NDC scientific publications which called out overtreatment in care of breastfeeding problems and unsettled babies
For many years, the Neuroprotective Developmental Care or the Possums programs have called out overdiagnosis and overtreatment of breastfeeding mothers, their babies, and of unsettled babies.
At the same time, the programs have aimed to offer effective, genuinely evidence-based clinical strategies for management of the wide range of breastfeeding problems faced by breastfeeding women and babies, and also for the management of unsettled infants (known as the Possums 5-domain approach to infant cry-fuss problems).
| Year | Topic | Scientific publications contributing to the Neuroprotective Developmental Care evidence-base, which raised the alarm about overtreatment and unintended outcomes |
|---|---|---|
| 2011-2013 | Reflux and allergy | An essay which (as far as the author was aware) was the first in Australia, and among the first internationally, to raise the alarm about inappropriate treatments of reflux and allergy for unsettled infants, which risked side-effects including true allergy diagnoses in later childhood. This was followed by a Medical Hypothesis article proposing that the epidemic of the diagnosis of infant reflux demonstrated mismatch between evolutionary biology and Western culture; cover articles on the BMJ and Archives of Disease in Childhood, and an article in the Journal of Paediatrics and Child Health, tried to reinforce this message. |
| 2013 | Infant sleep training | A systematic review which showed that the dominant sleep training approaches to infant sleep problems did not decrease frequency of night waking, and risked unintended outcomes. |
| 2018 | Upper lip-tie | A newsletter which was (as far as the team including the author knew) the first internationally to raise the alarm about the new diagnosis of upper lip-tie in infants, due to similar concerns. |
| 2013-2016 | Posterior tongue-tie | An article in Breastfeeding Medicine was the first to raise the alarm concerning the new diagnosis of posterior tongue-tie in infants with breastfeeding problems, arguing that this diagnosis lacked anatomic or functional rationale and applied a reductionist, medicalized theoretical frame to the complex problem of suboptimal biomechanics during sucking, and which again risked unintended outcomes; critiques of methodology of research claimed to support this diagnosis. This was followed up by a number of articles aiming to show how overdiagnosis of restricted oral connective tissues was taking hold. |
| 2019 | Mammary candidiasis | A systematic review demonstrating the lack of evidence to support long treatments with antifungal medications for lactation-related nipple pain. |
| 2022 | Breast massage | Letter to the Editor concerning use of therapeutic massage of lactation |
| 2022 | Breast inflammation and nipple pain | A trilogy of review articles critiquing low value care in the management of lactation-related breast inflammation and nipple pain. These were the first research publications to call out the lack of evidence base concerning use of lecithin, therapeutic ultrasound, probiotics, nipple balms, lanolin + hydrogels. This trilogy addressed unnecessary diagnoses such as subacute mastitis, infected galoctocoele, and infective vs inflammatory mastitis. |
| 2023 | Breast inflammation | A critique of Clinical Protocol #36 by the Academy of Breastfeeding Medicine demonstrating that it lacked a reliable theoretical frame or evidence-base, and promoted low value care and poor stewardship of antibiotic. |
| 2022 | Domperidone | I published an education article for GPs in The Medical Republic exploring the overuse of domperidone for low supply. |
Recommended resources
References
Douglas P. The rise and fall of infant reflux. In: Finkel E, editor. The best Australian science writing 2012. Sydney: New South 2011. p. 62-78.
Douglas P, Hill P. Managing infants who cry excessively in the first few months of life. BMJ. 2011;343:d7772.
Douglas PS, Hill PS, Brodribb W. The unsettled baby: how complexity science helps. Arch Dis Child. 2011;96:793-797.
Douglas P. Diagnosing gastro-oesophageal reflux disease or lactose intolerance in babies who cry alot in the first few months overlooks feeding problems. J Paediatr Child Health. 2013;49(4):e252-e256.
Douglas P, Hill PS. Behavioural sleep interventions in the first six months of life do not improve outcomes for mothers or infants: a systematic review. J Dev Behav Pediatr. 2013;34:497–507.
Douglas PS. Re-thinking 'posterior' tongue-tie. Breastfeeding Medicine. 2013;8(6):1-4.
Douglas PS. High level evidence does not support first wave behavioural approaches to parent-infant sleep. Sleep Medicine Reviews. 2015;29:121-122.
Douglas PS. Deep cuts under babies' tongues are unlikely to solve breastfeeding problems 2016. Available from: https://theconversation.com/deep-cuts-under-babies-tongues-are-unlikely-to-solve-breastfeeding-problems-54040.
Douglas PS. Tongues tied about tongue-tie. Griffith Review Online. 2016.
Douglas PS. Conclusions of Ghaheri’s study that laser surgery for posterior tongue and lip ties improve breastfeeding are not substantiated. Breastfeeding Medicine. 2017;12(3):180-181.
Douglas PS. Making sense of studies which claim benefits of frenotomy in the absence of classic tongue-tie Journal of Human Lactation. 2017;33(3):519–523.
Douglas PS. Special Edition: Tongue-tie Expert Roundtable. Clinical Lactation. 2017;8(3):87-131.
Douglas PS. Essays on health: Australia is failing new parents with conflicting advice - it's urgent we get it right. The Conversation. 2017;12 September https://theconversation.com/essays-on-health-australia-is-failing-new-parents-with-conflicting-advice-its-urgent-we-get-it-right-77943#comment_1401519.
Douglas PS. Untangling the tongue-tie epidemic. Medical Republic. 2017;1 September:http://medicalrepublic.com.au/untangling-tongue-tie-epidemic/10813.
Douglas PS. Preventing overdiagnosis in the first months of life (abstract). BMJ Evidence. 2019:10.1136/bmjebm-2019-POD.1139.
Douglas PS, Cameron A, Cichero J, Geddes DT, Hill PS, Kapoor V, et al. Australian Collaboration for Infant Oral Research (ACIOR) Position Statement 1: Upper lip-tie, buccal ties, and the role of frenotomy in infants Australasian Dental Practice. 2018;Jan/Feb 144-146.
Douglas PS. Overdiagnosis and overtreatment of nipple and breast candidiasis: a review of the relationship between the diagnosis of mammary candidiasis and Candida albicans in breastfeeding women. Women's Health. 2021;17:17455065211031480.
Douglas P. Re-thinking benign inflammation of the lactating breast: a mechanobiological model. Women's Health. 2022;18:17455065221075907.
Douglas PS. Re-thinking benign inflammation of the lactating breast: classification, prevention, and management. Women's Health. 2022;18:17455057221091349.
Douglas PS. Re-thinking lactation-related nipple pain and damage. Women's Health. 2022;18:17455057221087865.
Douglas PS. Does domperidone increase breast milk production? The Medical Republic. 2022;12 May: https://medicalrepublic.com.au/does-domperidone-increase-breast-milk-production/68870.
Douglas PS. Does the Academy of Breastfeeding Medicine Clinical Protocol #36 'The Mastitis Spectrum' promote overtreatment and risk worsened outcomes for breastfeeding families? Commentary. International Breastfeeding Journal. 2023;18:Article no. 51 https://doi.org/10.1186/s13006-13023-00588-13008.
Douglas PS. Author's response to Comment on: Rethinking lactation-related breast inflammation: classification, prevention and management Women's Health. 2023;19:17455057231166452.