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Infant feeding and atopic disease
  1. Health Visitor
  2. 58 Blake Dean Road.
  3. Lilliput, Poole
  4. Dorset BH14 8HH, UK

    Statistics from

    Editor,—I was offended by David’s observation1 that many health professionals are “no more equipped to breast feed than they are to give practical advice on the subject” and that the middle class solution would be to “close the door to the health visitor” and call in someone more appropriate.

    Health visitors are skilled practitioners and, apart from during the initial 10 day period when midwives are still involved, do more work with new mothers to promote breast feeding than any other health professional, and are aware of the benefits of breast feeding to the infant as well as the mother. However, in the postnatal period it is important that health visitors establish a long lasting professional relationship with the mother. We lose their favour, trust, and respect forever if they think that we are forcing them to make decisions or to continue breast feeding when they are desperate to stop.

    Contrary to David’s opinion, health visitors are not ill equipped to offer breast feeding advice. However, we work with the mother to help her adopt the type of feeding with which she is most comfortable. As a result, the mother may choose to change from breast to bottle feeding or, indeed, to mix the two types of feeding. Mothers are aware of the benefits of breast feeding to themselves and to the baby, but sometimes they prefer one type of feeding to another because it is more compatible with their lifestyle and commitments. As yet, I have had no success in helping a mother to continue breast feeding when she wants to stop, despite preparations made in antenatal classes.

    It is unlikely that doctors will see mothers who feel they should breast feed even though they are frustrated by the baby’s demands, and despite the health visitor’s reassurance that it is normal for infants to feed almost constantly for long periods in the first weeks after the birth. These women may be exhausted and tearful and may admit to resenting their baby when it cries. All possible help and reassurance cannot persuade them to continue breast feeding, and they feel intense relief when they are given permission to introduce formula milk and, thus, the relationship between mother and baby instantly relaxes and improves.

    I feel strongly, as do many of my colleagues, that the most important factor in the first weeks after the birth is that the mother and baby enjoy each other. Therefore, the mother should be able to stop breast feeding if her desire to do so outweighs the pleasure of her baby. Mothers are aware of the long and short term benefits of breast feeding and feel immense guilt when they realise they want to stop. Who are we to make them feel even more guilty?

    David should reconsider his comment that health visitors are worse than breast feeding counsellors, as sometimes the worst teacher is a woman who believes that she has had the best experience of childbirth or breast feeding and that others should adopt the procedures she found most suitable. It is a surprising comment for a doctor to make, as most health care professionals are familiar with the misconception that one should have had the condition oneself to be a good carer.


    Dr David comments:

    In reply to Ms Dion’s comments, the following points may be helpful:

    • The statement that some families opt for the support of—for example, a National Childbirth Trust trained breast feeding counsellor rather than a health visitor when seeking advice on breast feeding, does not imply criticism of health visitors. It is simply a factual observation.

    • It is well known that the quality of practical advice given to breast feeding mothers by all types of health care professionals (including doctors, midwives, and health visitors) is highly variable and often very poor.1-1 1-2 This may be one reason why some mothers prefer to seek the help of non-health care professionals who fulfil the dual criteria of either having successfully breast fed their own infant or having received training in how to advise breast feeding mothers.

    • It is plainly unhelpful to try to force reluctant mothers to continue breast feeding, or to try to impose ones own ideas as to what is correct.

    • Having breast fed ones own baby is unlikely to be the best basis for giving advice to other breast feeding mothers who are having problems. Training is essential. Women who have breast fed their own babies, and who have been trained to give practical breast feeding advice, are a valuable resource in the training of health professionals.1-3

    • Ms Dion says that mothers and babies should enjoy one another. I fully agree that this is of fundamental importance. I also fully agree that a mother who wishes to give up breast feeding should be allowed to do so, though I am saddened when I see that this has happened largely as the result of simple problems that have been inadequately or incorrectly addressed by misinformed health professionals.

    • It is correct to state that one does not have to have had a particular condition in order to care for someone with that condition. Nevertheless, I cannot comment on whether breast feeding is a condition. However, personal experience should not be dismissed as it can afford special insights—for example, as a paediatrician I have learned an enormous amount from having children of my own.


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