Common Breastfeeding Myths
by Lisa Marasco
Assistant Area Professional Liaison
LLL of Southern California/Nevada USA
From: LEAVEN, Vol. 34 No. 2, April-May 1998, pp. 21-24
Myth 1: Frequent
nursing leads to poor milk production, a weak let-down response and
ultimately unsuccessful nursing.
Fact: Milk supply
is optimized when a healthy baby is allowed to nurse as often as he
indicates the need. The milk-ejection reflex operates most strongly
in the presence of a good supply of milk, which normally occurs when
feeding on baby's cue.
De Carvalho, M. et
al. Effect of frequent breastfeeding on early milk production and infant
weight gain Pediatrics 1983: 72:307-11.
Hill, P. Insufficient
milk supply syndrome. NAACOG's Clin Issues 1992; 3(4):605-12.
Klaus, M. The frequency
of suckling: neglected but essential ingredient of breastfeeding. Ob
Gyn Clin North Am 1987; 14(3):623-33.
Neifert, M. Early
assessment of the breastfeeding infant. Contemporary Pediatrics
October 1996; 6-9.
Lawrence R. Breastfeeding:
A Guide for the Medical Professional, 4th ed. St. Louis: Mosby 1994;
188.
Salariya, F. et al.
Duration of breastfeeding after early initiation and frequent feeding.
Lancet 1978; 2(8100):1141-43.
Slaven, S. Harvey,
D. Unlimited sucking time improves breastfeeding. Lancet 1981;
14:392-93.
Stuart-Macadam, P.,
Dettwyler, K. Breastfeeding: Biocultural Perspectives. Hawthorne,
New York: Aldine de Gruyter, 1995; 129.
Woolridge, M. and
Baum, J. Infant appetite-control and the regulation of the breast milk
supply. Child Hosp Qtrly 1992; 3:113-19.
Myth 2: A mother
only needs to nurse four to six times a day to maintain good milk supply.
Fact: Research shows
that when a mother breastfeeds early and often, an average of 9.9 times
a day in the first two weeks, her milk production is greater, her infant
gains more weight and she continues breastfeeding for a longer period.
Milk production has been shown to be related to feeding frequency, and
milk supply declines when feedings are infrequent or restricted.
Daly, S., Hartmann,
R Infant demand and milk supply: Part 1 and 2. J Hum Lact 1995;
11(1):21-37.
De Carvalho, M. et
al. Effect of frequent breastfeeding on early milk production and infant
weight gain Pediatrics 1983: 72:307-11.
De Coopman, J. Breastfeeding
after pituitary resection: support for a theory of autocrine control
of milk supply. J Hum Lact 1993; 9(1):35-40.
Riordan, I. and Auerbach,
K. Breastfeeding and Human Lactation. Boston and London: Jones
and Bartlett 1993; 88.
Myth 3: Babies
get all the milk they need in the first five to ten minutes of nursing.
Fact: While many older
babies can take in the majority of their milk in the first five to ten
minutes, this cannot be generalized to all babies. Newborns, who are
learning to nurse and are not always efficient at sucking, often need
much longer to feed. The ability to take in milk is also subject to
the mother's let-down response. While many mothers may let down immediately,
some may not. Some may eject their milk in small batches several times
during a nursing session. Rather than guess, it is best to allow baby
to suck until he shows signs of satiety such as self-detachment and
relaxed hands and arms.
Lucas, A., Lucas,
P., Aum, J. Differences in the pattern of milk intake between breast
and bottle-fed infants. Early Hum Dev 1981; 5:195.
Stuart-Macadam, P.,
Dettwyler, K. Breastfeeding: Biocultural Perspectives. Hawthorne,
New York: Aldine de Gruyter, 1995; 129-37.
Myth 4: A breastfeeding
mother should space her feedings so that her breasts will have time
to refill.
Fact: Every baby/mother
dyad is unique. A lactating mother's body is always making milk. Her
breasts function in part as "storage tank," some holding more than others.
The emptier the breast, the faster the body makes milk to replace it;
the fuller the breast, the more production of milk slows down. If a
mother consistently waits until her breasts "fill up" before she nurses,
her body may get the message that it is making too much and may reduce
total production.
Daly, S., Hartmann,
R. Infant demand and milk supply: Part 2. J Hum Lact 1995; 11(1):21-37.
Lawrence R. Breastfeeding:
A Guide for the Medical Professional, 4th ed. St. Louis: Mosby 1994;
240-41.
Myth 5: Babies
need only six to eight feedings a day by eight weeks of age, five to
six feedings a day by three months, no more than four or five feedings
a day by six months of age.
Fact: A breastfed
baby's frequency of feeding will vary according to the mother's milk
supply and storage capacity, as well as baby's developmental needs.
Growth spurts and illnesses can temporarily change a baby's feeding
patterns. Studies show that breastfeeding babies fed on cue will settle
into a pattern that suits their own unique situation. In addition, the
caloric intake of a breastfed baby increases toward the end of the feeding,
so putting arbitrary limits on the frequency or duration of feedings
may lead to inadequate caloric intake.
Daly, S., Hartmann,
R. Infant demand and milk supply: Part 1. J Hum Lact 1995; 11(1):21-6.
Klaus, M. The frequency
of suckling. Ob Gyn Clin North Am 1987; 14(3):623-33.
Lawrence R. Breastfeeding:
A Guide for the Medical Professional, 4th ed. St. Louis: Mosby 1994;
253.
Millard, A. The place
of the clock in pediatric advice: rationales, cultural themes and impediments
to breastfeeding. Soc Sci Med 1990; 31:211.
Woolridge, M. "Baby-controlled
breastfeeding: biocultural implications" in Stuart-Macadam, P., Dettwyler,
K. Breastfeeding: Biocultural Perspectives. Hawthorne, New York:
Aldine de Gruyter, 1995; 217-42.
Myth 6: It is the
amount of milk that a baby takes in (quantitative), not whether it is
human milk or formula (qualitative), that determines how long a baby
can go between feedings.
Fact:Breastfed babies
have faster gastric emptying times than fomula-fed babies--approximately
1.5 hours versus up to 4 hours--due to the smaller size of the protein
molecules in human milk. While intake quantity is one factor in determining
feeding frequency, the type of milk is equally important. Anthropologic
studies of mammalian milk confirm that human babies were intended to
feed frequently and have done so throughout most of history.
Lawrence R. Breastfeeding:
A Guide for the Medical Professional, 4th ed. St. Louis: Mosby 1994;
254.
Marmet, C., Shell,
E. Breastfeeding Is Important. Encino, California: Lactation
Institute, 1991:4.
Stuart-Macadam, P.,
Dettwyler, K. Breastfeeding: Biocultural Perspectives. Hawthorne,
New York: Aldine de Gruyter, 1995; 129.
Myth 7: Never wake
a sleeping baby.
Fact: While most babies
will indicate when they need to eat, babies in the newborn period may
not wake often enough on their own and should be awakened if necessary
to eat at least eight times a day. Infrequent waking to feed can be
caused by labor drugs, maternal medications, jaundice, trauma, pacifiers
and/or shutdown behavior after delayed response to feeding cues.
In addition, mothers who
wish to take advantage of the natural infertility of lactational amenorrhea
find that the return of menses is delayed longer when baby continues
to suckle at night.
American Academy of
Pediatrics Policy Statement on Breastfeeding and the use of Human Milk.
Pediatrics 1997; 100(6):1035-39.
Klaus, M. The frequency
of suckling: neglected but essential ingredient of breast-feeding. Ob
Gyn Clin North Am 1987; 14(3):623-33.
Mohrbacher, N., Stock,
J. BREASTFEEDING ANSWER BOOK. Schaumburg, Illinois: LLLI, 1997; 60-65,
360-61.
Tips for Rousing
a Sleepy Newborn. LLLI, 1997. Publication No.485.
Myth 8: The metabolism
of a baby is disorganized at birth and it requires the implementation
of a routine or schedule to help stabilize this disorganization.
Fact: Babies are uniquely
wired from birth to feed, sleep and have periods of wakefulness. This
is not disorganized behavior but reflects the unique needs of newborn
infants. Over time, babies naturally adapt to the rhythm of life in
their new environment and do not require prompting or training.
Mohrbacher, N., Stock,
J. BREASTFEEDING ANSWER BOOK. Schaumburg, Illinois: LLLI, 1997; 24-29.
Sears, W. The Fussy
Baby. LLLI 1985;12-13.
Myth 9: Breastfeeding
mothers must always use both breasts at each feeding.
Fact: It is more important
to let baby finish the first breast first, even if that means that he
doesn't take the second breast at the same feeding. Hindmilk is accessed
gradually as the breast is drained. Some babies, if switched prematurely
to the second breast, may fill up on the lower-calorie foremilk from
both breasts rather than obtaining the normal balance of foremilk and
hindmilk, resulting in infant dissatisfaction and poor weight gain.
In the early weeks, many mothers offer both breasts at each feeding
to help establish the milk supply.
Mohrbacher, N., Stock,
J. BREASTFEEDING ANSWER BOOK. Schaumburg, Illinois: LLLI, 1997; 25.
Stuart-Macadam, P.,
Dettwyler, K. Breastfeeding: Biocultural Perspectives. Hawthorne,
New York: Aldine de Gruyter, 1995; 129.
Woolridge, M., Fisher,
C. Colic, "overfeeding" and symptoms of lactose malabsorption in the
breastfed baby: a possible artifact of feed management? Lancet
1988; II(8605):382-84.
Woolridge, M. et al.
Do changes in pattern of breast usage alter the baby's nutritional intake?
Lancet 336(8712):395-97.
Myth 10: If a baby
isn't gaining well, it may be due to the low quality of the mother's
milk.
Fact: 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 milk intake or an underlying health
problem in the baby.
Mohrbacher, N., Stock,
J. BREASTFEEDING ANSWER BOOK. Schaumburg, Illinois: LLLI, 1997; 116-32.
Wilde, C. et al. Breastfeeding:
matching supply with demand in human lactation. Proc Nutr Soc1
1995; 54:401-06.
Myth 11: Poor milk
supply is usually caused by stress, fatigue and/or inadequate fluids
and food intake.
Fact: The most common
causes of milk supply problems are infrequent feedings and/or poor latch-on
and positioning; both are usually due to inadequate information provided
to the breastfeeding mother. Suckling problems on the infant's part
can also impact milk supply negatively. Stress, fatigue or malnutrition
are rarely causes of milk supply failure because the body has highly
developed survival mechanisms to protect the nursling during times of
scarce food supply.
Dusdieker, B., Stumbo,
J., Booth, B. et al. Prolonged maternal fluid supplementation in breastfeeding.
Pediatrics 1090; 86:737-40.
Hill, P. Insufficient
milk supply syndrome. NAACOG's Clin Issues 1992; 3(4):605-13.
Woolridge, M. Analysis,
classification, etiology of diagnosed low milk output. Plenary session
at International Lactation Consultant Association Conference, Scottsdale
Arizona, 1995.
World Health Organization.
Not enough milk. Division of Child Health and Development Update
Feb 1995 21. http://www.who.ch/programmes/cdr/pub/newslet/update/updt-21.htm
Myth 12: A mother
must drink milk to make milk.
Fact: 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 he obtained
from a variety of nondairy foods such as dark green vegetables, seeds,
nuts and bony fish. No other mammal drinks milk to make milk.
Behan, E. Eat Well,
Lose Weight While Breastfeeding. New York: Villard Books, 1992;
145-46.
Mohrbacher, N., Stock,
J. BREASTFEEDING ANSWER BOOK. Schaumburg, Illinois: LLLI, 1997; 377,
379.
Myth 13: Non-nutritive
sucking has no scientific basis.
Fact: Experienced
breastfeeding mothers learn that the sucking patterns and needs of babies
vary. While some infants' sucking needs are met primarily during feedings,
other babies may need additional sucking at the breast soon after a
feeding even though they are not really hungry. Babies may also nurse
when they are lonely, frightened or in pain.
Riordan, J., Auerbach,
K. Breastfeeding and Human Lactation. Boston and London: Jones
and Bartlett, 1993; 96-97.
Lawrence, R. Breastfeeding:
A Guide for the Medical Profession, 4th ed. St. Louis: Mosby, 1994;
432.
Myth 14: The mother
should not be a pacifier for the baby.
Fact: 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. 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.
American Academy of
Pediatrics Policy Statement on Breastfeeding and the use of Human Milk.
Pediatrics 1997; 100(6):1035-39.
Barros, F. et al.
Use of pacifiers is associated with decreased breastfeeding duration.
Pediatrics 1995; 95:497-99.
Gotsch, G. Pacifiers:
Yes or No? LLLI, 1996. Publication No.45.
Mohrbacher, N., Stock,
J. BREASTFEEDING ANSWER BOOK. Schaumburg, Illinois: LLLI, 1997; 34-35,
43-44.
Newman, J. Breastfeeding
problems associated with the early introduction of bottles and pacifiers.
J Hum Lact 1990; 6(2):59-63.
Myth 15: There
is no such thing as nipple confusion.
Fact: Breast and bottle
feeding require different oral-motor skills, and rubber nipples provide
a type of "super stimulus" that babies may imprint upon instead of the
softer breast. As a result, some babies develop suck confusion and apply
inappropriate suckling techniques to the breast when they switch between
breast and bottle.
Blass, E. Behavioral
and physiological consequences of suckling in rat and human newborns.
Acta Paediatr Suppl 1994; 397:71-76.
Mohrbacher, N., Stock,
J. BREASTFEEDING ANSWER BOOK. Schaumburg, Illinois: LLLI, 1997; 82-87.
Neifert, M, et al.
Nipple confusion: toward a formal definition. J Pediatr 1995;
126(6):S125-9
Nipple Confusion
- Overcoming and Avoiding This Problem. LLLI, 1992. Publication
No.32.
Myth 16: Frequent
nursing can lead to postpartum depression.
Fact: Postpartum depression
is believed to be caused by fluctuating hormones after birth and may
be exacerbated by fatigue and lack of social support, though it mostly
occurs in women who have a history of problems prior to pregnancy.
Astbury, J. et al.
Birth events, birth experiences and social differences in postnatal
depression. Aust J Public Health.1994; 18(2):176-64.
Dunnewold, A. Breastfeeding
and postpartum depression: is there a connection? BREASTFEEDING ABSTRACTS,
LLLI, May 1996; 25.
Lawrence R. Breastfeeding:
A Guide for the Medical Professional, 4th ed. St. Louis: Mosby 1994;
191-2.
Myth 17: Feeding
on baby's cue does not enhance maternal bonding behavior.
Fact: The responsive
parenting of cue feeding brings mother and baby into synchronization,
leading to enhanced bonding.
Ainsworth, M. Infant-mother
attachment. Am Psych 1979; 34(10):932-37.
Berg-Cross, L., Berg-Cross,
G., McGeehan, D. Experience and personality differences among breast
and bottle-feeding mothers. Psych of Women Qtrly 1979; 3(4):344-58.
Kennell, I., Jerauld,
R., Wolfe, H. et al. Maternal behavior one year after early and extended
post-partum contact. Developmental Medicine and Child Neurology
1974; 16(2):99-107.
Temboury, M. et al.
Influence of breastfeeding on the infant's intellectual development.
J Ped Gastro Nutr 1994; 18:32-36.
Myth 18: Mothers
who hold their babies too much will spoil them.
Fact: Babies who are
held often cry fewer hours a day and exhibit more security as they mature.
Anisfeld, E. et al.
Does infant carrying promote attachment? An experimental study of the
effects of increased physical contact on the development of attachment.
Child Dev 1990; 61:1617-27.
Barr, K. and Elias
M. Nursing interval and maternal responsivity: effect on early infant
crying. Pediatrics 1988 81:529-36.
Bowlby, J. Attachment
and Loss: Attachment, vol 1. New York: Basic Books, 1969; 178, 208,
240.
Heller, S. The
Vital Touch: How Intimate Contact with Your Baby Leads to Happier, Healthier
Development. New York: Henry Holt, 1997;41-53, 204-21.
Hunziker U. and Barr
R. Increased carrying reduces infant crying: a randomized controlled
trial Pediatrics 1986; 77:641.
Matas, L., Arend,
R., Sroufe, L. Continuity of adaptation in the second year: the relationship
between quality of attachment and later competence. Child Dev
1978; 49:547-56.
Myth 19: It is
important that other family members get to feed baby so that they can
bond, too.
Fact: Feeding is not
the only method by which other family members can bond with the baby;
holding, cuddling, bathing and playing with the infant are all important
to his growth, development and attachment to others.
Heller, S. The
Vital Touch: How Intimate Contact with Your Baby Leads to Happier, Healthier
Development. New York: Henry Holt, 1997;54-55, 60-61.
Myth 20: Child-directed
feeding (nursing on demand) has a negative impact on the husband/wife
relationship.
Fact: Mature parents
realize that a newborn's needs are very intense but also diminish over
time. In fact, the teamwork of nurturing a newborn can actually bring
a couple closer as they develop parenting skills together.
Bocar, D., Moore,
K. Acquiring the parental role: a theoretical perspective. LLLI Lactation
Consultant Series. Unit 16. Garden City Park, New York: Avery, 1987.
Sears, W. BECOMING
A FATHER. Schaumburg, Illinois: LLLI 1986; 29-50,119-29.
Myth 21: Some babies
are allergic to their mother's milk.
Fact: Human milk is
the most natural and physiologic substance that baby can ingest. If
a baby shows sensitivities related to feeding, it is usually a foreign
protein that has piggybacked into mother's milk, and not the milk itself.
This is easily handled by removing the offending food from mother's
diet for a time.
Hudson, I. et al.
A low allergen diet is a significant intervention in infantile colic:
results of a commmunity-based study. J Allergy Clin Immunol 1995;
96:886-92.
Mohrbacher, N., Stock,
J. BREASTFEEDING ANSWER BOOK. Schaumburg, Illinois: LLLI, 1997; 97-99.
Salmon, M. Breast
Milk: Nature's Perfect Formula. Demarest, New Jersey: Techkits,
1994; 32-3.
Myth 22: Frequent
nursing causes a child to be obese later in life.
Fact: Studies show
that breastfed babies who control their own feeding patterns and intake
tend to take just the right amount of milk for them. Formula feeding
and early introduction of solids, not breastfeeding on demand, have
been implicated in risk of obesity later in life.
Dewey, K., Lonnerdal,
B. Infant self-regulation of breast milk intake. Acta Paediatr Scand
1986; 75:893-98.
Dewey K. et al. Growth
of breast-fed and formula-fed infants from 0 to 18 months: the DARLING
study. Pediatrics 1992a; 89(6):1035-41.
Kramer, M. Do breastfeeding
and delayed introduction of solid foods protect against subsequent obesity?
J Pediatr 1981; 98:883-87.
Stuart-Macadam, P.,
Dettwyler, K. Breastfeeding: Biocultural Perspectives, Hawthorne,
New York: Aldine de Gruyter, 1995; 192.
Woolridge, M. Returning
control of feeding to the infant. Paper presented at the LLL of Texas
Area Conference, Houston, Texas, USA, July 24-26, 1992.
Myth 23: The lying-down
nursing position causes ear infections.
Fact: Because human
milk is alive and teeming with antibodies and immunoglobulins, the baby
is less likely to develop ear infections overall, no matter what position
is used.
Aniansson, G. et al.
A prospective cohort study on breastfeeding and otitis media in Swedish
infants. Pediatr Infect Dis J 1994; 13:183-88.
Harabuchi, Y. et al.
Human milk secretory IgA antibody to nontypeable haemophilus influenzae:
possible protective effects against nasopharyngeal colonization.J
Pediatr 1994; 124(2)193-98.
Myth 24: Nursing
a baby after 12 months is of little value because the quality of breast
milk begins to decline after six months.
Fact: 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.
American Academy of
Pediatrics Policy Statement on Breastfeeding and the Use of Human Milk.
Pediatrics 1997; 100(6):1035-39.
Goldman, A. Immunologic
components in human milk during the second year of lactation. Acta
Paediatr Scand 1983; 72:461-62.
Gulick, E. The effects
of breastfeeding on toddler health. Ped Nursing1986; 12:51-54.
Innocenti Declaration
on the protection, promotion and support of breastfeeding. Ecology
of Food and Nutrition 1991; 26:271-73.
Mohrbacher, N., Stock,
J. BREASTFEEDING ANSWER BOOK. Schaumburg, Illinois: LLLI, 1997; 164-68.
Saarinen, U. Prolonged
breastfeeding as prophylaxis for recurrent Otitis media. Acta Paediatr
Scand 1982; 71:567-71.
Page last edited Sun Oct 14 09:31:42 UTC 2007.
