Breastfeeding Medicine

Physicians blogging about breastfeeding

Archive for November 2010

Sleep study no basis for clinical advice

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The following is a copy of the letter to be printed in Pediatrics responding to the article by Henderson et al. Clearly such a problematic study cannot be used as a basis for parental guidance!! See also the letter in Pediatrics from Jim Mckenna

To the Editor:
I am dismayed by the publication of the study of Henderson et al which ostensibly documents the normal patterns of sleep in infants in the first year of life. The population studied was non-random, self selected and not representative of the varied ethnic, cultural, socioeconomic diversity of a normal population. Thus, just on these grounds this inevitable selection bias precludes any conclusions.

Even more importantly, no information was provided as to the feeding patterns of the infants: what percentage if any were breastfed? In the breastfed infants to what degree was supplementary commercial formula added, at what age were complementary foods introduced and how (bottle, spoon), and what sleeping arrangements were followed (separate rooms, close proximity or co-sleeping)? The absence of information regarding these variables which impact on the sleeping pattern of infants similarly invalidates the presentation of the authors results as a description of the natural history of sleep and surely the results cannot serve as a basis for the guidance of parents as to what are normal infant care practices.

Furthermore, while the fact that the authors have no medical background may explain their lack of including such basic clinical data in the their study design, it does not explain the absence of even mentioning these serious limitations in the discussion section. This in of itself raises serious question as to the review process that the study underwent.

Dr. Arthur I Eidelman is a Professor of Pediatrics at Shaare Zedek Medical Center, Jerusalem, Israel. He is a Fellow of the Academy of Breastfeeding Medicine and Vice-President of ABM.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.

Written by aeidelmanmd

November 10, 2010 at 10:07 am

Breastfeeding is as much about the food as sex is about the sperm

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Breastfeeding is as much about the food as sex is about the sperm. Although it’s primarily designed for survival, it’s part of an intimate loving physical relationship- the template for all relationships in life. So for success, it involves persistence, commitment, giving beyond what seems reasonable- and provides rewards beyond what is given. -Nan Jolly, South Africa:

At ABM’s 2010 Intenational Meeting, members from around the world submitted their breastfeeding clinical pearls and mythbusters. We’ll be sharing the Top Ten winners on the blog this week. Clinical pearls reflect the opinions of individual ABM members, not the organization as a whole.

For comprehensive, evidenced-based guidelines on breastfeeding management, check out ABM’s Clinical Protocols, available in multiple languages.

Written by bfmed

November 5, 2010 at 7:13 am

Clinical pearl: The Murphy Maneuver for diagnosing tongue tie

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If baby is having trouble breastfeeding and you are not sure if he is tongue-tied, San-Diego pediatrician Dr. James Murphy suggests pushing your little finger to the base of the tongue on one side and sweeping it across the other side to see what you can feel. If you feel little or no resistance more than a small “speed bump,” then most likely there is no problem.

Should you feel a large speed bump that you can get past with a little more effort, it is most likely a “tree trunk” frenulum, a short, wide band of tissue buried in the floor of the mouth and attached to the base of the tongue. It usually, though not always, restricts tongue movements and causes latch problems even though it looks like there isn’t enough there to be a problem.

When you can’t sweep your finger across without pulling it back to “jump over a fence,” the frenulum is a fibrous band attached closer to the front of the tongue. It may be buried underneath the floor of the mouth or visible as an external web. If you see a narrow white streak running down the middle of the floor of the mouth that feels like a wire, it usually extends to the front of the tongue like a string. Pushing your finger into this “piano wire” frenulum will often cause the tip of the tongue to tilt downward and the center if the tongue to pull down and crease along the middle. “Tree trunk, “fence,” and “piano wire” frenulums are red flags for significant tongue function impairment.

At ABM’s 2010 Intenational Meeting, members from around the world submitted their breastfeeding clinical pearls and mythbusters. We’ll be sharing the Top Ten winners on the blog this week. Clinical pearls reflect the opinions of individual ABM members, not the organization as a whole.

For comprehensive, evidenced-based guidelines on breastfeeding management, check out ABM’s Clinical Protocols, including our protocol for managing Neonatal Ankyloglossia.

Written by bfmed

November 4, 2010 at 4:20 pm

Posted in Mythbusters, Protocols

Clinical pearl: Break up plugged ducts with an electric toothbrush

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Sometimes using the flat side of an electric toothbrush over a superficial duct plug in the breast helps them break up, a poor man’s ultrasound therapy. -Amy Evans, California

At ABM’s 2010 Intenational Meeting, members from around the world submitted their breastfeeding clinical pearls and mythbusters. We’ll be sharing the Top Ten winners on the blog this week. Clinical pearls reflect the opinions of individual ABM members, not the organization as a whole.

For comprehensive, evidenced-based guidelines on breastfeeding management, check out ABM’s Clinical Protocols.

Written by bfmed

November 4, 2010 at 8:37 am

Posted in Mythbusters

NICU pearl: Cover the containers during pumping to make more milk

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When mothers are initiating and maintaining lactation by expressing milk with a pump, cover the containers with a towel, a receiving blanket etc. When the moms stop staring at the bottles and counting every drop they are often surprised to see how much more milk they express. – Kathie Marinelli and Mary Lussier, Connecticut

ABM’s protocol on the NICU graduate going home offers evidence-based guidelines for supporting breastfeeding for NICU infants.

At ABM’s 2010 Intenational Meeting, members from around the world submitted their breastfeeding clinical pearls and mythbusters. We’ll be sharing the Top Ten winners on the blog this week. Clinical pearls reflect the opinions of individual ABM members, not the organization as a whole.

Written by bfmed

November 3, 2010 at 11:05 am

Posted in Mythbusters, Protocols

Clinical pearl: Use the cord clamp to bring babies back at 3-5 days

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In order to assure that every newborn is brought back to follow-up clinic between 3-5 days of age as recommended by the AAP, many years ago we instituted a policy in our hospital (The University of Chicago Hospitals) that all newborns would be discharged with the cord clamp remaining in place. When the infant completed the follow-up visit, we held a little ceremony to celebrate the removal of the cord clamp. Over a period of many years, we consistently had better than 90% returns to the early follow-up clinic. – Larry Gartner, Illinois and California

At ABM’s 2010 Intenational Meeting, members from around the world submitted their breastfeeding clinical pearls and mythbusters. We’ll be sharing the Top Ten winners on the blog this week. Clinical pearls reflect the opinions of individual ABM members, not the organization as a whole.

Written by bfmed

November 2, 2010 at 2:42 pm

Posted in Mythbusters

Clinical pearl: A quick fix for vasospasm

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My trick is: when I see a mother with vasospasm after nursing in our outpatient Breastfeeding Medicine Clinic, I will give her heel warmers to put in her bra to relieve the spasm on the trip home. – Sarah Riddle, Ohio

At ABM’s 2010 Intenational Meeting, members from around the world submitted their breastfeeding clinical pearls and mythbusters. We’ll be sharing the Top Ten winners on the blog this week. Clinical pearls reflect the opinions of individual ABM members, not the organization as a whole.

Written by bfmed

November 2, 2010 at 10:01 am

Posted in Mythbusters

Clinical pearl: Your baby has not read any of your books

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Your baby has not read any of your books; he relies on a special software program for babies called instinct! Parents can quickly learn their baby’s language by the immersion method: stay close, listen, watch and practice. – Verity Livingstone, Canada

At ABM’s 2010 Intenational Meeting, members from around the world submitted their breastfeeding clinical pearls and mythbusters. We’ll be sharing the Top Ten winners on the blog this week. Clinical pearls reflect the opinions of individual ABM members, not the organization as a whole.

Written by bfmed

November 1, 2010 at 12:43 pm

Posted in Mythbusters

Clinical pearl: Give baby until 4 days past his due date to get the hang of breastfeeding

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My pearl of wisdom is for moms who are having difficulty with breastfeeding that they need to give the baby until 4 days past his due date to get the hang of it, We see so many c-sections and planned inductions that some days the majority of our babies are 2-4 weeks early. Moms seem to understand this and many seem willing to try the extra work to get to this date (keep supplementing, keep waking, keep pumping). Of the mom and baby pairs that have continued to BF only 2 babies let me down by not catching on by the date. One of them had developmental delay. – ABM Member Gail Hertz, Pennsylvania, USA.

At ABM’s 2010 Intenational Meeting, members from around the world submitted their breastfeeding clinical pearls and mythbusters. We’ll be sharing the Top Ten winners on the blog this week. Clinical pearls reflect the opinions of individual ABM members, not the organization as a whole.

Written by bfmed

November 1, 2010 at 9:33 am

Posted in Mythbusters