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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