Saturday, 21 February 2009

Quick hit: Breastfeeding and dehydration

Here's a snippet from a lengthier article on Stuff today:
The World Health Organisation recommends exclusive breastfeeding until about six months of age and continuing breastfeeding with other foods to at least two years.

In England, it was reported that the push to exclusively breastfeed in the early months could increase the number of dehydrated babies because people were hesitant about criticising the practice.

Dr Sam Richmond, a consultant neonatologist at Sunderland Royal Hospital, said there had become something of a "religious affiliation" to breastfeeding,

Otago University Associate Professor of Human Nutrition Winsome Parnell said past research had suggested topping up with water in hot climates.

"New Zealand is temperate, so it's not the usual route. If a mother doesn't have enough breastmilk then formula must be given because giving water does not solve the energy problem."
I seem to recall being advised by several health professionals that it was ok to give Wriggly some teaspoons of cooled boiled water when it was really really hot, not long after he was born. He was breastfeeding and taking everything I had, and then still hungry, so until my milk supply came up enough we would top him up with some formula when he needed it. I felt pretty awful that I didn't have enough milk, but I got over it when it became apparent he was thriving anyway. I would have thought dehydration was pretty uncommon in breast fed babies, because they are pretty assertive about wanting more!


Anna said...

That's really interesting. I suppose it's logical that in hot weather, both mums and babies will get dehydrated - but since I had my babies in the lower half of the South Island, that wasn't a problem!

I completely acknowledge all the advantages of breastfeeding, but I do actually get a bit annoyed at people who are really hard core about it - because it makes those women who can't or choose not to breastfeed feel like inadequate mothers.

Having said that, I understand that being hard core about breastfeeding has been a political necessity, and I'm grateful for the women who've taken the issue up. I'm thinking back to the bad old days where a woman had to hide this almost indecent activity away.

Jennifer said...

I asked the doctor about this - my first baby was born into a Sydney summer. He said that as long as the mother isn't dehydrated, her breastmilk will adapt to cope - so the baby will drink more fluid, and it will contain the right level of nutrients.

Mothers have been breastfeeding babies in hot climates for thousands of years. I suspect the system copes pretty well.

lauredhel said...

Dehydration can certainly happen if feeding on a time-based schedule, which so many ill-informed sources (including healthcare practitioners and parenting books) are still pushing.

Babies who can breastfeed on cue can regulate their own thirst needs as well as their own hunger - and the breastmilk will adjust (frequent small feeds of watery foremilk) in a way that formula cannot.

And parents need to know how to assess their baby's hydration state, monitor urine output (more difficult with disposable nappies, unfortunately), and act accordingly.

Any talk of public health advice about water and small infants needs also to include a consideration of the risks. A teaspoon here or there obviously isn't going to kill a baby, but more can. Specifically, I'm talking about the risk of hyponatremic seizures when a small baby is given water to drink instead of breastmilk. Unfortunately, bottled water products have been marketed specifically aimed at the infant market, making the issue worse.

Tui said...

Unfortunately, bottled water products have been marketed specifically aimed at the infant market

Seriously? And I thought bottled water aimed at adults was bad enough. UGH.

Anna said...

I've got a bee in my bonnet about rigid feeding schedules too (although I haven't seen it in any recent official advice sources). I did get criticised for 'feeding on demand' though - apparently, it showed my self-indulgent lack of firmness as a parent, and was likely to produce children who grew up with no self-control. Whatever.

Azlemed said...

i have demand fed all of mine babies, sometimes i have given them boiled water but generally not in the first three months.

you do have to be militant at times in support of breastfeeding because of the pressure you feel to wean, or that you arent giving them enough etc. its unfortunate that we have to be like this.

hungrymama said...

Like Lauredhel said the boiled water is pretty bad advice. A baby fed on cue (a much nicer and more accurate word than demand IMO) by an adequately hydrated mother is very unlikely to get dehydrated in even the hottest climate. I believe breastmilk's composition changes when the weather does to meet the baby's need for hydration and babies often change their feeding patterns too often having lots of small feeds when it's hot.

The issue with dehydrated breastfed babies is AFAIK largely a beat-up and most of the cases have been caused by either scheduled feeding or a undiagnosed breastfeeding problem. If mothers are educated in what is normal for a breastfed baby, know how to tell when they have a problem and have the support to solve those problems this kind of dehydration would be very rare.

Julie said...

Thanks for all the feedback. I think the issue of the adequately dehydrated mum deserves some further discussion - I found this very difficult in those weeks after birth when I was pretending to be all Super Mummy and we had lots of people visiting the house to see Wriggly. Hardly anyone offered to get me a drink but many expectd me to make them one!

Anna said...

Very good point, Julie - I very seldom just sat down and fed my baby. Usually I was doing a million other things simultaneously (partly because I have trouble sitting still, but mostly because I had a million things to do). When life's like that, you can miss the cues from your own body - which is likely to impact on the baby, I guess.

M-H said...

Julie, when people visit you and you have a new baby the best thing is to sit down with the baby and say "Oh, sorry, s/he's due for a feed; would you mind putting the jug on?" They always go and make it for you. :) And, always drink a glass of water as you feed. That's a good way to prevent dehydration. I had three under four so I had to learn tricks to look after myself.

M-H said...

Oh, and I fed on demand (I like 'cue') and never gave boiled water. My kids didn't get spoiled. Well, that's my story.

hungrymama said...

Nature must have had here eye out for me ;-) I often get a raging thirst just as my milk lets down, especially in the early days, so I very quickly learned to make sure I had a water bottle to hand whenever I was feeding.

Julie said...

I should probably clarify that I never did give Wriggly any boiled water, he didn't need it. He mostly a routine feeder right from the first few days in hospital - he'd wake every four hours for a suck, and you could literally set your clock by it most of the time. I wouldn't have minded doing cue feeding (much nicer than demand!). If I have another one who knows what would happen?!

hungrymama said...

Julie - do you mean you imposed a every-four-hours feeding regime or do you mean that Wriggly cued to feed every four hours and you responded when he did because if it's the latter then that really is what cue feeding is.

Every four hours is the very outside of how often I'd be comfortable with a newborn eating but some do fall into that routine by themselves and as long as they are peeing, pooing and gaining weight that's ok.