Speaker 1: Appogia production.
Speaker 2: Hi everyone, thank you for tuning back into Tenantus for Nurses.
Speaker 2: I suspec Woodbine here this season. I am so excited
Speaker 2: to announce that the podcast as being supported by Nutritia,
Speaker 2: which is a global leader in medical nutrition. They understand
Speaker 2: the needs of nurses in the nutrition space and for
Speaker 2: over one hundred and twenty five years have provided products
Speaker 2: to support child health. Some of Nutrita's pediatric brands include
Speaker 2: Neo Kate Junior for children who have food allergies and
Speaker 2: app to Grow for those fussy eaters. And those of
Speaker 2: us who have children know many kids who go through
Speaker 2: the phases of definite fussiness. For more information and resources,
Speaker 2: visit the nutritiona Pediatrics hub at nutritia dot com dot
Speaker 2: au forward slash Pediatrics. I just want to say a
Speaker 2: huge thank you to Nutritia. Their desire to support nurses
Speaker 2: is truly appreciated, and they are allowing me to continue
Speaker 2: this podcast so that we can all grow as nurses.
Speaker 2: This season, we have some amazing speakers in the pediatric
Speaker 2: space which I cannot wait to share with you all. Hi,
Speaker 2: my name's Beck Woodbine and welcome to Tenderness for nurses.
Speaker 3: I'm grateful for the person that I have the opportunity to.
Speaker 1: Be, so I hit it and parked it for Nellie
Speaker 1: for years. We always have free will, We always get
Speaker 1: to choose. We are autonomous.
Speaker 2: Hi everyone, thank you for tuning into Tenderis for Nurses.
Speaker 2: We are very excited this season to be sponsored by
Speaker 2: NUTRITIONA and I have the fabulous professor Elizabeth Denny Wilson,
Speaker 2: who specializes in obesity prevention in babies, but also she
Speaker 2: has done some significant research into the area of mixed feeding,
Speaker 2: and probably that is what we're going to address a
Speaker 2: little bit more today.
Speaker 3: But thank you so much for coming on.
Speaker 2: I know you are super busy as a professor and
Speaker 2: studying and teaching and researching.
Speaker 1: We're all super busy, so that's no excuse.
Speaker 2: I am just so delighted and reading your bio and
Speaker 2: watching the videos that are on YouTube about you and
Speaker 2: what you have done around mixed feeding. We all know
Speaker 2: breast is best, and we all try to do the
Speaker 2: right thing by our kids.
Speaker 3: But sometimes you know you've.
Speaker 2: Got to go back to work, you're not well, you
Speaker 2: don't know the circumstances behind. So I'm making a decision
Speaker 2: to maybe mix feed. So do you mind explaining exactly
Speaker 2: what mixed feeding is?
Speaker 1: Yes, certainly, so I completely agree with you Beck. Breastfeeding
Speaker 1: is an extraordinary thing and an extraordinary thing that we
Speaker 1: can do for our babies, and it is one hundred
Speaker 1: percent the best way to feed human infants. But also,
Speaker 1: as you said, there are reasons why sometimes people don't
Speaker 1: want to breastfeed, or they feel pressures one way or
Speaker 1: another to not breastfeed, or they might feel like they
Speaker 1: have a low supply or that they don't have enough milk,
Speaker 1: or you know, there are lots of reasons why people
Speaker 1: might choose to introduce infant formula. So mixed feeding just
Speaker 1: means if you're combining breastfeeding with another form of feeding,
Speaker 1: So you're either feeding with infant formula in a bottle
Speaker 1: or in a cup, sometimes in a spoon, which would
Speaker 1: take a long time. So it just means that you're
Speaker 1: breastfeeding plus something else.
Speaker 2: And do you think there's a higher percentage of people
Speaker 2: doing that than anyone talks about because I know that
Speaker 2: if you have a season, you're shamed. If you don't breastfeed,
Speaker 2: you're shamed. I mean, I had a daughter that just
Speaker 2: wanted breast milk, and that was great and it suited me,
Speaker 2: but my second child had total refusal to eat. Ye
Speaker 2: period was a nasogastrically fed, then just to nuzzle a
Speaker 2: couple of weeks at some stage, and then we tried
Speaker 2: to get my breast milk back in and then he
Speaker 2: refused again. So I was very lucky that I had
Speaker 2: some amazing lactation consultants to come in, but in the
Speaker 2: end he just had to be not even bottle fed.
Speaker 3: He's one of those kids that were spoonfed.
Speaker 1: I had one of each as well, so yes, an
Speaker 1: enthusiastic breastfeeder who I fed for years and another one
Speaker 1: who it was pretty challenging. But I think we just
Speaker 1: don't know is the true answer. We know from our
Speaker 1: research and from other groups research that about half of
Speaker 1: babies will have some formula before they're six months old,
Speaker 1: but we don't have really good data on the proportion
Speaker 1: of people who were mixed feeding, so who were doing both.
Speaker 1: You know, we can kind of extract it from other studies,
Speaker 1: but we don't have really good data on the proportion
Speaker 1: of people who are mixed feeding. And I see this
Speaker 1: as a terrible gap because if we knew knew more
Speaker 1: about people who were mixed feeding, and if we knew
Speaker 1: more about why they were mixed feeding, then we'd be
Speaker 1: in a better position to develop interventions to support them
Speaker 1: to continue breastfeeding, to breastfeed more often, to maintain their
Speaker 1: breast milk supply, and we'd also be able to support
Speaker 1: our clinicians to support women to prolong breastfeeding, to increase breastfeeding.
Speaker 1: But we can't really do those things if we don't
Speaker 1: really understand who's doing it, why they're doing it, how often,
Speaker 1: whether their goal is to get through a period of
Speaker 1: challenge in their breastfeeding that they will then pick back
Speaker 1: up again. And certainly when I was had my babies
Speaker 1: and became really interested in the way people feed their babies,
Speaker 1: I was absolutely devoted breastfeeder and one hundred percent you know,
Speaker 1: behind breastfeeding being the best food for babies and breastfeeding
Speaker 1: at all costs. But I guess what I have come
Speaker 1: to understand through my research and through the women I've
Speaker 1: met in my role as a breastfeeding counselor but also
Speaker 1: in my role as a researcher, is that it's just
Speaker 1: not always what's right for them and if we could
Speaker 1: really understand more about why they've made the choices they've made,
Speaker 1: then we might be able to intervene sooner and help
Speaker 1: them to continue breastfeeding, or help them to breastfeed more often,
Speaker 1: or find a way of mixed feeding that doesn't lead
Speaker 1: to no breast milk, because some breast milk is better
Speaker 1: than no breast milk.
Speaker 3: Absolutely.
Speaker 2: Why do you think there is such a huge gap
Speaker 2: in that research space.
Speaker 1: One of the reasons is that I think for a
Speaker 1: long time, we've had people who research breastfeeding and we've
Speaker 1: had people who research other things, and we haven't necessarily
Speaker 1: communicated very well or done really good multidisciplinary work. And
Speaker 1: I also think because our health services and our health
Speaker 1: departments have had extremely strong pro breastfeeding policies, as they should,
Speaker 1: there hasn't necessarily been a place for doing research about
Speaker 1: mixed feeding. And there's also been a really strong sense
Speaker 1: over my lifetime of working in this field that there's
Speaker 1: enough information out there in the in the ether or
Speaker 1: in the way that is accessible to mums into wherever. Yeah,
Speaker 1: to give mums who are using it formula advice on
Speaker 1: using it formula. But I think what hasn't been captured
Speaker 1: well is that, of course, there are mums who exclusively
Speaker 1: breastfeed and that's fatastic, and there are mums who exclusively
Speaker 1: use infant formula, and that's they deserve our support. But
Speaker 1: when we do our work that was initially focused on
Speaker 1: obesie prevention, and there's a reason why we're interested in
Speaker 1: infant formula for obesie prevention, I guess we started to
Speaker 1: see that. And this work was led by one of
Speaker 1: my PhD students, and she talked to a lot of
Speaker 1: mums who were using infant formula, either mixed feeding or
Speaker 1: exclusively formula feeding, and there were a couple of things
Speaker 1: that she found that really sort of broke my heart
Speaker 1: a little bit. One of them was that mums don't
Speaker 1: seek health professional advice before they start introducing formula, and
Speaker 1: that's because they don't think they can, They feel judged,
Speaker 1: they feel like it's not the right thing to do,
Speaker 1: and that they won't necessarily get support. And the second
Speaker 1: thing that broke my heart was that the place where
Speaker 1: most people who are introducing infant formula get their information
Speaker 1: is from the tin, so from the tin of formula,
Speaker 1: and I just think we can do a lot better
Speaker 1: than that.
Speaker 3: That's where I got mine from.
Speaker 2: Yep.
Speaker 1: I just think that's a travesty because a lot of
Speaker 1: mums who are introducing infant formula are doing so at
Speaker 1: a point of distress or of christ or and we
Speaker 1: should be wrapping our arms around those mums, just as
Speaker 1: we should be wrapping our arms around all mums. We
Speaker 1: should be saying, what's your goal? Is this something you
Speaker 1: just want to do for a little while, or you know,
Speaker 1: have you thought about mixed feeding? Have you thought about
Speaker 1: this might be something you could do just to take
Speaker 1: the pressure off for a couple of days, and then
Speaker 1: you know, here's what you could do to keep your
Speaker 1: supply up, or here's what you could do to build
Speaker 1: your supply, or here's how you can do it without
Speaker 1: say that's it for my breastfeeding journey.
Speaker 2: So when someone decides to mix feed because of say,
Speaker 2: for example, they're going back and doing some part time
Speaker 2: work that sort of thing, you know, it might just
Speaker 2: be easy for them to go, Okay, I'm not going
Speaker 2: to breastfeed anymore.
Speaker 3: I'm just going to swoop to bottle formal food.
Speaker 2: But if they knew that, say, they could do morning
Speaker 2: and night exactly, just you know, a bit of a
Speaker 2: pump at lunchtime. You know, there's a room there that
Speaker 2: you know at work that you can do that, and
Speaker 2: then they can take that home and use that on
Speaker 2: the days off or a weekend when you know Nana
Speaker 2: and Papa are looking after the kid or something like that.
Speaker 2: But it's interesting I just found with my daughter, she
Speaker 2: just wanted breastpilk, that's it. And then she went straight
Speaker 2: to a cup because there was no way she was
Speaker 2: going to give that up.
Speaker 1: Yep.
Speaker 2: Jacob, on the other hand, just hated everything. I was
Speaker 2: at the end of my tether. I actually said it
Speaker 2: in a podcast previously. I was so beside my I
Speaker 2: went to the Maternal and Health Child Service Center, sat
Speaker 2: there on the steps before it had even opened, with
Speaker 2: this crying baby that just wouldn't feed, wouldn't stop crying.
Speaker 2: And I was sitting on those stairs with this baby crying, begging.
Speaker 2: I was begging for help. Yeah, he's lucky I didn't
Speaker 2: throw him in the rubbish bit seriously here. Yeah, and
Speaker 2: you know, I'm a nurse, so I have a bit
Speaker 2: of an idea about stuff.
Speaker 3: But imagine being.
Speaker 2: A mum and not having your mum around or being
Speaker 2: on your own or being a single parent or not
Speaker 2: having that support.
Speaker 1: Absolutely, and child family health services are not as available
Speaker 1: as they used to. I mean, if you've got a
Speaker 1: good child family health nurse, they are like gold, like
Speaker 1: absolutely salute gold because the relationship that they develop with
Speaker 1: new mums is just second to none, and they will
Speaker 1: support mums through thick and thin, and they have just
Speaker 1: such a beautiful way of you know, telling mums you
Speaker 1: know you're doing a great job, and that's exactly what
Speaker 1: mums need to hear. But it's not like when I
Speaker 1: had it. You know, when I have my babies, you
Speaker 1: could turn up for a drop in visit. I think
Speaker 1: it was every morning and they had appointments in the afternoon,
Speaker 1: so it was really available and I really needed it
Speaker 1: and a lot of mums really needed it, and then
Speaker 1: at other times I didn't need it at all. But
Speaker 1: now there aren't enough China family health nurses and there
Speaker 1: aren't enough Chime family health nursing appointments available or drop
Speaker 1: ins available, and that again it's not helpful for mums
Speaker 1: who need I mean, we all support when we're learning
Speaker 1: something new, don't we And we learn something new every
Speaker 1: time we have a new baby.
Speaker 2: Oh, breastfeeding just I mean, we all think it's meant
Speaker 2: to just happen, but it's not that easy, no.
Speaker 1: And I mean I should also say that they're fantastic
Speaker 1: support services like the Australian Breastfeeding Association, which is absolutely
Speaker 1: fantastic and is available twenty four hours a day, seven
Speaker 1: days a week, and that's absolutely fantastic. But if you've
Speaker 1: been sent home from hospital within forty eight hours of
Speaker 1: having a baby, your milk hasn't come in yet, and
Speaker 1: you're only getting a couple of visits from a midwife
Speaker 1: from the hospital, it's not enough for every month. Like,
Speaker 1: we really need to be able to wrap around mums
Speaker 1: and give them the support they need, and it's not
Speaker 1: necessarily going to work over the phone or online. And
Speaker 1: in terms of formula introduction, we know that most mums
Speaker 1: turn to the internet and in some groups, yeah, and
Speaker 1: some of the information on the internet is evidence based
Speaker 1: and is really reliable, and others is not. And again
Speaker 1: I've had PhD students who have looked at the quality
Speaker 1: and the content ofant feeding websites and ofant feeding apps,
Speaker 1: and the quality is really variable. So it's really tough
Speaker 1: for mums to know when they're tired, when they've got
Speaker 1: a crying baby, when they might not have a lot
Speaker 1: of experience in this area. You know, which website do I.
Speaker 2: Trust because we don't have, you know, the extended family
Speaker 2: like other cultures do.
Speaker 3: You're quite nuclear.
Speaker 2: And I remember when I did my nursing training and
Speaker 2: people would go on and do their midi and then
Speaker 2: they would go on and do family and child health.
Speaker 3: Is that still offered as a.
Speaker 1: Oh yeah, yeah, but you don't have to be a
Speaker 1: midwife to be a child and family health nurse. You
Speaker 1: can do that qualification from your bachelor degree. And similarly,
Speaker 1: a sort of fairly recent change is that you can
Speaker 1: get a child and family qualification and work as a
Speaker 1: child and family health nurse if you've done a Bachelor
Speaker 1: of midway free rather than a Bachelor of nursing. So that, okay,
Speaker 1: that has been a fairly recent change and has been
Speaker 1: really welcomed by some in the field and not by
Speaker 1: others in the field. So I'm remaining agnostic on that one.
Speaker 1: I just wanted to be more support from others.
Speaker 3: I couldn't agree more.
Speaker 2: And I just think my milk didn't come in until
Speaker 2: what day three, and I was a hot mess that day.
Speaker 3: Yeah, and literally a hot.
Speaker 2: Mess, and with these massive boobs, and I was sobbing
Speaker 2: at the side of the baby and someone came me
Speaker 2: in and I burst into tea like I was a mess.
Speaker 3: So if I hadn't have.
Speaker 2: Had that support that I had, yeah, you know, from
Speaker 2: my mom and from the nurses in the hospital, I
Speaker 2: would have really struggled.
Speaker 1: Yeah, and you need to be told, don't you this
Speaker 1: is normal, this is just what happens. Everything's temporary. It'll
Speaker 1: be better tomorrow, it'll be better the day after that.
Speaker 1: You need to hear that reassurance because it's a pretty
Speaker 1: phenomenal new thing in your life that's happened to you.
Speaker 1: And I think we have to be kind and supportive
Speaker 1: and make sure that mums have all of the support
Speaker 1: that they need to feel good about their mother ing
Speaker 1: and the extraordinary thing that they've just done, grown a
Speaker 1: human being.
Speaker 2: Do you think, because I feel that there's this big
Speaker 2: gap in healthcare in this space, you know, in my
Speaker 2: own clinic, we obviously we can't treat women for anti
Speaker 2: wrinkle or for lasers and things like that if they're pregnant,
Speaker 2: and often if they're breastfeeding. And you know, all of
Speaker 2: them say the same thing. They all wanted to breastfeed,
Speaker 2: and some did for a period of time, others didn't.
Speaker 2: But it was very interesting that I hear that some
Speaker 2: of them go. You know, I didn't tell anyone I
Speaker 2: wasn't breastfeeding because you know, I was shamed so badly,
Speaker 2: or someone had something to say, or someone will make
Speaker 2: a comment. And I don't think people realize we're very
Speaker 2: sensitive about our mothering and our mothering skills, especially when
Speaker 2: we're in umup. We're just looking to be built up
Speaker 2: and supported. And when you hear these women just going,
Speaker 2: I felt shamed or I embarrassed, you know. I just
Speaker 2: think we're really letting our sisters down by not supporting
Speaker 2: them in whatever.
Speaker 3: Their choice is.
Speaker 2: And yes, like you said, breast is best, and I
Speaker 2: had on heart can say it was the best thing.
Speaker 3: It was wonderful, but I couldn't do it for my
Speaker 3: second child. I tried but couldn't.
Speaker 1: So I sort of think about different layers of breastfeeding
Speaker 1: kind of feeding, and I feel like an individual mum
Speaker 1: who has struggled with breastfeeding or has decided not to
Speaker 1: breastfed for whatever reason, Why are we shaming her when
Speaker 1: there's all sorts of reasons why she might have made
Speaker 1: that decision that are kind of out of her control.
Speaker 1: So does she have the support at home? Did she
Speaker 1: receive enough support to breastfeed? Does she have to go
Speaker 1: back to work in a minute because she's got a
Speaker 1: huge mortgage, or she's the primary bread winner, or you
Speaker 1: know one hundred other reasons. Does she get all of
Speaker 1: the education and support and advice that she needed when
Speaker 1: she was in hospital? You know that's another layer. Does
Speaker 1: the society that we live in actually support her to breastfeed?
Speaker 1: Can she breastfeed in public without feeling uncomfortable?
Speaker 3: Actually?
Speaker 1: You know, is she being bombarded by social media that's
Speaker 1: suggesting that she should feed with him from formula rather
Speaker 1: than breastfeeding. I mean, all sorts of things at all
Speaker 1: sorts of different levels are impacting on that woman. So
Speaker 1: why would we be shaming her or making her feel
Speaker 1: uncomfortable when we don't know anything about what's going on
Speaker 1: with her. We should be telling her you're doing your.
Speaker 3: Great job, or can I give you a hand?
Speaker 1: Exactly if we knew more about why people stop breastfiting
Speaker 1: or about why they might be mixed feeding and if
Speaker 1: our clinicians, our time and family health nurses, our GPS,
Speaker 1: all of the people who see mums a lot, if
Speaker 1: they knew how to sort of ask mums the right questions,
Speaker 1: then they might be able to say, actually, you're going
Speaker 1: back to work in a few weeks time. Did you
Speaker 1: know that you could mixed feed? Did you know you
Speaker 1: could keep breastfeeding, you could breastfeed in the morning, you
Speaker 1: could breastfeed at night. Or your partners said, isn't it
Speaker 1: time to stop breastfeeding? Well, here are some things you
Speaker 1: could say to alleviate their concerns. Or you think your
Speaker 1: supplies low, Here's how you can tell if your supply
Speaker 1: is low. And here are some tips for increasing your supply.
Speaker 1: You know, there's all sorts of things that we could
Speaker 1: be doing to support that mum that are just not
Speaker 1: happening in a systematic way. A here's the Health Department's policy.
Speaker 1: We're going to see what we can do about increasing
Speaker 1: people's supply. Or here's the things we can put in
Speaker 1: place to support mums to continue breastfeeding at work.
Speaker 2: So, statistically, has breastfeeding increased. Our initiation rates of breastfeeding
Speaker 2: are fantastic. So in Australia, we've got very very high
Speaker 2: rates of breastfeeding initiations, so people are breastfeeding in hospital,
Speaker 2: but the drop off in that first month is really high, right.
Speaker 2: I would argue that the drop off in that first
Speaker 2: month is high because people are not adequately supported, and
Speaker 2: they're not adequately supported because they haven't received the support
Speaker 2: in the education or the.
Speaker 1: Not just verbal education. But you know, here's how you
Speaker 1: do it, here's physically how you do it, and here's
Speaker 1: how you could troubleshoot some things that might happen. And
Speaker 1: that's probably what's causing that big drop off in the
Speaker 1: first month. And then the drop off later is for
Speaker 1: all sorts of reasons. But we really need to know
Speaker 1: a bit more and to understand how to intervene to
Speaker 1: increase the duration of breastfeeding, make sure people are giving
Speaker 1: some breast milk. So if I could tell you my story, please,
Speaker 1: So when my son was born, he was born in
Speaker 1: the United States, which doesn't have a strong breast threading culture,
Speaker 1: and so he was in the nanatal nursery for a
Speaker 1: month and after about a week I was expressing quite
Speaker 1: large quantities and one of the doctors said to be oh,
Speaker 1: are you still doing that? We yes, I am, and
Speaker 1: so I persisted, and luckily we had a fantastic nurse
Speaker 1: who really got breast feeling going because he wasn't particularly
Speaker 1: interested because he'd lost his suck reflex from being inchbraded
Speaker 1: and blah blah. And then because it was the United
Speaker 1: States and I had to go back to work after
Speaker 1: three months, I used to have to travel a bit
Speaker 1: for work, and I would travel with an eskie and
Speaker 1: I would express while I was away and come home
Speaker 1: with the eski, and some of the sort of senior
Speaker 1: men in the company would look at the eski coming
Speaker 1: around the baggage and say, oh, I don't even want
Speaker 1: to ask what's in there, you know. So there was
Speaker 1: sort of this ky thing, and there was nowhere to
Speaker 1: express a work except the toilets. So after persisting with this,
Speaker 1: I just was really determined to exclusively breastfeedd him. After
Speaker 1: a while, it just came a bit too difficult, and
Speaker 1: so I did persist with that morning and evening, and
Speaker 1: that worked really well for us until he was almost
Speaker 1: a year old, when he chose to end it. So
Speaker 1: it can be done. But I was just really lucky
Speaker 1: that my cousin was a breastpending counselor. I had friends
Speaker 1: who were midwives and I could get that advice and
Speaker 1: support because it wasn't available to me in the health
Speaker 1: system there.
Speaker 2: Because when I had Jacob and I had all those issues. Yeah,
Speaker 2: lactation consultants were around, but it was fairly new and
Speaker 2: they were fantastic, but it was expensive, and that is
Speaker 2: something some people do say that if you get a
Speaker 2: private lactation consultant, for some.
Speaker 3: People it's just out of their budget.
Speaker 2: Yeah, you know, I understand people have to run a
Speaker 2: business and you know, everyone needs to make a living,
Speaker 2: but it does seem a shame that that's not as
Speaker 2: readily available to maybe people in the lower socioeconomic group
Speaker 2: who really would benefit from breastfeeding.
Speaker 1: And there certainly are BLACKTAH consultants in public hospitals, but
Speaker 1: there aren't enough and they're fantastic, but there are only
Speaker 1: so many hours in the strait and women are in
Speaker 1: and out of hospital quite quickly, and so they often
Speaker 1: need that support maybe five or six days down the track,
Speaker 1: and they're just they're just not enough of them.
Speaker 2: So you have found at that month stage, that's when
Speaker 2: a lot of mums is just getting too hard and
Speaker 2: that's when they tend to give up.
Speaker 1: It's in the first month. So we've got national data
Speaker 1: on the rates of breastfeeding by month, and the biggest
Speaker 1: drop off is in that first month, and then it's
Speaker 1: fairly steady out to six months.
Speaker 2: So how many then at six months do you find
Speaker 2: It would be say there's one hundred percent that leave
Speaker 2: hospital by that first month, sixty percent of dropped off
Speaker 2: and then of.
Speaker 1: That about still breastfeeding.
Speaker 3: It one way, okay, and then you find six months.
Speaker 1: From our research. From our study about twenty percent were
Speaker 1: mixed feeding, so we could figure out how many were
Speaker 1: mixed feeding, and it was about the same, so forty
Speaker 1: percent rest freading, forty percent formula that was in our study,
Speaker 1: so you know, other studies might be different. It was
Speaker 1: pretty representative, but not a lot of people from lower
Speaker 1: SOSO economic groups who we know are more likely to
Speaker 1: use in for formula. So that's probably a good sample.
Speaker 2: Are you currently studying more in that space or other people.
Speaker 3: That are absolutely and I also researching.
Speaker 1: Yeah, So one of my PhD students, her PhD was
Speaker 1: sort of looking at sources of information for feeding making
Speaker 1: feeding decisions, and she will go on to have a
Speaker 1: really strong research program in mixed feeding because she's really
Speaker 1: decided that's going to be her thing. And I would
Speaker 1: really encourage that because I think there's a lot to
Speaker 1: do in that area. You know, for me, this became
Speaker 1: an interest sort of by accident, because as an obesity
Speaker 1: prevention person, we're really interested in the way food is
Speaker 1: in that first year of life. We really worry about
Speaker 1: excess growth. So we want kids to sort of follow
Speaker 1: one of those lines on the growth chart. But some
Speaker 1: kids sort of jump over lines and keep jumping over lines,
Speaker 1: and that's called rapid weight gain. And that's more common
Speaker 1: in babies who are fed with infant formula.
Speaker 3: And so why do you think that is?
Speaker 1: Because they're probably being overfed, so they're probably getting more
Speaker 1: calories than they need through two mechanisms. So sometimes parents
Speaker 1: will over concentrate the bottle with a view to that
Speaker 1: may be making them sleep better. And the other thing
Speaker 1: is that if a baby's breast fed, when they've finish
Speaker 1: to feed, they come off the breast, they doze off
Speaker 1: to sleep. You know, the mum gets to be confident
Speaker 1: that they've had enough to drink, they've finished the feed,
Speaker 1: and that's the end of the feed. But when you
Speaker 1: are feeding with formula, you tend to make up a
Speaker 1: certain amount of milk in the bottle, and there's a
Speaker 1: real tendency to finish that bottle, even if the baby
Speaker 1: might halfway through be showing all of the signs that
Speaker 1: they're full. There's a sort of tendency and a temptation
Speaker 1: because you've got the information from the tin that says
Speaker 1: eight bottles of one hundred meals at this age, you think, right,
Speaker 1: I've got to do that, and so keep that baby
Speaker 1: feeding for longer than they need or for longer than
Speaker 1: they want. And so from an obesity prevention point of view,
Speaker 1: we really try to encourage people if they are using formula,
Speaker 1: to use it in a way that is similar to
Speaker 1: if they were breastfeeding. So you would still hold the baby,
Speaker 1: you would look into their eyes, make eye contact, and
Speaker 1: you would watch for signs of fullness, and when fullness
Speaker 1: is there, you stop.
Speaker 3: But you don't know that, you don't know what, you
Speaker 3: don't know.
Speaker 1: Exactly right, and that information is not on the tin.
Speaker 2: Because it would be you know, eight times or whatever
Speaker 2: one hundred meals and I know me when I was
Speaker 2: feeding Jacob, and I had no other information than the
Speaker 2: tin minde like he was fussy, but I still made
Speaker 2: up according to what the tin said.
Speaker 1: Of course you did, what else would you do? And
Speaker 1: of course you would think he's going to drink all
Speaker 1: of that. You know, I can't stop. And so the
Speaker 1: other thing that sometimes happens that we worry about from
Speaker 1: an obesity prevention point of view is that mums might
Speaker 1: be breastfeeding, but they might think my baby stopped growing
Speaker 1: fast enough, or I just want a little insurance policy
Speaker 1: that they're growing fast enough, so they might top up
Speaker 1: with formula even if they don't need it. So sometimes
Speaker 1: mums could really do with support from their trusted healthcare
Speaker 1: provider to say, if your baby's having this many wet nappies,
Speaker 1: and your baby's growing, and your baby seem settled in
Speaker 1: between feeds, then they're getting enough to eat. But mums
Speaker 1: often doubt themselves or second guests themselves, and so they think, oh,
Speaker 1: I better top up, or I don't trust my body
Speaker 1: to make everything my baby needs, so I better give
Speaker 1: some formula as well, and that probably.
Speaker 2: Doesn't need to h and that older generation as well,
Speaker 2: like my mum, I mean, I was bottlefed on carnation milk.
Speaker 3: You know, I think about it hour, I go oh,
Speaker 3: my god.
Speaker 2: And they really look at the baby and go oh,
Speaker 2: if they're a little bit fussy after you take them
Speaker 2: off the breast of the need a little bit of
Speaker 2: a top up. And Mum learned pretty quick not to
Speaker 2: say anything. But you know, if you come from a
Speaker 2: family that are full of big personal bodies and you
Speaker 2: know you just want to please everybody and shut everyone up,
Speaker 2: you are going to do that.
Speaker 1: Absolutely, you're going to do that. And also, some parents
Speaker 1: from some cultural backgrounds have a really strong preference for
Speaker 1: a bigger baby, and with a really plentiful supply of food,
Speaker 1: they will try to get that baby to be bigger
Speaker 1: than they would automatically be. And that's a real challenge
Speaker 1: for clinicians because they sort of need to find a
Speaker 1: culturally sensitive way of saying, baby, it probably doesn't need
Speaker 1: that extra top up. But if you've got other family
Speaker 1: members saying, oh, the baby's too skinny, then of course
Speaker 1: you're going to You don't want to be labeled a
Speaker 1: bad mother.
Speaker 3: So oh god, no, Elizabeth.
Speaker 2: If a baby, you know, at three months is sort
Speaker 2: of in that high percentile weight wise, is that an
Speaker 2: indication that they may struggle as an adult with obesity.
Speaker 1: Not necessarily. So if a babes weight for age and
Speaker 1: their length for age is about the same in terms
Speaker 1: of the centile they're on, then they've probably got tall parents. Yeah, so, yeah,
Speaker 1: they've probably got tall parents. If their length for age
Speaker 1: and their weight for age is on the sort of
Speaker 1: lower level than maybe their parents aren't very tall. There's
Speaker 1: also a chart called weight for length, and that's sort
Speaker 1: of a little bit like BMI. What you like to
Speaker 1: see is that that is pretty steady, so that they
Speaker 1: sit on the same centil and they sort of stay
Speaker 1: on the same centil, so it doesn't matter if they're
Speaker 1: on the twentieth centile or the eightieth centile. What you
Speaker 1: want to see is that they stay pretty steady because
Speaker 1: that means that their length is growing at a similar
Speaker 1: rate to their weight. Their weight isn't sort of getting
Speaker 1: ahead of their length, which is what happens with rapid
Speaker 1: weight gain, is that their weight is getting ahead of
Speaker 1: their length. So we would then put stratum is in
Speaker 1: place to let the baby grow into their weight.
Speaker 2: And one other question I have for you is the
Speaker 2: big thing when my kids would little, was you present
Speaker 2: food like at six months and when they start showing
Speaker 2: interest that sort of thing, you start to introduce food.
Speaker 3: Is that still the situation.
Speaker 1: Yeah, there's a number of different sort of signs of readiness,
Speaker 1: and that's definitely one of them, that they're taking interest
Speaker 1: in food or sometimes basically reaching out and almost grabbing
Speaker 1: the food that you've got. Okay, they need to have
Speaker 1: reasonable head control, and that's sort of usually around the
Speaker 1: six month age is what we say. So around six months.
Speaker 1: It might be a little bit earlier for some babies,
Speaker 1: it might be a little bit later for some babies,
Speaker 1: but around six months is the advice. I just would
Speaker 1: also just like to remind people that if babies have
Speaker 1: allergy risks, or they've been premature, or one of those
Speaker 1: other things, then please remember this is a general advice.
Speaker 1: Generals that those cases need to be treated carefully with
Speaker 1: professional advice. And the thing we say is parents provide
Speaker 1: child decides. So rather than again preparing a certain amount
Speaker 1: of food and shoveling that into the baby's mouth until
Speaker 1: it's gone, what we would recommend now is that you
Speaker 1: would offer a variety of foods, iron rich foods first,
Speaker 1: and you would offer those foods and let the baby
Speaker 1: decide how much they're going to eat. Of course, in
Speaker 1: the early days, giving breast milk first because that's the
Speaker 1: sort of major source of neutrasse. Still, yeah, and.
Speaker 2: Just one other question, I'd really be interested to hear
Speaker 2: academically where you came from and to your point now,
Speaker 2: just so other nurses can hear what you've achieved. I
Speaker 2: love hearing that from my colleagues. Yeah, fill us all
Speaker 2: in one. I started my journey your journey.
Speaker 1: So I'm quite old, so I'm a hospital trained nurse,
Speaker 1: and I was really interested. I did a critical care
Speaker 1: certificate and worked in cardiothoracic intensive care, and I started
Speaker 1: to sort of see people who had calivevascular disease and
Speaker 1: that some of it could have been prevented. And that
Speaker 1: was sort of an early spark. But then I went
Speaker 1: and worked in industry because I really really wanted to
Speaker 1: do research, and back then there wasn't a lot of
Speaker 1: nurse initiative research, and I thought I really wanted to
Speaker 1: do research, and so I worked in industry for a
Speaker 1: while and I ended up working in the United States,
Speaker 1: and then when we came home from the United States,
Speaker 1: I did my conversion degree, and then I did a
Speaker 1: master's of public health, and at this DAT had two
Speaker 1: little kids, and I was really interested in the way
Speaker 1: people made decisions about feeding their kids because it just
Speaker 1: seemed really interesting to me that the way people were
Speaker 1: influenced and what they thought was important, and the support
Speaker 1: they received and those sorts of things. I got a
Speaker 1: small project after my master's that was looking at child obesity,
Speaker 1: and I ended up doing my PhD with that same person.
Speaker 1: So initially I looked at clio vascular risk factors and
Speaker 1: other disease risk factors in adolescents, and it was really
Speaker 1: clear that obesity was quite a serious problem even in adolescents.
Speaker 1: So they had the kids who were living with obesity
Speaker 1: had lots of risk factors. And after that study, which
Speaker 1: I loved doing, I thought, well, I want to do
Speaker 1: something to prevent this. I want to work in prevention,
Speaker 1: and I want to work in prevention in primary health care,
Speaker 1: so with child of family health nurses, with GPS nurses
Speaker 1: in general practice, because they're the people who have access
Speaker 1: to everybody. And so I did quite a few different
Speaker 1: research projects in general practice and over the years, I've
Speaker 1: been interested in younger and younger and younger children, and
Speaker 1: so now my focus is the first year of life
Speaker 1: and that'll do me. You know, I'm getting close to
Speaker 1: retime and age. But I'm really happy to say that
Speaker 1: I think I've had twelve PhD students who I've survised
Speaker 1: to who have completed, and I've got three more to go.
Speaker 1: And I can say hand on heart that OBESI prevention
Speaker 1: research in the primary healthcaret setting is in really good
Speaker 1: hands because some of the students I've had it just
Speaker 1: out of this world. It's so fantastic. And so that's
Speaker 1: what I've done, and I think the thing I'm most
Speaker 1: proud of is having worked to co design with parents
Speaker 1: and with nurses. Told of Hemily Health Nurses an app
Speaker 1: that we've modified over the years that has supported parents
Speaker 1: with infant feeding decisions. And the initial app is very
Speaker 1: out of date now, so it's you know, it's probably
Speaker 1: on version five or six now.
Speaker 3: Yeah. Yeah.
Speaker 1: And one of the things we found was that the
Speaker 1: most visited pages on that app were around infant formula
Speaker 1: and mixed feeding. Wow, so we sort of knew we
Speaker 1: were onto something. I mean, we had an enormous amount
Speaker 1: of content about breastfeeding too, but those pages weren't as
Speaker 1: frequently visited because we think that was being handled by
Speaker 1: other people. You know, that people had that sorted, whereas
Speaker 1: the formula pages and the mixed feeding pages were really
Speaker 1: highly visited. So that was it was good for us
Speaker 1: to know.
Speaker 2: That because I truly believe mothers want a breastfeed for
Speaker 2: as long as they can.
Speaker 3: There's no doubt we would all do that.
Speaker 2: But yeah, there are so many circumstances, so I think
Speaker 2: even some is better than none.
Speaker 1: Any is better than none, and absolutely the more the better.
Speaker 2: Yeah, And I think it is so valuable because that's
Speaker 2: what I hear on the street, you know, with my
Speaker 2: clients that.
Speaker 3: And that a lot of them mixed feed. You have
Speaker 3: to go back to it.
Speaker 2: I mean, just look at the Economic Times and I
Speaker 2: think that's wonderful that you have a page.
Speaker 3: Up that helps and guides women.
Speaker 2: And I'm not surprised it's probably the most visited page.
Speaker 1: Yeah, so that's within that app that's what people really
Speaker 1: sound useful, and that's been a really interesting finding for us.
Speaker 2: Yeah, I think it's wonderful. Well, Elizabeth, I have loved
Speaker 2: this chat with you and I am very in awe
Speaker 2: of you know, in my heart I'd like to be
Speaker 2: a researcher, but I think I'm actually a clinician.
Speaker 1: So yes, but there's a role we need more clinician
Speaker 1: researchers that is so important that there's it's just not
Speaker 1: enough of them.
Speaker 3: It's not too late, No, it's never too late.
Speaker 2: One of my colleagues has actually she was in her
Speaker 2: late sixties doing her PhD.
Speaker 3: And more power to her.
Speaker 2: Lovely, completely love it so and she's a remarkable woman too.
Speaker 2: But thank you for your wisdom and your knowledge and
Speaker 2: sharing that. I really appreciate it.
Speaker 1: It's been a pleasure, lovely to chat to you.
Speaker 3: You too, thanks a losten.
Speaker 2: This season. I am so excited to announce that the
Speaker 2: podcast is being supported by Nutritia, which is a global
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Speaker 2: just want to say a huge thank you to Nutritia.
Speaker 2: Their desire to support nurses is truly appreciated, and they
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Speaker 2: can all grow as nurses.