Re: new AAP recomendation regarding iron supplementation

[Guest guest]

I do not follow AAP recomendations personally or privately on several

issues - where a baby should sleep, pacifiers, vit d or iron

supplementation. I believe there are much better ways to deal with all

of these issues. I give mothers information based on the research,

studies, mother wisdom from LLLI and anthropology and of course my

training and reading and experience. So I am aware of the AAP but I

don't care what they say most of the time. I care what the Bf section

says but the AAP at large is bought by and large by big pharma.

I'm with Jay Gordon on this!

Micky

>

> Hi Everyone,

>

> Things have been really stressful for me at home so I am only now getting a

> chance to say... Yay me! I passed the exam... with a very nice score I will

> add to brag just a bit. ) But that is an aside. I actually have a

> concern for which I would like opinions.

>

> Right after I got my results the strangest thing happened. I was in a store

> shopping as I normally do and was passing by a woman in the juice aisle. As

> I was passing, she loudly said... " Please can someone help me " . I stopped

> and said " of course what is it " She then proceeded to tell me that she was

> trying to pick out a juice for her baby... not sure if she should get the

> expensive small 4 pack with the baby on the front or a regular bottle of

> prune juice. I paused thinking how to respond as I don't recommend juice

> for babies at all... but that really wasn't her question. I think she saw

> the confusion on my face or was just ready to pore out her heart... but she

> proceeded to tell me how she couldn't believe she was in this situation.

> That her perfectly healthy no problems up till now 4 month old baby went to

> see the pediatrician for a check-op a few days ago and was told she needed

> iron supplements. She had been giving them for 3-4 days and her baby had

> changed from happy and healthy to crying, constipated and miserable and she

> didn't know what to do. She was trying to find a juice to relieve the

> constipation. Thanks to you wonderful ladies and my LLL buddies, I knew

> about this new recommendation and could talk to her about it knowledgably.

> She was especially confused because she didn't understand why her baby

> needed it as she thought breastfed babies had everything they needed for 6

> months. She also said she asked how they could know her baby was anemic

> without a test to determine this... esp. since her baby didn't show any

> classic signs of anemia like fingernail blanching, paleness or dry skin...

> this was clearly a savvy mom (IMO). She was told by her pediatrician that

> all breastfed babies need the iron because they didn't get any in

> breastmilk.

>

> She was relieved to find out (by me) that the research this was based on was

> extremely limited and at the conclusion of our discussion put the juices

> back and went home to breastfeed her baby. She left happy and I left

> distressed.

>

>

> Here are my questions...

>

> - What do you do in situations like this where you disagree with the

> information and recommendations given to mothers?

>

> - Do you give different information based on whether the pediatrician has

> referred the mother to you?

>

> - As a IBCLC, do we have an obligation to follow AAP recommendations?

>

> Any and all thoughts are welcome.

>

> Tammie Cruell, IBCLC

>

>

>

>

>

>

>

--

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Micky , BS, CLD, CD(DONA), HCHI, IBCLC

Certified Labor Doula - CAPPA and DONA

Hypnobabies Certified Hypnosis Instructor

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mother-baby specialist

www.ninemonthsandbeyond.com

1-877-365-(MAMA) 6262

Now taking registrations for 2010 Hypnobabies Classes beginning:

Aug 3, Sept 12,Oct 5 and Nov 14 2010

Hypnobabies Video:

[Guest guest]

I tell my clients in this situation that their ped can do a blood test if there is a concern.... in addition to the way you handled this already! Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/--- Subject:

new AAP recomendation regarding iron supplementationTo: ibclc-pp Date: Friday, December 3, 2010, 3:52 PM

Hi Everyone, Things have been really stressful for me at home so I am only now getting a chance to say... Yay me! I passed the exam... with a very nice score I will add to brag just a bit. ) But that is an aside. I actually have a concern for which I would like opinions. Right after I got my results the strangest thing happened. I was in a store shopping as I normally do and was passing by a woman in the juice aisle. As I was passing, she loudly said... "Please can someone help me". I stopped and said "of course what is it" She then proceeded to tell me that she was trying to pick out a juice for her baby... not sure if she should get the expensive small 4 pack with the baby on the front or a regular bottle of prune juice. I paused thinking how to respond as I don't recommend juice for babies at all... but that really wasn't her question. I think she saw the confusion

on my face or was just ready to pore out her heart... but she proceeded to tell me how she couldn't believe she was in this situation. That her perfectly healthy no problems up till now 4 month old baby went to see the pediatrician for a check-op a few days ago and was told she needed iron supplements. She had been giving them for 3-4 days and her baby had changed from happy and healthy to crying, constipated and miserable and she didn't know what to do. She was trying to find a juice to relieve the constipation. Thanks to you wonderful ladies and my LLL buddies, I knew about this new recommendation and could talk to her about it knowledgably. She was especially confused because she didn't understand why her baby needed it as she thought breastfed babies had everything they needed for 6 months. She also said she asked how they could know her baby was anemic without a test to determine this... esp.

since her baby didn't show any classic signs of anemia like fingernail blanching, paleness or dry skin... this was clearly a savvy mom (IMO). She was told by her pediatrician that all breastfed babies need the iron because they didn't get any in breastmilk. She was relieved to find out (by me) that the research this was based on was extremely limited and at the conclusion of our discussion put the juices back and went home to breastfeed her baby. She left happy and I left distressed.

Here are my questions... - What do you do in situations like this where you disagree with the information and recommendations given to mothers?

- Do you give different information based on whether the pediatrician has referred the mother to you?

- As a IBCLC, do we have an obligation to follow AAP recommendations?

Any and all thoughts are welcome.

Tammie Cruell, IBCLC

[Guest guest]

Dear all:

Here's my commentary on the iron:

http://www.nancymohrbacher.com/blog/2010/11/29/do-breastfeeding-babies-need-extr\

a-iron-at-4-months.html?lastPage=true#comment10724178

Basically, the Nutrition Committee ignored the Breastfeeding Committee and the

head of the Breastfeeding Committee is asking the Nutrition Committee to take

their names off the document because the Breastfeeding Committee does not agree.

As far as I'm concerned, the Nutrition Committee did NOT provide any credible

evidence that you need to routinely supplement with iron at four months of age.

And the Breastfeeding Committee reached the same conclusion. So you can cite the

breastfeeding committee of the AAP if needed.

As for iron tests -- the typical test done in a pediatricians's office is NOT

accurate. It does NOT test for for iron deficiency, only anemia. By the time a

baby is anemic, the damage is already done. You need other tests that require

venous samples to detect iron deficiency before anemia. Prematurity, premature

cord clamping, low birth weight are all risk factors for needing additional iron

BEFORE six months.

Best regards,

E. Burger, MHS, PhD, IBCLC

[Guest guest]

Clinical signs of anemia are a very late term indicator. By the time a baby

shows clinical signs, the baby is SERIOUSLY anemic. Iron is EXTREMELY important

for cognitive development and delays from iron deficiency can lead to permanent

delays, so I would not mess around with waiting for a baby to become that

anemic. This is why it is important to add sources of iron to a baby's diet

AROUND six months of age when solids are started. And it is warranted to use

iron supplements for early babies because they missed the storage that occurs in

the last trimester of pregnancy.

Best regards,

E. Burger, MHS, PhD, IBCLC

[Guest guest]

My final comment on this is that even though I used it as an argument in my

blog, the sample size is not really relevant. If you actually have a

significant difference, by DEFINITION, the sample size is large enough for that

parameter. The sample size was too small to detect the potentially deleterious

effect.

The more relevant argument would have taken a lot longer to explain. That

argument has to do with the fact that the tests they used are subject to a lot

of wobble, are not really predictive of later cognitive development, and the

results were so mixed that I personally think that it was a statistical

artifact. If you go on a statistical " fishing expedition " where you look for

differences between groups on a large number of outcomes, you will find a

certain percentage of differences just by chance. The test for which they found

a significant difference was on psychomotor development. They found zero

difference for mental development. They had to throw out infants whose mothers

did not COMPLY with the administration of iron to find an impact for visual

acuity. This tells me that they had a certain amount of side effects with the

syrupy liquid and/or the iron itself that cause mothers to not want to give the

iron or the baby to spit it out. The formula industry uses the visual acuity

information to claim that their DHA formulas improve cognitive development.

Those links are limited at best.

Furthermore, the iron absorption for these infants was compromised early on

because they were not, for the most part, exclusively breastfed.

Best regards,

E. Burger, MHS, PhD, IBCLC

[Guest guest]

In cases like this I speak from my own resources, and the parents get to decide

which approach they choose to follow (as it should be!). I'm not reluctant to

interject information as I know it, I think they key here is we better 'know'

it. Meaning for me I'm prepared to have a MD or CNM consult with me about the

recommendations I make and am prepared to provide the research/data to support

it. Thankfully from what I can tell I work in a collaborative community, I work

with a lot of providers and see a lot of clients and I have yet to experience

what I would consider a 'conflict' with any HCP about my recommendations,

although I have had my share of what I would consider collegial, lengthy

discussions about issues where the HCP was grossly misinformed. Probably the

most lengthy discussion I've had took about half an hour for us to thoroughly

exhaust review of one another's resources regarding a chest scan and the HCP's

direction to pump and discard, which wasn't necessary and the MD eventually

withdrew her instructions. I don't mean being challenged (for lack of a better

word) about these types of things, I think in most cases it comes from a place

of regard for the safety of mom and baby so I am happy to dialogue about it.

So you might respond to " wackadoo " recommendations with something like, " Hmmmm,

that's interesting. I'm not familiar with that recommendation. My training and

resources have concluded..... " I've given patients copies of various resources,

printed LactMed to share with them and they can share it with their provider to

discuss as they desire etc.

I think the key lies in our ability to be diplomatic with our communication

style. I think we are obligated to correct misinformation when it appears before

us.

>

>

> Hi Everyone,

>

> Things have been really stressful for me at home so I am only now getting a

chance to say... Yay me! I passed the exam... with a very nice score I will add

to brag just a bit. ) But that is an aside. I actually have a concern for

which I would like opinions.

>

> Right after I got my results the strangest thing happened. I was in a store

shopping as I normally do and was passing by a woman in the juice aisle. As I

was passing, she loudly said... " Please can someone help me " . I stopped and

said " of course what is it " She then proceeded to tell me that she was trying

to pick out a juice for her baby... not sure if she should get the expensive

small 4 pack with the baby on the front or a regular bottle of prune juice. I

paused thinking how to respond as I don't recommend juice for babies at all...

but that really wasn't her question. I think she saw the confusion on my face

or was just ready to pore out her heart... but she proceeded to tell me how she

couldn't believe she was in this situation. That her perfectly healthy no

problems up till now 4 month old baby went to see the pediatrician for a

check-op a few days ago and was told she needed iron supplements. She had been

giving them for 3-4 days and her baby had changed from happy and healthy to

crying, constipated and miserable and she didn't know what to do. She was

trying to find a juice to relieve the constipation. Thanks to you wonderful

ladies and my LLL buddies, I knew about this new recommendation and could talk

to her about it knowledgably. She was especially confused because she didn't

understand why her baby needed it as she thought breastfed babies had everything

they needed for 6 months. She also said she asked how they could know her baby

was anemic without a test to determine this... esp. since her baby didn't show

any classic signs of anemia like fingernail blanching, paleness or dry skin...

this was clearly a savvy mom (IMO). She was told by her pediatrician that all

breastfed babies need the iron because they didn't get any in breastmilk.

>

> She was relieved to find out (by me) that the research this was based on was

extremely limited and at the conclusion of our discussion put the juices back

and went home to breastfeed her baby. She left h