ResearchPod
ResearchPod
Fed is Best for neonatal health and nutrition
Active risks to children's health come in many shapes and sizes. While misinformation and bad advice won't turn up in a blood test, it can have just as damaging consequences as any infection.
Dr Christie del Castillo-Hegyi's research into child wellbeing and nutrition, in addition to her Fed Is Best Initiative, flies counter to a lot of the “received wisdom” new parents are given. Her cause is that babies get adequate care in their early development - a sentiment that is more controversial than it seems.
This episode includes discussion of maternal health, child malnutrition, medical trauma and child death. Listener discretion is advised.
Read the original research: https://doi.org/10.3390/children9091379
Pre-order the Fed Is Best book here: https://www.fedisbestbook.org/
00:00:04 Will Mountford
Hello I'm will welcome to Researchpod.
00:00:07 Will Mountford
As with other of our episodes touching on sensitive topics, I will say at the start that today's discussion includes topics of maternal health, child malnutrition, medical trauma and child death.
00:00:18 Will Mountford
As terrible as the loss of a child ever is, I had only recently become a parent. At the time of recording this episode myself. So I admit to some personal vulnerability throughout this discussion.
00:00:28 Will Mountford
That personal connection is also what made the work of Doctor Christie del Castillo-Hegyi so vital for us to cover her research into child well-being and nutrition in addition to her fed, is best initiative flies counter to a lot of the received wisdom new parents are given her cause as radical as it apparently seems, is that babies get adequate care in their early development.
00:00:48 Will Mountford
As for why that's controversial, let's go now to her interview to find out.
00:00:58 Will Mountford
Doctor Christie, hello.
00:00:59 Dr Christie del Castillo-Hegyi
Hello, thanks for having me.
00:01:01 Will Mountford
Thanks very much for your time today. Can you tell us a bit about yourself and a bit about the foundation and how you found yourself in the position that you hold today?
00:01:09 Dr Christie del Castillo-Hegyi
Well, thank you. I am an emergency physician in the United States and Cofounder of Fed Is Best Foundation, which is an organization that arose as a result of my personal experience as a first time mother.
00:01:26 Dr Christie del Castillo-Hegyi
When I was a first time mother, I was an attending physician. I was educated. I read all the parenting books and the current recommendations for children, and one of the most prominent ones that are told to mothers is the World Health organizations recommendation to exclusively breastfeed from birth.
00:01:46 Dr Christie del Castillo-Hegyi
With no supplements from birth to six months and I and there are multiple health benefits associated with with that recommendation, including reduced infectious disease and increased intelligence, all sorts of things that are said to be associated with exclusive breast feed.
00:02:03 Dr Christie del Castillo-Hegyi
I educated myself on how to achieve that, including reading breastfeeding books, going to the breastfeeding classes, and I had a normal, healthy pregnancy, healthy delivery. My child nursed well in the hospital as expected, and I was told to continue the recommendations upon discharge.
00:02:24 Dr Christie del Castillo-Hegyi
Upon discharge, my child exhibited prolonged feeding. He started to cry more, breastfeed for longer and longer and longer into the night, and then the next day we discovered at his pediatricians office that he had lost 1 LB. And three Oz from its birth weight, which we weren't told what the percent weight loss was, but.
00:02:44 Dr Christie del Castillo-Hegyi
Which was 15% of his birth weight at that time. We're still currently, many people believe that 10% weight loss is the cutoff for normal versus abnormal lost.
00:02:54 Dr Christie del Castillo-Hegyi
But we were.
00:02:55 Dr Christie del Castillo-Hegyi
Encouraged either to feed more frequently or supplement, and given the all the education we'd received about the dangers of formula supplementation and all of the things you know and the risk of failing to breastfeed as a result of supplementation, we said, well, let's.
00:03:13 Dr Christie del Castillo-Hegyi
That's we'll feed first. If he gets fussy, then we'll supplement and it never reached that point because that point he was getting more tired on the 4th day of life. We saw a lactation consult.
00:03:26 Dr Christie del Castillo-Hegyi
Went and did a weighed feeding, which is where you weighed them before and after a nursing session and after, you know, 15-20 minute good nursing session. We discovered that he was getting 0ML's from the feeding. So pretty much nothing.
00:03:44 Dr Christie del Castillo-Hegyi
And having studied newborn brain injury and specifically the effects of glucose, hypoglycemia and hypoglycemia, and newborn brain injury development and all of that.
00:03:55 Dr Christie del Castillo-Hegyi
I had knew that four days of not getting adequately fed could result in brain injury and starvation. So when he we got home, we get fed him his first two ounce bottle. He fell asleep for the first time in at least two days and and we did too and we set an alarm 3 hours later and found him.
00:04:15 Dr Christie del Castillo-Hegyi
Unresponsive when we tried to wake him for.
00:04:18 Dr Christie del Castillo-Hegyi
His next feed?
00:04:19 Dr Christie del Castillo-Hegyi
And we I knew it was happening and so I repaired a a bottle of formula which our pediatrician luckily sent us home with, cause I had none in the house. On the advice of a breastfeeding book and prepared it and pretty much forced him what we could, which woke him up and resulted in him seizing.
00:04:41 Dr Christie del Castillo-Hegyi
So what happens when you have no calories and then you save some calories? The first reaction the brain has is to seize because it's uncontrolled firing.
00:04:50 Dr Christie del Castillo-Hegyi
So we rushed him to the emergency room and there he was diagnosed with hypernatremic dehydration, which is a severe form of dehydration that can cause brain and vital organ injury and increase the risk of death.
00:05:02 Dr Christie del Castillo-Hegyi
Severe jaundice with a bilirubin of 24, and I suspected that he would go on to have some major.
00:05:12 Dr Christie del Castillo-Hegyi
Or, you know, or some kind of developmental disability and and little three to four years later, who was diagnosed with multiple developmental conditions. And to this day is still severely delayed in his language and his intellectual capacity, essentially severely disabled. And that is why that is best.
00:05:32 Dr Christie del Castillo-Hegyi
Exists.
00:05:34 Dr Christie del Castillo-Hegyi
To prevent these tragic, tragic outcomes that are completely preventable.
00:05:39 Will Mountford
This is part of why your work grabbed me so entirely when we started talking is because this is something that is close to my personal experience. Mine diverged in several important ways, but there's going to be a lot of people out there, a lot of young parents, and a lot of babies who.
00:05:54 Will Mountford
Those.
00:05:55 Will Mountford
Well, whose early days are going to be a struggle? And this is an important part, they say for the rest of their life is those first three or four days.
00:06:04 Dr Christie del Castillo-Hegyi
Yes.
00:06:05 Will Mountford
Could just maybe go over some of what this might mean to other people to look at some of global or National Statistics. You've mentioned the UN recommendations, but what is the global attitude or the global conceptions around breastfeeding and supplementation formula, the whole landscape that this sits in?
00:06:23 Dr Christie del Castillo-Hegyi
Exclusive breastfeeding guidelines are very well established and they have been around since the early 1990s and unfortunately like with any.
00:06:34 Dr Christie del Castillo-Hegyi
Global health policy it's possible to make mistakes along the way. Oftentimes, people who are on committees that create global policy have a specific perspective. They come from a particular socioeconomic background. They may have different Physiology. They tend to be of a more privileged status.
00:06:54 Dr Christie del Castillo-Hegyi
And so often that policies can be written from that very privileged status that includes the privilege of being fully capable of producing milk at the right amount, the right amount of of milk at the right time.
00:07:08 Dr Christie del Castillo-Hegyi
And that can create blind spots. And so this is what I believe has happened with global breastfeeding policy. The people who were involved early on in creating this policy were mostly self selected to be of this type where they were incapable of seeing the blind spots of their policy, namely what it posed.
00:07:30 Dr Christie del Castillo-Hegyi
To infants of mothers who had imperfect lactation, whose milk would be delayed, whose colostrum is not enough to meet their infants, basic nutritional requirements, or they would have prolonged problems with.
00:07:44 Dr Christie del Castillo-Hegyi
Milk insufficiency and and and unfortunately instead of looking at data and looking at the reality of what is happening within the population, their perceptions and their policies on their belief that because I didn't experience it, then this problem of insufficient milk must be rare. The rationale.
00:08:05 Dr Christie del Castillo-Hegyi
Often is that how can our population exist if milk was so commonly in?
00:08:13 Dr Christie del Castillo-Hegyi
That's a false narrative. That is a natural fallacy is what.
00:08:18 Dr Christie del Castillo-Hegyi
We call that.
00:08:19 Dr Christie del Castillo-Hegyi
Because it didn't happen to me. It must not be happening to other people. If in my mind, the only way the human population could exist is if lactation work perfectly, then that must be true. And then then I go on and create a.
00:08:33 Dr Christie del Castillo-Hegyi
Global policy that applies to every single human being on this planet, and they don't realize the dangers it poses to mothers.
00:08:41 Dr Christie del Castillo-Hegyi
Who don't fit the.
00:08:42 Dr Christie del Castillo-Hegyi
Hold. And so the reality is when you look at the data #1, let's go back to the beginning. What data did the World Health Organization have to determine this claim that exclusive breastfeeding is best for almost every child and that mothers rarely have insufficient milk to need supplementation?
00:09:04 Dr Christie del Castillo-Hegyi
There is not a single study in existence anywhere studying any population of mothers.
00:09:11 Dr Christie del Castillo-Hegyi
Measuring the daily milk production from birth six months to say that it is true the need for supplementation is rare. It has never existed even within the world. Health organizations and UNICEF and World Health Organization's own policy statements. When they're experts scrub the literature.
00:09:31 Dr Christie del Castillo-Hegyi
Or look through the literature for that data, their own experts said that it was rare to find mothers to exclusively breastfeed anywhere in the population in the developed world, as well as.
00:09:43 Dr Christie del Castillo-Hegyi
The developing world.
00:09:44 Dr Christie del Castillo-Hegyi
So here we are. Their own experts say. That is rare for any mother in nature to do this, from zero to six months, and somehow they're saying that this is possible for nearly every mother in the world.
00:10:02 Will Mountford
You've mentioned the breast is best. You've mentioned baby friendly hospitals and 10 steps to breastfeeding.
00:10:09 Will Mountford
Success. Could you tell us just quick terms what those are, where they fit into current guidelines and how they came about?
00:10:16 Dr Christie del Castillo-Hegyi
OK, so to 10 steps to successful breastfeeding launched in 1989 by the World Health Organization in UNICEF and they described 10 steps that we as a health system as a society can promote breastfeeding. Having written policies, having mothers room in a number of different steps to.
00:10:36 Dr Christie del Castillo-Hegyi
To promote breastfeeding, but number six step 6 is probably the.
00:10:41 Dr Christie del Castillo-Hegyi
Prominent of those steps which is do not give any supplemental food or fluid other than breast milk specifically from birth to six months and so that is where the foundations work revolves around all the risks associated with that. The Baby Friendly Hospital initiative was the.
00:11:01 Dr Christie del Castillo-Hegyi
Hospital policy program that arose from the 10 steps. So.
00:11:07 Dr Christie del Castillo-Hegyi
It is a hospital.
00:11:09 Dr Christie del Castillo-Hegyi
Nation that comes with training hospital health, education, training or health professional training and that basically trains health professionals to follow the 10 steps and implement those 10 steps in the hospital.
00:11:25 Dr Christie del Castillo-Hegyi
Hospital policy.
00:11:27 Will Mountford
To move from the big international efforts to a kind of a local framing for anyone listening to this who has recently gone through birth and is in breastfeeding, or anyone who might have been going to.
00:11:40 Will Mountford
Group what's the role of that peer support of having health visitors duellers whatever kind of informal learning and informal education, rather than receiving the the victim from on high of here, is behavior that should be followed for everybody.
00:11:57 Dr Christie del Castillo-Hegyi
Well, that certainly filters down because part of the 10 steps is creating community support for mothers, which is not bad and it of.
00:12:05 Dr Christie del Castillo-Hegyi
Itself, it's it's important to help mothers, because breastfeeding is hard. Parenting is hard.
00:12:12 Dr Christie del Castillo-Hegyi
Any kind of?
00:12:13 Dr Christie del Castillo-Hegyi
Parenting feeding is hard, but it's the type of support the devil is in the details. If you are receiving support that does not match your Physiology, your circumstance.
00:12:25 Dr Christie del Castillo-Hegyi
Your needs as a family as a parent. Then you are not getting optimal support.
00:12:32 Dr Christie del Castillo-Hegyi
The parent and so for, oftentimes in prenatal classes and and the parent support classes, especially those that are held by hospital facilities, lactation consultants, doulas, it is generally of the breast is best.
00:12:48 Dr Christie del Castillo-Hegyi
Mindset. Where exclusive breastfeeding is the pinnacle that you should be aiming for at whatever cost, and that combination feeding and lastly formula feeding are kind of second and last.
00:13:03 Dr Christie del Castillo-Hegyi
Nest and there's not very little nuance in that message you feed formula. You are doing a disservice to your baby, and this is exactly the kind of messaging that results in these tragic outcomes that happen routinely now in hospitals. So dehydration, jaundice.
00:13:23 Dr Christie del Castillo-Hegyi
Hypoglycemia from inadequate feeding while exclusively breastfeeding, especially before full milk comes in.
00:13:29 Dr Christie del Castillo-Hegyi
Are the most common reasons why healthy term newborn gets readmitted to the hospital, yet few parents are aware that that is a known risk of this World Health Organization recommendation and this is an outrage. Every parent should be fully informed of all their choices.
00:13:50 Dr Christie del Castillo-Hegyi
And all the risks that are associated with it, not just these vague risks of not being able to breastfeed and maybe risk of other health outcomes that have not been tied to temporary supplementation while a baby needs it while a baby is not getting adequately fed. That no.
00:14:08 Dr Christie del Castillo-Hegyi
No health bad health outcomes have ever been tied to supplementing a hungry baby, but there are plenty of negative health outcomes of failing to do so when they need it, and that includes brain and vital organ injury, long term developmental disabilities, intellectual disabilities, changes, and motor and sensory.
00:14:26 Dr Christie del Castillo-Hegyi
Too many to count and few parents are being told these realities in the pursuit of getting everyone to exclusively breastfeed, and that is unethical. That is negligent.
00:14:41 Dr Christie del Castillo-Hegyi
For a while, before Fed is best, a health professions gotten that this whole system of failing to inform has evolved to where even health professionals don't know what's safe and unsafe is they don't know what infant behavior is is an indication of severe hunger.
00:15:00 Dr Christie del Castillo-Hegyi
Versus versus normal behavior because their own guidelines have normalized the signs of infant hunger, especially in the newborn period. The academia breastfeeding guidelines says that constant nursing for hours and fussing are not indications for supplementations when those are exactly the signs of persistent.
00:15:22 Dr Christie del Castillo-Hegyi
Infant hunger. Why do we have to wait until a child has clinically proven hypernatremia excessive weight loss, brain threatening, jaundice, and hypoglycemia in order?
00:15:35 Dr Christie del Castillo-Hegyi
To be fed.
00:15:36 Dr Christie del Castillo-Hegyi
That allowing an infant to even reach or cross that threshold constitutes a human rights violation, and by these acts of omission where we don't inform parents about these risks, we don't tell them the importance of supplementation of an persistently hungry infant.
00:15:56 Dr Christie del Castillo-Hegyi
That this can protect their infant from lifelong disability. Those acts of omission constitute an act of medical negligence.
00:16:06 Dr Christie del Castillo-Hegyi
This is a very, very serious health problem, because this is a health problem that has been created by a global health policy that never existed before it. Before this policy. The goal of breastfeeding was feeding. It is common sense that has been the standard of human beings.
00:16:27 Dr Christie del Castillo-Hegyi
Are all of human evolution we evolved to supplement in response to infant hunger because bad things happen to babies who don't get fed.
00:16:38 Dr Christie del Castillo-Hegyi
And so we did it by any means necessary. We fed honey, we fed animal milk. You see infants, you see, old photographs of infants being nursing goats, teeth not because human beings are ignorant, it's because they didn't have safe substitutes with the choice is between.
00:16:58 Dr Christie del Castillo-Hegyi
Their infant dying or them getting a maybe contaminated source of.
00:17:03 Dr Christie del Castillo-Hegyi
Of nutrition. Then you're going to choose the contaminated source of nutrition, and now we are lovely to be in a time where we have a safe substitute. We have a substitute that can allow an infant to grow to adulthood. Being fully fed, having all the potential that's required that they could have.
00:17:23 Dr Christie del Castillo-Hegyi
If they had received breast milk.
00:17:25 Dr Christie del Castillo-Hegyi
Alone from a mom who had adequate milk. We have those options now, and now we are exposing children to these conditions that once existed. Starvation and malnutrition because of our choice to not feed them supplemental milk because we have chosen, as a matter of global policy, to not feed them.
00:17:46 Dr Christie del Castillo-Hegyi
Until they are at risk and that is just insane, there's no other way to describe it.
00:17:53 Dr Christie del Castillo-Hegyi
A mom, a high school friend of mine who was going through this after I discovered all the problems that could happen, asked me a very simple question. What does a baby need to be fed? How much milk does a baby do?
00:18:06 Dr Christie del Castillo-Hegyi
You know that answer?
00:18:08 Will Mountford
Until it starts coming back up, it's my experience.
00:18:10 Dr Christie del Castillo-Hegyi
Yeah, OK. Like but before that, when you were told informed by your breastfeeding class or maybe you or your partner read a breastfeeding book, if you look at any parenting book, does it say how much breast milk does a baby need to be safely fed?
00:18:28 Dr Christie del Castillo-Hegyi
And you cannot find that answer and most resources you certainly won't find it in breastfeeding class. They will not tell you the actual volume of milk a child requires to be satisfied and fully fit to have their caloric and fluid requirement so that this doesn't happen right? That starvation and dehydration doesn't happen, and that value is 110.
00:18:49 Dr Christie del Castillo-Hegyi
Calories per kilo per day be about two oz. Every three hours about. That's for an average sized baby. A newborn 2 oz. OK. Do you know how much milk they are? How much of that requirement they are receiving that first day from the average mothers?
00:19:07 Dr Christie del Castillo-Hegyi
Colostrum yield what percent would you estimate they are getting of that total volume from colostrum alone.
00:19:14 Will Mountford
I don't know if I should go very high or very low, because either way I feel like I'm going.
00:19:17 Will Mountford
To be caught off guard, let's say 20.
00:19:21 Dr Christie del Castillo-Hegyi
10% so that studies of colostrum yield in the first days of life the average healthy Caucasian mother because the studies are healthy Caucasian mother delivering a term baby produces about 10% of that caloric requirement. And then the next day it's about 33%. And then the next day after that 66% so.
00:19:42 Dr Christie del Castillo-Hegyi
Increases.
00:19:43 Dr Christie del Castillo-Hegyi
You know incrementally until the 4th day of life when they get they are able to produce the full coal work requirement of their infant. Now we're talking about that's the average. How long can a baby go being underfed? That is the question to be asked of the policymakers because their expectation.
00:20:04 Dr Christie del Castillo-Hegyi
Is that they can be fed and that they can safely rely on their internal reserves to make it through this period of under feeding without sustaining brain and vital organ.
00:20:16 Dr Christie del Castillo-Hegyi
And you would expect something as ubiquitous as this policy would have several randomized control studies with safety data, just like any drug, right? Any drug would have safety data would have 10s of thousands of participants looking at the outcomes as well as adverse effects. How many do you think there are?
00:20:36 Dr Christie del Castillo-Hegyi
Of this policy.
00:20:38 Will Mountford
If I remember correctly, you've already said zero.
00:20:41 Dr Christie del Castillo-Hegyi
The zero was the number of women who can produce exactly what their baby needs from zero to six months. But the number of studies looking at the using a randomized control trial looking at the efficacy as well as the adverse effects of the baby friendly hospital initiative or the 10 steps to successful breastfeeding.
00:21:00 Dr Christie del Castillo-Hegyi
Under the World Health Organization, UNICEF guidelines have zero studies on safety.
00:21:07 Will Mountford
You have a captive population here. If these people aren't going anywhere, they are in hospital holding a baby. Now is the perfect time to.
00:21:15 Will Mountford
Just gather some data. You're gathering a lot of data, you're making records, public records, lifelong records of birth, weight, name, location, that kind of thing.
00:21:25 Dr Christie del Castillo-Hegyi
And most importantly, long term outcomes data already exists, so the probit trial is the largest, the largest quasi randomized trial on the baby Friendly hospital initiative, and was conducted in Belarus.
00:21:41 Dr Christie del Castillo-Hegyi
I can't remember what year it started but.
00:21:44 Dr Christie del Castillo-Hegyi
19 nineties 2000s or something to that effect, and so we have a cohort of of it's quasi randomized because the way it was designed is that some cities, some hospitals were randomized to intervention which is baby friendly hospital initiative 10 steps recommendations, current recommendations and some hospitals were randomized to no intervention so standard.
00:22:06 Dr Christie del Castillo-Hegyi
Care. And they looked at rates of breastfeeding, exclusive breastfeeding after discharge, as well as certain health outcomes. They looked at multiple health outcomes, GI but rates of GI bug. So this is more of a population study of population.
00:22:20 Dr Christie del Castillo-Hegyi
Affect how many GI infections, respiratory infections, intelligence, BMI, diabetes, hypertension. Looking up to I think as of a couple of years ago, the cohort of babies already 16 so up to 16. So they have the data. All they have to do is look back at that same cohort of infants.
00:22:42 Dr Christie del Castillo-Hegyi
And look at rates of disability.
00:22:45 Dr Christie del Castillo-Hegyi
All they have to do is look at how many infants in the intervention group versus the standard group.
00:22:53 Dr Christie del Castillo-Hegyi
Developed problems with either intellectual development, seizure disorders, special education requirements, any number of markers of measures.
00:23:12 Dr Christie del Castillo-Hegyi
And so, you know, there continues to be infant formula, consent forms and hospitals for parents who, let's say, for instance, notice their babies aren't getting adequately fed or feel like they're not getting adequately fed. And some parents will reasonably ask for formula and they'll receive.
00:23:32 Dr Christie del Castillo-Hegyi
A informed consent form for formula that says your child is at greater risk of lower IQ, higher respiratory infections, higher SIDS, higher rates of leukemia for getting this bottle of formula when first of all, the studies don't support.
00:23:50 Dr Christie del Castillo-Hegyi
Observational studies may show that there's a difference, but then again, there are the confounding variables that limit the the validity of such associations that we find in those studies. So ultimately.
00:24:06 Dr Christie del Castillo-Hegyi
Ultimately, what we are receiving in real life as parents going into hospital when we're getting, you know, receiving the standard of care treatment for our children.
00:24:19 Dr Christie del Castillo-Hegyi
Are warnings that are not supported by the data, and most of all, these warnings are not warning us of the worst outcomes from not giving that formula to a child who's not getting adequately fed, so that that's where we are as far as baby friendly.
00:24:38 Dr Christie del Castillo-Hegyi
Hospital initiative how it plays out in the real world and what the data shows regarding Davy friend.
00:24:46 Dr Christie del Castillo-Hegyi
It is scaring them away from the decision to give formula with the misguided belief that that's going to improve that child's health and and and it's just and then there's no consequence if that child comes back with the hospital dehydrated and jaundiced.
00:25:05 Dr Christie del Castillo-Hegyi
Because they received that warning because they declined formula after receiving that warning, and now they're told. Ohh, I'm sorry. You did in fact did not have enough breast milk in your child. Now requires it in order to treat this dangerous condition that they've developed as a result of of our warning.
00:25:25 Dr Christie del Castillo-Hegyi
So that is the problem with with the whole the whole.
00:25:29 Dr Christie del Castillo-Hegyi
System at this time.
00:25:31 Dr Christie del Castillo-Hegyi
And and and somehow the training they're receiving have conditioned them to not want to know that there's a problem, a feeding problem to to reassure parents that there is no problem when there is setting the hospitals up for lawsuits. And then, of course, these.
00:25:52 Dr Christie del Castillo-Hegyi
Families, these unsuspecting families are just trying to do their best for their child, setting them up for a lifetime.
00:25:59 Dr Christie del Castillo-Hegyi
Kind of disability childhood disability. And I mean, there's one parent that posted on a one of our blogs and just really captured it perfectly. It feels like a life sentence.
00:26:12 Dr Christie del Castillo-Hegyi
It just really captures exactly what these families.
00:26:15 Dr Christie del Castillo-Hegyi
Are going through.
00:26:16 Dr Christie del Castillo-Hegyi
And and unfortunately, there's no one at the top who is, you know, us benefiting financially or professionally. Who is liable for these cases who get sued, the hospitals and the health providers, not the people who are.
00:26:30 Dr Christie del Castillo-Hegyi
Guiding the hospitals and health providers to provide this kind of care.
00:26:35 Will Mountford
Not that you going to be looking for blame here, exactly, but accountability.
00:26:39 Dr Christie del Castillo-Hegyi
Some kind of accountability, some kind of some kind of monitoring or internal process where cases of unharmed infants or bad outcomes are, uh, not only reviewed, but where there's some kind of.
00:26:58 Dr Christie del Castillo-Hegyi
Negative incentive? I don't know. It's see from at least health professionals who've spoken to to me, who are actively describing what it's like in their day-to-day work life.
00:27:14 Dr Christie del Castillo-Hegyi
There are a few repercussions.
00:27:16 Will Mountford
No justice for the patience either.
00:27:19 Dr Christie del Castillo-Hegyi
That's right. No justice. And then, of course, the only justice that they can get requires.
00:27:25 Dr Christie del Castillo-Hegyi
Major effort, major emotional and financial investment into a lawsuit that itself kind of re victimizes them in my state. Actually, there's a case, a jaundice case that was settled for like $40 million. And I'm sure this family deserved it.
00:27:45 Dr Christie del Castillo-Hegyi
The level of care the disabled child requires for the rest of their life, not to mention the lost income and life you know, you can't even quantify it. You can't quantify it, but the for a $20 carton of for.
00:28:02 Dr Christie del Castillo-Hegyi
Kayla.
00:28:03 Dr Christie del Castillo-Hegyi
Could have been prevented with that and a change in mindset.
00:28:09 Will Mountford
So the ten step initiative and the recommendations therein has all the appearance and all the trappings of something that's been considered thought about, you know, for the general good. So where are some of the issues, hurdles to making sure that what is actually being implemented is what's best for the patient rather than just.
00:28:29 Will Mountford
Following the letter of the law.
00:28:31 Dr Christie del Castillo-Hegyi
The 10 steps originated in 1989 and it was the first kind of plan for the World Health Organization to promote breastfeeding then, and if you think this 10 steps is that there's a perception that the 10 steps has been, you know, adequately vetted that each step was tested for efficacy as well as safety.
00:28:52 Dr Christie del Castillo-Hegyi
Well, that's not the case at all. It was put together. It was by expert opinion, you know.
00:28:59 Dr Christie del Castillo-Hegyi
I should mention that Malachi League International, which was most prominent breastfeeding promotion organization at the time were consultants, expert consultants to the initiation of the tense steps. You know there are many things in there that you know of course are good things. The things that you cannot possibly say.
00:29:19 Dr Christie del Castillo-Hegyi
Is wrong. So #1 teaching parents how to breastfeed. Of course we cannot promote breastfeeding without teaching. How to breastfeeding to how to breastfeed. Having a hospital policy or written hospital policy about breastfeeding? I can't argue with that.
00:29:34 Dr Christie del Castillo-Hegyi
But there are other things in the 10 steps that not only are not effective, but they are potentially dangerous to an infant. The most prominent of which being step 6, which is give no food or fluid other than breast milk unless medically indicated. Now, if you listen to that, that sounds very reasonable. We don't want to give formula unnecessarily, it might ruin some breastfeeding.
00:29:57 Dr Christie del Castillo-Hegyi
Who knows? You know, we're trying to promote breastfeeding, so why would we be permissive formula? Well, the devil is in the.
00:30:04 Dr Christie del Castillo-Hegyi
Details this, unless medically indicated, most people will read that and think, oh, there are some special children with special dietary needs or medical conditions that make breastfeeding not advisable. But what few parents understand is that quote, unless medically indicated, includes complications.
00:30:24 Dr Christie del Castillo-Hegyi
Of not getting enough milk while exclusively breastfeed.
00:30:28 Dr Christie del Castillo-Hegyi
And this is really the core of our work, because this is the trapping that most families who experience complications.
00:30:35 Dr Christie del Castillo-Hegyi
As a result of the baby Friendly hospital initiative fall into so, unless medically indicated includes dehydration, excessive jaundice, hypoglycemia, hypernatremia, all complications of not getting enough milk while exclusively breastfeeding, and the most common time that occurs.
00:30:56 Dr Christie del Castillo-Hegyi
Is in the immediate postpartum period before full milk comes in.
00:31:01 Dr Christie del Castillo-Hegyi
So the reason why my organization take up so much issue with this particular step is that this is the primary metric that hospitals are operating under, at least in the US, there is a hospital metric called the perinatal perinatal core Measure 5, which is essentially step 6 and it measures.
00:31:21 Dr Christie del Castillo-Hegyi
And it measures the number of babies who are exclusively breast fed, either. In other words, no formula was given to them unless there was a medical indica.
00:31:32 Dr Christie del Castillo-Hegyi
Upon discharge. So how does that play out in real life? Well, there are often babies who are not satisfied and not adequately fed or hydrated by colostrum alone. What their mothers produce their mothers either don't produce enough colostrum, the colostrum is not adequate to meet their nutritional needs.
00:31:51 Dr Christie del Castillo-Hegyi
And they will cry and cry, nurse and cry and nurse and cry all through the night.
00:31:57 Dr Christie del Castillo-Hegyi
And parents will reasonably look at this and think my child is hungry. They're not getting enough to eat, and sometimes they'll even pump. Maybe someone will give them a pump or they brought their own pump and they will observe that they have either little to no milk coming out of the breast because it has not come in yet.
00:32:15 Dr Christie del Castillo-Hegyi
And there is this mythology that drops of colostrum is enough to feed the vast majority of babies, and there's nothing to worry about when they're baby is showing these signs when in fact, these aren't these signs are the earliest signs of a child developing complications of getting inadequate.
00:32:33 Dr Christie del Castillo-Hegyi
Feeding and so this is where you know, this is what we've discussed as far as parents not receiving adequate information about the risks and benefits of their their feeding methods and they're not being adequately or safely counseled on how to feed their babies. Since there is this external metric.
00:32:55 Dr Christie del Castillo-Hegyi
That is, that is based off of step six, one of the 10 steps that pushes hospitals to avoid formula supplementation even when a child is crying for it. For additional milk. Really not just formula, just any.
00:33:08 Dr Christie del Castillo-Hegyi
Milk, human milk or formula? When they're telling, they're communicating to the world that they need more milk. They're being denied this formula. They're denied supplementation. At their risk. You know, they are being put at risk for these complications without the parents being told that there are these risks.
00:33:31 Dr Christie del Castillo-Hegyi
But for a child to suffer 2 to 3 days of hunger and eventually pass away from not getting food because their parents were told something that they were told and that they thought were the bet was for the best, and then they followed it and then this happens it's it's just.
00:33:51 Dr Christie del Castillo-Hegyi
And this is just the one story that got publicity.
00:33:55 Dr Christie del Castillo-Hegyi
There are a few more stories that have been published where I know one of the one in the UK. Well, actually a couple in the UK and there have been people who've sent stories to us and we published on our blog. But then there are those who I I am aware of from my communications with doctors and experts.
00:34:14 Dr Christie del Castillo-Hegyi
Goddess experts in the developing world, babies who die and have severe debility from this exact entity day in day out because there is most many people don't deliver in hospitals. They get 0 monitoring for jaundice or weight loss or dehydration not.
00:34:31 Dr Christie del Castillo-Hegyi
And then they come in, when their child is obviously medically ill, kind of like Landon Johnson. And by the time they get there, it's just too late. You know, the case fatality ratio for jaundice in the developing world is far higher than in the developed world. And the and and, but they don't get the press because they're in a low middle income.
00:34:52 Dr Christie del Castillo-Hegyi
They don't. There's no justice. There's absolutely no justice for those families who have to deal with the the lifetime disability of a child with even fewer resources than we have for disabled children.
00:35:11 Will Mountford
We've talked a lot about kind of policy content, but to think in terms of biological content, what is the molecular makeup of breast milk and what is the consequence of its absence? And then is formula an adequate supplement in the short term?
00:35:30 Will Mountford
In the long term.
00:35:32 Dr Christie del Castillo-Hegyi
Starting off with breast milk, so the first milk that comes through is colostrum. It is a small volume of breast milk. It has been studied the contents of of colostrum has 54 kilocalories. I'm going to interchange most people understand calories, but scientifically it's a kilo calorie. But.
00:35:52 Dr Christie del Castillo-Hegyi
Anyway, but I'm gonna say calories. So Claustrum has 54 calories per deciliter and mature breast milk.
00:36:01 Dr Christie del Castillo-Hegyi
Which is the milk that comes, you know, after two to three days, the full mature breast milk has about 66, anywhere from 66 to 77 calories per deciliter. That is that mature breast milk is what formula is fashioned after is designed to mimic.
00:36:13
There.
00:36:21 Dr Christie del Castillo-Hegyi
Formula has 66 calories per deciliter. That's the starting point. OK, fluid is fluid, water is water. There's no difference between the water and breast milk. And the water in formula. It's H2O.
00:36:33 Dr Christie del Castillo-Hegyi
And then now you get to proteins and fats. So formula is made from cow's milk. Generally cows milk is lower in carbohydrates than breast milk and so therefore cows milk has to be adjusted and you have to add carbohydrates to cow's milk.
00:36:54 Dr Christie del Castillo-Hegyi
In order to match the carbohydrate content of breast milk, the primary carbohydrate and breast milk and formula is lactose.
00:37:03 Dr Christie del Castillo-Hegyi
Similarly, protein content tells Milk has a higher protein content than breast milk, and so it has to be adjusted for that. And then of course, there's that. So I mean, those are the macro nutrients, calories and fat provide energy and the protein provides the building blocks to create muscles and vital organs. And all of that.
00:37:23 Dr Christie del Castillo-Hegyi
So on and so forth, and then now it's all the micronutrients.
00:37:26 Dr Christie del Castillo-Hegyi
Now we are often told that breast milk is the perfect milk. You know anyone who actually knows what's number and those types of breast milk and formula knows that's not exactly correct, but doesn't mean.
00:37:40 Dr Christie del Castillo-Hegyi
A.
00:37:41 Dr Christie del Castillo-Hegyi
Good source of nutrition. OK, it just means we need to supplement already. We have to supplement breast milk so it has been found that breast milk is relatively deficient in vitamin D and vitamin D is important for bone growth. So therefore any child.
00:37:57 Dr Christie del Castillo-Hegyi
Well, and that is not the case for formula because it's supplemented. So any child who is receiving either exclusive breast milk or up to half of their dietary intake is consist of breast milk has to be supplemented with vitamin D pretty much upon the first a follow up appointment.
00:38:18 Dr Christie del Castillo-Hegyi
After discharge from the hospital, so the vitamin D drops something like that. OK. And then in addition, breast milk is relatively deficient in iron, so newborns, infants, term infants have an iron store from.
00:38:33 Dr Christie del Castillo-Hegyi
But at around four months, we've seen that exclusively breastfed babies are at much higher risk of developing iron deficiency from that low iron content in breast milk. So infants who are exclusively breast fed are half fed breast human milk at four months.
00:38:53 Dr Christie del Castillo-Hegyi
It is recommended that they get iron supplementation that does not apply to formula fed babies. Now when we're talking about the content, right, that is.
00:39:02 Dr Christie del Castillo-Hegyi
Trust what it has. That's reality. Some people feel that when you say things like, well, breast milk doesn't have this or that you're being down on breast milk. That's not the case. Breast milk saves lives. This notice formula. Now what formula doesn't have are immune factors that are present in breast milk. So they are.
00:39:22 Dr Christie del Castillo-Hegyi
Are IGA, which are antibodies that can line essentially line the gastrointestinal?
00:39:28 Dr Christie del Castillo-Hegyi
Tract of infants. Maybe to some extent the respiratory tract, at least the upper respiratory tract of of infants and that is thought to be protective for against respiratory and GI buts which though is borne out in the data of the probit trial showed that there was a reduction in gastrointestinal and respiratory infections.
00:39:49 Dr Christie del Castillo-Hegyi
In the infants who were in the intervention arm, so who got breastfeeding intervention? So there may be.
00:39:55 Dr Christie del Castillo-Hegyi
A true population.
00:39:56 Dr Christie del Castillo-Hegyi
Effect of breastfeeding on reducing those infections, but about everything else that we're often told is reduced by breastfeeding, diabetes, hypertension, low IQ.
00:40:08 Dr Christie del Castillo-Hegyi
All those things do not bear out in the probit study. So in a well controlled study, those do not bear out only in observational studies where the outcomes can be affected by things that are not related to breast milk, like household income, parental education, access to healthcare.
00:40:28 Dr Christie del Castillo-Hegyi
Access to educational resources all these things and health seeking behavior.
00:40:33 Dr Christie del Castillo-Hegyi
Differences in self health seeking behavior cannot be parsed out in observational studies, but they do show that breastfed babies that babies were breastfed or breastfeeding household do better with regard to multiple outcomes. What is that from privilege? Is that from breast milk? Hard to say. But when you look at siblings who come from the same household.
00:40:53 Dr Christie del Castillo-Hegyi
Those differences disappear. Breast fed and formula fed babies who come from the same household have the same health.
00:41:02 Dr Christie del Castillo-Hegyi
Comes so hopefully that will be, you know, like a bomb for many parents cause there's so many ways to feed your baby if your baby is fed, then you're doing great. You are doing great.
00:41:15 Will Mountford
Having a sibling is the perfect AB trial of different circumstance, different outcome or.
00:41:21 Dr Christie del Castillo-Hegyi
Exactly, exactly. And unfortunately, this whole debate really plays on the insecurities of most parents. We all want the best. I mean, you know, any reasonable loving parent wants the best for their child. And if you're being told.
00:41:37 Dr Christie del Castillo-Hegyi
Told that this is the only way to give your child the best and giving formula is gonna ruin them for life. You're gonna believe them? And especially if it comes from a reputable organization like the World Health Organization, you're going.
00:41:52 Dr Christie del Castillo-Hegyi
To believe them.
00:41:54 Dr Christie del Castillo-Hegyi
And if they don't tell you things, details.
00:41:57 Dr Christie del Castillo-Hegyi
Like hypernatremia and jaundice and hypoglycemia as risks, you believe that to you, you believe that it's ohh. It's maybe, if not, any consequence to my child, even if it becomes so. And there are people, families who are living out these.
00:42:13 Dr Christie del Castillo-Hegyi
Senses. I mean, it seems very abstract for uh, well, you heard about this case or that case. Oh, poor. And now that's an unfortunate outcome. But there are families who are living every day with these outcomes and maybe not. It may not be disability or long term disability or something as dramatic. Or is it a death of an infant which has happened as well.
00:42:33 Dr Christie del Castillo-Hegyi
But even just the suffering that a mother experiences because she feels that her body is not meeting up to the social expectation societal expectation of what she can and should do for her child, and that no one wants to hear that they can't provide their child.
00:42:49 Dr Christie del Castillo-Hegyi
Guest no one wants to hear that, and so it is a very common finding in the parents we support where they have foregone sleep and taking care of themselves. Their mental health is in the dumpster because they're spending all their time in front of a pump.
00:43:08 Dr Christie del Castillo-Hegyi
To try to reach this unattainable goal for them, it doesn't even make sense. I I speak from experience because I was there. I experienced that. And yeah, you were there. I mean, that's countless parents have silently suffered this experience, and it's not right.
00:43:26 Dr Christie del Castillo-Hegyi
To have options that can lead to the best outcomes where you are recognizing the biology and the social circumstances of an individual family and coming up the best with the best solution, maybe it's a combination of breast milk or formula. Maybe it's just formula alone what works best for a family is a child.
00:43:47 Dr Christie del Castillo-Hegyi
Said a mom's father's family that is working well and is getting sleep and the whole family that is thriving as a result of their parenting regimen and we have forgotten that.
00:44:02 Dr Christie del Castillo-Hegyi
But that is the most important.
00:44:04 Dr Christie del Castillo-Hegyi
No.
00:44:05 Will Mountford
Which is why the Fed is best. Foundation has come to be, I suppose. Can you tell us all about the resources, the information available there, and what kind of platform you are providing for parents, for people going through childbirth and child rearing it, but also for clinicians and also for educators?
00:44:26 Dr Christie del Castillo-Hegyi
Thatisbest.org is where our platform mostly exists. It is a treasure trove of parent stories. People who have sent us their own personal stories of problems as well, successes with feeding their babies with either breastfeeding alone, combination feeding, temporary supplementation until they are able to exclusively breastfeed.
00:44:48 Dr Christie del Castillo-Hegyi
Formula feeding alone deciding or exclusive pumping all sorts of different stories that come from real people to tell you what the reality of it is, and then also from health professionals, things that health professionals have witnessed in hospitals as a result of the current.
00:45:04 Dr Christie del Castillo-Hegyi
Paradigm. And so the real story is there. And then we from these stories and from our review of pretty much everything that has ever been written about infant feeding and feeding complications, insufficient feeding complications, we've developed articles, guidelines, multiple resources to help parents know whether or not their babies are getting.
00:45:26 Dr Christie del Castillo-Hegyi
Adequately fed.
00:45:28 Dr Christie del Castillo-Hegyi
That includes daily milk calculator for any age child you have, you can put their weight, their age, their male, female or so on and so forth, and can come up with how much they need in a day. This applies to both breastfeeding and formula feeding families. Any milk, either of those they need that.
00:45:47 Dr Christie del Castillo-Hegyi
Amount per day and then signs of inadequate feeding. What normal labs are I have lectures on there. The link to the newborn weight loss tool, which is what helps guide normal versus abnormal weight loss with some caveats.
00:46:01 Dr Christie del Castillo-Hegyi
We also have social media. Right now, our largest platform is Facebook. I understand social media is evolving and there are other places where people spend their time, but right now we're on Facebook and we have a Facebook group and we screen and admit people into our parenting group and.
00:46:21 Dr Christie del Castillo-Hegyi
People give each other support and you know our moderators, our health professionals. So we make sure that anything that is either posted or responded to in our group is.
00:46:31 Dr Christie del Castillo-Hegyi
Sound advice, supportive, non judgmental, and right now we are in the middle of writing the Fed's best book, so we have a book scheduled to be published in June 2024 that is best guide and there's a full title I don't need to.
00:46:51 Dr Christie del Castillo-Hegyi
So, but at some point we'll be out. We also have a health professional group on Facebook for people to vent about the things that are happening in their hospitals and policies and how they can kind of advocate for their patients and maybe change hospital policies to make it safer for all babies. So those are the resources we have at this time.
00:47:11 Will Mountford
How do you remove yourself from the constancy of this work?
00:47:16 Dr Christie del Castillo-Hegyi
That's that's the thing. It's just you just have to. You do what you have to. I guess you know when you're a parent, you're a parent and and you know when something is necessary, you just do it. You know, there's, it's not a question of how. It's just you do because there are people who rely on you to be.
00:47:36 Dr Christie del Castillo-Hegyi
To be put together, people will rely on you to keep moving forward, you know, and it's just not not only my child, but other people's children that rely on this work, and there may be a minority.
00:47:47 Dr Christie del Castillo-Hegyi
But is important minority. It is something that shouldn't happen. It should never happen, ever. And yet it is. And so you keep doing it because you have to.
00:48:03 Will Mountford
Where can people find more and what do your message be to, you know, the different strata of public, professional and policy? What do people need to know in their family and for all families?
00:48:19 Dr Christie del Castillo-Hegyi
From a health policy perspective, we need more messaging to parents and health professionals at large. The importance of adequate feeding that the most important goal of breastfeeding and formula feeding combination feeding is making sure an infant is receiving their full caloric fluid and macronutrient and micronutrient.
00:48:39 Dr Christie del Castillo-Hegyi
Requirements every day without interruption in a way that allows them to reach their full potential. So we need that message out number one. Number two, we need policymakers to face the reality that the mothers, the population mothers, that they are, they are creating policies for.
00:48:56 Dr Christie del Castillo-Hegyi
Or do not have as perfect milk supply as they have believed, and that they need to face the reality that if that is the case and that is that it is common to find that in the population, it is the case that mother needs to be encouraged to supplement as needed, period that is.
00:49:17 Dr Christie del Castillo-Hegyi
Her right, her child's right to be fed. And if you don't provide the education or the permission, essentially for her to feed her child, what they need, whether it be breastfeed, breast milk and formula or formula alone, then that message will result in a child who does not get adequate nuts.
00:49:35 Dr Christie del Castillo-Hegyi
Option and then #3 from a global health policy. We need better monitoring of infant feeding parameters. So right now the subject of my paper is fatal hypernatremia. But there is a much larger population of infants who are experiencing hypernatremia, that is.
00:49:55 Dr Christie del Castillo-Hegyi
Those unrecognized in a study of universally screened term newborn infants.
00:50:00 Dr Christie del Castillo-Hegyi
Mixed cohort of breastfed, mixed fed and formula fed infants. It was found that more than 1/3 of infants met criteria for hypernatremia, so sodium of greater than one 45145 is hypernatremia and that is by definition dehydration and it is an indication for supplement.
00:50:22 Dr Christie del Castillo-Hegyi
At a sodium of 150 and above, it has been found in a study of 100 infants that were recruited consecutively and offered brain MRI 94 infants received that brain MRI. An astounding 42% had lesions on MRI consistent with injury.
00:50:41 Will Mountford
So almost half.
00:50:44 Dr Christie del Castillo-Hegyi
Yeah, almost half and right now, people believe that hypernatremia only occurs above 10% or 15% or 20% of these high extreme weight loss. It is found in that study that hypernatremia is occurring as early as 4.8% weight loss. So these newer.
00:51:03 Dr Christie del Castillo-Hegyi
Studies we are looking at the complication rates that are occurring as a result of our global health policy. They are showing that there is an unacceptably high complication rate and this is a major oversight in health policy.
00:51:19 Dr Christie del Castillo-Hegyi
And then, not to mention the now 30% of infants who are developing hyperbilirubinemia or excessive jaundice, that only occurred to 6% of infants before the baby friendly hospital initiative.
00:51:33 Dr Christie del Castillo-Hegyi
So this is a problem that did not exist before this initiative, and now we're here and we're not doing enough to prevent it. And they may look fine going out of the hospital. They may look fine after they get supplemented. It doesn't mean that they are fine in the years following, there is a problem. Families are experiencing it and they're going.
00:51:56 Dr Christie del Castillo-Hegyi
And to to live out the consequences of this flawed policy.
00:52:01 Dr Christie del Castillo-Hegyi
Now, from a hospital perspective, these are the things we can do. We need more frequent weighing of infants. We need every 12 hour weighing of infants because that's when they experience the greatest weight loss. The time from birth to about three to four days until milk comes.
00:52:19 Dr Christie del Castillo-Hegyi
Then.
00:52:20 Dr Christie del Castillo-Hegyi
Parents need to be taught to weigh their babies until their milk comes in, as at home with home baby scales, because that could potentially be life saving as well, because if they see that there's excessive weight loss at home, then they can issue initiate supplementation that can prevent these serious complications. Exclusively breastfed babies need glucose Mon.
00:52:40 Dr Christie del Castillo-Hegyi
During because they are receiving a fraction of their caloric requirement, the data shows that exclusively breast fed babies glucose levels are gradually declining until milk comes in, and if they reach a threshold below, let's say 454745, those numbers have been associated with higher risk of developmental.
00:53:03 Dr Christie del Castillo-Hegyi
The lower the worse, the lower they are, the worse the outcomes and the more prolong the hypoglycemia. The worst outcomes. And then lastly, we need more aggressive policies for preventing jaundice with formula supplementation. We have supplemented babies or donor breast milk if it's available.
00:53:22 Dr Christie del Castillo-Hegyi
Fed is fed as fed as fed. It does not matter if you have a safe alternative like donor breast milk or formula to feed it to prevent a child's dehydration, jaundice, or hypoglycemia. Feed it and then promote.
00:53:37 Dr Christie del Castillo-Hegyi
The breastfeeding worry about the breastfeeding at that point, there are many ways to keep up the stimulation for breast milk production without forcing a child to nurse day and night for hours at a time, losing weight during it, OK, and without forcing a mother.
00:53:54 Dr Christie del Castillo-Hegyi
To.
00:53:54 Dr Christie del Castillo-Hegyi
Lose sleep. OK, if you pump.
00:53:57 Dr Christie del Castillo-Hegyi
In place of a feeding that can provide adequate stimulation for breast milk production.
00:54:03 Dr Christie del Castillo-Hegyi
If you're making sure a mother is feeding at least every three hours for and pumping maybe 15 minutes each time, you can make sure there's enough stimulation to promote milk production. And most of all, we need policies that take care of the mom. So because of this policy, mothers are often forced.
00:54:23 Dr Christie del Castillo-Hegyi
To go without sleep, not only for the 2430 hours, however long as it takes to deliver the baby, but the three to four days after that, when the baby is crying nonstop.
00:54:34 Dr Christie del Castillo-Hegyi
Nursing nonstop, you know, putting the child at risk of accidental bed sharing when the mom falls asleep during breastfeeding or skin to skin and causing episodes and babies have literally died. From this, they have suffocated at their mother's breasts because their mothers have been too exhausted.
00:54:54 Dr Christie del Castillo-Hegyi
To stay awake through no fault of their own, this is a policy adverse effect. This is ridiculous. We've just the 10 steps has become a hazing ritual and it has negative effects that we are not fully informing parents.
00:55:11 Dr Christie del Castillo-Hegyi
We are following a 10 step that's become essentially transmutated into A10 commandments of breastfeeding to the point where in 2007, when two of the policies were actually abandoned by the World Health Organization expert panel, namely avoiding bottles and teats, was abandoned by the.
00:55:31 Dr Christie del Castillo-Hegyi
Expert recommendation based on lack of evidence and the pacifier, the No pacifier recommendation that was also.
00:55:38 Dr Christie del Castillo-Hegyi
Abandoned based on lack of evidence of promoting breastfeeding and also a pacifier use decreases the uses of SIDS so those two things were abandoned. But baby friendly USA has retained the recommendations despite their expert recommendations at the World Health Organization. Because of this belief that the 10 steps.
00:56:00 Dr Christie del Castillo-Hegyi
Have to be retained and kept together. I mean, it is religious thinking it is zealot.
00:56:07 Dr Christie del Castillo-Hegyi
Country. I mean, here you are. Something that is not actually helping and potentially harming infants by increasing rates of SIDS and you want to retain it just because science is not scientific thinking that is not evidence based. That's not even pro baby. That's just pro 10 steps.
00:56:28 Will Mountford
It's certainly not good care.
00:56:30 Dr Christie del Castillo-Hegyi
It is not good care. It is not good care and to promote it is the only way to provide good care to infants while effectively hiding the risks associated with it from parents. It is again negligence, absolute negligence.
00:56:49 Will Mountford
We'll put all the links that we can to the fetters, best resources in the episode description that goes with this and doctor Castillo, Hagee please keep on fighting the good fight for all of the babies and mothers and tired fathers out there as.
00:57:03 Will Mountford
Well, thank you.
00:57:05 Dr Christie del Castillo-Hegyi
Thank you.
00:57:05 Dr Christie del Castillo-Hegyi
Absolutely I will.