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Nancy E. Wight MD, IBCLC, FABM, FAAP
Exclusive breastfeeding has been shown to provide improved protection against many diseases and to increase the likelihood of continued breastfeeding for at least the first year of life.1 Although breastfeeding initiation rates have increased steadily since 1990, exclusive breastfeeding rates have shown no increase.2 Despite past and current American Academy of Pediatrics recommendations for exclusive breastfeeding for approximately the first 6 months of life1, data from the newborn screening database reveal that approximately 50% of breastfed infants are leaving California hospitals already being supplemented with formula. (See Figure 1).
Figure 1: Percent Any and Exclusive In-Hospital Breastfeeding in California 1994-2001. Source: Newborn Screening Database, Genetics Disease Branch, California DHHS.
Consequences of Inappropriate Supplementation. Supplementation has been found repeatedly to be one of the strongest factors associated with early breastfeeding termination.3-6 Although some supplementation is medically necessary, most is not. Inappropriate supplementation caries significant consequences including alteration of gut flora toward more pathogenic bacteria7, potential sensitization to
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foreign proteins (especially in allergic families) 8, infant preference for the nipple over the breast9, interference with the normal frequency of feedings10, misleading message to parents leading to continued supplementation at home, and most importantly, a shortened duration of exclusive and any breastfeeding. 3-6
Inappropriate Reasons for Supplementation. With the best of intentions, post-partum nurses sometimes suggest artificial milk supplementation as a means to achieve more maternal rest in the hospital. Unfortunately, research suggests that supplementation in the nursery does not increase the quantity or quality of a mother's sleep. 11 Supplementation is also suggested to prevent weight loss or dehydration. Infants are well hydrated via the placenta at birth with urine output greatly exceeding intake for the first 3 days of life. Small colostrum feedings (5-15 ml) are appropriate for the size of the infant's stomach12, sufficient to prevent hypoglycemia in normal term infants13, and easy to manage as the infant learns to coordinate suck, swallow and breathing. In optimally breastfed infants the maximal weight loss averages 6% of birthweight and occurs between day 2 and 3 of life. 14-16
Additional reasons given for supplementation in the hospital are to prevent hypoglycemia and jaundice. As noted above, healthy term infants do not become hypoglycemic simply from underfeeding. Supplementation may actually blunt an infant's normal adaptive response to transient hypoglycemia.17 The risk of early hyperbilirubinemia is inversely proportional to the number of
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Published by: SDCBC
Editors:
Kelly Barger, RD, CLE, CDE
Diana Lee, RD, CNSD, IBCLC
Angela Tenenini, BS
Eve Moeran, RN, IBCLC
Nancy Wight, MD, IBCLC
Designed by:
Jennifer Neal
Inquiries can be sent to:
San Diego County Breastfeeding Coalition
Children's Hospital
3020 Children's Way, MC 5073
San Diego, CA 92123-4282
sdcbc@breastfeeding.org
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