Monday, February 13, 2017

Breastfeeding Truths Come Under Attack--IBCLC Fights Back

I have comfortably watched from the sidelines as an ER doctor in Arkansas and one of her cohorts have taken a strange position in regards to breastfeeding. As far as I could tell from her blogs and postings, the doctor and her son suffered an unnecessary tragedy related to insufficient milk transfer right after delivery. No one accurately diagnosed her condition of retained placenta or evaluated the infant for milk transfer and growth. The consequences were dire. The infant did not thrive and the mother may have felt helpless and frightened. I have empathy for her. I share in her frustration. I am angered that the medical professionals and system let her down. What I do not understand is why she isn't lashing out at them. Why doesn't she insist on more observation, better care of moms in the postpartum period, regular assessments of the dyad. She stresses that she wanted to breastfeed, so it seems that it would be logical to take a pro-breastfeeding stand and help others that come after her avoid the same fate. Instead, she is working tirelessly to destroy the Baby Friendly Hospital Initiative, discredit the American Academy of Pediatricians, slander La Leche League International, and question the advice of Academy of Breastfeeding Medicine. The list of her antagonists goes on and on. Her message is destructive. Not only is she pedaling false information, she is also seeking ways to gain notoriety and attention by attacking pillars in the lactation community as well as stellar programs that exist to support and educate families.

Well, I have finally come in her cross-hairs and can no longer sit idly by.  Perhaps I should have spoken up sooner, but I truly felt the anger and accusations she was spewing would be her own downfall. I am responding now because I need to share truth and light in order to dispel shadows and doubt, besides, It is time for me to continue my campaign of evidence-based education backed by references and research.




When my product was recently mentioned in her blog, my first instinct was to ignore the post and focus on helping families. In fact, I would not have conceived this post if the complaints had just been aired on her editorial page. I know my product is well-respected by professionals and health organizations. I know it contains sound advice, backed by science. Unfortunately, I fell compelled to to respond now because a misled individual has gone to great lengths to discredit my work and the evidence behind it. She submitted a claim to the US Consumer Product Safety Commission accusing my product of leading to her son's starvation. Her reasoning is faulty to say the least. I am sharing the Open Letter I sent in response to the ridiculous and almost scandalous complaint she submitted. Let's end her tirade once and for all. Let's call out those who pretend to support breastfeeding but try to sabotage its success. Let's expose lies and half-truth.We cannot embrace "alternative truths" when it comes to infant feeding and public health. There is so much more I could say, but for now I will share my response to an invalid complaint about a powerful visual and important teaching tool that is empowering moms around the world.

For those who desire to see the "complaint" so you can understand my thorough frustration and confusion of why she projects blame on a teaching tool (that was not even widely marketed during the time she experienced) her for her child's condition, well, please refer to the claim she submitted here:

https://www.saferproducts.gov/ViewIncident/1600450

Now for my complete response:

US Consumer Product Safety Commission
Attn: Clearinghouse
4330 East West Highway
Bethesda, MD 20814-4408

January 29, 2017

Dear US Consumer Product Safety Commission and Reviewers:
I appreciate and respect the authority of your office and understand the gravity used in evaluating the safety of products. I recently received a notification that an invention I manufacture and market, the Lactation Lanyard, has been mentioned in a complaint. I am writing to clarify the utility of the product, the evidence that supports its use, and the fallacious nature of the accusations launched against this important teaching tool.

I understand that the complaint has been published and a response from myself or my company is not required, but I would be remiss if I did not respond to the false accusations directed at my product. I assure you that this is not an anonymous complaint by a “concerned citizen” but rather a spiteful person searching for an outlet for her anger and frustration.  I feel compelled to address the complaint and expose the misleading (and selective) information that the author of the submission provided on your form.

The individual who submitted the claim against my product has suffered a personal tragedy (as documented in her submission and on social media) and is trying desperately to find someone or something to blame for her circumstances.
She has gone to great lengths to skew information, and now I fear she has stooped to using your office to submit a frivolous complaint in an effort to execute a personal vendetta against lactation professionals. She has been making these claims on social media and appears frustrated that they have not been taken seriously by a wide audience.


Allow me to share some background information. The person who submitted the claim is part of an organization called “Fed is Best.” Her counterpart wrote a blog post attempting to discredit my lanyards and the established research that validates their utility. This new complaint issued to the Safety Commission appears to be yet another effort to grow an audience for their blog which recently featured complaints about the Lactation Lanyard. The picture of the Lactation Lanyard was removed from the editorial when I threatened a cease and desist letter. Even in the poorly written narrative, the author admits that the stomach capacity of a newborn is unknown, which is not entirely accurate. I am frustrated that this individual continues to spout misleading information in hopes of winning people over to her cause. In this case, the means definitely do not justify the ends. 
Blog by Jody Segrave-Daly, RN, IBCLC

Allow me to address each aspect of her accusations systematically. I believe once the scientific evidence is reviewed, it will be clear that there is absolutely no basis for her claims, and her complaint to the Commission will be disregarded.
First, the Product Detail section on the US Consumer Product Safety Commission report contains false information. The submitter states,

“The lactation lanyard and keychain are visual tools used to convince mothers that their newborns are not in need of supplemental feeding. It claims a newborn stomach size of 5-7 mL when in fact the scientific data has shown it is 20 mL. This is leading to dangerous newborn starvation and brain injury…”

My product is indeed a visual tool that shows the approximate intake of a newborn at day one and at day three, based on the anatomy and physiology of human newborns. The card attached to the lanyard also states that a newborn should be fed frequently and that the stomach grows as milk supply increases. The product comes with an instruction card and website address where we offer additional resources.  The lanyard in no way communicates that a mother should never supplement; that is a medical decision to be undertaken by the patient and her medical, nursing and lactation team. In reference to the last statement in the Product Detail, a visual aid cannot lead to starvation or brain injury; neglect and withholding nourishment can, and we would never condone anything remotely associated with that advice.

The complaint stresses the stomach size on day one. Immediately following birth, families are usually followed by a health professional whether a physician or medical staff in a hospital, or a midwife at a home birth or birth center. Families are cared for and educated by qualified staff who assess a baby for anything out of the ordinary. Knowing many hospitals and birth centers utilize the lanyards encourages me that these professionals share in the belief that breastmilk is the appropriate and sufficient nutrition for newborns, and will advise a family if supplementation becomes necessary. Dyads are closely monitored by health professionals during the postpartum stay, and surveys include tracking weight and output regularly.

The first 24 hours postpartum is mostly about rest and recovery. Newborns take in small quantities of milk during each feed. The exact amount measurable in milliliters is a moot point. When a mother is feeding from her breast, there is no need to use a feeding device and measure intake. Health care professionals have many ways to assess milk transfer, including documenting diaper count. Even though I will share references for the approximate capacity of a newborn on day one, the reality is we are not actually measuring 5-7 mL and feeding with a syringe, but rather feeding at the breast and ensuring milk transfer is occurring. The measurement of 5-7 mL thus reflects the stomach size and not the exact amount of milk transferred.

I am completely bewildered by the author’s paragraph on the Incident Details of the report. It is highly concerning that a Health Care Professional (stated in the submitters report and on her bio), would draw such utterly unscientific conclusions regarding a simple product. The author states:

Lanyards “…prevent them from supplementing newborns who are crying inconsolably for milk when there is not enough. The most recent scientific data shows that in fact, the newborn stomach size is 20 mL using ultrasound and autopsy…these…are leading to accidental newborn starvation and its complications, namely severe dehydration, hypernatremia, hypoglycemia and excessive jaundice which are all know causes of brain injury and permanent disability”

Again, there is not now, nor would there ever be a recommendation to “prevent them from supplementing newborns who are crying inconsolably for milk when there is not enough.” That would not only be barbaric, but unprofessional and dangerous. I will not justify the author’s accusation with further answers.

To address the author’s assertion about the newborn’s stomach capacity, there have been numerous studies performed a variety of ways that give approximations of a newborn’s stomach capacity, but all offer margins of error. There are no perfect studies, and each resource reiterates that the capacity is an estimate.

I will address the three resources the author cited as her evidence of the dangers of the Lactation Lanyard. I believe it will shed light on the situation and reveal the nature of her complaint.

The author confidently states that the “most recent scientific data shows that in fact…” But she neglects to mention that the “new” scientific data is a review of six previous studies. The studies cited were from 1920, 1987, 1988, 1992, 1997, 2000, 2001. Thus, even though the article was written in 2013, it was based on research from as early as 1920. Dr. Nils Bergman, the author of the article cited as documentation for the 20 mL stomach capacity, arrived at that volume based on an average. It is also important to mention that not all stomachs were measured right at birth. The author’s conclusion stated the need for shorter intervals in feeding since a newborn has a small stomach capacity.  I do not believe Dr. Bergman would approve of his research being used to justify a greater volume of feeds since his research centers on promoting frequent feeding, skin-to-skin and Kangaroo Mother Care. The point made in the article is regarding feeding intervals, it is not focusing on stomach capacity.

The abstract clearly proclaims, “There is insufficient evidence on optimal neonatal feeding intervals, with a wide range of practices. The stomach capacity could determine feeding frequency. A literature search was conducted for studies reporting volumes or dimensions of stomach capacity before or after birth. Six articles were found, suggesting a stomach capacity of 20 mL at birth.”

Dr. Nils Bergman’s brilliant work is worth reviewing Bergman, Nils J. "Neonatal Stomach Volume and Physiology Suggest Feeding at 1-h Intervals." Acta Paediatrica 102.8 (2013): 773-77. Web.

The following studies suggest a stomach capacity of approximately 5-7 mL.

Hanson, L., Korotkonva, M., The Importance of Colostrum, Breastfeeding May Boost baby’s Own Immune System. (2002). Pediatric Infectious Disease Jour; 21:816-821

Silverman, W.A.: Dunham’s Premature infants 3rd Edition. Paul B. Hoeber, Inc., Medical Division of Harper and Brothers. New York. 1961. Pp. 143-144

Scammon, R.E. and Doyle, L.O.: Observations on the capacity of the stomach in the first ten days of postnatal life. Am. J. Dis. Child. 20:516-538, 1920

Spangler, A., Randenberg, A., Brenner, M., Howette, M., (2008). Belly Models as Teaching Tools: What is Their Utility? Journal of Human Lactation. May 2008, vol 24; no 2

These studies demonstrate that there is plenty of scientific research that can be found supporting the 5-7 mL stomach capacity reference. There are also many studies that suggest that a newborn can hold a larger volume of fluid. I concur that this is certainly a possibility. What a newborn can consume and what a newborn should consume is also worth mentioning. Newborns, along with the general population, have physiological capacity and an anatomical capacity.

Even if a newborn’s stomach can hold more (as in the case of the autopsied newborns where the procedure to measure stomach capacity took a measurement when the stomachs began to bulge), it does not necessarily mean it SHOULD hold more. Nutritionists promote small, frequent meals as the ideal eating pattern for humans, a practice that seems to naturally begin at birth.

It also stands to reason that if women have small amounts of colostrum on day one, the baby must need small amounts of colostrum on day one. All of the emphasis on research and science laboratory studies is important, but it is equally important to consider the anthropology and biological norm of infant feeding.

The Lactation Lanyards have many uses, including supporting the evidence that newborns consume small amounts of colostrum. This information empowers mothers and gives them a more accurate consumption goal than the 2 oz. formula bottles distributed in many hospitals. If families are not shown the volume for an average feed on day one, they are apt to consider the formula bottle as the standard of feeding rather than the anatomy of the infant.

Even though research has validated the small stomach capacity of a newborn, perhaps the most compelling argument for educating families on the infant’s stomach capacity is corroboration by the most trusted health care agencies and organizations in the United States.  The following agencies accept the information shared on the Lactation Lanyards.

The Academy of Breastfeeding Medicine documents infant’s intake in the first 24 hours to be between 2-10 mL per feed.  BREASTFEEDING MEDICINE Volume 4, Number 3, 2009 © Mary Ann Liebert, Inc. DOI: 10.1089/bfm.2009.9991

American Academy of Pediatrics Section on Breastfeeding documents a newborns intake on days 1-2 will be between 5-10 mL


American Pregnancy Association: “It is normal to make only 1-4 teaspoons of colostrum per day.” http://americanpregnancy.org/breastfeeding/colostrum-the-superfood-for-your-newborn/



The support of professional organizations and well-documented research has spawned the development and spread of this valuable teaching tool. Many pharmaceutical companies have similar products to our Lactation Lanyard (see below), yet I did not see any reports on these products.  I am surprised to be personally targeted; it appears that the author’s complaint may be with me personally rather than truly concerned about a product I created. Why have none of these other teaching tools been reported?

The first picture is of the Lactation Lanyard, the following pictures are samples of other very similar items. 

  

The Lactation Lanyard is a portable teaching tool used by health professionals, perinatal professionals, public health educators and breastfeeding advocates. Lactation Lanyards come equipped with double-sided colostrum card and informational card. It also displays the website which provides additional education and resources. www.Birthingandbreastfeeding.com
 Belly Beads http://www.sbbreastfeedingcoalition.org/about-us
Baby Bellies Pocket Keychain

Many items are also sold internationally



Baby Bellies Display

Cascade Health Care Products https://www.1cascade.com/baby-bellies-display



Colostrum the Gold Standard Visual Aid

Many educational pamphlets and posters are available from companies that support health facilities. A few examples are provided below. 



 http://blog.medelabreastfeedingus.com/2015/04/the-size-of-your-babys-stomach-breastfeeding-in-the-early-days/



These complaints seems to stem from the offense the author takes regarding breastfeeding promotion and public health advocacy in regards to breastfeeding supporter. I am assuming that she is unaware that the formula companies also use the same research to educate families about the infant’s small stomach. 

A large formula manufacturer, Gerber, states:

“Your baby’s tummy is tiny at birth—the size of a marble—and grows to the size of an egg around day 10. Many babies eat a lot quickly, so spit-up is common, and often the result of overeating or air entering the stomach during feeding. ‘Happy spitters’ spit up one to two mouthfuls during, or shortly after, each feeding and show no sign of discomfort.
As your baby’s stomach grows and her digestive system matures, the rate and frequency of spit-up will decrease. Your baby will likely outgrow spitting up around the time he can sit up, but it can continue through the first year in some babies.” (www.Gerber.com)


Below are two samples of parent education provided by Similac, one of the top three formula manufacturers in the United States.


 If the author desires to take on the Lactation Lanyards, she must also work to discredit the American Nurses Association, Department of Women’s Health, AAP, ABM, Public Health Agencies, WIC, La Leche League, hospitals, formula companies and many educational institutions. There are a plethora of products and information sheets that she will need to prove provide “unsafe information.” We believe we are in good company and do not feel threatened by the baseless rhetoric being directed at our teaching tool.

In addition to Dr. Nils Bergman’s research, the author of the complaint offered two additional pieces to justify her submission to the Product Safety Commission. One such documentation, I will not address as it is her own blog about her story—hardly evidence-based research. The second is equally subjective, but I will address it as I feel it may be the main reason for her witch hunt.

The submitter shares a story about her son. It appears that she experienced a personal tragedy. The narrative on the report to Commission mirrors the story she shares across social media. Her story clearly states that she was followed by a lactation consultant and a pediatrician following the hospital birth of her son. She explains the feelings she encountered on day four, when she realized she had been starving her baby. There is not one mention of my lanyard in her story. There is not one reference to its use in leading to dehydration. The second part of her story reveals that she was diagnosed with retained placenta, a condition that results in inhibiting milk production (along with other complications). It is pertinent to note that it would not matter if her baby’s stomach capacity was 5 mL or 30 mL, the newborn was experiencing weight loss and dehydration due to little or no milk transfer, not because he had a small stomach. There is absolutely no parallel that can be drawn between our product and her baby’s consequences.  I can only speculate how she must have felt allowing her child to go hungry. She may have been failed by her medical team and may have ignored her own instincts—but whatever led to her withholding food from her newborn is in no way associated with a lanyard. She will have to come to grips with her own feelings and emotions. As a doctor, she is no doubt aware that complications and poor outcomes occur in spite of the best available care. Sometimes, there is not one to blame. https://fedisbest.org/2015/04/letter-to-doctors-and-parents-about-the-dangers-of-insufficient-exclusive-breastfeeding/

I can respect the concerns this individual shares. As a medical doctor working in an emergency room, she undoubtedly faces many difficult situations and hopes to avoid others going through what she experienced. I only hope she channels her energy in a positive, honest way. I question her lack of scientific evidence and knee-jerk reaction to attack those she perceives led to his condition—the science just does not back up her accusations.

According to the About Section on the Fed is Best Foundation’s Facebook page, “Christie del Castillo-Hegyi, M.D investigates the real-life breastfeeding stories of mothers through social media and holds the largest collection of breastfeeding stories in existence on her Facebook page.” I have no idea if her claims are true, but I do know she solicits stories from her followers that include “unacceptable outcomes” from breastfeeding and requests they sign her petition to “Protect Newborns from Brain Injury Caused by Insufficient Breast Milk Intake.”
 Her hobby of collecting stories has apparently caused her to put metaphoric rhetoric above science. She is creating her own truth—a very dangerous practice.

I believe I have done due diligence in refuting the complaint issued against the Lactation Lanyard. Not only did the submitter not prove the lanyards to be a safety concern, she used your organization and submission process to pursue a vendetta as publicly as possible. She has wasted everyone’s time engaging is this dispute.

I personally feel that Dr. Castillo-Hegyi acted irresponsibly in abusing the Public Safety Commission Office by submitting an unfounded, frivolous complaint. She has selfishly added to the demands of your office and consumed a considerable amount of my time in her efforts at self-promotion. I understand from the description on your website that this complaint should have never reached your office.
The U.S. Consumer Product Safety Commission (CPSC) is an independent federal regulatory agency that was created in 1972 by Congress in the Consumer Product Safety Act. In that law, Congress directed the Commission to "protect the public against unreasonable risks of injuries and deaths associated with consumer products."

From the statement on the complaint form, the submission was regarding information and how one individual was able to twist it to her perception. Your office handles complaints about a product. If your office is now in the business of handling complaints about information shared, then perhaps it is time for me to issue a counter-complaint about Dr. Castillo-Hegyi who apparently is offering fear-based education and is negligent in respecting the policy statements of her medical professional associations that recommend exclusive breastfeeding for the first six months as the optimal feeding advice.

In closing, I realize the US Consumer Product Safety Commission receives numerous complaints and must take each one seriously. However, I was disappointed that there does not seem to be an independent investigation prior to publishing complaints. A quick Internet search would have verified our tool has not been responsible for any harm and promotes the same information shared by our US health agencies.

I can sympathize with the doctor’s predicament, and her desire to find a cause for her son’s condition, but I do not respect her accusations against a product that promotes breastfeeding and supports every major health organization’s recommendations (WHO, CDC, AAP, ACOG and many more).
While the physician submitting a complaint was undoubtedly beside herself when her child became ill, my Lanyards cannot be faulted.

The author of the complaint shares her personal story as validation that the Lactation Lanyards caused dehydration in her infant. Let me reiterate: the Lanyards come equipped with a double-sided instruction card that explains that an infant’s stomach grows rapidly and babies must be fed frequently.

The size of the infant’s stomach is a moot point. No matter how small a newborn’s stomach size is, if a mother is not producing any milk due to retained placenta, the baby will become dehydrated. It is my professional opinion as an International Board Certified Lactation Consultant (IBCLC), that this scenario occurred due to insufficient milk transfer due to low milk supply. The diagnosis of retained placenta is of utmost concern. I am perplexed that a family doctor would try to blame a three dimensional teaching tool on her child’s condition. She shares the rest of her story (most likely what lead to low milk supply) here: https://fedisbest.org/2016/10/the-rest-of-my-breastfeeding-story/

This complaint appears to be an attempt to promote her blog and discredit science for personal gain and notoriety using the US Consumer Product Safety Commission platform. I am sorry your office was summoned for this purpose.

Thank you for your diligence in accepting complaints and rebuttals in an effort to improve safety for everyone.

Normalizing Breastfeeding through Education and Support,




Christy Jo Hendricks, IBCLC, RLC, CLE, CCCE, CD(DONA)


Medical professionals, health agencies, lactation consultants--should always assess the needs of the dyad. When supplementation is necessary or desired, a medical team should provide evidence-based, scientific information. We cannot neglect families by pretending to know what is best for their situation, nor should we use fear to force persuade them to breastfeed or formula feed. Human milk will always have benefits for humans--it was designed that way. Each mammal produces species-specific milk for their offspring. We must empower women who desire to breastfeed and support them to the full extent. 










68 comments:

  1. And why did the mother not say anything about the severely elevated bilirubin levels??? This infant needed an exchange transfusion of his blood to wash away all this bilirubin!!!!

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  2. How would an infant who receives absolutely nothing produce so much wet and dirty diapers??? I have seen cases of severe marasmus where a six month child is the size of a newborn , with no "seizures"!! In my opinion this is a straight case of vaccine related brain injury.

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    1. Dr Zohair, insufficient exclusive breastfeeding can result in hypoglycemia and hypoglycemic brain injury. This is an article showing the MRIs of babies who are found lethargic from starvation-related hypoglycemia. Children who starve lose brain cells. https://drive.google.com/open?id=0B0_MbXCqYazzVkMtejF3Y2tDLVk

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    3. Here is a child who became hypoglycemic to 20 mg/dL by day 3 of life with only 9% weight loss. The follow-up MRI shows hypodense areas in the occipital and parieto-occipital areas that is the classic appearance of hypoglycemic brain injury. The 10% weight loss criteria were based on a study of 7 babies that had no glucose or bilirubin levels documented in the paper. Therefore, many babies may run out of caloric reserve even before the 10% weight loss limit is reached. When calories run out, brain cells die. https://drive.google.com/drive/u/0/folders/0B0_MbXCqYazzeDA2SEs1dWZpY0E

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    4. Finally, this study shows that even babies who lose excessive weight can produce up to 6 wet and dirty diapers even on the 4th day of life. We are obligate eliminators. We urinate in order to prevent lethal electrolyte abnormalities. So even a child that is fluid deprived can produce diapers, which accelerates the weight loss. The wet and dirty diaper count does not indicate adequate milk intake. https://drive.google.com/open?id=0B0_MbXCqYazzUi0wWDJTRXVBY1E

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    5. Hypoglycemic brain injury is a tragedy. We do not know what causes it or how to adequately prevent it. Increased awareness, medical expertise, not forcing mothers to be discharged immediately after birth due to healthcare costs, increased breastfeeding education and support. Those are all highly necessary steps. The birth rate in Ohio was 137,000 per year in 2010. In a 3-year study (so roughly 400,000 infants born), 11 were found to have severe hypoglycemia. 9 of which were exclusively breastfed, and two were ALSO formula fed. Only 5 of these had MRI data. While this is a tragic outcome, it is EXCEEDINGLY RARE. There are many tragedies in the neonatal period and hypoglycemic brain injury is not the only one. By drawing an inordinate amount of attention to something VERY rare, you are attempting to undermine breastfeeding, discredit the highly researched and evidenced-based BFHI, and promote formula use. This is simply not right. I am very sorry for your personal tragedy, but this "movement" has become a reason to supplement all babies and that will cause far more dangerous issues than it solves.

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    6. The Nomssen Rivers paper on breastfeeding adequacy vs inadequacy as measured by diaper output is very interesting. It concludes that diaper output ALONE is likely not a sensitive nor specific tool to use EXCLUSIVELY, however, when used in conjunction with other lactation measures and measures of infant function, would be a useful component. Interestingly, the study mentions that the ILCA criteria are MORE stringent than AAP criteria and over identify infants that are adequately breastfed as "inadequate" - so lactation consultants are actually erring on the side of caution and flagging possible cases requiring more attention based on diaper count, while pediatricians are not.

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    7. And the lanyard teaching aid causes hypoglycemia, how?

      That's like saying a CPR pathway card causes heart attacks.

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    8. Hypoglycemia is caused by caloric deprivations dn starvation. If you do not know that, then you don't understand feeding. Hypoglycemia is not rare in breastfed babies. The most recent article showed that 10% of well-latched healthy, term EBF babies are hypoglycemic to below 40 by 6 hours of life when measured up to 48 hours. Please do not pretend to know what is common and rare without looking up literature on it. https://drive.google.com/open?id=0B0_MbXCqYazzSkliZEh3eTBvR2c

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  3. Show me the pictures of the newborn stomach that measures it to be 5 mL. Your resources do not measure the actual stomach size. Just because those resources cited the same sources and parroted the same teaching does not mean they looked at actual newborns to show that the stomach is 5 mL. Anyone who has taken gross anatomy would know that organs like the stomach would not magically grow 10-fold in 3 days. Any mother whose child is hospitalized for hypoglycemia, dehydration and hyperbilirubinemia because they were falsely told that their newborn's stomach is 5 mL deserves to seek damages from this product. If you can find ONE picture of an autopsy or ultrasound measuring the newborn stomach as actually 5 mL, then I will retract. You ill not find it because the IBCLE and the LLLI do not use science to come up with their feeding recommendations and millions of babies, not just mine, have been hospitalized for it.

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    1. The stomach grows 10 folds in a full year, not in 3 days, if you have studied gross anatomy

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  4. Furthermore, if the AAP truly believed that what I am campaigning for is untrue, then why would their colleagues, including one of the most prominent pediatrician, breastfeeding and public health investigator, Dr. Valerie Flaherman, come out and literally say that aspects of the BFHI are dangerous and deadly? Dr. Flaherman literally said that advising mothers to avoid supplementation carries risks that do not increase breastfeeding rates. She does not spell out those risks. But the risks of starving a child by telling their mother that formula is unnecessary when their child is crying inconsolably, losing weight and becoming lethargic from starvation is brain injury. Hypoglycemia, hypernatremia, hypotension and hyperbilirubinemia cause brain injury and they are all directly caused by underfeeding.

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  5. From a mom: "Just One Bottle" would have prevented my child's one month NICU admission and thousands of dollars in medical costs.
    https://www.facebook.com/fedisbestfoundation/photos/a.516916735139064.1073741829.442765282554210/833664543464280/?type=3&theater

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  6. From Jill Johnson who gave birth to her son at a BFHI hospital where she was "cluster feeding" non-stop for 48 hours fully supported and closely monitored by her IBCLCs, RNs and MDs. He had hypernatremic dehydration at 10% weight loss and cardiac arrest 12 hours after being discharged. "If I had given him just one bottle, he would still be alive."

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    1. You do have to realize, this comment backs Christy's response to your complaint of her product... In this comment you cite that multiple health care professionals were in charge of the mother and child's care, yet a horrible medical trauma happened to the child. NO WHERE IN THAT (OR YOUR OWN COMPLAINT) IS HER LANYARD MENTIONED! It's not her products fault that medical professionals did not catch what was happening sooner. That's what CMP's, CBC's, Glucose levels, weight checks, and so on are for. Looking at a lanyard is not being suggested instead of actual medical monitoring and care.

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    2. Agreed, why was the baby in this particular indecent released from hospital with such significant weight loss? Because breastfeeding weight gain is different than formula feeding, the protocol should be adjusted to reflect as such. No baby neither breast fed or formula fed, should be released from hospital in these circumstances. Based on the mothers condition alone he should not have been released until his weight was at the least not continuing to diminish. I do believe breast is best, but not for everyone, as was in this case, so obviously fed is best (that's a no brainer!) Therefore, I believe that it was at the fault medical professionals, it was not a product that helps families who are breastfeeding under more normal circumstances to breastfed. The fact that the mothers breast milk was not sufficient in this case was not the mothers fault, not the product or the products producers fault, but the fault of the medical system. Again, I believe that breast is best and it can be a struggle to get through, but the best result that could come of this is that more is done before mother and child are released from hospital to ensure it doesn't happen again. Breast Friendly hospitals are very important, but it's the health care professionals need to be more alert to recognize the signs when needed. Lack of medical monitoring and care are what failed this family. Not wanting to give breastfeeding a good try or a lanyard that helps support breast feeding families.

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  7. So good to see others using their platform to speak up about the FIB Foundation. They refuse to allow people to refute them on their page, silencing everyone who brings light to the flaws in their anti-breastfeeding propaganda. It is so frustrating, if they were speaking truths and facts, why not allow others to discuss and argue, it saddens me to think they know that they are wrong and try to cover it up by deleting comments and banning anyone who has enough knowledge to counter their claims. I wouldn't mind seeing them silenced for a change.

    I am sorry for what happened to them, but efforts should be made toward making sure parents receive the right feeding support after delivery to make sure it doesn't happen to others. Instead they are attacking and misleading people, and that is so misguided and a waste of such a sad lesson learnt.

    You have a lot of support and you are not alone. Thank you for your articulate and professional response.

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  8. While the FiB Foundation has identified a genuine problem - my baby became dehydrated in her first few days as I was so ill from a birth that nearly killed us both that I wasn't producing anything - they have got the totally wrong answer. It's not the breast is best message that failed these mothers, it is the medical establishment who failed to diagnose and treat a serious condition. There is a time and place for formula, just like a crutch, it got us through until I was well again. What we need is proper training of doctors, nurses and midwives so that they can do their jobs properly and not fail babies and mums like they currently do. If only people would put the effort into getting HCPs properly trained that they put into FiB.

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    1. But that's exactly what FIB wants. The failures are not because providers are lazy or poorly trained, but because they are mistrained, given inaccurate information about feeding (for example, that insufficient supply is very rare) and trained to ignore and dismiss the early warning signs. The failures happen not because preventing insufficient intake is difficult, but because it is not a priority.

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  9. Lastly, if you believe that 5 mL of colostrum is enough to fully feed a newborn, how many calories is that giving them? The most basic nutritional information that EVERY clinical nutrition expert is required to know is the number of calories they are feeding a patient and the number of calories that patient requires to NOT starve. Yet not a single IBCLC has any idea what those two numbers are. 5 mL of colostrum provides 3 Calories of the 300 Calories a day a 3 kg one-day-old newborn requires to feed their living cells and not starve. I suggest you start researching the sources of the information that the IBCLE gives you. The newborn stomach sizes that you believe in are derived from the daily colostrum production of mothers in the first days of life divided by ten. They made the illogical conclusion that what a mother produces must be the size of the newborn stomach. That is like saying the money in my wallet must be the amount needed to buy a refrigerator. It makes no sense. No one ever measured the one -day old stomach newborn until SIX studies described in that article using autopsy and ultrasound found that the newborn stomach was actually 20 mL at birth. Furthermore, it is attached to the small intestines, which holds even more. I suggest you speak to an attorney before publishing any more unsubstantiated comments on the newborn stomach size and demand original sources of information that you have been given from the IBCLE. Taking your word for it and the opinions of other breastfeeding advocates does not consitute evidence.

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    1. It is obvious that you and your baby had a wrong start , with lack of information and support . It is understanding what you feel amd why you think is normal to spread it all around the world . It is , because noone wants to see a baby getting sick or worse , die.

      But please , choose your words wisely . No one told you directly that your unique baby is having a 5 ml stomach ! That , as any other tool measurement , is just a tool . You really need to understand better this things .
      Babies are different , mums are different , every birth and every start of life is different .

      Fed is fed ! Breastfeeding is beyond this and much more !

      Again , look carefully on your words . Studies are made to sustain something , to refer to , at a large scale ! But each individual is UNIQUE!

      And one more thing , you have a stomach too , and believe or not , it is also attache to intestines , exactly like you said about babies . But i am SURE you don't eat more than your stomach capacity allows , just because you can store it on your intestines too . This made me laugh ! Think before speak / write!

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    2. And it is a tool used to tell mothers that their crying and desperately hungry newborn is not starving when they are. Your lack of understanding of how telling mother wrong information about the newborn stomach size is what is laughable.

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  10. So strange for BFHI to be deadly, i thought it was recommended by WHO and UNICEF

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    1. This comment has been removed by the author.

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    2. The WHO and UNICEF are made of people who can overlook major errors in public health policy. The advice to avoid supplementation has tampered with the naturally protective instinct of a mom for feed their hungry and crying newborn when breast milk is not enough. Now starvation -related complications are the leading cause of newborn hospitalization in the world and contributes significantly to long-term morbidity, disability and mortality in the developing world.

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  11. Wow!! Just wow Christie. I'm so glad formula has been invented now you've uncovered these "facts", otherwise the human race would just die out, presumably.

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    1. Why would the human race die out just because lots of babies die of insufficient breastmilk? The natural miscarriage rate is 20% and we haven't died out. Why would high neonatal mortality be any different?

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    2. Lol, how is that comparable at all there "doctor" Amy?
      That is such a Non-sequitur.

      Christy here is saying that colostrum can't sustain a human infant in the first few days.

      Which the poster above is pointing out would mean that, before the invention of formula, would mean *all* infants would have starved to death.
      Which is BS.

      But nice to see a "doctor" use such logic.

      Would *love* to see real numbers and studies on all these babies that have died from "insufficient milk". 🙄

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    3. Before formula, mothers supplemented almost universally with the milk of wet nurses, animal milk and sugar water to keep their babies from starving.

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    4. MoodyAlly, there was never a time in human history were babies were not supplemented or exclusively fed homemade "formulas" or pureed/mashed foods from birth.

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    5. Then explain how I, my mother, my friends, we're all able to breastfeed our babies exclusively without any formula or wet nurse or animal milk. Two of my four children were gaining weight before we were discharged from the hospital, 1 was above her birthweight.

      The majority of women's bodies are able to grow a baby, and so shouldn't it follow that the MAJORITY of women's bodies are able to feed a baby?

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  12. This illustrates the real difference between medical professionals and LCs. When a tragedy occurs, medical professionals try to figure out what went wrong and fix it. LCs, in contrast, never take responsibility for misinformation and blame everyone else but themselves.

    Babies are dying because lactivists are lying.

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    1. Ahhhh there it is....the MD god complex.

      By that logic, the only one responsible for Christie's son's tragedy is herself.

      Fortunately, most of us "non MDs" see the flaw in that and don't blame the poor doc.

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    2. What went wrong was that medical professionals did not use their knowledge, skills and judgment to figure out that this baby was unwell.

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    3. What went wrong is that the LC establishment literally lie and hide the fact that insufficient milk and newborn starvation from EBFing is common.

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  13. If she failed to diagnose a viral meningitis in a patient, instead calling it a migraine and prescribed Imitrex, and the patient ended up with cognative deficits due to her misdiagnosis, what she is doing is the equivalent of blaming the Imitrex for the patient's cognative deficit. Her level of cognative dissonance is staggering.

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    2. ^^This^^ What Angela said. I'd love to see Amy or Christie actually respond to this.

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    3. Viral meningitis is generally not treated. You may be thinking of bacterial meningitis. That aside, the issue is that if you erroneously teach people to diagnose meningitis as migraine, it is YOUR responsibility if the provider erroneously diagnoses meningitis as migraine. Similarly, if lactivists teach providers that infants cannot be screaming from hunger because they have a stomach capacity of only 5-7 cc when it is actually 20 cc and then providers fail to diagnose hunger, it is LACTIVIST'S fault when babies get injured and die from dehydration and starvation.

      You can't have it both ways. You can't claim to be experts in what infants need from a breastfeeding relationship and then blame others when they are not getting it. If lactation consultants are the experts in breastfeeding then THEY are responsible for alerting other providers to imminent dehydration and starvation.

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    4. But what difference does it make if the stomach capacity is 5 ml or 20 ml, if nobody is measuring it? There are other ways of assessing successful milk transfer that should be used. The lanyard and stomach size has nothing to do with this case.

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  14. I love how the to biggest anti-breastfeeding "doctors" are here shouting "alternative facts".
    You know you are making too much sense when they show up to throw mud and troll. ;)
    So "professional" they are.

    They must really be intimidated by a visual aid. *snort*

    If I where the athour I would turn off commenting or delete their comments.

    Do we really need to give them another platform?


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  15. MoodyAlly I think the Blog owner is allowing them to reply as they often shut down and delete or block people who argue against them. This is a forum they do not control and lets people argue against Not a doctor any longer Amy Tutur and FIB lier witu actual science and genuine facts.

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    1. You are right that's exactly what they do! I replied to a few fear mongering comments on their facebook page (I was not profane or vulgar, the only causes for censorship on a public site, IMO) & they deleted my comments & blocked me from their page. They did the same to another mom in my mom group. Same thing she just simply called out their falsehoods. Something is very wrong here!

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  16. You need to read the paper on which the claim is based. It doesn't say what you have been taught that it says.

    The claim is based on a study from 1920 by Scammon and Doyle. In that study the authors found that the average PHYSIOLOGIC capacity of the newborn stomach is 5-7 cc. but that’s a misuse of the term “capacity.” It’s actually the size of the average infant MEAL as measured by weighing the baby before and after breastfeeding with mothers allowed to breastfeed only 5 time per day. It has nothing to do with the ANATOMIC capacity of the stomach itself.

    The anatomic capacity of the stomach is the amount that the stomach can hold during a meal without becoming distended. According to Scammon and Doyle, the ANATOMIC capacity of the stomach at birth is 33 cc.

    So while the average size of the MEAL on the first day is approximately 5-7 cc under the restrictive conditions of the study (only 5 feeds per day), the average size of the infant stomach is far larger and there are plenty of babies who need much more than the average amount for each meal.

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    1. It really makes no difference what this stomach capacity is. Should the baby need more than 5 ml, they will get more than 5 ml if they are allowed to nurse on demand. Unless there is a (very rare) problem with insufficient milk supply or transfer, which should then be diagnosed and treated. Still nothing to do with the stomach capacity.

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  17. We would NEVER encourage anyone to constantly eat the amount their stomach CAN hold. What a dangerous concept. Women are amazing. Their bodies make people and then nourish those people. Their abilities will not be minimized by lies. Dyads are assessed and may need supplementing, but undermining a new moms capability is asinine. As a side note, Google analytics shows that this blog hasnow been viewed and shared close to 40 thousand times in two days. Thank you everyone for spreading truth and light. On a side note, please do not assume this doctors views is the same as practicing Physicians. I have a wonderful network of absolutely amazing doctors I work with and would be happy to give referrals to anyone looking for a supportive, well educated and well respected physician in the field.

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    1. I didn't say that every infant can or should eat the maximum amount the stomach can hold. What I pointed out is that your product is fundamentally misleading because you claim that the bead is the size of the newborn stomach. That's harmful because it's not true. If you wish to understand what the science ACTUALLY shows, read the paper.

      Your product is based on a harmful lie and you should fix it to represent the truth.

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    2. why are you so obsessed with glorifying mothers abilities and ignoring starving children? DEAD BABIES DONT BREASTFEED

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  18. Ms. Amy, isn't the MD behind your name a harmful lie you should fix to represent the truth? ��

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  19. I believe this blog is to help LCs feel better about what they are doing to mothers and babies, not about trying to keep babies from starving. Mothers know that their babies actually are hungry when their milk has not come in yet. We are exposing your profession's lies and your inability to be accountable for your lies that cause babies to starve and become hospitalized. Good luck to you all. Real health professionals seek to correct policies that harm patients. You clearly have more loyalty to protecting your feeding policy that has no data on safety than protecting babies from brain injury and starvation.

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  20. I must say, those who read the article understand the situation perfectly. (BTW, love the comment above about the CPR card). I have allowed the comments to prove my point. Most people who follow my page are health professionals and breastfeeding advocates and they need to see the way this group operates (with fear and accusations--trying to discredit lactation professionals who strive to serve families). I also am sharing the posts with my mom groups. Allowing all comments to stay posted clearly reveals that a couple of people continue to stray from the points I made in the article about the complaint sent to the PSC. Again, if you have only read the comments, please read the blog :) I am especially in awe of the accusation that the lanyards encourage moms to let their babies cry inconsolably. Wow, just Wow--how unethical and a complete lie. There really is no valid complaint that stands. As another reader pointed out, an educational card is not responsible for this person's problems. The Lactation Lanyard comes with a card that is double-sided and equipped with information about small tummies and frequent feeding. The accompanying educational card mentions diapers, weight gain and other signs of milk transfer. The letter to PSC was an invalid attack and attempt to spread fear. Here's some good news, whether it is just a coincidence or fate, today we shipped our largest international order received in one single day. We also received a request for an invoice for 250 Lactation Lanyards. Reminds me of the quote, "they tried to bury us, but didn't realize we were seeds." I think we can agree that families need prenatal education, birth support, assessment and guidance along with evidence-based information and supplementation options when necessary or desired. I applaud the Lactation Consultants, doctors, midwives, educators, nurses, La Leche League Leaders and other professionals who work every day to accomplish just that--you are my heroes. I think most of us realize that it's not that difficult to support and love people unconditionally.

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    1. But the information on it is a lie! If you believe otherwise, please show us the scientific evidence that newborn stomach size is only 5 ml. You don't seem to be able to do that.

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  21. The "MD" above is probably a hired agitator by the formula companies to discredit breastfeeding in any and all ways, no matter what. This person resorts to shouting about "lies" and is stuck on one piece of variable information about the size of an infants stomach, like a broken record. If one replaced the topic of breastfeeding with say, "climate change", or "reproductive rights" or "public education", the answer will always be denial. Because anti-science, anti-public health, anti-education rhetoric is always the same, with the same purpose which is to discredit the value of accessible, equitable, compassionate, humane, progressive, evidence-based information. I suggest this person is argumentative and disagreeable, a troll, with a bigger agenda. I think the doctor who suffered her personal tragedy by her own lack of responsibility to herself, has garnered enough attention for her loss, and unfortunately has created her club to fan the flames of blame.

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    1. There have been many speculations as to where "Dr" Amy gets her funding and why she does what she does, but I think she is a lot like Milo Y - she found a nice audience of self-important followers, and everything she does creates a more loyal, angry set of followers. They do a lot of the same things Milo's crowd does - doxxing people, calling the authorities on them, public shaming, etc. - only instead of targeting women, transgender people, and undocumented immigrants, they target natural birthers and breastfeeding advocates. The goal is the same - make a name for themselves out of targeting activists, fringe groups, and others who are trying to help circumvent our system, and make money at the same time.

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  22. I say this respectfully with no intent to upset or undermine any mothers effort but it would seem that most times breastfeeding journeys fail before they begin due to a mothers desire to be the 'better mother' which she hinges on a set of weird parameters. It's almost like setting yourself up to fail before you begin.
    This is what I sense from the complaints personal blog posts.
    And then when things go wrong we hinge that failure on the parameter we valued the most at the time.

    While I do appreciate her argument with respect to stomach size, I find it weak as the size of my stomach is irrelevant in the face of a failing appetite, illness, and numerous other factors. And I believe a better advice trumps her entire hassle with the stomach size and it is simple:

    Watch your baby!

    Read, be informed prepare for everything possible but be sure to keep at the back of your mind a baby regardless of it's size can change your plans drastically, they are individuals with unique demands so is your body following every child birth.

    Research will always exist to support either side of the divide but one thing research will never dispute is the advice to watch your baby, which one can only do when you disassociate your expectations of motherhood (breastfeeding included) with your present realities.

    Fed is best (no doubt)
    Breast is best (vote renewable energy versus non-renewable energy)
    Watch your baby, watch yourself( trumps it all any day) revisiting breastfeeding when baby and yourself certainly trumps debating tummy sizes.

    By the way well done to both bloggers as you have through this issue drummed traffic for yourselves. (the pessimist in me couldn't help writing this last line)

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  23. I don't think you understand the gravity of this situation and what your responsibility is as a health professional. If there is anything about a product that we use to impart information to a patient is inaccurate or disproven by the most recent scientific literature, we are obligated to change what we say to patients in order to prevent patient injury. I am telling you that the reason why your product exists is to convince mothers that crying newborns are not hungry when in fact they are. It is not true that babies can get all that they need by just by putting them on the breast 24/7 because mothers produce an average of 60 mL total on the first day, some less. That provides 10% of a 3 kg newborns basal metabolic rate. If a newborn is depleted of calories when they are born, they can develop serious hypoglycemia if they are not supplemented immediately. They will often show signs of hunger and starvation before this happens even on the first day of life. If you use your lanyard to convince their mother that they're crying is not out of hunger and not due to insufficient breastmilk, you will harm the child irreversibly. In a study of claims awarded in the UK for neonatal hypoglycemia, the most common sign was poor feeding behavior. Signs of starvation include inconsolable crying and constant nursing which are often recommended by lactation consultants who believe that it will always provide enough calories to a baby. What they don't understand is that a baby who nurses for hours a day can burn more calories nursing than they are receiving. This can cause starvation very quickly, then hypoglycemia and then brain injury. I review charts where a child is found crying and nursing constantly then losing their vital signs from hypoglycemia soon thereafter. That is exactly the behavior mothers are told as normal feeding behavior aided by false teachings, the kind that your lanyard imparts. In this study, 25 out of 30 claims went to the plaintiffs and each of those families were awarded 6,300,000 pounds or $8.1 million. Do you realize what convincing one mother that her crying child is not hungry will cost you if you cause her to starve and disable her child? Do you think you will have a job if you are representing the stomach as a size that is very different from what the most recent scientific literature says it is and you cost a hospital $8.1 million?

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    1. Dr. del Castillo-Hegyi, I'm trying to assimilate all the information being presented here. You quote an average maternal milk production of 60 mL on day one post partum, which caught my eye in that it contradicts my prior understanding (which admittedly could be wrong). I'd like to understand this better. Could you please cite your sources for this figure? I am unable to uncover much in my own literature search.

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  24. After reading the incident report written by Dr. Christie I am astounded by her claim that her son was producing sufficient diapers (wet and dirty) for THREE days despite not making a single drop of milk or colostrum. She not only had a weighted feed on the forth day to prove her inability to produce any milk for her son, but she also pumped and manually expressed to find that she was not producing anything. I am astounded by the alleged description of what happened. I do not believe for a second that her son was producing diapers. You have to have something going in (formula, combination, or exclusive breastmilk) for something to come out. I am perplexed as to why she is blaming your lanyards instead of her inability (along with her medical team) to see the signs of starvation. Thank goodness that she had a weighted feed with an LC. What if she had listened to the pediatrician and continued to wait for day five or even six? I am also wondering what stomach size has to do with anything in her claim. If a newborn baby is feeding well and has full access to a breast or breasts that are producing colostrum and then milk that stomach (regardless of size) is receiving food around the clock. Babies SHOULD be fed often. What is her purpose for all of this? Should all babies be supplemented from birth to prevent the rare case of severe dehydration? Why not fight for weighted feeds or bilirubin checks? What about free access to lactation care and support in the form of home visits for any and all mothers that want to breastfeed? Does she really believe she can take on a normal biological process? Supplementation is an intervention and and it should be treated as such, it should not be the norm. Her correlation that she asserted in her complaint against you and your lanyards and then her son being diagnosed with autism makes me very uncomfortable. She is treading very dangerous waters. I will be sure to share this blog with any and every mother I approach when counseling about breastfeeding. I also want to add that you have been very professional in your approach Christy Jo. Have you had the chance to read some of the comments made by the Dr. on Facebook? She sounds incredibly unprofessional! She also censors her Facebook page quelling any and all objections to her posts and claims. Keep up the good work Christy Jo. Your reply to the complaint made against you was stellar and rooted in good science. I particularly enjoyed seeing actual images from Similac that also echo what your lanyards display.

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    1. Thank you for your kind response. Her story is tragic and if I were her, I would welcome teaching tools and items used to inform parents of frequent feeding, responsive feeding, signs of milk transfer, etc. I would have been happy to explain the purpose of the tool and how it is utilized (along with the informational card that accompanies the lanyard), but I was not given that opportunity. I am shocked that her recourse is to attack someone whose goal is to help families avoid the very thing that happened to her. All of the items similar to my product (and the formula card) all explain that the "serving size" is an approximate and babies need to eat frequently due to small quantities. I guess I just have to leave it with the understanding that "hurting people hurt people"

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    2. "Does she really believe she can take on the normal biological process??"
      Yes!!!!

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  25. I applaud you, Christy Jo for not shutting down or silencing people, as the Fed Is Best campaign does for anyone who calls them out for spreading falsehoods & fear mongering. It's obvious that she is hurting & as you say, hurting people hurt people. What an accurate statement!
    The truth is, if FIB was confident in their stance they would not censor or silence people. Doing so just proves that they know they are wrong.
    Christy Jo, it has to be a good feeling to know you have right on your side, not to mention science, medicine, health & human biology. Thank you so much for all that you do!

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  26. I have also been shut down and deleted from the Fed Is Best FB page. If you read it ANY comment which questions their data/agenda/method is deleted- so it PURELY their opinion and those who support it aired. Surely a forum created to support mothers would encourage ALL to share their experience. Explore GOOD experiences of breastfeeding/postnatal care. Fascinating that Amy and Christie D. H are TOTALLY unable to hear/accept any challenge to their world view. Bit like a certain president currently in power...., thank you thank you thank you for allowing these comments to exist and remain and good luck to those of you on here genuinely helping and supporting GOOD postnatal care.

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    1. Actually, Jody and Christie have been shown to be correct in their criticism of the lanyards. La Leche League UK has already changed their graphics to reflect the fact that the lanyards DON'T show stomach size ... EXACTLY as Jody and I explained to you. So Christy Jo was utterly wrong and owes Fed Is Best an apology.

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  27. You are hilarious. Do u sleep ever? It must take a huge amount of time to troll the sites you do...

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    1. According to La Leche League, it was recently brought to their attention (presumably by Fed Is Best that their claims about stomach size were misleading. They've changed them: https://www.laleche.org.uk/milk-volumes/. Looks like LLL was willing to acknowledge that Christy Jo is utterly wrong. Too bad she isn't willing to acknowledge it.

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