Despite the evidence of breastmilk’s awesomeness, specific recommendations from organizations such as the American Academy of Pediatrics, and the fact that humans tend to lactate after giving birth to an infant, you can’t guarantee that the doctor you choose to look after your baby will be supportive of breastfeeding. Some might blatantly and obviously state that breastfeeding doesn’t matter all that much (although, if it matters to you, it matters—period). Some may subtly and accidentally undermine breastfeeding by suggesting that you switch to bottles or introduce supplementing without addressing underlying concerns. And some will be awesome, whether they had wonderful breastfeeding experiences themselves or went out to get additional education on the topic.
I reached out to Dr. Pamela Heggie—a St. Paul-based pediatrician, fellow of the American Academy of Pediatrics, IBCLC, and fellow of the Academy of Breastfeeding Medicine—for her take on what families can look for in a pediatrician or family doctor to gauge their support for breastfeeding. She also offered some tips on how to approach your doctor if you feel you were not given the best information about breastfeeding for your situation.
When choosing a doctor for your baby, what kinds of questions can parents ask as a litmus test of the level of support for breastfeeding they may receive?
“What is your perspective about breastfeeding?” If they say breastfeeding and formula are the same, then go to a different doctor! If they say, “I support breastfeeding, ask them how.
“Do you work with a lactation consultant and is there one in the office?”
“If I have a breastfeeding question who should I ask?”
“What do you know about the Baby-Friendly Hospital Initiative?”
“What do you recommend about breastfeeding?” The American Academy of Pediatrics recommends exclusive breastfeeding for the first 6 months and then until at least 1 year of age after foods are introduced and after that as long as either mother or baby want to.
“When do you recommend formula for babies?” They should say something like “only when medically indicated/needed.” NOT for fussy babies, “just to be sure the baby gains weight,” or “for jaundice.” These are red flags that the doctor does not know much about breastfeeding.
It would be great if the doctor said something like, “I try to promote mother’s own pumped milk or donor milk if the baby needs supplementation for some medical reason. They might also say, “I only use formula as a ‘bridge’ if needed and I use formula very carefully, just like I am careful to only use antibiotics for a serious bacterial infection but not for a viral infection when it is not indicated and won’t help.”
What should parents know about the presence of formula company advertisements, promotional material, and samples in a doctor’s office? Are these red flags?
Yes, these are red flags. A truly breastfeeding friendly practice will not be getting free formula or have formula ads in the waiting room. However, sometimes the clinic is part of a larger organization that controls these things and the doctor may be more “breastfeeding friendly” than their clinic or organization.
What can parents do if their doctor gives them advice about feeding their baby that they feel isn’t quite right? For example, it’s not uncommon for a doctor to suggest feeding a baby solid foods starting as early as four months of age. Could or should parents contradict this, and how could they do so?
Parents can share what they’ve read about or heard about and ask what the doctor thinks about that. It is ultimately up to parents to decide how they want to feed their baby. I would encourage getting another opinion from another doctor or nurse if you get advice you disagree with. I encourage families to be upfront with their doctor about these differences and have a conversation about it. Try to hear where the doctor is coming from as well, to better understand his/her reasons for the advice given. That’s what collaborative, family-centered care is all about and what everyone deserves![Tweet “”Collaborative, family-centered care is what everyone deserves.” Pam Heggie, MD IBCLC”]
When it comes to growth charts, a common piece of advice is to make sure that your doctor is using the World Health Organization growth charts for children up to two years of age, instead of the CDC charts.* Even though the CDC recommends using the WHO growth charts during this period, is it still a good idea to ask your child’s doctor if that is what their office uses? How much of a difference could this make when it comes to tracking growth?
It does make a big difference, especially between 3 and 9 months of age. Most offices use the WHO charts now, but if there is a concern about baby’s weight, be sure to ask how they are figuring out the percentiles of weight. If they say they are using the CDC growth curves, ask that they plot the baby’s growth on the WHO curve instead. Almost any percentile is fine (except way below the curve) as long as the baby is following his or her “own curve,” which means staying at the same percentile after about 1 month of age. Percentiles vary a lot after birth since birth weights vary so much, but once a baby starts tracking on a curve consistently usually after about 3 to 4 weeks, then adequate growth should track at about the same percentile for the first year or so. After a year many babies “thin out” and change percentiles as they start to be more mobile, and that’s okay if it stabilizes again and is not a flat line with no growth.
My rule of thumb for minimum weight gain in the first 1 to 2 months is “an ounce a day and time off for weekends” or about 3/4 ounce per day or 5 ounces per week or more. After 2 months, the percentiles are most important to follow.
Dr. Heggie was kind enough to answer more of my questions about how she came to become a lactation consultant, how she balances being an MD and IBCLC, the value of having lactation support in a clinic setting, and her opinions on the push for licensure of lactation consultants in this blog post.
*The WHO (World Health Organization) growth curves are tools that were established using only breastfed babies as the norm. The CDC curve combines breastfed and formula fed babies. It is currently recommended by the CDC that all children under two years old, regardless of how they are fed, have their growth plotted on the breastfeeding growth curves (WHO curves). Breastmilk feeding sets the standard for what normal growth is. Despite this recommendation, some doctors and clinics use the CDC growth charts for children under 2 years of age.