Imagine if I told you that tens of thousands of babies were being hospitalized each year for a common problem and yet we weren’t merely doing nothing about it; we were actively promoting more harm. You’d be outraged, wouldn’t you?
Prepare to be outraged.
Tens of thousands of babies are being hospitalized each year, some sustaining permanent brain damage, and a few even dying, because of a common problem — insufficient breastmilk. We aren’t merely doing nothing about it; lactation professionals are actively promoting more harm by lying about the existence of the problem, its frequency, its diagnosis and its prevention.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The most reliable sign of neonatal dehydration is weight loss, NOT wet diapers.[/pullquote]
A new paper, Neonatal Hypernatremic Dehydration, should cause soul searching and policy changes among lactation professionals everywhere. I’m not holding my breath.
It should also give pediatricians and obstetricians renewed impetus to push the deadly Baby Friendly Hospital Initiative out of hospitals. I have far more hope that they will do the right thing and put scientific evidence ahead of ideology.
The paper demonstrates yet again how so much of what passes for “knowledge” among lactation professionals is actually lies.
1. Insufficient breastmilk is common.
Dehydration/excessive weight loss is defined as a loss of more than 10% of birth weight prior to the end of the first week of life, and is thought to occur in up to 15% of exclusively breast-fed infants.
Lactation professionals owe the Fed Is Best Foundation a deep and profound apology. The Foundation was created to highlight both the frequency and the dangers of insufficient breastmilk. Founders Christie del Castillo-Hegyi, MD and Jody Seagrave Daly, RN, IBCLC recognized years ago — through bitter personal and professional experience respectively — that lactation professionals were lying to themselves and each other about the dimensions and harms of the problem. Yet rather than receiving the thanks of the lactation profession, they have been defamed and demeaned by the very people who were causing all the harm.
2. The incidence of clinical neonatal dehydration is high.
Up to one-third of these infants will also be hypernatremic, and the reported incidence of hypernatremic dehydration in term neonates requiring admission ranges from 1% to 5%, with higher rates reported in developing countries.
Despite published statistics, the true incidence of hypernatremic dehydration is difficult to define, as some retrospective studies have included only term neonates, whereas others have included late preterm (>35 weeks gestation) neonates. None have included neonates with predispositions to feeding problems, such as cleft palate, Trisomy 21, neurodevelopmental, or craniofacial disorders.
3. The consequences of neonatal dehydration can be devastating.
Serum sodium level greater than 160 mEq/L is a risk factor for morbidity and mortality. The most commonly cited complications include seizures, bradycardia, vascular thrombosis, disseminated intravascular coagulation, renal failure, intracranial hemorrhage, pontine myelinosis, cerebral edema, and death. Seizure is the most common complication and usually occurs during correction of the hypernatremia, as do the other common complications.
4. Neonatal appearance and the number of wet diapers are NOT reliable indicators of dehydration.
Hypernatremia results in hypertonic intravascular contents, which causes fluid shifts from the cells to the intra-vascular space. Thus, the neonate may appear less hemodynamically compromised, resulting in underestimation of the degree of dehydration by as much as 5%. This also increases the chances an affected infant will present late for medical care.
It’s hard to over-emphasize the importance of this point.
As with many serious neonatal conditions, newborns can look fine right up until the moment they collapse; they have compensatory mechanisms that work until they fail abruptly and completely. In the case of dehydration, infants compensate for the low blood volume caused by dehydration by pulling water out of cells into the bloodstream. As a result, they can keep perfusing their kidneys — and keep urinating — even as they may be dying.
Many lactation professionals and lactivists owe both Jillian Johnson and Christie del Castillo-Hegyi deep and profound apologies for publicly doubting that their babies were dehydrated and for blaming medical staff for failing to recognize the “signs” of dehydration. If you wait to diagnose dehydration until a baby is no longer urinating frequently, you could easily wait past the point of brain damage to the point of death.
5. The most reliable sign of dehydration is weight loss.
Mild hypernatremia should not be considered a benign occurrence, and breast-fed infants with greater than 7% weight loss or significant jaundice should be evaluated for hypernatremic dehydration and the possible need for oral or parenteral fluid supplementation.
This is precisely what the Fed Is Best Foundation has been saying for years. As a result they’ve been vilified by the lactation professionals who are still lying to themselves and each other about the depth and breadth of the problem.
Though this paper doesn’t mention it, lactation professionals have compounded the problem and raised the risk by banning formula supplementation. Multiple scientific papers have shown that judicious formula supplementation is not merely compatible to subsequent exclusive breastfeeding, it actually improves the rate of subsequent exclusive breastfeeding. Moreover, it dramatically decreases the risk of newborn hospital readmission. Infants allowed unrestricted access to formula had a 76% lower incidence of hospitalization.
This new paper on neonatal dehydration illustrates three critical points.
First, the lactation profession as based on ideology, not science. It was ideology that led lactation professionals to claim that breastfeeding, uniquely among all bodily processes, was perfect. Science always showed the opposite.
Second, while the benefits of breastfeeding term babies range from theoretically possible to completely non-existent (no one has yet been able to show a single term baby whose life has been saved by breastfeeding), the risks are very real with literally tens of thousands of babies suffering so much that they must be readmitted to the hospital for treatment.
Third, the public discussion of breastfeeding has been controlled by lactivists to the detriment of babies and mothers. Type “breastfeeding” into Google each and every day as I do to see the latest articles and you will find a myriad of pieces bemoaning the “horror” of some woman somewhere being shamed for public breastfeeding. Yet there is rarely if ever any article in the mainstream media about the dangers of insufficient breastmilk, a problems that is affecting more than 1% of exclusively breastfeeding newborns DAILY.
There is one very obvious thing to do if we wish to help these babies and mothers, prevent tens of thousands of hospitalization a year and dramatically reduce the risk of permanent brain damage or death: allow new mothers unrestricted access to infant formula. If we care about babies, we will do it. If we only care about breastfeeding, we will continue to let babies suffer.
There is also one less obvious thing to do: eject the Baby Friendly Hospital Initiative from hospitals. There is no place in any hospital for an organization whose primary commitment is to its own ideology instead of to patients. It has indisputably harmed hundreds of thousands of babies and mothers. It’s time to end the harm.
