I have a thorny issue, and once more I bring it to your august ears.  
And any July ones also listening.  ;-)

I've just received a copy of a High Court judgement, stating that a 12 
month old baby, Baby D, was unlawfully detained, and subject to neglect, 
by the UK Government at an Immigration Detention Centre.

The judgement itself, is impeccable.  However, the cause of neglect, is 
thorny.  Baby D was detained with his dark skinned mother, at a UK 
detention centre, two days after being assessed by a GP as happy healthy 
and thriving 7 months.  5 months later, when mother and baby were 
released, baby was suffering badly from rickets and anaemia.  Mother had 
breastfed baby exclusively  in detention, and had received no advice, 
support or vitamin drops.  The medical services (two separate ones - two 
different detention centres) had examined baby repeatedly, and not 
looked for causes of distress, nor offered either mother or baby any 
supplementation.  Mother had made complaint that baby was not eating 
solids due to distress, this had been noted, but ignored medically.

Detainees, unlike prisoners in the criminal justice system, are not 
entitled to daylight exercise, so the dark skinned mother had been 
locked indoors the entire five months.  Mother was also noted as 
depressed and suicidal at points.  Mother was without support for food 
etc, during pregnancy and up to the point of detention, so diet was 
likely to have been poor.

Now, the ruling states that it is common medical knowledge that 
exclusively breastfed babies past six months, require both iron and 
vitamin D supplementation, in order to keep baby healthy.  And in lack 
of such from the detention centres, they were negligent.  I have no 
problem with this judgement per se:

My problem is, however,  the same problem we always have when things 
like this arise: it sounds like the breastmilk was at fault, and in 
reading, one is left with the feeling that the baby would have been fine 
if not breastfed.  

After all, it was not the role of the High Court Judge, to pronounce on 
how good the breastfeeding was - just to decide on the neglect of the 
authorities in failing to ensure one of their detainees received 
adequate iron and Vit D.    The judgement, and the doctor's notes called 
in evidence, make several comments about the baby "still 
breastfeeding".   This raises my hackles and requires vigorous defence!  
I received the judgement details in a large cc'd email, that went to 
other interested parties who won't know enough to understand the 
'extended' breastfeeding issues, and who need to know the benefits of 
the breastfeeding is not in contention.  Therefore it is my intention to 
respond with a detailed explanation of what's missing in the picture: 
namely the huge benefits conferred to both mother and baby by the 
breastfeeding, and comment upon the  nutritional state the mother needed 
to have been in, for this poor baby to be so badly affected.  

We've had issues before on poor nutrition within the centres, especially 
for infants and young children, who routinely go to bed hungry.  Their 
formula bottles are also made up centrally to control costs, and handed 
out twice a day, and left to stand for hours and hours at a time.  So 
I'm especially keen to 'defend' breastfeeding in the centres, and repel 
any sense that formula would be better for older babies.  Now that a 
centre has been brought to book for this neglect, I can see 
breastfeeding mothers being forced to formula supplement in order to 
protect the authorities.  As breastfeeding mothers have slightly more 
protection on separation from their infants, it's in the interests of 
the centres to discourage breastfeeding. 

I need armed with facts and references, on how bad maternal nutrition 
needs to be, for this sort of thing to happen.  I know in terms of Vit 
D, it's quite clear... but on iron?  The notion that iron _must_ be 
given in supplements past six months is surely superseded?  The point 
I'd like to make, is that this is an indicator of how poorly nourished 
the mother was, and that was also the responsibility of the detention 
authorities.  In particular, evidence from resource-poor areas that 
maternal nutrition can supply enough iron etc at this age even on a 
sub-standard diet, most desired.  Best case scenario, would be some sort 
of Big Gun document, making clear statements about how bad maternal 
nutrition would have to be, for this sort of malnourishment to appear in 
5 months.  In short, I wish to point out the lack of the essential iron 
in the baby, had as much to do with the maternal malnourishment, as the 
lack of  'drops'.  See how thorny my issue is?

Given how often the 'breastfed babies must have iron after six months' 
spectre still raises itself, and how I've seen this argued over quite a 
few times.. I suspect your collective responses may be quite 
illuminating.  :-)  "For" on the left please, "against" on the right!  
Line up neatly.

Thanks in advance - I'll post my letter for you all to see.

Morgan Gallagher
www.nursingmatters.org.uk

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