June 22, 2025 • 40 mins
Today on the podcast we chat with Nursing Professor, Elizabeth Denny-Wilson.
Elizabeth specialises in obesity prevention research with special focus on infant feeding and primary health care.
Elizabeth is on the WHO committee writing the guidelines around infant obesity prevention. She has a position on the National health and research council and is a member of their obesity committee. Elizabeth is also a board member of The Sydney Children’s Hospital Network.
Elizabeth is a remarkable woman and nurse whose empathy and compassion for new mothers and their babies is clearly evident throughout our chat together.
Through all the research she has done and contributed to, she has found a large gap around mixed feeding for mothers.
We all know breast milk for babies is the gold standard, but what if you can’t breast feed, have to return to work, have poor milk supply or baby refusal of breast?
What happens then?
We discuss this and more! We talk about mixed feeding where breast and formula milk are both used and just how little information there is around this. Elizabeth discusses the need for us to be supportive of new mums as this can be a very stressful time, especially when there is advice and suggestions coming from loved ones, well meaning friends and even strangers feel they can add their opinions unsolicited.
I felt so privileged to chat with such a remarkable nurse. I hope you enjoy this conversation with Elizabeth.
Bek x
This episode has been sponsored by Nutricia, and my heartfelt thanks goes to their amazing support of our nursing community.
This episode was created independently by the speakers and the views expressed herein are those of the speakers, not of Nutricia. This content is intended for healthcare professionals. Medical professionals should rely on their own skill and assessment of individual patients.
www.nutricia.com.au
www.tendernessfornurses.com.au
Support the show: https://www.patreon.com/tendernessnurses
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Appogia production.
Speaker 2 (00:10):
Hi everyone, thank you for tuning back into Tenantus for Nurses.
I suspec Woodbine here this season. I am so excited
to announce that the podcast as being supported by Nutritia,
which is a global leader in medical nutrition. They understand
the needs of nurses in the nutrition space and for
over one hundred and twenty five years have provided products
(00:31):
to support child health. Some of Nutrita's pediatric brands include
Neo Kate Junior for children who have food allergies and
app to Grow for those fussy eaters. And those of
us who have children know many kids who go through
the phases of definite fussiness. For more information and resources,
visit the nutritiona Pediatrics hub at nutritia dot com dot
(00:54):
au forward slash Pediatrics. I just want to say a
huge thank you to Nutritia. Their desire to support nurses
is truly appreciated, and they are allowing me to continue
this podcast so that we can all grow as nurses.
This season, we have some amazing speakers in the pediatric
space which I cannot wait to share with you all. Hi,
my name's Beck Woodbine and welcome to Tenderness for nurses.
Speaker 3 (01:17):
I'm grateful for the person that I have the opportunity to.
Speaker 1 (01:21):
Be, so I hit it and parked it for Nellie
for years. We always have free will, We always get
to choose. We are autonomous.
Speaker 2 (01:31):
Hi everyone, thank you for tuning into Tenderis for Nurses.
We are very excited this season to be sponsored by
NUTRITIONA and I have the fabulous professor Elizabeth Denny Wilson,
who specializes in obesity prevention in babies, but also she
(01:51):
has done some significant research into the area of mixed feeding,
and probably that is what we're going to address a
little bit more today.
Speaker 3 (02:02):
But thank you so much for coming on.
Speaker 2 (02:04):
I know you are super busy as a professor and
studying and teaching and researching.
Speaker 1 (02:09):
We're all super busy, so that's no excuse.
Speaker 2 (02:12):
I am just so delighted and reading your bio and
watching the videos that are on YouTube about you and
what you have done around mixed feeding. We all know
breast is best, and we all try to do the
right thing by our kids.
Speaker 3 (02:29):
But sometimes you know you've.
Speaker 2 (02:31):
Got to go back to work, you're not well, you
don't know the circumstances behind. So I'm making a decision
to maybe mix feed. So do you mind explaining exactly
what mixed feeding is?
Speaker 1 (02:44):
Yes, certainly, so I completely agree with you Beck. Breastfeeding
is an extraordinary thing and an extraordinary thing that we
can do for our babies, and it is one hundred
percent the best way to feed human infants. But also,
as you said, there are reasons why sometimes people don't
(03:06):
want to breastfeed, or they feel pressures one way or
another to not breastfeed, or they might feel like they
have a low supply or that they don't have enough milk,
or you know, there are lots of reasons why people
might choose to introduce infant formula. So mixed feeding just
means if you're combining breastfeeding with another form of feeding,
(03:29):
So you're either feeding with infant formula in a bottle
or in a cup, sometimes in a spoon, which would
take a long time. So it just means that you're
breastfeeding plus something else.
Speaker 2 (03:42):
And do you think there's a higher percentage of people
doing that than anyone talks about because I know that
if you have a season, you're shamed. If you don't breastfeed,
you're shamed. I mean, I had a daughter that just
wanted breast milk, and that was great and it suited me,
but my second child had total refusal to eat. Ye
(04:02):
period was a nasogastrically fed, then just to nuzzle a
couple of weeks at some stage, and then we tried
to get my breast milk back in and then he
refused again. So I was very lucky that I had
some amazing lactation consultants to come in, but in the
end he just had to be not even bottle fed.
Speaker 3 (04:18):
He's one of those kids that were spoonfed.
Speaker 1 (04:20):
I had one of each as well, so yes, an
enthusiastic breastfeeder who I fed for years and another one
who it was pretty challenging. But I think we just
don't know is the true answer. We know from our
research and from other groups research that about half of
babies will have some formula before they're six months old,
(04:42):
but we don't have really good data on the proportion
of people who were mixed feeding, so who were doing both.
You know, we can kind of extract it from other studies,
but we don't have really good data on the proportion
of people who are mixed feeding. And I see this
as a terrible gap because if we knew knew more
(05:06):
about people who were mixed feeding, and if we knew
more about why they were mixed feeding, then we'd be
in a better position to develop interventions to support them
to continue breastfeeding, to breastfeed more often, to maintain their
breast milk supply, and we'd also be able to support
(05:26):
our clinicians to support women to prolong breastfeeding, to increase breastfeeding.
But we can't really do those things if we don't
really understand who's doing it, why they're doing it, how often,
whether their goal is to get through a period of
challenge in their breastfeeding that they will then pick back
(05:49):
up again. And certainly when I was had my babies
and became really interested in the way people feed their babies,
I was absolutely devoted breastfeeder and one hundred percent you know,
behind breastfeeding being the best food for babies and breastfeeding
(06:10):
at all costs. But I guess what I have come
to understand through my research and through the women I've
met in my role as a breastfeeding counselor but also
in my role as a researcher, is that it's just
not always what's right for them and if we could
(06:33):
really understand more about why they've made the choices they've made,
then we might be able to intervene sooner and help
them to continue breastfeeding, or help them to breastfeed more often,
or find a way of mixed feeding that doesn't lead
to no breast milk, because some breast milk is better
(06:57):
than no breast milk.
Speaker 3 (06:58):
Absolutely.
Speaker 2 (06:59):
Why do you think there is such a huge gap
in that research space.
Speaker 1 (07:05):
One of the reasons is that I think for a
long time, we've had people who research breastfeeding and we've
had people who research other things, and we haven't necessarily
communicated very well or done really good multidisciplinary work. And
I also think because our health services and our health
departments have had extremely strong pro breastfeeding policies, as they should,
(07:30):
there hasn't necessarily been a place for doing research about
mixed feeding. And there's also been a really strong sense
over my lifetime of working in this field that there's
enough information out there in the in the ether or
in the way that is accessible to mums into wherever. Yeah,
(07:53):
to give mums who are using it formula advice on
using it formula. But I think what hasn't been captured
well is that, of course, there are mums who exclusively
breastfeed and that's fatastic, and there are mums who exclusively
use infant formula, and that's they deserve our support. But
when we do our work that was initially focused on
(08:17):
obesie prevention, and there's a reason why we're interested in
infant formula for obesie prevention, I guess we started to
see that. And this work was led by one of
my PhD students, and she talked to a lot of
mums who were using infant formula, either mixed feeding or
exclusively formula feeding, and there were a couple of things
(08:39):
that she found that really sort of broke my heart
a little bit. One of them was that mums don't
seek health professional advice before they start introducing formula, and
that's because they don't think they can, They feel judged,
they feel like it's not the right thing to do,
and that they won't necessarily get support. And the second
(09:02):
thing that broke my heart was that the place where
most people who are introducing infant formula get their information
is from the tin, so from the tin of formula,
and I just think we can do a lot better
than that.
Speaker 3 (09:18):
That's where I got mine from.
Speaker 2 (09:19):
Yep.
Speaker 1 (09:21):
I just think that's a travesty because a lot of
mums who are introducing infant formula are doing so at
a point of distress or of christ or and we
should be wrapping our arms around those mums, just as
we should be wrapping our arms around all mums. We
(09:41):
should be saying, what's your goal? Is this something you
just want to do for a little while, or you know,
have you thought about mixed feeding? Have you thought about
this might be something you could do just to take
the pressure off for a couple of days, and then
you know, here's what you could do to keep your
supply up, or here's what you could do to build
your supply, or here's how you can do it without
(10:04):
say that's it for my breastfeeding journey.
Speaker 2 (10:09):
So when someone decides to mix feed because of say,
for example, they're going back and doing some part time
work that sort of thing, you know, it might just
be easy for them to go, Okay, I'm not going
to breastfeed anymore.
Speaker 3 (10:21):
I'm just going to swoop to bottle formal food.
Speaker 2 (10:26):
But if they knew that, say, they could do morning
and night exactly, just you know, a bit of a
pump at lunchtime. You know, there's a room there that
you know at work that you can do that, and
then they can take that home and use that on
the days off or a weekend when you know Nana
and Papa are looking after the kid or something like that.
But it's interesting I just found with my daughter, she
(10:49):
just wanted breastpilk, that's it. And then she went straight
to a cup because there was no way she was
going to give that up.
Speaker 1 (10:54):
Yep.
Speaker 2 (10:55):
Jacob, on the other hand, just hated everything. I was
at the end of my tether. I actually said it
in a podcast previously. I was so beside my I
went to the Maternal and Health Child Service Center, sat
there on the steps before it had even opened, with
this crying baby that just wouldn't feed, wouldn't stop crying.
(11:17):
And I was sitting on those stairs with this baby crying, begging.
I was begging for help. Yeah, he's lucky I didn't
throw him in the rubbish bit seriously here. Yeah, and
you know, I'm a nurse, so I have a bit
of an idea about stuff.
Speaker 3 (11:33):
But imagine being.
Speaker 2 (11:34):
A mum and not having your mum around or being
on your own or being a single parent or not
having that support.
Speaker 1 (11:42):
Absolutely, and child family health services are not as available
as they used to. I mean, if you've got a
good child family health nurse, they are like gold, like
absolutely salute gold because the relationship that they develop with
new mums is just second to none, and they will
support mums through thick and thin, and they have just
(12:03):
such a beautiful way of you know, telling mums you
know you're doing a great job, and that's exactly what
mums need to hear. But it's not like when I
had it. You know, when I have my babies, you
could turn up for a drop in visit. I think
it was every morning and they had appointments in the afternoon,
so it was really available and I really needed it
(12:26):
and a lot of mums really needed it, and then
at other times I didn't need it at all. But
now there aren't enough China family health nurses and there
aren't enough Chime family health nursing appointments available or drop
ins available, and that again it's not helpful for mums
who need I mean, we all support when we're learning
(12:50):
something new, don't we And we learn something new every
time we have a new baby.
Speaker 2 (12:56):
Oh, breastfeeding just I mean, we all think it's meant
to just happen, but it's not that easy, no.
Speaker 1 (13:02):
And I mean I should also say that they're fantastic
support services like the Australian Breastfeeding Association, which is absolutely
fantastic and is available twenty four hours a day, seven
days a week, and that's absolutely fantastic. But if you've
been sent home from hospital within forty eight hours of
having a baby, your milk hasn't come in yet, and
(13:25):
you're only getting a couple of visits from a midwife
from the hospital, it's not enough for every month. Like,
we really need to be able to wrap around mums
and give them the support they need, and it's not
necessarily going to work over the phone or online. And
(13:47):
in terms of formula introduction, we know that most mums
turn to the internet and in some groups, yeah, and
some of the information on the internet is evidence based
and is really reliable, and others is not. And again
I've had PhD students who have looked at the quality
(14:09):
and the content ofant feeding websites and ofant feeding apps,
and the quality is really variable. So it's really tough
for mums to know when they're tired, when they've got
a crying baby, when they might not have a lot
of experience in this area. You know, which website do I.
Speaker 2 (14:30):
Trust because we don't have, you know, the extended family
like other cultures do.
Speaker 3 (14:36):
You're quite nuclear.
Speaker 2 (14:38):
And I remember when I did my nursing training and
people would go on and do their midi and then
they would go on and do family and child health.
Speaker 3 (14:46):
Is that still offered as a.
Speaker 1 (14:49):
Oh yeah, yeah, but you don't have to be a
midwife to be a child and family health nurse. You
can do that qualification from your bachelor degree. And similarly,
a sort of fairly recent change is that you can
get a child and family qualification and work as a
child and family health nurse if you've done a Bachelor
(15:10):
of midway free rather than a Bachelor of nursing. So that, okay,
that has been a fairly recent change and has been
really welcomed by some in the field and not by
others in the field. So I'm remaining agnostic on that one.
I just wanted to be more support from others.
Speaker 3 (15:29):
I couldn't agree more.
Speaker 2 (15:31):
And I just think my milk didn't come in until
what day three, and I was a hot mess that day.
Speaker 3 (15:38):
Yeah, and literally a hot.
Speaker 2 (15:41):
Mess, and with these massive boobs, and I was sobbing
at the side of the baby and someone came me
in and I burst into tea like I was a mess.
Speaker 3 (15:51):
So if I hadn't have.
Speaker 2 (15:52):
Had that support that I had, yeah, you know, from
my mom and from the nurses in the hospital, I
would have really struggled.
Speaker 1 (16:00):
Yeah, and you need to be told, don't you this
is normal, this is just what happens. Everything's temporary. It'll
be better tomorrow, it'll be better the day after that.
You need to hear that reassurance because it's a pretty
phenomenal new thing in your life that's happened to you.
(16:21):
And I think we have to be kind and supportive
and make sure that mums have all of the support
that they need to feel good about their mother ing
and the extraordinary thing that they've just done, grown a
human being.
Speaker 2 (16:41):
Do you think, because I feel that there's this big
gap in healthcare in this space, you know, in my
own clinic, we obviously we can't treat women for anti
wrinkle or for lasers and things like that if they're pregnant,
and often if they're breastfeeding. And you know, all of
them say the same thing. They all wanted to breastfeed,
(17:03):
and some did for a period of time, others didn't.
But it was very interesting that I hear that some
of them go. You know, I didn't tell anyone I
wasn't breastfeeding because you know, I was shamed so badly,
or someone had something to say, or someone will make
a comment. And I don't think people realize we're very
sensitive about our mothering and our mothering skills, especially when
(17:27):
we're in umup. We're just looking to be built up
and supported. And when you hear these women just going,
I felt shamed or I embarrassed, you know. I just
think we're really letting our sisters down by not supporting
them in whatever.
Speaker 3 (17:46):
Their choice is.
Speaker 2 (17:46):
And yes, like you said, breast is best, and I
had on heart can say it was the best thing.
Speaker 3 (17:51):
It was wonderful, but I couldn't do it for my
second child. I tried but couldn't.
Speaker 1 (17:57):
So I sort of think about different layers of breastfeeding
kind of feeding, and I feel like an individual mum
who has struggled with breastfeeding or has decided not to
breastfed for whatever reason, Why are we shaming her when
(18:19):
there's all sorts of reasons why she might have made
that decision that are kind of out of her control.
So does she have the support at home? Did she
receive enough support to breastfeed? Does she have to go
back to work in a minute because she's got a
huge mortgage, or she's the primary bread winner, or you
know one hundred other reasons. Does she get all of
(18:42):
the education and support and advice that she needed when
she was in hospital? You know that's another layer. Does
the society that we live in actually support her to breastfeed?
Can she breastfeed in public without feeling uncomfortable?
Speaker 3 (18:58):
Actually?
Speaker 1 (18:59):
You know, is she being bombarded by social media that's
suggesting that she should feed with him from formula rather
than breastfeeding. I mean, all sorts of things at all
sorts of different levels are impacting on that woman. So
why would we be shaming her or making her feel
(19:20):
uncomfortable when we don't know anything about what's going on
with her. We should be telling her you're doing your.
Speaker 3 (19:27):
Great job, or can I give you a hand?
Speaker 1 (19:30):
Exactly if we knew more about why people stop breastfiting
or about why they might be mixed feeding and if
our clinicians, our time and family health nurses, our GPS,
all of the people who see mums a lot, if
they knew how to sort of ask mums the right questions,
(19:50):
then they might be able to say, actually, you're going
back to work in a few weeks time. Did you
know that you could mixed feed? Did you know you
could keep breastfeeding, you could breastfeed in the morning, you
could breastfeed at night. Or your partners said, isn't it
time to stop breastfeeding? Well, here are some things you
could say to alleviate their concerns. Or you think your
(20:12):
supplies low, Here's how you can tell if your supply
is low. And here are some tips for increasing your supply.
You know, there's all sorts of things that we could
be doing to support that mum that are just not
happening in a systematic way. A here's the Health Department's policy.
(20:33):
We're going to see what we can do about increasing
people's supply. Or here's the things we can put in
place to support mums to continue breastfeeding at work.
Speaker 2 (20:43):
So, statistically, has breastfeeding increased. Our initiation rates of breastfeeding
are fantastic. So in Australia, we've got very very high
rates of breastfeeding initiations, so people are breastfeeding in hospital,
but the drop off in that first month is really high, right.
(21:05):
I would argue that the drop off in that first
month is high because people are not adequately supported, and
they're not adequately supported because they haven't received the support
in the education or the.
Speaker 1 (21:17):
Not just verbal education. But you know, here's how you
do it, here's physically how you do it, and here's
how you could troubleshoot some things that might happen. And
that's probably what's causing that big drop off in the
first month. And then the drop off later is for
all sorts of reasons. But we really need to know
(21:38):
a bit more and to understand how to intervene to
increase the duration of breastfeeding, make sure people are giving
some breast milk. So if I could tell you my story, please,
So when my son was born, he was born in
the United States, which doesn't have a strong breast threading culture,
(22:00):
and so he was in the nanatal nursery for a
month and after about a week I was expressing quite
large quantities and one of the doctors said to be oh,
are you still doing that? We yes, I am, and
so I persisted, and luckily we had a fantastic nurse
who really got breast feeling going because he wasn't particularly
(22:21):
interested because he'd lost his suck reflex from being inchbraded
and blah blah. And then because it was the United
States and I had to go back to work after
three months, I used to have to travel a bit
for work, and I would travel with an eskie and
I would express while I was away and come home
with the eski, and some of the sort of senior
men in the company would look at the eski coming
(22:43):
around the baggage and say, oh, I don't even want
to ask what's in there, you know. So there was
sort of this ky thing, and there was nowhere to
express a work except the toilets. So after persisting with this,
I just was really determined to exclusively breastfeedd him. After
(23:04):
a while, it just came a bit too difficult, and
so I did persist with that morning and evening, and
that worked really well for us until he was almost
a year old, when he chose to end it. So
it can be done. But I was just really lucky
that my cousin was a breastpending counselor. I had friends
(23:24):
who were midwives and I could get that advice and
support because it wasn't available to me in the health
system there.
Speaker 2 (23:32):
Because when I had Jacob and I had all those issues. Yeah,
lactation consultants were around, but it was fairly new and
they were fantastic, but it was expensive, and that is
something some people do say that if you get a
private lactation consultant, for some.
Speaker 3 (23:49):
People it's just out of their budget.
Speaker 2 (23:51):
Yeah, you know, I understand people have to run a
business and you know, everyone needs to make a living,
but it does seem a shame that that's not as
readily available to maybe people in the lower socioeconomic group
who really would benefit from breastfeeding.
Speaker 1 (24:07):
And there certainly are BLACKTAH consultants in public hospitals, but
there aren't enough and they're fantastic, but there are only
so many hours in the strait and women are in
and out of hospital quite quickly, and so they often
need that support maybe five or six days down the track,
and they're just they're just not enough of them.
Speaker 2 (24:29):
So you have found at that month stage, that's when
a lot of mums is just getting too hard and
that's when they tend to give up.
Speaker 1 (24:37):
It's in the first month. So we've got national data
on the rates of breastfeeding by month, and the biggest
drop off is in that first month, and then it's
fairly steady out to six months.
Speaker 2 (24:49):
So how many then at six months do you find
It would be say there's one hundred percent that leave
hospital by that first month, sixty percent of dropped off
and then of.
Speaker 1 (24:59):
That about still breastfeeding.
Speaker 3 (25:03):
It one way, okay, and then you find six months.
Speaker 1 (25:08):
From our research. From our study about twenty percent were
mixed feeding, so we could figure out how many were
mixed feeding, and it was about the same, so forty
percent rest freading, forty percent formula that was in our study,
so you know, other studies might be different. It was
pretty representative, but not a lot of people from lower
SOSO economic groups who we know are more likely to
(25:31):
use in for formula. So that's probably a good sample.
Speaker 2 (25:35):
Are you currently studying more in that space or other people.
Speaker 3 (25:39):
That are absolutely and I also researching.
Speaker 1 (25:43):
Yeah, So one of my PhD students, her PhD was
sort of looking at sources of information for feeding making
feeding decisions, and she will go on to have a
really strong research program in mixed feeding because she's really
decided that's going to be her thing. And I would
really encourage that because I think there's a lot to
(26:05):
do in that area. You know, for me, this became
an interest sort of by accident, because as an obesity
prevention person, we're really interested in the way food is
in that first year of life. We really worry about
excess growth. So we want kids to sort of follow
(26:26):
one of those lines on the growth chart. But some
kids sort of jump over lines and keep jumping over lines,
and that's called rapid weight gain. And that's more common
in babies who are fed with infant formula.
Speaker 3 (26:40):
And so why do you think that is?
Speaker 1 (26:42):
Because they're probably being overfed, so they're probably getting more
calories than they need through two mechanisms. So sometimes parents
will over concentrate the bottle with a view to that
may be making them sleep better. And the other thing
is that if a baby's breast fed, when they've finish
(27:05):
to feed, they come off the breast, they doze off
to sleep. You know, the mum gets to be confident
that they've had enough to drink, they've finished the feed,
and that's the end of the feed. But when you
are feeding with formula, you tend to make up a
certain amount of milk in the bottle, and there's a
(27:25):
real tendency to finish that bottle, even if the baby
might halfway through be showing all of the signs that
they're full. There's a sort of tendency and a temptation
because you've got the information from the tin that says
eight bottles of one hundred meals at this age, you think, right,
I've got to do that, and so keep that baby
(27:47):
feeding for longer than they need or for longer than
they want. And so from an obesity prevention point of view,
we really try to encourage people if they are using formula,
to use it in a way that is similar to
if they were breastfeeding. So you would still hold the baby,
you would look into their eyes, make eye contact, and
(28:09):
you would watch for signs of fullness, and when fullness
is there, you stop.
Speaker 3 (28:15):
But you don't know that, you don't know what, you
don't know.
Speaker 1 (28:18):
Exactly right, and that information is not on the tin.
Speaker 2 (28:23):
Because it would be you know, eight times or whatever
one hundred meals and I know me when I was
feeding Jacob, and I had no other information than the
tin minde like he was fussy, but I still made
up according to what the tin said.
Speaker 1 (28:37):
Of course you did, what else would you do? And
of course you would think he's going to drink all
of that. You know, I can't stop. And so the
other thing that sometimes happens that we worry about from
an obesity prevention point of view is that mums might
be breastfeeding, but they might think my baby stopped growing
fast enough, or I just want a little insurance policy
(29:00):
that they're growing fast enough, so they might top up
with formula even if they don't need it. So sometimes
mums could really do with support from their trusted healthcare
provider to say, if your baby's having this many wet nappies,
and your baby's growing, and your baby seem settled in
(29:21):
between feeds, then they're getting enough to eat. But mums
often doubt themselves or second guests themselves, and so they think, oh,
I better top up, or I don't trust my body
to make everything my baby needs, so I better give
some formula as well, and that probably.
Speaker 2 (29:38):
Doesn't need to h and that older generation as well,
like my mum, I mean, I was bottlefed on carnation milk.
Speaker 3 (29:45):
You know, I think about it hour, I go oh,
my god.
Speaker 2 (29:49):
And they really look at the baby and go oh,
if they're a little bit fussy after you take them
off the breast of the need a little bit of
a top up. And Mum learned pretty quick not to
say anything. But you know, if you come from a
family that are full of big personal bodies and you
know you just want to please everybody and shut everyone up,
you are going to do that.
Speaker 1 (30:10):
Absolutely, you're going to do that. And also, some parents
from some cultural backgrounds have a really strong preference for
a bigger baby, and with a really plentiful supply of food,
they will try to get that baby to be bigger
than they would automatically be. And that's a real challenge
for clinicians because they sort of need to find a
(30:32):
culturally sensitive way of saying, baby, it probably doesn't need
that extra top up. But if you've got other family
members saying, oh, the baby's too skinny, then of course
you're going to You don't want to be labeled a
bad mother.
Speaker 3 (30:47):
So oh god, no, Elizabeth.
Speaker 2 (30:51):
If a baby, you know, at three months is sort
of in that high percentile weight wise, is that an
indication that they may struggle as an adult with obesity.
Speaker 1 (31:02):
Not necessarily. So if a babes weight for age and
their length for age is about the same in terms
of the centile they're on, then they've probably got tall parents. Yeah, so, yeah,
they've probably got tall parents. If their length for age
and their weight for age is on the sort of
(31:22):
lower level than maybe their parents aren't very tall. There's
also a chart called weight for length, and that's sort
of a little bit like BMI. What you like to
see is that that is pretty steady, so that they
sit on the same centil and they sort of stay
on the same centil, so it doesn't matter if they're
on the twentieth centile or the eightieth centile. What you
(31:45):
want to see is that they stay pretty steady because
that means that their length is growing at a similar
rate to their weight. Their weight isn't sort of getting
ahead of their length, which is what happens with rapid
weight gain, is that their weight is getting ahead of
their length. So we would then put stratum is in
place to let the baby grow into their weight.
Speaker 2 (32:08):
And one other question I have for you is the
big thing when my kids would little, was you present
food like at six months and when they start showing
interest that sort of thing, you start to introduce food.
Speaker 3 (32:21):
Is that still the situation.
Speaker 1 (32:24):
Yeah, there's a number of different sort of signs of readiness,
and that's definitely one of them, that they're taking interest
in food or sometimes basically reaching out and almost grabbing
the food that you've got. Okay, they need to have
reasonable head control, and that's sort of usually around the
six month age is what we say. So around six months.
(32:45):
It might be a little bit earlier for some babies,
it might be a little bit later for some babies,
but around six months is the advice. I just would
also just like to remind people that if babies have
allergy risks, or they've been premature, or one of those
other things, then please remember this is a general advice.
Generals that those cases need to be treated carefully with
(33:10):
professional advice. And the thing we say is parents provide
child decides. So rather than again preparing a certain amount
of food and shoveling that into the baby's mouth until
it's gone, what we would recommend now is that you
would offer a variety of foods, iron rich foods first,
(33:32):
and you would offer those foods and let the baby
decide how much they're going to eat. Of course, in
the early days, giving breast milk first because that's the
sort of major source of neutrasse. Still, yeah, and.
Speaker 2 (33:46):
Just one other question, I'd really be interested to hear
academically where you came from and to your point now,
just so other nurses can hear what you've achieved. I
love hearing that from my colleagues. Yeah, fill us all
in one. I started my journey your journey.
Speaker 1 (34:08):
So I'm quite old, so I'm a hospital trained nurse,
and I was really interested. I did a critical care
certificate and worked in cardiothoracic intensive care, and I started
to sort of see people who had calivevascular disease and
that some of it could have been prevented. And that
was sort of an early spark. But then I went
(34:31):
and worked in industry because I really really wanted to
do research, and back then there wasn't a lot of
nurse initiative research, and I thought I really wanted to
do research, and so I worked in industry for a
while and I ended up working in the United States,
and then when we came home from the United States,
I did my conversion degree, and then I did a
(34:52):
master's of public health, and at this DAT had two
little kids, and I was really interested in the way
people made decisions about feeding their kids because it just
seemed really interesting to me that the way people were
influenced and what they thought was important, and the support
they received and those sorts of things. I got a
(35:13):
small project after my master's that was looking at child obesity,
and I ended up doing my PhD with that same person.
So initially I looked at clio vascular risk factors and
other disease risk factors in adolescents, and it was really
clear that obesity was quite a serious problem even in adolescents.
(35:36):
So they had the kids who were living with obesity
had lots of risk factors. And after that study, which
I loved doing, I thought, well, I want to do
something to prevent this. I want to work in prevention,
and I want to work in prevention in primary health care,
so with child of family health nurses, with GPS nurses
(35:58):
in general practice, because they're the people who have access
to everybody. And so I did quite a few different
research projects in general practice and over the years, I've
been interested in younger and younger and younger children, and
so now my focus is the first year of life
(36:19):
and that'll do me. You know, I'm getting close to
retime and age. But I'm really happy to say that
I think I've had twelve PhD students who I've survised
to who have completed, and I've got three more to go.
And I can say hand on heart that OBESI prevention
research in the primary healthcaret setting is in really good
(36:41):
hands because some of the students I've had it just
out of this world. It's so fantastic. And so that's
what I've done, and I think the thing I'm most
proud of is having worked to co design with parents
(37:02):
and with nurses. Told of Hemily Health Nurses an app
that we've modified over the years that has supported parents
with infant feeding decisions. And the initial app is very
out of date now, so it's you know, it's probably
on version five or six now.
Speaker 3 (37:19):
Yeah. Yeah.
Speaker 1 (37:20):
And one of the things we found was that the
most visited pages on that app were around infant formula
and mixed feeding. Wow, so we sort of knew we
were onto something. I mean, we had an enormous amount
of content about breastfeeding too, but those pages weren't as
frequently visited because we think that was being handled by
(37:40):
other people. You know, that people had that sorted, whereas
the formula pages and the mixed feeding pages were really
highly visited. So that was it was good for us
to know.
Speaker 2 (37:52):
That because I truly believe mothers want a breastfeed for
as long as they can.
Speaker 3 (37:58):
There's no doubt we would all do that.
Speaker 2 (38:00):
But yeah, there are so many circumstances, so I think
even some is better than none.
Speaker 1 (38:07):
Any is better than none, and absolutely the more the better.
Speaker 2 (38:11):
Yeah, And I think it is so valuable because that's
what I hear on the street, you know, with my
clients that.
Speaker 3 (38:21):
And that a lot of them mixed feed. You have
to go back to it.
Speaker 2 (38:24):
I mean, just look at the Economic Times and I
think that's wonderful that you have a page.
Speaker 3 (38:30):
Up that helps and guides women.
Speaker 2 (38:33):
And I'm not surprised it's probably the most visited page.
Speaker 1 (38:36):
Yeah, so that's within that app that's what people really
sound useful, and that's been a really interesting finding for us.
Speaker 2 (38:45):
Yeah, I think it's wonderful. Well, Elizabeth, I have loved
this chat with you and I am very in awe
of you know, in my heart I'd like to be
a researcher, but I think I'm actually a clinician.
Speaker 1 (38:57):
So yes, but there's a role we need more clinician
researchers that is so important that there's it's just not
enough of them.
Speaker 3 (39:06):
It's not too late, No, it's never too late.
Speaker 2 (39:10):
One of my colleagues has actually she was in her
late sixties doing her PhD.
Speaker 3 (39:15):
And more power to her.
Speaker 2 (39:16):
Lovely, completely love it so and she's a remarkable woman too.
But thank you for your wisdom and your knowledge and
sharing that. I really appreciate it.
Speaker 1 (39:27):
It's been a pleasure, lovely to chat to you.
Speaker 3 (39:29):
You too, thanks a losten.
Speaker 2 (39:33):
This season. I am so excited to announce that the
podcast is being supported by Nutritia, which is a global
leader in medical nutrition. They understand the needs of nurses
in the nutrition space and for over one hundred and
twenty five years have provided products to support child health.
Some of Nutrita's pediatric brands include Neo Kate Junior for
(39:55):
children who have food allergies, and apt to Grow for
those fussy eaters. And those of us who have children
know many kids who go through the phases of definite fussiness.
For more information and resources, visit the nutritiona Pediatrics hub
at nutritia dot com dot au forward slash pediatrics. I
just want to say a huge thank you to Nutritia.
(40:17):
Their desire to support nurses is truly appreciated, and they
are allowing me to continue this podcast so that we
can all grow as nurses.
Appogia production.
Speaker 2 (00:10):
Hi everyone, thank you for tuning back into Tenantus for Nurses.
I suspec Woodbine here this season. I am so excited
to announce that the podcast as being supported by Nutritia,
which is a global leader in medical nutrition. They understand
the needs of nurses in the nutrition space and for
over one hundred and twenty five years have provided products
(00:31):
to support child health. Some of Nutrita's pediatric brands include
Neo Kate Junior for children who have food allergies and
app to Grow for those fussy eaters. And those of
us who have children know many kids who go through
the phases of definite fussiness. For more information and resources,
visit the nutritiona Pediatrics hub at nutritia dot com dot
(00:54):
au forward slash Pediatrics. I just want to say a
huge thank you to Nutritia. Their desire to support nurses
is truly appreciated, and they are allowing me to continue
this podcast so that we can all grow as nurses.
This season, we have some amazing speakers in the pediatric
space which I cannot wait to share with you all. Hi,
my name's Beck Woodbine and welcome to Tenderness for nurses.
Speaker 3 (01:17):
I'm grateful for the person that I have the opportunity to.
Speaker 1 (01:21):
Be, so I hit it and parked it for Nellie
for years. We always have free will, We always get
to choose. We are autonomous.
Speaker 2 (01:31):
Hi everyone, thank you for tuning into Tenderis for Nurses.
We are very excited this season to be sponsored by
NUTRITIONA and I have the fabulous professor Elizabeth Denny Wilson,
who specializes in obesity prevention in babies, but also she
(01:51):
has done some significant research into the area of mixed feeding,
and probably that is what we're going to address a
little bit more today.
Speaker 3 (02:02):
But thank you so much for coming on.
Speaker 2 (02:04):
I know you are super busy as a professor and
studying and teaching and researching.
Speaker 1 (02:09):
We're all super busy, so that's no excuse.
Speaker 2 (02:12):
I am just so delighted and reading your bio and
watching the videos that are on YouTube about you and
what you have done around mixed feeding. We all know
breast is best, and we all try to do the
right thing by our kids.
Speaker 3 (02:29):
But sometimes you know you've.
Speaker 2 (02:31):
Got to go back to work, you're not well, you
don't know the circumstances behind. So I'm making a decision
to maybe mix feed. So do you mind explaining exactly
what mixed feeding is?
Speaker 1 (02:44):
Yes, certainly, so I completely agree with you Beck. Breastfeeding
is an extraordinary thing and an extraordinary thing that we
can do for our babies, and it is one hundred
percent the best way to feed human infants. But also,
as you said, there are reasons why sometimes people don't
(03:06):
want to breastfeed, or they feel pressures one way or
another to not breastfeed, or they might feel like they
have a low supply or that they don't have enough milk,
or you know, there are lots of reasons why people
might choose to introduce infant formula. So mixed feeding just
means if you're combining breastfeeding with another form of feeding,
(03:29):
So you're either feeding with infant formula in a bottle
or in a cup, sometimes in a spoon, which would
take a long time. So it just means that you're
breastfeeding plus something else.
Speaker 2 (03:42):
And do you think there's a higher percentage of people
doing that than anyone talks about because I know that
if you have a season, you're shamed. If you don't breastfeed,
you're shamed. I mean, I had a daughter that just
wanted breast milk, and that was great and it suited me,
but my second child had total refusal to eat. Ye
(04:02):
period was a nasogastrically fed, then just to nuzzle a
couple of weeks at some stage, and then we tried
to get my breast milk back in and then he
refused again. So I was very lucky that I had
some amazing lactation consultants to come in, but in the
end he just had to be not even bottle fed.
Speaker 3 (04:18):
He's one of those kids that were spoonfed.
Speaker 1 (04:20):
I had one of each as well, so yes, an
enthusiastic breastfeeder who I fed for years and another one
who it was pretty challenging. But I think we just
don't know is the true answer. We know from our
research and from other groups research that about half of
babies will have some formula before they're six months old,
(04:42):
but we don't have really good data on the proportion
of people who were mixed feeding, so who were doing both.
You know, we can kind of extract it from other studies,
but we don't have really good data on the proportion
of people who are mixed feeding. And I see this
as a terrible gap because if we knew knew more
(05:06):
about people who were mixed feeding, and if we knew
more about why they were mixed feeding, then we'd be
in a better position to develop interventions to support them
to continue breastfeeding, to breastfeed more often, to maintain their
breast milk supply, and we'd also be able to support
(05:26):
our clinicians to support women to prolong breastfeeding, to increase breastfeeding.
But we can't really do those things if we don't
really understand who's doing it, why they're doing it, how often,
whether their goal is to get through a period of
challenge in their breastfeeding that they will then pick back
(05:49):
up again. And certainly when I was had my babies
and became really interested in the way people feed their babies,
I was absolutely devoted breastfeeder and one hundred percent you know,
behind breastfeeding being the best food for babies and breastfeeding
(06:10):
at all costs. But I guess what I have come
to understand through my research and through the women I've
met in my role as a breastfeeding counselor but also
in my role as a researcher, is that it's just
not always what's right for them and if we could
(06:33):
really understand more about why they've made the choices they've made,
then we might be able to intervene sooner and help
them to continue breastfeeding, or help them to breastfeed more often,
or find a way of mixed feeding that doesn't lead
to no breast milk, because some breast milk is better
(06:57):
than no breast milk.
Speaker 3 (06:58):
Absolutely.
Speaker 2 (06:59):
Why do you think there is such a huge gap
in that research space.
Speaker 1 (07:05):
One of the reasons is that I think for a
long time, we've had people who research breastfeeding and we've
had people who research other things, and we haven't necessarily
communicated very well or done really good multidisciplinary work. And
I also think because our health services and our health
departments have had extremely strong pro breastfeeding policies, as they should,
(07:30):
there hasn't necessarily been a place for doing research about
mixed feeding. And there's also been a really strong sense
over my lifetime of working in this field that there's
enough information out there in the in the ether or
in the way that is accessible to mums into wherever. Yeah,
(07:53):
to give mums who are using it formula advice on
using it formula. But I think what hasn't been captured
well is that, of course, there are mums who exclusively
breastfeed and that's fatastic, and there are mums who exclusively
use infant formula, and that's they deserve our support. But
when we do our work that was initially focused on
(08:17):
obesie prevention, and there's a reason why we're interested in
infant formula for obesie prevention, I guess we started to
see that. And this work was led by one of
my PhD students, and she talked to a lot of
mums who were using infant formula, either mixed feeding or
exclusively formula feeding, and there were a couple of things
(08:39):
that she found that really sort of broke my heart
a little bit. One of them was that mums don't
seek health professional advice before they start introducing formula, and
that's because they don't think they can, They feel judged,
they feel like it's not the right thing to do,
and that they won't necessarily get support. And the second
(09:02):
thing that broke my heart was that the place where
most people who are introducing infant formula get their information
is from the tin, so from the tin of formula,
and I just think we can do a lot better
than that.
Speaker 3 (09:18):
That's where I got mine from.
Speaker 2 (09:19):
Yep.
Speaker 1 (09:21):
I just think that's a travesty because a lot of
mums who are introducing infant formula are doing so at
a point of distress or of christ or and we
should be wrapping our arms around those mums, just as
we should be wrapping our arms around all mums. We
(09:41):
should be saying, what's your goal? Is this something you
just want to do for a little while, or you know,
have you thought about mixed feeding? Have you thought about
this might be something you could do just to take
the pressure off for a couple of days, and then
you know, here's what you could do to keep your
supply up, or here's what you could do to build
your supply, or here's how you can do it without
(10:04):
say that's it for my breastfeeding journey.
Speaker 2 (10:09):
So when someone decides to mix feed because of say,
for example, they're going back and doing some part time
work that sort of thing, you know, it might just
be easy for them to go, Okay, I'm not going
to breastfeed anymore.
Speaker 3 (10:21):
I'm just going to swoop to bottle formal food.
Speaker 2 (10:26):
But if they knew that, say, they could do morning
and night exactly, just you know, a bit of a
pump at lunchtime. You know, there's a room there that
you know at work that you can do that, and
then they can take that home and use that on
the days off or a weekend when you know Nana
and Papa are looking after the kid or something like that.
But it's interesting I just found with my daughter, she
(10:49):
just wanted breastpilk, that's it. And then she went straight
to a cup because there was no way she was
going to give that up.
Speaker 1 (10:54):
Yep.
Speaker 2 (10:55):
Jacob, on the other hand, just hated everything. I was
at the end of my tether. I actually said it
in a podcast previously. I was so beside my I
went to the Maternal and Health Child Service Center, sat
there on the steps before it had even opened, with
this crying baby that just wouldn't feed, wouldn't stop crying.
(11:17):
And I was sitting on those stairs with this baby crying, begging.
I was begging for help. Yeah, he's lucky I didn't
throw him in the rubbish bit seriously here. Yeah, and
you know, I'm a nurse, so I have a bit
of an idea about stuff.
Speaker 3 (11:33):
But imagine being.
Speaker 2 (11:34):
A mum and not having your mum around or being
on your own or being a single parent or not
having that support.
Speaker 1 (11:42):
Absolutely, and child family health services are not as available
as they used to. I mean, if you've got a
good child family health nurse, they are like gold, like
absolutely salute gold because the relationship that they develop with
new mums is just second to none, and they will
support mums through thick and thin, and they have just
(12:03):
such a beautiful way of you know, telling mums you
know you're doing a great job, and that's exactly what
mums need to hear. But it's not like when I
had it. You know, when I have my babies, you
could turn up for a drop in visit. I think
it was every morning and they had appointments in the afternoon,
so it was really available and I really needed it
(12:26):
and a lot of mums really needed it, and then
at other times I didn't need it at all. But
now there aren't enough China family health nurses and there
aren't enough Chime family health nursing appointments available or drop
ins available, and that again it's not helpful for mums
who need I mean, we all support when we're learning
(12:50):
something new, don't we And we learn something new every
time we have a new baby.
Speaker 2 (12:56):
Oh, breastfeeding just I mean, we all think it's meant
to just happen, but it's not that easy, no.
Speaker 1 (13:02):
And I mean I should also say that they're fantastic
support services like the Australian Breastfeeding Association, which is absolutely
fantastic and is available twenty four hours a day, seven
days a week, and that's absolutely fantastic. But if you've
been sent home from hospital within forty eight hours of
having a baby, your milk hasn't come in yet, and
(13:25):
you're only getting a couple of visits from a midwife
from the hospital, it's not enough for every month. Like,
we really need to be able to wrap around mums
and give them the support they need, and it's not
necessarily going to work over the phone or online. And
(13:47):
in terms of formula introduction, we know that most mums
turn to the internet and in some groups, yeah, and
some of the information on the internet is evidence based
and is really reliable, and others is not. And again
I've had PhD students who have looked at the quality
(14:09):
and the content ofant feeding websites and ofant feeding apps,
and the quality is really variable. So it's really tough
for mums to know when they're tired, when they've got
a crying baby, when they might not have a lot
of experience in this area. You know, which website do I.
Speaker 2 (14:30):
Trust because we don't have, you know, the extended family
like other cultures do.
Speaker 3 (14:36):
You're quite nuclear.
Speaker 2 (14:38):
And I remember when I did my nursing training and
people would go on and do their midi and then
they would go on and do family and child health.
Speaker 3 (14:46):
Is that still offered as a.
Speaker 1 (14:49):
Oh yeah, yeah, but you don't have to be a
midwife to be a child and family health nurse. You
can do that qualification from your bachelor degree. And similarly,
a sort of fairly recent change is that you can
get a child and family qualification and work as a
child and family health nurse if you've done a Bachelor
(15:10):
of midway free rather than a Bachelor of nursing. So that, okay,
that has been a fairly recent change and has been
really welcomed by some in the field and not by
others in the field. So I'm remaining agnostic on that one.
I just wanted to be more support from others.
Speaker 3 (15:29):
I couldn't agree more.
Speaker 2 (15:31):
And I just think my milk didn't come in until
what day three, and I was a hot mess that day.
Speaker 3 (15:38):
Yeah, and literally a hot.
Speaker 2 (15:41):
Mess, and with these massive boobs, and I was sobbing
at the side of the baby and someone came me
in and I burst into tea like I was a mess.
Speaker 3 (15:51):
So if I hadn't have.
Speaker 2 (15:52):
Had that support that I had, yeah, you know, from
my mom and from the nurses in the hospital, I
would have really struggled.
Speaker 1 (16:00):
Yeah, and you need to be told, don't you this
is normal, this is just what happens. Everything's temporary. It'll
be better tomorrow, it'll be better the day after that.
You need to hear that reassurance because it's a pretty
phenomenal new thing in your life that's happened to you.
(16:21):
And I think we have to be kind and supportive
and make sure that mums have all of the support
that they need to feel good about their mother ing
and the extraordinary thing that they've just done, grown a
human being.
Speaker 2 (16:41):
Do you think, because I feel that there's this big
gap in healthcare in this space, you know, in my
own clinic, we obviously we can't treat women for anti
wrinkle or for lasers and things like that if they're pregnant,
and often if they're breastfeeding. And you know, all of
them say the same thing. They all wanted to breastfeed,
(17:03):
and some did for a period of time, others didn't.
But it was very interesting that I hear that some
of them go. You know, I didn't tell anyone I
wasn't breastfeeding because you know, I was shamed so badly,
or someone had something to say, or someone will make
a comment. And I don't think people realize we're very
sensitive about our mothering and our mothering skills, especially when
(17:27):
we're in umup. We're just looking to be built up
and supported. And when you hear these women just going,
I felt shamed or I embarrassed, you know. I just
think we're really letting our sisters down by not supporting
them in whatever.
Speaker 3 (17:46):
Their choice is.
Speaker 2 (17:46):
And yes, like you said, breast is best, and I
had on heart can say it was the best thing.
Speaker 3 (17:51):
It was wonderful, but I couldn't do it for my
second child. I tried but couldn't.
Speaker 1 (17:57):
So I sort of think about different layers of breastfeeding
kind of feeding, and I feel like an individual mum
who has struggled with breastfeeding or has decided not to
breastfed for whatever reason, Why are we shaming her when
(18:19):
there's all sorts of reasons why she might have made
that decision that are kind of out of her control.
So does she have the support at home? Did she
receive enough support to breastfeed? Does she have to go
back to work in a minute because she's got a
huge mortgage, or she's the primary bread winner, or you
know one hundred other reasons. Does she get all of
(18:42):
the education and support and advice that she needed when
she was in hospital? You know that's another layer. Does
the society that we live in actually support her to breastfeed?
Can she breastfeed in public without feeling uncomfortable?
Speaker 3 (18:58):
Actually?
Speaker 1 (18:59):
You know, is she being bombarded by social media that's
suggesting that she should feed with him from formula rather
than breastfeeding. I mean, all sorts of things at all
sorts of different levels are impacting on that woman. So
why would we be shaming her or making her feel
(19:20):
uncomfortable when we don't know anything about what's going on
with her. We should be telling her you're doing your.
Speaker 3 (19:27):
Great job, or can I give you a hand?
Speaker 1 (19:30):
Exactly if we knew more about why people stop breastfiting
or about why they might be mixed feeding and if
our clinicians, our time and family health nurses, our GPS,
all of the people who see mums a lot, if
they knew how to sort of ask mums the right questions,
(19:50):
then they might be able to say, actually, you're going
back to work in a few weeks time. Did you
know that you could mixed feed? Did you know you
could keep breastfeeding, you could breastfeed in the morning, you
could breastfeed at night. Or your partners said, isn't it
time to stop breastfeeding? Well, here are some things you
could say to alleviate their concerns. Or you think your
(20:12):
supplies low, Here's how you can tell if your supply
is low. And here are some tips for increasing your supply.
You know, there's all sorts of things that we could
be doing to support that mum that are just not
happening in a systematic way. A here's the Health Department's policy.
(20:33):
We're going to see what we can do about increasing
people's supply. Or here's the things we can put in
place to support mums to continue breastfeeding at work.
Speaker 2 (20:43):
So, statistically, has breastfeeding increased. Our initiation rates of breastfeeding
are fantastic. So in Australia, we've got very very high
rates of breastfeeding initiations, so people are breastfeeding in hospital,
but the drop off in that first month is really high, right.
(21:05):
I would argue that the drop off in that first
month is high because people are not adequately supported, and
they're not adequately supported because they haven't received the support
in the education or the.
Speaker 1 (21:17):
Not just verbal education. But you know, here's how you
do it, here's physically how you do it, and here's
how you could troubleshoot some things that might happen. And
that's probably what's causing that big drop off in the
first month. And then the drop off later is for
all sorts of reasons. But we really need to know
(21:38):
a bit more and to understand how to intervene to
increase the duration of breastfeeding, make sure people are giving
some breast milk. So if I could tell you my story, please,
So when my son was born, he was born in
the United States, which doesn't have a strong breast threading culture,
(22:00):
and so he was in the nanatal nursery for a
month and after about a week I was expressing quite
large quantities and one of the doctors said to be oh,
are you still doing that? We yes, I am, and
so I persisted, and luckily we had a fantastic nurse
who really got breast feeling going because he wasn't particularly
(22:21):
interested because he'd lost his suck reflex from being inchbraded
and blah blah. And then because it was the United
States and I had to go back to work after
three months, I used to have to travel a bit
for work, and I would travel with an eskie and
I would express while I was away and come home
with the eski, and some of the sort of senior
men in the company would look at the eski coming
(22:43):
around the baggage and say, oh, I don't even want
to ask what's in there, you know. So there was
sort of this ky thing, and there was nowhere to
express a work except the toilets. So after persisting with this,
I just was really determined to exclusively breastfeedd him. After
(23:04):
a while, it just came a bit too difficult, and
so I did persist with that morning and evening, and
that worked really well for us until he was almost
a year old, when he chose to end it. So
it can be done. But I was just really lucky
that my cousin was a breastpending counselor. I had friends
(23:24):
who were midwives and I could get that advice and
support because it wasn't available to me in the health
system there.
Speaker 2 (23:32):
Because when I had Jacob and I had all those issues. Yeah,
lactation consultants were around, but it was fairly new and
they were fantastic, but it was expensive, and that is
something some people do say that if you get a
private lactation consultant, for some.
Speaker 3 (23:49):
People it's just out of their budget.
Speaker 2 (23:51):
Yeah, you know, I understand people have to run a
business and you know, everyone needs to make a living,
but it does seem a shame that that's not as
readily available to maybe people in the lower socioeconomic group
who really would benefit from breastfeeding.
Speaker 1 (24:07):
And there certainly are BLACKTAH consultants in public hospitals, but
there aren't enough and they're fantastic, but there are only
so many hours in the strait and women are in
and out of hospital quite quickly, and so they often
need that support maybe five or six days down the track,
and they're just they're just not enough of them.
Speaker 2 (24:29):
So you have found at that month stage, that's when
a lot of mums is just getting too hard and
that's when they tend to give up.
Speaker 1 (24:37):
It's in the first month. So we've got national data
on the rates of breastfeeding by month, and the biggest
drop off is in that first month, and then it's
fairly steady out to six months.
Speaker 2 (24:49):
So how many then at six months do you find
It would be say there's one hundred percent that leave
hospital by that first month, sixty percent of dropped off
and then of.
Speaker 1 (24:59):
That about still breastfeeding.
Speaker 3 (25:03):
It one way, okay, and then you find six months.
Speaker 1 (25:08):
From our research. From our study about twenty percent were
mixed feeding, so we could figure out how many were
mixed feeding, and it was about the same, so forty
percent rest freading, forty percent formula that was in our study,
so you know, other studies might be different. It was
pretty representative, but not a lot of people from lower
SOSO economic groups who we know are more likely to
(25:31):
use in for formula. So that's probably a good sample.
Speaker 2 (25:35):
Are you currently studying more in that space or other people.
Speaker 3 (25:39):
That are absolutely and I also researching.
Speaker 1 (25:43):
Yeah, So one of my PhD students, her PhD was
sort of looking at sources of information for feeding making
feeding decisions, and she will go on to have a
really strong research program in mixed feeding because she's really
decided that's going to be her thing. And I would
really encourage that because I think there's a lot to
(26:05):
do in that area. You know, for me, this became
an interest sort of by accident, because as an obesity
prevention person, we're really interested in the way food is
in that first year of life. We really worry about
excess growth. So we want kids to sort of follow
(26:26):
one of those lines on the growth chart. But some
kids sort of jump over lines and keep jumping over lines,
and that's called rapid weight gain. And that's more common
in babies who are fed with infant formula.
Speaker 3 (26:40):
And so why do you think that is?
Speaker 1 (26:42):
Because they're probably being overfed, so they're probably getting more
calories than they need through two mechanisms. So sometimes parents
will over concentrate the bottle with a view to that
may be making them sleep better. And the other thing
is that if a baby's breast fed, when they've finish
(27:05):
to feed, they come off the breast, they doze off
to sleep. You know, the mum gets to be confident
that they've had enough to drink, they've finished the feed,
and that's the end of the feed. But when you
are feeding with formula, you tend to make up a
certain amount of milk in the bottle, and there's a
(27:25):
real tendency to finish that bottle, even if the baby
might halfway through be showing all of the signs that
they're full. There's a sort of tendency and a temptation
because you've got the information from the tin that says
eight bottles of one hundred meals at this age, you think, right,
I've got to do that, and so keep that baby
(27:47):
feeding for longer than they need or for longer than
they want. And so from an obesity prevention point of view,
we really try to encourage people if they are using formula,
to use it in a way that is similar to
if they were breastfeeding. So you would still hold the baby,
you would look into their eyes, make eye contact, and
(28:09):
you would watch for signs of fullness, and when fullness
is there, you stop.
Speaker 3 (28:15):
But you don't know that, you don't know what, you
don't know.
Speaker 1 (28:18):
Exactly right, and that information is not on the tin.
Speaker 2 (28:23):
Because it would be you know, eight times or whatever
one hundred meals and I know me when I was
feeding Jacob, and I had no other information than the
tin minde like he was fussy, but I still made
up according to what the tin said.
Speaker 1 (28:37):
Of course you did, what else would you do? And
of course you would think he's going to drink all
of that. You know, I can't stop. And so the
other thing that sometimes happens that we worry about from
an obesity prevention point of view is that mums might
be breastfeeding, but they might think my baby stopped growing
fast enough, or I just want a little insurance policy
(29:00):
that they're growing fast enough, so they might top up
with formula even if they don't need it. So sometimes
mums could really do with support from their trusted healthcare
provider to say, if your baby's having this many wet nappies,
and your baby's growing, and your baby seem settled in
(29:21):
between feeds, then they're getting enough to eat. But mums
often doubt themselves or second guests themselves, and so they think, oh,
I better top up, or I don't trust my body
to make everything my baby needs, so I better give
some formula as well, and that probably.
Speaker 2 (29:38):
Doesn't need to h and that older generation as well,
like my mum, I mean, I was bottlefed on carnation milk.
Speaker 3 (29:45):
You know, I think about it hour, I go oh,
my god.
Speaker 2 (29:49):
And they really look at the baby and go oh,
if they're a little bit fussy after you take them
off the breast of the need a little bit of
a top up. And Mum learned pretty quick not to
say anything. But you know, if you come from a
family that are full of big personal bodies and you
know you just want to please everybody and shut everyone up,
you are going to do that.
Speaker 1 (30:10):
Absolutely, you're going to do that. And also, some parents
from some cultural backgrounds have a really strong preference for
a bigger baby, and with a really plentiful supply of food,
they will try to get that baby to be bigger
than they would automatically be. And that's a real challenge
for clinicians because they sort of need to find a
(30:32):
culturally sensitive way of saying, baby, it probably doesn't need
that extra top up. But if you've got other family
members saying, oh, the baby's too skinny, then of course
you're going to You don't want to be labeled a
bad mother.
Speaker 3 (30:47):
So oh god, no, Elizabeth.
Speaker 2 (30:51):
If a baby, you know, at three months is sort
of in that high percentile weight wise, is that an
indication that they may struggle as an adult with obesity.
Speaker 1 (31:02):
Not necessarily. So if a babes weight for age and
their length for age is about the same in terms
of the centile they're on, then they've probably got tall parents. Yeah, so, yeah,
they've probably got tall parents. If their length for age
and their weight for age is on the sort of
(31:22):
lower level than maybe their parents aren't very tall. There's
also a chart called weight for length, and that's sort
of a little bit like BMI. What you like to
see is that that is pretty steady, so that they
sit on the same centil and they sort of stay
on the same centil, so it doesn't matter if they're
on the twentieth centile or the eightieth centile. What you
(31:45):
want to see is that they stay pretty steady because
that means that their length is growing at a similar
rate to their weight. Their weight isn't sort of getting
ahead of their length, which is what happens with rapid
weight gain, is that their weight is getting ahead of
their length. So we would then put stratum is in
place to let the baby grow into their weight.
Speaker 2 (32:08):
And one other question I have for you is the
big thing when my kids would little, was you present
food like at six months and when they start showing
interest that sort of thing, you start to introduce food.
Speaker 3 (32:21):
Is that still the situation.
Speaker 1 (32:24):
Yeah, there's a number of different sort of signs of readiness,
and that's definitely one of them, that they're taking interest
in food or sometimes basically reaching out and almost grabbing
the food that you've got. Okay, they need to have
reasonable head control, and that's sort of usually around the
six month age is what we say. So around six months.
(32:45):
It might be a little bit earlier for some babies,
it might be a little bit later for some babies,
but around six months is the advice. I just would
also just like to remind people that if babies have
allergy risks, or they've been premature, or one of those
other things, then please remember this is a general advice.
Generals that those cases need to be treated carefully with
(33:10):
professional advice. And the thing we say is parents provide
child decides. So rather than again preparing a certain amount
of food and shoveling that into the baby's mouth until
it's gone, what we would recommend now is that you
would offer a variety of foods, iron rich foods first,
(33:32):
and you would offer those foods and let the baby
decide how much they're going to eat. Of course, in
the early days, giving breast milk first because that's the
sort of major source of neutrasse. Still, yeah, and.
Speaker 2 (33:46):
Just one other question, I'd really be interested to hear
academically where you came from and to your point now,
just so other nurses can hear what you've achieved. I
love hearing that from my colleagues. Yeah, fill us all
in one. I started my journey your journey.
Speaker 1 (34:08):
So I'm quite old, so I'm a hospital trained nurse,
and I was really interested. I did a critical care
certificate and worked in cardiothoracic intensive care, and I started
to sort of see people who had calivevascular disease and
that some of it could have been prevented. And that
was sort of an early spark. But then I went
(34:31):
and worked in industry because I really really wanted to
do research, and back then there wasn't a lot of
nurse initiative research, and I thought I really wanted to
do research, and so I worked in industry for a
while and I ended up working in the United States,
and then when we came home from the United States,
I did my conversion degree, and then I did a
(34:52):
master's of public health, and at this DAT had two
little kids, and I was really interested in the way
people made decisions about feeding their kids because it just
seemed really interesting to me that the way people were
influenced and what they thought was important, and the support
they received and those sorts of things. I got a
(35:13):
small project after my master's that was looking at child obesity,
and I ended up doing my PhD with that same person.
So initially I looked at clio vascular risk factors and
other disease risk factors in adolescents, and it was really
clear that obesity was quite a serious problem even in adolescents.
(35:36):
So they had the kids who were living with obesity
had lots of risk factors. And after that study, which
I loved doing, I thought, well, I want to do
something to prevent this. I want to work in prevention,
and I want to work in prevention in primary health care,
so with child of family health nurses, with GPS nurses
(35:58):
in general practice, because they're the people who have access
to everybody. And so I did quite a few different
research projects in general practice and over the years, I've
been interested in younger and younger and younger children, and
so now my focus is the first year of life
(36:19):
and that'll do me. You know, I'm getting close to
retime and age. But I'm really happy to say that
I think I've had twelve PhD students who I've survised
to who have completed, and I've got three more to go.
And I can say hand on heart that OBESI prevention
research in the primary healthcaret setting is in really good
(36:41):
hands because some of the students I've had it just
out of this world. It's so fantastic. And so that's
what I've done, and I think the thing I'm most
proud of is having worked to co design with parents
(37:02):
and with nurses. Told of Hemily Health Nurses an app
that we've modified over the years that has supported parents
with infant feeding decisions. And the initial app is very
out of date now, so it's you know, it's probably
on version five or six now.
Speaker 3 (37:19):
Yeah. Yeah.
Speaker 1 (37:20):
And one of the things we found was that the
most visited pages on that app were around infant formula
and mixed feeding. Wow, so we sort of knew we
were onto something. I mean, we had an enormous amount
of content about breastfeeding too, but those pages weren't as
frequently visited because we think that was being handled by
(37:40):
other people. You know, that people had that sorted, whereas
the formula pages and the mixed feeding pages were really
highly visited. So that was it was good for us
to know.
Speaker 2 (37:52):
That because I truly believe mothers want a breastfeed for
as long as they can.
Speaker 3 (37:58):
There's no doubt we would all do that.
Speaker 2 (38:00):
But yeah, there are so many circumstances, so I think
even some is better than none.
Speaker 1 (38:07):
Any is better than none, and absolutely the more the better.
Speaker 2 (38:11):
Yeah, And I think it is so valuable because that's
what I hear on the street, you know, with my
clients that.
Speaker 3 (38:21):
And that a lot of them mixed feed. You have
to go back to it.
Speaker 2 (38:24):
I mean, just look at the Economic Times and I
think that's wonderful that you have a page.
Speaker 3 (38:30):
Up that helps and guides women.
Speaker 2 (38:33):
And I'm not surprised it's probably the most visited page.
Speaker 1 (38:36):
Yeah, so that's within that app that's what people really
sound useful, and that's been a really interesting finding for us.
Speaker 2 (38:45):
Yeah, I think it's wonderful. Well, Elizabeth, I have loved
this chat with you and I am very in awe
of you know, in my heart I'd like to be
a researcher, but I think I'm actually a clinician.
Speaker 1 (38:57):
So yes, but there's a role we need more clinician
researchers that is so important that there's it's just not
enough of them.
Speaker 3 (39:06):
It's not too late, No, it's never too late.
Speaker 2 (39:10):
One of my colleagues has actually she was in her
late sixties doing her PhD.
Speaker 3 (39:15):
And more power to her.
Speaker 2 (39:16):
Lovely, completely love it so and she's a remarkable woman too.
But thank you for your wisdom and your knowledge and
sharing that. I really appreciate it.
Speaker 1 (39:27):
It's been a pleasure, lovely to chat to you.
Speaker 3 (39:29):
You too, thanks a losten.
Speaker 2 (39:33):
This season. I am so excited to announce that the
podcast is being supported by Nutritia, which is a global
leader in medical nutrition. They understand the needs of nurses
in the nutrition space and for over one hundred and
twenty five years have provided products to support child health.
Some of Nutrita's pediatric brands include Neo Kate Junior for
(39:55):
children who have food allergies, and apt to Grow for
those fussy eaters. And those of us who have children
know many kids who go through the phases of definite fussiness.
For more information and resources, visit the nutritiona Pediatrics hub
at nutritia dot com dot au forward slash pediatrics. I
just want to say a huge thank you to Nutritia.
(40:17):
Their desire to support nurses is truly appreciated, and they
are allowing me to continue this podcast so that we
can all grow as nurses.
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