The rest:


     Dr. Dworkin writes: “Appropriate infant growth and development
indicates appropriate nutrition.”  This is inaccurate, at best.  Growth
monitoring of children is an excellent way to get a quick feeling for how
the child is growing and developing.  I am an expert in growth monitoring
and have used it extensively in my research in West Africa.  However, just
because a child is growing well physically does not mean they are as healthy
as they could be if they had better nutrition (that is, if they were
breastfed instead of bottle-fed).  You also need to look at mortality rates
(death), morbidity rates (illnesses), and cognitive development.  Two
children may have exactly the same birth weights and growth in weight,
height, and head circumference over the course of their first year of life.
But the formula-fed child also (on average) has many more illnesses, more
severe illnesses, is sicker longer, and is generally fussier and crankier.
He is more likely to die of SIDS or necrotizing enterocolitis.  His
cognitive development is clearly going to be less, on average, than that of
the breastfed child, even with the same head circumference.  Equal growth
does not indicate equal health and cognitive development.
     Dr. Dworkin writes: “[F]or those who are unable to produce enough milk,
I often suggest formula supplementation.”  Formula supplementation should be
the last resort, and should be used only after (1) major efforts to increase
the mother’s milk supply, including the use of prescription drugs and
over-the-counter herbs, as well as more frequent nursing, better latch, etc.
and/or (2) use of human breast milk from another mother or from a milk bank.
  The dangers of formula are real and serious, and no one should ever
supplement a child with formula until all other options have been exhausted.
  No one should ever supplement a child with formula until the parents have
signed an informed consent form that clearly outlines the risks, either.
     Dr. Dworkin writes: “Recently, one of my patients was breastfeeding for
two hours per feed because her newborn son had difficulty suckling. He had
not gained weight after his first week of life. She cut down the time to 10
minutes a breast and bottle-fed formula thereafter. Her son is now growing
well. She gets more sleep and her mood is improved. Her husband assumes some
of the feeding responsibilities.”  How much better for everyone concerned if
the doctor had figured out why the child was having difficulty suckling, and
then fixed the problem!  The mother could have used an electric breast pump
to provide high-fat hind milk for supplementation, or she could have gotten
human milk from a milk bank until the suckling problem was fixed and her
milk supply built up.  Either solution would have eliminated the risks of
formula as well as stimulated more milk production.  Her husband could have
helped by assuming responsibilities for diapering and bathing the child, not
to mention doing the laundry, the grocery shopping, the cooking, the dishes,
and the other housework.  These are much better solutions to this problem
than the one the doctor seems so happy with.
     Dr. Dworkin writes:  “Fathers feel useless because there is little they
can do to help with breastfeeding problems.”  There are many things fathers
can do, starting with supporting the mother in her conviction that
breastfeeding matters.  He can call La Leche League, or an Internationally
Board Certified Lactation Consultant.  He can keep away all the people who
would tell his wife that she isn’t capable of breastfeeding and that it
isn’t important.  He can find her a better-informed and more supportive
health care provider for their child!
     Women know that breastfeeding is important.  They feel tremendous guilt
if they fail at breastfeeding.  Women who bottle-fed their children out of
ignorance should feel regret that they didn’t have the information they
needed to make an informed decision or get the help they needed.  And most
importantly, they should feel rage that health care professionals would dare
to withhold information and support that would allow them to be successful
at breastfeeding their children.  It is the ethical obligation of all health
care professionals to provide complete and accurate information about the
risks of formula-feeding to all women, without respect to the health care
provider’s own feelings or infant-feeding history, and without respect to
whether or not a woman might feel guilty about the choices she makes.
     I frequently give a 1.5 hour presentation at lactation/breastfeeding
conferences titled "Promoting Breastfeeding, Promoting Guilt?" which
includes many examples of health care providers using guilt to promote
healthier choices, and why guilt should not be an issue.  It concludes with
a list of 10 steps for moving beyond guilt.  If any of your readers would
like a copy of the outline, handout, and references for this presentation,
they can email me at [log in to unmask]


Sincerely,



Katherine A. Dettwyler, Ph.D.
Associate Professor of Anthropology and Nutrition
Texas A&M University






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