Bullshitometer: Food before one is just for fun

Poster A: I’ve been doing baby led weaning for the past few months, but I’m starting to get discouraged. DD is 10mo and eats basically nothing. She plays with pieces of food, gums them and drops them on the floor. Occasionally a bit of food will actually make it into her. She has plenty of breastmilk and seems okay, but my health visitor is starting to get on my case about it, saying she’s going to become anemic because my milk isn’t enough! I don’t know who to believe any more. 

Poster B: Just keep repeating to yourself: Food before one is just for fun. Your LO is doing fine—playing with food is all they actually NEED to be doing at this stage. 

Poster C: Your HV doesn’t know what she’s talking about. Breastmilk is a good source of iron, because it’s so bioavailable (see Kellymom). Anyway, it doesn't make any evolutionary sense that babies would need anything other than BM before they are able to feed themselves--what did tribal babies do before pureed babyfood and iron supplements? Keep on doing what you are doing, mama! 

Poster D: Babies eat when they are ready. If she isn’t willing and able to self-feed, that means her gut isn’t mature enough. Trust your instincts and remember that food is just for fun until they’re one. 

"Food before one is just for fun" has become a common phrase heard on the ‘net in recent years, probably due to the popularity of lactivism and baby led weaning (BLW). Lactivism tends to assert that breastmilk is the perfect food—the more breastfeeding the better, pretty much. BLW (in its true form, I mean, not as a newfangled term for finger foods alongside mashed food) is a philosophy asserting that babies should self-feed all foods right from the start, and that the development of the motor skills needed for self-feeding—sitting unassisted, picking things up, chewing and so forth—are actually signs that your child needs food for the first time. In parts of the parenting universe where BLW and “natural” childrearing methods are popular, therefore, it’s not uncommon to hear of babies who are seven, nine, 12, 15 months or even older and still virtually exclusively breastfed, while their relationships with solids amount to little more than playing with food before chucking it on the floor.

When mothers express anxiety at this state of affairs, the responses given tend to be more or less as given in the above exchange, and “Food before one is just for fun” is much heard. But how true is this? Breastmilk is a wonderful food, but do babies really have no need at all for solids in their first year?

A metallic problem
As I discussed in a previous post, in terms of calories, most mothers—assuming their supply is decent and they are prepared to do some night feeds—are probably capable of meeting the calorific needs of a baby through breastmilk alone until at least the age of 12 months. Breastmilk is a highly nutritious, digestible and well-absorbed food that really does contain most of the things a body needs—there is certainly nothing to be gained from crowding it out of the diet too quickly. And yet there are a couple of exceptions which keep coming up again and again in the literature; basically, iron and zinc. Because breastmilk isn't a very good source of either of these. And both iron and zinc are very important for a child’s developing brain.

What the World Health Organization says
The WHO's views on the role of solids for 6-12mo babies are set out comprehensively in its Guiding Principles for Complementary Feeding of the Breastfeed Child (2004, most recent edition). I don't know where the "food before one..." meme came from, but it's not from the WHO. After reiterating its support for delaying solid foods for six months, the WHO goes on to stress (repeatedly and explicitly) the importance of complementary solids from the middle of the first year onwards:

"Breast milk can make a substantial contribution to the total nutrient intake of chil- dren between 6 and 24 months of age, particularly for protein and many of the vitamins. However, breast milk is relatively low in several minerals such as iron and zinc, even after accounting for bioavailability. At 9-11 months of age, for example, the proportion of the Recommended Nutrient Intake that needs to be supplied by complementary foods is 97% for iron, 86% for zinc, 81% for phosphorus, 76% for magnesium, 73% for sodium and 72% for calcium (Dewey, 2001)." 

"...the Expert Consultation concluded that the potential health benefits of waiting until six months to introduce other foods outweigh any potential risks. After six months of age, however, it becomes increasingly difficult for breastfed infants to meet their nutrient needs from human milk alone (WHO/UNICEF, 1998)." 

"Average iron intakes of breastfed infants in industrialized countries would fall well short of the recommended intake if iron-fortified products were not available (WHO/UNICEF, 1998)" 

Iron- and zinc-fortified foods are encouraged on the grounds that without fortified foods or meat, it is difficult to meet babies' micronutrient needs. (Yikes, "solids are important" AND the dreaded rice cereal... no wonder none of the crunchy sites post links to the Complementary Feeding guidelines.) Incidentally, I quoted the WHO not because I think they are the top authority on everything (their recommendations do often tilt towards the developing world), but because the WHO is really, really, really pro-breastfeeding. If even they are stating explicitly that breastmilk is generally not enough to meet babies' micronutrient needs for much beyond six months, I think we should probably sit up and listen.

That Kellymom page
The evidence most often cited in support of the "babies-under-12-months-don’t-need-solids-or-additional-iron" idea is the Kellymom page on iron. The message that is often taken home from this page is that (a) Breastmilk is an awesome source of iron because it is so bioavailable to the infant; and (b) In any case, babies are born with enough iron to last them for their first year of life.

Now, breastmilk iron is unusually bioavailable (which means, roughly, that a high proportion of its iron is actually usable by the baby); but the amount of iron found in breastmilk in the first place is so low that even with a high absorption rate, the absolute amount available to the infant is still not very high--as Science of Mom discusses here in her excellent post, even with breastmilk's unusually bioavailability a baby aged 6-12 months would need to drink 4-13 liters of breastmilk a day to get enough iron. Most babies don't drink much more than a liter a day.

As for babies’ iron stores… the Kellymom page doesn’t actually say that babies are born with a year’s worth of iron inside them. It actually says that babies are born with enough iron for “at least the first six months” provided that they are (1) born at term; (2) at least 3000g/6.5lb at birth; and (c) born to mothers without gestational diabetes. It goes on to say that babies will certainly need to have additional iron from somewhere-or-other “toward the end of the first year”; so even Kellymom is not actually saying that babies need no food whatsoever for the first year.  Also, check the dates on the sources given towards the end of the page. There is a 1999 American Association of Pediatrics report, but not the Association's well-publicized 2010 Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Anemia in Infants and Young Children (0-3 Years of Age), which emphasizes iron for breastfed infants much more strongly (Seattle Mama Doc has an excellent summary of the report--see Further Reading below). Basically, the conclusions of the AAP committee regarding breastfed infants are that breastfeeding exclusively past four months—not six—creates an increased risk of iron deficiency, and that therefore babies older than this should ideally be either supplemented with iron or given iron-rich complementary foods. It also states explicitly that “Exclusive breastfeeding for more than 6 months has been associated with increased risk of IDA [iron deficiency anemia] at 9 months of age.”

By the way, I think the Kellymom people could do with updating their entire list of sources—it has at least one broken link and a lot of old/tiny studies which in many cases appear to be cherry-picked or misunderstood. For example, the Kellymom page states rather vaguely that babies “have been shown” to maintain normal iron stores and hemoglobin levels up to nine months… but the only evidence it gives in support of this turns out to be a single very small (30 infants) study that took place in Honduras back in 1995. (I am, of course, being flippant: of course Kellymom is not going to update their source page, because the people at Kellymom have already decided that iron supplementation and encouraging baby to eat enough solids are generally Bad Things, so they are not going to link to any paper which seems to contradict these ideas—even though the AAP's conclusions are up-to-date and based on a review of 77 studies.)

It’s difficult to find actual studies of babies in whom solids have been delayed for long periods of time simply because we are talking about a non-conventional parenting style. However, the fact that a significant minority of exclusively breastfed babies are already iron deficient at the six-month mark makes it hard to believe that there are not potential issues with waiting much longer for solids/supplementation (Even the World Health Organization admits that exclusive breastfeeding to six months can lead to iron deficiency in susceptible infants, but asserts that nevertheless, this disadvantage is outweighed by the fact that exclusive nursing for six months in developing countries is associated with lower rates of diarrheal disease and later return of fertility in mothers—both facts which are a lot less relevant for those of us in the developed world).

What does “natural” mean, anyway?
Now I'll be honest; whenever I hear someone talk about "readiness" for anything in a child-development context, I tend to reach for my skepticism; has anyone ever actually proven that the ability to sit up unassisted or reach out and grab things has any particular relationship with babies' ability to digest food or their nutritional requirements for it? And if we accept the "babies need additional iron and zinc" thing already discussed, the idea that babies only start to need solids once they reach certain development stages becomes a bit problematic. Like... okay, are we all supposed to believe that children who are slower than average to sit up are the ones who are handily born with larger-than-average iron stores in their bodies, while the ones born with less iron conveniently start sitting up earlier, or something? It doesn't really make a lot of sense to me, and as it happens the only evidence that I’m aware of on this topic seems to suggest the exact opposite—we know that in fact, iron stores tend to be lower in babies who were born small and/or premature, and these babies are also slower to reach milestones, on average.

Why would human babies and human mothers have evolved in such a way that significant numbers of babies need either iron supplementation or foods from six months at the latest (when many babies are incapable of self-feeding significant amounts of food) to avoid iron deficiency? The Science of Mom article discusses this very point.

It’s possible that breastmilk’s iron levels are low because of a good old evolutionary trade-off. Lower iron levels in the baby's GI tract reduce the risk of infections. Those cave-babies living eons ago were at high risk of gastro infections which were frequently lethal--better to risk developing a slight iron deficiency than to wind up dead from diarrhea. For those of us living in cleaner environments today, breastmilk's iron level may not be optimal and perhaps supplementation may have its merits. Furthermore, the environments where human beings evolved were also places where where (a) babies may have acquired extra iron from eating dirt off the cave floor, and (b) cord clamping was probably delayed.

Another possibility raised by a commenter on the above post is that both mothers’ and babies’ bodies evolved based on the “assumption” that babies would in fact be supplemented with easy-to-eat iron-rich food sources by the middle of the first year if not earlier. Pre-chewing of foods—especially meat—and feeding them to infants from about the middle of the first year is the norm among hunter-gatherer societies, as suggested by this intriguing paper here which floats the possibility that pre-mastication may have developed in humans as a way of providing babies with iron and other micronutrients. As I suggested in my previous post on BLW, this reality is another reason why I would question the “naturalness” of a strictly baby-led, self-feeding-only approach to solids; I think a more “natural” approach to solids might, rather, involve feeding different foods in a variety of ways, including—when necessary—mashing certain foods and helping the baby get them into his/her mouth. After all, if it’s good enough for orangutans….?

Oh the iron-y
Iron deficiency is popularly associated with pallor and general languidity; the truth is a bit more worrying than that. You can’t generally see moderate iron deficiency and it doesn’t necessarily result in your child showing any obvious signs of anemia. But that doesn’t stop it having negative and permanent effects on your child’s growing brain. Iron deficiency really does matter.

There has for a long time been a well-established body of robust evidence (see here, here and here) showing that iron deficiency in infants is associated with delayed milestones, in terms of both motor skills (walking, sitting and so on) and speech/social development. Worryingly, problems appear to persist even after the iron deficiency is caught early and corrected, suggesting that there are “window periods” when sufficient iron is needed for the normal development of particular cognitive functions: when infants who have previously been diagnosed as iron deficient are followed-up years later, they show higher rates of learning-related problems such as inattention, clumsiness and shyness, are more likely to repeat a grade and score lower on IQ tests, even after controlling for other factors such as maternal IQ and lead levels. These correlations are both robust across numerous studies and statistically significant.

Can you imagine the reaction we would see in the parenting blogosphere if a study were to come out which found comparable neurological/behavioral differences between—say—children who had been formula fed and those who had been breastfed? I just don't understand why so many breastfeeding advocates are so cavalier about iron and zinc. These things are important. Of course, an older baby eating very little is a lot less concerning if supplementary iron is given; however, a lot of the crunchy mothers tend to resist the idea of giving supplements, perhaps because they have bought so strongly into the idea that breastmilk is always a complete diet right into toddlerhood etc.; giving a supplement would be tantamount to admitting that that may not always be the case.

Bullshitometer verdict
I think the phrase “Food before one is just for fun” needs to go die a merciful death, to be honest. In all likelihood, the phrase itself was invented by some well-meaning person who wanted to encourage a more relaxed approach to solids among anxious mothers who were engaging in weird little mompetitions with other mothers about who could cram the most “jars” inside their child--and in the process, harmfully crowding breastmilk/formula out of the baby's diet.

But it’s looking increasingly as though this phrase has begun to be interpreted as meaning that solid foods play no nutritional role at all before one year of age—and that therefore, it’s completely fine and not an issue if months and months go by while your older baby eats basically no foods at all and does not receive any micronutrient supplementation either. And the evidence suggests strongly that this is just not true.

Obviously, you can hardly force-feed a child who doesn't want solids, but there is such a thing as being flexible--trying different things (purees, finger foods, spoon feeding, whatever) and seeing what the baby takes to, rather than insisting that a baby who won't self-feed is "not ready" for solid foods and therefore should not have them. And if a baby or toddler is refusing solids in any shape or form, an iron and zinc supplement is a wise idea. Rice-cereal-phobes can take heart, by the way—it’s looking increasingly as though iron is actually absorbed better from natural sources such as ground meat (which also provides much-needed zinc to babies).

Finally, it’s good to see that delayed cord clamping seems to be becoming mainstream, as routine DCC could prevent a fair bit of iron deficiency. When all's said and done, though, DCC appears to improve infants' iron store levels up to six months of age; even if this became standard practice from tomorrow onwards, babies wouldn't be getting a years' worth of iron pumped into them.

I do understand that there is a lot of resistance to the idea that most breastfed babies probably need some solids (or supplements) by six months or so, because so many people are powerfully attached to the idea of breastmilk as being the perfect food. But perhaps, as Science of Mom suggests, “This should not be taken as a deficiency of breast milk but rather as an indicator that it is important and natural for babies to start consuming solid foods around 6 months.” Breastfeeding is best; but we should also be focusing on the nutritional quality of the complementary foods that we offer babies, and in doing what we can to help them eat enough of them.


Further reading
Guiding Principles for Complementary Feeding of the Breastfeed Child: Good background reading, but like all WHO stuff should probably be taken as a very rough guide--trying to make sure your child gets XXX number of solid-food calories a day sounds like a guide for how to give yourself a nervous breakdown
 Guiding Principles for Feeding Non-Breastfed Children 6-24 Months: For you bottle feeders; I haven't had a chance to look through it, though!
Why is breastmilk so low in iron: A great post from a real nutritionist (and extended breastfeeding mother!)
Baby Led Weaning (or starting solids) book review and nutritionist weighs in (with her 7 month old daughter!) Another blog post by someone who knows about nutrition
Iron for babies & toddlers: I love Seattle Mama Doc; she is always so reassuring and kind.

Latch On NYC: Less spin, more details please

"Mayor Bloomberg pushing NYC hospitals to hide baby formula so more new moms will breast-feed" screamed the headline a few days ago. In Mayor Bloomberg's Latch On NTC initiative, we were all told, not only were formula samples to be banned, but formula was now to be hidden away "in out-of-the-way secure storerooms or in locked boxes like those used to dispense and track medications," in order to discourage bottlefeeding, while those wicked mothers who requested bottles anyway were to be subjected to a "talking-to" for each and every bottle they received, by staff who will explain "why they should offer the breast instead." Now, two thoughts ran through my head upon seeing this. The first was, "Wow. This is going to cause a bit of controversy in the mommy blogosphere. I wonder if The Fearless Formula Feeder and Kellymom are onto this yet?" The second was, "Hmm. I notice that article doesn't actually link to an original source. I wonder how much of what's written here is true and how much is spin...?"

Well, the blogosphere got wind of Mayor Bloomberg's little wheeze, and commentary rapidly split down two predictable lines. The "Anti-lactivist camp" (many of the commentators on The Skeptical OB, The Fearless Formula Feeder, Bottle Babies and others) fumed about the proposals. "This is outrageous! It's a woman's right to choose formula--how dare hospitals lecture them about it? Or treat formula as though it was something akin to cigarettes?" The "Lactivist camp" (Kellymom, Best For Babes and all the rest of the crunchosphere--which, by the way, hugely dominate online discourse about motherhood in spite of the beleaguered-minority identity) immediately shot back, "No, this is a great initiative. And the media hasn't reported this properly. Go to the Latch On NYC website--they're not going to lecture women about using formula. And by the way, it's normal hospital practice to lock up items used in the hospital, including food."

Well... with some trepidation, I went to the Latch On NYC website, grimly saying to myself over and over again, "I will not, NOT form an opinion until I have read what the actual initiative itself says...minus the media spin." And even before opening up the Initiative Description and FAQs, it was pretty apparent that there was some serious spin going on. I mean, before long there were news articles appearing which were proclaiming "NYC plans to ban baby formula in hospitals"--absurd.

Well, according to the Initiative Description, the initiative consists of the following:

A call to all NYC maternity hospitals to make a voluntary commitment to support mothers who choose to breastfeed by:
- Enforcing the NYS hospital regulation to not supplement breastfeeding infants with formula
feedings unless medically indicated
- Limiting access to infant formula by hospital staff
- Discontinuing the distribution of promotional or free infant formula
- Prohibiting the display and distribution of infant formula promotional materials in any
hospital location
- A public awareness campaign to promote the health benefits of breast milk, and to inform women of their right to receive education, encouragement and support to breastfeed their babies if they choose to do so.

 So, it looks like the lactivist camp was right to claim that there is some media misreporting--or at least, overextrapolation--going on.
I'll be honest--I think much of what is written here falls into the categories of "Good" or "Neutral." I'm agnostic on ban-the-bags--I don't particularly feel that one's human rights are infringed on by not receiving a freebie; I didn't get free formula from my Japanese hospital, either, and didn't feel deprived. I also feel that ethically speaking, it is questionable for hospitals to receive gifts from commercial organizations because it can create conflicts of interest--although I think that if we are going to ban the bags then to be fair we should be banning all gifts and samples to the hospitals. The "unless medically indicated" bit did make me raise my eyebrows for a second... are they proposing that formula feeding should only be permitted for medical reasons, meaning women should not be permitted to formula feed by choice? But a second glance indicates that this is for breastfed infants only (i.e., you don't give formula to babies whose mothers have chosen breastfeeding, unless there is a medical reason to override her wishes). That's a positive thing.
What about the locking-up of formula? Let's take a look at the FAQ page.

 What does it mean to restrict access to formula?


Restricting access to formula means storing formula away from where it is easily visible and accessible to staff and mothers. Access to formula is restricted by both:


Storing formula in a locked location, such as a storage room, cabinet or an automated medication system or, storing formula in a location outside, but reasonably near, the maternity unit...

  "Locking up" does sound alarming, but I think it's only fair to point out that hospital supplies including sanitary pads, food and just about everything else are usually locked up, recorded and tracked--in part because patients are usually charged for them. Again I think we are seeing a little bit of the phenomenon of journalism that epidemiologist Elizabeth Pisani calls "beating it up." "Making it up" means inventing things up out of thin air. "Beating it up" means presenting true facts in a way which makes them sound as alarming as possible, in order to whip up a bit of hysteria and controversy (which in turn will generate sales and page clicks).

What does concern me a little, is the following sentence:

...Limiting the number of hospital staff with access to formula by implementing a system to identify which hospital member accessed the formula supply; some examples are a log book, a code or a key system.


Restricting access decreases the likelihood that staff will distribute, and inadvertently market, formula.

 It may well do so. It also increases the likelihood that mothers are going to be kept waiting God knows how long while waiting for a bottle to appear (as their newborn screams with hunger) because the reality of hospitals is that there are never enough staff and there are constant complaints from new mothers about lack of support already anyway, and restricting. And then you get mothers inadvertently stretching out the periods between feeds  as long as possible... and pushing the baby to "finish the bottle" when the formula is finally available, in order to avoid the whole process of trying to actually get hold of a bottle of milk. This isn't promoting good feeding practices or responsive parenting. Rule No. 1 = Feed The Baby.

What about the "lecture with every bottle" bit that is allegedly going to form part of Latch On NYC? Here is the relevant section in the FAQ.

What do we tell our staff to do when mothers (families) request infant formula?


While breastfeeding is healthier for both mothers and babies, staff must respect a mother’s infant feeding choice. Educating mothers and families about breastfeeding and providing encouragement and support, both prenatally and after birth, is the best way to ensure breastfeeding success in your hospital.


While in the hospital your staff can:
Assess if breastfeeding is going well and encourage the mother to keep trying.
Provide education and support to mothers who are experiencing difficulties.
If the mother still insists on receiving formula, document it in the chart along with the  reason and distribute only the amount of formula needed for the feeding.
Train staff in breastfeeding support (CLC, IBCLC) who can be available to assist new mothers at all times regardless of day, night or weekends.

 Well, first of all, claims that formula feeding is going to be banned from New York hospitals do indeed appear to be a bit of media hype; Latch On NYC does give at least token support for mothers' choice to formula feed. The bit about training staff in breastfeeding support is great.

But what does "Assess if breastfeeding is going well and encourage the mother to keep trying" actually mean in practice? If the mother says clearly "I don't want to do this any more," is the nurse required to keep urging her to continue? Where do you draw the line between support and nagging? The initiative gives us no clear answers. Certainly, the use of the word "insist" here is deeply problematic. My understanding is that a person only "insists" on doing something when they continue to state their need after having experienced a considerable amount of pressure to do the opposite.

My guess is that what will actually happen is that these ideas will be interpreted in different ways depending on the hospital staff member in question: staff who are basically respectful of all feeding choices will continue to act accordingly, but staff who have the lactofanatic light in their eyes may well see this as a permission slip to harangue mothers more than they are already doing. I don't think it's much of a stretch to imagine this, given that women are already being harassed in "baby friendly hospitals" for choosing to give formula.

Details, details, details
There is a lot about this initiative that is concerning, but we need to make sure that we are focusing on the right things. The initiative doesn't say anything about giving mothers a "talking-to" about using formula, and it certainly doesn't seek to ban formula. But there are some real problems with some of the things it is outlining. What's more, a lot of the initiative is maddeningly vague, and that openness to different interpretations could result in it becoming a green light for bullies.

There has been a lot of negativity about Latch On NYC in the past few days; if its authors want to rescue its credibility, they need to rewrite the thing, spelling out carefully exactly what they are going to do to support breastfeeding and formula feeding mothers and make their lives easier. Otherwise, the only thing Latch On NYC will achieve will be to add an extra keg of dynamite to the mommy wars.

Cups: the new bottles

This morning, I've been packing up Baby Seal's teeny-tiny baby stuff to give to a friend-of-a-friend who is expecting twins. Oh, the little tiny shirts and babygrows (could she really have ever fitted inside those?). The Miracle Blanket I could never figure out how to use. The Japanese diaper covers that I innocently used with the tabs the wrong way round for the first month.

And then there were the bottles--unused, because these were the ones I had bought in a fit of desperation when she was three months old and had decided that bottles were evil. "Buy lots of different bottles and try them out," I was advised when I posted online for tips. I did. She refused to let any of them near her mouth. After a few sessions that felt more like attempts at waterboarding than anything else, I gave up, encouraged by online voices pointing out that you could spoonfeed breastmilk in the meantime, and that babies could take cups as early as six months. My mother, however, was dismayed when I said I was going straight to cups. "They don't drink as much from cups. And babies need to suck; it's a comfort thing for them." Hmmm... my baby seemed to find bottlefeeding more of a battleground than a comfort zone, but there you are...

Of course, babies being what they are, when I took Baby Seal back to my parents' place for a visit at 9 months old she found a dusty old bottle lying at the back of a drawer and started sucking on it, whereupon my mother filled it up with water and gave it to her. "Look, she's drinking from a bottle!" said my mother triumphantly. "Bit pointless now, though," I pointed out, since she was getting towards the age when you are supposed to be getting them off the bottle anyway. "Nonsense," said my mother. "Babies like bottles! Look at your sister's kids--they continued to have a bottle as part of the bedtime ritual till they were over two! I don't know why you girls nowadays seem to want to get rid of the bottles in such a hurry."

There does seem to be more a move nowadays towards nixing bottles early or skipping them altogether and moving to sippy cups within the first year--not necessarily out of dire necessity because baby is a bottle-hater, but as a choice among formula feeders and breastfeeders whose babies take bottles happily. I wonder why that is. Maybe sippies are better designed nowadays--the soft-spout ones, for example, are less intimidating to a younger baby. I suppose many parents are also attracted by the unspoken rule that you need to sterilize bottles but not sippies.

But perhaps another reason is the kind of vague stigma that seems to have attached itself to bottles in general. Take, for example, the bizarre outcry in New Zealand over All Black player Piri Wipu appearing in a public health advert in which he hed his six-month-old from a bottle; the fact that we don't even know what's in the bottle, the fact that men can't breastfeed, dammit, the fact that the baby was six months old and most breastfed babies that age are having at least the occasional bottle or sippy, didn't stop the NZ La Leche League spazzing over the fact that a (dum dum DAHHH) bottle was being shown in an advert.

There's no doubt that among some of the more extreme lactivist circles, bottles themselves seem to be regarded with deep suspicion, hedged about with lots of "Well, if you absolutely must abandon your precious infant to some boobless freak of a co-parent leave baby with your husband..." and talk about the wonders of cup-, syringe-, dropper-, finger- or spoon-feeding breastmilk into baby's mouth instead (the funny thing is that many of the same people who are adamantly opposed to spoonfeeding solid food are convinced that this is a superior way to administer breastmilk). All these methods certainly have a place as a temporary way to feed a baby while you are getting breastfeeding established, or as a last resort if your baby is convinced that bottles are instruments of torture (raises hand), but I've seen more than one lactivist advocate using these feeding methods long-term, as an alternative to the bottle. As someone who had to ask her long-suffering mother-in-law to mess around with spoon-feeding and cup-feeding breastmilk, all I can say is that the advantages of such methods can be overstated <Yours Truly pauses to black out hideous memories of her screaming baby thrashing about demonically and knocking containers of painstakingly expressed liquid gold all over the floor>. Can you imagine finding a non-family member willing to do this?

Of course, the inefficiency of such methods is probably the whole point, since the basic thinking of Jack Newman and his ilk seems to be that preferably your baby will be consuming almost nothing at daycare anyway, and making up for it by nursing all night long instead, but that's a subject for another post. Given that the Jack Newman page I linked to also suggests a movie theater for an ideal first outing with baby (good Gawd), and hints grimly that if your teenager is surly about spending time with the rest of the family it's probably because you left her with a babysitter and a bottle to go to a wedding or something when she was a few months old, I'll be taking his views with a pinch of salt.... and advising my new friend-of-a-friend that whatever feeding method she chooses for her twinsies, getting them used to a bottle early on is a good idea.