Why I'm concerned about Tizzie Hall's Breastfeeding Advice - PART 1

I'm going to make this two part entry my last for a while on the subject of Tizzie Hall. I mentioned in my last blog post that I wanted to cover one particular section of her breastfeeding advice - an area which concerned me. However this post ended up so long I have split it in half so you can stand a chance of getting to the end ;)

Part 1 which is below, explores restricting breastfeeding frequency, some of Tizzie's ideas and why I think mums planning on following Tizzie's advice should be cautious...

In her book "Save Our Sleep", Tizzie firstly suggests that feeding "on demand" may be linked to obesity in later life.

"If your baby knows you will keep offering him a snack every couple of hours, he will never feel the need to have a full feed.  Putting your baby on a routine gets him into the habit of filling right up when you offer the breast or bottle, because he soon learns it will be quite some time before you make the offer again."

and

"Teaching bad habits:
If you feed your baby every time he cries, you run the risk of teaching him that the answer to all his emotional ups and downs is to eat, irrespective of whether he is actually hungry.  For example, if a baby is tired and crying because he doesn't know how to put himself to sleep, feeding teaches that he needs to eat in order to fall asleep.  If a bored and crying baby is picked up and fed he starts to understand that if he is bored then eating will help.
My problem with this is that as your baby turns into a toddler, his whingeing will see you starting to replace bottles or breastfeeds with a piece of fruit or a biscuit which reinforces the regime of feeding him when he cries.  Perhaps that is one of the reasons why we now see a lot of obesity in children and teenagers, and why others eat to solve emotional imbalance."

What doesn't get a mention in the "obesity ponderings" is that not breastfeeding has long been linked with increased risk.  But that aside really just how healthy is "filling right up"?  Don't recommendations now support responsive feeding regardless of how an infant is fed?

Breastmilk is digested within a couple of hours, so a baby eating every couple of hours isn't "snacking" -  but eating normally.  Little and often is actually exactly how humans are supposed to eat, it keeps blood sugars stable and promotes normal metabolism.  Paul Mckenna's whole diet theory is based on adults learning to re-recognise when they are full, but at what point did they forget?  Milk is all an infant gets, their tummies are much smaller than ours - yet I wonder how many people reading ensure no food or drink passes their lips unless three hours has passed?

Lynne Daniels, a professor of nutrition at Queensland University of Technology, Australia, and researcher with the Early Prevention of Obesity in CHildren (EPOCH) collaboration, has demonstrated routine fed infants were heavier at 14 months than those fed responsively.

The professor said: 

"If the mother is responsive, she is responding to the child’s cues of hunger and not over-riding them.  Whereas, if a mother feeds in schedule, she decides whether or not he is hungry."

Quite.

Tizzie goes on to say:

"I don't want to infer that demand  feeding won't work for everyone.  In the end, all parents have to do what it best for them and if you are one of the lucky ones that can interpret your baby's cries, that's great."

It's fascinating that someone calling themselves a "Babywhisperer" thinks babies need to cry to tell you they're hungry.  Crying is the last cue of hunger - one that only comes out to play if all his earlier signs are ignored..

Secondly - Tizzie expects mothers to tell the difference between a "protest" (which she defines as the equivalent of a temper tantrum) and an "emotional" (has a need) cry, based on a description in her book - but then states mothers who can interpret cries are the lucky ones.  Confused yet?

Thirdly it assumes breastfeeding is all about calories.  It's not.

Truth is that the breast meets every need a newborn has except a dirty nappy - the skin to skin regulates their temperature and other vital stats, so baby doesn't need to expend energy doing so.  Milk is a live substance and at night contains properties that induce sleep, whilst the act of feeding releases hormones to relax both mum and baby (strange if we aren't meant to feed our infants to sleep or during the night!).  If baby is hungry or thirsty it nourishes, and it provides the ultimate security for a newborn who only has 25% of his brain fully developed at birth and who is working at a very primal level.

Furthermore breastfeeding is recognised as pain relieving, and in the early days has more antibodies than blood.  If baby is feeling under the weather he often turns to the breast, and with good reason.  The germ is passed to mum, she makes relevant antibodies and then passes them back to baby at subsequent feeds.

It is a baby's first "vaccination" and the most nutritionally complete food they will ever consume.

Let's look at Tizzie's list as to what she states prompts an "emotional cry" in her TV appearance with Kerry Ann::

• Discomfort 
• Hunger
• Tiredness
• Wind
• Thirsty
• Hot or Cold

Yep - breast takes care of those.  And want to know what else?

"It is now known that high levels of melatonin in breast-milk appear during the night and low levels during the day. Since melatonin is the hormone that regulates the sleep/wake cycle, these changes in breast-milk will doubtless be the signal to help the baby adapt as quickly as possible to the day/night versus sleep/wakefulness environment. (1-4)"

Yaha - so the breast even helps them start to regulate sleep cycles.  Top that Tizzie ;-)

What did bemuse me a little is how simplistic Tizzie's list of needs that can cause an emotional cry is - what about scared, lonely, needing a cuddle?   Tizzie claims in one of her TV interviews that she doesn't support "controlled crying" - the act of leaving a baby to cry but checking in with them every so many minutes. She states that if you return to an infant when they're "protesting", they will then start an "emotional cry", feeling rejected they've been left.

Yet walking in and out wouldn't cause any of the list above, which would seem to prove that babies cry an "emotional cry" for not only the six tangible reasons Tizzie claims, but also for reasons we can't label quite so neatly - rejection being one.  Interestingly in her book she adds a seventh item to her list which is "bored" - we can accept an infant can be bored, but not scared?  or that they might indeed use a cry with gaps to signal a great deal more than a "protest" or "temper tantrum".

The book describes a child falling asleep protest crying (this is from the section advising to leave a newborn to "protest" for a minimum of two minutes):

"If you are able to watch your baby without him seeing, you will see him shut his eyes and nod off before jumping and yelling again, as though he has realised he is falling asleep"

Why would any animal not want to sleep? Especially a tiny baby. Why would it be normal for them to half fall asleep, realise, panic and start "yelling" again?

All I do know is I don't observe any of this fighting, crying or jumping awake realising they're falling asleep when baby does so in a sling or next to mum.  Perhaps because baby feel safe, isn't scared to sleep - ultimately is where he is supposed to be?

Tizzie talks about how many mothers nowadays don't have the community that passes down tips and knowledge - but if we follow that logic right back, Stone Age women used slings...

The psychology of how adults respond to cries is also very interesting, in studies adults responded similarly to different pitch and frequency of crying - different types of cry clearly evoke different feelings and I suspect this is for a reason; the more urgent the cry, the quicker the response (pretty important if there's a tiger near by and you're a baby on your own!) but does this therefore mean as Tizzie suggests that non intense crying, or crying with gaps should be ignored, particularly if they trigger an instinct in mum to respond?

Tizzie warns:

"it's not fair on baby to be taught that someone will respond to every protest because, as your baby grows up, other people won't like this behaviour."

What behaviour? a child who expects his feelings to be acknowledged?  Yes perish the thought.  I do hope Tizzie never has cause to visit Mongolia - because there babies are wrapped up like parcels and put to the breast everytime they squeak for the first six months.  Imagine their behaviour! (not to mention of course they must all be obese).

Regardless, what Tizzie seems to fail to realise is that over the coming days and weeks as the mother learns her newborn and he develops - the relationship progresses so mum can understand his cries, and he soon develops lots of new ways to express himself too; which doesn't result in a comfort eating toddler!  This would make no sense as the entire population would be obese prior to the introduction of scheduled feeding (which took off in Victorian times).

It also assumes toddlers "whinge", and that a mum would respond to this with food instead of communicating with her child, and that a toddler will eat a piece of fruit if not hungry - what are these assumptions based on?  Clearly not cue fed infants as that results in a toddler who has retained the ability to regulate their own appetite (as long as starting solids hasn't been handled insensitively) which I guess will mean he also won't need to buy Paul's book when older....

Click Here To Read Part Two. which explores Tizzie's recommendation to also limit the duration of feeds.

RELATED POST: Suck a finger with Tizzie Hall...

References:

1. Illnerová H, Buresová M, Presl J. Melatonin rhythm in human milk. J Clin Endocrinol Metab 1993; 77: 838–841.

2. Cubero J, Valero V, Sánchez J et al. The circadian rhythm of tryptophan in breast milk affects the rhythms of 6-sulfatoxymelatonin and sleep in newborn. Neuro Endocrinol Lett 2005; 26: 657–661.

3. Cubero J, Narciso D, Aparicio S et al. Improved circadian sleep–wake cycle in infants fed a day/night dissociated formula milk. Neuro Endocrinol Lett 2006; 27: 373–380.

4. Aparicio S, Garau C, Esteban S et al. Chrononutrition: use of dissociated day/night infant milk formulas to improve the development of the wake–sleep rhythm. Effects of tryptophan. Nutr Neurosci 2007; 10: 137–143.