Dr. Plastic Picker’s thoughts on Breastfeeding, Frenotomies and Formula
January 25, 2020
I have been practicing pediatrics for 15 years, and have been a general pediatrician at my current HMO for over 10 years. I have been in the same office at the end of the hallway this entire time. Right outside my office is an old radiology light-box reading light, that I have asked them to leave it there eventhough we’ve moved onto digital images a decade ago because I like how old-school it looks. Sometimes I walk by and push the on and off light button just for fun. I also fished out an old-fashion stadiometer scale out of the supply closet two summers ago and put it at the end of the hallway next to my office (where the hallway ends without an egress) because sometimes the old-fashioned things that have been tried and true work best. I use that stadiometer with its level and weights and tap tap tap until I get the right measurement sometimes, and pull out the metal stadiometer bars to see how tall the kids are. It’s always accurate unlike the digital ones.
Sometimes the old-fashioned way is the best. And that includes breastfeeding. Probably one of the best things that happened to me as a pediatrician, is that I had a very difficult time breastfeeding my first child. In retrospect, our son had a very tight frenulum and probably a simple scissor frentomy would have prevented all the nipple trauma and pain and allowed us to have a successful breastfeeding experience. But 1-2 decades ago, the world of pediatrics was on one side of the pendulum and no one was looking at frenulums. Now, we have swung to the other side and people are clipping like there is no tomorrow (not in our organization) and some mistakenly have prophesized that clipping frenulums will cure everything from breastfeeding issues to headaches. I have organized one journal club on this issue, where we discussed this as a group and then did another literature review for our department and attended one talk at an AAP conference several years ago. So I’m as well read as anyone on it. And anyone who reads more that that, who is not an ENT or a researcher, probably is trying to find some alternature truth that does not exist. But a recent paper came out that will hopefully put the issue at rest, clip some but don’t clip too much.
I’m not sure why patients can’t see charlatans whether they be physicians, dentists or “alternative health providers.” There are some that are charging out in private practice (not in our HMO) hundreds of dollars for a simple clip or swipe of a laser, and likely waving their manicured MD hands over the babies chanting myths about how clipping the frenulum will guarantee a Rhodes Scholarship. Then they pawn the family off to a lactation consultant that is associated with the practice, and I’m sure making money off or that person’s labor. I often wonder why patients and families don’t have more common sense. In my office, I will clip only if I need to and if I think it will help with breastfeeding and it’s a simple thin anterior frenulum. I don’t make patients come back for a separate second appointment and I don’t make them see lactation afterwards. We have lactation if they need. Usually it’s like magic, and the mothers put the child on the breast afterwards and there is a difference right away. Half of the parents I tell them, the frenulum is not the problem and there is no reason to clip the tongue.
Anyway, going back to breastfeeding. Our oldest in retrospect needed that simple procedure but it was not even being done at that point. Breastfeeding was painful and excrutiating and I ended up pumping instead for the year, and bottle feeding him mostly pumped breastmilk. That experience helped me as a pediatrician, because it brings me so much joy to see mother and baby dyads do it when I was not able to. When the mothers in my practice are breastfeeding, I cheer them on and congratulate them. I am amazed they were able to do something I was not and I take true joy in it. It’s like when my amazing younger sister won a prestigious fellowship post graduate to study history abroad. I remember standing outside the Chinese Food Truck that was parked near our medical school (I never had the bandwidth to apply for any fellowships since I was stressed about just getting into medical school), and I even now still remember that beautiful spring Boston day and how warm the sun was. I remember looking across the medical school quad at the white marble of the main library and the world seemed so bright that day, and I was so happy. I knew my sister had an amazing two years ahead of her of for growth and learning, and I knew I had given her good advice as an older sister. I feel the same kind of joy for my patients. I know that they will have such a wonderful time of learning about their babies and themselves.
And for those moms for whatever reason, whether it be by choice or by circumstance, cannot fully breastfeed or chose not to, I tell them that it is okay. Lactation consultants, nurses, your pediatrician and your mommy group – should not judge! Oh my gosh! I am not sure why we as women do this to each other. Maybe it is because we are in such stressful times in our lives with competing demands. Why do we as mothers get the blame for everything???!!! It is not your fault. Pumping is fine, formula is fine. Your baby is going to turn out okay. The health benefits of breastfeeding are certainly there, but it has not proven to be the be all and end all of it. I think the last study that came out said the health benefits of breastfeeding versus formula feeding leveled out by kindergarten. Indeed, both my babies who are taller than me now got some formula. And the oldest is in AP Computer Science and the younger one is a dedicated History Day competitor. They are fine.
And when I did not use my pumped breastmilk, I actually bought generic formula! I was reminded about this because two recent new families came to my practice. I love new families. I forget how wide-eyed and innocent and vulnerable new parents are. For various reasons their babies need to be on formula, and one young mother told me she had done her research and was buying a special organic formula from Germany for $45 a small can! Another family asked me today about adding a formula because mom is back to work and her supply went down a bit. I advised her to try power pumping but certainly a bit of formula is fine. The child has eczema and should be on a partially hydrolyzed formula. But I advised her to buy the generic version
Formula companies are profitable and they are trying to make money off of you. Never forget that. According to one economic article, “The baby formula market is already worth $47 billion a year, and it’s predicted to increase by around 50% in the next three years — making it one of the world’s fastest-growing packaged food markets. ” And these products are concentrated in six companies many who are peddling single use plastics in other product lines. The Global Citizen article continues, “And while it is extremely profitable, the baby formula market is also highly concentrated — in the hands of six major international companies and their subsidiaries: Nestle (the leading company with 22% of the global market share), Danone, Mead Johnson (now RB), Abbott, FrieslandCampina, and Heinz.” https://www.globalcitizen.org/en/content/breastfeeding-baby-formula-report/
But the reality is that sometimes you need formula, so you will need to buy it. And don’t make infant formula from some homemade recipe. There have been cases of infants dying of electrolyte imbalances or nutritional deficiencies. Don’t feed your infant goat’s milk because the baby will get megaloblastic anemia from B12 deficiency. Don’t give your infant coconut milk. That is crazy. No one who is from a country that has a lot of coconuts would ever think of giving their infant’s coconut milk. Think about it. Should you buy someone else’s breastmilk on-line when your baby is full term and healthy? To that drplasticpicker will just look at you and say, “wow.” Priorities people. When you are in infant, it’s either breastmilk or an FDA-approved formula. And for most babies, generic and boring is fine. Save your money.
I was thinking I was going to calculate out cost per ounces of generic versus name brand, or how much plastic you would save by breastfeeding, or give you the amount of money you would have in your college 529 if you bought generic versus the German formula. But it is Girl Scout cookie season and I have to go pick up cookies and sort them in two hours. @drplasticpicker is in my 5th year as Cookie Troop Manager and 6th year as Girl Scout Co-Leader.
So I’ll just leave everyone with this simple message. Breastfeeding is best, and aim for 12 months but any amount of breastmilk is good. More breastmilk, less plastic for the earth. Don’t spend $700 out of pocket for the frenotomy package from the prviate-practice/fee for service place that only does frenotomies. Just don’t. If not breastmilk, than generic formula for most heatlhy babies. And when you get to 12 months of age, just whole milk and no toddler formula. Toddler formula for most heatlhy children does not need to exist.
Also just buy Carlsons Vitamin D drops for babies, and read here about why I don’t give out one company’s “Free Samples” https://drplasticpicker.com/free-baby-vitamin-d-samples-i-should-have-known-there-is-no-such-thing-as-a-free-buy-carlsons-instead/