17 “Koei feite”


17 “Koei feite”

You only use 10% of your brain. Eating carrots improves eyesight. Vitamin C cures the common cold. None of these are true. But the facts don't actually matter: People repeat them so often that they believe them. Welcome to the “illusory truth effect,” a glitch in the human psyche that equates repetition with truth.(2) “Feit soos ‘n koei”…. Many people believe “anecdotal” observations are solids evidence based truths.

What have you heard that you suspect is an “illusory truth effect”?

I spoke to a few parents and the following were just a few of the “koei feite”, they have heard:

I was told

1. During pregnancy nipples and breasts need to be prepared for breastfeeding

Nature takes care of the physical (anatomical) preparations. All you need to do is to get your “head” ready, attend antenatal classes, have you baby at a Baby Friendly accredited hospital and make sure you have a support network ready to support you in breastfeeding.(1)

I was told

2. In the beginning baby should only feed for a few minutes a side building up more minutes each day to prevent sore nipples

Effective positioning and latch is going to prevent sore nipples. Breastfeeding in not supposed to hurt - ever. No cracks, No bleeding, No lipstick shaped nipples after feeds, No blisters, No ridges, No scabs. If you are told “he is lazy“ or worse “you are doing it wrong” get better help.(3)

I was told

3. Baby should feed both breasts for “x” minutes per feed each feed to stimulate breasts equally AND may ONLY feed 3-hourly thus baby needs to be stretched (with a dummy) until it is feeding “time”

Every seen a baby born with a watch? Babies do not know time exist; they do not know it is 2018. They live in the here and now. They just want their biological needs met as it has been in the womb, to help them transition to the outside world.

You may have heard that mothers produce two kinds of milk: “fore-milk”, the thinner milk the baby gets first, which has a lower fat content; and “hind-milk”, the high-fat, creamier milk that follows? These terms can make it seem as if the breasts produce two distinct kinds of milk, which is not the case. A woman's breast really only makes one type of milk, the higher-fat milk that we typically think of as “hind-milk”.(4)

When you drink milk from a glass and you look at the empty glass, can you see “milk” left behind on the inside of the glass? Well the same thing happens in the breasts.

Milk in glass

Diana West and Lisa Marasco explain the process in their book, “The Breastfeeding Mother's Guide to Making More Milk”: The fat globules in the milk tend to stick to each other and to the walls of the alveoli (“factories” where the milk is made – looks like a cluster of grapes ;-).

Anatomy

Milk is made continually and between feedings, when the alveoli gets too full to hold the milk, milk starts moving down the ducts toward the nipple, leaving more and more of the fat "stuck" further back in the milk ducts. The more time between feedings, the lower the fat content of the “fore-milk” available to baby at the beginning of the feeding. Once the let-down (or *Milk Ejection Reflex/MER) is triggered (by baby's feeding, moms pumping, etc.), the milk is squeezed out of the alveoli, down the ducts by the contracting muscles cells surrounding the alveoli. The fat globules begin to dislodge and move down the ducts. So the further into the feed, the higher the fat content of the milk, as more and more fat globules are forced out. The end result is that the milk gradually increases in fat as the feeding progresses.(5)

Let down

* Milk Ejection Reflex/MER happens when baby sucks at the breast, stimulating the very sensitive nipple/areola area, sending a nerve message to the brain, which causes the hormone oxytocin to be released into the bloodstream and this hormone causes the muscle cells around the milk glands (alveoli) to tighten and squeeze the milk out.

3 course meal

Diane Wiessinger (6) talks about a “three course meal”. From the description above you can see baby may start with the soup (so called “fore-milk”) and as the milk “lets-down” baby goes over to the main meal and ends the feed with the high-fat “chocolate-pudding” dessert which is what satisfies baby’s hunger (and babies feed for calories, not for volume!). Now you may also begin to understand why we should rather let baby finish a feed at one breast before offering the other? No time limits per breast!

Babies drink differently – You get the little Gourmet feeders, the Barracudas and the Suck-and-Snooze feeders

Mother’s storage capacity differs

A mother’s breast storage capacity refers to the maximum volume of milk available to her baby when her breast is at its fullest.(7) Unrelated to breast size, breast storage capacity is determined by the amount of room in her milk-making glandular tissue. Breast size is determined primarily by the amount of fatty tissue.(8) The maximum volume of milk in the breasts each day can vary greatly among mothers. Two studies found a breast storage capacity range among its mothers from 74 to 606 g or ml.(9),(10)

What does this mean? It means that if you have a small storage capacity in your breast they might, for example only hold about 60 ml per breast and by 1 month old your baby’s tummy can hold ±120 ml of milk per feed – so baby will want to feed from both breasts about 8 – 10 times a day to get the milk s/he needs in 24 hours. S/he will probably continue to feed like this every few hours day and night for some time so s/he can get the milk s/he needs and you can keep up your supply. And you can and will provide enough milk for baby to grow and thrive!

Another mom’s breasts can for example, hold maybe 120 ml per breast; she has a large storage capacity. Her 1 month-old baby takes only 1 breast per feed, and as this baby grows, her/his tummy grows and s/he takes in more milk per feed (say 180ml, 120ml from breast A and a bit from breast B) AND the number of feeds s/he takes per day goes down to maybe 6 per day, because this is enough for her/him to take in the milk s/he needs over 24 hours. S/He might even start stretching longer at night at an earlier age. Think of storage capacity as a cup – you can easily drink a large amount of water throughout the day using any size of cup – small, medium or large – but if you use a smaller cup it will be refilled more often.

I was told

4. Baby’s feeds need to be spaced so breasts have time to refill

This advice reflects a basic misunderstanding of how milk production works. Research has found that the fuller breasts become the slower milk was produced. More milk out = more milk in. Breasts are factories, not container. The emptier your breasts, the more milk you will make. It is a law of supply and demand. Like factories, if the demand is going to be low, the supply is going to be low. Research shows milk contains a small whey protein called Feedback Inhibitor of Lactation (FIL). The role of FIL appears to be to slow milk synthesis when the breast is full. Thus milk production slows when milk accumulates in the breast (and more FIL is present), and speeds up when the breast is emptier (and less FIL is present), thus feed-feed-feed-feed!(11)

See breast storage capacity above.

Another bit of interesting research: Healthy, exclusively breastfed 1 to 6 month-old babies consume 0 to 240 g of milk between 6 and 18 times during 24 hours, with 64% of babies breastfeeding 1 to 3 times at night. On average, 67% of the available milk is consumed at each breastfeeding. The fat content of breast milk varies between mothers (22.3 – 61.6 g/L) and within and between breastfeedings.(12)

I was told

5. Never wake a sleeping baby

Un-medicated babies who room in with their mothers tend to feed 8-12 times in 24 hours. If they don’t - we need to offer feeds at least 8 times in 24 hours. Hard to fit in 8 feed in 24 hours if you let your baby sleep for more than one 4-hour stretch in 24 hours. Babies whose mothers had birth medications may be unable to rouse themselves normally for feeds. Babies not with mothers tend to shut down to conserve energy. Wake a baby to feed at a minimum of 8 feeds in 24 hours until baby self-wake to feed.(1)

I was told

6. If babies feed a lot that means they are not getting enough milk

Breast milk is so easy to digest, babies generally get hungrier sooner than if they are formula-fed. It's appropriate for your breastfeeding newborn baby to eat every two to three hours or more often.(13) Weight gain is the “acid test” that babies are getting enough. Weigh baby at least once a week for the first 6 weeks.

I was told

7. If a baby is not gaining well, it is due to the low quality of a mother's milk

Studies have shown that even malnourished women are able to produce milk of sufficient quality and quantity to support a growing infant. Most cases low weight gain are related to insufficient and milk intake/ ineffective feeding or an underlying health problem in the baby.(1)

I was told

8. A mother should avoid certain foods while breastfeeding because it will give baby gas and result in colic

How nice would it have been if fussiness and spots were due to what we ate? Because then we could control fussiness and spots by what we eat!

Between 2 and 3 weeks of age, noticeable developmental change takes place: the “baby-moon” is over, babies feed more often, are awake for a little longer, and cry more. Many parents interpret this as cramps and due to what the mother ate. PLEASE, babies are little individuals, not everything baby does is because of you (or what you ate)!! The role of a mother’s diet has been exaggerated and many mothers are given a list of “forbidden foods”. The percentage of babies who are truly sensitive to specific foods is pretty small, most mothers can eat a healthy, balanced diet and nothing is forbidden. Use common sense and eat moderate portions of everything you like. Anything goes but moderation is key.

Providing “rules” about diet during lactation without considering maternal nutritional status and dietary preference can undermine breastfeeding and should be avoided.(16) A mother with healthy eating habits does not usually need to change her diet while she is breastfeeding.(15) Although exceptions exist, most breastfeeding mothers can eat anything they like in moderation – including chocolate and spicy food- without any effect on their baby. Health Professionals should keep diet information simple. Perceiving nutrition information as complicated may convince a mother not to breastfeed.(17)

A Study done by Jeong G, et al. on Maternal food restrictions during breastfeeding(18), concluded that “most mothers restricted certain foods unnecessarily. Literature review identified no foods that mothers should absolutely avoid during breastfeeding unless the infant reacts negatively to the food. Nursing mothers should be educated on proper diet practices while being warned about unscientific approaches to diet restriction”. If a food allergy is suspected as the basis for colicky behavior in newborns and infants, they should be assessed by a medical professional like a paediatrician. Maternal elimination diets should be done under the guidance of a registered dietician.

I was told

​9. A mother must drink milk to make milk

No other mammal drinks milk to make milk. A healthy diet of vegetables, fruits, grains and proteins is all that a mother needs to provide the proper nutrients to produce milk. Calcium can be obtained from a variety of non-dairy foods such as dark green vegetables, seeds, nuts and bony fish.(1)

I was told

​10. The mother should not be a pacifier for the baby

Comfort sucking is a normal part of breastfeeding. Babies breastfeed for reasons other than just for food or to quench their thirst. Babies breastfeed to feel safe, to calm down, to warm up, for reassurance, to connect with mother, for pain relief, to fall asleep and because they love to suck. Whether for hunger or comfort, breastfeeding is usually the answer to whatever is troubling baby with the added bonus of some extra calories and sleep inducing hormones built in along the way. Mothering through breastfeeding makes for healthy brain development and well adjusted, well fed, secure attached children.

Breastfeeding is the basis for baby’s psychological development.(19)

Comforting and meeting sucking needs at the breast is nature's original design. Pacifiers (dummies, soothers) are literally a substitute for the mother when she can't be available - offering an index finger may be a better option. Other reasons to pacify a baby primarily at the breast include superior oral-facial development, prolonged lactational amenorrhea, avoidance of nipple confusion and stimulation of an adequate milk supply to ensure higher rates of breastfeeding success.

I was told

11. Sparkling wine and beer will increase milk supply

Beer or champagne / sparkling wine (and other alcoholic drinks) does NOT increase your supply. Two standard drinks or more at a time can impair your judgment and functioning, and contribute to depression and fatigue (not something you need now!). Also daily consumption of alcohol has been shown in the research to increase the risk for slow weight gain in the infant and is associated with a decrease in baby’s gross-motor-development.(20)

Be careful if people suggest alcohol to increase your milk supply. Alcohol can inhibited the “let down reflex”(21) and reduce the volume of milk baby is receiving per feed by as much as 23%.(22),(23)

It may be the barley that is the prolactin-stimulating component of beer, not the alcohol that helps. Non-alcoholic beer would probably have the same effect.(24)

Alcohol does not accumulate in breastmilk; it passes easily into breastmilk by simple diffusion, reaching levels almost equal to that in the mother’s blood stream. The Molecular weight of alcohol is 46 Dalton and anything lower than 500Da enters milk easily. It also leaves the milk easily. Thus no need to pump and dump milk after drinking alcohol, other than for comfort, because pumping and dumping does not speed the elimination of alcohol from the milk, it is not "trapped" in breastmilk, it returns to your bloodstream when your blood alcohol level drops. Alcohol peaks in mom's blood and milk approximately ½ -1 hour after drinking (but there is considerable variation from person to person, depending upon how much food was eaten in the same time period, mom's body weight and percentage of body fat, etc.). Thomas W. Hale, R.Ph. Ph.D. (author of Medications and Mothers' Milk) says: "mothers who ingest alcohol in moderate amounts can generally return to breastfeeding as soon as they feel neurologically normal.” Still unsure? If you drank alcohol, do not breastfeed until you are completely sober. Again, moderation is KEY.

I was told

12. Parents who hold their babies too much will spoil them

Babies who are held often cry fewer hours a day and exhibit more security as they mature.(25)

I was told

13. It is important that other family members get to feed baby so that they can bond with baby

Feeding is not the only method by which other family members can bond with the baby; holding, cuddling, bathing, playing, winding, rocking to sleep, etc. with the babies are all important tasks to their growth, development and attachment to others. Dads are the perfect people to teach baby that love does not have to come with food.(1)

I was told

14. Breastfed babies will need more and more milk as they grow

Parents may think that as their baby grows bigger and heavier they will need to increase their milk production. They assume that—like babies fed formula—their breastfed babies will need more and more milk as they grow. These mothers are usually tremendously relieved to learn that the amount of milk breastfed babies consume daily between 1 and 6 months of age stays remarkably stable, on average a litre in 24 hours. So if a baby is thriving on exclusive breastfeeding for his first six weeks that mother is set. She is already producing as much milk as her baby would ever need. All she needs to do is maintain it. For example: at a month, baby will just be pooping out the excess of that litre he is not using, from there on they usually start pooping less and less as they use more and more milk and at 6 months they are using all the breastmilk they take in over 24 hours and might only pooh once a week.(26),(27),(28),(29)

I was told

15. I need to pump to see how much milk my breasts make

For many women, milk expressing is a learned skill that takes time and practice to master (it is not the same relationship than with a baby). Even when the most effective types of pump (the rental pump) is used, factors unrelated to milk production (such as fit and responsiveness) can affect the volume a mother is able to pump.

Most current breastpumps are based on a study by Einar Egnell (et alia).(30) These studies have established that a total negative (vacuum) pressure of about 220 to 230 mmHg (millimeters of mercury) is typically produced when a baby is breastfeeding and the maximum pressure is usually held for less than one second. Factors influencing how the pump works, is amount of suction applied (measured using: mmHg millimeters of mercury), the length of time that maximum suction is applied before it is released (ideally 1-2sec, and that determines the cycles per minute), and how well the breast fits into the pump flange and tunnel (tunnel size in mm). Efficiency is another way of rating breast pumps, and this can also go hand in hand with comfort (pain increases adrenalin which suppresses oxytocin release resulting in less milk pumped. Because the brain is wired in such a way that the nerve pathways for milk ejection run through the emotion-processing area of the brain, it is also possible that the let-down reflex (MER) can be slowed by things like tension or stress).(32)

Warming breast-shield showed it improved the efficiency of milk removal.(33)

An important factor in being able to express breastmilk, is the let-down reflex or MER. This causes the milk to be released from the little alveoli. When baby sucks at the breast, nerves send a message to the brain, which causes the hormone oxytocin to be release, coming back to the breast in the bloodstream and contracting the muscle cells around the alveoli squeezing out the milk. An efficient pump will stimulate a milk-ejection reflex (MER) or let-down and remove milk thoroughly and quickly, important for employed mothers with time constraints. An Australian study of 28 breastfeeding mothers with established and ample milk production found 11% were unable to express much milk using any of the 7 pump cycling patters tested.(31)

Doing breast compressions while pumping can help stimulate additional let-downs, and help to thoroughly drain all of the milk ducts, it also increases the amount of milk & fat content expressed.(34),(35)

What does all this tell us? Babies are much more effective in taking milk out of the breast than a pump, do not trust the pump!

I was told

16. Expressing breastmilk and feeding it in a bottle is just as good as breastfeeding

Feeding breastmilk from a bottle is not the same as breastfeeding. For one the close physical contact with baby helps a mother’s body create antibodies to germs in baby’s environment. When she breastfeeds baby directly, her body responds to cues from baby’s saliva and other secretions. After exposure to new pathogens, her body can make targeted antibodies available to her baby within the next several hours. While a bottle of milk from a previous date will provide baby with beneficial anti-infective factors, it will not contain antibodies to germs s/he was exposed to today.(36)

Breastfeeding also directly supports the normal development of a baby’s jaw, teeth, face, and speech. The activity of breastfeeding helps exercise the facial muscles and promotes the development of a strong jaw and symmetric facial structure. Several studies have shown breastfeeding to enhance speech development and speech clarity. An increased duration of breastfeeding is associated with a decreased risk of the later need for braces or other orthodontic treatment. One study showed that the rate of misaligned teeth (malocclusion) requiring orthodontia could be cut in half if infants were breastfed for one year.(37)

Infants who are bottle-fed in early infancy are more likely to empty the bottle or cup in late infancy than those who are fed directly at the breast.(38) Infants fed at the breast learn and develop better control of their milk intake, whereas bottle-feeding may decrease infants’ abilities to self-regulate milk intake. Regardless of bottle contents, infants who often emptied their bottles in early infancy also had increased odds of having excess weight in late infancy, relative to those who rarely emptied their bottles.(39)

In order to understand the difference between the way a baby uses a bottle nipple and a human nipple, one lactation consultant suggests this vivid demonstration:

Put your index finger in your mouth, closing your lips on the first knuckle. Begin sucking. Feel how your tongue flattens your fingertip up to the roof of your mouth. Now feel how your lips close around your finger very tightly. Feel the strength of your jaw and how your teeth make contact with your finger. This simulates the way a baby sucks from most artificial nipples. It is also the same way a baby sucks when he is latched shallowly on the breast.

Now, put your finger in your mouth to the second knuckle. Notice that the tip of your finger almost touches the back of your soft palate. Begin sucking and feel the motion of your tongue, which is now elongated, curved around your finger, and massaging it. Feel they way your lips are slightly open and completely relaxed. Feel the way your jaw is more open and relaxed. Feel the way your teeth on your finger are now barely or not at all touching. This sucking technique approximates the use longer nipples with a round end. It also approximates the way a baby sucks when he is latched deeply and effectively on the breast.

When a baby is feeding at the breast, he has complete control and is able to stop and start when he wishes. Breastfeeding relaxes him thoroughly, which is evidenced by his gradually relaxing hands and body posture. His oxygen levels are stable and high because he can breathe more deeply and regularly. He extends his tongue and cups it around the nipple and areola. His lips are open, wide, and relaxed. Fed by bottle, most babies are cuddled in an almost lying-down position, which greatly accelerates the rate of flow from the bottle. The milk or formula gushes out quickly and the baby must swallow rapidly in order to avoid choking. He has very little control and his oxygen levels are low. These babies have a very tense body posture during bottle-feedings for this reason. In order to exert control of the flow, they quickly learn to retract their tongues and press it up against the tip of the bottle nipple. Their lips will be tight and pursed around the bottle and they do use a jaw motion to move the milk. Because they are swallowing without any effort, their facial muscles cannot develop in the same way as breastfed babies’ will.

I was told

17. Breastfeeding a baby after 12 months is of little value because the quality of breast milk begins to decline after six months

The composition of human milk changes to meet the changing needs of baby as he matures. Even when baby is able to take solids, human milk is the primary source of nutrition during the first year. It becomes a supplement to solids during the second year. In addition, it takes between two and six years for a child's immune system to fully mature. Human milk continues to complement and boost the immune system for as long as it is offered.(1)

Next time someone tells you something that sounds a lot like a “koei feit”, first check if their info is anecdotal, then politely say thank you and move on.

Breastfeeding should be easy and trouble free. SO if breastfeeding is difficult, especially during the 1st weeks, prompt and reliable assessment is vital! Breastfeeding families can get reliable help from an IBCLC®*.

*IBCLCs (International Board Certified Lactation Consultants®) have passed a rigorous examination that demonstrates their ability to provide competent, comprehensive lactation and breastfeeding care. IBCLCs may have different areas of expertise, so you might have to seek further help if you needs are not met.

Reference:

  1. La Leche League International. 2010. The Womanly Art of Breastfeeding (WAB)

  2. https://www.wired.com/2017/02/dont-believe-lies-just-people-repeat/

  3. BABY-FRIENDLY HOSPITAL INITIATIVE Revised Updated and Expanded for Integrated Care SECTION 3 BREASTFEEDING PROMOTION AND SUPPORT IN A BABY-FRIENDLY HOSPITAL A 20-HOUR COURSE FOR MATERNITY STAFF

  4. Diana West, BA, IBCLC & Lisa Marasco, M.A., IBCLC. (2009). The Breastfeeding Mother's Guide to Making More Milk. USA: McGraw-Hill

  5. J Mammary Gland Biol Neoplasia. (1996). Feedback control of milk secretion from milk. Peaker M, Wilde CJ. Hannah Research Institute, United Kingdom, Jul;1(3):307-15

  6. www.normalfed.com

  7. Ramsay, D.T., Kent, J.C., Hartmann, R.A., Hartmann, P.E. 2005, 'Anatomy of the lactating human breast redefined with ultrasound imaging', Journal of Anatomy, 206, pp. 525-534

  8. Geddes, D. T. (2007). Inside the lactating breast: The latest anatomy research. Journal of Midwifery & Women’s Health, 52(6), 556-563

  9. Daly, S. E., Owens, R. A., & Hartmann, P. E. (1993). The shortterm synthesis and infant-regulated removal of milk in lactating women. Experimental Physiology, 78(2), 209-220

  10. Kent, J. C., Mitoulas, L. R., Cregan, M. D., Ramsay, D. T., Doherty, D. A., & Hartmann, P. E. (2006). Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics, 117(3), e387-395

  11. J Mammary Gland Biol Neoplasia. (1996). Feedback control of milk secretion from milk. Peaker M, Wilde CJ. Hannah Research Institute, United Kingdom, Jul;1(3):307-15

  12. Jacqueline C. Kent, PhD, Leon R. Mitoulas, PhD, Mark D. Cregan, PhD, Donna T. Ramsay, PhD, Dorota A. Doherty, PhD, Peter E. Hartmann, PhD. Volume and Frequency of Breastfeedings and Fat Content of Breast Milk Throughout the Day. NEOREVIEWS, Vol. 117 No. 3 March 1, 2006

  13. Zoya Gridneva, Sambavi Kugananthan, Anna R. Hepworth, Wan J. Tie, Ching T. Lai, Leigh C. Ward, Peter E. Hartmann, Donna T. Geddes. Effect of Human Milk Appetite Hormones, Macronutrients, and Infant Characteristics on Gastric Emptying and Breastfeeding Patterns of Term Fully Breastfed Infants. Nutrients. 2017 Jan; 9(1): 15. Published online 2016 Dec 28. doi: 10.3390/nu9010015)

  14. Institute of Medicine (US) Committee on Nutritional Status During Pregnancy and Lactation. (1991). Nutrition During Lactation. Washington (DC): National Academies Press (US)

  15. Sheri Lyn Parpia Khan. Maternal Nutrition during Breastfeeding. NEW BEGINNINGS, Vol. 21 No. 2, March-April 2004, p. 44

  16. Hale, T & Hartmann, P. et al. Textbook of Human Lactation. Amarillo, TX, USA: Hale Publishing, 2007; p378

  17. Mohrbacher, N. Breastfeeding Answers Made Simple: A Guide for Helping Mothers. Amarillo, TX, USA: Hale Publishing, 2010; p513, 516

  18. Jeong G, et al. Maternal food restrictions during breastfeeding. Korean J Pediatr 2017; 60(3):70-76

  19. Hale, T & Hartmann, P. et al. Textbook of Human Lactation. Amarillo, TX, USA: Hale Publishing, 2007

  20. Little, R. E.; Lambert, M. D. ; And Worthington ­ Roberts, B. Drinking and smoking at 3 months postpartum by lactation history. Paediatric and Perinatal Epidemiology 4: 290 302, 1989

  21. Cobo E. Effect of different doses of ethanol on the milk-ejecting reflex in lactating women. American Journal of Obstetrics and Gynecology. 1973;115:817–821

  22. Mennella, J. A. And Beauchamp, G. K. The transfer of alcohol to human milk: Effects on flavor and the infant' s behavior. New England Journal of Medicine 325: 981 985, 1991

  23. Mennella, J. A. And Beauchamp, G. K. Beer, breast feeding and folklore. Developmental Psycho-biology 26: 459 466, 1993

  24. Jack Newman M.D. & Teresa Pitman. (2006). The Ultimate Breastfeeding Book of Answers: The Most Comprehensive Problem-Solving Guide to Breastfeeding from the Foremost Expert in North America, Revised & Updated. New York: Three Rivers Press

  25. Hunziker UA, Garr RG. (1986) Increased carrying reduces infant crying: A random-ized controlled trial. Pediatrics 77:641-648

  26. Butte, N.F., Lopez-Alarcon, & Garza, C. (2002). Nutrient adequacy of exclusive breastfeeding for the term infant during the first six months of life. Geneva, Switzerland, World Health Organization. http:// whqlibdoc.who.int/publications/9241562110.pdf

  27. Kent, J. C., et al. (2006). Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics, 117(3), e387-395

  28. Volume and Frequency of Breastfeedings and Fat Content of Breast Milk Throughout the Day, Jacqueline C. Kent, PhD, Leon R. Mitoulas, PhD, Mark D. Cregan, PhD, Donna T. Ramsay, PhD, Dorota A. Doherty, PhD, Peter E. Hartmann, PhD, NEOREVIEWS Vol. 117 No. 3 March 1, 2006

  29. Islam, M.M, Peerson, J.M., Ahmed, T., Dewey, K.G., & Brown, K.H. (2006). Effects of varied energy density of complementary goods on breast-milk intakes and total energy consumption by healthy, breastfed Bangladeshi children. American Journal of Clinical Nutrition, 83(4), 851-858

  30. Back to the Breast: Natural Motherhood and Breastfeeding in America by Jessica Martucci. 2015. University of Chicago Press

  31. Kent JC, Ramsay DT, Doherty D, Larsson M, Hartmann PE. Response of breasts to different stimulation patterns of an electric breast pump. J. Hum. Lact. 2002;19(2):179–187

  32. The Breastfeeding Mother’s Guide to Making More Milk by Diana West, Lisa Marasco, 2009

  33. Effect of Warm Breastshields on Breast Milk Pumping, Jacqueline C. Kent, DipEd, PhD, Donna T. Geddes, Postgrap Dip(Sci), DMU, PhD, Anna R. Hepworth, BSc(Hons), DipEd, Peter E. Hartmann, PhD

  34. J Perinatol. 2009 Nov;29(11):757-64. Epub 2009 Jul 2. Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. Morton J, Hall JY, Wong RJ, Thairu L, Benitz WE, Rhine WD

  35. Journal of Perinatology , (5 January 2012) | doi:10.1038/jp.2011.195 Combining hand techniques with electric pumping increases the caloric content of milk in mothers of preterm infants J Morton, R J Wong, J Y Hall, W W Pang, C T Lai, J Lui, P E Hartmann and W D Rhine

  36. Chirico, G. et al (2008) Antiinfective Properties of Human Milk, Journal of Nutrition 138, 1801S–1806

  37. Palmer, B. (2008) The Influence of Breastfeeding on the Development of the Oral Cavity: A Commentary Journal of Human Lactation, 14(2), 93-98

  38. Do Infants Fed From Bottles Lack Self-regulation of Milk Intake Compared With Directly Breastfed Infants? Ruowei Li, Sara B. Fein and Laurence M. Grummer-Strawn, Pediatrics 2010

  39. Association of Breastfeeding Intensity and Bottle-Emptying Behaviors at Early Infancy With Infants' Risk for Excess Weight at Late Infancy, Ruowei Li, Sara B. Fein and Laurence M. Grummer-Strawn, Pediatrics 2008

#breastfeeding #notenough #enoughmilk #TCs

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