>Does anyone know of standards that have been set by WHO or other such organizations? < WHO/UNICEF's medical criteria for supplementation are part of the BFHI Global Criteria and guidelines. BFHI is the only global quality assurance programme where postpartum women are concerned. I'm enclosing the revised version (mostly linguistic change, but some tightening/correction of criteria - eg, PKU is always a cause for monitoring but not always an indication for supplements, and so Oz experts felt it should not be named as though supplementation was inevitable) adopted in Oz as the BFHI standard. Some one else can pot the Global version: I can't find it in the bowels of this computer, only the OZ revision. " 5.6 "Acceptable medical reasons" for supplementation A few medical indications in a maternity facility may require that individual infants be given fluids or food in addition to, or in place of, breastmilk. It is assumed that severely ill babies, babies in need of surgery, and extremely low birth weight infants (less than 1,000 grams) will be in a special care unit. Their feeding will be individually decided, given their particular nutritional requirements and functional capabilities, though breastmilk is recommended whenever possible. These infants in special care are likely to include *infants with very low birth weight or who are born preterm, at less than 1500g or 32 weeks gestational age *infants with severe dysmaturity with potentially severe hypoglycaemia, or who require therapy for hypoglycaemia, and who do not improve through increased breastfeeding or by being given breastmilk. For babies who are well enough to be with their mothers on the maternity ward, there are very few indications for supplements. In order to assess whether a facility is appropriately using other fluids or breastmilk substitutes, any breastfed infants receiving additional supplements must have been diagnosed as: * infants whose mothers have a serious illness which precludes breastfeeding [indications deleted as not universally agreed as always mandating supplements: in fact we couldn't think of any condition short of bilateral mastectomy where we'd want the documents to suggest that every mother with that condition must give supplements/alternatives] * infants with inborn errors of metabolism [specifics deleted as -other than galactosaemia, which is obvious and breastfeeding impossible - not universally agreed as always mandating supplements] * critically dehydrated infants [almost never seen in the immediate postpartum period, though of course they can be if outborn in the bush and admitted later] * infants whose mothers are taking medication which is contraindicated when breastfeeding [very rare indeed] When breastfeeding has to be temporarily delayed or interrupted, mothers should be helped to establish or maintain lactation, for example by manual or hand-pump expression of milk, in preparation for the time when breastfeeding may be begun or resumed. For a full discussion of this and related issues see: Chapter 3, Health factors which may interfere with breastfeeding. In: Infant feeding: The Physiological Basis. Bulletin of the World Health Organization, 67, supplement (1989)." The paediatricians who helped develop this certainly wouldn't think supplementing 50% of babies an acceptable figure. Maureen Minchin, IBCLC. Christ Church Vicarage, 14 Acland St., St.Kilda, Vic. 3182 Australia. tel/fax: 61 3 9537 2640 "Taking paths of least resistance is what makes rivers - and people - crooked." poster in Palmerston North NZ bookshop...