Dear Annie VerSteeg and Janice Berry ,

Part 1

Thank you for the vote of support.  I am proud to announce that my video has
passed La Leche League's high standards and will be included it in their
upcoming catalogue.  LLLI ahs also invited me to present my work at their
conference in 2003.  In addition, I am delighted to announce that Dr. Ruth
Lawrence and I are in the midst of making plans for showing my video to all
postpartum moms at her hospital and making it available at the hospital gift
shop.

I hope that my work will be seen as a return to the ancient wisdom of baby
rearing.  It is a direct response to books like "Baby wise" and "The Baby
Whisperer" which rush to put babies on schedules and allowing them to
cry...which we all know is against every new mother's instinct.

For years, I have been a medical advisor to the UCLA Lactation Training
program and have lectured doctors on breast to Cedar Sinai and other medical
centers.  I totally support breastfeeding as the best, healthiest and most
beneficial form of nutrition.  Of course, as a pediatrician caring for many
varied families, I also know also the importance of assuaging feelings of
fear and inferiority among parents who can't exclusively nurse or choose not
to (adopted, failure despite the best lactation help, going back to work and
unable to pump).

My goal is to give moms the best information available (from feeding, to
vaccines to limit-steeing, etc.) and to support their right to choose what's
best for their child.  I have always tried to support my patients decisions
and while energetically encouraging the breast I also try not to make women
feel guilty or rejected by me if they choose otherwise.

My firm belief is that the techniques in my book and video will greatly
INCREASE a woman's breastfeeding success.  They keep nursing moms
abandonning the breat because of misinformation that their baby is crying
because their milk is too thin, too rich, or contaminated from their diet.
My techniques can also help babies sleep an extra hour or two which can
increase a woman's confidence, milk supply and satisfaction.


Thank you Janice for your very thoughtful and comprehensive suggestions.
Many of them are useful and will be addressed in the upcoming paperback
revision.  And, I appreciate Lacnet giving me the opportunity of addressing
your concerns:

- on Page 200, he says, "If your baby goes more than two days without a
stool and does not improve with a change in formula or your diet, you should
check in with your doctor." He says the doctor may want to evaluate the baby
for hypothyroidism, Hirschsprung's disease, or infantile botulism.

- Constipation - while it's true I clearly state breastfed babies often skip
days, rarely there may be medical problems causing the infrequent poos, that
is why I think it's prudent at least to give the doctor/PNP a call to check
that everything is OK.

- Page 174: "You can satisfy your baby's sucking needs one of two ways: 1.
Use a pacifier; 2. You as a pacifier. For thousands of years a mother's
breasts have been their baby's pacifiers. That arrangement may be fine for
some moms, but it's a burden for others. Luckily, parents today have [an]
efficient alternative-pacifiers." Follows with tips on how to use. He does
mention nipple confusion as a possible pitfall, but says, "You may offer
your baby a pacifier on Day One, but be prepared to stop using it for  a
while if your baby is having trouble breast-feeding."

- Pacifiers - as you note I begin by stating that the breast is, and always
has been, the #1 pacifier for babies.  And, that is how it should, however,
even Dr. Sears agrees pacifiers can play a role in soothing newborns.  In my
experience, nipple confusion is the result of nursing babies being offered
bottles.  It is uncommonly associated with pacifiers (nonnutritive sucking
is distinct from nutritive...after all fetuses are often spend hours sucking
on their fingers inside the womb).  However, as I state on page 178, "You
may offer your baby a pacifier on Day One, but be prepared to stop using it
for a while if your baby is having ANY trouble breast-feeding."


- Page 176: "Try not to offer your baby a bottle until she's two weeks old
and the feeding is going really well. Then offer her a bottle every day or
two." "Most moms fill the bottle with breast milk, water, or mint or
chamomile tea."  He cautions, "Don't wait one to two months before
introducing the bottle. Parents who do this are often rudely surprised by
their baby's emphatic rejection of the synthetic nipple."  No explanation is
provided about why it is necessary to offer a bottle; it sounds like a
mandatory part of baby care.


- It is true that I advise nursing mothers that a single bottle be offered
once a day or every other day after the breastfeeding is well
established...and I should have added in the text of my book...this only if
a mother will ever have the need or desire to give a bottle to her baby.
Many time I have had mothers offer the first bottle at 2 months of age, a
week before they have to return to work, only to find their baby absolutely
refuse it.  I have also had terribly frustrated babies and families when
babies stubbornly refuse the bottle when their mothers unexpectedly became
ill (placed on medicine or hospitalized) and unable to nurse.  I have never
once in 20 years had a mother be unable to breastfeed because of this
solitary supplemental bottle!  Of course, if a baby is having problems
breast feeding I advise mothers to get help and ask about an SNS  ("This
method helps a woman rebuild her milk supply without teaching her baby a
wrong way to suckle, a problem that may occur when nursing babies are given
too many bottles."

- Page 178: In response to a mother who nurses often and was worried that
she was spoiling her baby or making him colicky, he says that you can't
spoil a baby, but that "she needed to call her doctor to make sure her baby
was getting enough milk." Maybe in his practice this call would be fruitful,
but in many, it would be the on-ramp to premature weaning. He also says this
mother is ignoring other calming tools, and dad will feel left out.

- I can't speak to other practices (I am lucky to have with 2
extraordinarily good PNP/lactation consultants in my practice), however, if
a baby is crying all the time and only calms with sucking I do think it is
important to discuss that with a health professional to make sure she is
gaining weight and receiving sufficient milk.

- Page 179: "Once your baby's teeth begin to come in, be aware that nursing
through the night (feedings lasting more than a half hour) can cause tooth
decay."

- Prolonged nursing (babies who fall asleep and stay on the breast for more
than 1/2-1 hour)at night CAN develop severe dental decay. Most pediatricians
and pediatric dentists with large breastfeeding populations have witnessed
this and it often requires painful and expensive dental surgery.

- Pages 180-81: He tells of a seven-week-old pulling away after 10 minutes
and arching as though he had forgotten how to eat. "Seconds later he would
arch his back and wail as if he wanted to be out of his mother's arms." But
if put down he cried harder. His diagnosis is oversupply, and his
description is: "When Stanley tried extra suckling for fun at the end of his
feeding, Maria's breasts continued releasing a steady stream of milk into
his throat ..  Once [the parents] began offering the pacifier when he
finished his feedings, he became an angel again."

- This child had a strong need to suck but was being flooded by his mother's
huge milk supply built up from all his sucking.  He needed to suckle and the
pacifier allowed him to do this without his choking on the milk and
continuing to overstimulate his mother's breast.

- On page 198, in a discussion of food allergies, he says that if you
eliminate dairy because baby is sensitive, there are many other ways to get
calcium and baby is not at risk. He adds, "However, if you stop dairy
products for more than a few weeks, speak to your doctor or your baby's
doctor to make sure you're meeting your body's calcium needs."

- Of course dairy is not the only source of calcium...still I believe it is
prudent for a woman on a nondairy diet to consult her healthcare provider to
make sure she is getting enough calcium.

- On page 199, he says bottle-fed babies "certainly do get constipated."
When that happens, he encourages their parents to add to the formula one
ounce of water or one-half to one ounce of prune juice, and to insert a
Vaseline-greased thermometer or Q-tip one inch into the anus to prompt a
b.m. The breastfeeding mother cannot stop drinking milk without calling her
doctor to see if it's safe, but the formula-feeding mother is advised to
tweak the mixing of formula or stick things in baby's anus without checking
with the doctor ... I feel this sends the wrong message about which feeding
method is normal and which is risky.

- I don't understand this objection.  I clearly state that breastfed babies
never get constipated and that constipation is a complication only of
formula.  I also state that these babies require help and the doctor should
be consulted if the constipation is lasting more than 2-3 days.  Yes, I do
recommend that, after a few weeks off of dairy, women consult their doctors
regarding their nutrition, but I fail to see how that is more supportive of
formula over breast milk, or how that implies that breast milk is risky.

- Page 201: Where sore or cracked nipples are mentioned, he advises letting
milk dry on them and provides no other suggestions -- no mention of
positioning or latch.

- My book is not an exhaustive book on nursing technique.  While I do state
breast milk on irritated nipples is soothing, I mention twice in the
paragraph before and after that all mothers with nursing problems should get
help from a lactation consultant or LLLI ASAP.

- Pages 200-01, addressing whether baby is crying because he is not getting
enough milk, Dr. Karp says that if you answer no to ANY of the following
questions, it's possible that baby is hungry, so, "Try giving her a few
ounces of formula or pumped breast milk. If she's truly hungry, that will
stop her fussing immediately." Here are some problems I see with the
questions:
    * Nothing is said about the frequency of feeds.
    * He has "Is your baby peeing enough?" with no mention of bowel
movements. He says baby should pee five to eight times a day after the first
few days. How does any mother whose baby is in diapers measure how many
times a baby pees?
    * "Are your breasts making enough milk?" He qualifies them if they feel
heavy when mother wakes, they occasionally leak, and you can hear baby
gulping when feeding.
    * "Is your baby happy to suck on your finger or pacifier?" Remember that
any "no" here means you need to try supplementing, and think of how many
reasons there may be for baby to not be "happy" to suck on a finger or
pacifier.
    * Dr. Karp does appropriately include "Is your baby gaining weight
normally?" and gives four to seven ounces a week as the range. He also
states that babies lose eight to 12 ounces over the first few days of life
and gain after that.


- I do discuss frequency of feeds("Empty your breast frequently.  Nurse your
baby every 2-3 hours (during your waking hours)"  I don't mention bowel
movement because the normal variation is wide enough that I don't find that
a helpful sign of milk sufficiency.  Most mothers can tell if their baby has
peed in the diaper because it feels heavy.  You're correct, just because a
baby refuses to suck on a finger doesn't mean a woman's milk supply is
low...a simple no in a situation where a baby is otherwise nursing well and
thriving should certainly NOT prompt concerns.  However, if a fussy baby is
happy sucking on a finger, it is usually a sign that a mother IS making
enough milk because if the baby were truly famished she would begin to fuss
and be dissatisfied with the finger after a few unproductive sucks.



Harvey Karp, MD
Assistant Professor of Pediatrics
UCLA School of Medicine

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html