Lactation consultants care about breastfeeding; pediatricians care about babies.


To a hammer, everything looks like a nail.

To a lactation consultant (LC), every problem looks like it can be solved by breastfeeding harder.

And just as hammering a screw harder will make things worse, breastfeeding harder in the face of infant weight loss may make things much worse. In the first situation you could permanently strip the threads. The potential consequences in the case of a baby losing weight while breastfeeding are far worse: dehydration, seizures, permanent brain damage, and even death.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Weight loss means that a baby is cannibalizing her own body to fuel her vital organs.[/pullquote]

That’s why in any conflict between a pediatrician and a lactation consultant over a baby who is losing weight, you should IGNORE the lactation consultant.

Consider this post that appeared recently on Reddit:

My baby girl just turned 12-weeks yesterday. She was born 16 days early, and only weighed 5lbs 12oz at birth. On May 6th, she weighed 7lbs 12oz. A little light, but no big deal. A few days ago, my wife felt something was wrong, so she made an appointment with a lactation consultant. We went and weighed her there. She was down to 7lbs 10oz.

She feeds all the time, and just isn’t making enough. Breastfeeding alone isn’t working anymore. I desperately want to supplement her with formula (I’d even be happy with just 4-6 ounces a day), but my wife isn’t having it. She completely refuses, screaming to the point of tears when I suggest it…

A pediatrician left an excellent response and I sincerely hope that the father followed it:

… [T]his is a pediatric emergency. Please take your daughter to an emergency room (at a Children’s Hospital if available) or her pediatrician’s office NOW, today! Do not wait until the holiday weekend is over. She needs assessment and treatment immediately! I cannot emphasize this enough. Please get her medical care immediately!

There is no question that this is an emergency. Beyond the first few days, an infant should NEVER lose weight. Weight loss means that the baby has been so deprived of nutrients that she is beginning to cannibalize her own body to continue fueling her vital organs.

Infancy is a period of extraordinarily rapid brain growth and the brain can only grow if nutrients are available in ample supply. When an infant is losing weight, she is potentially losing brain growth and the loss may be permanent. Even if you believe that breastmilk is superior to formula in promoting optimal brain function (I don’t), there is simply no question that adequate formula is far superior in all respects to inadequate breastfeeding.

Malnutrition is not the only problem. Breastmilk is the only source of fluid for exclusively breastfed infants. When they are not getting enough breastmilk, they quickly become dehydrated. Their electrolyte levels can rise very high and high sodium levels lead to seizures, brain damage and death. Indeed a baby can die of dehydration long before it would die from malnutrition.

Sadly, many LC have an unreasoning fear of formula. They have spent so much time and energy demonizing it that they are incapable of recognizing when it might be necessary.

They believe erroneously that inadequate breastmilk is always better than adequate formula. They believe erroneously that formula supplementation interferes with breastfeeding when the scientific evidence shows that judicious supplementation promotes breastfeeding. They believe erroneously that even one bottle of formula harms the infant gut (it doesn’t), failing to realize that when it an infant is losing weight, protecting the BRAIN is more important than protecting the gut. And they believe the biggest breastfeeding lie of them all, the fantasy that all women can produce enough breastmilk when we KNOW that 5-15% or more are biologically incapable of doing so under any circumstances.

Pediatricians, in contrast, have only one goal, keeping babies healthy, growing and able to reach their full physical and intellectual potential. Unlike LCs who have only hammers at their disposal, they have a full tool belt including tools of every type and size. A baby who is losing weight NEEDS supplementation, either formula or donor breastmilk. Pediatricians recognize that an adequate amount of milk is far more important than whether the baby is fed breastmilk exclusively.

There’s another factor that we must consider: letting a baby starve is CRUEL.

Hunger is painful. You might believe that tofu is healthier than steak and that water is healthier than soda, but suppose that you were given only one small piece of tofu and 3 ounces of water each day even though you need 1400 calories and 2 liters of fluid a day to survive. You’d quickly become painfully hungry and desperately thirsty with all the signs and symptoms of malnutrition and dehydration. If meat were available, would you ignore your hunger pangs day after day hoping that more tofu will magically become available in the near future? If soda were available would you ignore you desperate thirst hoping that more water will magically appear? Or would you eat the meat and drink the soda in order to survive?

I’d be willing to bet that you would find your hunger and thirst to be so painful that you would quickly decide that eating and drinking enough is infinitely more important than eating inadequate amounts of healthiest foods. If you wouldn’t allow yourself to starve, how could you possibly think it is okay to let your baby starve?

Lactation consultants mean well, but they’re not medical professionals and have only the vaguest knowledge of infant metabolic needs. They are hammers and everything looks like a nail to them. Pediatricians ARE medical professionals and they have a firm and detailed understanding of infant metabolic needs. More importantly, their primary goal is to meet those needs, not allegiance to any particular feeding method. They are handymen and handy women with every possible tool at their disposal.

Is your baby more than a few days old and losing weight? It’s a medical emergency.

Take your child to a medical professional and follow their medical recommendations. Listening to an LC and letting your baby suffer hunger pangs and desperate thirst in an effort to promote breastfeeding is missing the forest for the trees. It is shockingly cruel and startlingly dangerous.

Never forget: Fed Is Best!