In the Academy of Breastfeeding Medicine’s new position statement, we recognize the critical role of exclusive breastfeeding for the first six months of life to ensure optimal infant health. Paula K. Schreck, MD IBCLC FABM, contacted the lead author on the position statement, Lori Feldman-Winter, MD MPH FABM, to get more insight into the topic.

Question:

Dr. Feldman-Winter, I attended a presentation by you many years ago at an ABM annual meeting entitled “Why Not Just One Bottle?” which I still remember vividly. It had a great impact on me. How has the messaging on exclusivity evolved since you first started teaching the importance of exclusivity?    

Response:

I first became interested in the importance of exclusivity because of my background as a researcher in molecular immunology and my desire to better understand the ontogeny of the immune system. Our understanding of the complex interplay between mother and baby and the early origins of our immune system continues to evolve, with so many gaps that we still need to close. I am delighted to see that this research continues to blossom and new scientists are getting involved each year. The evidence continues to support the concept that a tightly balanced immune system is reliant on exclusivity and closely tied to other developing systems such as the microbiome, gastrointestinal, respiratory, and nervous systems. What has become even clearer over the past decade is the macro-level impact of exclusive versus supplemented breastfeeding. Using sophisticated epidemiological methods, we can now estimate the likelihood of premature weaning from in-hospital (early) supplementation to be over two and a half times over exclusive breastfeeding. Most supplementation given in the first few days is not medically indicated, leading to overfeeding. Overfeeding then leads to a downhill spiral of breastfeeding difficulties.

Question:

Can you help us script a response at the patient level? What would you say to the parent who says that their baby WANTS to eat a higher volume and, therefore, it is justified?

Response: 

Babies love to suckle and feed often. This should not be mistaken as always being hungry. Babies learn how to get milk while breastfeeding and how to suckle at the breast without removing milk. Mothers' milk production is tied to how much milk is removed from the breast. Some mother-baby dyads feed less often but transfer the same amount of milk as another mother-baby dyad that feeds more often and removes less milk each time.

In most cases, each individual mother-baby dyad will learn to feed enough to avoid underfeeding. However, assessments should be done to check just to make sure. Counting wet and dirty diapers and monitoring the baby's weight during the first week helps to provide that reassurance.

Question: 

Do you feel that commercial milk feeding promotes overfeeding? If so, how?

Response: 

Not all supplementation needs to involve commercial milk formula; if a mother is making milk, she can express her own milk to feed as a supplement if the baby is not able to transfer enough milk directly at the breast. If the mother's milk production is suboptimal for the baby's needs, however, then either donor milk or commercial milk formula should be recommended. Too often, commercial milk formula is given "just in case" because of the concern that the baby is not getting enough milk directly from the breast. Some of these messages are promoted by the commercial milk formula industry with their marketing tactics. This is why it is necessary to spread the word about the importance of exclusive breastfeeding and ensure that all breastfeeding dyads are supported as well as properly assessed, especially during the early weeks of breastfeeding.

Question: 

How do you suggest this position statement be used by members and friends of ABM reading this blog?

Response: 

As members of the ABM, we are ideally positioned to disseminate this position statement and enhance the understanding of overfeeding and underfeeding. The ABM has resources to help clinicians be better prepared to support exclusive breastfeeding and recognize the risks of both overfeeding and underfeeding. The position statement can also be a catalyst to encourage more doctors to seek education and training in breastfeeding medicine. 

As a leader in breastfeeding, lactation, and human milk feeding, ABM provides expertise, resources, and protocols to appropriately assess and manage exclusive breastfeeding, as well as identify the need and support all breastfeeding decisions, including supplementation.

Access the position statement