-----Original Message-----
From: Vandenberg, Janet
Sent: Thursday, May 29, 2003 1:55 PM
To: [log in to unmask]
Subject: Breastfeeding information on Family Practice Notebook
website


Dear Scott,

I would like to provide some feedback about the breastfeeding information
on your web site http://www.fpnotebook.com/OB75.htm.

I am concerned about some of the suggestions listed on various parts of
your site. I realize that this was written 3 years ago but even then this
information was not accurate and some could, in fact, be dangerous.

Examples:
Masse cream and Bag Balm for sore nipples:  Masse cream contains peanut
oil, bag balm is not approved for use in humans and certainly not newborns.

Treatment for vomiting is confusing - is the one side per feeding meant to
reduce oversupply as a cause of reflux?  Why clear liquids - and what clear
fluids are we talking about here?  Oral rehydration fluids?  The current
general recommendation for vomiting in a breastfed infant is to continue
with short frequent feeds and watch for dehydration. For example, from our
local pediatric centre:
http://www.yourchildshealth.ca/hsc/echn.nsf/pages/sframe


Normal stools in a breastfed baby:
Green? Water ring in diaper?  This is diarrhea by my definition. Yellow and
seedy are the norm.  Frequency of stools is a key point as well. From day 4
onwards babies should have more than 2 large yellow stools each 24 hours
until 4-6 weeks of age. Since the info on the Breastfeeding Technique page
about stools is more accurate I am guessing this is just an error. Did
the "green and watery" description just end up in the wrong spot?

Maternal dietary causes of rapid transit in the infant: shouldn't
oversupply be the main cause?  I haven't seen research to support caffeine
causing rapid transit - do you have a source for this?

Proper Infant latch-on and positioning: Baby should latch onto entire
areola (not nipple)  & Center nipple in babies mouth
This is not a very accurate description of proper latching - areola's vary
in size between women.  Lactation specialists have found that an
asymmetrical latch actually works the best.  For more details see these
links: http://www.lalecheleague.org/llleaderweb/LV/LVAugSep00p63.html
and
http://www.bflrc.com/newman/overheads/when%20latching.htm
Breastmilk suppression page: Alcohol swabs applied to nipple and areola:
why?  I am afraid I 'm don't understand the rationale for this one.
Wouldn't this just cause the skin to dry out and break down?
Breastfeeding Resources page:  Could use some updating - titles are from
the 1980's!  Great spot for links such as  the LLLI website:
www.lalecheleague.org

From the Breastfeeding Techniques page:
There was certainly lots of positive info and messages on this page.  The
positives message about breastfeeding lead me to think that you would be
interested in making your pages as accurate and helpful as possible.

Some minor points on this page
"High Milk" contains more nutrients: Did you mean "hind"milk?  The more
nutrients meaning fat?

By 8 months, feedings settle down to 3-4 per day: 3-4 feeds per day at 8
months indicates early weaning.  Breastmilk should make up the majority of
infant's diet until 1 year of age.  Most babies who are not being pushed to
wean, or whose mothers are not misinterpreting the distractibility of this
age, nurse more often at 8 months of age.

Daily weight gain: 28 grams (1 ounce) Weekly weight gain: 110-220 grams (4-
8 ounces): I agree that 4-8 oz per week is correct.  The daily weight gain
needs to be adjusted to 1/2 to 1 oz per day to match the weekly gain.

Thank you for providing this opportunity to comment on your site.  There is
certainly lots of good information including  the benefits of
breastfeeding. I hope you will find this feedback helpful.


Janet Vandenberg RN, BScN, IBCLC
Ontario, Canada

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