The article on phototherapy for neonatal jaundice by Dr Tan1 highlights several important issues for consideration. While he reports a "decreased response" to phototherapy in his breast-fed only group, I believe what he is observing is an interaction between the act of breast-feeding and the results of initiating phototherapy. It has been established that mother and infant separation has a negative effect on breast-feeding.2 Phototherapy, as it is often done, requires that the infant be in a nursery or central area where mothers are only allowed visitation. Additionally, it gives the infant an "untouchable" aura, resulting in longer intervals between handling. These types of mother-infant separation interfere with the frequent interactions needed for effective breast-feeding. In this article, the group 2 infants began feeding at 15- to 60-minute intervals but changed to an average of 3-hour intervals while undergoing phototherapy. The author credits this change to "lactation presumably established," noting that it matched feeding patterns from birth in the other 2 groups.
Hertz GS. Supplemental Breast Milk Is the Best Milk. Arch Pediatr Adolesc Med. 1999;153(6):655. doi: