Hi everyone

I read this blog with great interest. While I applaud the writer for questioning current thinking and wisdom and going into the research (always a good idea to make sure we are learning new things every day and are improving our practice), I was very disappointed at the one sided stance she took. Stomach sizes are a myth, but conventional wisdom on the amount of calories needed to sustain growth is not? She is using a NICU population and compares it to a term well born population. As a consumer of research, she should know you cannot extrapolate one set of results and apply them to a different population. I agree that we do not have enough information on how big stomach sizes are, but I do question where this minimum amount of calories needed per day to sustain growth comes from. How old is that research. I know 25 years ago when I worked in a NICU we were using exactly the same calculations we use today.

I also have concerns about stating (albeit indirectly) that the only thing we are looking for in breastmilk and colostrum is calorie count, and because colostrum has less calories, it is therefore inferior to breastmilk and formula. I am sure that is not what the writer intended her message to be, but certainly, reading it at 5am, after working a night shift (so in a similar state to most new mom's) that was one of my take home messages. 

My other big research questions is what do newborns really need in the first few days of life? Do they really need nutrition as much as they need immunity? Isn't colostrum the immunity idol in the survivor game of life? Isn't that why healthy term babies have brown fat? What do we do to a baby's metabolism and all it's other systems when we start to over feed our babies? What do we do if we underfeed them? What exactly is normal. How much is enough? How much does a preterm baby really need? Are we overworking those kidneys with those huge amounts of fluids? If we are underfeeding babies at the 5 to 7 mls per feed in the first 24 hours (remember when we used to keep babies NPO for the first 24 hours...) are we preventing organs from kick starting into active mode? If we are overfeeding our babies at 20 to 30 ml per feed in the first 24 hours, are we setting them up for all sorts of health issues, such as obesity, (because we always make sure a baby finishes the bottle, we are trained to finish our plate of food...) or any other unknown issues that can develop because of overload of internal organs in the first few weeks after birth?

What about children and adults? Can children and adults overeat? Sure we can, so what makes babies immune to overeating? Why can't babies become obese? Oh, that's right, they can, and childhood obesity is a growing concern. Adequate growth is so much more than just calorie count and volumes. Do we know enough? NO, we sure don't. But just because we don't know enough doesn't mean we get to swing the pendulum from too little to too much every few years. It means someone has to step up to the plate and do the research. Good research, with good data and good interpretation of data. 

I somewhat hesitate to say this, but I am not sure that those of use who live in a developed world, who are so in the science we cannot see the woods for the trees, and rely on numbers and research can answer the question of what is normal. Our world view is so biased, so off center that any time we look at anything it is with a skewed lens. 

So in the end, I was very disappointed that someone who is both an RN and an IBCLC forgot to look at the whole picture when she wrote her blog. I would also encourage those  of us who are responding to remember to look at the whole picture. I am saddened that mothers turn to these blogs and cite them as evidence to do one thing over another. I am saddened that the world of breastfeeding can be so divided it becomes more a game of us and them than a game of lets discover and learn together. 

Sonya
Who is starting to think 3 hours of sleep in 36 is not good for her emotional state... too much sadness... off to bake and feel better!

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