Common Breastfeeding Myths
By Lisa Marasco
Assistant Area Professional Liaison
LLL of Southern California/Nevada USA
From: LEAVEN, Vol. 34 No. 2, April-May 1998, pp. 21-24
Readers are cautioned to remember
that research and medical information change over time
Myth 1:
Frequent nursing leads to poor milk production, a weak let-down
response and ultimately unsuccessful nursing.
Fact: Milk supply is optimized when a
healthy baby is allowed to nurse as often as he indicates the need.
The milk-ejection reflex operates most strongly in the presence of a
good supply of milk, which normally occurs when feeding on baby's
cue.
De Carvalho, M. et al. Effect of frequent
breastfeeding on early milk production and infant weight gain
Pediatrics 1983: 72:307-11.
Hill, P. Insufficient milk supply syndrome.
NAACOG's Clin Issues 1992; 3(4):605-12.
Klaus, M. The frequency of suckling:
neglected but essential ingredient of breastfeeding. Ob Gyn Clin
North Am 1987; 14(3):623-33.
Neifert, M. Early assessment of the
breastfeeding infant. Contemporary Pediatrics October 1996;
6-9.
Lawrence R. Breastfeeding: A Guide for
the Medical Professional, 4th ed. St. Louis: Mosby 1994; 188.
Salariya, F. et al. Duration of
breastfeeding after early initiation and frequent feeding. Lancet
1978; 2(8100):1141-43.
Slaven, S. Harvey, D. Unlimited sucking
time improves breastfeeding. Lancet 1981; 14:392-93.
Stuart-Macadam, P., Dettwyler, K.
Breastfeeding: Biocultural Perspectives. Hawthorne, New York:
Aldine de Gruyter, 1995; 129.
Woolridge, M. and Baum, J. Infant
appetite-control and the regulation of the breast milk supply.
Child Hosp Qtrly 1992; 3:113-19.
Myth 2: A mother only needs to nurse
four to six times a day to maintain good milk supply.
Fact: Research shows that when a mother
breastfeeds early and often, an average of 9.9 times a day in the
first two weeks, her milk production is greater, her infant gains
more weight and she continues breastfeeding for a longer period.
Milk production has been shown to be related to feeding frequency,
and milk supply declines when feedings are infrequent or restricted.
Daly, S., Hartmann, R Infant demand and
milk supply: Part 1 and 2. J Hum Lact 1995; 11(1):21-37.
De Carvalho, M. et al. Effect of frequent
breastfeeding on early milk production and infant weight gain
Pediatrics 1983: 72:307-11.
De Coopman, J. Breastfeeding after
pituitary resection: support for a theory of autocrine control of
milk supply. J Hum Lact 1993; 9(1):35-40.
Riordan, I. and Auerbach, K.
Breastfeeding and Human Lactation. Boston and London: Jones and
Bartlett 1993; 88.
Myth 3: Babies get all the milk they
need in the first five to ten minutes of nursing.
Fact: While many older babies can take in
the majority of their milk in the first five to ten minutes, this
cannot be generalized to all babies. Newborns, who are learning to
nurse and are not always efficient at sucking, often need much
longer to feed. The ability to take in milk is also subject to the
mother's let-down response. While many mothers may let down
immediately, some may not. Some may eject their milk in small
batches several times during a nursing session. Rather than guess,
it is best to allow baby to suck until he shows signs of satiety
such as self-detachment and relaxed hands and arms.
Lucas, A., Lucas, P., Aum, J. Differences
in the pattern of milk intake between breast and bottle-fed infants.
Early Hum Dev 1981; 5:195.
Stuart-Macadam, P., Dettwyler, K.
Breastfeeding: Biocultural Perspectives. Hawthorne, New York:
Aldine de Gruyter, 1995; 129-37.
Myth 4: A breastfeeding mother should
space her feedings so that her breasts will have time to refill.
Fact: Every baby/mother dyad is unique. A
lactating mother's body is always making milk. Her breasts function
in part as "storage tank," some holding more than others. The
emptier the breast, the faster the body makes milk to replace it;
the fuller the breast, the more production of milk slows down. If a
mother consistently waits until her breasts "fill up" before she
nurses, her body may get the message that it is making too much and
may reduce total production.
Daly, S., Hartmann, R. Infant demand and
milk supply: Part 2. J Hum Lact 1995; 11(1):21-37.
Lawrence R. Breastfeeding: A Guide for
the Medical Professional, 4th ed. St. Louis: Mosby 1994; 240-41.
Myth 5: Babies need only six to eight
feedings a day by eight weeks of age, five to six feedings a day by
three months, no more than four or five feedings a day by six months
of age.
Fact: A breastfed baby's frequency of
feeding will vary according to the mother's milk supply and storage
capacity, as well as baby's developmental needs. Growth spurts and
illnesses can temporarily change a baby's feeding patterns. Studies
show that breastfeeding babies fed on cue will settle into a pattern
that suits their own unique situation. In addition, the caloric
intake of a breastfed baby increases toward the end of the feeding,
so putting arbitrary limits on the frequency or duration of feedings
may lead to inadequate caloric intake.
Daly, S., Hartmann, R. Infant demand and
milk supply: Part 1. J Hum Lact 1995; 11(1):21-6.
Klaus, M. The frequency of suckling. Ob
Gyn Clin North Am 1987; 14(3):623-33.
Lawrence R. Breastfeeding: A Guide for
the Medical Professional, 4th ed. St. Louis: Mosby 1994; 253.
Millard, A. The place of the clock in
pediatric advice: rationales, cultural themes and impediments to
breastfeeding. Soc Sci Med 1990; 31:211.
Woolridge, M. "Baby-controlled
breastfeeding: biocultural implications" in Stuart-Macadam, P.,
Dettwyler, K. Breastfeeding: Biocultural Perspectives.
Hawthorne, New York: Aldine de Gruyter, 1995; 217-42.
Myth 6: It is the amount of milk that a
baby takes in (quantitative), not whether it is human milk or
formula (qualitative), that determines how long a baby can go
between feedings.
Fact:Breastfed babies have faster gastric
emptying times than fomula-fed babies--approximately 1.5 hours
versus up to 4 hours--due to the smaller size of the protein
molecules in human milk. While intake quantity is one factor in
determining feeding frequency, the type of milk is equally important.
Anthropologic studies of mammalian milk confirm that human babies
were intended to feed frequently and have done so throughout most of
history.
Lawrence R. Breastfeeding: A Guide for
the Medical Professional, 4th ed. St. Louis: Mosby 1994; 254.
Marmet, C., Shell, E. Breastfeeding Is
Important. Encino, California: Lactation Institute, 1991:4.
Stuart-Macadam, P., Dettwyler, K.
Breastfeeding: Biocultural Perspectives. Hawthorne, New York:
Aldine de Gruyter, 1995; 129.
Myth 7: Never wake a sleeping baby.
Fact: While most babies will indicate when
they need to eat, babies in the newborn period may not wake often
enough on their own and should be awakened if necessary to eat at
least eight times a day. Infrequent waking to feed can be caused by
labor drugs, maternal medications, jaundice, trauma, pacifiers
and/or shutdown behavior after delayed response to feeding cues.
In addition, mothers who wish to take advantage
of the natural infertility of lactational amenorrhea find that the
return of menses is delayed longer when baby continues to suckle at
night.
American Academy of Pediatrics Policy
Statement on Breastfeeding and the use of Human Milk. Pediatrics
1997; 100(6):1035-39.
Klaus, M. The frequency of suckling:
neglected but essential ingredient of breast-feeding. Ob Gyn Clin
North Am 1987; 14(3):623-33.
Mohrbacher, N., Stock, J. BREASTFEEDING
ANSWER BOOK. Schaumburg, Illinois: LLLI, 1997; 60-65, 360-61.
Tips for Rousing a Sleepy Newborn.
LLLI, 1997. Publication No.485.
Myth 8: The metabolism of a baby is
disorganized at birth and it requires the implementation of a
routine or schedule to help stabilize this disorganization.
Fact: Babies are uniquely wired from birth
to feed, sleep and have periods of wakefulness. This is not
disorganized behavior but reflects the unique needs of newborn
infants. Over time, babies naturally adapt to the rhythm of life in
their new environment and do not require prompting or training.
Mohrbacher, N., Stock, J. BREASTFEEDING
ANSWER BOOK. Schaumburg, Illinois: LLLI, 1997; 24-29.
Sears, W. The Fussy Baby. LLLI
1985;12-13.
Myth 9: Breastfeeding mothers must
always use both breasts at each feeding.
Fact: It is more important to let baby
finish the first breast first, even if that means that he doesn't
take the second breast at the same feeding. Hindmilk is accessed
gradually as the breast is drained. Some babies, if switched
prematurely to the second breast, may fill up on the lower-calorie
foremilk from both breasts rather than obtaining the normal balance
of foremilk and hindmilk, resulting in infant dissatisfaction and
poor weight gain. In the early weeks, many mothers offer both
breasts at each feeding to help establish the milk supply.
Mohrbacher, N., Stock, J. BREASTFEEDING
ANSWER BOOK. Schaumburg, Illinois: LLLI, 1997; 25.
Stuart-Macadam, P., Dettwyler, K.
Breastfeeding: Biocultural Perspectives. Hawthorne, New York:
Aldine de Gruyter, 1995; 129.
Woolridge, M., Fisher, C. Colic, "overfeeding"
and symptoms of lactose malabsorption in the breastfed baby: a
possible artifact of feed management? Lancet 1988; II(8605):382-84.
Woolridge, M. et al. Do changes in pattern
of breast usage alter the baby's nutritional intake? Lancet
336(8712):395-97.
Myth 10: If a baby isn't gaining well,
it may be due to the low quality of the mother's milk.
Fact: Studies have shown that even
malnourished women are able to produce milk of sufficient quality
and quantity to support a growing infant. Most cases low weight gain
are related to insufficient milk intake or an underlying health
problem in the baby.
Mohrbacher, N., Stock, J. BREASTFEEDING
ANSWER BOOK. Schaumburg, Illinois: LLLI, 1997; 116-32.
Wilde, C. et al. Breastfeeding: matching
supply with demand in human lactation. Proc Nutr Soc1 1995;
54:401-06.
Myth 11: Poor milk supply is usually
caused by stress, fatigue and/or inadequate fluids and food intake.
Fact: The most common causes of milk
supply problems are infrequent feedings and/or poor latch-on and
positioning; both are usually due to inadequate information provided
to the breastfeeding mother. Suckling problems on the infant's part
can also impact milk supply negatively. Stress, fatigue or
malnutrition are rarely causes of milk supply failure because the
body has highly developed survival mechanisms to protect the
nursling during times of scarce food supply.
Dusdieker, B., Stumbo, J., Booth, B. et
al. Prolonged maternal fluid supplementation in breastfeeding.
Pediatrics 1090; 86:737-40.
Hill, P. Insufficient milk supply syndrome.
NAACOG's Clin Issues 1992; 3(4):605-13.
Woolridge, M. Analysis, classification,
etiology of diagnosed low milk output. Plenary session at
International Lactation Consultant Association Conference,
Scottsdale Arizona, 1995.
World Health Organization. Not enough
milk. Division of Child Health and Development Update Feb
1995 21. http://www.who.ch/programmes/cdr/pub/newslet/update/updt-21.htm
Myth 12: A mother must drink milk to
make milk.
Fact: A healthy diet of vegetables, fruits,
grains and proteins is all that a mother needs to provide the proper
nutrients to produce milk. Calcium can he obtained from a variety of
nondairy foods such as dark green vegetables, seeds, nuts and bony
fish. No other mammal drinks milk to make milk.
Behan, E. Eat Well, Lose Weight While
Breastfeeding. New York: Villard Books, 1992; 145-46.
Mohrbacher, N., Stock, J. BREASTFEEDING
ANSWER BOOK. Schaumburg, Illinois: LLLI, 1997; 377, 379.
Myth 13: Non-nutritive sucking has no
scientific basis.
Fact: Experienced breastfeeding mothers
learn that the sucking patterns and needs of babies vary. While some
infants' sucking needs are met primarily during feedings, other
babies may need additional sucking at the breast soon after a
feeding even though they are not really hungry. Babies may also
nurse when they are lonely, frightened or in pain.
Riordan, J., Auerbach, K. Breastfeeding
and Human Lactation. Boston and London: Jones and Bartlett,
1993; 96-97.
Lawrence, R. Breastfeeding: A Guide for
the Medical Profession, 4th ed. St. Louis: Mosby, 1994; 432.
Myth 14: The mother should not be a
pacifier for the baby.
Fact: Comforting and meeting sucking needs
at the breast is nature's original design. Pacifiers (dummies,
soothers) are literally a substitute for the mother when she can't
be available. Other reasons to pacify a baby primarily at the breast
include superior oral-facial development, prolonged lactational
amenorrhea, avoidance of nipple confusion and stimulation of an
adequate milk supply to ensure higher rates of breastfeeding
success.
American Academy of Pediatrics Policy
Statement on Breastfeeding and the use of Human Milk. Pediatrics
1997; 100(6):1035-39.
Barros, F. et al. Use of pacifiers is
associated with decreased breastfeeding duration. Pediatrics 1995;
95:497-99.
Gotsch, G. Pacifiers: Yes or No?
LLLI, 1996. Publication No.45.
Mohrbacher, N., Stock, J. BREASTFEEDING
ANSWER BOOK. Schaumburg, Illinois: LLLI, 1997; 34-35, 43-44.
Newman, J. Breastfeeding problems
associated with the early introduction of bottles and pacifiers.
J Hum Lact 1990; 6(2):59-63.
Myth 15: There is no such thing as
nipple confusion.
Fact: Breast and bottle feeding require
different oral-motor skills, and rubber nipples provide a type of
"super stimulus" that babies may imprint upon instead of the softer
breast. As a result, some babies develop suck confusion and apply
inappropriate suckling techniques to the breast when they switch
between breast and bottle.
Blass, E. Behavioral and physiological
consequences of suckling in rat and human newborns. Acta Paediatr
Suppl 1994; 397:71-76.
Mohrbacher, N., Stock, J. BREASTFEEDING
ANSWER BOOK. Schaumburg, Illinois: LLLI, 1997; 82-87.
Neifert, M, et al. Nipple confusion:
toward a formal definition. J Pediatr 1995; 126(6):S125-9
Nipple Confusion - Overcoming and
Avoiding This Problem. LLLI, 1992. Publication No.32.
Myth 16: Frequent nursing can lead to
postpartum depression.
Fact: Postpartum depression is believed to
be caused by fluctuating hormones after birth and may be exacerbated
by fatigue and lack of social support, though it mostly occurs in
women who have a history of problems prior to pregnancy.
Astbury, J. et al. Birth events, birth
experiences and social differences in postnatal depression. Aust
J Public Health.1994; 18(2):176-64.
Dunnewold, A. Breastfeeding and postpartum
depression: is there a connection? BREASTFEEDING ABSTRACTS, LLLI,
May 1996; 25.
Lawrence R. Breastfeeding: A Guide for
the Medical Professional, 4th ed. St. Louis: Mosby 1994; 191-2.
Myth 17: Feeding on baby's cue does not
enhance maternal bonding behavior.
Fact: The responsive parenting of cue
feeding brings mother and baby into synchronization, leading to
enhanced bonding.
Ainsworth, M. Infant-mother attachment.
Am Psych 1979; 34(10):932-37.
Berg-Cross, L., Berg-Cross, G., McGeehan,
D. Experience and personality differences among breast and
bottle-feeding mothers. Psych of Women Qtrly 1979;
3(4):344-58.
Kennell, I., Jerauld, R., Wolfe, H. et al.
Maternal behavior one year after early and extended post-partum
contact. Developmental Medicine and Child Neurology 1974;
16(2):99-107.
Temboury, M. et al. Influence of
breastfeeding on the infant's intellectual development. J Ped
Gastro Nutr 1994; 18:32-36.
Myth 18: Mothers who hold their babies
too much will spoil them.
Fact: Babies who are held often cry fewer
hours a day and exhibit more security as they mature.
Anisfeld, E. et al. Does infant carrying
promote attachment? An experimental study of the effects of
increased physical contact on the development of attachment.
Child Dev 1990; 61:1617-27.
Barr, K. and Elias M. Nursing interval and
maternal responsivity: effect on early infant crying. Pediatrics
1988 81:529-36.
Bowlby, J. Attachment and Loss:
Attachment, vol 1. New York: Basic Books, 1969; 178, 208, 240.
Heller, S. The Vital Touch: How
Intimate Contact with Your Baby Leads to Happier, Healthier
Development. New York: Henry Holt, 1997;41-53, 204-21.
Hunziker U. and Barr R. Increased carrying
reduces infant crying: a randomized controlled trial Pediatrics
1986; 77:641.
Matas, L., Arend, R., Sroufe, L.
Continuity of adaptation in the second year: the relationship
between quality of attachment and later competence. Child Dev
1978; 49:547-56.
Myth 19: It is important that other
family members get to feed baby so that they can bond, too.
Fact: Feeding is not the only method by
which other family members can bond with the baby; holding, cuddling,
bathing and playing with the infant are all important to his growth,
development and attachment to others.
Heller, S. The Vital Touch: How
Intimate Contact with Your Baby Leads to Happier, Healthier
Development. New York: Henry Holt, 1997;54-55, 60-61.
Myth 20: Child-directed feeding
(nursing on demand) has a negative impact on the husband/wife
relationship.
Fact: Mature parents realize that a
newborn's needs are very intense but also diminish over time. In
fact, the teamwork of nurturing a newborn can actually bring a
couple closer as they develop parenting skills together.
Bocar, D., Moore, K. Acquiring the
parental role: a theoretical perspective. LLLI Lactation
Consultant Series. Unit 16. Garden City Park, New York: Avery,
1987.
Sears, W. BECOMING A FATHER. Schaumburg,
Illinois: LLLI 1986; 29-50,119-29.
Myth 21: Some babies are allergic to
their mother's milk.
Fact: Human milk is the most natural and
physiologic substance that baby can ingest. If a baby shows
sensitivities related to feeding, it is usually a foreign protein
that has piggybacked into mother's milk, and not the milk itself.
This is easily handled by removing the offending food from mother's
diet for a time.
Hudson, I. et al. A low allergen diet is a
significant intervention in infantile colic: results of a
commmunity-based study. J Allergy Clin Immunol 1995;
96:886-92.
Mohrbacher, N., Stock, J. BREASTFEEDING
ANSWER BOOK. Schaumburg, Illinois: LLLI, 1997; 97-99.
Salmon, M. Breast Milk: Nature's
Perfect Formula. Demarest, New Jersey: Techkits, 1994; 32-3.
Myth 22: Frequent nursing causes a
child to be obese later in life.
Fact: Studies show that breastfed babies
who control their own feeding patterns and intake tend to take just
the right amount of milk for them. Formula feeding and early
introduction of solids, not breastfeeding on demand, have been
implicated in risk of obesity later in life.
Dewey, K., Lonnerdal, B. Infant
self-regulation of breast milk intake. Acta Paediatr Scand
1986; 75:893-98.
Dewey K. et al. Growth of breast-fed and
formula-fed infants from 0 to 18 months: the DARLING study.
Pediatrics 1992a; 89(6):1035-41.
Kramer, M. Do breastfeeding and delayed
introduction of solid foods protect against subsequent obesity? J
Pediatr 1981; 98:883-87.
Stuart-Macadam, P., Dettwyler, K.
Breastfeeding: Biocultural Perspectives, Hawthorne, New York:
Aldine de Gruyter, 1995; 192.
Woolridge, M. Returning control of feeding
to the infant. Paper presented at the LLL of Texas Area Conference,
Houston, Texas, USA, July 24-26, 1992.
Myth 23: The lying-down nursing
position causes ear infections.
Fact: Because human milk is alive and
teeming with antibodies and immunoglobulins, the baby is less likely
to develop ear infections overall, no matter what position is used.
Aniansson, G. et al. A prospective cohort
study on breastfeeding and otitis media in Swedish infants.
Pediatr Infect Dis J 1994; 13:183-88.
Harabuchi, Y. et al. Human milk secretory
IgA antibody to nontypeable haemophilus influenzae: possible
protective effects against nasopharyngeal colonization.J Pediatr
1994; 124(2)193-98.
Myth 24: Nursing a baby after 12 months
is of little value because the quality of breast milk begins to
decline after six months.
Fact: The composition of human milk
changes to meet the changing needs of baby as he matures. Even when
baby is able to take solids, human milk is the primary source of
nutrition during the first year. It becomes a supplement to solids
during the second year. In addition, it takes between two and six
years for a child's immune system to fully mature. Human milk
continues to complement and boost the immune system for as long as
it is offered.
American Academy of Pediatrics Policy
Statement on Breastfeeding and the Use of Human Milk. Pediatrics
1997; 100(6):1035-39.
Goldman, A. Immunologic components in
human milk during the second year of lactation. Acta Paediatr
Scand 1983; 72:461-62.
Gulick, E. The effects of breastfeeding on
toddler health. Ped Nursing1986; 12:51-54.
Innocenti Declaration on the protection,
promotion and support of breastfeeding. Ecology of Food and
Nutrition 1991; 26:271-73.
Mohrbacher, N., Stock, J. BREASTFEEDING
ANSWER BOOK. Schaumburg, Illinois: LLLI, 1997; 164-68.
Saarinen, U. Prolonged breastfeeding as
prophylaxis for recurrent Otitis media. Acta Paediatr Scand
1982; 71:567-71.
Last edited
Friday, February 10, 2006 10:53 AM
by jlm.
|
