Hello April

Your questions are really important; thank you for tackling them.

I too struggled with feelings of "now the damage is done" when faced with
newborns on a mixed diet.  However just as a surgeon has to do his best for
an accident victim, so do we lactation specialists have to find ways to
stitch up breastfeeding relationships.  The scars may of course always
remain, but less noticeably.

I can't answer your question yet on where to find the best original research
but have a few developing thoughts which I'm sure others can take much
further.

You do have to keep in mind the "benefits" of breastfeeding while searching,
because that is how most research was phrased up till now, even though
breastfeeding is the norm and we should only research the way anything else
harms proper development.  As we know, so much of the older research did not
clearly define breastfeeding and "any breastfeeding" was included with
exclusive breastfeeding, instead of kept separate or included with the
exclusive harmful alternative, so your task is likely to be muddied by those
older studies.

In fact, we (you!) are more likely interested to know *when* and *how*
formula feeding or bottles cause damage.  I'm really interested to know if
any study has taken place with this in mind (especially as it does not seem
to be possible to study, ethically, in a randomised controlled trial).

So if I may be as bold as to rephrase your questions to us:

<<1.a Which benefits of breastfeeding remain when an infant is being
*non-exclusively* breastfed?>> becomes
"Which aspects of breastfeeding (nutrition [can be defined further perhaps
into lipids, carbs, proteins, vitamins, taste, allergens etc], appetite
control, emotional growth, gut maturation, immunities, food changing
composition, mother's hormones etc) are least interfered with when formula
is added to the diet?  Is there a safe time to add formula?"

<<1.b  Which benefits decline significantly when exclusivity is lost?>>
"Which aspects are most interfered with when anything else is added to the
diet?"

<<2.a On a similar note, which benefits of breastfeeding remain when a baby
is being fed human milk via bottle?>>
"Which aspects of breastfeeding are least interfered with when human milk is
fed **in any other way** and specifically by a bottle? [suckling mechanism,
palate development, issues of inhalation, supply-demand issues on mother,
increased demands on her time, lack of stimulation, unphysiologic milk
removal, changing milk composition, milk separation, etc]  Is there a safe
time to introduce the bottle and pumping?"

<<2.b Which benefits are lost when feeding does not take place at the
breast?>>
"Which aspects of breastfeeding are most interfered with when feeding does
not take place at the breast?"

Except that I would ask the part b before part a each time.  In the sense
that if you prove *one really bad thing* about my actions, I might be more
convinced to change than if you build up to it gradually.

Please post later with a link to your final paper, and best of luck.

Jacquie Nutt IBCLC
South Africa





----- Original Message ----- 
From: "April Rosenblum" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, October 21, 2010 5:55 AM
Subject: Looking for research


> Hello,
>
> I'm a lactation student in Philadelphia and am hoping you all can
> point me toward some useful studies.
>
> The issue is this: Ever since learning about the incredible research
> of people like Lori Feldman-Winter on the lasting damage that any
> amount of formula does to a newborn's GI tract, I feel some
> hopelessness when I run into families who have already supplemented
> with formula (sometimes out of medical necessity, sometimes not), or
> who are going to be dependent on formula supplements for the
> foreseeable future. It is difficult for me to get revved up to cheer
> them on about the benefits of providing any amount of breastmilk to
> their baby, when I know that in at least one significant way, the
> 'damage is done.'
>
> I'd like to get in a better mindset about this, and Kay Hoover is
> letting me use this as a research topic. Can any of you point me
> toward evidence-based research (the studies or meta-analyses
> themselves, not book chapters that summarize them) that would help me
> build my knowledge on the following two questions?
>
> 1. Which benefits of breastfeeding remain when an infant is being
> *non-exclusively* breastfed? Which benefits decline significantly when
> exclusivity is lost?
>
> 2. On a similar note, which benefits of breastfeeding remain when a
> baby is being fed human milk via bottle? Which benefits are lost when
> feeding does not take place at the breast?
>
> Thanks for any works you can point me towards.
>
> April
>
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