- Email: [email protected]
On “A Call for Clarity in Infant Breast and Bottle‐Feeding Definitions for Research”
JOGNN
LETTERS
On ‘‘A Call for Clarity in Infant Breast and Bottle-Feeding Definitions for Research’’ To the Editor, I read ‘‘A Call for Clarity in Infant Breast and BottleFeeding De¢nitions for Research’’ by Diane Thulier with great interest. As noted, I was involved with an international process to develop de¢nitions for research on breastfeeding many years ago. Our selfassigned task was to ensure that the de¢nitions would be equally useful in the study of mothers as well as babies. The de¢nitions arose from a process wherein we collected information on de¢nitions used from eight major domestic and international infant feeding organizations and analyzed the compendium for themes and consistencies. We then held a group meeting to discuss the ¢ndings and develop the de¢nitional schema. After the meeting, the schema was sent out to about 40 recognized experts for input and review before it was published. At the time, our de¢nitions were accepted and used in author instructions by several major journals, including Journal of Human Lactation. Therefore, it was exciting to see the rebirth of our essential schema. Unfortunately, the newly suggested de¢nitional schema, though quite interesting indeed, has not undergone the rigorous international and expert review as did the earlier one or the authors might have noted the following issues: 1. Consumption by the infant of human milk will not have the same impact on maternal physiology as will breastfeeding. 2. There may be some concern that 75%/25% divide may not have a physiological basis for mother or baby, although they are indeed easier to use. 3. Less importantly, the phrase predominant breast milk feeding has been heavily used by the World Health Organization and might lead to confusion. I am personally grateful to the author for reraising this important issue for better understanding of research and program reporting and look forward to the day when we have consistent de¢nitions that allow breastfeeding research to examine impact on mother or baby and for all published studies to be more compatible.
140
Thank you, and thanks to Diane Thulier for her ¢ne review, good works, and catalyzing this discussion.
REFERENCE Thulier, D. (2010). A call for clarity in infant breast and bottle-feeding de¢nitions for research. Journal of Obstetric, Gynecologic, & Neonatal Nurses, 39(6), 627-634.
Miriam H. Labbok Miriam H. Labbok, MD, MPH, FACPM, IBCLC, FABM, is a professor and director at Carolina Global Breastfeeding Institute, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, CB#7445, Chapel Hill, NC 27599-7445. [email protected]
In Response: I respectfully acknowledge and appreciate the previous work completed by Dr. Labbok and her colleagues to provide feeding de¢nitions for practice. The previous de¢nitions raised awareness and helped to provide data that showed a relationship between breastfeeding and positive health outcomes. The previous de¢nitions laid the groundwork on which these new de¢nitions are based. The proposed de¢nitions allow us to now shift focus from the mode of milk delivery to the content of feedings. This will allow researchers to more accurately describe the true di¡erences between human and arti¢cial milk. Dr. Labbok noted that the proposed de¢nitions did not undergo the same rigorous international and expert review process, prior to their publication, as did the previous de¢nitions. Although this is true, these de¢nitions are based on prior work and only time and implementation of the proposed de¢nitions will ultimately determine their usefulness. It was suggested that the consumption of human milk will not have the same impact on maternal physiology as will breastfeeding. A similar concern was identi¢ed in the paper, regarding infants who drink expressed milk versus those who feed directly
& 2011 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses
http://jognn.awhonn.org
LETTERS
On ‘‘A Call for Clarity in Infant Breast and Bottle-Feeding Definitions for Research’’ To the Editor, I read ‘‘A Call for Clarity in Infant Breast and BottleFeeding De¢nitions for Research’’ by Diane Thulier with great interest. As noted, I was involved with an international process to develop de¢nitions for research on breastfeeding many years ago. Our selfassigned task was to ensure that the de¢nitions would be equally useful in the study of mothers as well as babies. The de¢nitions arose from a process wherein we collected information on de¢nitions used from eight major domestic and international infant feeding organizations and analyzed the compendium for themes and consistencies. We then held a group meeting to discuss the ¢ndings and develop the de¢nitional schema. After the meeting, the schema was sent out to about 40 recognized experts for input and review before it was published. At the time, our de¢nitions were accepted and used in author instructions by several major journals, including Journal of Human Lactation. Therefore, it was exciting to see the rebirth of our essential schema. Unfortunately, the newly suggested de¢nitional schema, though quite interesting indeed, has not undergone the rigorous international and expert review as did the earlier one or the authors might have noted the following issues: 1. Consumption by the infant of human milk will not have the same impact on maternal physiology as will breastfeeding. 2. There may be some concern that 75%/25% divide may not have a physiological basis for mother or baby, although they are indeed easier to use. 3. Less importantly, the phrase predominant breast milk feeding has been heavily used by the World Health Organization and might lead to confusion. I am personally grateful to the author for reraising this important issue for better understanding of research and program reporting and look forward to the day when we have consistent de¢nitions that allow breastfeeding research to examine impact on mother or baby and for all published studies to be more compatible.
140
Thank you, and thanks to Diane Thulier for her ¢ne review, good works, and catalyzing this discussion.
REFERENCE Thulier, D. (2010). A call for clarity in infant breast and bottle-feeding de¢nitions for research. Journal of Obstetric, Gynecologic, & Neonatal Nurses, 39(6), 627-634.
Miriam H. Labbok Miriam H. Labbok, MD, MPH, FACPM, IBCLC, FABM, is a professor and director at Carolina Global Breastfeeding Institute, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, CB#7445, Chapel Hill, NC 27599-7445. [email protected]
In Response: I respectfully acknowledge and appreciate the previous work completed by Dr. Labbok and her colleagues to provide feeding de¢nitions for practice. The previous de¢nitions raised awareness and helped to provide data that showed a relationship between breastfeeding and positive health outcomes. The previous de¢nitions laid the groundwork on which these new de¢nitions are based. The proposed de¢nitions allow us to now shift focus from the mode of milk delivery to the content of feedings. This will allow researchers to more accurately describe the true di¡erences between human and arti¢cial milk. Dr. Labbok noted that the proposed de¢nitions did not undergo the same rigorous international and expert review process, prior to their publication, as did the previous de¢nitions. Although this is true, these de¢nitions are based on prior work and only time and implementation of the proposed de¢nitions will ultimately determine their usefulness. It was suggested that the consumption of human milk will not have the same impact on maternal physiology as will breastfeeding. A similar concern was identi¢ed in the paper, regarding infants who drink expressed milk versus those who feed directly
& 2011 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses
http://jognn.awhonn.org