Newborn babies are being made ill by strict rules in hospitals that are aimed at getting more women to breastfeed – and they don’t even work.
Global guidelines, set by UNICEF, say that women trying to breastfeed shouldn’t use occasional bottles of formula, even in the first few days after birth when they might not be making much milk. But refraining from using formula during this time can in some cases lead to babies getting dehydrated and developing jaundice.
Parents are also told not to give their baby a dummy, or pacifier, in case they prefer sucking on that to the breast. But dummies seem to reduce the risk of cot death, also known as sudden infant death syndrome.
Now, medical body the US Preventive Services Task Force says there is no evidence that either strategy raises breastfeeding rates, and has published an updated review of such strategies. Valerie Flaherman at the University of California, San Francisco, warns in an editorial in the same journal that hospitals should reconsider these policies as they “risk causing unnecessary harm”.
Is breast always best?
How babies are fed has long been contentious. Last century, formula manufacturers advertised their products as being better than breast milk – which proved lethal in some developing countries where the water used to make up formula is sometimes contaminated.
In Western nations, many studies suggest that breastfeeding is beneficial. It is said to protect against infections, allergies, obesity and even raise IQ – although critics say these claims are overblown and that the correlations arise mainly because poorer women are less likely to breastfeed.
Now, the standard advice worldwide is to try to breastfeed exclusively at least for the first six months. And many hospitals in countries such as the UK and the US follow strict rules about breastfeeding in order to get accredited by UNICEF’s Baby Friendly Initiative.
These rules include giving newborns nothing to drink except breast milk unless medically necessary. Francesca Entwistle of UNICEF says dehydration or jaundice could be classed as a medical need for formula. But some have noticed that certain hospitals trained by UNICEF have begun to interpret the rules to mean they should store no formula milk on postnatal wards. “The Baby Friendly Initiative has gone hand in hand with less support for formula or mixed-feeding parents,” says Sasha Howard, a paediatrician at Barts Health Trust in London.
However, some new mums don’t make much milk in the first few days or the baby doesn’t latch on to the breast properly. “Ten years ago, you could ask for a bottle of formula,” says Howard. “It’s no longer available in some hospitals. I hear of dads being sent out to buy some at 3 am because the baby wasn’t feeding and there simply was no formula.”
As well as this policy contributing to babies becoming dehydrated or getting jaundice, it could even be counterproductive. A study has suggested that if breastfeeding is difficult because a new mum isn’t producing enough milk, giving the baby small amounts of formula in the first few days can tide them over until the supply of breast milk increases, raising the breastfeeding success rate in the long term. “Banning formula may impact negatively on the very thing you’re trying to achieve,” says Howard, who has co-written a book called Guilt-Free Bottle Feeding.
Now, the US Preventive Services Task Force says that although giving women struggling with breastfeeding one-to-one support is helpful, there is no evidence for blanket hospital policies like banning formula and dummies.
The change of heart comes after concerns that advice to avoid giving infants any solid food until they are six months old – also designed to promote exclusive breastfeeding – could be contributing to the rising rate of food allergies.
A trial found that giving infants peanuts and egg well before six months helped avoid allergies to these foods.
Journal reference: Journal of the American Medical Association, DOI: 10.1001/jama.2016.15083