

No mention of the fact that the researchers themselves stressed that breastfeeding was only protective in certain ways, and not others, and that aside from consuming more veggies/fruits/water, there were no other nutritional advantages associated with breastfeeding in this study. No mention that they found no positive association between breastfeeding and food allergies in the highest-risk populations.Just a skewed interpretation that makes it sound like breastfeeding is the MOST important part of your child’s future health and nutrition, instead of ONE important part.

Strange framing also comes from Today.com:

Breast-feeding in infancy also increased the likelihood that children would be consuming a healthy diet later on. At age 6, children who were breast-fed drank sugary beverages less often and consumed water, fruits and vegetables more often than those who were bottle-fed, CDC researchers found.

 

That all makes sense, Scanlon said. “We know from other studies that children’s eating behaviors and preferences develop very early and are influenced by a variety of factors,” she explained. “They seem to have an innate preference for sweet and salty foods and dislike bitter flavors, which are found in vegetables.”

 

That can be changed when children are exposed to in utero and through breast milk to the flavors found in vegetables, Scanlon said. “Breast-fed infants are more open to different flavors,” she added.

Sure, that makes sense. But considering the same study found that breastfed infants were just as likely to eat junky savory/salty snacks, I am not sure that one could say breastfeeding = “healthy diet”. What the study did find was that they drank a statistically significant less juice, and ate more fruits and veggies at age 6. My daughter can’t stand juice and eats her weight in brussel sprouts, broccoli, and blueberries. But she also pours sugar on oatmeal and sneaks chocolate chips from my fridge and basically lives on soy yogurt. I wouldn’t call that a “healthy diet”.

WebMD’s title suggests a much different story than the one we can glean from the studies – “Breast-Feeding Lowers Kids’ Allergy, Infection Risk” – and frames the findings in a way that is…. well, see for yourself:

They found that children who had been exclusively breast-fed for four months or more had about half the odds of developing a food allergy compared to children who had been breast-fed for a lesser amount of time.

 

As Wu noted, the finding did have one limitation, however. “While breast-feeding did not decrease food allergies in high-risk populations, such as families who already have a history of food allergy, there was a decrease in low-risk populations,” she said.

“One limitation, however”? Um, considering the highest rates of allergy were found in the “high risk populations”, and this particular finding was somewhat brushed aside by the researchers themselves, it’s puzzling that WebMD latched on (sorry) to it.

And then –

Another expert said the studies provide valuable information.

 

Nina Eng, chief clinical dietitian at Plainview Hospital in Plainview, N.Y., said the findings “point out two of the many important benefits of breast-feeding.”

 

“These articles provide evidence that should inspire new moms to breast-feed their children,” she said.

 

Does it? Will it? I don’t know about you, but I don’t think any of these findings are so convincing that they might “inspire” a mom to breastfeed if she’s already decided not to. For those who have chosen to breastfeed, sure, maybe they will be somewhat heartening…. but I find it seriously odd that the media is spinning these studies as evidence of a “breastfeeding boost” (thank you, Today.com) instead of the more realistic framing: we now have a body of evidence that shows that choosing better foods at weaning and being responsive to feeding cues may have lasting effects.

In other words, give your kids produce and don’t force feed them. But that’s not as sexy as talking about breastfeeding, so…. BOOBS. There you go. Problem solved.

 

FFF Friday: “I’m glad I have recourse to something other than what’s ‘natural'”

“Intuitively and rationally, it makes no sense that this poisonous smelling, lab-created powder has been so much better for my daughter, has made her happier and healthier.”

Sarah’s story will resonate with many of you, but I think those who dealt with food allergies/sensitivities will find it especially powerful. I remember feeling the same way – how could something made in a lab make my baby so much happier than what my body created? It’s a tough question to toss around in a newly postpartum brain, one that is already confused, conflicted, and overloaded. I believe that a large part of the link between depression and early weaning isn’t simply the hormones at play, but rather these very emotions. We are taught that our bodies create the perfect food for our babies, but what happens when this isn’t true? What happens when our babies wretch, cry, writhe and bleed, despite all of our best intentions? 

I’ll tell you what happens: it’s devastating. 

And then, what happens when you switch to formula? If your baby is happier and healthier, you feel guilt. You feel regret. You feel anger. You feel jealousy. And then you feel like shit, because you should be feeling relief and gratitude that your baby is finally thriving. 

It’s a mind-fuck. And that’s before you make the mistake of going online, where a thousand bloodthirsty strangers will tell you that you could have tried harder, done it differently, made a better choice.

And we wonder why there is a high incidence of postpartum depression in women who are formula feeding.

Happy Friday, fearless ones,

The FFF

***

Sarah’s Story 

I want to begin this story with my first child, who was exclusively breastfed – not because I’m hoping for the Nobel Prize in Breastfeeding – but to illustrate how unusually challenging breastfeeding was for me (and my whole family,) how committed to it I was (and am,) and yet how much I know I’ll be judged ‘round these parts for publicly feeding my second with a bottle full of formula.

My first was born at home in the major metropolitan area we lived in at the time.  I was the only person I’d ever known who’d chosen a home birth, and I was a crunchy curiosity among our friends and family for this and for things like choosing to use cloth diapers.  Breastfeeding was so obvious there was no thought involved.  When my daughter was finally delivered – an enormous, incredibly alert baby – and immediately and expertly latched on like pit bull, gulping eagerly, the midwife squealed, “Oooh!  One of those tiger babies!  What a great latch!”  No problems there, except excruciating pain and bloody nipples for a few weeks.  I’d never heard that breastfeeding was painful at the beginning, until asking real mothers…. One inane breastfeeding book I had read, “If breastfeeding hurts, something’s wrong.”  I was in a panic until everyone, even the midwife, gently told me – it just hurts, at first.  Which makes sense, when you think about it.  It’s an extremely tender part if your anatomy that is suddenly getting quite a lot of force applied, (if you have a “tiger baby,” anyway,) pretty continually.  I think more women would breastfeed if they were given an accurate picture of its challenges, knowing that some of them are temporary, rather than being given a – frankly – propagandizing picture (“It’s bliss! You’ll feel wonderful! Your baby will never become ill or have allergies for all of her long, healthy life!  You’ll lose all the baby weight!  You and your child will have a close bond forever!”) and then having their actual experience fall quite short of that expectation and think something must be very wrong, and discontinue.

I started noticing something strange, however, after the first rush of postpartum hormones subsided.  Just before initial let-down, every time, I’d experience a brief wave of crushing sadness and horror.  (Think: you just heard that an atomic bomb is headed toward your vicinity, and there’s no time to escape.  That kind of feeling.)  It relieved me to make the connection that I only felt that way at this particular time and synapse, and that it must be due to some chemical imbalance I didn’t understand, but no one else knew what I meant or had had the same experience.  “A sad wave, huh?  That’s interesting,” was all my midwife could offer.  A few years later I discovered that what I had dealt with was Dysphoric Milk Ejection Reflex; a very uncommon disorder that hadn’t even been given a name by the medical community at the time I first experienced it.  I was still undeterred and continued breastfeeding.

When my daughter was around three months of age the supply problems started in earnest, and in the end, nothing other than almost total bed rest for a couple of days at a time made a difference.  I had chosen to stay home with my daughter, and while this was hardly feasible even for me, I can’t imagine handling such a problem while working outside of the home.  I nursed my daughter every hour during the day, and every couple of hours during the night.  It wasn’t until she started solids and finally agreed to drink out of a sippy cup (she’s still a remarkably stubborn little girl!) that she (and I) slept for any considerable stretch at night.  By the time she was ten months old, my supply had dried up completely, although I continued to nurse – i.e., be a human pacifier, as distinct from breastfeed – if she woke at night and needed soothing for another couple of months.

The next year we moved for my husband’s work to another, and demographically very different, part of the country.  Here, EVERYONE has a home birth.  EVERYONE nurses into the preschool years, EVERYONE cloth diapers, NO ONE vaccinates or circumcises, etc.  (Or so it seems.) You get the picture.  I was no longer crunchy, I was disastrously conventional; and I was swiftly and completely cold-shouldered from play groups.  (No doubt in part because I was not nursing my toddler multiple times during a half hour library program – I couldn’t – and no doubt also in part because I look so different.  I’m a petite little Italian in this bright white land of strapping, squatting birthers; I wear foundation and mascara; I wear shoes….)  It’s been interesting to learn that, oftentimes, the folks who preach the loudest against appearances (and specifically, against judging women in particular by appearances) are those who are quickest to do just that.  It also saddens and perplexes me that – increasingly – women are judged (in fact, judge each other) once again by their ability to bear and nourish offspring, and the homes they create.  (What is your “birth story?”  How long did you nurse? What kind of crafting do you do?  Are you “unschooling” your children? And so on.) It makes me wonder what the initial women’s rights movement truly did accomplish, when, in certain circles, I have little value and my conversation has little interest other than describing my (horrific) labor, how many cycles I put our pocket diapers through, or what non-GMO seeds I plan to plant in the family garden in the spring.

In another couple of years, I became pregnant again, and this summer chose to deliver in the local hospital.  We felt it was safest after my first experience, which included a hemorrhage, but it elicited some raised eyebrows.  Then I ended up with a c-section (which didn’t surprise me after my first labor and birth,) and more raised eyebrows and pointed questions.  “Do you think you really needed that c-section?” (Well, I don’t know, but I’m sure glad I didn’t have to find that out for certain in its absence….)  The D-MER waves began this time in my third trimester, before I even began lactating.  This time I had a name for it, though, and a rough understanding of the possible chemical pathways.

My second was born, an astonishingly even bigger and more alert baby girl, who also delighted nurses, midwife, doctors, and staff with her latching performance.  This time, every let-down, not just the initial one, brought the horrible feeling, and, this time, also brought physical nausea with it.  Still no question whether or not I would breastfeed.  I did, however, attempt getting our newest to take a bottle with expressed milk fairly regularly as a precaution – in case I faced supply problems once again.  At one month, my daughter developed a severe milk and soy protein intolerance – and abruptly and consistently refused the bottle.  I immediately and completely cut both dairy and soy out of my diet, and for a couple of weeks, the problem was solved.  Then the symptoms began again: bloody diarrhea, severe eczema, hives, wheezing.  Fish, wheat, nuts, corn, chocolate, eggs, berries in the rose family, grapes, tomatoes, citrus, coconut, even quinoa, believe it or not, rapidly went the way of milk and soy.  My daughter dropped from the 100th percentile to the 40th in a month’s time.  For the next three months I lived on a handful of foods, and she did okay.  Not great, but okay.  Unsurprisingly, I had another supply problem.  Meat – turkey and bison – was my only protein source. (Not wonderful for this former vegetarian.) Over Thanksgiving, the symptoms started again: two more foods (apples and millet) were out.  Another week, and nothing was safe.

I should add here that I tried everything to save breastfeeding; in part, just to save my baby, who is particularly attached to Mommy, from the emotional trauma of weaning her from what she was used to.  I consulted with multiple pediatricians, a pediatric allergist, a neonatologist, and upwards of twenty lactation consultants.  I tried pancreatic enzymes (turned out she has a particularly severe intolerance to pork,) plant-based broad spectrum digestive enzymes (did nothing,) two different types of supposedly hypoallergenic infant probiotics (both caused vomiting,) took mega-doses of hypoallergenic probiotics myself, and obviously lived on the most extreme rotation and elimination diet known to woman.  I even, albeit briefly, contemplated the possibility of living on a specialty formula myself, so that there would be no foreign proteins in my milk, and continuing to breastfeed.  I asked my husband if he thought it was unreasonable to even entertain the idea.  “YES,” he told me firmly.

I made the most difficult decision I have ever had to make, and began to wean her completely to Neocate, an amino acid formula.  This stuff smells and tastes unbelievably vile – just so you can understand some of my internal conflict over discontinuing breastfeeding.  It’s also incredibly expensive. (Forty-five dollars a can.  We’re still fighting her insurance to cover it.) It took us six days to finally get her to take a bottle.  In between, I spent all day dribbling the Neocate in her mouth with a syringe or sippy cup with the stopper removed; she wailed, and spit three-quarters of it out.  The grief of this sudden, early weaning was and still is overwhelming.

The night that she finally broke down and took a bottle from my husband, she rapidly downed ten ounces; and then went to sleep without any more noise than a yawn, and slept for six hours straight.  (She’d been getting up every couple of hours prior to this to nurse, and taking close to an hour to settle down before sleeping.)  The next night she slept for nine hours straight, again without a peep.  Intuitively and rationally, it makes no sense that this poisonous smelling, lab-created powder has been so much better for my daughter, has made her happier and healthier.  (I almost feel unreasonably insulted, especially after trying so hard to accommodate her.)  But there it is.  I resent the fact, though, that any time I want to feed her in public, now, I have to take a deep breath and begin explaining.  I’m pretty darn sure I’ve gone to far greater lengths to breastfeed than almost any other woman out there, and yet I know I’ll provoke contempt.  Appearances again.  There are so many reasons, even in just this one instance, why someone may be doing something that doesn’t appear to be in their child’s best interest.  Infant allergies, maternal medication, adoption; I wish I could lobby to change the slogan to “Breast is usually best, but it’s not really my business anyway.”

I also want to say here that supply problems are a lot more common than many lactation consultants, and the most ravening of lactivists, are willing to admit, if my own experiences and the experiences of friends and family are anything to go by.  I don’t know why that should be; I don’t know why millions of years of evolution, or the creative power of God, or both, or whatever you reason or believe, or both, hasn’t straightened that out for so many women and their babies.  My default – or rather, my husband, the biologist’s, – default response is, “Nature weeding out the unfit.”

Regardless, I’m glad I have recourse to something other than what’s “natural,” at times.  I’m glad we can sidestep evolution.  (Or fallen nature, or, again, whatever you’d like to call it.) I’m glad for unnatural human compassion that works so hard in these unnatural laboratories so that unnatural (and wonderful, infinitely precious) children like mine can safely eat, and thrive.  I can’t believe I’m saying this, but I’m so glad for formula.

***

Have a story you’d like to share? Email it to me – formulafeeders@gmail.com.

FFF Friday: “I don’t think I have ever felt quite so judged about any other parenting choice.”

So much of the conversation on infant feeding focuses on first-time mothers and their breastfeeding experiences, for understandable reasons. But that also makes it easy for some to dismiss these experiences as simply “misconceptions”, “nervousness” or “inexperience with breastfeeding”.

But what happens when a third-time mom has twins, and despite the fact that she breastfed successfully twice before, she finds herself dealing with unexpected complications? Turns out, in Michelle’s case, that mother ends up dealing with the same emotional turmoil, conflict, and confusion as the first-timers. Because breastfeeding problems are not the sole property of any “type” of mother, of any age, socioeconomic group or ethnicity, or parity. These problems can strike any mother – and when they do, each and every one of us deserves support, respect, and the opportunity to make the best decision for our families. 

Happy Friday, fearless ones,

The FFF

***

Michelle’s Story

When I found out that baby #3 was going to be baby #3 and #4 I was understandably excited and nervous. One one the first things people commented/questioned me about was whether i was going to try to breastfeed them. My answer was always that I would play it by ear and see how it went.

The twins developed something called TTTS (twin to twin transfusion syndrome, which can happen when identical twins share a placenta) and I was hospitalized for 6weeks with daily ultrasounds and monitoring, to make sure the babies were still okay. Every day I worried that one or both babies had died. It was not a relaxing pregnancy.

My babies were born at 31 weeks….tiny but perfect. They spent 6weeks in the NICU and I spent those six weeks pumping every 3-4 hours and making trips back and forth to the hospital while also trying to care for my other two kids who were not quite 2 and 6. I was generally NOT at the hospital for feedings, but the girls were getting my milk, first through an NG tube and then when they got better at suck/swallow/breathe, through a bottle. When they were getting close to discharge, the nurses told me to buy bottles and I was clueless and overwhelmed because I had always breastfed my others and had never used a bottle. I had requested a lactation consultant to help me transition them from bottle to breast, but she told me to nurse them and give them bottles afterward if they still seemed hungry. Prior to their discharge, I had attempted putting them on the breast exactly one time and it was not what in would call a rousing success.

They were discharged at 37 weeks and they were still incredibly sleepy and not interested in working for their food. I continued with nursing, bottle feeding, pumping every 3-4 hours. I was attached to the pump. I was miserable . I got in touch with a different LC who was more helpful and over the course of a week or so, I got the girls to latch and eat and finally I could be rid of the infernal pump.

Around 40 weeks the girls woke up. And they screamed. They screamed and they screamed and they screamed. They were miserable. I contacted the same LC again and she thought maybe I had oversupply. I worked on that. The babies continued to be miserable. I took them to the pediatrician who said some babies are just miserable and despite the fact that I had experience with two other babies, I had not had experience with twins. The girls still screamed. Finally when they were around three months old I read about milk protein intolerance and decided to eliminate dairy from my diet. There was much less screaming. There was still some though, and their stools were still showing signs of further intolerance, so I stopped eating soy also. That seemed to be the magic thing. Finally, I had happy babies (their bowel movements still seemed weird, but they were happy, I was happy…everything was finally good in our world). They were five months old at that point and I was finally enjoying them.

Fast forward to their weight checks. The older they got, the less they were gaining. They started out at three pounds, were almost five pounds when they came home at 6weeks old, and at five months were eight pounds. At six months they were up a couple more ounces each. We were going to the pediatrician for weight checks weekly and they were gaining, but slowly. Nobody suggested formula (I had on occasion used nutramigen when I got too touched out and needed a break. They also suffered from pretty severe reflux and wanted to nurse ALL THE TIME. I had tried a “gentle” formula once and it had resulted in immediate screaming that lasted two days, so that solidified my belief that these babies could not tolerate any dairy).

At their NICU developmental follow up appointment at almost 8months, the neonatologist was very concerned about their weights. At first they were recommending physical therapy, but he thought that if they started growing that it would not be necessary. They were 8 and 9 pounds and had been within 6 ounces of that same weight for at least 10 weeks. He suggested me doing an elimination diet and also supplementing with puramino formula 2x a day to see if that would help. I was already struggling without dairy/soy and feeding the rest of my family, so I was not thrilled about an elimination diet. I was not thrilled about the prospect of formula either. I thought long and hard about it, and decided to give them the formula and go back to eating what I wanted. I continued to pump just in case, for about three weeks. I watched my supply dwindle. I initially struggled with guilt, despite the fact that in the month they have been on the formula, they have each gained THREE pounds. There are rolls of chub on their legs! They are finally thriving and I love seeing them grow (they are almost 9months old now).

Nobody says “Good for you for feeding your babies!”. People insinuate that I didn’t try hard enough, that if I were a really good mother I would have gone on the elimination diet. One lady told me that I finally gave in to the evil medical establishment and that I should go back to breastfeeding. I don’t think I have ever felt quite so judged about any other parenting choice. I hate that I feel like I have to explain how we got to this point and despite me resolving NOT to explain, I feel oddly compelled to anytime anyone comments (which they all do immediately upon seeing a bottle).

One thing these babies have taught me is empathy. I never really understood empathy like I do now. I am much better able to put myself in someone else’s shoes and not be judgmental (secretly or otherwise).

I am so incredibly grateful that i found FFF when I did. My healthy thriving babies are glad also!

***

Share your story. Email me at formulafeeders@gmail.com.

FFF Friday: “By choosing to formula feed, I created a much better environment for my child…”

Welcome to Fearless Formula Feeder Fridays, a weekly guest post feature that strives to build a supportive community of parents united through our common experiences, open minds, and frustration with the breast-vs-bottle bullying and bullcrap.

Please note, these stories are for the most part unedited, and do not necessarily represent the FFF’s opinions. They also are not political statements – this is an arena for people to share their thoughts and feelings, and I hope we can all give them the space to do so.

I thought I’d heard of every breastfeeding-related complication under the sun, until I read Beth’s story. HIVES? From hormones release during lactation? Apparently, Beth isn’t the only one – and experts don’t seem to know why this occurs in some women. Add this to the list of “Things They Don’t Cover in Popular Breastfeeding Literature”, I suppose.

Happy (and hopefully hive-free) Friday, fearless ones,

The FFF

***

Beth’s Story

During my pregnancy, I was dead set on breastfeeding exclusively for at least 6-9 months. When I was 37 weeks along, I found out my baby was breech. At 39 weeks, I had a c-section. I was all for having a natural birth, no epidural, and had never had any kind of major surgery or stayed overnight in a hospital before, so having a c-section terrified me. I had also heard that when you have a c-section, it’s harder to bond with your baby because you don’t get to hold them right away and you also don’t get to breastfeed them right away, which also scared me.

Baby and I made it through just fine, and less than an hour after she was born, I was breastfeeding her. We stayed in the hospital for 4 days. After just 1 day of breastfeeding, my nipples were cracked and bleeding. Breastfeeding was SO painful, nothing like I was expecting. All the nurses were amazed at my baby’s “textbook” latch, but also told me if we were doing it right, it shouldn’t hurt, so I had no idea what was wrong! They told me she must just have a strong suck, which was good because it would make my milk come in stronger. The day we went home from the hospital, my milk finally came in. However, my baby had lost about 12% of her birth weight. The nurses and doctors were concerned, but since my milk had just come in, they were confident that things would turn around. I scheduled a visit with our pediatrician for a couple days later to check her weight.

Just a few hours before we were going to leave the hospital, I noticed a large patch of hives on my upper arm and elbow. I took a shower (the first time I was able to in 4 days, yuck!) thinking that would help, but it didn’t. I pointed it out to the nurse, and they had several doctors and nurses come in and look at it, and everyone was baffled. They finally sent me home with some hydrocortisone cream and I thought everything would be ok. When we got home, I breastfed her again. I noticed several minutes into the breastfeeding that I was getting hives on my thighs and knees as well as my upper arms and elbows. The hives kept spreading and getting more swollen and painful. I breastfed her a second time and they got even worse! Both thighs and knees were completely covered and they were so swollen and painful I could hardly bend my legs! My arms were almost as bad. I was freaking out! I called my OB, who was out of the office of course, so I talked to one of her nurses. She told me to take Benadryl, and if they didn’t go away within an hour, to go straight to the emergency room. I asked if the Benadryl would affect my breastfeeding, and she told me that if I took it over a long period of time, it would eventually dry up my milk supply, so to be careful with it! I was reluctant to take the Benadryl, because I wanted to find out what was actually causing the hives and treat the problem, not the symptom, but ended up giving in and taking it because I was so miserable! The hives finally went away and I felt much better. However, they reappeared several minutes after beginning a new breastfeeding a few hours later! After doing some internet research and having a friend check with her mid-wife, we finally discovered it had something to do with my hormones when my milk let down. So here I was, a first-time new mommy, already sleep-deprived and having to take Benadryl to keep from getting severe hives every time I breastfed. I was exhausted and a basket case to say the least. On top of that, we had been going to the pediatrician every 2-3 days for those first 2 weeks because my daughter STILL was not gaining weight.

I felt like all I was doing was breastfeeding. I had finally gotten over my cracked, bleeding nipples, she was latching on like a pro, feeding every 2-3 hours, my breasts felt full and heavy, and even leaked quite often. I took Benadryl every 4-6 hours to keep from breaking out in hives, and even those cleared up on their own after a couple weeks. I felt like things were going fairly well. But I was miserable because it seemed I was never able to get off the couch and do anything but breastfeed, and I was suffering from the “baby blues” and freaking out that something was wrong with me and/or my baby since she still wasn’t gaining weight. Finally, during that second week, the pediatrician recommended giving her formula as a supplement to my breastfeeding. The lactation consultant recommended that I be very careful with the supplements and even gave me all these tubes and other contraptions to try out so she wouldn’t get too used to the bottle or get “nipple confusion.” We tried everything but she just wanted something to suck on, so we finally gave in and gave her a bottle of formula. It broke my heart watching her suck it down like she was starving! I didn’t want to give her too much of it, because the LC warned it would decrease my supply, but seeing how satisfied she was afterwards made me feel guilty for not giving it to her sooner! But yet I also felt guilty for not breastfeeding her because that “breast is best” mentality had been pounded into my head! I was suffering from a lot of anxiety over this, so I had a couple friends come over who were also new moms…one with her first and another with her fourth. They were very in to the AP method, and apparently were breastfeeding pros! They came with all kinds of LLL books and handouts and support, but were very adamantly against me giving her too much formula to supplement and told me that if I just breastfed her often enough, soon I would be “flowing with milk!” I decided to try it, so for one full day my daughter and I sat on the couch and breastfed all day, for about 7-8 straight hours. To say we were both miserable is an understatement! She would finish feeding on one side and I would switch her to the other breast, and she would just cry and cry. We repeated that over and over again and she just was not satisfied. I thought, based on what my friends told me, that if we could just stick with it for a day or two, my supply would increase. They assured me that it would be difficult, but it would be worth it. It wasn’t. When my husband got home from work, he found his wife and daughter sitting on the couch crying. I was worn to a frazzle, extremely frustrated and distraught that there was something wrong with me because I couldn’t feed my baby th

e way I was supposed to! I was convinced I was less of a mom because of it. My husband assured me that I shouldn’t listen to my friend’s advice, but that I needed to do what was best for me and my baby. I gave her a bottle of formula and she fell into a satisfied sleep!

Finally, when she was 3 weeks old, she gained enough weight to be back at her birth weight. From then on, I would breastfeed her 6-8 times/day and if she wasn’t satisfied after a breastfeeding, I would give her 2-4 ounces of formula. I gradually cut back on how many times a day I was breastfeeding her, and she is now 4 months old and exclusively formula fed. The week I stopped breastfeeding her completely I had mixed feelings. There was still a tiny part of me that felt less of a mom knowing I wasn’t going to be breastfeeding anymore, but my baby and I are both happy and healthy and that is all that matters! She is growing like a weed, is very strong, and is even ahead of her age developmentally.

I think we have a great bond, and I am confident that it will grow stronger as she gets older. To me, there are a lot more things I can do with her to strengthen that bond than just feed her! While I struggled with thinking myself as less of a mom for not being able to breastfeed, I realize that it doesn’t work perfectly for everyone, and by choosing to formula feed, I created a much better environment for my child (I am a much happier, stress-free mom) plus I was giving her the nourishment she obviously just wasn’t getting by exclusively breastfeeding. I know there may be people who are disappointed with my choice, or who think they’re a better mom than me because they “stuck it out”, but I don’t let that bother me anymore. I know that I made the best choice for me and my family and that’s all that matters!

I hope this helps others struggling with guilt or feeling like they failed because they weren’t able to breastfeed exclusively or even at all. It helped me to read other people’s stories and know I wasn’t alone. You are NOT a failure if you aren’t able to breastfeed…you just feed your baby the way it takes for you both to be happy and healthy, and you are a success!

***

As my son’s BFF told him the other day, “sharing is caring.” So show you care, and share your story with me and the FFF audience – send it in to formulafeeders@gmail.com.

The FFF Quick-and-Dirty Guide to Formula Feeding: Recognizing Sensitivity, Intolerance or Allergy to Formula

Those of you who haven’t been following this blog since the beginning may not know this, but my son Fearless Child (FC) has a dairy allergy, which went undiagnosed for the first few months of his life. Having his insides assaulted on a daily basis made him grumpy – so grumpy that he screamed bloody murder for about 20 hours a day. And yet it took us over a month of elimination diets, doctor visits, and late-night consultations with Dr. Google to figure out what was going on. This was partly because FC’s symptoms were slightly atypical, but more so because as new parents, we were utterly confused as to what was “normal” newborn behavior and what necessitated medical intervention.

There’s a good deal of information on dairy intolerance in babies on the Web, but not much specifically geared towards bottle-feeding parents. This is unfortunate, as those of us feeding our kids in this manner actually have a really simple way of figuring out if food issues are at play – and yet so many of us struggle for months, feeling increasingly frustrated and hopeless with our inability to comfort or feed our children adequately.

I always hesitate to offer what might be construed as medical advice, since there’s far too many hacks out there doing just that. So before I continue with this post, let me reiterate: I am not a doctor. I haven’t even played one on t.v. (Does anyone still get that reference? Or does it make me sound old?)  The following information is what I have culled from my own research, talking to pediatricians and pediatric GIs, and from my own experience as the mother of two kids with feeding issues.

Oh, and one more note: I am going to use the terms “intolerance”, “sensitivity”, and “allergy” interchangeably here, even though these three things are entirely different. This is because until you see a physician, you won’t know which of the three you are dealing with. My purpose with this post is to help you realize when something is amiss, and to assist you in navigating a medical system which often ignores the power of parental intuition and knowledge of one’s own child. You’ll have to see an actual MD to get a true diagnosis… and I don’t meant Dr. Google.

 

Behavioral Symptoms of Formula Intolerance or Allergy in Young Babies

Newborns are complicated creatures. Some are calm and sweet (this is the kind of baby everyone else seems to get at least once, but apparently my and my husband’s genetics do not morph in a manner conducive to a docile temperament), others are generally chill except for a bout of colic between weeks 2-8, and others are fussy all.the.time. This last group is the one that we need to worry about. Typically, a calm, contented baby is a well-fed and happy one. This is not to say that food allergies will not strike later in life, once solids are introduced, but a newborn who is sensitive to something in formula will usually express discomfort in a pretty vocal way. Watch out for:

– Extreme fussiness. Colic is defined as crying for a period of 1-3 hours, at least 3 days a week, typically in the evening. A baby who is sensitive to formula will cry constantly, throughout the day. They can sometimes be comforted, but only by extreme measures like continuous movement (we had to bounce FC so vigorously that once, while shopping for a new car, a man came up to us in horror and told us we should stop shaking our baby; a friend’s dairy intolerant breastfed baby was only comfortable while being vibrated in his bouncer – all night long), specific holds (the Harvey Karp /Happiest Baby hold is magical for babies with tummy issues). The difference between a “normal” fussy baby and one with potential allergy or intolerance is that they have 2 settings: sleep and screaming. The fussiness is the default, rather than the exception.

– Trouble sleeping. While many young babies sleep erratically, they usually sleep a lot cumulatively.  A newborn with a formula intolerance will often be too uncomfortable to sleep.

– Trouble eating. This one gets tricky, because other issues can cause trouble with feedings – sensory issues, reflux, dislike of the type of bottle or nipple you are using… but one common symptom in babies experiencing formula intolerance is fussiness around eating. They may pull away from the bottle and scream; or eat only small amounts at a time. Reflux can also be associated with formula intolerance, so spitting up an excessive amount after every feeding (especially if there is curdled formula or blood in the spit up) might signal a problem. Some babies might develop an aversion to eating, associating the formula with pain, and refuse the bottle altogether. Others may “comfort feed” and want to eat constantly (more on this later).

– Inability to connect or bond. Again, this can signal a far more serious issue, but it should be noted that babies who are in constant pain have a rough time chillaxing enough to focus on their parents or begin engaging in social interactions. I’ve had numerous parents tell me that they had secretly worried their baby “had no soul” or “wasn’t all there” prior to diagnosing and solving a severe allergy or intolerance. If your baby is screaming constantly or is noticeably stiff, writhing, or doesn’t seem to be comforted by touch, see your doctor.

 

Physical Symptoms of Formula-Related Food Intolerance or Allergy

The physical manifestations of a formula intolerance are more straightforward, but they also tend to suggest a more serious problem (i.e., clinical allergy versus sensitivity). In terms of getting a diagnosis, they do make life easier, but they can also be scary when first encountered. These include:

– Weight loss, or extreme weight gain, from comfort feeding.  I’ve heard of more than a few cases where babies who are overeating are misdiagnosed with the excuse that “milk protein intolerance causes failure to thrive”. This is true; many kids will have aversions to formula or breastmilk caused by associations with pain, and refuse to eat; these conditions can also cause malabsorption, so the baby isn’t getting the necessary nutrients to grow. But some babies find the liquid comforting as it goes down (especially those who have reflux associated with the intolerance or allergy), or like the sucking action, and want to eat constantly. The offending food causes more distress, which then creates a need to comfort feed more… and suddenly you’ve got Jabba the Hut, Jr. on your hands. Their girth may cause doctors to dismiss discomfort and symptoms as “overeating”(which can certainly cause a whole list of problems, but my point is that sometimes, the overeating is a symptom, not a cause).

– Blood in the stool – this can appear looking like strawberry jelly (red) or like coffee grinds (black). If you see blood, drop everything and call your pediatrician.

– Mucous in the stool – this is a biggie, because often the blood will be invisible to the naked eye, but mucous is easy to spot. Mucous looks like stringy, gelatinous strands, usually white or clear in color.

– Rashes – these can appear in a variety of forms, and may be hard to differentiate from normal newborn skin issues like diaper rash or infant acne. Sometimes the rashes might look like hives, but they can be atypical. FC would get petechia-type red dots on his cheek, right next to his eye, and down his cheek. (This same reaction continued as he grew into toddlerhood, and was a great way for us to know we’d screwed up and allowed for accidental exposure). Other parents have told me that the rashes congregate near the joints, or as a red ring around the anus. All lovely and comforting things to see on your precious newborn, right?

– Vomiting up blood. Again, this merits a panicked call to the doctor. Stat.

Something you should also know is that milk protein allergies come in two forms: rapid onset (immediate reaction) or delayed onset (reaction within 7-10 days of ingesting milk). This may explain why some babies don’t start reacting to formula until a week or so after birth/switching over from breastfeeding. Rapid onset looks more like a “classic” food allergy – hives, wheezing, bloody diarrhea. The rapid onset form is far more dangerous, as allergies can worsen with every exposure, eventually leading to anaphylaxis, so if you see these sort of symptoms, do not pass go, do not collect $200, just dial your pediatrician.

Which brings me to….

Seeing Your Doctor

There are a lot of fabulous pediatricians out there. There are also some really crappy ones. And in the middle, there are doctors who have seen thousands of neurotic new parents who freak out at the first sign of slight fussiness in their babies, and also a slew of legitimately concerned parents dealing with the untreatable hell that is infant colic. Considering that in the majority of cases the babies they see are either healthy and just waking up to the world (it’s normal for a baby to be impossibly easy and sweet for the first few weeks and then wake up one day with an attitude. Think of it as good practice for the teen years), or are unfortunate victims of colic and just have to wait it out (excuse my tangent for a moment but I cannot for the life of me understand why no one has figured out this colic thing. Seriously? We can clone sheep and we can’t figure out why some babies cry inconsolably for exactly 3 hours at the same time every night??!), it is understandable that some pediatricians have dismissive or patronizing attitudes towards those complaining about fussy babies.

I have seen parents who do overreact to sudden onset of mild spitting up, fussiness, or constipation- it’s hard not to, considering the lack of sleep, the hormones, and the lure of the Internet (Dr. Google is an alarmist). But for the most part, every parent who has emailed me with a laundry list of weird symptoms and a general, foreboding sense that something is “not right” with their newborn, has later followed up to confirm diagnosis of an allergy or intolerance. I’m a big believer in mommy/daddy “gut” when it comes to your baby’s gut.

So, here’s what I would suggest: before you go in for your child’s appointment, write down a list of every symptom you have observed. If you’ve been noticing mucous or blood, collect a stool sample, and show your doctor the craziness that is coming out of your kid’s tush. If your doctor starts talking about colic, explain to him/her that you are well aware of what colic is, and colic does not explain the other symptoms you are noticing (you might also want to mention if your child’s crying doesn’t follow a colic-like pattern – meaning that it is not sustained crying for a specific period of time, but rather constant fussiness throughout the day).

It is also well within your rights to request allergy testing, but here’s the thing: with this sort of testing, only a clinical allergy will show up. If your baby has an intolerance or sensitivity, the testing will probably come back as inconclusive or “normal”. Additionally, there is some controversy on whether allergy testing in young infants is even accurate.

Luckily, there is another, non-invasive way to see if the formula you are using is the problem, which is what I like to call…

The Miracle Cure

I could write a Shakespearean sonnet for hypoallergenic formulas, and I’m sure the folks who like to think I’m paid off by formula companies will find fodder for this conspiracy theory in how often I hawk Alimentum on here. But I just love the stuff. And not just Alimentum. Nutramigen, and Neocate, and whatever comparable product is on the European/Asian markets. The stuff is stinky, expensive….and utterly lifesaving.

If you suspect that your baby has a milk protein sensitivity, and the symptoms are not severe enough to necessitate medical intervention, you might want to consider doing a 48-hour hypoallergenic challenge. This is a 4-step process:

1. Get thee to thy nearest drugstore/grocery store

2. Purchase a commercial hypoallergenic formula (please read my post on types of hypoallergenic formula to ensure that you are choosing a true hypoallergenic and not simply a “sensitive” brand)

3. Serve said formula to thy infant, and observe for the next day or two

4. Thou shalt be singing high praises to the heavens by yonder morning, otherwise the formula probably wasn’t the problem in the first place.

While milk and soy protein allergies are the most prevalent in young infants, there are some kids who are sensitive to corn or other ingredients in formula. And for children with severe milk protein allergy, a commercial hypoallergenic isn’t going to cut it – they will need an amino acid-based formula, which is available by prescription only. But for most babies suffering from mild to moderate sensitivities/intolerances, a hypoallergenic formula is truly a godsend. You should see a marked improvement within 2 days if the problem is food related and not due to some other underlying medical condition (cough*call doctor*cough) or- and I seriously hate to say this – if it’s just colic or fussiness, in which case you really do just need to give it time, and start drinking heavily to get through the next few months. Kidding. (Maybe…)

If you are dealing with colic or normal infant fussiness, the good news is that you can skip the following section, and not have to worry about a childhood without ice cream and birthday cake. But if the formula does make a dramatic difference, you may want to consider….

What the Future Holds

If the hypoallergenic works wonders, you can continue to use the formula and try re-introducing a normal or sensitive formula at about 6 months, once your baby’s system has developed a little more. If symptoms return, then you simply return to the hypoallergenic.

That said, hypos are quite costly, and if your child does have a true milk protein allergy, you might be able to get the formula covered by your insurance. You’ll need to see your pediatrician to get the right paperwork filled out in order to do this.

I’d also suggest that you do ask for a referral to an allergist and/or pediatric GI, just so you will have someone in your corner when you start solids. While most children outgrow a milk protein allergy or intolerance as they become toddlers, some take longer than others. It gets really difficult to figure out a delayed-reaction allergy once they start solids, because the exposure could have been anytime in the week or so prior to the reaction. Also, weaning off formula looks a bit different in a dairy intolerant/allergic child. Sometimes, pediatricians will want you to stay on formula a little longer since it’s harder for kids to get the nutrition they need when they can’t eat or drink dairy products. In other cases, using a milk substitute like soy (unless your child is sensitive to soy as well, which many milk protein intolerant kids are), rice, almond (as long as you’ve seen an allergist and been tested for nut allergies), oat. or hemp, can be a perfectly acceptable option. My kids have both thrived on unsweetened almond milk, which is fortified with so much stuff nowadays that the only thing milk trumps it on is protein content and fat (and we incorporate other foods into their diets that compensates for this).

You’ll get very good at reading labels, and creative with recipes, and become a master at surreptitiously pulling vegan cupcakes out of your diaper bag at birthday parties so your kid won’t feel left out. You’ll probably do “challenges” with your kid every so often to see if his or her body has decided to make friends (or at least frenemies) with dairy, and when that day comes, you may even get to see a face like this:

Fearless Child’s first time eating cake & ice cream at a friend’s birthday. And yes, I cried.
Until then, remember- you are the expert on your child. You are also your child’s best advocate. Formula can be changed at any time, so there is no reason to suffer stoically if you suspect an intolerance or allergy to the one you are using now.
Great Links/Sources
http://kidshealth.org/parent/medical/allergies/milk_allergy.html
http://www.allergy.org.au/patients/food-allergy/cows-milk-dairy-allergy
http://foodallergies.about.com/od/dairy/a/babymilkallergy.htm
http://adc.bmj.com/content/92/10/902.full.pdf
http://www.kidswithfoodallergies.org/resourcespre.php?id=140&
http://www.medscape.org/viewarticle/563463
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