Sunday, January 31, 2010

Deconstructing Gerber: Why Industry Should Not be Giving Health Advice

I was recently interviewed by a reporter from WebMD. She was knowledgeable and pleasant to talk with, and wrote a nice article about a new research study on how the SSRI-class of antidepressants influenced a breastfeeding woman’s milk supply. Since only 8 women in the study were actually taking the medication, the findings were not something that particularly worried me. And the resulting article was well-written and reflected that.

Imagine my surprise when I actually received the link to the article and found a slide-show imbedded right in the middle. It was entitled “Breastfeeding Hints and Hurdles.” I thought “what a good idea. I’ll take a look.” What I found was an attractive slide show, with some accurate information. The problem was that there was enough inaccurate information to cause breastfeeding failure. And on the very last page, just in case failure occurred, there was an ad for formula. Did I mention that the slide was funded by Gerber? (I posted the entire slide show on my previous post.)

In recent years, there has been a move throughout the health care industry to free health care from relationships with commercial companies. It is an idea I have always supported. But it is sometimes challenging for health care centers to implement having become accustomed to everything from free pens to continuing education to hospital equipment. But the Gerber slideshow is a great example of why these policies must be implemented. It does not make sense for a company to provide health information, in this case breastfeeding advice, when it is in their economic interest for breastfeeding to fail. It’s a bit like cigarette companies funding anti-smoking campaigns.

Let me show you what I mean. The photographs are copyrighted, so I can’t show them here. But I will do my best to describe them. Because of limited space, I can only share a couple. But you can read the analysis of all of the slides on my Web site.

Soothing Sore Nipples
(Picture of a rolled white terrycloth towel)
To soothe sore nipples, use warm moist compresses, rub a bit of fresh breast milk on your nipples and then let it dry, or dab on a bit of lanolin made for breastfeeding. A little pain and tenderness is normal at first. Pain usually goes away once you find a good breastfeeding position and baby latches on comfortably. Be sure to see your doctor if soreness increases or lasts several weeks.

Here's My Take
Warm compresses for sore nipples? Really? Lanolin is OK, as long as there's not an infection and the reason for soreness is addressed. But here’s where it gets bad. First, nipple pain as normal. At least they only said “a little.” But “be sure to see you doctor if soreness increases or lasts several weeks.[emphasis added] How many mothers would still be breastfeeding?

Ready for another one?

How Often Do Babies Nurse?
Photo of a jaundiced breastfeeding baby

Newborns should nurse every two to three hours, according to the American Academy of Pediatrics. That’s eight to 12 times in 24 hours.
Baby may feed from both breasts during one nursing session. And you can switch from side to side to avoid exhaustion. Baby is full when sucking has slowed or he turns away. After the first month, feedings may start decreasing to seven to nine times a day.

Here's My Take
OK, they’ve got the 8-12 times/day right. But every 2-3 hours? What about when babies cluster feed, such as in the evening?

Switch from side to side to “avoid exhaustion”? Whose exhaustion and how does that help avoid it?
“Baby is full when sucking has slowed”? Is that true for the jaundiced baby in the photo or is he simply falling asleep because he is jaundiced?
And decreasing feedings to 7-9 times a day after the first month? Says who? What if a mother has a small storage capacity and her baby needs to be fed more often? Unfortunately, mothers who follow this advice wonder why their supply has suddenly dropped. Good thing there is a coupon for formula!

At the end of this slide show purportedly about breastfeeding is an ad with coupons for Gerber infant formula, information on bottle-feeding, and link so readers can forward this “health information” to others. To me, the tactics of the formula companies are nothing new. Lactation consultants encounter them all the time.

But I’ll tell what I did find concerning: finding this slide show on WebMD. Consumers come to this site expecting to see evidence-based, impartial information--and this is anything but. True, they did clearly post that this was slide show was funded by Gerber. But new parents, the very ones most susceptible to this campaign of misinformation, may not realize the significance of that, and may take as gospel the advice that may very well derail their efforts to breastfeed their babies. And that, to me, is the real shame.


  1. Unlike books or other print media I think the internet is particularly vulnerable to the insertion of paid information. It is going to be harder and harder to find sites that can be trusted. (I wonder how many pregnant women on Facebook have to look at ads for formula on their sidebars?) All I can say is that until more people know about the WHO code we have our work cut out for us indeed.
    Kathy Abbott, IBCLC

  2. Oh yes. It's unbelievable.

    They say nipple confusion is "not very common" and say to wait "2 to 4 weeks" before introducing them and close by warning mothers that if they don't push this bottle thing the baby will never take it.

    Yet, "One study found that 95% of babies will become confused if given a bottle during the first 3-4 weeks of life."

  3. Thank you for doing that analysis, Kathy. It should be compulsory reading for both consumers and health care professionals!

    About that *2-4 weeks before introducing a bottle.* It has been my understanding that it take a baby about 6-8 weeks to really learn how to nurse, and about the same time for a mother to establish her milk production.

    Over the years I have seen the recommended time to introduce a bottle go down from 8 weeks to 2 weeks. I do understand that if a mother is returning to work at 6 weeks pp then she may want to introduce a bottle earlier, but at 2 weeks it is getting ridiculous!

  4. Good post!

    to the curious lactivist...I agree about the ads, most of the internet browsers now have ad blockers, you just need to enable them... Firefox has an add on called adblock is most excellent at hiding those pesky ads!! :) I don't search without it.

  5. oops that should say "browse" without it, since it works on any and all sites. ;)

  6. Nestle/Gerber strikes again. They've gotten a lot bolder recently, going from tricking people to flat out lies.
    I love to tell people that you should never take advice from anyone who profits from your failure, or from anyone who doesn't benefit from your success.

  7. Thank you for raising this important issue on your blog.

    In the midst of the Nestle Family controversy, a friend of mine wrote a guest post for my blog dissecting the breastfeeding advice given by Nestle:

    I also wrote a post with my thoughts on the value of breastfeeding advice from a formula company:

  8. My first time nursing, my nipples were sore and painful for 6+ weeks. I do not find their assessment of this issue a problem. I have very sensitive nipples and was working from day one with a certified lactation consultant who confirmed my son was latching on properly. I worked through it and nursed my son for 14 months. BF is downright painful and irritating for some. To depict it as simply pleasurable for all women is misleading, and I think more likely to cause women to fail because they wonder why they feel the way they feel. Needless to say because of the desensitization process I went through with my first son, nursing my second son has been much easier.

    And as far as the number of nursings per day, the slide does say at one month of life they "may" go down to 7 to 9 times per day.

    It is clear this slide show only gives limited info. However, I completely agree that a formula company should not be the one developing instructional literature on nursing.

  9. That is awful. And although it does say it's funded by Gerber, it says the content is controlled by WebMD, giving it even more legitimacy.

    I was particularly upset that they said "By the second month, some babies no longer need night feedings, and may even sleep through the night," setting up unrealistic expectations and leading moms to CIO or top up with formula to get their babies to sleep longer.

    They also talked about growth spurts, but didn't mention the big one at 6 weeks (HELLO?!?) and told mom to avoid spicy and "gas-producing" foods. All the typical bad info as most other mainstream sources. :(

  10. Just to clarify, in case not everyone is aware, Gerber is owned by Nestle, which is the world's worst offender in terms of unethical formula marketing practices.

  11. Julakemla--I'm fair skinned, and based on many things I heard about fair skinned mothers...I prepared for nursing to be painful as I expected my first child...and I was not disappointed! For 6 weeks, latch on was toe-curling painful.

    With my second it wasn't quite so long.

    As a childbirth educator and doula, I can tell you that most of my clients that encounter pain with nursing do not "stick it out" that long.

    Before my third was born, I learned that despite being told I had a good latch, I DIDN'T The top lip was not flared out enough. I diligently worked to keep that lip flared, and I have had no pain with breastfeeding for any of my children since then.

    It really is true that breastfeeding should NOT be painful.

    For all those folks who aren't aware of this...WIC is a MAJOR supporter of Nestle/Gerber. Please write letters expressing your disatisfaction with how much of our tax dollars is going into their pockets! Women who receive WIC benefits are only allowed to purchase Gerber cereal for their babies (what if they want another brand? Or what if, like me, they don't use infant cereal at all? Why can't I buy Cheerios when my baby at 10 months old?), and only allowed to purchase Gerber infant juice (again...what about moms like me who don't really use a lot of juice? Why can't I buy fresh fruit?).

    Most recently...they have started giving WIC recipients coupons to purchase NINETY jars of stage 2 fruits/veggies/meats every month for babies ages 6 months to one year. That is not restricted to Gerber brand...but realistically...a lot of those purchases are Gerber. Now I didn't use 90 jars of baby food total for my first 4 children, let alone 90 jars for one baby in one month! But beyond that...does an 8 month old baby really need to be eating stage 2 foods? Again, wouldn't allowing a woman to purchase fresh foods be better? Try boneless chicken breast at $2-3/lb rather than those disgusting meat sticks at $6-8 lb...

  12. Great post! Occasionally I will pretend to be a first time mother doing a web search. I am 28 wks preggers with my 3rd baby and I goggled '28 weeks pregnant' and one of the top ones was from Similac. I'm finishing a blog post about that site and how I think I would feel if this was my first baby and I had never breastfeed before. I'm linking to this post of yours when it is done because you have some great points!

  13. I take exception to feeding babies solids at 4 months. And heavens, don't wait until your baby is over a month old to train them on the bottle or they'll NEVER take it! HORROR!

    I AM part of the WIC program and they DO give me over 90 jars of baby food! This is my 8th nursed baby. I stopped wasting my time on jarred babyfood years ago! And I buy Beechnut, because some Gerber brands have cornstarch in them and I am trying to limit my family's exposure to GMOs.
    My 7 mo eats MAYBE one jar per day. And she's much more interested in table foods than baby mush.

    I am curious, though. I have had extreme nipple pain (cracked/bleeding) with all eight of my babies. I have had many different lactation consultants, La Leche leaders, etc. try to help but it seems that this is normal *for me* (I am very fair.) Do you think nipple soreness is ever normal? I've learned that if I can just push past day 7 I'll be ok.

  14. Would you take advice on kicking the smoking habit from a tobacco company?

    No, seriously, would you?

    This Gerber story is a good example of a conflict of interest.

  15. Stories like these just make me sad. Mothers and babies deserve better. I like the believe that few people would turn to Nestle / Gerber for breastfeeding advice. It makes me feel a little better. But when it's featured prominently someplace like WebMD, I'm not sure that my self-platitudes hold true. :(

  16. Hi Ladies:
    Thanks so much for all your posts. I appreciated your comments.
    But I would like to speak to the mothers who had sore nipples for weeks. First of all, I'm so sorry you had that experience. God bless you for hanging in there. Second, your experiences make me wonder if there wasn't something else going on inside your babies' mouths. Sometimes, latch can look fine from the outside. But if it still hurts, there is something else going on (perhaps a tongue-tie. Sometimes those can be quite tricky to diagnose.)

    But I am sorry you experienced so much pain!

  17. great post - I just found this via a friend who linked to it on Facebook. The bit about switch nursing to "avoid exhaustion" really conveyed the tone they were trying to set - that breastfeeding is difficult and fraught with troubles.

    I have not used WebMD for years - since I was pregnant with my oldest and they began putting formula ads on their pregnancy/breastfeeding/pediatric pages. It's a total conflict of interest.

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  37. I think this is an interesting article. I always thought Gerber was the best choice for babies out there.



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