The post about the mother with CF got me thinking about how we handle
breastfeeding and babies with CF.  This is the perfect example of how
physicians (especially pediatricians) have so much faith in formula,
and so little faith in breastfeeding.  It also points out how
"routines" undermine breastfeeding.

At the Hospital for Sick Children (Toronto), babies with cystic
fibrosis are taken off the breast and fed formula for 3 days so that
the extent of stool fat loss is determined.  It is "necessary" to take
the baby off the breast, because it is necessary to know how much the
baby gets.  When I asked why this is done, nobody really was able to
clear it up, until a former resident in respiratory pediatrics said up
front "You can't get anything published if you don't have that data".
They do not use breastmilk, because they don't know the fat content
(could be measured, couldn't it?).  They don't measure the fat content
in the formula, because, I presume, they believe the published
figures.  But errors are made, aren't they?

Finally, a baby on formula is not a "normal" baby.  This is pointed
out by the fact that some babies with CF do well on breastfeeding, and
only run into problems once weaned or have added formula.  Some babies
with CF who are breastfed present with Kwashiorkor, which is different
from babies on cow's milk formula.

Of course, the diagnosis means that the baby needs enzymes, and of
course, the "only" way to give this is mixed with milk in a bottle.

If the hospital were supportive of breastfeeding, I think *all* of the
"problems" above could easily be resolved and more mothers of babies
with CF could succeed at breastfeeding, instead of suffering yet
another loss (not being able to breastfeed).

Jack Newman, MD, FRCPC