The lactivist lie that causes so many babies to suffer

Crying newborn baby boy

Lactation consultants and organizations tell new mothers that the average size of a newborn baby’s stomach is only a teaspoon (5 cc). That’s supposed to ease their minds when their newborns are screaming in hunger and they can tell that they are producing very little colostrum or milk.

There’s just one problem. It’s not true.

Nevertheless, that lie has been enshrined in a variety of products designed to hammer home the lie to lactation consultants, nurses and new mothers that infants need far less to eat than they really do.

The average size of the newborn stomach on day 1 is NOT 5-7 cc but 20 cc or more.

Lactation consultant Christy Jo Hendricks is one of the leading purveyors of products that promote the lie and she’s very upset that the Fed Is Best Foundation is working hard to debunk that lie.

Here is the product that Hendricks sells, a lanyard that supposedly illustrates the size of the newborn stomach on day one.

IMG_1908

It’s accompanied by a card that contains 3 sentences, all of them lies.

The biggest lie is that the capacity of the newborn stomach is only 5-7 ml.

Here’s what the scientific evidence actually shows:

IMG_1910

The chart comes from a literature review published in Acta Pediatrica in 2013. You can see that the average stomach size was found to be anywhere from double to nearly quintuple the size quoted by lactation consultants.

Why is there such a big discrepancy? The problem lies in the nomenclature.

The lactivist claim is based on a study from 1920 by Scammon and Doyle. In that study the authors found that the average PHYSIOLOGIC capacity of the newborn stomach is 5-7 cc. but that’s a misuse of the term “capacity.” It’s actually the size of the average infant MEAL as measured by weighing the baby before and after breastfeeding with mothers allowed to breastfeed only 5 time per day. It has nothing to do with the ANATOMIC capacity of the stomach itself.

The anatomic capacity of the stomach is the amount that the stomach can hold during a meal without becoming distended. According to Scammon and Doyle, the ANATOMIC capacity of the stomach at birth is 33 cc. If you look carefully at the chart from the literature review, you will see that Scammon and Doyle report the largest anatomic capacity of any of the papers.

So the average size of the newborn stomach is NOT 5-7 cc but closer to 20 cc, rising dramatically over the first first days. And some babies need every one of those 20 cc per feeding and more!

The Fed Is Best Foundation has filed a complaint with the Consumer Product Safety Commission alleging that the lanyard is based on claims that are factually false and can lead to infant harm.

Dr. Christie Castillo-Hegyi wrote:

“The lactation lanyard and keychain are visual tools used to convince mothers that their newborns are not in need of supplemental feeding. It claims a newborn stomach size of 5-7 mL when in fact the scientific data has shown it is 20 mL. This is leading to dangerous newborn starvation and brain injury…”

How does Hendricks respond?

I know my product is well-respected by professionals and health organizations. I know it contains sound advice, backed by science. Unfortunately, I fell compelled to to respond now because a misled individual has gone to great lengths to discredit my work and the evidence behind it… I am sharing the Open Letter I sent in response … Let’s end her tirade once and for all. Let’s call out those who pretend to support breastfeeding but try to sabotage its success. Let’s expose lies and half-truth.We cannot embrace “alternative truths” when it comes to infant feeding and public health. There is so much more I could say, but for now I will share my response to an invalid complaint about a powerful visual and important teaching tool that is empowering moms around the world.

But you can’t empower women with a lie and Hendricks’ product is based on a serious misunderstanding of a paper from 1920.

In Hendricks’ defense, I doubt that she has ever read the Scammon and Doyle paper. She was taught the lie by other lactivists who did read it and either didn’t understand what they read or chose to lie about what they read.

Why would they lie? For the exact reason that Dr. Castillo-Hegyi noted. It is an effort to prevent women whose babies are screaming from hunger to supplement with formula.

Lactivists don’t merely fetishize breastmilk as some sort of magic elixir, they also fetishize exclusivity. They suggest or even claim that “one bottle” of formula can ruin the breastfeeding relationship and the infant gut microbiome. Neither is true. Indeed no less an authority that Alison Stuebe, MD of the Academy of Breastfeeding Medicine acknowledges:

…a substantial proportion of infants born in the US require supplementation. Delayed onset of lactogenesis is common, affecting 44% of first-time mothers in one study, and 1/3 of these infants lost >10% of their birth weight. This suggests that 15% of infants — about 1 in 7 breastfed babies — will have an indication for supplementation.

Other scientific evidence demonstrates that judicious early formula supplementation not only DOESN’T harm the breastfeeding relationship, but can actually IMPROVE it.

Hungry babies are suffering babies. Most mothers understand that instinctively and want to ease their babies’ pain by supplementing. Lactivists prefer to let babies scream. Instead lactivists falsely reassure mothers with products that graphically represent a believe a lie.

That’s not merely wrong and dangerous to infant health; it is insupportably cruel.

  • Maman

    I had a nightmare of a time establishing breastfeeding with my first. I supplemented with formula after he lost more than 10% of his body weight. I have never felt such a rollercoaster of emotions: fear, anxiety, guilt. I have NEVER felt more alone. Even though I was making the right choice – feeding my son! As I await baby #2, i promised myself to supplement with no guilt or fear if i need to (same for getting an epidural). I don’t know why we moms beat ourselves up so hard.

  • Pibo

    Thank you! So many of your articles are providing such useful informations for those who are interested about the other side of very new, natural and cool trends out there. Keep going with this, even if your political incorrectness may make some feel ‘offended’

  • Dr.Ro

    The whole concept of the marble is used to demonstrate that a relatively large bottle of formula milk is critically different to the first breastfeed, followed by regular feeds afterwards. The aim is not to starve babies but to encourage more frequent feeds: little and often. I think the problem you are fighting here is that women should be better educated and supported before, during and after childbirth. Clearly, the best thing for a baby is to remain well hydrated and fed. Often formula milk can be introduced too early and disrupt the feeding of a baby that would otherwise have been breastfed successfully, without harm and indeed with the result of a happy, healthy baby. Blood sugar can drop rapidly after birth and attending health professionals may panic and want to introduce a known quantity using formula. In the majority of cases this can be achieved safely using breastfeeding and supplementation with expressed formula and syringes.

    • Empress of the Iguana People

      This is the kind of thing that had my sister taking her then new-born off while he was still hungry and she still had milk. Fortunately Mom was able to set her straight.
      (Yes, my survivor sister, she bf’d until chemo started)

    • Gene

      So, Doctor, what is your recommendation for a newborn with a glucose of 45, hypothermic, and lethargic (TRULY lethargic, not just “sleepy”)? Baby can’t latch due to lethargy and mom’s milk not yet in at DOL #4. Baby shows up in your clinic, what do YOU recommend? Death? Seriously, I want to make sure I’m following your standard of care. Death, right?

    • AnnaPDE

      Yeah nah. Stop inventing convoluted nonsense please.
      The whole concept of the marble is to pretend that a baby’s stomach is much smaller than it actually is and argue that a tiny amount of colostrum can actually satisfy a hungry baby, in order to keep people from actually feeding their babies until their milk has come in.
      Because beforehand it’s literally just drops. Which is why pretty much every culture came up with the brilliant idea of prelacteal feeds — starving newborns just to make a point only became a fashionable thing very recently.

    • Sarah

      How exactly does a marble demonstrate that, as opposed to the allaged size of a baby’s stomach?

    • Nick Sanders

      The aim is not to starve babies but to encourage more frequent feeds: little and often.

      Why?

      Often formula milk can be introduced too early and disrupt the feeding of a baby that would otherwise have been breastfed successfully

      How?

    • Heidi_storage

      What’s “expressed formula”? And why is taking care of dropping blood sugar a bad thing?

    • corblimeybot

      There is so much shit in the world that is actually worth fighting for and worth making a big deal about. Yet you have chosen to waste your time and energy being a lactivist.

  • Dr.Ro

    I respect your desire to “out” “lactivists” but see your approach to natural birthing and breastfeeding as needlessly aggressive and divisive. This makes me wonder if you receive money or benefits from the formula industry? I don’t understand your problem? Did you have bad labour experiences? Did you struggle alone to breastfeed?

    • Poogles

      “This makes me wonder if you receive money or benefits from the formula industry? I don’t understand your problem? Did you have bad labour experiences? Did you struggle alone to breastfeed?”

      Or maybe she’s just trying to dispel all the misinformation surrounding breastfeeding and “natural” childbirth so that women can make decisions based on accurate information? Why do you think she must be receiving money or that she is only doing this because she had “bad” experiences herself? Her approach is on purpose – there are other voices/blogs/etc out there addressing the same topics with a much “nicer” tone/approach, but they do not get nearly the same amount of attention and traffic as this site. If the point is to get this information out there, traffic is important.
      (FYI – Dr. Amy had 4 vaginal deliveries, 2 of them un-medicated, with no complications. She also successfully breastfed all 4 of her children without incident. Not that it matters.)

    • Sarah

      That you wonder that is indicative of a problem with you and to a lesser extent the wider climate, not with Dr Amy’s approach.

  • Caroline Conway

    My middle child had an enormous appetite from birth…he cried, I fed. Breast, bottle, it didn’t matter to him. His very first bottle had 4oz in it. He drained it (age: > 1 day). I learned that each baby is different. My oldest, 2 oz, she was done. Youngest, mom ONLY and as often as possible. But of course, I had my babies in the “dark ages” (’82, ’87 & ’90)….

  • Lissie

    So….letting older babies cry for 10-15 minutes while Feberizing is child abuse, but letting a newborn cry and starve for DAYS is good parenting? What the everloving FUCK?! These people need to be drawn and quartered. I teach high school and thought I had heard some good whoppers until I was introduced to lactivists and their lies. They put my teens to shame.

    • Amy

      You’re using the wrong metric. It’s all about how much work the mother has to do. Anything that lessens the mother’s work load is child abuse, anything that forces the mother to remain by the baby’s side 24-7 is “good parenting.”

  • sara, MD

    Thanks for this. I had been meaning to check this fact with my fetal pathologist friend. Sounded like total crap to me.

  • MichelleJo

    She’s mad. As are all her supporters. Why on earth are they spreading something based on a study they’ve never read from 100 years ago, when it couldn’t be simpler to find out the truth. Feed a new baby a bottle of formula, and check how many ccs are left in the bottle when the baby is satisfied. Ask any formula feeding mum how much her baby takes on day one if they aren’t willing to subject the baby to drinking milk from a rubber nipple themselves. And anyone who formula feeds knows that they take a whole lot more than 5 cc. The amount usually goes up to 40 on day 2, and 60 on day 3 when it remains constant until around 10 days. I know, I’ve formula fed four babies from birth. Who cares what scientific studies show about the capacity of the stomach. Just observe what the baby takes. Especially since the stomach size is not be the only indicator of what a baby needs. The stomach can stretch, and conversely, babies may take a small amount on day one for any number of reasons, unrelated to what the stomach can actually hold. Do these women scientifically check the stomach capacity of a grown man to determine portion size when they serve their husband a meal? They know how much it takes till he’s full up! Babies aren’t born with much sense, but an appetite doesn’t need an IQ. A daft sheep knows when he’s had enough.

    • Empress of the Iguana People

      Don’t you know, sticking a bottle in the kid’s mouth is the equivalent of force feeding fowl so we can have foie gras. /sarcasm

  • Madtowngirl

    That baby center discussion you posted yesterday was a prime example of this in action. I couldn’t believe the number of, “well, I’m sure they aren’t letting the baby starve at the hospital” comments. It happened to me! They let my pre-term baby lose more than 10% of her weight and discharged us anyway, because I planned to breastfeed. It’s happened to countless others.

    I can’t remember if I got fed the size lie at the hospital, or if I found it while desperately googling at 3 am with a screaming newborn, but I sure heard it.

  • TheArtistFormerlyKnownAsYoya

    I had a baby in November and this lie has permeated throughout medical staff. I heard this from nurses as well as the LC. My milk took 5 days to come in and nobody ever mentioned that my baby might be hungry. Nobody was even checking to see if I had milk. We supplemented until my milk was established but I only knew to do that from having read here, it sure wasn’t discussed with me at the hospital. This is terrifying.

    • Empress of the Iguana People

      Me too, only 3 years ago. My baby’s eff for other reasons.

    • Wasnomofear

      Yeah, on the first night after my toddler was born, the floor nurse really wanted me to room her in, and I was like no thanks, I’m sleeping, give her formula kthxbye! She started on some breastfeeding relationship nonsense and I was like combo-feeding, don’t care either way lol! The next morning, I slept til a lazy 9 or 10, and they brought her in. They said they had accidentally given her too much formula during the night and had to suction some back out through her nose? Of course, they have all these same b.s. cherry pit (I may be exaggerating that) to walnut to whatever to diagram stomach capacity signs everywhere and I always wondered if that wasn’t some weird way for that nurse to get back at me for not rooming baby in with me that night. Either way, I didn’t worry over it, and the charge nurse on night two was awesome – she said heck yeah, I haven’t had a baby myself, yet, but I’ll be sending it to the nursery overnight when I do!

      And I’m the one who had my first in a freestanding birth center, so we were 100% alone with her as a neonate. After I found this site while pregnant with that second baby, the switch was flipped and there was no way I was rooming in. Main thing, if newborn has a health crisis and I’m sleeping, I may not know. Second, why not take the two days to get full nights of sleep, because it’ll be the last time for a while! Third, milk isn’t in anyway, and it’s a big fat lie that nipple stim makes it come in, so pass!

      • MichelleJo

        “They said they had accidentally given her too much formula during the night and had to suction some back out through her nose?”
        Tell me this isn’t true. Please.

        • Dr Kitty

          Overfed babies have their own, very efficient, mechanism of getting rid of excess milk, as anyone who has been vomited on while burping a baby will well know.

          • MichelleJo

            And boy do I know that. With one kid in particular. These crazies sem to view formula as medication that babies can overdose on.

          • Empress of the Iguana People

            hooboy, do they ever! My first would all the time (via breastfeeding!) Comfort suckling is a bad idea when you have oversupply

          • sdsures

            Exactly!

          • FormerPhysicist

            I swear my first had baby bulimia! Overfeed, vomit, rinse, lather, repeat …

      • Amy Tuteur, MD

        Suction out extra formula? That doesn’t sound likely.

    • sdsures

      What kind of insane medical system thinks starving a baby for 5 days is OK? #holdme

  • MI Dawn

    We used to tell moms that a baby’s stomach was about the size of the baby’s fist *when empty* but made sure they were aware that stomachs can and DO stretch when food or liquid is put into them. Fortunately, I never had a mom so determined to EBF that they would refuse a bottle and let the baby starve instead. However, I was out of active practice before all this Baby-Friendly stuff got too involved. I am making plans for if/when my daughters get pregnant and they will NOT be starving their babies for boob’s sake.

    • Allie

      Thankfully, the day we were discharged (2 days after LO was born), we had a very practical RN, who saw our distress, took one look at our baby, and said, “why don’t you give her some formula?” She went and got it and we supplemented with formula for a few days while we waited for my milk to come (which it did on day 4) and kept practicing the latching. So grateful for that nurse (she was older and perhaps that is why she seemed wiser to us). I can say categorically that the supplementation helped me in my efforts to establish nursing. A baby who is weak and lethargic from hunger cannot learn to latch. After we would give her a bit of formula, she would instantly get colour in her cheeks and more energy to keep trying the latch until we got it. If you’ve ever watered a droopy house plant and watched it spring back to life, it was like that. She went on to nurse like a champ – a little too well, and too long, if you ask me : )

    • sdsures

      Basic biology: stomachs stretch. *eyeroll* How can they not know this?

  • myrewyn

    I just bought a little case of nursettes to sneak into my baby friendly hospital when I deliver this May. I feel like such a rebel… no actually I feel sad and frustrated that I have to hide the fact that I’m going to FEED my baby if she is unsatisfied at the breast while we are there.

    • TheArtistFormerlyKnownAsYoya

      I did the same. I was actually nervous a nurse might walk in on us giving him a bottle. I had thought the nurses were pushing EBF on me but I think this is how they’ve been trained to “support” breastfeeding. Since I’d said I wanted to breastfeed, they would “help” by not ever suggesting another option – even though my milk wasn’t coming in they still “supported” me EBFing (though I never SAID I was against supplementing – this was assumed). After we gave him a bottle we told the nurse and I was surprised when she said to let her know if we wanted some of the hospital’s formula since it’s very expensive. I think staff have been scared into not speaking up when they should. My milk took 5 days to come and I can’t imagine not supplementing until then.

      • L&DLaura

        That is exactly what’s happening.

    • KeeperOfTheBooks

      Something I like to mention to new moms who are considering supplementing or FFing: if you contact Similac and Enfamil, they are happy to send you a package of samples of their various types of formula, including a box or two of the RTF nursettes, for free. I did this when DS was born last year. It was rather handy because while the (BFHI) hospital did supply formula, it was Similac, and while his big sister had done well on that, his little tummy really preferred Enfamil. Then I donated what I didn’t use to the food bank.

  • TsuDhoNimh

    A newborn kitten weighing 100 grams will take 4 to 5 ml in EVERY FEEDING! (that’s 6-7 feedings a day if bottle fed)

    So how is a newborn human, weighing 2500 grams, 25 times more than a kitten, going to have that tiny a stomach?

    That is total BS.

    • sdsures

      Yes! *former farm girl, raised kittens and baby goats when they were abandoned*

  • Amazed

    OT (again): An acquaintance of mine was reading all kind of pro and con vaccines. She’s, thanks God, fully vaccinated as she works in a daycare. She doesn’t see any crowds of sick, damaged vaccinated children and yet fear was too great when it came to her own baby. And then, a truly emergent C-section later, she was asked about vaccines and she said, in her haze: “Yes, yes, all of them!” Now, she still isn’t sure that she did the right thing but she remembers that at that moment, all she thought about was “Protect the baby!” And to her instincts, protection meant vaccinate him.

    I find it interesting since it’s usually the opposite: instinct screams at new mothers to protect their babies from germs and shots. With her, it was the other way round, and that was after being long conflicted.

    • KeeperOfTheBooks

      That is interesting! I agree that instinct says “ahhh, no, don’t stick sharp pointy needles full of germs in my perfect baby!”–whereas, of course, it’s a damn good idea to do exactly that anyway. I was 100% in favor of vaccines during pregnancy, and both kids are and have always been up to date, but I still get that twist in my stomach when they get them cos lizard brain or something.

      • Allie

        I hear you. I was almost physically ill when my LO got her first set (three jabs in the thigh). She screamed so hard she ran out of air and did the silent scream – heart breaking! But I am just old enough to remember people who were debilitated by vaccine preventable illnesses. My grandfather, for one, had scarred lungs from a childhood bout of whooping cough, which contributed to his early death from a heart attack. Knowing your child was permanently debilitated by a vaccine preventable illness would be far, far worse than enduring the temporary discomfort of a needle stick.

        • KeeperOfTheBooks

          Exactly!
          My grandfather had polio. A man who I somewhat view as a father had polio, and still walks with a considerable limp some 50 years later. I have no interest whatsoever, thankyouverymuch, in seeing that crap reintroduced.

  • Amazed

    OT (not quite): I’m coming from Danielle Yeager’s page. Jan and fellow asshole murderers are at it again, making HER to be the bad guy because she wants to spare other parents the grief she’s going through.

    Each time I see their dribble, I see red. And doctors and sane CNMs are supposed to work with these “medical colleagues”? And these assholes are getting acknowledgment by some states? What the actual fuck?

    • MaineJen

      The amount of harassment and vitriol these loss mothers are subjected to never ceases to amaze me.

  • evidencebasedbreastfeeding

    The LLL (GB) have released fairly new posters again based on the 5-7ml stomach capacity:
    https://www.laleche.org.uk/milk-volumes/
    The posters are aimed at health professionals to help them in their communication with mothers.
    The only scientific source that is quoted for the resources, is the paper in Acta Paediatrica that Dr Amy cites above. Which does not estimate 5-7ml but rather as she says, 20ml for stomach volume. Where they then get the different numbers they show in their posters, I have no idea. (the Acta Paediatrica paper doesn’t give any data that would be used to estimate stomach volume for later ages of baby, but nevertheless LLL-GB give numbers in terms of ml for later ages. Without a scientific reference to support it.
    I’m very irritated about this and much else besides, frankly; it all seems to me to be preconditioned ideas dressed up as science, and doesn’t match what best we can try to understand from the actual evidence. (Which obviously, is difficult to estimate and is going to be different from different babies, but that all means it’s imperative to indicate our uncertainty and the source of the information, and the possible sources of bias etc etc etc).

    • Allie

      WTF is this nonsense?!?!
      So LLL make a bunch of posters procaiming the stomach capacity at birth is “a few drops to 5 ml”. Then they ‘back it up’ with a reference (including link to the abstract!) that clearly states the stomach capacity at birth is around 20 mls?
      Dr Amy, please do everything you can to spread knowledge on this pseudoscientific disgrace. New parents are being systematically given false and dangerous information by ‘healthcare professionals’ who are more concerned with their precious belief system than the patients under their care.
      This has to end.

      • Chi

        We were fed the same BS at our antenatal class. We were told that a newborn’s stomach was the size of a marble, then over the first 3-4 days it gradually expanded to the size of a shooter marble.

        It needs to stop because SO many mothers will not realize that they are actually starving their baby, leading to excessive weight loss, dehydration and god only knows what else.

        The fact that this junk science has crept its way into not only district health board sanctioned antenatal classes, but also into the nurse training as well is, frankly, utterly terrifying.

        • Empress of the Iguana People

          considering my daughter was 8, 12 at 38 weeks, I cannot believe she had a marble for a stomach. My young Entling <3

        • MichelleJo

          I find this extremely disturbing, as this is something new that has crept in over the last year or two. And it has to be stamped out. Even Jack Newman never claimed that, although he might jump on the bandwagon.

    • PeggySue

      Junk science plus junk reading of old science. What could possibly go wrong?

  • Andy

    I had this experience, here in the Philippines they call themselves “breastfeeding counselors” – there are only very few certified LCs here. A “breastfeeding counselor” told me I didn’t need to supplement that I was making enough milk and my son’s tummy was too small anyway so he didn’t need to be supplemented with formula. My son was born via CS – my milk hadn’t come in so I had to supplement with formula for the first 2 days of his life. But I really wanted to BF. When I came home, a breastfeeding counselor – gave me post natal massage to help my milk flow. She did in fact help clear the clogged ducts on my breast. After her post natal massage, colostrum did show up. She said it’s time to keep away the formula and bottles because I would not need them anymore and in the coming days my milk will “overflow” – that was the term she used. But my gut told me otherwise – I texted a pediatrician who is also a family friend of ours advised me not to stop supplementing if my milk is not enough otherwise my son would starve and not grow normally. After a few weeks of 24/7-latching, pumping, supplementing, I found out that I had IGT so my milk would never “overflow” good thing I listen to my gut feeling and to an actual doctor

  • StephanieA

    Of course LC’s don’t care if babies scream, because they don’t have to hear it. They work with mom for 15 min per day, spout their nonsense, and leave. I’ve been so frustrated at my BFH lately. It’s sad because I love my job, but I don’t know how much longer I can stay at a place that truly believes these things like the 5 cc stomach. We do have stickers that we are encouraged to wear, and to show mothers when they’re concerned their babies are hungry (I don’t).

    • Platos_Redhaired_Stepchild

      Maybe you can print out the relevant page from Fed Is Best and pass it along to the moms.

      • Roadstergal

        Or print out that list of citations above!

      • StephanieA

        I’ve thought about showing the research to my director. But our hospital is very strict Bfh culture, and I’m worried that my job would be in jeopardy. I don’t think they can technically fire a nurse for suggesting a practice change, but they can make working on a unit so awful for you that you want to leave. I’ve been there for almost two years, so I definitely don’t have the respect that many other nurses do.

        • Platos_Redhaired_Stepchild

          Maybe you can get the nurses they do respect on board with Fed Is Best and letting them suggest a change in practice. Or get someone to forward the information for you that isn’t employed there.

          • KeeperOfTheBooks

            That, and/or mentioning to those patients who are justifiably unhappy *exactly* how to best voice their concerns. In detail. With names and job titles. “Yes, Mrs. Smith, I understand that you feel angry that you were expected to assume solo care of an infant while unable to walk or toilet yourself. I am really sorry you had to experience that, but I don’t make the policies. However, if you’d like to talk to someone who does…”

    • L&DLaura

      I am with you there. I can’t stand it.

    • KeeperOfTheBooks

      Sympathetic hugs. I recently had a baby at a BFHI hospital, and about the only really nice thing I can say about it is that several of the nurses clearly thought that much of the BFHI stuff was completely idiotic. As one nurse put it, her previous job had been at a county hospital in another area. The women on her ward were nearly all on public aid, the patients were several to a room, etc. “But even there,” she said, “we had a nursery! And we didn’t expect the moms to do everything for themselves as soon as they’d finished with their labor or C-section! This is crazy!”
      Indeed. (I, of course, both agreed 100% and didn’t mention this to any other staff member cos I didn’t want her to get in trouble.)

  • Jules B

    I heard this lie when I had my daughter 4.5 years ago – from a couple different LC’s and in the breastfeeding class I took while I was pregnant. I still assumed it was true until I read this! Well, I did and I didn’t, because I remember looking at my baby just after she was born and thinking “Okay, I know all the various parts of her are tiny because she is a newborn…but surely her stomach is not THAT tiny??” I mean, I have no real idea of how big stomachs are in proportion to the rest of the body, yet the size they told me it was seemed…wrong, just on an intuitive level.

  • Inmara

    Someone will bother to comment on other parts of Bergman paper? It seems to recommend hourly feedings during first 4 weeks(!) if I haven’t misunderstood it, and in general clings to the noble savage trope by implicating that we should follow whatever practices hunter-gatherers are using in postnatal period.

    • evidencebasedbreastfeeding

      I read the Bergman paper in full a little while back, and believe the hourly feeding interval was calculated by dividing the 20ml estimated stomach capacity into a 24-hour estimate for required milk intake that was based on much older babies! (thus producing a much higher feed frequency/lower feed interval number). If you look at the amount he uses in his calculations (“for a total daily feeding volume of 160 mL/kg”) – this isn’t the amount of milk that would be relevant for a just-born newborn! (eg, a 3kg newborn he would be assuming 480ml). 480ml / 20=24. That’s probably getting towards the daily milk intake of a 2 week old (although much variation between babies) – by which time their tummies are probably waaaay larger.
      So the math there by Dr Nils has gone a bit screwy, IMHO.

      • EmbraceYourInnerCrone

        I am not a scientist(I’m a computer tech) but wouldn’t it make more sense to follow a large group of healthy newborns and have their parents record how much they consumed?
        I know it’s harder with breastfed babies but a lot of them are fed with bottles when they are in daycare or when they are at home with the non-breastfeeding parent.

        Dr Nils seems to be making a lot of (unfounded?) assumptions…

        • myrewyn

          But don’t you know, babies only know when to be born. They are ignorant when it comes to their own hunger.

        • KeeperOfTheBooks

          Plus, the Latest Thing (TM) in bottlefeeding a breastfed infant is paced feeding. Give the kid a few swallows, wait a minute or two, another couple of mouthfuls, another minute or two…
          Then you get a screaming, frustrated baby who sees bottles as inefficient sources of food and a caregiver who’s ready to lose his/her mind because it shouldn’t take an hour to feed a kid a damned bottle–er, I mean, “a replication of the breastfeeding experience so that baby doesn’t learn to prefer bottles to mom.” These people also claim that baby only needs an ounce per hour that mom’s away, which often leads to a miserable baby because he’s hungry and frustrated, and then a baby/mom who are up all night so baby can nurse.
          Sigh.

          • Shawna Mathieu

            Oh, that “paced feeding” crap. I started seeing that around the time I had my daughter and my first thought was “I can’t think of a quicker way to piss a baby off>”

          • Allie

            LOL, yes. I tried that once and let’s just say her royal highness was not pleased. Didn’t try it again : /

          • Roadstergal

            They just come up with any crap they can think of to take away the practicality of bottles, don’t they? Next step, you must twerk while bottle-feeding.
            Needless to say, I’m sure they don’t suggest ‘pacing’ breast-feeding. :p

          • KeeperOfTheBooks

            Pretty much!

        • evidencebasedbreastfeeding

          Hi, I’m just checking one of my textbooks, “Breastfeeding a guide for the medical profession” (lawrence&Lawrence — one of the better ones) and p88 in my edition there is a graph of milk intake from healthy EBF newborns for the 1st week postpartum, guaged from test-weighing methods. this gives 24-hr milk intakes getting up to 600ml by 4day postpartum. Depending on no of feeds – that might give, eg 60ml/feed (if 10 feeds/day) by day 4. day 2 you have 200ml/day, so if 10 feeds again, would be 20ml per feed.
          The test weighing method would be one of the few ways of accurately guaging *actual* milk intake for an EBF baby who is feeding at the breast, you could of course look at amounts transferred by bottle but that doesn’t quite answer the same question as how much they will take while at the breast directly. (Scientists interested in the physiology of lactation were interested early on in trying to get some concrete data on this specific question and you can then correlate that with amounts that might be transferred via bottle, or how much the mum can express from the breast and see whether there are differences etc). I’ve not done a lot of reading into this so not really fully up to speed to be honest however. Working out what is going on in the actual breast-baby thing is tricky, but there are methods that allow it to be done….

          I agree with you re the Bergman conclusion of an hourly feed interval (suspect that would kill a lot of mums early on, certainly me!) — I personally feel his conclusion about the 20ml stomach volume seems *reasonably* robust, at least based on what data is out there, but the next step of his calculation is a bit, erm… questionable…?

  • Dr Kitty

    https://www.theguardian.com/society/2017/feb/14/new-mothers-midwife-new-study-nct

    I am hopping mad.

    The NCT has said that GPs “aren’t properly trained” to manage the needs and concerns of new mothers and their babies.

    It should be possible to call for more access to midwives postnatally, and suggest that it is inappropriate for women to seek care from GPs and A&E which should more properly be provided by Midwives WITHOUt implying that GPs are provided substandard or inadequate care or aren’t properly trained to deal with the needs of Postnatal women and their babies.

    Midwives CALL GPs when they are out of their depth- we are well trained and have perfectly adequate knowledge and skills to manage the physical and mental health issues which concern new mothers.

    This may seem like nothing, but I feel professionally insulted and denigrated and frankly I’m not happy about it.

    The NCT got at least one angry email today.

    • Empress of the Iguana People

      What the heck?!
      Nurses are awesome, but they aren’t doctors.

      • evidencebasedbreastfeeding

        Oh, for sure.

        The thing I hear all the time in doing my BF support (from colleagues etc) is “Doctors/Midwives/Health visitors don’t know anything about breastfeeding. You guys know waaaayyy more than they do”. Ahem!!!!

        And then I hear about half an hour later one of the little memes get trotted out:

        “Infant weights are so unreliable, those 4 day weigh ins don’t mean anything, all they do is trigger the Dr’s/MWs to recommend supplementing, which will kill the BF relationship”
        *Food before one is just for fun. Babies don’t need anything other than breastmilk for XYZ (insert ridiculously long period of time)”
        *This new guidance on giving Vitamin D from birth to BF babies, those drops will harm the baby’s virgin gut, I’m not going to recommend these
        *Just one bottle (formula) will ruin baby’s gut health
        *Even mums who are HIV positive (in rich countries) can breastfeed
        *Even if mum has a really poor diet, it’s better if she breastfeeds than gives formula. Even mums who are close to starvation in the developing world can breastfeed
        *There’s no risk of SIDS with cosleeping, as long as mum doesn’t smoke etc, it can be done safely

        all of which (as far as I can tell from my pubmedding) don’t comport with the scientific evidence, and I’m pretty sure most docs/MWs would have a far more sensible view on those ridiculous statements… Which is why I think that infant feeding support does need professionals to deliver it who are able to integrate their support properly with all the other aspects of infant and maternal health that need to be delivered.

        The problem in the UK is I think we have an echo chamber effect where the people delivering BF support are either volunteers or IBCLC’s/LC’s and don’t have the expertise or ability to parse out the actual science, and have no health professional training, so are really vulnerable to quite a lot of distorted statements that appear on social media, blogs etc. And then trot out these statements again assuming that because they heard them from (XYZ well-respected “name” in the BF world) they “must” be true….

        And then mums have a hard time (as well as being on the receiving end of BS), and say they want more support, which then triggers those in the BF world to say, aha, more support is needed! but all the time, no one is asking what “support” really means or WHO are the most properly placed professionals to be delivering that support.

        • Dr Kitty

          YUP.

          The woman with the six week old EBF baby who was still below its birthweight and attending NCT BF support meeting and being told just to keep feeding and ignore the HV and GP’s concerns because they were just trying to sabotage the BF relationship comes to my mind.

          Basically the baby was admitted with FTT and the only way the mum would agree to it was because the GP and HV advised that social services would be involved if she didn’t.

          She was making almost no milk, and what she was making was watery. A few days of formula and EBM with supplements powder added and the baby was thriving, and a few hours of uninterrupted sleep did mum the world of good too.

          This was a woman who had literally done EVERYTHING- skin to skin, lying in bed nursing 24/7 for days at a time, pumping around the clock, oatmeal/fenugreek/domperidone, obsessivelyreading Kellymom, frequent BF support group meetings- you name it.

          The baby was healthy, his latch was fine- she just wasn’t making milk, and the breastfeeding support groups just wouldn’t accept that as a possibility.

          It wasn’t that the GP wasn’t adequately trained, they had been telling her for weeks that BF wasn’t working and to supplement- but she had no confidence that they knew what they were talking about.

          • evidencebasedbreastfeeding

            I know. It is really tough. We are quite clearly trained to never go against medical advice but I am not sure that really gets through to everybody (and certainly not in many BF supporters informal conversations!)
            It is really tragic when you see babies that are suffering – for the life of me, it just CANNOT be physiologically normal for a baby to not be back to birth weight by 4 weeks, 6 weeks etc.
            The problem I find is that if one challenges any of these unscientific claims, one is accused of being “anti-breastfeeding” – I’ve had a hard time recently trying to take some assertions to task that I felt weren’t well supported scientifically, and really felt on the sidelines/persona non grata for trying to rein things in and bring stuff back to the data. (I sort of got the impression people wanted to say “who let HER in here?? Why won’t she just go away/shut up”).
            The problem being, the more BF advocates spout unscientific rubbish, the more they alienate a) the majority of sensible mums who just want to get on and care for their babies b) doctors/HCPs c) scientists/researchers who might otherwise actually do some good research on breastfeeding and thus advance knowledge, for the betterment of babies and mothers!
            Hence, the situation is that we actually have a really poor evidence base for a lot of issues in infant feeding (esp related to the clinical management of breastfeeding), because good researchers don’t want to work in this area. It’s just too controversial, and they don’t want to get slammed if their actual data ends up going against ideology.

    • maidmarian555

      I read this today. The bit I found a bit disingenuous (and recognised as such) was that they included post-natal appointments for c-section scar issues. I had that. I was told to keep a really close eye on my wound and when it went a bit red and puffy, I immediately phoned my GP (who was brilliant and got me in right away that morning). It didn’t even occur to me to ring the midwife- they can’t prescribe antibiotics. Why would I try and make an appointment with somebody who isn’t able to provide the thing I actually need? I dont understand why something that (in my mind at least) would require a GP appointment would be included in a list of things that women are apparently unable to get appointments with a midwife for?

      • Dr Kitty

        Exactly.
        I get calls from midwives that so-and-so has a wound infection, mastitis or endometritis and needs antibiotics. But I’ still the one who has to prescribe the antibiotics.

        I’m also the one who sees anyone with Postnatal depression to arrange CBT or medication. The midwives can’t do that.

        What I think they mean is specifically regarding breastfeeding support.
        Despite the fact that most GPs are female, and mothers and breastfed.
        And just because we tend to be more open to supplementation, combo feeding or just giving up on breastfeeding than midwives doesn’t necessarily mean that we’re inadequately trained.

        • maidmarian555

          It also completely ignores the existence of Health Visitors. I know it’s a bit of a post-code lottery and they’re all having their funding squeezed but they also (certainly where I live) offer breastfeeding support. The team in my area (if you can’t get an individual appointment) run a breastfeeding drop-in once a week where you can spend the entire day (if you need to) so that they can have good look at the baby feeding and give support and advice. I don’t understand why they think that midwives and only midwives should be the ones providing all of these essential post-birth services.

          • Dr Kitty

            It’s the NCT.
            Bastion of white middle class homebirthing AP NCB lactavists.

            Neck deep in woo and providers of the kind of antenatal classes that Dara Ó Briain so beautifully skewers (“paging Dr Bear!”).

            Don’t get me wrong, I absolutely think that the NHS community midwife should be the first port of call for new mothers, but not because GPs “aren’t properly trained”.

            More because we’re seriously overworked as it is and definitely over qualified to dispense the kind of common sense advice, tea and sympathy that is what most women need. We already get the PPD, serious infections and dehydrated babies because the midwives and health visitors refer them to us…we don’t need “is the poo supposed to be that colour” and “Is this amount of lochia nornal?”.

            I LIKE doing six week Postnatal appointments, I’m good at it, I enjoy it and my patients tell me that they appreciate it.

            But I don’t need to be the one telling a new mum to try hot compresses and cold cabbage leaves to ease engorgement day 6 post natal- midwives are more appropriately placed to do that.

          • maidmarian555

            For sure. And yet the article gave examples that could all potentially be emergencies, or certainly situations where a midwife would need to make a referral. The four main concerns they list mothers as having are babies not feeding properly, maternal emotional and mental wellbeing, stitches and scars. The examples they give are a case of potential DVT and a dehydrated baby. I’d be totally fine with them arguing that many new mums would benefit from more midwife-lead support and advice so they aren’t wasting GP appointments talking about poo colour but that’s not what they appear to be saying. It’s stuff like this that made being a new mum about a million times more confusing for me than it needed to be. I can see the holes in it now I have a 10 month old. When I was pregnant I’d read things like this and be left feeling even more clueless than before.

          • Dr Kitty

            Yep.
            NCT has an agenda, and it often seems to get in the way of actual common sense.

            As for DVT- bugger all a MW can do about that except send the woman to A&E or the local DVT assessment Clinic for Dopplers and Clexane.

          • MichelleJo

            They SHOULD be going to their GP about poo colour, because the midwife will tell them that the colour is individual to each baby and nothing to worry about. Then a pat on the back and ‘you’re doing really well, baby is fine’. If the baby has green stool after the first week, it is a red flag that the baby could be underfed. A well fed baby, regardless of how it is fed, will have soft yellow stool. A GP will actually asses the baby for dehydration. I picked up my daughter from day care at the end of my first day back at work, and was asked why I said that the baby was EFF, when her stool was yellow. (As in Reason No 7 to Breast Feed: Your baby’s stool will be soft, yellow, of a mustard consistency and have a sweet smell. [Yum.] Formula fed babies have hard green stool because they can’t digest the formula properly.) I just pointed out that her eyes were brown. Hey, there’s another potential stunner to end a discussion before it get’s off the ground when a nosy nobody asks why you EFF. “I prefer the colour green.” Others that have been tried and tested are, ‘I formula feed exclewwwsively,’ or ‘don’t you know that formula feeding is healthier? nursed babies are deficient in VitD’ or ‘Why not?’.

          • Dr Kitty

            Stool colour is really not as useful as that.
            Green stool in a well hydrated, happy baby that is growing well… not a problem, despite the many, many posts on various parenting forums that would have you believe otherwise.

            And if the baby isn’t happy, hydrated and thriving- I don’t care what colour the poop is, there is a problem!

            In a well baby the paediatricians don’t get excited unless the poop is red,white or black- anything on a spectrum from yellow-orange-green-brown and they are happy.

            So no, I really don’t want to see the happy thriving babies who happen to have green, brown or orange poo and anxious parents.

          • Nick Sanders

            I know black and red are upper and lower GI bleeds, respectively, but what is white? Pus?

          • Kerlyssa

            liver problems

          • Dr Kitty

            http://www.hopkinsmedicine.org/johns-hopkins-childrens-center/what-we-treat/specialties/gastroenterology-hepatology-nutrition/stool-color-overview.html

            Poop is coloured because of bile.
            If bile can’t get into the bowel the poop stays white.
            So, white stool suggests a blockage in the gallbladder or liver or very high up in the gut near the liver.
            In babies it usually indicates biliary atresia and is accompanied by prolonged jaundice.
            Biliary atresia is fatal if untreated, and treatment requires surgery and sometimes liver transplantation.

          • MichelleJo

            I was not implying that green poop alone is a sign of dehydration. More that if a mother comes to a midwife with a baby that she is seriously worried about, the midwife is more likely than a GP to shrug off all her concerns. If a baby is thriving and satisfied, of-course green poop alone is of no concern with it not being a medical indicator of dehydration or starvation. But, as many underfed babies do in fact have green poop, if they are showing all the other medical signs of dehydration then taken together, it should not be shrugged off. My knowledge of this is not from internet mothering boards, but more anecdotal. Given the number of times I have seen it, it has too consistent for it to be a fluke.I am from a family of non-nursers due to low to zero supply; my mother and three sisters all had the same issue. We’re talking 35 babies here although a minority were EFF from birth. And in every case where it got to the point of screw-the-midwife-let-the-kid- be-dumb-overweight-immuno-compromised-for-life-but-let-him-eat-so-he-can-live-that-life, there was always a change in colour from green to yellow. (I guess I didn’t ‘see’ my mother’s first few babies, but she remembers it well.

          • FallsAngel

            Green poop can mean the stool is passing through the intestine very quickly. So in some cases, it can mean an intestinal infection, which of course, can cause dehydration. But sometimes, poop is just, well, green. You have to look at the whole picture, not just the color of the poop.

          • Empress of the Iguana People

            My eff kid’s poo has yet to be green, though we have achieved a purplish color thanks to blueberries and purple carrots!

          • AnnaPDE

            Wow, you’d think they’d have poo figured out at a daycare of all places… Yes, there is a slight colour difference between the milk and formula hues of mustard yellow, but you’d have to know the individual kid’s baseline and then have an eye for colour to spot it.

    • Madtowngirl

      I figure if my GP is well trained enough to perform a pap, then he/she is well trained enough to check a 6 week old c-section scar. I’ve also never had a GP hesitate to refer me to a specialist when they are out of their comfort zone.

      I mean, what the actual hell is the agenda here?

      • Dr Kitty

        Breast feeding support.
        The NCT feels GPs aren’t properly trained to offer breastfeeding support, because generally speaking we take a “fed is best” approach and don’t toe the lactavist line, despite the majoroty of UK GPs now being women , most of us are mothers and most of whom actually choose to breastfeed.

        Possible DVT, wound infections, endometritis, mastitis, postnatal depression, contraception, marital difficulties, colicky baby, GORD, failure to thrive, milk allergy- all perfectly within the GP skillset.

        The “special skills” midwives are supposed to offer and the areas GPs “aren’t properly trained in” is “breastfeeding support”… i.e. the “breast feeding will eventually work if you keep breast feeding” school of lactavism.

        • Madtowngirl

          Ugh. That’s gross. I’m glad you wrote an angry response to that.

  • OttawaAlison

    When I first heard the lactation talking points 10 years ago, I realized most were 20 years old:
    “Doctors 30 years ago said formula was better than breastmilk”
    “You needed more education”
    “You didn’t have the support you needed”
    “you’re surrounding by women who bottlefeed thus that’s why you bottlefed”.
    The talking points were often the same in the 80s as they were in the aughts as they often are now.
    Here was my reality:
    – Basically my mom during 70s was encouraged to breastfeed.
    -I was breastfed
    – I had read many books/websites/pamphlets on the importance of breastfeeding
    – most women I knew breastfed.
    So it doesn’t surprise me in the least they hang onto the baby stomach size myth.

  • Emilie Bishop

    For all the things my “baby-friendly” hospital totally screwed up with me and my son, this was surprisingly not one of them. I never saw a nurse or LC with one of these lanyards or was told any estimate of my son’s stomach size that I remember. I say surprisingly because this is yet another example of lactivists wishing reallyreallyreally hard that human bodies always function a certain way that just isn’t true, right up there with all mothers always make enough milk for their babies unless they aren’t trying hard enough, which I did hear a lot from my hospital. And frankly, this woman making the lanyards scares me when she refuses to listen to genuine data from reputable sources telling her she’s mistaken. All the lactivist lies that are being taken on by data and stories of harm should make these people revise their methods if they truly cared about moms and babies. The fact that they just insist that they’re right should show everyone else that there are other motivations at work.

    • OttawaAlison

      That’s a huge part of the problem. The amount of LCs who hold onto their beliefs without looking at the data or only look at the data that confirms their beliefs. Many doctors adjust their treatment protocols when new research emerges, yet when it comes to the lactation professionals, how many are doing that? That’s what I find so troubling.

  • Heidi_storage

    When we finally gave my older son formula about 20 hours after his birth, the nurse advised that he probably shouldn’t have more than 10-15 mL at a time. The poor kiddo sucked down 20 mL before we could stop him.

    (Oh, and after he’d had a couple of formula feedings, he was STILL found to have lost 10% of his birth weight at the 24-hour check.)

    • EmbraceYourInnerCrone

      Ok I don’t understand. Why limit the poor kid to just 10 – 15 mL if they are hungry and need more?

      • Heidi_storage

        I’m guessing she was worried that overfeeding him would make him throw up, but I never asked. Maybe she bought into the whole “5 mL stomach” thing; the hospital was moving toward BFHI certification. (Thankfully, they had reversed course by the time I delivered my younger son.)

        • Kelly

          We were always told to only give one ounce at a time for the first day. A new nurse gave one of mine two ounces on the first day and she spit up and choked much more than with one ounce. It is just an anecdote but maybe they are working about aspiration?

          • Amy Tuteur, MD

            An ounce is 29 cc. That’s more than 4X higher than the lactivist claim about stomach size.

          • Kelly

            Ok, I think I misread it then. So my formula baby can get 4x more food but my breastfed babies suddenly have small stomachs? Yeah, that is quite fishy.

  • The Bofa on the Sofa

    Another time when we need the commenter FAQ. I have described previously when my first niece was born. She was born by c-section at about 7 pm, and I went to the hospital with my folks and got there about 8:30. I remember distinctly my BIL saying, when we got there, that she had already drunk an ounce of fluid from the bottle (some version of water).

    An oz is 30 mL, and even assuming there might have been some left over, we are still talking well beyond 5 mL.

    How did that happen if her stomach could only hold 5 mL? It’s obviously wrong.

    • LovleAnjel

      My daughter ate an ounce of formula when they did her first check after coming out the escape hatch. Repeating: she ate an ounce when she was MINUTES old. And she was under 6 lbs in weight.

  • Empress of the Iguana People

    My anecdata is my daughter who was drinking half a 2 oz bottle by her 2nd feeding. In the blinking NICU!
    Then there’s the size thing. My husband was literally twice my size at our respective births. All of his organs would’ve been much larger than mine!

  • Mel

    My son was born at 26 weeks gestation.

    He was polishing off 9mL feedings within a week of birth, so I’m willing to use my anecdotal singular data point to guesstimate that his tummy may have actually been 3mL-5mL at time of birth…three and a half months early.

    The term size newborns in his NICU unit usually gulp down between 10mL and 20mL per feeding when offered bottles.on the first day they are in the unit – but one little girl was working on 27mL yesterday.

    Just give the kid a bottle of formula. The NICU nurses do it all the time and the kids still end up taking the breast happily.

    • Empress of the Iguana People

      My daughter had no problem being given a boob when the engorgement just got too much. It’s like these tiny humans have the ability to learn multiple things.

      • Helen

        My daughter, garage fed for the first days of independent life, was ecstatic to see a human nipple for the first time. Afterwards, both she and her sister switched back and forth without complaint.

    • Roadstergal

      The more I hear about successful combo-feeding relationships, the more I think instances of ‘nipple confusion’ are “I like a bottle better” – whether because the baby isn’t getting enough milk from the boob, or because they just plain prefer a bottle.

      Why do we think babies aren’t smart enough to learn different kinds of nipples, or to have preferences?

      • MaineJen

        Silly Roadstergal. Babies clearly know when to be born, but they haven’t a clue what’s good for them when it comes to feeding! They only *think* they’re still hungry.

        • Roadstergal

          It’s amazing how smart babies are when it lines up with NCB/AP – smarter than doctors! – versus how incredibly dumb they are when it doesn’t.

      • Dr Kitty

        Or you can have babies like both of mine who steadfastly refused to drink breastmilk from anything except the breast.

        My daughter remained exclusively breastfed, because I never considered giving her formula.

        My son got formula from a bottle which he took greedily and was perfectly happy to continue to breastfeed, but when it suited me (he only started getting formula after six months when he was already on solids).

        • Mishimoo

          Same with my 3 kids, until they felt like weaning. Even then, it was hard to find something they liked even though they were refusing the breast.

      • Azuran

        For that matter, why are they even promoting finger feeding?
        Maybe I just have extremely abnormal fingers or nipples, but they sure as hell don’t look anything alike. I really doubt sucking on a finger is the same thing as sucking from a nipple.
        So why is no one worried about ‘finger confusion’?

        • Roadstergal

          I would guess it’s more about ‘smells and tastes human’?

          However, of the people that I’ve been with, I can’t think of anyone where the fingers and nipples tasted the same…!

          • Azuran

            But then what about feeding from a cup or a spoon?
            They are really just anti bottle because bottle = formula.

          • Roadstergal

            And bottles can be convenient. They don’t want women finding anything that could compete with breast for convenience.

      • AnnaPDE

        Oh, they know perfectly well that the baby really just prefers the bottle.
        And that’s how they are “confused”: they want something different than what they’re supposed to, so something must be wrong with them. No sane baby would prefer anything to the magic superboob juice!