It is timely that Laura raised these issues about this questionable, non-evidence-based practice.  It is reminiscent of the past practice of adding cereal to the contents of feeding bottles, which health authorities in Australia criticized. As well as the issues of potential contamination from adding PIF and an increased solute load, there is another issue here, too.  That is the implied message that breastmilk is okay - provided the mother adds something to it. In other words, it sends the message that breastmilk is "insufficient" in composition (when it seems that it is the quantity that needs increasing).  Most of us are a long way from our rural roots, or people would be aware that cow's milk, on which these PIFs are based, isn't sufficient to the needs of the young for which it is the species-specific food.  Calves need to start eating grass very early (around three weeks) to add to the nutrients from the milk of the cow. Human milk is a much more complete food for human babies than cow's milk is for calves.

The advice to add calories (and push up the solute load) seems to me to have the "quick fix" mentality, ignoring the need to do more, i.e. referring the mother for more time-consuming advice about stimulating the maternal milk supply.

One question I have, perhaps to Susan Burger, is whether there is any down-regulating effect of the PIF (or any non-human milk) on the anti-infective properties of the human milk, other than by dilution?  This was the reason behind the recommendation to avoid mixing artificial milk with mother's milk in a bottle, and to give it separately - a recommendation which I came across when researching advice from the early 20th century. This was a period when other recommendations lacked an evidence basis.  So - wise ones - is there evidence for this?  I still recommend that the good stuff, mother's milk, be given first and separately, if only to make sure none is wasted.  It also gives it the  chance to start being digested before the lesser, more slowly digested product is administered.

A happy New Year to you all, and to your loved ones.

Virginia

Dr Virginia Thorley, OAM, PhD, IBCLC, FILCA
Private Practice lactation consultant
Cultural Historian of the History of Medicine
Brisbane, Queensland, Australia
~~~~~~~~~~~~~~~~~~~~~~~~

Laura Spitzfaden wrote:

I am feeling frustrated that I keep meeting moms who have been advised to mix powdered formula directly into their breastmilk in order to increase calories.  Some of them have babies who are failure to thrive and some have babies who are gaining slowly.  I was under the impression that this practice puts a baby at risk for kidney stress and dehydration but I am finding the advice to be very commonplace.  The usual suggestion is to put a teaspoon of PIF into 3 or 4 ounces of expressed breastmilk and feed this to the baby by bottle.

I checked the archives and found this post.

http://community.lsoft.com/scripts/wa-LSOFTDONATIONS.exe?A2=ind1012A&L=LACTNET&P=R583&1=LACTNET&9=A&J=on&d=No+Match%3BMatch%3BMatches&z=4

Does anyone else have any evidence (other than common sense) that demonstrates that this is not a good practice?  Why is this practice recommended and is there any evidence to show it is beneficial?  What about for premature babies?  Also, shouldn't off label use of PIF be evidence based?  I am very frustrated that I need to show it is unsafe.  Isn't the burden of proof on those who are using this product off-label?  How can a pediatrician or nutritionist advise this without proof that it is safe?

Now that the AAP is advising a decontamination step (recommended by WHO) for PIF, how does that affect this practice?

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