Big Thumbs Down For Dr Ellie

Dr Ellie off the Telly decided to add her two penneth to the whole "feeding older babies" debate this weekend.  For those who haven't had the pleasure, Dr Ellie is a bit like a female version of Dr Christian Jessen; her website confirms she:

"Works in a busy inner city NHS practice as well as a private practice. She has a very family-orientated practice, specialising in children health from newborns to teenagers."

It's never promising when the publisher is the "Daily Mail", but as Dr Ellie specialises in infants and children - she will surely have her facts straight right?

Errrrrrrrrrrrrrrr hmmmmmmmmm

"Women who breastfeed their older children argue they are doing nothing wrong, and that each mother should be free to do what is right for their child, whether not to breastfeed at all or continue indefinitely.
But as a doctor, I must advise there is little benefit and possibly harm to be done by the latter."

Yikes, right!

Best read on!

Dr Ellie acknowledges the WHO recommendation to breastfeed for two years before adding:

"But there is little evidence of any health benefits beyond the age of one. ."

But hang on,

"WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends."

So why would they recommend at least two years if actually only a year mattered?  Does Dr Ellie have evidence there aren't health benefits beyond a year?

I could re-write the reply to Clare-Byam Cooking in my last blog post - but as it was only yesterday, I will go for a copy and paste!

Dewey in 2001 found:

"Breast milk continues to provide substantial amounts of key nutrients well beyond the first year of life, especially protein, fat, and most vitamins.”

From Kellymom:

In the second year (12-23 months), 448 mL of breastmilk provides:
29% of energy requirements
43% of protein requirements
36% of calcium requirements
75% of vitamin A requirements
76% of folate requirements
94% of vitamin B12 requirements
60% of vitamin C requirements

Furthermore breastmilk isn't just about nutrition is it? Even if we take this out of the equation, what about immunological implications?

The American Academy of Family Physicians note:

"Children weaned before two years of age are at increased risk of illness (2008).

Again from Kellymom:

“Antibodies are abundant in human milk throughout lactation. In fact, some of the immune factors in breastmilk increase in concentration during the second year and also during the weaning process. (Lawrence & Lawrence 2011, Goldman 1983, Goldman & Goldblum 1983, Institute of Medicine 1991)."

If we think about what's in breastmilk, there is protein that cause cell suicide in over 40 types of cancer, stem cells that develop into many different cell types in the body, serving as an internal repair system. Lymphocytes that kill infected cells directly or mobilise other components of the immune system, enzymes, immunologlobulins and a whole lot more, that actively seek out and destroy harmful pathogens, sweeping them from the body and regulating immune response. Anti infective factors, hormones, growth factors, anti-inflammatories and more. Why on earth would we assume that this is of no benefit after 12 months when we know a child's immune system doesn't mature fully until much later? Where is the evidence supporting this frankly archaic statement?

We can go a step further and remove the nutritional and immunological reasons to breastfeed after a year, and there is still a whole plethora of reasons to continue! Kellymom again covers this in great detail with references here, so I see little point reinventing the wheel; but numerous implications are "dose related" - ie the longer it happens the bigger the "benefit" (or if you want to word things accurately, the earlier it ceases the more increased the risk).

Dr Ellie doesn't stop there though:

"But in my opinion, breastfeeding your child up until three or even later is unnecessary"

Right so is that Dr Ellie's professional or personal opinion?  At least there is clarification it's opinion and not fact.

Dr Ellie then moves on to Sears:

"Every cry from an infant is a cry for help and should never be ignored, he says. Dr Sears even claims that allowing a baby to cry for too long can cause them brain damage."

The "even" implies the comment outlandish, but what Dr Ellie fails to mention is this isn't some far fetched ideal Dr Sears has come up with.  It's one supported by evidence. A 2002 paper entitled "Infant Crying: Nature, Physiologic Consequences, and Select Interventions" states:

"Documented immediate and long-term sequelae of crying include increased heart rate and blood pressure, reduced oxygen level, elevated cerebral blood pressure, initiation of the stress response, depleted energy reserves and oxygen, interrupted mother-infant interaction, brain injury, and cardiac dysfunction. Caregivers are encouraged to answer infant cries swiftly, consistently, and comprehensively."

In fact I would suggest Dr Ellie takes a look at this article as a matter of urgency to bring herself up to date with the latest research surrounding infant crying given her "day job".   Darcia Narvaez, Ph.D. provides an excellent referenced run down on the topic.

Anyway, back to the article:

"The attachment parenting crowd argue this is the way parents have been doing things for thousands of years. I’m not an anthropologist, but I do know that we’re living in an era when these things are not the norm"

Well I think the "AP crowd" probably argue that because it makes anthropological sense?  I appreciate Dr Ellie acknowledges she isn't an anthropologist, so if you would like to hear from someone who is and read an educated opinion  - click here.  Nope it's not the norm, that doesn't therefore make it wrong though does it?

"And breastfeeding until a child goes to school is fulfilling a mother’s needs, not a child’s. It is self-indulgent and possibly narcissistic. Children are at the centre of our world but it doesn’t mean we need to be at the centre of theirs."

Woah backup the truck Dr Ellie, we're definitely into "personal opinion" territory now right?  I know Dr Ellie confessed to no training in anthropology, but surely she can recognise that "appropriate nursing duration" is based on social norms not biological?

Dr Ellie then states that many psychologists worry that "extreme breastfeeding" (perhaps whilst parachuting?) hinders normal child development and indulges the mother with attention and purpose.

I would suggest any such concerned psychologists explore the numerous cultures where children are often nursed until older such as Mongolia, are they a country full of narcissistic needy mothers caring for developmentally delayed children?

Or perhaps some existing research?

In 2010 a study set out specifically to evaluate whether breastfeeding duration predicted later psychosocial development.     Researchers found the opposite of the concerns Dr Ellie raises, and that breastfeeding duration was a positive predictor of future psychosocial development (using an index shown previously to predict school readiness) measured in late childhood, concluding:

""These findings add to growing evidence that breastfeeding could provide lasting economic and social benefits" (Am J Hum Biol. 2010 Nov-Dec;22(6):725-30.)

The American Academy of Paediatrics state:

“Increased duration of breastfeeding confers significant health and developmental benefits for the child and the mother… There is no upper limit to the duration of breastfeeding and no evidence of psychologic or developmental harm from breastfeeding into the third year of life or longer.”(AAP 2012)"

 The Academy of Breastfeeding Medicine state:

“The average age at weaning ranges anywhere from six months to five years… Claims that breastfeeding beyond infancy is harmful to mother or infant have absolutely no medical or scientific basis".

Just to throw a few in to start with...


Back to Dr Ellie:

"Children go to nursery aged three, so they need to be able to cope without their parents."

Um, children don't always go to nursery at three; some go much earlier and others not at all.  But I don't see the link between the "need to be able to cope without their parents" and breastfeeding?  Does Dr Ellie really think toddlers who are breastfed when at home with their mother, can't go to nursery and cope without?

That because they choose to still feed at the breast, this is comparable to feeding a newborn who cannot be left or that the toddler will choose to stay home just because the breast is there?  The mind boggles as to what Dr Ellie thinks feeding a toddler is like!

A bizarre comparison is then made to continuing breastfeeding and not allowing a child to move on from nappies or a pushchair.   As though continuing to provide a child with milk of their own species rather than swapping to that from a cow was directly comparable to these acts.  Perhaps I'm wrong but my radar detects "personal baggage" sneaking into the mix here...

The next comment is the one I find most disturbing:

Toddlers & Tiaras

"Children are sexually aware from a young age. They become interested in body parts and what they do. Breastfeeding a child old enough to walk over to his mother and open her shirt creates a confusing message about personal boundaries and our bodies."

Dr Ellie is attributing sexual traits to a toddler?  For real?  Yikes, I've no idea where Dr Ellie lives but I can assure you that my toddler was not sexually aware!  He still isn't at 6 although he self weaned several years ago, but he does understand breasts are there for the purpose of nourishing (regardless of what else he goes on to appreciate them for as he matures!).

Perhaps I'm the only one that finds it disturbing to hear a Doctor making such links?  For those interested in the culture of sexualising our toddlers, this may be of interest.  But my children could walk over to me and lift my shirt at 10 months and a year respectively, should I have weaned them then despite the evidence highlighting the risks of doing so?

So to conclude, a statement from the American Academy of Family Physicians about GPs and lactation:

"Family physicians should be knowledgeable regarding the ongoing benefits to the child of extended breastfeeding, including continued immune protection, better social adjustment, and having a sustainable food source in times of emergency. The longer women breastfeed, the greater the decrease in their risk of breast cancer.” (AAFP 2008)"

It seems some still have rather a long way to go...