Early limited formula (ELF) study

[@llli*sarah.beachy]

Did anyone else read about the study on early limited formula use (soon to be published in the journal Pediatrics)? I read about it here: http://www.ucsf.edu/news/2013/05/105...astfeed-longer

I'm really curious about what some of the experts at LLL would say about this. Anyone?

Sarah DB

[@llli*still.here]

Those are some pretty striking statistics. But I think if it's a matter of making mothers feel more comfortable (ie a psychological benefit to the mother rather than a physiological benefit to the child) then having supportive doctors and nurses reassure her that the weight loss is normal and that she IS making enough milk should have a similar effect.

I definitely think it has the potential to be misused/overused. Slippery slope indeed. I have very little confidence that the majority of pediatricians would use this technique appropriately.

[@llli*lllkaren]

There's a good analysis of the study on the Academy of Breastfeeding Medicine blog:

http://bfmed.wordpress.com/2013/05/1...d-formula-use/

It covers some of the weaknesses of the study and what further questions it raises.

[@llli*carm3]

I think it will be interesting to see if the results can be replicated in larger studies. But the study doesn't really get into what kind of breastfeediing support the mothers had available and what effect that had on why those that stopped breastfeeding did so. I'm not sure about other studies that have been done to that effect, but I have to wonder if adequate support would play at least as strong a role in the continuing of breastfeeding as this limited formula use did.

[@llli*carm3]

Thanks for that article, Karen. I especially liked Dr. Newman's response at the bottom. He makes a lot of sense!

[@llli*bfwmomof3]

I haven't read the study. But:
This part drives me crazy:

"Women do not immediately produce high volumes of milk after childbirth. Instead, at first mothers secrete small amounts of colostrum, which contains high concentrations of nutrients and antibodies for the baby. During this period, babies often lose weight and new mothers may be concerned that their babies appear fussy or hungry. “Many mothers develop concerns about their milk supply, which is the most common reason they stop breastfeeding in the first three months,” said Flaherman.

“But this study suggests that giving those babies a little early formula may ease those concerns and enable them to feel confident continuing to breastfeed,” she said.

Why not have supportive doctors, nurses, LCs etc - as still.here points out. Totally agree with that point. Losing weight in the first few days is NORMAL. Colustrum is NORMAL. Why interfere with a NORMAL process - it just ends up taking a normal process and turning it into a pathological one that needs to be "fixed."

And I think it's really, really important to keep in mind that this is a single-center study at an academic institution. The "real-world" application of this could look much, much different.

That said, I think THIS part is good: “It is crucial that we have more randomized controlled trials on interventions to increase breastfeeding rather than relying on heavily confounded observational studies or biased expert opinion.”

But I would really love to see interventions that do not involve the use of formula. For example, randomize mothers and/or pediatricians and/or maternity ward RNs to receive specific education about what is NORMAL: that is normal for a breastfed baby to lose weight; that it is normal for there to be nothing but colostrum for the first 2-5 days and that this is the perfect nutrition for a newborn, etc - and see what the results are.

[@llli*bfwmomof3]

Thanks for that article, Karen. I especially liked Dr. Newman's response at the bottom. He makes a lot of sense!

I especially liked this comment:
"There is nothing worse than “proponents of breastfeeding” who believe in solving problems with breastfeeding by giving formula. Those are the ones that confuse the mothers the most."

[@llli*mommal]

There's a good analysis of the study on the Academy of Breastfeeding Medicine blog:

http://bfmed.wordpress.com/2013/05/1...d-formula-use/

It covers some of the weaknesses of the study and what further questions it raises.

Loved this!

I really disliked seeing how much play this one small study got in the press. I do fear that it will translate into "a 6 pack of formula in every bassinet, because we KNOW formula is good for breastfeeding rates" and further pathologicalization of normal weight loss in newborns.

[@llli*bfwmomof3]

Exactly. Because people are going to forget (if they ever even knew) that in the study, they were syringe feeding the babies 1/3 of an ounce. Or that it was 40 babies. They're just going to remember the "formula is good for breastfeeding rates" and stick the 12 ounces into the bassinet. Argh.

[@llli*mommal]

Yeah, the more I think about it, the more I cannot believe how much play this has gotten! 40 babies, with more multiparous moms- who are more likely to breastfeed successfully than primiparas- in the intervention group than in the control group. That just doesn't sound like a well-designed study, in my book. With such a small population, statistical outliers become a big problem.