Midirs draft article on the media coverage of infant feeding
The full reference for this draft article is: Trotter S (2011). Media coverage of infant feeding studies: informed choice or promotional opportunity? Midirs Midwifery Digest 2011 vol 21, number 2, page 233-4.
Click on the links below to read sections of the article:
Fortification of expressed breast milk:
My initial comments were prompted by the article, ‘Fortification of maternal milk for very low birth weight (VLBW) pre-term infants’ reprinted in the March 2011 MIDIRS (Realli et al 2010). However there are wider issues at stake which I discuss further in this letter.
The article provides comprehensive information on the composition and types of fortification that can be added to maternal milk. However it includes little or no reference to alternative solutions for optimising nutrition based on direct breastfeeding and the establishment of a close bond between mother and baby. Sadly the article raises more questions than it answers. Its subtle bias towards artificial fortification leads me to suspect the existence of a tenuous link to a formula milk manufacturer, although this is not acknowledged.
Unfortunately, the authors failed to describe the overwhelmingly positive effects of skin-to-skin contact between the mother-baby dyad, which is known to positively affect growth rates of low birth weight (LBW) and VLBW infants (Hayes 1998, Anderson 2004). The concept of supplementing the mother (thereby boosting the quality of her milk) is not explored although this is an obvious solution. There are a number of risks associated with artificial supplementation of breast milk, including delayed absorption of nutrients by the baby and possible contamination. This method is more complex and expensive than prescribing simple vitamin and mineral supplements for the mother. I would suggest that a baby who is kept close to its mother via close skin-to-skin contact, and fed only its mother’s milk (hind milk expression is a great way to optimise absorption of higher calorific milk) could not fail to thrive at a rate at least equal to that of a baby fed with fortified or artificially engineered feeds.
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Early weaning:
A few weeks ago, the publication of Mary Fewtrell’s article (2011) in the British Medical Journal (BMJ) article caused a similar media splash. The article was about reducing the age of weaning from the recommended six months to four. Anxious parents flooded breastfeeding forums in the UK and beyond with their messages. I was incensed that the media had yet again used a sensationalist ‘hook’ to disseminate negative and misleading advice that further confused vulnerable parents.
The whole story was totally misrepresented by the media. Any opportunity to portray breastfeeding in a bad light seems to be seized upon with glee. I downloaded and read the full article from the BMJ website – this is freely available to all. Mary Fewtrell does not suggest that parents should change what they are doing. She does not say that they should no longer be encouraged to breastfeed for six months and beyond. Instead, she suggests that some parents may wish to introduce certain weaning foods (not formula or follow-on milks) in the weeks leading up to six months. This is already happening: as we know, only 1 percent of UK mothers exclusively breastfeed until six months.
Increased rates of food allergies may well be the result of the early weaning that is already taking place. This makes it even more important to leave the recommendations to six months unchanged. If this was reduced to four months, parents may think they can start even younger - this could have untold consequences! The only winners would be the manufacturers of baby milk and weaning foods. I can’t help but suspect that they are behind all this media hype.
Exclusive breastfeeding in developing countries saves countless lives. Recent floods around the world highlight the potential for loss of life when it is not possible to prepare formula feeds. Most of the studies considered for the article were carried out in the developed world where artificial feeds can be prepared safely. This is not always the case in developing countries.
While there is no evidence to suggest that weaning at six months is unsafe, numerous studies have shown that we should not support earlier weaning. Current advice by the World Health Organisation (WHO 2009) to exclusively breastfeed during the first six months of life should be followed. Exclusive breastfeeding provides for all the nutritional, emotional and psychological needs of a baby.
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Media influences:
As a passionate advocate of exclusive breastfeeding for babies of any gestational age, and for at least the first six months, I am concerned about the media’s interpretation of clinical trials and academic papers about infant feeding. Too often media coverage tends to be weighted towards the promotion of artificial formula feeds, follow-on milks and weaning products.
Media reports which seem to contradict themselves every few months are likely to upset parents at a time when they may be especially vulnerable. What parents need are common-sense solutions to help them with everyday parenting issues.
By adopting a more balanced approach to the interpretation of clinical studies, the media could avoid confusing parents who frequently complain of conflicting advice.
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References:
Anderson G C, Moore E, Hepworth J & Bergman N (2004) Early skin-to-skin contact for mothers and their healthy newborn infants (Cochrane Review). In: The Cochrane Library, issue 1. Chichester, UK: John Wiley & Sons, Ltd.
Fewtrell M, Wilson D, Booth I et al (2011). Six months of exclusive breast feeding: how good is the evidence? BMJ 2011; 342:c5955 doi: 10.1136/bmj.c5955
Hayes J A (1998). TAC-TIC Therapy: a non-pharmacological stroking intervention for premature infants. Complementary therapies in nursing and midwifery. 4 (1): 25-7.
Reali A, Greco F, Fanaro S et al (2010). Fortification of maternal milk for very low birth weight (VLBW) pre-term infants. Early Human Development, vol 86, no 1, suppl, 2010, pp33-36
World Health Organization. Child and adolescent health and development. 2009. Available from: http://www.who.int/child_adolescent_health/documents/9789241597494/en/index.html
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Sharon Trotter©2011
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