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Author Topic: AAP issues it's strongest breastfeeding recommendations
dread pirate romany
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http://seattletimes.nwsource.com/html/nationworld/2002172941_breastfeeding07.html

quote:
"Our typical image of how we feed infants is to stick a bottle in their mouth. We need to make breast-feeding the standard way we think of infants being fed," said Laurence Grummer-Strawn, chief of maternal and child nutrition at the Centers for Disease Control and Prevention (CDC).

Nursing should continue until the baby is at least 1 year old, and there is no problem with continuing into the third year of life or longer, the new policy states. Other health groups, such as the World Health Organization, recommend breast-feeding for two years or more.

I have to say, I find this pretty exciting [Smile] .
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TheHumanTarget
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I whole-heartedly agree. I see no reason that I can't be publicly breast-fed! Just because I'm 28 years old, I'm always getting hassled! I don't arrest you for eating a burger at McDonalds, and I demand equality!
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jeniwren
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dpr, I suspect that part of the reason most women stop breastfeeding exclusively before their child is 6 months old is that it's nearly impossible to do so and work outside the home.

Hard to believe that a flight attendant would be that callous -- I would think he'd be *grateful* the baby wasn't screaming his head off.

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TheHumanTarget
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I'm just amused by the level of concern surrounding breast-feeding, but I suppose that's what we can expect based on the overreaction to last years SuperBowl half-time show.
We're very puritanical when it comes to any form of nudity, but revel in levels of violence that would put barbarians to shame.

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Hobbes
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In all fairness violence can be faked, and you can't really do that with nudity...

Hobbes [Smile]

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Icarus
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quote:
The recommendations also challenge society to support breast-feeding by enacting legislation to protect it, setting expectations in the workplace and considering it in custody settlements. [Emphasis added]
If you're the father of a toddler and divorcing, you can just forget about getting custody right now. All your other qualities, and those of your spouse, have been trumped by the ability to breastfeed.
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mothertree
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Consider = trumped. Nice.
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TheHumanTarget
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Hobbes,
Is faking violence better than showing real violence? Is there a discernable differnce? I'd take real nudity over fake violence any day (I will admit to some bias [Smile] )

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ketchupqueen
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People need to realize that just because you're still breastfeeding doesn't mean you shouldn't start other foods, though. I know a two year old who's still almost exclusively breastfed, and she's very, very tiny. She really should be eating other things as well by now.

Not that I have a problem with extended breastfeeding; I'd continue until Ems was at least two myself if I didn't plan to be pregnant again by then. However, she's doing really well with other foods as part of her diet, and I don't intend to stop her progress in that area just because I want to keep breastfeeding her.

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Icarus
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Trish, mothers already get greater consideration than fathers do--to an unfair extent, I believe. What effect do you think a specific recommendation to consider breastfeeding in custody decisions will have?
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Hobbes
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quote:
Hobbes,
Is faking violence better than showing real violence? Is there a discernable differnce? I'd take real nudity over fake violence any day (I will admit to some bias )

If I kill someone that's a lot worse than pretending I'd killed someone in a movie...

Hobbes [Smile]

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dread pirate romany
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quote:
If you're the father of a toddler and divorcing, you can just forget about getting custody right now. All your other qualities, and those of your spouse, have been trumped by the ability to breastfeed.
No, I think this is saying that a toddler's need to not be forcibly weaned will be balanced against the relative parenting skills of the mother and father.It may also bring about "graduated" plans where joint custody is the goal,but cold turkey night weaning or being away from mom for three weeks would be traumatic for the baby. If the father is overall a better parent, of course the decision should be made for him.
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ketchupqueen
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It also might mean a stipulation that the father must be willing to feed the baby pumped milk rather than formula, and to accomadate said pumping if necessary.
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mothertree
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On the general issue of custody, Icarus, I agree it should be a more level playing field mainly to discourage people from getting divorced. If a woman is confident she'll get to keep the kids, it undermines fairness in divorce mediation IMHO.

But the value of breastfeeding is a real factor and should play into custody arrangements for any child up to a year in age at least.

[ February 07, 2005, 04:00 PM: Message edited by: mothertree ]

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dread pirate romany
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kq, I didn't read anything that suggested to me an older baby should not have other foods. [Dont Know] Simply that there is no need to wean once the baby reaches a certain age. Which is good, since so many of my freinds have said, "Oh she's turning (one/one and a half/ six months) soon so I HAVE to wean". It should always be a personal decision, which means woman should know there's not an "expiration date".
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ketchupqueen
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Oh, I wasn't talking about the recommendations. Just about people who get overzealous and take it too far.

And personally, when my daughter wasn't gaining weight, I added formula to her diet (replacing 2 of her solid food feedings, not nursing sessions) as well as trying to change her nursing habits. I think mothers should also know it's not an all-or-nothing thing. If all you can do is before you leave for work and after you get home at night, that's better than nothing. Too many times it's stressed so much, I think women just decide if they can't do it all the time, they just won't do it at all. It needs to be whatever works for both mother and baby.

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jeniwren
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kq...a two year old being almost exclusively breast-fed is...well, IMO, that's criminal neglect. A child that old cannot possibly get all the nourishment they need from breastmilk alone. It's good stuff but not that good. 'Sides...when in the world does the mom think that child is going to get used to solid foods if not now? Sorry, especially if she's your friend...I can't picture that mother as anything other than neurotic, serving her own needs instead of her child's. To the point of neglect.
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ketchupqueen
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She's not my friend, don't worry. She's my second cousin. I hardly ever see her.

And don't worry, her mom called my mom and asked my mom to talk some sense into her, as a loving cousin and as a health care professional. When my mom goes to stop something, it stops. She'll almost certainly cut back to morning and night by the end of the month.

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dread pirate romany
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quote:
kq...a two year old being almost exclusively breast-fed is...well, IMO, that's criminal neglect.
Unless the child has severe allergies.
My daughter would projectile vomit everything but breastmilk until 13 months. She was tiny then..but..she didn't actually gain any weight when she started solids. There are rare, but existing health considerations that may make it neccesary.

But if the kid sis perfectly healthy, then it seems the mom is trying to prove something and has to actually hold the kid back from chowing down on solids.

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TheHumanTarget
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Okay, Hobbes, my stuffed-tiger friend, let me 'splain...no, let me sum up... [Smile]

In the purely pretend realm of entertainment, violence is as real as nudity. In the real world, killing someone is much worse than flashing them (I think).

Back on topic, though, I think the push for breast-feeding should be tempered by the fact that not all mothers can breast-feed, and should in no way be made to feel inadequate because of it.

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Hobbes
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quote:
In the purely pretend realm of entertainment, violence is as real as nudity. In the real world, killing someone is much worse than flashing them (I think).
Nudity is nudity, if you show someone's breasts on television then they're nude, and making fake breasts that look exactly like real breasts or something like that don't solve the issue most people have with nudity.

Violence is bad because it hurts someone, you can get rid of that problem in the media (fake hurting people). Do I think there's too much violence and an lax standards regarding it? Yes I do, but fundementally you can have fake violence, what the equivelent for fake nudity?

Ohh, and of course I agree that real violence is much worse than "real" nudity, I wasn't trying to argue that. [Smile]

Hobbes [Smile]

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jeniwren
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*whew* I'm glad to hear that. Stories like that make me want to jump in my car and go steal children from their parents. Which, aside from being terribly illegal, isn't always the best way to solve a problem. [Smile]

I wonder how her little daughter is going to take the change. Starting solids now is going to seem really weird to her, I should think.

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ketchupqueen
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Yes, but my mom is an RN/OTR who works with kids with craniofacial disorders, many of whom have feeding problems, so I'm sure she'll have some good advice. [Smile]
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jeniwren
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dpr, I thought about severe food allergies when I was writing that post, but it occurred to me that you can't breastfeed a child into adulthood, even with severe food allergies. By age 2, something else would have to be figured out, I would think.

I'm glad your daughter is doing better now. The banana-formula smoothies still popular?

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ketchupqueen
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Oh, heck yes. She would take more if I let her, but since she's gaining steadily and I want to hold nursing where it is for right now, I'm mean and make her drink only 2 6-oz. sippy cups full a day. [Smile]
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Amka
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From the article

quote:
infant mortality is 21 percent lower in breast-fed babies
Wow... I mean, a doctor will do a Cesaerean for less risk than that.

I've been doing a bit of research as well, and one thing I had never thought of is the problem of human error in the production of formula. There have actually been deaths due to such errors before the formula was recalled.

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TheHumanTarget
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Let me just say again, Not all women can breast feed. My wife was unable to for different reasons with both of our daughters, and the open scorn she received distorted my perception on the righteousness of this issue.
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jeniwren
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That's awesome, kq! [Smile]
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Christy
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quote:
dpr, I suspect that part of the reason most women stop breastfeeding exclusively before their child is 6 months old is that it's nearly impossible to do so and work outside the home.

Which is why I'm excited by the strong recommendations. It isn't impossible and if there were more advocates, I think more women would give it a try. It is definitely inconvenient, but possible.

That said, I'm running up against solid food troubles myself. On one hand, we have my mother-in-law who is adament that we exclusively breastfeed for a year plus and on the other hand, our daycare who is giving Sophie crackers now every afternoon, which, imho, is a bit over-eager and unhealthy.

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ketchupqueen
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Even these recommendations say exclusive breastfeeding until 6 mos.! You'll be nursing all the time if you try to satisfy a baby much longer than that with just breastmilk!
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mothertree
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Noted, HT. Kwea knows like 8 people who can't breastfeed. Which makes me wonder if they all really can't or if some took permission from the legitimate medical conditions of their friends.

I don't have a problem with people having a medical situation. I am just dubious when people who know that person come down with the same thing in large numbers.

[ February 07, 2005, 05:00 PM: Message edited by: mothertree ]

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Christy
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HumanTarget, I would agree, but I've known more than several women who couldn't breastfeed because "it stressed them out"

With a little support and some stronger reassurance, these women could have happily breastfed.

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ClaudiaTherese
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quote:
infant mortality is 21 percent lower in breast-fed babies
This is likely confounded by the fact that mothers who chose to breastfeed tend to be of higher education and socio-economic status, at least these days.

That is, the set of "breastfed babies" picks out babies that are unusual for other reasons, too. And the largest risk factor in infant mortality is low socioeconomic status (it is a marker for poor prenatal care, lack of access to medical care in general, exposure to certain allergens (such as roach feces) which trigger astma attacks, etc.).

[ February 07, 2005, 04:57 PM: Message edited by: ClaudiaTherese ]

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ketchupqueen
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Human Target, there will always be some women who really can't. They shouldn't feel guilty about it. But I agree with Christy, we need to support those who really may be able to but are stressed, having trouble, and don't have support at home and/or work.
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Christy
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And she's definitely interested and grabbing at foods, so I can't understand why MIL would want to hold back.

Still, she's not so keen on tastes yet. *smile* She gets the funniest look on her face when the food goes in and progress has been small.

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mothertree
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You think the AAP is picking its statistics to promote an agenda CT?

Excuse me while I adjust my wedgie. I'm just facing pressure to wean my 20 month old. It's not her sole source of nourishment. Trust me, I'd love it if she would decide she was done. So I'm very neurotic about the whole situation.

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Amka
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I think there is a difference between trying to breastfeed and deciding not to.

I also think that much of what goes on in the hospital discourages breastfeeding or makes it more difficult. For instance, my sister and her baby got a truly horrible case of thrush because the nurses gave her a broad spectrum antibiotic for type B Strep. They use that because it can be stored right there on the floor and doesn't require a trip to the hospital pharmacy. But killing off so many bacteria actually makes the body more vulnerable to yeast infections.

When my youngest was born, she had low blood sugar. This can actually be dangerous, and so they got her some glucose water. I had no problem with it, until the nurse came in with a bottle, AFTER I plainly stated that there would be no bottles. I made that nurse go back and get a medicine syringe for it. I had to do that twice.

If you let the baby go into the nursery and fall asleep, don't be suprised if baby gets fed a bottle, despite you stating that the baby will be exclusively breastfed. This can cause nipple confusion.

I've also had a friend who was so poorly evaluated and taught by a nurse that once a lactation consultant was brought in, it was too late and difficult to get the child sucking properly.

I really think our problem is lack of education, and social inhibitions that make women afraid they can't or ashamed to do it in public. Once that kind of fear, and the need to perform for medical personel sets in, breastfeeding becomes a challenge rather than something one simply does naturally.

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ketchupqueen
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See, I couldn't even keep Ems off solids until 6 mos. She was thrilled with rice cereal, even (at least for the first few weeks). Of course, she now notices that she's not eating what we're eating, and that makes her very mad... She's also developed a sweet tooth. She said "cookie" on Sat.-- the day she turned 10 mos. old. (Okay, really "ookie". But three times, with meaning.)

Of course, she still loves her "na-na"s (her first word), and demands to nurse regularly.

[ February 07, 2005, 04:58 PM: Message edited by: ketchupqueen ]

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TheHumanTarget
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With our first daugher, my wife went to a lactation consultant, but our daughter would not breastfeed so Sarah (my wife) pumped for six months, and supplemented with formula. When our second daughter was born she was immediately taken to the NICU, and wasn't allowed to eat for four days. In the interim, the medication my wife was prescribed prevented her from even attempting to breast feed.
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Christy
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*in complete agreement with Amka*
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Elizabeth
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All the women in my husband's family "tried" breastfeeding for six weeks. All of them.

They are all close as cousins, and watched what the others ad been through.

Yes, there are women who really can't breastfeed, but there are many who just don't want to. I don't think there is anything wrng woth that decision, and I would never make them feel that there was,I just think many of the "can'ts" are really "won'ts."

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Amka
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Was your daughter fed a bottle in the hospital? Bottles are easier to suck than breasts, and they will then get frustrated with the breast.

This is where lack of education on the part of medical personel comes in, I think THT. Your wife could still have been expressing and discarding milk to help it come in. Pumps can be very painful, especially so early on, so hand expression of milk is superior in those cases and causes better nipple stimulation to help the uterus go down.

One thing that I think is absolutely important is that baby is latched onto mom within moments of birth, if possible. The instinct really is there, and is strongest right after birth. It is good for mom too, helping her organs to recover faster because it causes the body to produce oxytocin. There should be gentle helping in making sure baby has latched on properly the first time.

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ClaudiaTherese
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quote:
You think the AAP is picking its statistics to promote an agenda CT?

Excuse me while I adjust my wedgie. I'm just facing pressure to wean my 20 month old. It's not her sole source of nourishment. Trust me, I'd love it if she would decide she was done. So I'm very neurotic about the whole situation.

I'm sorry about your wedgie. [Smile]

I'm delighted about the new recommendations. I'm pro-breastfeeding, myself. On the other hand, I don't think it would be useful to cherry-pick studies which may not have been well-done. In my opinion, the case is strong enough without overstatement, and doing so would just undercut the reliability and strength of the argument.

There is definite and clear benefit to breastfeeding to decrease the incidence of ear infections and certain other causes of morbidity.
Overstating that case isn't necessary in order to make the important point. I personally think there is more than sufficient accurately presented information to make the benefits of breastfeeding clear.

There is also a need for iron and calorie supplementation (as well as some other nutrients) for babies that are exclusively breastfed past 6 months of age, if you want to optimize growth and development. doesn't mean they shouldn't be breastfed, just that it's worth doing carefully. Which -- I am sure -- you are.

I like the Rehydration Project's Guidelines for Appropriate COmplementary Feeding of Breastfed Chidren Age 6-24 Months. Rehydration.org is very breast-friendly, and they encourage long-term breastfeeding. They are also quite evidence-based and practical.

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ClaudiaTherese
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quote:
I also think that much of what goes on in the hospital discourages breastfeeding or makes it more difficult. For instance, my sister and her baby got a truly horrible case of thrush because the nurses gave her a broad spectrum antibiotic for type B Strep. They use that because it can be stored right there on the floor and doesn't require a trip to the hospital pharmacy. But killing off so many bacteria actually makes the body more vulnerable to yeast infections.
I would definitely agree that most hospitals are not breast-friendly. Even in the ones which are, there can be intense pressure to adopt easy short-term solutions instead of spending the time and resources to get past that initial hurdle.

That being said, there is a standard broad-spectrum antibiotic given to prevent Group B streptococcal sepsis, and I doubt there was a better choice available (regardless of storage issues). However, I could certainly be wrong.

Which antibiotic was she given?

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ketchupqueen
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That looks good to me, except that the "approximate" calorie intake definitely applies in our case; my daughter has a very high metabolism, which she inherited from both sides. (I was the only one of my mother's kids who needed to be supplemented before 6 mos.; my husband eats about 2 1/2 times what he should need to maintain his weight according to his age and activity level, and still loses if he doesn't watch out.) So, more calories for Emma, but glad to know we're on track.
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mackillian
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I actually wonder about the bonding process between mother and child.

I ask this because from information from both sides of my family (father's and mother's), my mother had no interest in taking care of as an infant. At all. No breastfeeding, obviously. But the middle of the night stuff, it was my father or my father's mother who came and got me. My father's mother had to FORCE my mother, after a few months, to take care of me. Eventually, when my father's parents moved away (and he went with them to work a better job for more money for my mother and me), my mother's older brother called my dad's parents and told them to come and get me. My mother had stopped caring for me and left it up to her brothers and mother. At some point, she'd managed to dislocate my shoulder.

I wonder about the bonding because my mother seems to have no real bond with me at all. She really confuses the hell out of my grandmothers and even my shrink because she hasn't spoken to her own kid in two years, the time she's been away from my father. How can a mother do that? I mean, if a mother had bonded with her child, would she be capable of that?

My father did bond with me as an infant. He actually read to me, took care of me at night. Yeah, he royally screwed up as I got older. But now with me as an adult, he's been able to verbally tell me, to my face, that he effed up. And now, he gives a crap. He isn't pefect, he isn't a dependable, real father, but he's THERE in my life, at least.

What's up with my mother?

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ClaudiaTherese
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Like all guidelines, it has to be adapted for individual cases. But I like the emphasis of RP's focus on breastfeeding first with other tactics seen as complementary.

e.g.,
quote:
Appropriate complementary feeding involves a combination of practices to maintain breastmilk intake and, at the same time, improve the quantity and quality of foods children consume. The 6– 11 month period is an especially vulnerable time because infants are just learning to eat and must be fed soft foods frequently and patiently. Care must be taken to ensure that these foods complement rather than replace breastmilk. For older infants and toddlers, breastmilk continues to be an important source of energy, protein, and micronutrients. Therefore, breastfeeding should continue through 24 months and beyond.
Honest, just because I insist on rigor for the science doesn't mean I don't agree that the Breast is Best. I do.
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ClaudiaTherese
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mack, I've always wondered about post-partum depression in your mother.
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dread pirate romany
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[Hail] Amka [Hail]

quote:
That being said, there is a standard broad-spectrum antibiotic given to prevent Group B streptococcal sepsis, and I doubt there was a better choice available (regardless of storage issues).

When anti-biotics are neccesary, there are measures that can ( and, IMO, should, ) be taken to prevent thrush. (Experience has made me a reluctant thrush expert). Probiotic supplement, avoidance of sugars by the mother, air drying the breasts to avoid that damp environment the yeatsies love.

Re: the work issue, I think the guidelines may make it more likely a mother can combine breastfeeding and work. It will raise awareness in employers to the importance of breastfeeding, inspire mothers to "push harder", and maybe even bring about "mother/baby friendly workplace" legislation.

HT, most people do recognise that there are medical reasons breastfeeding may not work...and I totally respect that your wife pumped for 6 months!

[ February 07, 2005, 05:51 PM: Message edited by: dread pirate romany ]

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ClaudiaTherese
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Amka is, indeed, very wise and well-spoken. I hope she does public advocacy work for breastfeeding, too. She'd be a marvel.
quote:
When anti-biotics are neccesary, there are measures that can ( and, IMO, should, ) be taken to prevent thrush. (Experience has made me a reluctant thrush expert). Probiotic supplement, avoidance of sugars by the mother, air drying the breasts to avoid that damp environment the yeatsies love.
Sure enough! [Smile] Even if they used the proper antibiotic, doesn't necessarily mean the total care was optimized.

dpr, have you had any experience with Gentian violet (purple-staining plant extract) for thrush? I think it is more effective than the traditional antifungals against Candida. [Major Bummer: "though it seems Candida albicans is starting to show some resistance to gentian violet, as it is to other antifungal agents." [Frown] ]

quote:
Re: the work issue, I think the guidelines may make it more likely a mother can combine breastfeeding and work. It will raise awareness in employers to the importance of breastfeeding, inspire mothers to "push harder", and maybe even bring about "mother/baby friendly workplace" legislation.
In Wisconsin, some as yet unpublished research indicates that the reason more Native American mothers are not breastfeeding is that they feel pressure to return to work in the casinos in order to keep their jobs. Which is really a shame, as breastfeeding seems to help both childhood and maternal obesity in this population. That has serious implications for diabetes.

I believe many of the casinos have breastfeeding/-pumping rooms, but I doubt they are conveniently loated. There also may be a tradeoff between smoking break time and breastpumping time.

[ February 07, 2005, 06:04 PM: Message edited by: ClaudiaTherese ]

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