I hope I'm speaking to my friends - and I may be getting in really hot water here...but thought I'd also suggest that when working with moms, this option might actually work to help breastfeeding.

Just like the use of nipple shields and the use of bottles to support breastfeeding were once considered absolute no-no, and then we learned that there were times and places and situations that these tools were totally appropriate...perhaps we may want to see how this study might provide us with an additional tool.  Below are some quick thoughts: 

1. I wonder about the why they used 5% weight loss by 36 hours?  Now that we have studies indicating that babies may lose a considerable amount due to "over-hydration" when mom received IVs late in labor - that amount of weight loss would occur in a large portion of the babies in some hospitals.  Perhaps clarification of using the 24 hour weight?  I imagine the "up to 36 hours" was due to the fact that all (in my experience) healthy moms/babies are discharged in the US by that time.  

2. I appreciate the limited amount of formula (10 ml or 2 tsp),  mentioned - in SOME of the reports, but not all -  the timing (after breastfeeding) the feeding method (syringe) giving the parents the clear indication that this is a very time-limited intervention.

3. It appears that in addition to the use of small amounts of formula, there was close follow-up of these families - that, also, needs to be included in any care plan being developed utilizing this study as a reference.

When a mother insists in supplementing, this option (limited amounts, given after breastfeeding and for limited time) may be a useful alternative - with clear instructions (Plan, Rationale, Duration) and appropriate (within 24 hours after discharge) follow-up.  

Again, this is a "tool" that may help to avoid the situation mentioned in one of the comments after one of the articles by an already-experienced breastfeeding mother, referring to the "breastfeeding nazi" who was obviously unable to hear the mother's frustration and exhaustion - and respect the mother's decision to supplement while she recovered.    

As IBCLCs we may not like the idea of giving formula - knowing full-well the importance of keeping the baby's digestive system free of non-human proteins.  However, as the Code of Professional Conduct stresses that IBCLC is to provide the mother with the ability choose an option "to meet her breastfeeding goals" that might be less damaging to breastfeeding while meeting a mother where she is...  we may want to keep an open eye/ear/mind to this tool!

If we research other articles by the primary author - Dr. Valerie Flaherman - i.e. "New moms who express milk by hand breastfeed longer" and others -  we may be willing to read this study with a more open mind?

(By the way, if you do a search on this article, which seems to be published in over 30 different sites that I could find, you see picture after picture of older children drinking huge amounts from bottles - including clear liquids - but not one could I find with the actual feeding device: a syringe...formula companies must love this!)

Jeanette Panchula, BSW, RN, PHN, IBCLC
Vacaville, CA
(Hesitatingly sending this off...hoping not to set off too many fireworks...)

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