We are advocating on behalf of XXXXX, a breastfeeding infant. We would like to bring to your attention several pertinent points about XX, and her specific needs. These facts need to be taken into consideration when you discuss care arrangements for XXX during this investigation: specifically, the proposal to enforce an abrupt cessation of night feeding upon XXXX, by prohibiting her access to her mother’s breast between and .
XXX is a bed sharing, night time breastfeeding infant. She feeds anywhere between 5 and 7 times a night. This represents normal parenting practice with a breastfeeding infant. It is both the cultural norm, globally, and medically researched and evidenced as excellent parenting practice.
An abrupt cessation of night time feeding will adversely affect the health and well being of XXXX, and her mother in the following ways.
*XXXX will become distressed and emotionally distraught at the sudden weaning. She will probably lose weight, as she will have lost much of her calorific intake, as night feeding is higher in fats than day time feeding. Her distress may become so great, she might refuse the breast completely. This premature weaning will raise her risks of significant illness later in life, including a higher probability of heart disease and diabetes.
*Her mother will suffer engorgement from the abrupt weaning. If not given appropriate support, this could lead to swelling and infection, and require anti-biotic treatment. Her milk supply will be adversely affected by the lack of night time feeds, and this may result in the loss of the breastfeeding relationship.
Night time breastfeeding supports XXXX’s health and well being by:
giving her excellent nutrition, important when already fighting an infection
supports her immune system, important in helping her heal her burns
comforts and soothes her pain and distress, she is in pain and distress from the burns
protects her mother’s milk supply, particularly when she is distressed herself
We urge you to consider XXXXX’s night time breastfeeding needs as you consider how to support her during this investigation. Her mother has already offered to reside with XXXX in any residential unit you might suggest. Given that enforced and abrupt night time weaning will adversely affect XXXX, and may have life enduring health consequences for her, we advise extreme caution in relation to any proposal to deny her breastfeeding rights.
Evidence and experts
We’ve enclosed full supporting material on all the statements made here, about XXXX’s breastfeeding needs. Many world renowned experts have hurried to XXXX’s defence, and their supporting letters are copied here. Lactation experts such as Dr Jack Newman, Pamela Morrison, and Karleen Gribble, have all written in medical support of XXXX’s needs, with references. Pamela Morrison and Dr Newman are also undertaking an exhaustive study of XXXXX’s weight records from birth, to see if evidence of a clinical problem can be found. This will also allow us to clearly identify any weight loss from enforced weaning, and allow that to be excluded from any investigation of her health since statutory agencies became involved.
All of these experts are happy to be contacted by the statutory agencies, free of charge, in order to give further appropriate medical advice.
If you wish to discuss the risks to XXXX’s health with a breastfeeding expert who is neither part of our organization, nor knows the family, and is local to you, please phone XXXX. She is a breastfeeding counsellor and trainer with the NCT in XXXX.
The European Court of Human Rights’ imperative that breastfeeding infants not be denied the breast is recognized within the English court system:
"Per curiam. If the state, in the guise of a local authority, seeks to remove a baby from his parents at a time when its case against the parents has not yet even been established, then the very least the state can do is to make generous arrangements for contact, those arrangements being driven by the needs of the family and not stunted by lack of resources. Typically, if this is what the parents want, one will be looking to contact most days of the week and for lengthy periods. Local authorities also had to be sensitive to the wishes of a mother who wants to breast-feed, and should make suitable arrangements to enable her to do so, and not merely to bottle-feed expressed breast milk. Nothing less would meet the imperative demands of the European Convention on Human Rights."...
In the matter of unborn baby M; R (on the application of X and another) v Gloucestershire County Council. Citation: BLD 160403280;  EWHC 850 (Admin). Hearing Date:
If you require any further clarification, or medical evidence from us, please don’t hesitate to contact me.
Should you decide to enforce night weaning upon XXXX, we advise you that her mother will immediately require proper lactation support. She will need access to a hospital grade breast pump, at night, to deal with her engorgement and maintain her supply. The expressed milk will need to be stored and transported to XXXX under appropriate storage conditions. We have collected the appropriate information for you, on pump hire suppliers and costs, and couriers capable of cold storage delivery in the XXXXX area.
We are advocating on behalf of XXXX, a breastfeeding infant. We have been informed that XXXX’s growth has been called into question, specifically her weight gain profile and status. Therefore, we commissioned an independent and well qualified and experienced expert in the field, to conduct as assessment of XXXX’s official NHS weight gain records since birth. Her comprehensive results and analysis are in the next section of this statement.
The expert has stated that there is no indication of any problem in XXXX’s weight chart.
Understanding how to interpret weight gain charts is a complex business. Therefore, for the advantage of the layman, we have also included here a brief summary of how to use weight gain charts. Our expert used the internationally recognized and globally accepted standard of growth, the World Health Organisation’s Child Growth Standards.
The growth standards encompass a weight to height graph, with the normal bell curve of small growth children from smaller than average growth parents, through average growth ranges, to larger growth ranges from larger than average parents. The important factor is not which percentile (where you lie as a reference to rest of the normally growing population) but the individual pattern of growth, the ‘trajectory’:
"The assessment of growth implies looking not at a single measurement point but at the overall trajectory of growth to determine whether a child is tracking along the curve or is crossing centiles towards the lower centiles. Infants born with low birthweight will be expected to track along the lower centiles of the WHO standard since exclusive breastfeeding does not alter the fact that they were small for age in the first place. By looking at a single point, a baby in this category will indeed be considered low weight-for-age; but before deciding that exclusive breastfeeding is inadequate, most health professionals will consider the baby’s birthweight, growth trend, any problems with lactation, and infections that might explain the apparent growth failure." “WHO Child Growth Standards” Dr Mercedes de Onis & Dr Adelheid Onyango, Co-ordinators, WHO Child Growth Standards Project,
Therefore, there is no causality between being on a low numbered percentile, and this being an indicator of faltering or problematic growth. An infant that tracks through from the 10th percentile from birth, is as healthy and robust as an infant in the 90th percentile that is tracking equally smoothly.
In order to make this more clear to the layman, in terms of XXXX’s status as a normally breastfeeding toddler on an appropriate diet of offered complementary solids, we contacted Dr Mercedes de Onis, at the World Health Organization, and explained that a perfectly tracking infant on the 15th percentile (XXXXX) was being flagged up as having problematic weight growth on the basis of the sort of ‘single point’ assessment the above quote flags up. Her co-worker, Dr Adelheid Onyango, responded on XXXXX’s behalf:
“The internationally accepted cut-off for underweight (by a single-point evaluation) is
equivalent to the 3rd centile. Therefore, a child whose growth is tracking on the 15th
centile cannot be considered to be underweight.”
Dr Adelheid Onyango, Coordinator, Growth Assessment and Surveillance,
Nutrition for Health and Development (NHD), World Health Organization,
CH-1211, GENEVA 27, Switzerland, firstname.lastname@example.org
(telephone contact via Family & Community Health, GENEVA, + 041 791 2888)
Therefore, as XXXX’s advocates, we have to inform you that using all current, evidence based medically researched data and theory, no suitably qualified expert can find any indication of a problem with XXXX’s weight gain and pattern of growth, from either a long term trajectory analysis or a single point evaluation.
Please don’t hesitate to contact me if we can help in any other way. Both Pamela Morrison (IBCLC) and Dr Onyango are happy to comment further if required.
** XXX’s Weight Chart Assessment (Pamela Morrison, IBCLC)
** Handy ‘understanding weight and babies’ info sheet (Dianne Weissinger, IBCLC