Breastfeeding: It’s not just about the food

Babies don’t nurse just for food. This often comes as a surprise to parents, but babies go to the breast for many reasons. They’re hungry, thirsty, tired, hurt, overstimulated, bored, lonely, in the mood for cuddles, etc. All are equally valid reasons to nurse. Believing that babies only nurse because they are hungry can lead to problems if parents try to hold off feedings because “he can’t be hungry he just ate!”. I’m sure most of us have heard someone say “Don’t let your baby use you as a pacifier!”. My response to this is “I’m not pacifying, I’m mothering!” Pacifiers were invented to allow babies to satisfy their sucking needs when mom is not available, not the other way around. Mothers are not meant to nurse their babies only when a pacifier isn’t available!

Rather than becoming “spoiled” as is commonly believed, research shows that babies who are held and nursed frequently, actually go on to be very outgoing and adventurous children. Babies’ first relationships set the tone for all future relationships in life. By responding to our babies’ needs quickly, consistently and with love, we teach our children that the world is a safe and wonderful place. This gives them the courage to go out and explore because they know that they have a safe and loving place to return to.

Breastfeeding is a relationship that is about much more than just food. The whole experience of being close to mom, having skin-to-skin contact, smelling mom’s familiar scent, hearing her voice and seeing her face, receiving the comfort of warm milk, and the biologically specific components of human milk, all work together to provide the necessary environment for healthy growth and development of your baby.

I have heard people say that comfort nursing is bad because it teaches children to associate food with comfort, but breastfed babies aren’t thinking “I need comfort, so I need to eat”. They are thinking (or probably more accurately, feeling) “something’s not right, I need Mom”. Any milk they get while nursing is an added benefit, but what baby really wants and needs is the comfort and security of being close to mom. Research is showing us that babies who are not breastfed are more likely to be obese, and one theory as to why this is, is that breastfed babies have control over how much milk they take in, and they learn to eat only until they are full. For babies who are not being fed at the breast, someone else has control over the feeding, and bottle fed babies often end up taking in more milk than they really need/want. It is theorized that the overeating that bottle fed babies often experience can set the baby up for overeating later in life as well. There are also hormones present in breastmilk that help to control hunger and  metabolism. These hormones are absent in infant formula.

Breastfeeding is the ultimate mothering tool. You can’t go wrong putting your baby back to breast even if he did eat only an hour ago. Your baby may not be looking for food, but rather the comfort and security that comes with breastfeeding. You’re not being a pacifier, and you’re not creating any bad habits, you’re responding to your baby’s needs. The only time that frequent nursing may be cause for concern is if your baby is not gaining weight appropriately, isn’t having lots of wet and dirty diapers, or consistently seems unsatisfied right after coming off the breast. If this is the case, it would be a good idea to follow up with an International Board Certified Lactation Consultant to determine if something else is going on.

Obese 9 month olds?

Several news stories appeared yesterday, based on new research that suggests that almost one third of 9 month old babies are obese (along with 34% of 2 year olds). I haven’t been able to access the original study yet, but according to this news story: “The researchers classified the babies’ weights based on CDC growth charts, which compare a baby’s growth to a standardized growth curve. Kids in the 95th percentile of weight were categorized as “obese,” while kids in the 85th to 95th percentile were counted as “at-risk,” similar to the adult category of “overweight,”.

I see a problem with this. The researchers were using the CDC growth charts when even the CDC itself recommends that the World Health Organization (WHO) growth charts should be used for children ages 0-2. The WHO charts, unlike the CDC charts, are based on the growth of babies under biologically normal conditions (breastfeeding, mother’s who don’t smoke etc). When looking at a child’s growth, it is important to be comparing to the biological norm, not a cultural one (if they had used the WHO charts they likely would have found even higher numbers of “obese” babies!).

The report goes on to say: “The find hints at an unfortunate pattern: Kids who start out heavier end up heavier. Of kids who were normal weight at 9 months old, 75 percent were still normal weight at 2 years. But kids who were at-risk at nine months had only a 50 percent chance of being normal weight at age 2. More than 28 percent of at-risk kids ended up obese by their second birthday.”

Another problem: what is a “normal weight” for a baby? Weight for age growth charts compare a child’s weight to other children of the same age, which really is not very useful. Is your baby healthier than mine because he weighs more or less than mine does? Of course not. All babies are different and someone has to be in the lowest percentile, just like someone has to be in the highest.

The 50th percentile on a growth chart does not equal “normal” weight. It simply means that statistically speaking, 1/2 of all babies of the same age will weigh more, and 1/2 will weigh less. Isolated points on a growth chart have little meaning. What is important is whether or not your not your child is following his/her own curve. If your child falls on the 75th percentile, then he should continue to follow that line on the chart. If your baby falls on the 5th percentile, and is following that curve, then your baby is growing appropriately. A baby on a lower percentile isn’t any more or less healthy than a baby on a higher percentile.

I am curious how the researchers decided that babies who fell in the 95th percentile would be classified as “obese”, and those falling in the 85th-95th would be classified as “at risk”.  Obesity in adults is classified according to Body Mass Index (BMI), not weight. It is not clear from the news story which growth charts the researchers were using in the study (weight for age, weight for length or BMI for age). The type of chart used makes a big difference to how the results should be interpreted.

Childhood obesity is certainly a serious issue that needs to be addressed, but I worry that news stories like these will cause parents to worry unnecessarily about their baby’s weight. Not having a proper understanding of how growth charts work and how they should be used, can lead to parents (and even health care providers!) making changes to a baby’s diet that are usually not in the best interest of the baby. Parents being told to supplement breastfeeding with formula because their baby is on the 3rd percentile and therefore “too small” or being told to restrict feedings or give water between feedings because their baby is “too big” are getting bad advice (and yes, I’ve heard both from parents that I’ve worked with!). Growth patterns can vary widely among young children. Some start out very long and lean and slowly put more weight on, and others start out shorter and heavier and gradually grow into their weight. Labeling a baby as “obese” at 9 months old when most babies haven’t even started walking yet seems absurd.

Thoughts?