Laurie asks:


>  I have
>asked this question several times, and I don't know if there is an answer:
>WHICH DOES LESS HARM: BABY LOSING WT BUT GETTING ONLY BREASTMILK *OR* BABY
>GAINING ROBUSTLY BUT GETTING FORMULA SUPPLEMENTS? HOW MUCH IS TOO MUCH WT
>LOSS AND FOR HOW LONG? WHICH IS WORSE: EXPOSURE TO FORMULA DURING THIS (I
>assume) CRITICAL PERIOD *OR* LACK OF ADEQUATE CALORIES/NUTRITION DURING THIS
>CRITICAL PERIOD. This is a fine line to walk and is often a judgement call.


(The Caps were Laurie's, BTW!)

You are absolutely right, Laurie...there is a real lack of solid
evidence to answer these questions. Obviously, working on the
breastfeeding to fix it if it's not going well is crucial, whatever
the short-term decision on supplements/no supplements.

What we *do* have evidence for is that introducing formula is a real,
major risk to continued breastfeeding, so on the basis of what we
know, formula should be regarded as a very Big Deal Indeed. We also
have evidence that even a small amount of formula can affect the
long-term health of the baby, even if that baby goes on to be
exclusively breastfed....so that's another point against it.

Supplements, in any case, could/should be of human milk, when possible.

What we really do not know - at all - is how much weight loss is
physiologically normal, and as well as that, how much weight loss is
normal in a baby who has been born in a less-than-physiological way,
and who has been cared for with institutional separation and so on. A
recent paper on dehydration in new babies (cited here on Lactnet -
Magda and I both had letters responding to it, see here
http://adc.bmjjournals.com/cgi/eletters/archdischild;85/4/318) used
data from the 1960s and 1980s to work out what weight loss 'should'
be, and as feeding practice has changed since then, we urgently need
new data. The 10 per cent rule is pretty arbitrary, based on custom
and practice as far as I can see, rather than anything else...it also
does not encourage mothers or HCPs to look at the feeding
holistically.

We also don't know if this is a crucial period nutritionally - but I
think that would be harder to find out.

Heather Welford Neil
NCT bfc Newcastle upon Tyne UK

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