And special X-rays using contrast media? As long as no radioactive isotope is used there is no concern and the mother should not stop even for one feed. Herein are included studies such as intravenous pyelogram, lymphangiogram, venogram, arteriogram, myelogram etc. What about studies using radioactive nucleotides (bone scans, lung scans, etc.)? The baby will get a little radioactive nucleotide. However, as we often do these very same tests on children, even small babies, and the potential loss of benefits if the mother stops breastfeeding are considerable, the mother should continue breastfeeding. The exception is the thyroid scan. This test must be avoided in breastfeeding mothers. There are many ways of evaluating the thyroid, and only very occasionally does a thyroid scan truly have to be done. Check first before taking the radioactive iodine—the test can wait until you know for sure. In many cases where the scan must be done, it can be put off for several months.

2. Breastfeeding mothers' milk can "dry up" just like that.

Not true! Or if this can occur, it must be a rare occurrence. Aside from day to day and morning to evening variations, milk production does not change suddenly. There are changes which occur which may make it seem as if milk production is suddenly much less:

1. An increase in the needs of the baby, the so called growth spurt. If this is the reason for the seemingly insufficient milk, a few days of more frequent nursing will bring things back to normal. Try compressing the breast with your hand to help the baby get milk (Handout #15, Breast Compression).

2. A change in the baby's behaviour. At about 5-6 weeks of age, more or less, babies who would fall asleep at the breast when the flow of milk slowed down, tend to start pulling at the breast or crying when the milk flow slows. The milk has not dried up, but the baby has changed. Try compressing the breast with your hand to help the baby get more milk.

3. The mother's breasts do not seem full or are soft. It is normal after a few weeks for the mother no longer to have engorgement, or even fullness of the breasts. As long as the baby is drinking at the breast, do not be concerned (see handout 4 Is my baby getting enough milk).

4. The baby breastfeeds less well. This is often due to the baby being given bottles or pacifiers and thus learning an inappropriate way of breastfeeding.

The birth control pill may decrease your milk supply. Think about stopping the pill or changing to a progesterone only pill. Or use other methods.

If the baby truly seems not to be getting enough, get help, but do not introduce a bottle which will only make things worse. If absolutely necessary, the baby can be supplemented, using a lactation aid which will not interfere with breastfeeding. However, lots can be done before giving supplements. Get help. Try compressing the breast with your hand to help the baby get milk (Handout #15, Breast Compression).

3. Physicians know a lot about breastfeeding.

Not true! Obviously, there are exceptions. However, very few physicians trained in North America or Western Europe learned anything at all about breastfeeding in medical school. Even fewer learned about the practical aspects of helping mothers start breastfeeding and helping them maintain breastfeeding. After medical school, most of the information physicians get regarding infant feeding comes from formula company representatives or advertisements.

4. Pediatricians, at least, know a lot about breastfeeding.

Not true! Obviously, there are exceptions. However, in their post medical school training (residency), most pediatricians learned nothing formally about breastfeeding, and what they picked up in passing was often wrong. To many trainees in pediatrics, breastfeeding is seen as an "obstacle to the good medical care" of hospitalized babies.

5. Formula company literature and free formula samples do not influence whether or how long a mother breastfeeds.

Really? So why do the formula companies work so hard to make sure that new mothers are given these samples, their company's samples? Are these samples and the literature given out to encourage breastfeeding? Is the cost of the samples and booklets taken on by formula companies so that mothers will be encouraged to breastfeed longer? The companies often argue that, if the mother does give formula, they want the mother to use their brand. In competing with each other, the formula companies also compete with breastfeeding. Did you believe that argument when the cigarette companies used it?

6. Breastmilk given with formula may cause problems for the baby.

Not true! Most breastfeeding mothers do not need to use formula and when problems arise that seem to require artificial milk, often the problems can be resolved without resorting to formula. However, when the baby may require formula, there is no reason that breastmilk and formula cannot be given together.

7. Babies who are breastfed on demand are likely to be "colicky".

Not true! "Colicky" breastfed babies often gain weight very quickly and sometimes are feeding frequently. However, many are colicky not because they are feeding frequently, but because they do not take the high fat milk as well as they should. Typically, the baby drinks very well for the first few minutes, then nibbles or sleeps. When the baby is offered the other side, he will drink well again for a short while and then nibble or sleep. The baby will fill up with relatively low fat milk and thus feed frequently. The taking in of mostly low fat milk may also result in gas, crying and explosive watery bowel movements. The mother can urge the baby to breastfeed longer on the first side, and thus get more higher fat milk, by compressing the breast once the baby no longer actually swallows at the breast. (Handouts #3 Colic in the breastfed baby and #15 Breast Compression).

8. Mothers who receive immunizations (tetanus, rubella, hepatitis B, hepatitis A, etc.) should stop breastfeeding for 24 hours (3 days, 2 weeks).

Not true! Why shouldn't they? There is no risk for the baby, and he may even benefit. The rare exception is the baby who has an immune deficiency. In that case the mother should not receive an immunization with a weakened live virus (e.g. oral, but not injectable polio, or measles, mumps, rubella) even if the baby is being fed artificially.

9. There is no such thing as nipple confusion.

Not true! A baby who is only bottle fed for the first two weeks of life, for example, will usually refuse to take the breast, even if the mother has an abundant supply. A baby who has had only the breast for 3 or 4 months is unlikely to take the bottle. Some babies prefer the right or left breast to the other. Bottle fed babies often prefer one artificial nipple to another. So there is such a thing as preferring one nipple to another. The only question is how quickly it can occur. Given the right set of circumstances, the preference can occur after one or two bottles. The baby having difficulties latching on may never have had an artificial nipple, but the introduction of an artificial nipple rarely improves the situation, and often makes it much worse. Note that many who say there is no such thing as nipple confusion also advise the mother to start a bottle early so that the baby will not refuse it.

Handout #14. More and More Breastfeeding Myths. Revised January 1998

Jack Newman, MD, FRCPC is a pediatrician, a graduate of the University of Toronto medical school. He started the first hospital-based breastfeeding clinic in Canada in 1984. He has been a consultant with UNICEF for the Baby Friendly Hospital Initiative in Africa. Dr. Newman has practiced as a physician in Canada, New Zealand, and South Africa.

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