Last week saw news coverage of the tragic story of Jillian, a mother in the United States who lost her baby, Landon, due to severe dehydration. Health professionals and others who provide support to parents for feeding are rightly saddened, as well as concerned to ensure that lessons from the case are learned and that expectant parents can be reassured. The need for expert, reliable support for mothers and babies during the first critical hours and days is clear.
We are unable to comment on this individual case as we do not know all of the circumstances that led to such a devastating outcome. However, our work in the UK with health services over the past 20 years, as well as extensive evidence on the issue, demonstrates that hypernatremic dehydration in the absence of underlying illness is highly preventable, without the need for routine supplementation of all babies, which has been shown to undermine breastfeeding success.
A key aspect of the Unicef UK Baby Friendly Initiative standards is the provision of professional, consistent and vigilant care to protect the safety of both mother and baby. They require that parents receive education in the antenatal period on how to breastfeed and how to spot when breastfeeding is not going well. In the immediate post-natal period, parents should be supported to get breastfeeding off to a good start and given information on how to recognise that their baby is getting enough breastmilk prior to discharge from hospital.
Health professionals are required to support mothers with positioning and attachment to ensure effective feeding. They should carry out frequent formal breastfeeding assessments in the first two weeks after birth, including examining the baby, monitoring urine and stool output and weight. They should also identify all at risk babies so that a feeding plan can be developed. With early detection, most breastfeeding problems can be quickly resolved; however, in a few cases the problems will be more complex, and supplementation may be required. In these cases the Baby Friendly Initiative recognises the need for supplementation whilst continuing to provide support to maintain lactation.
There is extensive and resounding evidence that breastfeeding improves health and saves lives in all countries, rich and poor alike. However, mothers need expert and reliable support to get breastfeeding off to a good start, and regular monitoring in the early days. The Baby Friendly standards enable health professionals to provide this high quality care and ensure the safety of all babies.