I am surprised at the reaction of Dr Newman to my article on the response of breast-fed infants to phototherapy.
That jaundice is often associated with breast-feeding is beyond dispute, as numerous articles have attested to this phenomenon. Furthermore, it has been well established that breast milk does not immediately flow copiously from the moment of delivery of the infant. Indeed, breast-feeding consultants were available to give advice from the moment of childbirth. Because of the relative poor milk production initially, greater early weight loss should be no surprise. That dehydration could have contributed to the onset and progression of neonatal jaundice is probable; however, this could not be very significant as the age at commencement of phototherapy among the 3 groups was not significantly different! During phototherapy the breast-fed group gained weight at a faster rate than the other 2 groups, an indication of successful breast-feeding in this group; this despite Dr Newman's contention that breast-feeding had not been practiced correctly. In this situation where dehydration was no longer a factor, the response of the breast-fed group was poorer than that of the other 2 groups; breast-feeding was therefore the main cause of the reduced response.
Tan KL. Breast-feeding, Jaundice, and Formula—Reply. Arch Pediatr Adolesc Med. 1999;153(6):657. doi: