Breast Milk Versus Formula

I decided to delve into this controversial debate about breast milk versus baby formula. I thought this might be an interesting blog post for a couple of reason. First of all it had been in the media quite frequently after President Trump tweeted "The failing NY Times Fake News story today about breast feeding must be called out. The U.S. strongly supports breast feeding but we don’t believe women should be denied access to formula. Many women need this option because of malnutrition and poverty." 


So if you are wondering about this article that President Trump said was Fake News you can find it HERE.  I would encourage you to read through it and see what your thought are. The main accusation against the United States is the reported situation as follows ... "American officials sought to water down the resolution by removing language that called on governments to “protect, promote and support breast-feeding” and another passage that called on policymakers to restrict the promotion of food products that many experts say can have deleterious effects on young children." That might not have been that big of an issue, but when other countries didn't come to back the United States' proposed changes then things got more heated. "When that failed, they turned to threats, according to diplomats and government officials who took part in the discussions. Ecuador, which had planned to introduce the measure, was the first to find itself in the cross hairs. The Americans were blunt: If Ecuador refused to drop the resolution, Washington would unleash punishing trade measures and withdraw crucial military aid. The Ecuadorean government quickly acquiesced." That is the part that bothered me. I don't think we should go threatening countries to get policy changes. That is something that I think is wrong and seems to be behaving kind of like a bully. 

So that was kind of a crazy response to something like breast feeding. I honestly was quite surprised to read that article. Then there started to be more articles and other opinions written. and I wanted to make sure to share those with you too. I really liked this article by VOX because I thought it did a good job at outlining the main issue that was being debated by the United States and other countries. "The UN group responsible for setting the standards on how countries should regulate food products, the Codex Alimentarius, hasn’t yet decided whether follow-up formulas should be treated like infant formulas — as “breastmilk substitutes.” Calling them a substitute for mother’s milk would mean heavier scrutiny and regulation — something public health advocates want. The US wants to call it a food, not a breast milk substitute,” said Elizabeth Zehner, project director for Helen Keller International’s child feeding project, who was present at the Codex negotiations. “That will leave the door open for all countries to call these products as non-breast milk substitutes, so they will get advertised on TV — and they look just like the infant formula.” 

So that is the main part of the debate ... how to categorize this formula products. I know it seems like a simple issue, but it can have big ramifications. Food is a complicated thing and when it is regulated different can lead to a large variance in products. The supplement industry is that perfect example. That is the under the Food and Drug Administration and anything classified as a supplement doesn't meet the same scrutinized criteria as other actual food items. So companies can put whatever health claims on those products and they aren't held to the same regulations as the food industry. I would say most of the time that can be ok, but I understand the concern voiced in the VOX article about how toddler formulas are regulated, because if they are labeled as "breastmilk substitutes" that would change their nutrition make up and how they are marketed to families. 

There was another story published on NPR on this topic and I wanted to make sure you had access to that as well, CLICK HERE. I think that this debate is not other and the formula industry does have a lot more money to lobby with compared with advocates for breast feeding. They are pushing a product and want to make money. That being said I believe in a baby being fed and healthy and that can be accomplished through either breast milk or baby formula. The debate here isn't necessarily which is better nutritionally, the debate comes down to money and how these formulas are categorized. That will then have a big influence on the products that are manufactured and then marketed to families. I would say our country has come a long way in encouraging mothers to breast feed and educating families on why that is the best thing for your baby. I think like any basic mothering skill, there are so much emotion that gets ties into this topic and can lead to guilt and regret. That is another blog post, but I wanted to make sure that you got some information on this debate and maybe some more insight as to why the President cared if women were breast feeding or using formula. 


The Gift of Breastfeeding

So I am officially a breastfeeding mama. It has been quite the adventure let me tell you. I have worked with Moms and breastfeeding with my job a Registered Dietitian and on a feeding team, but this is my first time actually doing this myself. I wanted to make sure that I talk about on this blog the reality of breastfeeding. Sometimes I think Moms aren't exactly sure what they are in for and sometimes it can be very overwhelming. 

Here are some statistics for you about breastfeeding that came from an article that was released just a few days ago: 

  • In 2012, estimated 80% of mothers started breastfeeding their infants. By 6 months of age, an estimated 51.4% continued to breastfeed and by 12 months of age that number fell to 29.2% of mothers still breastfeeding. 
  • Goals for Healthy People 2020 are for these rates at birth to be at 81.9%, by 6 months keeping 66.6% of mother breastfeeding and by 12 months of age having 34.1% of mothers continuing to breastfeed.
  • Breastfeeding support programs are effective in helping to encourage and support mothers of all ages to continue to breastfeed.
  • Breastfeeding has several maternal benefits including - lower risk of breast and ovarian cancers, less visceral adiposity, reduced rates of diabetes and cardiovascular disease in the mothers.

I wanted to make sure that I shared with you some of my experiences with breastfeeding. I have only been doing this a few weeks, but I think it is an important thing to talk about and prompt discussion.

The initial latch - Can we talk about how when your baby latches for the first time it hurts? It is very uncomfortable. I was really concerned at the beginning that William wasn't latching correctly and that was causing some pain, but after speaking with a lactation consultant in the hospital, he was doing a great job and had a great suck. It took about 2-3 days for the initial "pain" with the sucking to go away. Lanonlin was my best friend. That helped so much to help relieve some of that pain and keep my nipples from cracking and bleeding. I would apply it after each time breast feeding. 

Milk coming in - Oh my goodness this was a surprise. My milk came in on day #3 after having William and WOW! I was so overwhelmed. It was painful to have super huge boobs and have them filled with milk. I didn't know this was going to happen so quickly. I had a ton of milk immediately and I didn't know what to do with it all. Originally, I was not going to pump for the first month, but when my milk came in I had to pump. I had to relieve that pressure. So I started pumping twice a day and I have been sticking with that regime since that first day home. 

Engorgement - I didn't know how to handle this side effect of breastfeeding either. I wasn't prepared for the engorgement feeling and again because my milk came in so quick I was so overwhelmed. It was such a crazy experience to be solely responsible for feeding your child. I have been thankful that I have a good milk supply. I know that lots of women struggle to increase their supply. Breastfeeding is tough and takes lots of time. 

It is a gift - In the midst of feeling overwhelmed and learning how to breastfeed I had a wonderful chat with my husband, Chas. He was so encouraging and helped to remind me that I didn't have to breastfeed. If there was any point that I felt like I didn't want to breastfeed, I didn't have to. There are other ways that we could feed William. He reminded me that he would support me in whatever I decided to do. He also said that if I continue to breastfeed that is a special gift that I am able to give William. It is something that I can choose to give him. Taking that perspective has been so helpful for me. Viewing breastfeeding and pumping as a gift for my son really hit home for me. I thought this perspective was worth sharing. If you are a breastfeeding Mom and feeling discouraged, remember what you are doing 6-12 times per day is a gift. All of the hard work is something special that you can give your child. 

I will keep you posted on how breastfeeding is going. We are now 3 weeks into this adventure and it is going well. William loves to eat and is growing quickly. Our next big challenge will be next month when William goes to daycare and I head back to work. Until then, we will continue to breastfeed, practice with a bottle 1-2 times a day and pumping ~3 times a day. Keep up the hard work if you are currently breastfeeding and if you know someone who is breastfeeding give them a pat on the back. 


Working In A Formula Room

It has been awhile since I have spoken about my day job here on the blog. As you may recall, I work in a Neonatal Intensive Care Unit (NICU) and I am a pediatric dietitian. I work with newborn babies and I calculate their nutrition needs to help them grow appropriately since most of our patients are born early. Another part of the job, is helping to oversee our Formula Rooms. This is the part of the NICU where all of the feedings are put together/made for our patients in 24 hour batches. We help to schedule, oversee and hire the Formula Room Technicians that work in those mixing rooms. Sometimes the dietitians fill in those shifts as well if we don't have enough techs to fill the spots on a particular weekend. 

This last week I have had the opportunity to work in our Formula Rooms a couple of times. I am always impressed with our system and how we so accurately get all of our babies fed ~ 8 times a day. It is truly a well oiled machine and is so neat to be a part of that. 

I thought it might be neat to address some of the Frequently Asked Questions that I get about our Formula Room/NICU and how nutrition plays a role in that environment. Most people are surprised to learn that there are dietitians in the NICU and that we have a mixing room for feedings. 

Frequently Asked Questions

  1. What does a dietitian do in a NICU?
    • This is a great question. The role of a dietitian in a NICU varies, but the main role is to help provide nutrition care to this specialty population. The RD serves as the nutrition expert on the medical team and provides guidance/advice to the neonatologist about  the best feeding recipe for each patient. Each week the RD sees every patient in the NICU and writes up a nutrition note about their plan of care that week. The RD would suggestion what feeding option might be best for that patient, the avenue of administering the feeding, when start vitamins, how feedings might change based on lab values and monitor growth velocity and tweak the nutrition plan as needed. 
  2. Do you just mix formula in the Formula Room?
    • No. In our Formula Room we prepare ALL of the feedings for ALL of our patients and they are stored in a refrigerator in that room. The RN will come in and out of the Formula Room to get the feedings and take that aliquot to the bedside and feed the baby. Each patient has their own bin in the refrigerator and their feeding is in that bin for the RN to grab anywhere from 6-8 times per day.
  3. How do you feed your patients?
    • In the NICU, since our patients are normally premature, our most common form of administering nutrition is via a feeding tube or via TPN. We prefer to use the GI tract and will try to give feedings via the feeding tube and we work to wean TPN support as soon as possible due to line infection risk and liver damage. Infants do not have their swallow/feeding reflex developed until ~34 weeks gestation and so that would be the point that with cues, we might start some bottle feedings. 
  4. Do you feed your patients breast milk? 
    • Yes. Our goal is to use maternal breastmilk whenever possible. That is the gold standard for all of our babies, because it has so many protective properties. Some times there are medical diagnoses that prevent the use of breastmilk, but those cases are limited. Premature babies also need higher calories, more fat and more protein. They are born early and their nutrition needs are higher compared with a term infant. This means that unfortified breastmilk won't meet their nutrition needs so in the NICU we use different formula/fortifier to add to the breastmilk to increase the calories, protein, fat and other vitamins the infant is receiving. We have recipes that we use to mix these feedings and that is the primary role of our formula room technicians. They are the ones that will mix up these recipes for each baby in 24 hours batches and those feedings will be used throughout the day by the nursing staff.
  5. How much do you prepare each day in the Formula Room?
    • Our technicians make 24 hour batches for all the babies that we are mixing for that day. Our NICU holds 90 babies and our nursery unit holds an additional 10 babies. There is the potential that we could mix for all 100 babies, but that is normally not the case. It is inevitable that there is a baby or two who are NPO (nothing by mouth). Our average census is ~70-80 patients at a time. 
  6. Why do you have technicians mixing feedings compared with nursing staff? 
    • Nursing staff in some hospitals do mix feedings and they have at our hospital in the past. With this creation of a Formula Room space it is more conducive to having one person mixing up feedings compared with each RN mixing their feedings. It decreases the number of people in the room and would decrease risk of errors/infection risk. We work hard to make sure that our technicians are trained well and mix the feedings appropriately. This helps give the RNs more time at the bedside to do what they do best, provide that direct care for our babies. 

Hopefully this has given you a little better idea about what we do in the NICU and how we provide top-notch nutrition care to our patients. We have some of the sickest babies in the state at our hospital and I am so proud of our medical staff for the level of care that we provide each and every day!