Talk:Breastfeeding/Archive 5

"Beyond
The sentence already said "at least" therefore "beyond" is redundant and I have trimmed. https://en.wikipedia.org/w/index.php?title=Breastfeeding&type=revision&diff=719115870&oldid=718987543

Doc James (talk · contribs · email) 18:05, 7 May 2016 (UTC)


 * The WHO would not say "or beyond" when they give guidelines and offer instructional courses for infant and young child feeding counselling unless that was exactly what they meant. Please quit suggesting that you know more than the WHO and revert your edit.   Thanks. Gandydancer (talk) 00:25, 9 May 2016 (UTC)
 * Ah we are to paraphrase. And WHO does not use "at least" and "beyond" in the same sentence. Doc James  (talk · contribs · email) 00:39, 9 May 2016 (UTC)N

''Jane Doe was still nursing her daughter when she was 2 1/2 years old. Her neighbor, Mary Busybody, said that maybe two years old might be acceptable but anything beyond two would be a disgrace and unnatural. They argued about it and Jane said, "OK, let's look it up in Wikipedia." They did and Mary said, "See, it says right there in Wikipedia 'After the introduction of foods at six months of age, continued breastfeeding until at least one to two years of age is then recommended'."''

I went through this same sort of unreasonable objections to extended breastfeeding last year about this time. Must I again waste my time, especially now when I have so little of it? I would like to continue to improve this article but if I continue to find that I need to waste most of time time on this one issue it is doubtful that I would be able to find time for little else. All in all a very discouraging situation for me... Gandydancer (talk) 17:25, 9 May 2016 (UTC)

The problem is that the WHOs recommendations are not based upon sound science. They should definitely not be in here, but we shouldn't pretend that they are scientific. Carl Fredik  💌 📧 21:41, 9 May 2016 (UTC)


 * Not sound science? Well that's a new one...


 * The American Academy of Pediatrics recommends that “Breastfeeding should be continued for at least the first year of life and beyond for as long as mutually desired by mother and child… Increased duration of breastfeeding confers significant health and developmental benefits for the child and the mother… There is no upper limit to the duration of breastfeeding and no evidence of psychologic or developmental harm from breastfeeding into the third year of life or longer.” (AAP 2012, AAP 2005)


 * The American Academy of Family Physicians recommends that breastfeeding continue throughout the first year of life and that “As recommended by the WHO, breastfeeding should ideally continue beyond infancy, but this is not the cultural norm in the United States and requires ongoing support and encouragement. It has been estimated that a natural weaning age for humans is between two and seven years. Family physicians should be knowledgeable regarding the ongoing benefits to the child of extended breastfeeding, including continued immune protection, better social adjustment, and having a sustainable food source in times of emergency. The longer women breastfeed, the greater the decrease in their risk of breast cancer.” They also note that “If the child is younger than two years of age, the child is at increased risk of illness if weaned.” (AAFP 2008)


 * The Academy of Breastfeeding Medicine affirms breastfeeding beyond infancy as the biological norm. “The average age at weaning ranges anywhere from six months to five years… Claims that breastfeeding beyond infancy is harmful to mother or infant have absolutely no medical or scientific basis,” says Arthur Eidelman, MD, president of the Academy of Breastfeeding Medicine. “Indeed, the more salient issue is the damage caused by modern practices of premature weaning.”  The global organization of physicians further notes that “Human milk contains nutrients, antibodies, and immune-modulating substances that are not present in infant formula or cow’s milk. Longer breastfeeding duration is further associated with reduced maternal risks of breast cancer, ovarian cancer, diabetes, hypertension, obesity, and heart attack.” (ABM 2012)


 * Gandydancer (talk) 00:15, 10 May 2016 (UTC)
 * Yupp, if you actually look at the underlying literature and the things they cite, you will find that those recommendations are not supported by the science. There is a massive degree of moralism, and while the positions merit weight in the article, we also need to present the actual base of their arguments, which in this case is far less solid than it would seem.
 * For example the difference in diarrhea and URI cases in breast-fed vs. not breast-fed children in the developed world is negligible, which makes the WHO recommendation flimsy at best. (The same is true for WHO-recommendations for salt-intake, you can read the American Heart Association's comment on that recommendation if you wish.)
 * The reason I have not yet worked on these topics is that it is such a massive field and digging through to the appropriate literature to give a balanced view is a major undertaking. Most of what I've done up to now has involved cleaning up outright misunderstandings and misrepresentation. Carl Fredik  💌 📧 12:02, 10 May 2016 (UTC)

We currently say "After the introduction of foods at six months of age, continued breastfeeding until at least one to two years of age is then recommended" This means breast feeding should continue until the child is one or two years of age or longer. Do not understand the concern? Doc James (talk · contribs · email) 02:00, 10 May 2016 (UTC)


 * I just don't see how I can make it any plainer. When the WHO's recommendations are used in the numerous articles/reviews/studies/etc. around the web the words used are always with supplemental breast feeding continuing for two years and beyond.  They don't ever say "at least 2 years", and for good reason - it does not mean the same thing.  And in this case, a situation where mothers who nurse longer than 2 years face social criticism in many countries, it is important to clearly say that the WHO endorses extended breastfeeding.   Gandydancer (talk) 13:31, 12 May 2016 (UTC)
 * IMO it is sufficiently clear as is. They also say "and continue breastfeeding until at least 12 months of age" for mothers with HIV  Doc James  (talk · contribs · email) 02:55, 13 May 2016 (UTC)


 * The HIV advice has nothing to do with this discussion. The WHO advises at least 12 months of nursing for HIV mothers in countries where adequate substitute nutrition is not available even when the mother does not have access to treatment because it is so important for the baby.  In other words, better to risk exposure to infection than the high death rate related to infants who get only contaminated and inadequate nutrition.


 * Since it seems that we cannot come to an agreement re wording I will change the article to the use of quotes rather than your interpretation, or mine, on how to paraphrase. Despite CFCF's claim that science does not support the current breastfeeding advice, every expert source now says that mothers should continue to nurse as long as they and their baby wants despite the criticism that their decision may provoke, and that should be made clear in the lead.   Gandydancer (talk) 17:02, 13 May 2016 (UTC)
 * We typically paraphrase not quote. You could try a RfC. What you mention is already clear in the lead. Doc James  (talk · contribs · email) 19:32, 13 May 2016 (UTC)

The question of the science behind the recommendation is an entirely separate issue. These are recognized experts and their recommendations and they absolutely belong in the article. If anyone wants to debate the MERIT of these recommendations, they may do so in their own thing and on their own space. Just because someone claims that the science behind these recommendations is faulty is no reason to exclude those recommendations from the article.

In this case, I also agree that a quote makes the most sense. The argument that"and beyond" is redundant ignores the reasons why "and beyond" is indeed the exact wording used. Also, in the case of a recommendation, a quote is obviously the most accurate and therefore truthful way to accurately portray type of information.

To say, "this organization recommends" and then to use your OWN WORDS had great potential for misunderstanding and error.

A recommendation IS a quote. My recommendation something is the exact words I used. Or else it is someone else's interpretation of my recommendation. There is no two ways about this. — Preceding unsigned comment added by Amyanda2000 (talk • contribs) 15:53, 13 September 2016 (UTC)

Benefit
I think we can leave the discussion for the degree of benefit with respect to diarrhea and pneumonia in the developing versus the developed world can be left to the body of the article. Doc James (talk · contribs · email) 20:44, 26 September 2016 (UTC)

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Alcohol
This ref says "There's some evidence that regularly drinking more than two units of alcohol a day while breastfeeding may affect your baby's development. But an occasional drink is unlikely to harm your breastfed baby. It's recommended that breastfeeding mothers have no more than one or two units of alcohol once or twice a week."

Thus we say "Smoking, limited amounts of alcohol, or coffee are not reasons to avoid breastfeeding." Doc James (talk · contribs · email) 21:47, 17 April 2017 (UTC)
 * The other sources in the article at a little more clear on that the alcohol itself is negligible (essentially far lower than many foodstuffs deemed absolutely non-alcoholic). However the lack of judgement that may come with alcohol-consumption is notable. I wonder if we could write this in the lede is some way... Carl Fredrik  talk 00:05, 18 April 2017 (UTC)
 * Not sure what you mean? We say some alcohol is okay with continued breast feeding. Is a lot okay? Some harm has been found with a lot. Doc James  (talk · contribs · email) 00:46, 18 April 2017 (UTC)

Ethics
In Muers’ article entitled “The Ethics of Breastfeeding”, she sets out to “challenge the individualization of responsibility, and of the attendant guilt” that results from current arguments and social attitude towards breastfeeding. The action being the mother’s choice burdens the woman into deciding whether to conform with “a prescribed standard of good mothering” and feel guilty for even considering to choose something is often labeled as unhealthy.

However, Benoit’s article highlights not the importance of breastfeeding in regards to the child’s needs but rather in terms of the woman’s decision, or lack thereof due to a “society whose values are predominantly defined by men”. Women who breastfeed, especially in public space, are often looked upon with disgust and disapproval regardless of the naturalness of breastfeeding. But this distaste is not because of the crude stigma modern society has developed about nudity but is instead about the “desexualization” of the female body when breastfeeding. A patriarchally imposed oppression would not approve of a different use for an otherwise sexual part of the female anatomy than the use predetermined by said overarching opposition. And while this is understood socially, such an aggressive attitude towards women can only be practiced through politics. Muers writes that “infant feeding… is [a] key instance of the ‘personal’ within women’s lives that needs to be [re]named as ‘political’”.

Although, the medical importance of breastfeeding cannot be underscored. Scholar Lisa H. Amir recognizes the need to increase breastfeeding rates yet notes that acknowledging “social circumstances [can] improve our understanding of infant feeding” as it directly relates to the feminist ideology behind making the decision to breastfeed. In recent years, this decision has been either praised or refuted based on “the baby’s behavior” and whether it is “well fed, satisfied, settled, and gaining weight”. In other words, social approval depends how the baby appears to society instead of what the woman feels is the right course of action to take. This places an unfair question on the woman’s morality and ethical outlook, reducing the woman to acting on a decision out of selfishness.

Woman's voice
Bernice Hausman explains that arguments advocating for breastfeeding as an alternative to formula “turn on...whether science can tell us that women should breastfeed” because of the obvious suppression of a feminist approach. What she implies is that the focus of the argument is warped—the social structure that “impedes women’s freedoms” is the question that is hiding behind the debate over the “value of breastfeeding”.

There is another layer of breastfeeding that is often overlooked that regards the physical sensations and emotional feelings that naturally arise from breastfeeding. From her studies and experiments, Charlotte Faircloth has concluded that the subjects that were supportive of the action felt as though what they were doing was right because it felt right. She learned that some mothers felt such a strong bond with the child that it triggered a profound reaction within themselves as women, a truth that was often “indescribable”. But her main point stems from this conclusion: whether it is moral and feminist simply because the emotional response received is a pleasurable one.


 * Stuff like "But her main point stems from this conclusion: whether it is moral and feminist simply because the emotional response received is a pleasurable one." appears to be original research unless she says "My main point is"
 * Not seeing this as encyclopedic in tone. This sources are not really overviews of the topic in question but the opinions of single people (ie primary sources). Others thoughts. Doc James  (talk · contribs · email) 16:37, 1 May 2017 (UTC)
 * This was written as a student assignment. I left a message on the editor's talk page at User talk:Iihiimarii in hopes of some improvement but the editor has not edited since. I think the whole section should be removed.
 * This is a real and interesting topic. It could well be a section or an entire article in itself. But this student essay is misleading and does not begin to cover this complex topic. StarryGrandma (talk) 18:22, 1 May 2017 (UTC)

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Newer resouces
These are Lancet articles about breastfeeding. Only one in the series was referenced in this article. Here are the rest in the series:
 * Congo
 * Smart investment
 * Improvement
 * Support paradox
 * The new normal

Others:
 * Unicef UK
 * Barbara (WVS) ✐   ✉  23:21, 4 August 2017 (UTC)

Please watchlist Low milk supply and Kangaroo care
There is an approved Did You Know hook for the Low milk supply article. It would be good to have a few people with knowledge of breastfeeding watching it when eventually finds its way to the Main Page. Cheers, Clayoquot (talk &#124; contribs) 23:54, 9 December 2017 (UTC)

Also, Skin-to-skin contact, which redirects to Kangaroo care, is part of the DYK hook so please watchlist that too. Clayoquot (talk &#124; contribs) 05:29, 18 December 2017 (UTC)

Content removed in Latching on section
Just catching up on explaining my edit from a couple of days ago. I reverted a change to restore deleted information about the latching process & importance to milk transfer and to make the description of a good latch more clear. The following content was removed through my reversion:


 * Latching on refers to how the baby fastens onto the breast while breastfeeding. A good latch means that the bottom of the areola (the area around the nipple) is in the baby's mouth and the nipple is back inside his or her mouth. A poor latch happens when the baby does not have enough of the breast in his/her mouth or is too close to the tip. This can cause cracked nipples and a reluctance to continue to breastfeed.

The phrase "the bottom of the areola... is in the baby's mouth" was particularly unclear to me, even though it was well-sourced. Assuming the phrase "bottom of the areola" means "inferior part of the areola": Clayoquot (talk &#124; contribs) 04:45, 21 March 2018 (UTC)
 * Women cannot see the bottom of their areolas without a mirror.
 * The baby is usually covering up the bottom of the areola so nobody else can see it either.
 * Defining a good latch this way makes sense only if the baby is parallel to the mother's body. That's not a typical breastfeeding position for a newborn, especially when the pair are at the stage of trying to get the latch right.
 * Also in the source but I don't like and don't feel to be needed is "too close to the tip" (I think the ref uses "too close to the end of the nipple"). Isn't it obvious that if the babies lips are way out at the end of the nipple they are not also on the areola?  Also, I've added some info that needs the ref to be fixed.  I will try to fix it but would appreciate any help.  Gandydancer (talk) 16:32, 21 March 2018 (UTC)
 * I fixed the ref., your revert brought back the text that has the issues we're describing here. I know womenshealth.gov is WP:MEDRS compliant than and askdrsears.com definitely isn't, but the older text is much, much clearer. Latching is not really a biomedical issue (unless a medical problem is interfering with it) - it's more of a parenting skill. Clayoquot (talk &#124; contribs) 04:04, 22 March 2018 (UTC)
 * Can we use better references? I see we are now using better references. There are health care providers who specialist in breastfeeding.
 * Doc James (talk · contribs · email) 04:08, 22 March 2018 (UTC)

Inaccuracies in video
There are some points in the video that seem inaccurate:
 * 1) "Breast milk contains all the nutrients a baby needs for its first year" - What is the reliable source for this? The WHO says, "By the age of 6 months, a baby has usually at least doubled his or her birth weight, and is becoming more active. Exclusive breastfeeding is no longer sufficient to meet all energy and nutrient needs by itself, and complementary foods should be introduced to make up the difference."
 * 2) In the diagram of a latch, the baby's mouth does not seem to be open very widely, and hardly any of the areola is in its mouth.
 * 3) There is a popular belief that a healthy well-balanced diet is important to breastfeeding, but evidence indicates otherwise. Maternal diet is important to postpartum recovery, but breast milk production doesn't depend on it.
 * 4) Low milk supply after reduction mammoplasty is not rare. It is associated with a fivefold increase of risk of lactation insufficiency. The American Academy of Pediatrics recommends that babies of mothers who have had this surgery be monitored to make sure they are getting enough milk.

Clayoquot (talk &#124; contribs) 23:41, 28 November 2017 (UTC)
 * True definitely for the first 6 months. But than "provide up to half or more of a child’s nutritional needs during the second half of the first year"
 * WHO does make dietary recommendations for breast feeding. And this ref says "Very hard scientific evidence supports the importance of lifestyle and dietary habits (with adequate micronutrient intakes) during pregnancy and breastfeeding, for the health status of women and their offspring."
 * Will ask them to look at this. Doc James  (talk · contribs · email) 03:38, 29 November 2017 (UTC)
 * I believe there might be some definitional confusion with the term "exclusive breastfeeding". WHO has a strict definition, however it tends to be used more loosely in other contexts. In US English typically exclusive breastfeeding means no formula, but doesn't exclude solids. Whereas in British English it connotes no solids (as per the WHO definition). So this might be the source of the issue. This paper from Australia suggests that even scientific studies used inconsistent definitions for the term, i.e. using the "no formula" definition instead. https://www.ncbi.nlm.nih.gov/pubmed/19426375 Mvolz (talk) 11:30, 29 November 2017 (UTC)
 * Excellent point, thanks Mvolz. Doc James  (talk · contribs · email) 18:29, 29 November 2017 (UTC)

Re: Point #3, Yes Doc James you're right on this one. However, the mother's milk is still high-quality even if the mother's diet is deficient in some ways. ("Mother’s milk is recommended for all infants under ordinary circumstances, even if the mother’s diet is not perfect, according to the Committee on Nutrition During Pregnancy and Lactation of the Institute of Medicine" )

Some more issues with content:
 * 1) Smoking should not appear in a list of contraindications to breastfeeding. Ruth Lawrence's textbook says on p. 352, "Given the value of breastfeeding to the infant, especially in reducing the risk for sudden infant death syndrome, it is important that smokers try to reduce the smoke exposure but still breastfeed".
 * 2) In cases of nipple cracking, the baby's latch should be evaluated. The whole slide on breast/nipple is so oversimplified that it is not useful.
 * 3) I don't understand the phrase "bottom of the areola"
 * 4) It says caffeine can "alter the baby's physiology". I don't know what this means and I don't think serious medical reference works use this handwavy kind of explanation.
 * 5) This isn't a MEDRS-compliant source. The script writer is a medical resident whose specialty seems to be genetics.

Some thoughts generally on video in Wikipedia: There is a lot of potential for using video effectively in articles on breastfeeding. I don't think this particular form of video, which is basically a Powerpoint presentation that covers the topic at a stub-class or start-class level, is useful. This form of video is mostly text, in a medium that's frustratingly labour-intensive to review and almost impossible to revise. It's the equivalent of several paragraphs of text with no citations and no ability to be tagged as disputed. And at the end there is advertising.

What I would love to see in video are: high-quality demonstrations on how to get a good latch, demonstrations of various breastfeeding positions, and demonstrations of how to assess whether a baby is drinking effectively at the breast. And maybe demonstrations of things like signs of infant hunger and manual expression of breastmilk. The value of video is showing rather than telling. Clayoquot (talk &#124; contribs) 23:53, 29 November 2017 (UTC)

I found a decent source for the health risks of introducing solids too late: poor growth, anemia, and feeding problems. I'll remove the video for now and put it on this Talk page. There could be some still diagrams or snippets of the video that, if anyone wants to edit them out, would make a good complement to cited text. Clayoquot (talk &#124; contribs) 05:49, 1 December 2017 (UTC)
 * User:Clayoquot you will need consensus to remove the video. It has been in the article a long time. The issues you have raised are minor. Adjustments can be made.
 * If you want to make a video for "high-quality demonstrations on how to get a good latch, demonstrations of various breastfeeding positions, and demonstrations of how to assess whether a baby is drinking effectively at the breast." please do.
 * "bottom of the areola" means inferior part of the areola.
 * With respect to "alter the baby's physiology" I see nothing wrong with that.
 * The overview of benefits is excellent.
 * Are you stating this is wrong "In cases of nipple cracking, the baby's latch should be evaluated"?
 * The video does not say smoking is an absolute contraindication. It says it is discouraged. What is wrong with that? Doc James  (talk · contribs · email) 09:57, 1 December 2017 (UTC)
 * I am saying that "In cases of nipple cracking, the baby's latch should be evaluated" is right. The video doesn't say it. It only recommends topical creams and ointments, which will do no good if the cause of nipple pain is poor latching/positioning as is usually the case. Also nipple pain is normal for the first couple of days, not the first few suckles as the video says.
 * Re: smoking, what's wrong with it is that messages around smoking and breastfeeding sometimes end up discouraging smokers from breastfeeding. Smoking is more of a contraindication to formula-feeding than to breastfeeding, but when people hear "If you breastfeed, you shouldn't smoke" what they often think is, "I shouldn't breastfeed until I quit smoking." Our article, and particularly our lead section, talks about substance use far more skillfully: "Smoking, limited amounts of alcohol, or coffee are not reasons to avoid breastfeeding."Clayoquot (talk &#124; contribs) 21:01, 1 December 2017 (UTC)
 * Sure so it can be improved a bit. The script for this video is on Wikipedia somewhere.
 * The video specifically says that smoking is NOT an absolute contraindication. That is perfectly reasonable and correct.
 * Osmosis is happy to have constructive feedback. The bit about improper latch I am sure can be added. Doc James  (talk · contribs · email) 22:22, 1 December 2017 (UTC)

A few comments:


 * What is the status re the glaring incorrect statement re "adequate nutrition for the first year of life"? IMO this should be enough to remove the video till it is corrected.


 * Has anything been done about adding "improper latch" related to cracking nipples to the video?


 * RE "under the areola", yes it is an odd and confusing way to term the fact that the areola surrounds the nipple. Also the "first few suckles" which is really quite obvious as incorrect considering that the first few suckles are completed in a matter of a few hours.


 * However, my second biggest problem with this video has to do with the statement that breastfeeding after breast surgery is rarely any problem at all. I first viewed this video and called it "great!" after comparing it to the abortion video (which has been removed). By comparison it certainly is great except that the abortion video was just awful.  I always try to imagine just who comes to our articles and I tend to doubt that women looking for help on how to breastfeed or those with breastfeeding problems come here.  But I can easily imagine women coming here who have had breast surgery or who plan to have it done.  And especially so when I can't find much on the web, or what I can find is so obviously biased, such as this  https://www.cohenwintersplasticsurgery.com/breastfeeding-after-breast-implants/.  At any rate, when I watched the video I made the same mistake that our readers make and believed what Wikipedia said:  Surgery is rarely a problem.  Jeeze, if even I believed it (and I don't believe much of what I read), certainly our readers believe it.  IMO we need to correct this information ASAP and I'd like to see something about breast surgery added to the article.  Gandydancer (talk) 18:37, 10 December 2017 (UTC)
 * It's been almost four months and the video remains without corrections to what I consider at least two egregious errors (though it could well be said that there are far more than only two), the one relating to the incorrect information re the fact that every body of medicine recommends that solid food be started at six months and the claim that breast augmentation or reduction only rarely causes any problems. See this systemic review  which states, This systematic review and meta-analysis suggests that women with breast implants who breastfeed were less likely to exclusively feed their infants with breast milk compared to women without breast implants. Considering that breast surgery is now so common one would think that we should not mislead our readers, considering the importance of breastfeeding for both mother and baby. Also, the suggestion above re some sort of "definitional confusion with the term 'exclusive breastfeeding'", which DocJames calls "a good point", is not.  I'd call it more beside the point and confusing for our readers.  I'm going to remove the video again since four months is plenty of time to have had it fixed.  Gandydancer (talk) 16:55, 26 March 2018 (UTC)
 * User:Gandydancer and User:Clayoquot yes I agree that this was missed and corrections should be made before the video is returned. Best Doc James  (talk · contribs · email) 19:13, 27 March 2018 (UTC)


 * It was not "missed" as the above discussion clearly shows. If the video is returned, and I hope that it is not, I find several other problems with it as well that have not yet been brought up, that I would like to see fixed.  Gandydancer (talk) 16:44, 28 March 2018 (UTC)
 * I had requested it be fixed. It has not been. As such I agree it should not be used. Doc James  (talk · contribs · email) 20:07, 5 April 2018 (UTC)

Recommended duration of breast feeding
"After the introduction of foods at six months of age, recommendations include continued breastfeeding until at least one to two years of age."

This means breast feeding until one or two years old at least.

"After the introduction of foods at six months of age, recommendations include continued breastfeeding for at least one to two years or more."

This means breast feeding until at least 18 month or 36 months. Which refs support the later?

Doc James (talk · contribs · email) 20:04, 5 April 2018 (UTC)


 * According to the two lead sources we are using:


 * WHO says: (after 6 months of age) continue frequent, on-demand breastfeeding until 2 years of age or beyond
 * The AAP says: ...with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant.


 * Add these up and you get one or two years or beyond. This is important because many places mothers face criticism for nursing much beyond a year, let alone two or more.  We need to get the word out that longer periods of nursing is not queer, odd, and strange, with even suggestions that it is done for the mother's pleasure and not the health of the child.  BTW, you and I argued about this several years ago and I had to "give in".  Gandydancer (talk) 20:40, 5 April 2018 (UTC)
 * We say "at least" one to two years of age. This acknowledges that more than two years is fine if mutually desired.
 * We could say "breastfeeding until one to two years of age or beyond" if that would work for you. What is not supported is breastfeeding for at least 18 months.
 * Yes I agree we argued about this several years ago. Doc James  (talk · contribs · email) 21:05, 5 April 2018 (UTC)
 * I guess what was missing was "until one to two years of age or more." which I would also be fine with. I read it to mean one or two years after six months.
 * The APP also says "Mothers should be encouraged to continue breastfeeding through the first year" indicating 12 months not 18 months as the recommended minimum. Doc James (talk · contribs · email) 21:08, 5 April 2018 (UTC)

My edit read: After the introduction of foods at six months of age, recommendations include continued breastfeeding for at least one to two years or more. Which was just fine. And I don't understand why you keep saying I mentioned 18 months as I didn't. IMO your adding of "...one to two years of age or more" is not an improvement. One might say "more than one year", for example, but if one were speaking of age one would say "or older". But at least we've made some progress since previously you would not allow any mention of "or more" at all. Gandydancer (talk) 21:50, 5 April 2018 (UTC)
 * Back to re-read and I see my mistake re adding "of age" and your point is taken. My thinking cap was not on securely, it seems.  Gandydancer (talk) 00:05, 6 April 2018 (UTC)
 * IMO "at least" equal "or more". I do not care which of the two we use. Doc James  (talk · contribs · email) 18:22, 7 April 2018 (UTC)
 * Thanks. My fault was that I did not take the first 6 months into my total and it took me a tad to see my error.  As I said, I feel that it's important to say "or more".  Gandydancer (talk) 18:47, 7 April 2018 (UTC)
 * Okay. Are you happy with the current wording? Doc James  (talk · contribs · email) 18:56, 7 April 2018 (UTC)

Help with sourcing needed
I would like to add information related to breast surgery to our article and would like to ask for feedback on a few sources.
 * Is there any problems with this Stanford Medicine source ? It seems to include some helpful information.
 * Would it be acceptable to use information from this source (a review) such as:


 * The internet currently serves as a prominent source of medical information for people considering plastic surgery [6,7]. However, a considerable amount of the information accessed through search engines regarding breast augmentation in general and its effects on lactation in particular is either misleading or inaccurate [8,9]. Other media have also been shown to be unbalanced, with two thirds of the feature articles on cosmetic surgery in the UK portraying it as risk-free with no mention of potential problems or complications.


 * Is National Women's Health Network an acceptable source?


 * Could recent (2015) information from this medical journal be used ?

Also please add anything you can find. Thanks


 * I believe med.stanford.edu is not MEDRS-compliant, and we do need MEDRS-compliant sources here. The National Women's Health Network is also not MEDRS-compliant. The rest look fine to me. By the way, w.r.t. breast augmentation, Ruth Lawrence's book mentions that it is not known whether breast augmentation surgery causes low milk supply or if the correlation is due to the fact that women with insufficient glandular tissue are more likely to opt for breast augmentation surgery. All moms who have had prior breast surgery of any kind should be closely monitored for low milk supply - I have sources saying this and will dig them up. Most should be encouraged to breastfeed as much as possible anyway. Clayoquot (talk &#124; contribs) 17:30, 3 April 2018 (UTC)
 * All of the first six sources cited in the low milk supply article list breast surgery as a risk factor for low milk supply. I've added wording to that effect. Clayoquot (talk &#124; contribs) 06:03, 15 April 2018 (UTC)
 * Also, a source that recommends close monitoring for supply issues after any breast surgery is this book from the AAP. Clayoquot (talk &#124; contribs) 06:18, 15 April 2018 (UTC)

History section
That was an opps on my part. I thought that the new (excellent) addition was the part that had been deleted and not the parts that were correctly deleted. Carry on! Gandydancer (talk) 16:35, 28 April 2018 (UTC)

"Social factors/Healthcare/Medications" subsection
I just rewrote a sentence. This very topic is covered (with a significantly different emphasis) higher up the article under "Process/Drugs". --Anthonyhcole (talk · contribs · email) 23:54, 3 May 2018 (UTC)

Methods - incomplete information
The section on Expressed Milk [i.e. pumping] seems to be biased. I'm certainly not well informed on this subject but Stanford has a site and a video which conflicts with the "adequacy" claims found in the section, especially the last paragraph about EP-only. Read material at http://med.stanford.edu/newborns.html or (for the video, which worked as of 28/5/2018) https://med.stanford.edu/newborns/professional-education/breastfeeding/maximizing-milk-production.html clearly says/shows that pumping without additional massage results in much less milk - pumping may only produce half of the volume available with pumping+massage. At the very least, this should be included. The conflict between the pollyanna-ish "everything is fine" claims currently in the section (and please note all of the vague qualifications) and the claims of the Stanford site are glaring. I also recommend these: https://breastfeedingusa.org/content/article/how-much-milk-should-you-expect-pump-0 https://breastfeedingusa.org/content/article/pump-more-milk-use-hands-pumping Given that milk supply depends on demand, then if pumping (demand) is half of what is available, then pumping must have less than optimum impact on milk supply. Surely worth noting.98.21.221.175 (talk) 21:36, 28 May 2018 (UTC)
 * I agree. It is well-documented that many women experience a gradual reduction in milk supply when exclusively pumping. Clayoquot (talk &#124; contribs) 04:25, 29 May 2018 (UTC)

Newly added text
In the section "Health effects" the following was added:


 * A United Nations resolution promoting breast feeding was passed despite opposition form the Trump administration. Lucy Sullivan of 1,000 Days, an international group seeking to improve baby and infant nutrition, stated this was “public health versus private profit. What is at stake: breastfeeding saves women and children’s lives. It is also bad for the multibillion-dollar global infant formula (and dairy) business.”[92] On July 9th, President Trump opposed the United Nation’s public support of breast-feeding, therefore opposing decades of research regarding the benefits of breastfeeding for both mother and child. Global health experts suggest that Trump did not have full knowledge regarding the detrimental marketing of formula particularly in developing countries. America threatened that if Ecuador did not drop the resolution, they would withdraw military aid as a punishment. This threat caused other poor nations in Latin America and Africa to reject the proposal in fear of retaliation. It is detrimental that America would deny the health of children and mothers in order to salvage the multi-billion dollar formula industry.[93][94]

Is this text really appropriate for this article, and especially for that section? Is the tone of the text appropriate? Surely "It is detrimental that America would deny the health of children and mothers in order to salvage the multi-billion dollar formula industry" cannot be an encyclopedic tone. The text now makes most of the intro of the section "Health effects" (before the subsections start), despite the fact that it isn't really about health effects of breastfeeding; it's rather about the Politics of Donald Trump. The text gives undue weight to this incident; and it gives a biased slant to the article (out of all people who have ever contested various aspects of breastfeeding promotion, it chooses only one person as an example - which no doubt is likely to influence readers). 2A02:2F01:5CFF:FFFF:0:0:6465:433D (talk) 23:33, 29 July 2018 (UTC)
 * I agree that it is not appropriate and removed it. I left the longer standing info and the two NYT refs.  Thanks for the input as I was hoping that someone other than me would dispute it.  Gandydancer (talk) 00:50, 30 July 2018 (UTC)
 * Thank you both for dealing with that. Clayoquot (talk &#124; contribs) 17:01, 30 July 2018 (UTC)

Lede (factual accuracy and neutrality)
In the lede it is said "Breastfeeding is less expensive than infant formula.[9][10]"

This is an oversimplification, and it also contradicts the section Financial considerations which states:
 * Breastfeeding is less costly than alternatives, but the mother generally must eat more food than she would otherwise. In the US, the extra money spent on food (about US$14 each week) is usually about half as much money as the cost of infant formula.[192] Breastfeeding represents an opportunity cost. This is the cost of the mother having to spend hours each day breastfeeding instead of other activities, such as paid work or home production (such as growing food). In general, the higher the mother's earning power, the less likely she is to save money by breastfeeding.[193]


 * Breastfeeding is not cheaper if the mother ends up losing her job (if she was employed at the time and there isn't sufficient legal maternity protection in that country) or if she was unemployed, but ends up missing an important job opportunity because of breastfeeding, and this prolongs her unemployed status. It is also not cheeper if she is at home on unpaid leave, rather than working. Even if she is on paid leave, it may not be cheaper, depending on how much she is paid, and other specific circumstances. The financial considerations of breastfeeding are very complex and depend on geographical location, personal circumstances, and numerous other factors.

This claim from the lede needs to be removed or rephrased.2A02:2F01:5CFF:FFFF:0:0:6465:433D (talk) 23:03, 29 July 2018 (UTC)
 * The second part of what you quote above (ref #193) is somebody's fantasy. The ref actually states a large savings considering the well-documented illnesses that a baby who is not nursed can expect to experience.  (I saved the ref and added it to the following para.)  BTW, a red flag should have gone off for anyone reading that info when it said that hours of time are saved when not nursing. If a mother is unable to nurse I'm sure she knows that she needs to hold her baby for feedings rather than just prop a bottle and leave the baby to do the best s/he can.  Gandydancer (talk) 02:02, 30 July 2018 (UTC)


 * "BTW, a red flag should have gone off for anyone reading that info when it said that hours of time are saved when not nursing.If a mother is unable to nurse I'm sure she knows that she needs to hold her baby for feedings rather than just prop a bottle and leave the baby to do the best s/he can."
 * Formula feeding doesn't necessary have to be done by the mother, unlike breastfeeding. This can save some time for the mother.2A02:2F01:5CFF:FFFF:0:0:6465:45FF (talk) 02:56, 30 July 2018 (UTC)


 * So true, and equally true that a mother might enjoy a few minutes of time off from house work and child care of other children by relaxing while nursing while her partner does some house work, takes care of the other kids, does the wash, and etc. Gandydancer (talk) 03:15, 30 July 2018 (UTC)


 * I agree the financial issue is complex. In most societies, the mother is with her infant all the time, so breastfeeding is definitely cheaper. In the U.S., where maternity leaves are shorter, the choice that individual women face is not really between breastfeeding and formula; it's between breastfeeding and daycare. I've added this issue to the lead. Clayoquot (talk &#124; contribs) 17:24, 30 July 2018 (UTC)

Supplements for newborns between 24 and 72 hours old
I removed this statement from our article:

A 2017 study found that introducing after birth limited formula use to aid breastfeeding difficulties does not interfere with breastfeeding later, and may be an important therapeutic option for newborns with the potential to reduce readmission rates.[199]

It was returned saying: ''the section deals with criticisms and relevant opinions (supported with studies) should be introduced. And given that many countries either have never implemented or have abandoned BFHI it is relevant''

The (one) source says this:

''In this randomized controlled trial, we enrolled 164 exclusively breastfeeding newborns, 24-72 hours old, whose weight loss was ≥75th percentile for age, and whose mothers had not yet begun mature milk production. Enrolled newborns were assigned randomly to either supplement breastfeeding with early limited formula (ELF), 10 mL of formula after each breastfeeding stopped at the onset of copious maternal milk production (intervention), or to continue exclusive breastfeeding (control). Outcomes assessed through 1 month included breastfeeding duration, readmission, and intestinal microbiota.''

According to La Leche League guidelines: After about two to four days [48 to 96 hours], your milk will “come in” and become plentiful. Your baby will continue to nurse often and start to gain weight.

According to my extensive reading on breastfeeding, the worst thing that a mother can do is to supplement before any number of considerations have been looked into and certainly it is not the very first thing to do. Just for starters, one should be alarmed that in this study infants only 24 hours old were receiving supplemental milk. (As an aside, this is just asking for an infant to go on a "nursing strike", something that happened to me with my second baby when she was around a month old after just one experience with a bottle feeding.) BTW, it seems to me that I read somewhere that if supplemental milk must be used, feed it with a teaspoon rather than from a bottle.

Considering that the CDC, the WHO, and most authorities have accepted that breastfeeding without supplements is best for the baby except in the very rare instances of insufficient breast milk, I just don't see how a panel of a few MDs can dispute what has become the acceptable information for mothers from such a large number of authorities. I'd appreciate feedback. Gandydancer (talk) 23:37, 26 July 2018 (UTC)


 * I reverted the text you deleted (you deleted more, not just what you quoted), which contained links to 2 studies. The article needs to reflect all relevant views, with due weight given to them, according to sources. The passage added into that section was not in any way breaking the WP:UNDUE policy; and to delete it would be to remove text supported by sources - text which is relevant to the section in question (and to a lesser degree to the article as a whole) - simply because one might not like it. The Baby Friendly Hospital Initiative is by no means without controversy around the world (at lest in its rigid, inflexible, literal implementation), which is why most countries either don't implement it, or implement it only partially. There are also other issues, for example:  . And many others. Please let's remember that WP:NPOV and WP:SOAP are cornerstones; and that this article is called "Breastfeeding" not "Formula is bad because it is made by aggressive corporations". Nobody is trying to deny the scientific consensus that breast milk (in the absence of certain medical conditions) is superior to formula; but there are other issues that need to be addressed and which are supported by reliable sources, and they should be discussed giving them due weight. Also it is interesting that you object to these studies, but you are ready to quote La Leche League as the ultimate  authority. 2A02:2F01:52FF:FFFF:0:0:BC19:1BD1 (talk) 02:15, 27 July 2018 (UTC)

You don't seem to understand the importance of using only good sources when you expect this article to include criticism published as an opinion piece by only three MDs to refute the opinions of the following authorities who have endorsed the Baby Friendly Hospital Initiative:

American Academy of Family Physicians; American Academy of Nursing; American Academy of Pediatrics; American College of Nurse-Midwives; American College of Obstetricians and Gynecologists; Academy of Breastfeeding Medicine; Academy of Nutrition and Dietetics; Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN); Centers for Disease Control and Prevention (CDC) National WIC Association U.S. Breastfeeding Committee (USBC); U.S. Preventive Services Task Force; U.S. Surgeon General Note also that in this followup opinion it is pointed out that the claim in the opinion piece you site  which states that compliance with the HFBI, specifically early skin-to-skin contact, causes SUPC, is without sourcing and is, according to the statistics offered not factual.

The two BBC articles you offer, "Weaning before six months 'may help breastfed babies" and another one that claims that babies that are given solids after 3 months sleep better which goes against both the WHO, the CDC and many other authorities recommendations does not meet the RS standards we would use in our article.

See also BFHI "saves lives" another JAMA opinion but using using a meta-analysis of studies that have evaluated the BFHI. Gandydancer (talk) 11:58, 27 July 2018 (UTC)


 * What do you mean by "good sources"? Sources which agree with your views? The two studies cited comply with the reliable sources policy, so they are 'good', as long as they are given due weight in the article. With regard to the two BBC articles I reffed to here on talk, I wasn't suggesting the BBC articles themselves should be cited in the wiki article (because indeed they don't meet the RS standards) but the BBC articles have a link to the studies and that's why I offered them as an example here on talk. I'm not going to continue to engage with you because you clearly have very strong views on the issue, but you need to seek WP:CONSENSUS before reverting sourced material. 2A02:2F01:5DFF:FFFF:0:0:6465:4FC0 (talk) 17:39, 27 July 2018 (UTC)
 * No, I do not need to seek consensus because your sources are very clearly not adequate to dispute conclusions drawn by numerous authorities (see my above list) and several Cochrane reviews. You are using only one viewpoint article attributed to 3 MDs and one small study of less than 200 infants to refute hundreds conclusions that have come out firmly in favor of early skin-to-skin. Gandydancer (talk) 18:31, 27 July 2018 (UTC)

Here are my thoughts on the recently-added content on supplemental formula for babies 24 - 72 hours old: In summary: The source isn't appropriate, and it doesn't support the content that was added. There is strong medical consensus that supplemental formula should be given when medically necessary and only when medically necessary. The common mentality of, "Mom is having trouble breastfeeding so let's give the baby a bottle - it won't hurt" is what we should be educating against. Clayoquot (talk &#124; contribs) 05:55, 28 July 2018 (UTC)
 * If you haven't already, please read WP:MEDRS, which describes Wikipedia's special sourcing requirements for biomedical content. The MEDRS guidelines are stricter than our WP:RS guidelines. The source given for this content is a classic example of a source that is not generally appropriate according to WP:MEDRS, as it is primary research describing a single clinical trial, rather than secondary or tertiary synthesis of biomedical knowledge. An example of an ideal source for information about newborn supplementation would be this protocol document from the Academy of Breastfeeding Medicine. La Leche League is also not a good source for biomedical aspects of breastfeeding, although it is a good source for things like how to get a good latch.
 * The added content makes far more sweeping claims than what its stated source actually supports. The source studied a particular subset of newborns, i.e. those who had lost an unusual amount of weight, not newborns whose mothers had "breastfeeding difficulties". There are many common breastfeeding difficulties, such as sore nipples, for which supplementation is utterly inappropriate and can be harmful. The phrase "limited formula use" does not get across several important facts about the study: Formula was offered in the study only after a breastfeeding session, the quantity of formula offered was very small (two teaspoons), and no further formula was given after the mom's milk came in.
 * I've removed this content. I'll try to comment later on the BFH and advocacy issues. Clayoquot (talk &#124; contribs) 05:59, 28 July 2018 (UTC)

Regarding criticism of breastfeeding promotion and the Baby Friendly Hospital Initiative, critical points of view are well-documented in reliable sources and held by more than a tiny minority, so we do have to include them. We should also include rebuttals to the criticism such as the articles GandyDancer mentions above. I'd like to see our article focus more on the facts rather than the rhetoric, so that the reader can decide which points of view have the most validity.

BTW, there is some controversy around whether solids should be started at 4 months or 6 months, but the people who advocate starting solids at 4 months are not, in general, criticizing the promotion of breastfeeding. All they are criticizing is the concept that breastfeeding continue exclusively after 4 months. Clayoquot (talk &#124; contribs) 20:56, 28 July 2018 (UTC)

I am quite critical of keeping the JAMA opinion article, an article we would generally not consider for medical information, by putting it  in the "Criticism of breastfeeding advocacy" section where the sourcing would perhaps be adequate. Of course the press just loved it and took the criticism and ran with it, but that does not change the fact that the article is a criticism of the BFHI and actually belongs in that section, if anywhere, IMO. If we include this criticism by three MDs do we then use a Huff Post criticism of their criticism...or what? Influential article against Baby-Friendly is based on a false claim -   IMO we need to be careful in what we include here - while the press widely circulated this opinion piece we should be careful that we don't do the same, giving our readers the impression that we see it as important and fitting for our article. Gandydancer (talk) 15:15, 29 July 2018 (UTC)


 * I've moved the problematic and contested proposed content addition here while it is being discussed (see WP:ONUS:
 * The opinion of the trio of Massachusetts MDs was widely panned, but that fact isn't evident in the proposed content addition. Also, as noted above by editor Gandydancer, the proposed location of the content is problematic.  Having read other sources regarding the same subject (Response 1 in JAMA, Response 2 in JAMA, Response 3 in JAMA, Response 4 in JAMA, Response 5 in JAMA, Response 6 in JAMA, Response 7 in JAMA, Reply to some of the Responses in JAMA, Baby Friendly USA response, CHAMPS Response to JAMA Opinion piece), I'm inclined to omit the content at this time per our WP:UNDUE policy, which states: Generally, the views of tiny minorities should not be included at all, except perhaps in a "see also" to an article about those specific views. Xenophrenic (talk) 22:53, 29 July 2018 (UTC)
 * I'm glad you removed that content because it failed to present the anti-BFHI as a minority one. When a point of view has been widely panned, Wikipedia usually describes the point of view and the panning of it. We don't ignore misinformation - we call it out. If anyone wants to take on the task of writing an NPOV summary of the controversy, that would be nice. It's better to have nothing than to have just one-sided misinformation though. Clayoquot (talk &#124; contribs) 17:32, 30 July 2018 (UTC)
 * I'm glad you removed that content because it failed to present the anti-BFHI as a minority one. When a point of view has been widely panned, Wikipedia usually describes the point of view and the panning of it. We don't ignore misinformation - we call it out. If anyone wants to take on the task of writing an NPOV summary of the controversy, that would be nice. It's better to have nothing than to have just one-sided misinformation though. Clayoquot (talk &#124; contribs) 17:32, 30 July 2018 (UTC)


 * I have made the same argument myself in the past on the subject of the use of a Monsanto product - information that the media just loved since it is well known that a majority of people "just hate" Monsanto (including me {), but the information was not really very accurate. Clayoquot, it would be great to see a different POV on BFHI and I looked for it but could not find anything we could use.  What have you been able to find?  As an aside, I sure do wish they would say that pacifiers, while not appropriate till nursing is established, may be desirable for some babies/parents.  IMO they are a godsend for both a lot of babies and parents as well.  Who does not have a funny story about losing the baby's pacifier?  That could be a WP article alone: Loss of baby's pacifiers.  Gandydancer (talk) 19:10, 30 July 2018 (UTC)

Pacifier use and breastfeeding relationships
I am thinking that we should perhaps include a pacifier discussion in this article. Also, I note that our Pacifier article uses WP voice re the APA advise without a source which needs fixing. I'll work on that article as time permits. I found this excellent article published by the Canadian Paediatric Society, and it covers the question quite well. Gandydancer (talk) 15:17, 31 July 2018 (UTC) Here is a 2016 Cochrane review on the use of pacifiers. Gandydancer (talk) 15:20, 31 July 2018 (UTC)

Hydration issue moved to talk for discussion
I have moved this recent addition to the talk page for discussion:

There is no evidence to support increased fluid intake for breastfeeding mothers to increase their milk production.

Here is what the source says:


 * "We did not identify any randomised controlled trials for inclusion. We included one quasi‐randomised trial (involving 210 women and their full term infants) that examined the effect of extra fluids on breast milk production (Illingworth 1953). The study was considered to be at a high risk of bias. The report indicated that advising women to consume extra fluids did not translate to increased breast milk production, as measured by test feeds (also known as test weighing). At the time the study was conducted (the 1950s), it was common for babies in developed countries to be weighed before and after a feed, known as test weighing or test feeding. The practice is now not routinely practiced for term infants and is only sometimes practiced with ex‐premature infants as they develop their suck‐swallow skills over time. The concern with test weighing is the lack of precision: a comparison of infant weight change before and after milk intake, with the known amount of milk ingested, can range from ‐12.4 mL to 15 mL (Savenije 2006). Such imprecision could impact on care practices with premature infants, albeit unnecessarily. Therefore, although the trial reported by Illingworth 1953 did not demonstrate any effect of increased maternal fluid intake, it is possible that there may have been benefit, but that at most, it would have been a small amount (measured in mL) that would not impact on the overall care of a term infant."

Considering that this study is over 60 years old and involves only around 200 women during their first 8 days of breastfeeding, days when colostrum and milk production is a matter of only a few ounces, I can't see any reason to include this information. Gandydancer (talk) 16:27, 13 September 2018 (UTC)
 * . JenOttawa (talk) 17:10, 13 September 2018 (UTC)


 * The cited study is actually 4 years old, but the review refers to a single study conducted over 60 years ago. It criticizes the methodology of the old study and concludes that there have been no credible studies conducted to answer this question. The addition of this reference to the article was meant to highlight a lack of evidence to support an unproven theory that increased fluid intake can help to increase a mother's milk production. Does that help? Mcbrarian (talk) 18:18, 13 September 2018 (UTC)


 * Yes, of course I am aware that the actual review was done 4 years ago but IMO that does not make it especially important since it only reviews one study done more than 60 years ago. And then add that to the fact that there is actually no controversy about fluid intake to increase milk production in the first 8 days postpartum that I'm aware of.  See for example Le Leche League info:   Mcbrarian, my concern is that we seem in our article to suggest that increased hydration has no impact on milk supply.  Period.  This study applied to only the first few days of breastfeeding when actually a three or six-month old baby may very well affect the amount of fluids that a nursing mother may need to consume.  I assume.  But we have no studies on that.  Best not to introduce the topic in the first place.  IMO.  Gandydancer (talk) 18:52, 13 September 2018 (UTC)


 * Gandydancer, I think the sentence you removed was actually good. Ruth Lawrence's 206 textbook says:
 * The volume of milk produced varies over the duration of lactation from the first few weeks to 6 months and beyond but is remarkably predictable except during extreme malnutrition or severe dehydration. In periods of acute water deprivation, manifested in a healthy mother by an acute bout of vomiting and diarrhea, the volume of milk will diminish only after the maternal urine output has been significantly compromised (10% dehydration).
 * I did not notice any mention of maternal hydration in the La Leche League article you linked to, and La Leche League is not WP:MEDRS compliant anyway. There are plenty of good reasons for new moms to drink lots of water, but there is no evidence that it increases milk production under normal circumstances. Cheers, Clayoquot (talk &#124; contribs) 04:14, 14 September 2018 (UTC)


 * Clayoquot, perhaps I have not been clear in my wording. I am not arguing that drinking more water will increase milk supply and am actually arguing that the study offered proved next to nothing.  As for bringing up La Leche League, I did not use it to ascertain any medical facts but to use as an example of what a new nursing mother may read for guidance and I note that LLL does not' mention a need to improve hydration to increase milk supply - to prove my point that there was no need for our article to fix something that was not broken.   At any rate it seems that it is important to you and the editor that entered it that the article mention hydration and I will assume that you are correct since in my experience you have always offered sound suggestions.  Though it would be nice to improve the ref to something more fitting?  Best, Gandy  Gandydancer (talk) 14:59, 14 September 2018 (UTC)


 * The motivation to include this study was not to suggest to the reader that increased intake of fluid does not have any impact on milk production, but rather to emphasize that there is no evidence to support this theory. The fact that the review is only 4 years old but was unable to include recent studies is, imo, further indication that this theory is not proven and merits further investigation. That is not to say it is untrue, but rather that there is no evidence to suggest one way or another. Mcbrarian (talk) 16:42, 17 September 2018 (UTC)


 * Certainly I appreciate your note here but never the less I do have my concerns that our readers do not understand the way we go about editing our articles. For example I now see that info re workplace nursing requirements with a Cochrane review that said, "There is no strong evidence comparing the effectiveness of these different workplace interventions" added.  I don't think that our readers understand this med-speak and rather think that it means that since there is no evidence of benefit there is no reason for corporate companies to improve their efforts to insure that more mothers feel that they work for a nursing-friendly company--and as a result be more likely to nurse.  I'm presently working on that addition to include CDC and other info but it really is rather irksome to me... Gandydancer (talk) 20:23, 19 September 2018 (UTC)


 * Hm, I see your rationale. Sorry for the delay in my response, I've been away. But it makes sense to me that in an effort to be exhaustive, we could in fact be unintentionally misdirecting the users... I'm still learning here so I appreciate the clarification Mcbrarian (talk) 20:50, 9 October 2018 (UTC)


 * Thanks for the response. I look forward to more info/edits here or on other women-related articles. I hope I didn't sound too cranky..{  Gandydancer (talk) 02:05, 11 October 2018 (UTC)
 * Just wanted to say thanks Gandydancer for bringing these issues up, and to Mcbrarian for looking into them. I don't know anything about workplace interventions and my brain has been too full lately to get up to speed on the topic, so I probably won't have much to say. Clayoquot (talk &#124; contribs) 05:18, 11 October 2018 (UTC)


 * Using Cochrane can be troublesome. For example this addition was added to the Workplace section: "There is no strong evidence comparing the effectiveness of these different workplace interventions."  At first I tried to monkey with that info to show our readers that Cochrane's "no strong evidence"  may not mean what they think it does.  Eventually my reading around the web brought forth a great deal of positive info re working place conditions that, as it turned out, show very strong evidence that it matters a great deal.  How often I think about what we learned in nursing school re Flo's statement "If you can't help at least do no harm" - and there is some of that on WP, IMO.  Gandydancer (talk) 18:32, 11 October 2018 (UTC)

Key goal is exclusive breast feeding for the first 6 months
Not sure why this was removed from the lead? Doc James (talk · contribs · email) 01:28, 11 December 2018 (UTC)
 * What exactly was removed? The lead currently includes the sentence, "Health organizations, including the World Health Organization (WHO), recommend breastfeeding exclusively for six months." Did it previously say more than that? Cheers, Clayoquot (talk &#124; contribs) 06:29, 11 December 2018 (UTC)


 * Hi, We seem to be having a bit on an edit war here. You've twice changed what I wrote: "In the United States in 2015, 83% of women begin breastfeeding and 58% were still breastfeeding at 6 months, although only 25% exclusively. The rate of starting breastfeeding is up from 76% in 2009." to "In the United States in 2015, 83% of women begin breastfeeding, while 25% only breastfeed until the age of six months." Both versions cite the same CDC report from this August. Your version "... 25% only breastfeed until the age of six months" is not supported by the CDC report. Yes, 6 months of exclusive breastfeeding is the goal, but I'm not aware of any research that suggest that if a mother gives her 5-month old some non-breastmilk food it negates the benefits of breastfeeding. Even if we only include the 25% number, the text should make clear that this number is for exclusive breastfeeding. Also why doesn't the fact that U.S. breastfeeding rates have increased in the last decade, again well supported by the CDC reference, belong in the article?--agr (talk) 20:15, 11 December 2018 (UTC)

My error User:ArnoldReinhold. Have restored "In the United States in 2015, 83% of women begin breastfeeding and 58% were still breastfeeding at 6 months, although only 25% exclusively." Per "25% only breastfeed until the age of six months" that is what exclusive breastfeeding is.

Per the increase or decrease since 2009 in one country, IMO that should go in the body of the text and I have moved there. Doc James (talk · contribs · email) 22:44, 11 December 2018 (UTC)


 * , thanks for making the change. I can accept putting the increase sentence in the body, but I'd like to try to persuade you otherwise. There has been so much negative news on the healthcare front: obesity, opioids, suicides, screen addiction, costs out of control, etc., that a piece of good news deserve some prominence. This is the English Wikipedia so U.S. results have importance, and there are similar number for the U.K. I'll let you make the call.--agr (talk) 20:16, 12 December 2018 (UTC)
 * Would be more interesting to look at the changes in breastfeeding in different countries over the last 50 years. Not sure if there is data for that. There must be for the USA and I will look in a bit. That of course would fit best in the body of the article Doc James  (talk · contribs · email) 12:11, 13 December 2018 (UTC)
 * Here is a link with some data on the UK:, but there is one datum there I suspect is a typo, the 5% 2009 number. It's widely reported that the low point for BF initiation in the U.S. was 1972 at 22%. If possible, I'd go back more than 50 years.--agr (talk) 16:46, 13 December 2018 (UTC)

Benefits
This "immediate release of the hormone oxytocin" is not an actual real life benefit but sort of a mechanism. Belongs in the body not the lead IMO. Doc James (talk · contribs · email) 16:01, 13 January 2019 (UTC)

Milk kinship
Is already discussed here Breastfeeding. The rest is primary sources. Doc James (talk · contribs · email) 17:28, 31 January 2019 (UTC) I think religious view should have a separate paragraph. I have added tafsir ibn Kathir which is secondary source. I’m writing about quranic view which tells that mothers or wet nurses should breastfeed children for two years. And that such breastfeeding prohibits marriage with foster female ancestor and foster siblings. You can see whole of Wikipedia has primary sources as an additional to secondary source and this is in accordance of Wikipedia guidelines. Thank you. Smatrah (talk) 03:46, 1 February 2019 (UTC)

"A Comparison of Breastfeeding Rates by Country" listed at Redirects for discussion
An editor has asked for a discussion to address the redirect &. Please participate in the redirect discussion if you wish to do so. UnitedStatesian (talk) 18:19, 10 April 2019 (UTC)

Religion
Fits fine under society and culture. Does not need its own section. Doc James (talk · contribs · email) 05:48, 1 May 2019 (UTC)

adding to section on Breastfeeding in Public
Hi folks. My name is Amanda and I am a student at the University of Washington. I'm in the process of editing this page to add to the already existing section on public breastfeeding. These are a few of the resources I've located that I am finding to be useful. If anyone else has suggestions or feedback, do let me know. I hope to have my new content posted in the coming weeks!

AfD for Google Glass article
Watchers of this page might be interested in the following AfD: Articles for deletion/Google Glass breastfeeding app trial (2nd nomination) Cheers, Clayoquot (talk &#124; contribs) 07:32, 26 May 2019 (UTC)

2019 update
More needs to be in about HIV and breastfeeding. Breastfeeding is not recommended if safe formula is available and the mother is HIV positive. There could be a page about exclusive breastfeeding or the page about HIV & breastfeeding could be added to. See talk page on HIV & pregnancy. TamaraStaples (talk) 17:34, 24 December 2019 (UTC)
 * Perhaps a tad more but I am satisfied with what we've got. As you likely know, the question of HIV nursing mothers was quite complicated because at one time the WHO wrongly said they should not nurse...period...  So anyway, we had a huge amount of copy at this article.  I was ever so happy to see an editor do some work on it and remove most of it - and if I remember it was a student editor at that!  What do you think we need to add here?  Gandydancer (talk) 19:11, 24 December 2019 (UTC)

In the HIV & pregnancy page we need to add that women living with HIV are advised by the WHO not to breastfeed and to formula feed if certain conditions for formula feeding are met according to the latest WHO guidelines. If women living with HIV are in a country where formula feeding is not recommended then they need to exclusively breastfeed. We then need to say what exclusive breastfeeding means. The section could probaly be titled Breastfeeding and HIV and direct people to the Breastfeeding and HIV page for more information. The breastfeeding and HIV page needs to have a number of updates. I don't think that this is a highly contested area any more since the latest WHO recommendations were produced. The HIV and pregnancy page also needs to be updated so that it no longer suggests that there should be a page on exclusive breast feeding. South Africa no longer needs to be singled out as a developing country nor the United States as a more developed country. Referencing WHO guidelines is more inclusive. Also, all women with HIV should be taking antiretrovirals. If people wish I can update these pages, but I will wait until I get some feedback. I think that the pages as a group need to be updated soon as I think that as they are at the moment they could be misunderstood and/or give misleading information to women living with HIV. It is not that the previous updates were wrong, it is just that things have moved on a lot in the last few years. For example, it is only fairly recently that it was recommended that all women living with HIV should be taking antiretrovirals.TamaraStaples (talk) 10:05, 26 December 2019 (UTC)
 * Looking at our article as it stands I see that it is under the heading "Healthcare" and I'm thinking that perhaps you are correct it would be better to have a heading that shows up in our article info box? I think it should be a short section since we have a main article.  I haven't looked at the main but it does not surprise me that it needs a lot of work and it would be great to have someone update/improve it.  User:Clayoquot works very closely with this page and perhaps she will make some suggestions. Perhaps you'd like to make a suggested section for this article on the talk page for comments?  Gandydancer (talk) 14:15, 26 December 2019 (UTC)

Unless the paragraph starting "Health organisations"is moved it is in this area that the changes need to take place. In this paragraph I would take out the sentence starting "Medical conditions" and the one starting "Mothers who take". I would then add a new paragraph — Preceding unsigned comment added by TamaraStaples (talk • contribs)

Breastfeeding & HIV
When women are HIV positive, the World Health Organisation recommends either exclusive breastfeeding or the provision of safe formula. National health authorities are now recommended to endorse one approach, that is either exclusively breastfeeding with antiretroviral therapy or avoid all breastfeeding. All women known to be HIV positive should be taking lifelong antiretroviral therapy.(same reference for these as well) TamaraStaples (talk) 18:23, 26 December 2019 (UTC)


 * If I understand you correctly, you're saying that where the article discusses the recommendation to exclusively breastfeed, it should also mention that this isn't recommended for HIV positive mothers in countries where formula feeding is relatively safe. I agree with that. I'm confused by some of your comments above, however, because they gave me the impression that you thought the current version of the article doesn't talk about HIV as a contraindication for breastfeeding at all. HIV is covered in a subsection called "Maternal infections" in the section on Healthcare. As Gandydancer said, it's kind of buried over there. I'd be in favour of moving the "Maternal infections" subsection to be part of the Duration and exclusivity section, and renaming it as "Contraindications". I think the wording within the "Maternal infections" subsection is currently clearer than what you propose above, and it also appropriately covers things like tuberculosis in addition to HIV. Clayoquot (talk &#124; contribs) 06:00, 27 December 2019 (UTC)

You are quite correct in saying that I didn't notice the section on breastfeeding and HIV. That is why it needs to be moved, and also why the paragraph near the start of the page needs to be altered so that it says that HIV is an exception.I don't mind how it is done so I suggest that you do it as you wish, I just want it to be accurate. I also think that you need to take out the mention to TB. With TB the issues and recommendations are quite different. As far as I can see there is no mention of breastfeeding on the main TB page. Incidentally, I think there is a need to be careful about the words that are used. Many people reading the pages will not have English as their first language, and so they may not understand what Contraindications means. TamaraStaples (talk) 16:37, 27 December 2019 (UTC)
 * OK, I've moved the section. The part about TB and Human T-lymphotropic virus needs sourcing and perhaps expansion. I'll have to leave this to others as I don't know much about these things and don't have time to investigate. Take care, Clayoquot (talk &#124; contribs) 17:37, 27 December 2019 (UTC)

Occupational therapists
Hi. I just removed the following good-faith addition:


 * Occupational therapists are professionals that help people engage in meaningful everyday activities called occupations. Occupational therapists can help support breastfeeding which is a co-occupation that the mother and infant share. Occupational therapists can help mothers establish breastfeeding routines leading to longer breastfeeding duration and can promote breastfeeding in early intervention and community-based settings.

I believe this placed an undue emphasis on occupational therapy. As the source notes, "breastfeeding as an activity or method of feeding has received minimal attention in the occupational therapy literature." Some occupational therapists may have the training necessary to support breastfeeding, but most do not. Clayoquot (talk &#124; contribs) 19:12, 3 May 2021 (UTC)

"Chestfeeding" in lead
An editor has removed "chestfeeding" from the first sentence. What do people think of having this term in the first sentence? La Leche League Canada and La Leche League USA support use of this term. The editorial decision on whether to include a synonym in the first sentence could consider this along with other factors such as how commonly the term is used. Clayoquot (talk &#124; contribs) 00:24, 6 June 2021 (UTC)
 * Clayoquot I hated it so much that I decided to wait for others to chime in on it since I felt so emotional about it. I think it should be noted that while Le Leche wholeheartedly accepts the term they have not done any changing on the various pages and continue to refer to it as breastfeeding.  I think it should be in the lead but not the lead's first sentence.  Actually it could be argued that the male "chest" must be altered by a female hormone to make nursing possible and it could be argued that males develop "breasts" that can nurse a child.  Thanks for bringing it to talk.  Gandydancer (talk) 02:27, 6 June 2021 (UTC)
 * I hear you. My emotional reaction is in the same direction as yours, although perhaps less strongly. I can't think of a way to include it in the lead without giving it an entire sentence, which would be undue weight in the lead. How about if we add a sentence in the "Social acceptance" section mentioning that breastfeeding can be done by non-women, where it is called chestfeeding? And leave it out of the lead altogether? Clayoquot (talk &#124; contribs) 18:51, 6 June 2021 (UTC)


 * I'd be very happy with that. I tried to figure out how often it is done but had no luck with a google search.  Do you have any idea?  Gandydancer (talk) 19:27, 6 June 2021 (UTC)


 * I think this is a very important term to put in this article, especially considering how many transgender people there are in general. I have found a few studies regarding transmasculine lactation and induced lactation, as well as studies regarding how chest surgery can affect lactation. Even if we do not add this information, we should at the very least represent trans populations who feel unrepresented on this page, though these are issues they face and struggle with as well. (Sneezygirl) (talk) 12:12, 13 October 2021 (UTC)
 * Hi, and welcome. There seems to be consensus for adding a sentence on chestfeeding to the Social acceptance section. Would you like to do this? Cheers, Clayoquot (talk &#124; contribs) 22:09, 14 October 2021 (UTC)
 * Hi all! New to this page here. As said, I think it is extremely important to have the term Chestfeeding in this article, and I think it is worth including it in the lead. I think that one thing to remember is that it is not just Trans-female parents (Male to female) who we are talking about with regards to chestfeeding. It is also trans-male parents who lactate without supplemental hormones, as well as parents who may identify as non-binary or genderqueer, for whom the term "breast" is not inclusive. While it may be a point of contention for editors on this post, I think the term at least deserves a place in the intro/lead, as opposed to far down in the Social acceptance section. As written currently, the Social acceptance section is focused on breastfeeding in public, and breast vs. formula feeding in general. I feel that it could be ostracizing to an entire population of patients to list an inclusive term such as chestfeeding in this section, comparing and/or equating it to the social disagreements aforementioned. Additionally, this section is currently fairly far down in the table of contents; personally, I feel like waiting that long to share such a simple term for the benefit of an entire group of people is not worth it. Let me know what y'all think. -Kporter0918 (talk) 22:46, 26 October 2021 (UTC)
 * As a WP:Student editor, you may not be as familiar with how Wikipedia does things. (Sneezygirl is also a student editor per her userpage.) We don't write our articles around our own guesses about what might please some group of readers, per WP:NOTADVOCACY. Instead, we represent reliable sources with WP:DUE weight. Those sources overwhelmingly use the term "breastfeeding". That is the medically accurate term and the one used in the vast scientific literature. Even cis men have "breasts" - so even the few trans men who breastfeed (any who have not had mastectomies and are not made dysphoric by breastfeeding and also have young children) are included in that terminology. The still-rare use of the term "chestfeeding" is very much a matter of culture and society, not of medical description. Crossroads -talk- 04:32, 27 October 2021 (UTC)
 * Hi Crossroads, while I share your conclusion that chestfeeding should not be in the lead section, I'm not crazy about how you're making this point. Let's set an example for our newest editors by showing how we do do things: Wikipedia is a place where everyone can make a case for changing an article, and the editor community evaluates proposed changes based on the strength of arguments, not based on how long the proposer has been here. We focus on the edit, not the editor (although I must say that Kporter0918, given her description below, is probably one of the top ten most breastfeeding-knowledgable people who has ever edited Wikipedia).
 * Kporter0918, we always try to reflect the language and the emphases used in the highest-quality sources on whatever topic an article is about. To make a case for more emphasis on chestfeeding, you would need to show that sources like the WHO and the APA are also emphasizing the concept in their literature on breastfeeding as a whole in say the past 5 years. Also note that the lead section of a Wikipedia article is a summary of the entire article, which is a bit different from being an introduction (see WP:Lead section). Cheers, Clayoquot (talk &#124; contribs) 15:04, 27 October 2021 (UTC)
 * Hi Crossroads. While I understand where your argument is coming from, I would argue that the term chestfeeding and the term bodyfeeding, as well as more gender neutral language surrounding gestational parents, is being used by many reputable sources now (including the ACOG, CDC and Planned Parenthood). The fact is that there are many gender non-conforming individuals who have become pregnant or have chestfed children. Though there aren't a ton of studies about it, that doesn't nullify the experiences of gender non-conforming individuals who chestfeed. Are we really going to refuse to represent the people we know are experiencing this because of the lack of the rest of the world acknowledging those experiences? (Sneezygirl) (talk) 12:14, 28 October 2021 (UTC)
 * Regarding the text of the article in general: You will want to read this discussion summarizing the Wikipedia community's consensus on this issue of how to write about sex-specific topics. While a few American organizations may talk like that sometimes, especially ones engaged in advocacy (Planned Parenthood) or subject to political/governmental directives (the CDC), we write from a global perspective. And above all, we follow the WP:MEDRS - the academic medical literature. Incidentally, to be clear, a great many "gender non-conforming" individuals still identify as women even while being butch or masculine. Crossroads -talk- 04:20, 29 October 2021 (UTC)
 * , in the WP:MEDRS page, the CDC is described as a "reputable major medical and scientific bodies may be valuable encyclopedic sources". As for the global perspective, there are little to no studies about transgender and gender non-conforming people across the globe. In the US, however, there was a recent study which estimated that there are 1.4 million trans adults living in the US today. This study was done by The Williams Institute within the UCLA School of Law. While this might not be up to wikipedia's standard of primary sources, it nonetheless gives an idea of how many trans and GNC people live in America. As for your claim about 'most GNC people still identifying women', I'd love to see an article proving that, as that is a woefully untrue and transphobic comment about the GNC community. Also, the gender neutral language discussion you sent me to is interesting, but I believe as it is in the village proposal area, it is a proposal rather than an obsolete rule. Furthermore, this specific discussion is about adding the word 'chest-feeding' ONCE in this whole article. I fail to see how this is changing all of the gendered language into neutral language, as it is quite literally the bare minimum. Edit: If this would appease you, we could move this term to the Social and Culture section under the Language heading, and simply add a sentence explaining the use of the term in the US.(Sneezygirl) (talk) 11:47, 2 December 2021 (UTC)
 * Sneezygirl, please can you avoid describing either an editor here or an editor's comments as "transphobic". While it can be ok to comment negatively about what another editor wrote (vs being negative about the editor), terms like "transphobic" imply that the comments were written with a bad intention or from a unacceptable belief. You may be insterested in this article. The final words "The important thing, always, is to operate in good faith." align with Assume good faith. I think it would be appropriate to mention "chestfeeding" in the language sub-section of Social and Culture. But not in the way done below, where it suggests this term is inclusive or that 'breastfeeding' is heteronormative. The paper used below gives a definition, which could be paraphrased for our purposes and used as a source. -- Colin°Talk 18:09, 7 December 2021 (UTC)

I've undone an edit by ShelbyShag that added to the research section 'Additionally, breastfeeding research is being done to examine the LGBTQIA+ community's experience with lactation, as well on research on less heteronormative and more inclusive terms, such as "chestfeeding"'. The source mentions the steps one hospital is taking wrt LGBTQI+. It doesn't mention research. Nor does it suggest that "chestfeeding" is itself "less heteronormative and more inclusive". Indeed their linked paper ( here) defines chestfeeding as "A term used by many masculine-identified trans people to describe the act of feeding their baby from their chest, regardless of whether they have had chest/top surgery (to alter or remove mammary tissue)". In other words, not inclusive at all, but just a term used by a minority group about themselves. The authors of that paper call themselves "Academy of Breastfeeding Medicine", not "Academy of Chestfeeding Medicine". -- Colin°Talk 17:57, 7 December 2021 (UTC)

I don't think WP:WEIGHT would currently permit this term in the lead section. For example, Googling  returns couple of dozen documents (and "chest feeding" a handful more), all, as far as I can see, using the term as an addition to "breastfeeding". A similar search on ".gov.uk" returns nothing for the single word and only five results for the two words. Of those, two are duplicates and one is unrelated to the topic. Of the remainder, one is a question to an MP and the other a passing mention of "a new policy ‘Breast-feeding/ Chest-feeding/ Co-nursing policy’". This would suggest that in the UK at least, the term has not found widespread usage. Many of the NHS results refer to the Brighton and Sussex University Hospitals guideline that I mention in "Terminology" below, and which the authors acknowledge they are "leading the way". Others can search reliable US publications. My evidence so far suggests our language section could mention it very briefly, and does not support the idea that this term is widely proposed as an inclusive alternative, rather than occasionally used as an inclusive addition. -- Colin°Talk 19:34, 7 December 2021 (UTC)