Marie,
Thank you for your vote of confidence about my insightfulness. It was a
lovely way to start the day!
You noted:
<The important thing to remember here is that these kids
were *exclusively* breastfed for 6 months, and we can't necessarily
generalize the results to kids here in the US, who are, typically, NOT
exclusively breastfed.>
Haven't gotten around to checking my files yet for the summer 2000 issue
of Breastfeeding Outlook to re-read your synopsis of the obesity risk
article yet but I will.
However, the part that stood out to me in the Medline review was:
<There was also a
dose-response effect for the duration of breast feeding on the prevalence
of obesity.">
I'm sure that that part stood out for me precisely because so many of the
mothers I work with at WIC do not breastfeed exclusively, and many who
do, end up starting solids and/or substituting formula occasionally,
before the age of 6 months.
Either way, I think it's a good talking point that might persuade more of
them to start out breastfeeding, to breastfeed exclusively, and for a
longer time, to supplement less when they do supplement, etc., and to
slow down the bottlefeedings (whether done personally or by significant
others or baby-sitters) when they do occur.
I have a strong impression that "how" the early feeding/swallowing habits
are formed has some definite impact on lifelong eating habits, air
swallowing, over-filling the gut, and subsequent tendency to obesity.
(Some of this deep thinking comes from my own weight struggles.)
And my observation is that that impact is a separate issue from the
"what" that the baby is fed. I wish someone would do more observational
studies on the cardio-respiratory stresses caused by the speed of
delivery by many rubber nipples. IME, hospital personnel and significant
others as well as parents, often permit bottle feeding to progress at too
rapid a pace.
Even those moms with whom I discuss bottle feeding, of either EBM or AIM,
I will explore their baby's apparent "greediness" with them, and to help
them understand the benefit of responding to early feeding cues rather
than waiting till the baby is ravenous.
And even more important, I will explain the benefit of mimicking the
gentle pulsation/trickle/pulsation pattern of natural MER in helping the
baby control the speed of intake when using artificial nipples.
I will emphasize the baby's need to coordinate breathing and swallowing,
and explain how to avoid the anxious chuggalugging coping pattern by
slowing down the speed of the first 1-2 ounces by deliberate pauses.
I will try to help them understand that satiety depends not on how
literally "full" the stomach is, but the fact that it takes 15-20 minutes
for the digestive process to convey the satiety signal to the brain.
In this way, I hope to have an effect on the misinterpretation of baby's
body language and the gross overfeeding I often see, even more
devastating when it is done with AIM.
Just my thoughts.
Jean
***********************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA
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