Recent blog posts tell the tragic story of Landon, an infant who died at 19 days of age. Baby-Friendly USA extends its deepest sympathy to his family.
The lesson of this story is not that exclusive breastfeeding is dangerous as these posts suggest. Most infants exclusively breastfeed successfully with no major health problems. Breastfeeding is safe and is the method of infant nutrition recommended by national and international health authorities such as the Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics (AAP), and the World Health Organization (WHO).
The real lesson of this story is that there are certain conditions that require further assessment and close follow-up with the mother, infant, or both. This kind of care is called for in the Baby-Friendly Guidelines and Evaluation Criteria which clearly state that “additional individualized assistance should be provided to high risk and special needs mothers and infants and to mothers who have breastfeeding problems” . The news reports about Landon suggest some critical factors that put him at high risk, and may have contributed to this child’s death. High risk conditions do warrant increased monitoring along with the creation of specific infant feeding and care plans, which may or may not include supplementation with infant formula. The Guidelines and Evaluation Criteria support supplementation for medical reasons and when mothers have made an informed, educated decision .The decision to supplement is delicate. Infant formula changes the infant’s gut. It can also negatively impact the establishment of the mother’s milk supply, thus affecting long term breastfeeding success. Practitioners and mothers should carefully weigh the risks and benefits of this decision.
We would like to point out how the Baby-Friendly Guidelines and Evaluation Criteria indicate ways to provide lactation support to mother infant pairs with feeding difficulties:
“Health care professionals should assess the mother’s breastfeeding techniques and, if needed, should demonstrate appropriate breastfeeding positioning and attachment with the mother and infant, optimally within 3 hours and no later than 6 hours after birth. Prior to discharge, breastfeeding mothers should be educated on basic breastfeeding practices, including:
- the importance of exclusive breastfeeding,
- how to maintain lactation for exclusive breastfeeding for about 6 months,
- criteria to assess if the infant is getting enough breast milk,
- how to express, handle, and store breast milk, including manual expression, and
- how to sustain lactation if the mother is separated from her infant or will not be exclusively breastfeeding after discharge.” 
Mothers expressing discomfort with breastfeeding or who are exhibiting irritated, cracked or bleeding nipples especially require this assessment.
“Additional individualized assistance should be provided to high risk and special needs mothers and infants and to mothers who have breastfeeding problems or must be separated from their infants.”
Mother’s with metabolic disorders and physiologic conditions that might alter their ability to produce an adequate supply of milk should have their milk production and milk transfer assessed periodically during the hospital stay and again, before discharge. Individualized plans of care should be implemented accordingly.
“The designated health care professional(s) should ensure that, prior to discharge, a responsible staff member explores with each mother and a family member or support person (when available) the plans for infant feeding after discharge…an early post-discharge follow-up appointment with their pediatrician, family practitioner, or other pediatric care provider should also be scheduled. The facility should establish in-house breastfeeding support services if no adequate source of support is available for referral (e.g. support group, lactation clinic, home health services, help line, etc.).” 
The care described in the news reports and blog regarding baby Landon are not consistent with the full implementation of the Baby-Friendly Hospital Initiative Guidelines and Evaluation Criteria. Baby-Friendly USA certifies hospitals based on a large set of criteria that must be maintained by the hospital itself. Being Baby-Friendly does not and cannot assure that every staff member will perform according to Baby- Friendly standards. However, in 2012, Baby-Friendly USA implemented a quality improvement program that requires hospitals to annually audit and report on their practices. Quality improvement plans are required for facilities whose audit results indicate their practices have fallen below the Baby-Friendly standards. Baby-Friendly USA continues to strengthen this program.
Links to some additional comments on the topic:
1 Guidelines and Evaluation Criteria, 2016 Revision, Guideline 5.1, p. 16
2 Guidelines and Evaluation Criteria, 2016 Revision, Guideline 6.1, p. 18
3 Guidelines and Evaluation Criteria, 2016 Revision, Guideline 5.2, p. 17
4 Guidelines and Evaluation Criteria, 2016 Revision, Guideline 5.1 ,p. 16
5 Guidelines and Evaluation Criteria, 2016 Revision, Guideline 10.1, p. 22