Dear all:

I firmly believe that IBCLCs should know the infant feeding literature beyond 3 months, beyond 6 months beyond 1 year --- we should know the literature to at least two years of age because this is the recommended minimum duration of breastfeeding based on the literature.

There is a large body of evidence on infant feeding frequency.  While there are always exceptions to the "Averages" we have a childhood obesity epidemic int the United States and Great Britain.  We have cultures that push mothers to feeding frequencies that are well under the norms for cultures that have not been as contaminated by artificial feeding.  When I did my doctoral dissertation research, the data from Guatemala -- hardly a stellar example of perfect breastfeeding, showed that infants were still breastfeeding 8-12 times per 24 hours even into the second year of life.  In some areas of Africa, mothers feed 20 times a day without counting and their babies are very happy despite not paying any attention to the concept perpetuated by Woolridge that there might be foremilk hindmilk imbalance from frequent breast switching.  This is NORMAL in much of the world and was NORMAL in developed areas as well until the formula industry and the pediatric community tried to come up with convenient schedules that overrode normal infant physiology.

Many people use the excuse, well I seem OK, or this baby seems OK when a practice is questioned.  Babies in orphanages are often really well behaved according to unrealistic expectations of infant and young child behavior.  They don't cry.  In bad orphanages these seemingly well behaved babies become severely emotionally disturbed because they have been taught to stifle all communication and interaction concerning their very important physical and psychological needs.  Furthermore, someone can have cancer long before it can become apparent.  My father smoked his whole lifetime and he is tottering along at 82 still alive. It took a long time for the emphysema to show up.

There is a fair amount of evidence (I cannot give you THE article, I've read filing cabinets full of articles on infant and young child feeding) to show that TODDLERS need 5 meals a day.  In New York City PUBLIC schools, elementary school children get a snack in the morning so they can concentrate.  They also get a snack in the afternoon so they can concentrate.  To nudge a baby from only 4 feeds a day to 5 feeds a day sets the mother up for establishing a healthy eating schedule for her toddler, preschooler and elementary school child.

Why, given the rates of overweight among elementary school  (which in New York City are less than in New York State probably because we are forced to walk more) are OVER 40%. and are probably equally high or higher in other parts of the country -- why would you not want to encourage an eating pattern that will be healthier over the course of that baby's future life?  

No, I do not think that four feeds a day is acceptable given the vast body of research I have read.  Moreover, I think we have an opportunity to steer mothers into future patterns of eating that are healthier for their children as they grow.

Sincerely,

Susan E. Burger, MHS, PhD, IBCLC

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