Pediatrician’s perspective on pumped breast milk

[sophiahrz]

ETA UPDATE: Which is primarily to say thank you so much to everyone for taking the time to read & engage with this post. For those of you not familiar with exclusive pumping, many of us found our way to this form of feeding after nursing didn’t succeed- often times quite emotionally. Only to say that knowing when to wean can be difficult after working so hard to adjust to plan b. This is just to explain how much I appreciate being able to process with all of you- sincerely, thank you so much for the support. I know that pediatrician had mine & my LO’s best interest at heart (as all pediatricians- regardless of varying opinions- do, right?). As for the PPA comments- thank you for your concern and speaking up. It makes a difference. I’ve spoken openly with my Ob and pcp and both have cleared me of PPA but gently said I’m just working through “normal” new parent anxious feelings, if you will. Who knew it came with the territory of adjusting? Not me . Another reason your support is appreciated. All the best!!

Hi! Cross over post from r/exclusivelypumping thank you so much for any feedback!

Pediatrician perspective

Hi and as always thank you to this community who has been so helpful and supportive. TLDR: yesterday we had my LO’s 4 mo pediatrician appt. Pediatrician said at this point benefits of breast milk are primarily for bonding/ nursing and if pumping is not something I enjoy, wean. Many, many more thoughts and details below. I welcome opinions and thoughts on next steps.

More details/ context: my LO is 4.5 mo (appt was a little late) and I have been EP since 6 weeks primarily because both my husband and I felt so strongly about LO having the benefits of BM. I cried endlessly for weeks after nursing failed and went through phases of hating pumping. Quick context for me personally: undersupplier, currently 5ppd (no motn pump), supplement my supply with formula which LO tolerates well, probably 90%bm, 10% formula. I have recently been feeling pretty good about our situation (as compared to different times during my pumping journey where I felt trapped/ in pain/ very upset). I was feeling like my updated from 1 year to 6 mo goal was very reasonable, and we wanted to chat with pediatrician to see if, for example, BM would benefit him significantly more at 8 mo as opposed to 6- I would be able to make it.

New ped for us, and when we told her about our current situation she said essentially my summary above. That at this stage for LO since he’s 4.5 mo, the primary benefit of BM would be nursing/ bonding but if we are picking up baby and responding to them when they cry, all good on the bonding front. She also only suggested that because they tolerate formula well- growing and sleeping well and also because I said I didn’t really love pumping. Which, despite being at a good place with it, like- of course it’s tiring to wake up early, stay up late, have to coordinate 4.5 hours of pump time, have sensitive nipples constantly etc. I told her I had read that providing BM past 6 mo could help prevent cancer, etc. and she said none of those studies had been proven, and that genetics play a much larger role than anything else. She also said if I have extra milk it would be great to give to LO when they are sick, and also made a comment to the effect of BM very beneficial when they are younger for immune system- I think she said before 3 mo. I was kind of in shock so don’t remember exactly what she said but she was definitely pro- Bm. I had a call with her while pregnant and she said the practice standard is “breast is best” so just for context on their perspective.

I think I just… don’t know what to do with that information?! I’m really surprised, and despite feeling like she’s given me “permission” to stop pumping (for the reason I personally cared about), I am somehow having a very difficult time with the thought of weaning?! Yet- I can see how my life would be so much easier if I was no longer pumping (or even pumping less?). We’re in the process of trying to sell our house and move, which will mean my husband’s commute is further/ will be home less to help watch our LO while I pump. Maybe I just wait until the timing makes more sense to drop pumps/ wean?

Any opinions, perspectives, advice welcome and appreciated.

I also want to say I know this is one pediatrician’s opinion and I promise I am everyone’s biggest cheerleader for those who are providing BM far past where I’ve made it thus far. I see and appreciate your sacrifice and am so glad that’s working for your family. For those who maybe didn’t make it to where I am, perhaps some reassurance if LO got any of your BM? The best to everyone, always!

 

[sarebear1992]

@sophiahrz Reposting more or less the same thing I post every time in response to a post like this.

The TLDR version is: your pediatrician is right. there is no scientific evidence to support any long term or lasting benefits of breastmilk over formula, particularly in the developed world and once accounting for socio-economic status. Generally breastmilk-fed babies can expect a cold or two less a year (maybe) and possibly less eczema in their first year of life. There is also no science analyzing combo feeding or what amount of breast milk provides “benefits” as almost all studies compare exclusively breast fed babies to exclusively formula fed. That’s not to say that you personally might not find benefits from combo feeding or pumping or a personal satisfaction in providing for your LO in that particular way. I pumped until LO was 4 months old because to the extent there are proven scientific benefits they start tapering off around there. I was lucky to have an oversupply so we got LO through til about 5+ months largely on breast milk. Honestly though, pumping is HARD and for me it was taking time away from LO for, IMO, no reason.

Longer discussion below:

So there’s no actual science supporting X amount of breastmilk delivers “benefits”. Largely because most studies compare exclusively formula fed babies to exclusively breast fed babies. It’s also hard to measure because it’s unclear which “benefit” we would be trying to measure and how to decide how much breast milk to test (25%, 50%, a set ounce amount). It’s a real gap in the research that I think we all wish we had a better answer for. People usually cite to a Kelly mom article for the 50ml stat but she doesn’t provide any sourcing to back it up.

The AAP has a study that shows some benefits (table 2) using an “ever” vs never breastfed comparison but it’s not adjusted for socioeconomic status and therefore it doesn’t really make a lot of sense (like it doesn’t make sense that one instance of breastfeeding (an “ever”) would result in a 40% decrease of some disease). https://publications.aap.org/pediat...ding-and-the-Use-of?autologincheck=redirected

What we do know from the sibling studies and PROBIT, is there is really no discernible or lasting difference in health or intelligence outcomes between formula fed and breastfed babies. So do whatever works best for you, your mental health and your family.

Here’s one sibling study.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4077166/

Breastfeeding rates in the U.S. are socially patterned. Previous research has documented startling racial and socioeconomic disparities in infant feeding practices. However, much of the empirical evidence regarding the effects of breastfeeding on long-term child health and wellbeing does not adequately address the high degree of selection into breastfeeding. To address this important shortcoming, we employ sibling comparisons in conjunction with 25 years of panel data from the National Longitudinal Survey of Youth (NLSY) to approximate a natural experiment and more accurately estimate what a particular child’s outcome would be if he/she had been differently fed during infancy.

Results from standard multiple regression models suggest that children aged 4 to 14 who were breast- as opposed to bottle-fed did significantly better on 10 of the 11 outcomes studied. Once we restrict analyses to siblings and incorporate within-family fixed effects, estimates of the association between breastfeeding and all but one indicator of child health and wellbeing dramatically decrease and fail to maintain statistical significance. Our results suggest that much of the beneficial long-term effects typically attributed to breastfeeding, per se, may primarily be due to selection pressures into infant feeding practices along key demographic characteristics such as race and socioeconomic status.

Additional easier to digest research here:

https://fivethirtyeight.com/features/everybody-calm-down-about-breastfeeding/amp/

https://freakonomics.com/podcast/how-important-is-breastfeeding-really/#:~:text=OSTER%3A%20One%20of%20the%20real,this%20if%20they%20want%20it.

 

[sophiahrz]

@sarebear1992 Okay- seriously thank you so much for taking the time to write all of this out. I think I’ll have to read through this a bunch of times to process so apologies for a lack of a more thorough response! My husband is very science-y so he will love reading all of this, too. Thank you

 

[sarebear1992]

@sophiahrz Of course! It’s so hard. I thought breastfeeding would be easy for me and was obviously “the right” thing to do. But it wasn’t. LO was born at 37+2 had a terrible latch, and I was a FTM. I saw a bougie lactation consultant several times to try and make breast-feeding work and instead ended up exclusively pumping around six weeks. My husband is an ER doctor and was very supportive of me doing whatever feeding method I felt most comfortable with, but he was very clear from the start with that formula was an equally valid and beneficial option without pressuring me one way or another. Good luck with whatever you decide!

 

[robinrocks]

@sarebear1992 Thank you, also came here for all this info!!

 

[wackyjacqui]

@sarebear1992 I mean, sort of? I read Emily Oster's take on this too, and I wanted to be persuaded by it, but my independent dive into the research persuaded me that the AAP / WHO recommendations are actually better supported.

Oster makes it sound like researchers are just naively overlooking obvious cofounders like maternal IQ, socioeconomic status, etc. that drive group differences, when in fact there are many studies that include such controls. Here, for example, is an older meta-analysis that finds an adjusted IQ difference of about 3 points (and you might be surprised by Table 2 if you only read Oster). Here is a more recent one that reaches the same conclusion. Here is an even more recent study that has similar findings, and which assesses breastfeeding duration (not simply breastfeeding yes/no). There is also research to the effect that children whose mothers chose to provide milk but failed to do so had the same IQ as those whose mothers elected not to provide breast milk.

Another interesting study that deals with confounding, and potentially also "combination" feeding, looked at preterm infants whose breastmilk was supplemented by formula in varying amounts as needed, and the feeding quantities were carefully monitored in the NICU. It found a dose-response relationship; infants fed a higher percent breastmilk had improved cognitive development, even controlling for SES in the regression.

Even within sibling studies, the results are conflicted. Here's one that finds "a persistent positive correlation between breastfeeding and cognitive ability."

A separate body of research looks at experimental formulas that are chemically closer to breastmilk. Unlike with breastfeeding, you can truly randomize who gets an enhanced formula versus standard formula. New research (e.g., 100331-1/fulltext), 2) is showing long-term cognitive benefits for infants who were randomized to receive the enhanced formulas that are closer to breastmilk, even after applying additional SES controls.

And I've only touched on cognition, not the other health benefits summarized in the AAP's recommendation. And the effect sizes are small! But in the view of this anonymous internet commentator, the AAP / WHO recommendations seem supported by the preponderance of the evidence.

 

[alangeh]

@sarebear1992 Question on this, I’ve heard this stance before and seen these studies, but wonder why the WHO and AAP and every other body we often trust explicitly disagrees that there’s no evidence, and we consistently challenge the available data? Whereas other guidelines by these agencies are taken as the gold standard and essentially law.

 

[sarebear1992]

@alangeh My view is that it’s because 1) the WHO is trying to give best practices globally. The reality is much of the world doesn’t live with US/European privilege or access. So things like clean drinking water for formula, or to clean and sterilize bottles, or relatively accessible healthcare or preventive disease treatment aren’t accessible. In those situations there are substantial benefits to breastmilk over formula and 2) same, to a large extent, for the AAP. I cited to an AAP study, but it doesn’t adjust for socio-economic status. It’s easier to say you should breastfeed over formula than to say get out of poverty (along with all the attendant behaviors that come with that, like less smoking, lower maternal BMI and better maternal healthcare, better access to fresh food and prenatals, ect.) So much of the advice is designed for the lowest common denominator and it can’t, inherently , be individualized. We know that the largest predictor of childhood health, IQ and success is parental socio-economic status and education, not formula or breastmilk.

Also. A separate rant. But it is INSANE that they recommend 2 years of breastfeeding. It completely ignores the reality of working women of all stripes and basically presumes that women have enough time, money and resources (or such a lack thereof that they have no working options) to do so. It is to, to me, a regressive and unrealistic view of a woman’s place in the modern world.

 

[netwaxer]

@sarebear1992 2 years seems insane if you don't know the details on how it actually looks for toddlers - many will nurse twice a day, once in morning and once before going to sleep. And for many women that would be actually doable. It is not at all the same as with kids below 12 months.

 

[angel_sword]

@sarebear1992 I still nurse my 15 month old in the morning and evening and it’s not a big deal. He eats solids the rest of the day. There is intense pressure to wean him and I wish people would just stop asking me when I will finally wean. It’s not like they see it anyway but I don’t want to lie either. I have to say it’s super depressing to read all these posts on how breastmilk is not beneficial at all since that’s one thing where I actually felt good about something with my child and actually enjoyed.

 

[newparadigm]

@angel_sword The fact that you feel good about it and enjoy it, is benefit enough. Ignore everyone and do what works for your family.

 

[toysernis]

@angel_sword The vast majority of mothers you meet won’t even have nursed 3 whole months. Of COURSE they’re going to tell you it isn’t that important to breastfeed. Breastfeeding is the one area on this sub where we are supposed to be quiet about the science (and suspend common sense)eat someone’s feelings get hurt.

 

[toysernis]

@sarebear1992 It literally takes maybe 10 min a day to nurse my 2 year old lol. Not sure how that’s unrealistic for “women in the modern world” or whatever but toddlers (particularly 15+ months) do not nurse much at all.

 

[sarebear1992]

@toysernis Well considering fewer than 25% of American women even make it to 6 months of exclusively breastfeeding, it seems pretty unrealistic. And that’s not even considering multiple kids and how many years that takes.

 

[toysernis]

@sarebear1992 Currently tandem nursing a 4 month old & a 24 month old. I am well aware of what it takes and the ways people do or don’t accommodate for that. It’s unrealistic if you don’t want to make changes to do it, sure. The fact that most people choose the easier route doesn’t mean the harder route isn’t possible.

 

[sarebear1992]

@toysernis That’s great that your lifestyle and whatever your profession is has enabled you to do that. Most women’s don’t. And placing it entirely on women taking an “easy” route or not being willing to make “changes” isn’t fair. The truth is that American policy choices and nearly all employers don’t make it possible, regardless of how much that woman might want to. Just look at how inadequate the PUMP act is and that’s considered groundbreaking legislation.

ETA: i see your a SAHM. That’s wonderful and I’m glad it gave you the option to breastfeed your children how you want. Many many many people cannot afford to be SAHM. My comment was, I thought, pretty obviously referring to working women. And also the concept that women should be at home full time rather than having careers.

 

[toysernis]

@sarebear1992 Yup, US maternal support could be improved… but if breastfeeding is actually important to you, you can absolutely make changes prior to even conceiving a baby to make sure you’re more easily able to do so. Though when most babies aren’t planned in the first place, can’t really expect parents to really be intentional with this stuff, I suppose. Still doesn’t mean the recommendations should cater to the fact that some people fail to plan for parenthood. BFing to age 2+ at mother’s and baby’s comfort and desire is biologically normal and is the best practice, regardless of anyone’s individual feelings on the matter or how possible any given family feels it is for them.

 

[nyki_t]

@alangeh There is evidence.

 

[nyki_t]

@sarebear1992 This meta analysis suggests benefits after 4 months: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-021-01950-5

 

[sarebear1992]

@nyki_t Interesting but, to me personally, not that persuasive. and though she has her flaws, I buy into the Oster approach to this type of analysis. One, there’s no accounting for genetic risk factors which are the largest drivers of cancers in general. Two, the overall risk of childhood leukemia is extremely low, so this is a question of does a statistically significant difference as a matter or research mean anything in the real world in terms of decision making? In other words, the rate of childhood leukemia is approximately 4.9 per 100,000 or the odds of occurring is .0049%. This meta analysis suggests that breastfeeding for 9 months may reduce that risk by 20%. Now that is certainly statistically significant but most people would not change their lives based on something that has a .0049% chance of occurring to make it a .0039% chance. Again that’s not to say there are no benefits of breastfeeding, but they’re really aren’t any long term or lasting ones for health outcomes or IQ. And by 6 months old, less than 25% of babies in the US are exclusively breastfed. Clearly there’s not something horribly wrong or terrible outcomes for the vast majority of US babies.