Hi. I'm Emma Pickett, and I'm a lactation consultant from London. When I first started calling myself Makes Milk, that was my superpower at the time, because I was breastfeeding my own two children. And now I'm helping families on their journey. I want your feeding journey to work for you from the very beginning to the very end. And I'm big on making sure parents get support at the end to join me for conversations on how breastfeeding is amazing. And also, sometimes really, really hard. We'll look honestly and openly at that process of making milk. And of course, breastfeeding and chest feeding are a lot more than just making milk.
Emma Pickett 00:47
I am very honoured to be joined today by Shel Banks IBCLC. We could literally devote the entire hour of the episode describing all the roles she does and all the areas of expertise she has, but here's my attempt at a quick summary. So she's a Board Certified Lactation Consultant. Shel works the NHS and she's based in hospital in northwest of England. She trains others and infant feeding support and infant care within the NHS and privately. She's an author and the link linked her book will be in the show notes. Her book on formula feeding was published last year. She's a trustee of the UK Association of Milk Banking, and she runs at least two other organisations as a volunteer. She's also a clinical director for Anya, which we'll be talking about later, they pioneer how technology can support new parents for good, which is exactly what we need. And on top of all that, and I don't know whether she has time to sleep or eat. She is studying for a PhD in supporting families with unsettled babies. And that's an area that she's really specialised in over the years and very much become known for specialising in in the UK. So she developed clinical guidance and research in this area as well. And that's why I've asked her to join me today to talk particularly about unsettled babies who might be struggling with colic or reflux or faltering growth. In particular, we're going to talk about what those words mean, we're going to talk about how we can help parents who are struggling. And before we get started, I just want to say one word to you. If you are listening to this, and you are a parent who is struggling with an unsettled baby, please know you are seen and heard. And hopefully the next hour or so will give you some help and support. You know, we are here to help you and we know how difficult it is living day to day and managing day to day. So Shel, are you still there, that was about 10 minutes. Is there anything I missed? That I didn't know about what you're doing?
Shel Banks 02:38
I don't think so. Thanks for that. Yeah, I do do a lot. I do a lot in small ways. Because there's so many of them, the more you stick your fingers in pies and wiggle them around, the more people ask you to do and it's so difficult when you're offered such great opportunities not to get involved. So I'm just greedy really.
Emma Pickett 02:58
So you're bad at saying no. Is that what you're really bad at saying? No.
Shel Banks 03:01
Yeah. And you know, great opportunities, you shouldn't turn them down, should you no one should look a gift horse in the mouth, etc.
Emma Pickett 03:07
That's definitely the dream. If you've got space for it, we're we're very glad that you do do all those things, because they support lots of different families in lots of different ways. How did you start to specialise in unsettled babies in particular, how did that become your kind of area of expertise?
Shel Banks 03:21
Well, I think I just noticed that there was a pattern of, well, exactly what you've just said, for the people who are listening. If they are out there, and they're struggling, there was a pattern for me, of them not being heard, there was a pattern for me that where I think I saw several families that are run, who'd got these babies who were itchy, or Wrigley or, you know, puking or, or, you know, awful nappies or whatever, and the parents were told, there's nothing wrong, this baby is fine. And it coincided with the opportunity to sit as a member of the nice guideline for filtering weight or filtering growth committee. And I just thought there's so many families who are in such a state and we'd seen them, you know, in, in private practice, but also peer supporters. And also just, you know, hanging out on mom's forums, you see these families who are in such distress. And I knew that I've got a place on this committee to do some work with faltering growth and at the same time, and I was meeting all these people in private practice at the same time and opportunity came up with my NHS role to do a secondment for one year to child health. So I had to take a pay cut. But I moved over to Child Health as an administrative researcher to do some work on Cochrane Systematic Reviews around colic. And I was so excited because I thought this next year, I'm gonna get to do the nice guideline, I'm going to get to read all this amazing literature about colic. By the end of the year, I'll have all the answers. And actually, by the end of the year, I'd got so many well defined question. Shouldn't it's not very many answers because the research isn't out there. And that, to me explained why families are struggling, why they feel unsupported. It's because we as practitioners, and the practitioners who can prescribe things, do not have the answers do not have the right guidance, we have a really good nice guidance on reflux, but it's for gastroesophageal reflux disease, not for standard physiological guests gastro esophageal reflux, that many babies something like 60% of babies, Puke once a day, regurgitate something, and parents whose babies seem to be in distress or parents who are distressed by it aren't being listened to, they're told it's normal and to kind of go away. So it seemed like a big opportunity for that year when I was very excited. And then, since then, I've just been frustrated. And then eventually, I got so frustrated that I applied to do a PhD. So I couldn't find the answers.
Emma Pickett 05:56
Good. So we'll come back to you in a few years time and end of podcast. Thanks, everyone. That was five minutes, we'll cut. So we're going to come back to again, when your PhD is done. Because yeah, hopefully there'll be more answers. But actually, talking to someone who knows the questions is helpful. And yeah, and even if we don't have the answers, you are a good person to help someone, investigate and tinker around the edges. And we need the people like you who who say that there aren't answers, because the dangerous, scary people are the people who say they've got the 100%, definite answer that's going to solve the problem.
Shel Banks 06:28
That's why I'm in private practice, I think, is I don't you know, as you, as you said, don't really have time for private practice. But if somebody finds me, and I don't advertise at all, but if somebody finds me, and they say, Gosh, my friend, Julie's sister's cousin, said, you sorted it for her and or I've heard about you somewhere, I don't turn people away, I try and find them some information, throw them some stuff, make some suggestions. And I probably say two, maybe three clients a month, and all remotely. And I have evolved a kind of way of working through what it might be for specific types of issues. That seems to work really reliably. But it's not evidence based. It's purely my empirical study of this, you know, 500 people I've worked with, where it has worked for people and where I believe it works, but it's not an evidence base, because I haven't got any kind of trial or, and that's where the PhD comes in. So alongside a literature review, alongside speaking to hundreds and hundreds of families, I'm going to present some ideas and ask them to tell me whether we think what I've suggested will work and then do a small evaluative study at the end to see if it does. That's the hope.
Emma Pickett 07:45
Okay, well, I'm confident that you're going to come up with something useful at the end of it. And I'm also confident that what you're doing now is useful, because I know I know some families you've worked with that you've really helped turn around. So that's what we're going to suck out of you in the next 50 minutes.
Shel Banks 07:57
One at a time is great, isn't it? One at a time is grateful that family, but I think like you, I sometimes get frustrated that it's only one family at a time and we should be there should be a faster, easier, better way of us all supporting everybody.
Emma Pickett 08:13
Yeah, that's definitely the dream. So let's imagine then Julie's cousins, hairdressers, neighbour phones, you and says that their their baby is crying all the time. They are really at their wit's end. What are some of the first questions that you ask when you're starting to investigate what's going on?
Shel Banks 08:29
Well, I think we know that some of what causes these babies to be unhappy is deviations from the biological norm. So we're thinking about microbial things sometimes for if they've got a gut upset, if they're crying appears to be the classic colic or reflux, you know, if they're, either they're regurgitating, or they are pulling their knees up and fro in the bodies about and they'd go solid, and they've got punched fests and all of that farting loads, not doing any pose, all of these sorts of things. And they appear to be in some sort of intestinal distress. Then as a as an adult human, we know that if you've got some sort of gut cramp or some intestinal distress, something is going on. Either you've eaten something weird, or somebody that didn't agree with you, or you've got a bit of a tummy upset and something because I use the phrase deviated from the biological norm a lot. And if we've got that kind of microbial dysbiosis, or bacteria on functioning, right, that's when we as grown ups have problems. So maybe that's what's going on for these babies is where I'm starting from. Okay. And so if they've had a caesarean birth, and they've missed out on that vaginal seeding, if they've had antibiotics, and they've had that immediate deviation of their bacteria, if they've maybe started off formula feed or they've they've breastfed, but they've had formula supplements, usually within the first 48 hours is really key 48 to 72 hours, just one supplement can do it if that family has got some pre existing kind of immune disorder stuff going on, so even even hay fever and asthma and eczema, but certainly if you've got the kind of classic IBS, I know, there's something that upsets me and sometimes I bloat and I take busker pan. And, you know, I have to have to take probiotics every couple of weeks to kind of make myself gut feel better. If you've got that going on in the parents, I think it forms a picture in which this baby was already vulnerable. And then the new vulnerabilities that we've given it since it's been born, just form this perfect storm for these little babies. Because lots of the older generation say, Oh, you've never had any of this colic reflux nonsense when I was in all these allergies we've got now we don't have didn't used to have them, I think, I think it might actually be true that we didn't have them a generation ago, and two generations ago, and that we are just a bit sicker. We more Ultra processed food with we've been eating oatmeal for processed food for probably 30 or 40 years. And we we've deviated massively, we've got a really high Caesarean section rate, our formula rates formula, supplementation rates are still high. We're a couple of generations into that particular deviation from the biological norm. So we're not breastfeeding. I think it's that perfect storm. So the questions I ask are, what was your birth? Like? Did you have skin to skin? You know, did they breastfeed to start with the did breastfeed again? And did they have formula at some point? And what is your family health like?
Emma Pickett 11:47
Yeah, I mean, what you're saying about us being sicker than perhaps previous generations ago, I mean, slightly off topic. But are we to clean is that that thing about all this antibacterial cleans and cleansing and antibacterial hand washes and
Shel Banks 12:00
Three years of anti back to get rid of a virus has always confused me. But before that, yeah, we were, you know, without that advert of kills 99% of germs dead? Well, where is it 80%, microbial or something that they the current figure they're talking about? We don't want to kill all our microbes. We are a super organism. We need them. They help us we should all go outside and probably eat some debt. You know?
Emma Pickett 12:28
Yeah, I once watched a documentary about how we're all meant to have worms and childhood. And actually childhood worms is how humans have developed through many, many millennia, and who, when we don't have worms, our immune system does weird stuff, and gives us a fever and starts looking for other things to be allergic to. And that's slightly I'm not proposing that your PhD topic is should we giving everybody worms, but maybe that's the area for the next one.
Shel Banks 12:52
I heard of a family yesterday, who, who, at the moment, the child seems to be squirming before they've seen any worms, they they take a shot of the worming solution, everyone in the house takes a shot of the webbing solution. It's like, wow, that's just a real willingness to take medication when you don't need this medication. You don't even know if there's a reason to have the medication out of a fear of something that we all had as kids.
Emma Pickett 13:20
Yeah, we'll come on to taking medication and perhaps you don't need to take medication. This is a minefield in this area. So let's come back to that word colic. Obviously, when someone signs up and says their baby's crying all the time, I'm guessing there's a bit of investigation about what does that mean? Because for some parents, perhaps a neurodivergent parent or a parent who's got other issues of dealing with noise and crying, yeah, a lot of crying might be somebody else's baby not crying very much. So yeah. What is normal for crying? And when do we start using the word colic? And what do you mean by the word colic?
Shel Banks 13:53
He he, I'll answer the first two bits, or the last two bits, first, I think the original definition of infantile colic is from 1954, a group of paediatricians made this beautiful thing called Whistles rule of three. The definition of colic, therefore, would be a minimum of three hours of crying per day, for a minimum of three days in a week, for a minimum of three weeks between the third week and the third month of life, which is just beautiful, as if nature arranges itself in such a way neat, it's very neat, and because it's tied up in a bow like that, all the doctors remember it. And so you arrive at the GP and say, Hi, my baby's crying. They go more than three hours a day, more than three days a week. How long has it been going? It's colic. I have diagnosed colic, but of course that only describes crying. And if I if I had a broken leg, and I'd been dragging my broken leg around on treated, I'd probably cry for a minimum of three hours a day for a month. have three days a week and so on. So it doesn't describe what kind of trigger there is for the colic or where that where that crying has, where the pain is that's causing that crying. So that that definition doesn't work. It works. It's a nice neat thing, but it doesn't describe what's going on. So the descriptor of what's going on is best served. And again, beautiful definition, it's in the I think the room five gastrointestinal disorders. Definition. And this is it's the spasmodic contraction of the smooth wall of the intestine, causing pain and discomfort. And that, as an adult, you recognise, you've had that you've had something Squeezy and painful in your gut. And when you see a baby writhing around, drawing their knees up clenching their fists, not knowing what to do with themselves, you can associate what you felt with what they look like, and understand what they're going through. And if they're crying because of that, that's why the parents are beside themselves, because they know what it feels like they can feel they can sense they can empathise with that child, and they just want to make it better. And as an adult, we go, hot drink is a hot drink helping Oh, no, it's not Oh, lying on my side, and curling up, no straightening out, I'll stand up a walk around. Babies can't do any of that they're in our arms. And they're just saying, Please help me, this hurts, you're my person make it go away. And that's why it's so so triggering for parents. And as you say, if you're neurodivergent, and the noise of that the overwhelm of that the, the sensory trigger of that is, is worse. And so when we get back to what normal baby behaviour might be, and what really is an extreme amount of crying versus what's a normal amount of crying, and that will vary from person to person to person. But that whistles rule of three is where we start. So if the baby's crying for more than three hours a day, bingo, that's our threshold. It's a nice easy one. But whether you feel like it's crying all the time, whether it adds up to a total of three hours, or whether we're talking about three hours of continuous crying, you know, sort of very subjective.
Emma Pickett 17:19
Yeah, different parents, parents exactly the same situation are going to need different help and different ways to stuff cost of living obvious. So colic is not wind, colic is not trapped wind.
Shel Banks 17:30
If it was that simple. You know, we just stick them all over our shoulder and they'd burp and that would be the end of that. Yeah, it is for some babies. It's simply that we filled them with liquid and gas, and then lay them on their back and expect them to be happy with it. But more often it isn't. If it was that simple. I wouldn't talk to anybody, I'd just send them a leaflet
Emma Pickett 17:51
and go off and sit on a beach somewhere with a chocolate umbrella in it. Yeah. Okay, so, so sometimes then, if a baby's crying a lot, it could be about wind and lactation consultants. We're going to start by looking at latching and positioning. And we're going to start by looking at how much boob is in a baby's mouth. are they feeding their oral cavity with breast, refer back to my episode on lip positioning attachment with Maddie to look about to look at how we can optimise latching So that is step one. And then it could be taking an air because it's fast flow and there's overactive letdown, and we might be looking at supply management. So so we're getting in isn't completely part of you know, separate from this story. None of that there is an element of that for sure. There are so many myths that fly around when it comes to thinking about why babies are unsettled. And I know you're somebody who really wants to be able to share evidence with families. Just to come back to your point about working on that Cochrane Review. What is a Cochrane review? And what do we how do we get to finding evidence out about babies.
Shel Banks 18:48
So if somebody does one study, and they have, you know, 500 people in the study, and they have a control where it's maybe normal behaviour or normal treatment, and then an intervention, which is whatever it is, they're going to test, and they roll right at the paper, and they will have a conclusion that will either be statistically significant or not statistically significant. And that one piece of evidence might contribute to the overall evidence, and people can pick and choose. So you might get somebody saying, but you know, the sky is green. And here is the proof, because I've done one study and it says that the sky is green, but actually there are 5 billion other studies that show that most people require regard the sky is blue. So a systematic review, looks to take and that's what Cochranes are. They're a systematic review. It looks to take all of the bits of evidence, all of the bits of research that people have done, and not do new research, but do a piece of research that puts all of these pieces of research together and builds a bigger body of evidence. Even though the parameters might be slightly different. The source material might be slightly different, the intervention might be likely different, the age of the participant might be slightly different. But to bulk them together as best you can, and come up with a much more significant solution or conclusion from all of that research. So it's the, it's the, it's the gold standard of research, because doing one piece of research is important. But if you've got 20 pieces of research, you can clump together, you're less likely to have that kind of error that you accidentally find out the sky is green because of one study. Then Cochran is world renowned as the kind of gold standard off the gold standard, it's a specific way of doing this review, that would be reproducible by anybody else. So the way that you write it up the way that you propose it, the way that it is critiqued by others, is done in such a way that everybody can check your work, and could redo it in a couple of years time with some new evidence to even further improves this sort of solidity of those conclusions. So it's all about how you write it up in the first place. It's all about how you say what you're going to do. And lots of them are abandoned partway through because it becomes obvious that it's, it's not possible to do it the way they wrote it up. So I was actually seconded to do three, one on dietary modifications to manage existing colic in milk fed infants. So that was either changing the type of formula or changing the maternal diet, obviously, for the breastfed babies, and then the second one was about probiotic use to prevent colic, not to manage it. And the third one, which is the one I really wanted to do, and therefore the one that they made me leave to last was the, you know, know, your audience was parental education to support families whose baby were defined as having colic, a meeting that threshold of three hours a day, and so on. And I was really hopeful that there would be some amazing education out there that we could lean on. And I could just use that and, you know, TLDR, there isn't. And what it did show was that, I mean, really loosely, there were two ways of measuring whether it solved the problem of colic or not. One of them was the recording device in the family's home, which literally just heard of the baby was crying, and worked out how much it was crying. And the other was the parents writing a diary to see how much they thought they were crying. Most of the studies, they had parent reporting, some of the studies, they had a recording device in the home, one of the studies, they had both, and the parents after the intervention, by and large, and I'm sure you can already guess what's coming, they had an intervention, and they reported less crying, even though there wasn't less cry. Even though when we looked at these studies with the recording, the babies were not statistically significantly reducing their crying even after the intervention. And at that point, I realised, it's not about solving the child's crying, it's not about figuring out the cause for everybody. For some people, for most people, if we could just make the parents feel better about it. That's the bigger long term impact. Because the families I meet when I say, that question I asked, which is, do you have any kind of allergic history yourself, you know, do? Do you have IBS or any kind of immune disorder? The majority of the families I'm dealing with who've got these babies who are crying, say, Oh, my goodness, my mom tells stories about how I was just a dreadful baby and I cried all the time. And actually, in my house, they still call me the winter. And you know, you're talking to like a 38 year old woman who's a proper grown up with her life and a career and you know, and her family still think she's the windy one because as a three months old, she cried. So for me, if I can make that go away, for these families and break that cycle, and these babies don't get those labels, those parents don't feel like bad parents. That's the answer. If I could just, you know, give them a pill or hypnotise them so that they didn't care that the baby was crying, the baby will eventually stop crying, and the parents will have had a better relationship with parenting.
Emma Pickett 24:19
Yeah, that magic pill that will be Oh, you couldn't you couldn't make lots of money from that magic? Yeah, no, that's normally what you do with a budget. Okay? So I don't want to drill down into the research too much, because I hear what you're saying about how there weren't necessarily definitive answers. But let's just come back to a couple of quick myths in this space. Myth number one, your child has colic because you're eating the wrong thing. And probably your child has colic because you're drinking dairy. The number of people literally in the last 24 hours and mom has said we've had a really unsettled day so I'm going to take dairy out of my diet. That was the conversation I had with somebody literally yesterday. It What do you say to somebody when they say oh, yeah, call it that's that's dairy isn't it? That's that's, that's that problem.
Shel Banks 24:57
I say, what an interesting thing to choose out of all the things you eat. So there's a couple of things on this. First of all, when I learned about physiology, I'm sure when you did as well, and when most of the doctors that we are talking about GPS and paediatricians who've reached the point where they're proper practitioners, what they learned about at medic medical school was the way that we digest our food is it goes in at the top, it goes through our digestive system, and it gets broken down. So we should not have chicken proteins or carrot proteins, or beetroot proteins running around in our blood because they should have been broken down in our digestive system into amino acids. So dairy, cow's milk protein should not be able to be running around in our blood. So how on earth would it be causing a problem of for years, and I've, I've been supporting moms for, you know, 22 years or something. And I think about 20 years ago, the first person said to me, Oh, my child's allergic to dairy that I'm eating and I thought it dickless that's not how it works. And then I met more and more and more of them who it wasn't just dairy, it was dairy and egg or it was soy or, you know, these This lists and they got longer and longer these lists over time. And I initially poo pooed it completely and thought that's not how digestion works. And then saw that they had found something that they cut out of their diet, and the child's issues went away. And I'm not just talking about parent reporting crying. I'm talking about a change in the colour of the poo as evidenced by a photograph or a change in the child's rash, as evidenced by a photograph. And the babies don't know about placebo. And I don't know how you would manufacture a change in paywall rashes via placebo. But anyway, so I I reluctantly started to think maybe there was something in this allergy thing. And then I looked for the literature. And at that time, probably, you know, 1520 years ago, the majority of the textbooks and I've got some big meaty old textbooks are by some ridiculous things. I've got paediatric neuro gastroenterology set up here on my windowsill, which I've dipped in and out of, but I can't say I've read it at about 100 pages long. But the these books just didn't cover this in any detail. But then they started as they had new iterations or new editions of books, they'd started off by saying, oh, there's no way that you can have a an allergy. If the mothers breastfeeding, it's only if the child is being formula fed. Then they started reluctantly saying, Oh, but there might be a dairy allergy. And so you could start taking dairy out of the diet and see if that works. And it's like, the literature took a while to catch up with what the parents were telling me. And now we know that the number one allergen for a milk fed baby is dairy. And that's because a large proportion of our babies receive infant formula milk made with cow's milk protein. So it stands to reason, but then when we start saying, but what about carrot and beetroot, and, you know, it's never carrots, and it's never been beetroot in my knowledge, but, but people add in soy. And then there's this idea that soy is very similar to dairy, and so that, but it actually isn't at all similar, and the proteins don't look at all alike. And it is more that we've used it in a similar way. So a generation ago, a baby who was reacting to their formula would have been given soy formula instead of cow's milk protein formula. And so here we are a generation later, and lots of babies are reacting to soy.
Emma Pickett 28:35
Okay, so baby with colic, the allergy conversation is gonna possibly be part of that conversation. But obviously, today's we're not so focusing on allergy in detail today. But But quickly, it wouldn't just be crying, what if it was allergy, that's a that's a gut in distress. And we're going to see other symptoms as well.
Shel Banks 28:54
Yeah, but I mean, it wouldn't just be crying. Because they'd be showing you that they were in pain as well. So they're not crying like in a temper. And they're not crying like I've hurt my leg. They'd be crying and arching their back and so on. I mean, I'm, I'm quite an allergic adult. And I, I react to different foods in different ways. So they could be reacting to different foods in different ways. It's not to say that it's always allergy, but a lot of it is react and an allergy is an immune reaction. And sometimes these might be intolerances instead, but for the purposes of this, it doesn't matter whether it's actually an allergy or an immune problem, because if you take the thing away, the problem stops. But it isn't always dairy, you know, to go back to your original thing. It's not always dairy. And sometimes it's dairy and 10 other things for that family, but actually, sometimes it's trapped gas. Sometimes it's parents not understanding how babies sleep. Sometimes it's over feeding, sometimes it's under feeding. Yeah. So it's not I've Googled called Like up dairy, I'm gonna start doing my own elimination diet by myself in my flat in Sheffield without any support from family cutting down professional thing that family say I've cut down, well, that's not going to do it. It's a it's an all or nothing if you want to actually test if something's causing a problem, you got to take it out completely cutting down won't do it. Because if it is a gut problem that's been triggered by this thing. It's triggered already. So even a tiny amount would do it. If you scratch your arm. The first Scratch is a bit painful, but then if you keep picking it scratch, it'll get worse. So that's the skin just like the skin on the or insights, you know, if it's triggered already, you need to take the problem away completely. And then see if when you put it back, it's still a problem.
Emma Pickett 30:46
Yeah. And don't do it by yourself. Get some support before you make that decision. Or you end up just eating rice. Yeah. Which is not going to not going to help you mental health as and you don't really know. Yeah. Okay, so probiotics. I know there are lots of products that parents take for colic, we could run through the whole list of all the different things but let's start with wouldn't want to. Let's start with probiotics. Is that something that you talk about with parents? And what did the Cochrane Review show? And is it a product that's worth trying infant probiotics?
Shel Banks 31:18
So I have personal opinions on probiotics, which are driven by evidence base, but the evidence base isn't good enough to have, you know, proper guidelines or recommendations. The preventative use of probiotics suggested that we need more research. That's all that's all that Cochrane came up with. It said, we need more research. And I thought, Good, I'm glad I'm not the researcher who has to do that. Because I'm my personal opinion is I'm not super keen on randomly, effectively randomly, giving live bacteria deliberately to young babies. If we knew if we were in the business of doing proper screening of the gut microbes in a particular baby by doing stool tests, and we could see what they were really short in and we could guess at what they might need supplementing with that will be great. But we aren't. So the ones that are mostly available quite easily to families, the big names that we that we know, tend to be targeted at babies born by caesarean section and babies who are formula fed, and it targets the bacteria that they're most likely to be deficient in. So that might be a really useful first step. For a formula fed says every unborn baby, but not for ages and ages, not before every feed forever, just a little, you know, few days to help establish in that baby with any baby where the mother is breastfeeding at all. I would suggest the parent would take probiotics, and that they wouldn't take a very simple thing. They'd take effectively a scattergun multi spectrum, loads of different strains, lots of different types of bacteria, because I've got some much more robust as adults, sticking a few live bacteria in there, given what we've probably done in our guts for the rest of our lives. Probably not a big issue. But again, I would say short, sharp, sharp, rather than rather than taking them every day, forever and ever. Because if they're going to do their job, they're going to colonise, and then the body should do the rest.
Emma Pickett 33:28
So it's not that that if the parent takes that bacteria it's is it that the bacteria enters their milk? Or actually, is it that the bacteria is going into the gut system, therefore is in the home is in the environment?
Shel Banks 33:39
It's both. Yeah, so the second is very important that the mother's got improves because the root of everything getting from her diet into her baby is via her own gut, and the stronger and more effective her gut is at screening stuff out the better. But it's her baby, you know, through the marvellous and terror memory pathway where the baby can tell the mom what she needs, what the what the baby needs, and the mom can deliver it mom can only deliver what she's got. So she's deficient in an entire group of microbes that the baby is keen on having. Mum can only have them if she's got them. So popping them back into mum. So she can colonise and then share. That's the route. I'm not, as I say, not keen on deliberately giving them to babies. But if you've got a caesarean born formula fed baby, there is no other route. And it might be worth upon.
Emma Pickett 34:31
Worth a punt PhD. Yeah, okay, so Okay, so yeah, I hear what you're saying just short, sharp shock and do your own reading and do what make a decision that feels comfortable based on the information you can absolutely that may not necessarily be a lot of it, but all about informed choice. The lack here is the inflammation. So what about some of these other things? We combine the shelves then what about colic drops, and we I guess we've got the drops that deal with wind Enos. And then we've got the drops that claim to affect digest Doing or, or provide lactase? What's your feelings about some of these other products.
Shel Banks 35:05
If somebody, a baby or an adult, has got for short term, a bit of a lactase issue, because they've had a gut insult of some sort, they've had diarrhoea, they've got a bit of a sore tummy for whatever reason. And they can't therefore digest the lactose in the milk products they're eating and drinking, it's worth taking lactase in order, just in the short term to make it easier for the body to adjust. So a milk fed baby, who is struggling, has had an upset has had green poo and, you know, mucousy stuff and a bit of really watery poo and some upset for a couple of days, just because they've had a virus or some sort of, you know, or their older sibling has given them something completely inappropriate to eat, that's worth again worth a punt for a couple of days, it will do no harm in those first in those few days, and it is only for a few days while the gut recovers. However, colic is not a lactose problem. That's it's not just that's what it is. So those collect drops aren't something that you should need before every feed or anything like that. And they're ridiculously difficult to give to a breastfed baby because you'd The instructions say to express some milk on to a teaspoon. So what that's five mil and put four drops of the lactase in. So now I think we can fairly, you know, categorically say there's no none of that sugar left in that milk and digested by the lactase enzyme. Give that to the baby. And then the moms to breastfeed as normal. And I've always wondered how it is that they think the lactase is going to hang around in the stomach while the mom does a 40 minute feed. And of course, it doesn't work like that at all. So it is just a way of being able to sell it to breastfeeding families as well as to sell it to babies, families, you could breast you could express your milk and put it in a bottle, but it's so much more faff to do it that way. So yeah, I'm not I'm not a big fan of those. The other kind of drops that you mentioned are the ones that supposedly DEAL WITH THE WIND problem. But they are designed to reduce the surface tension of gas bubbles and liquid. So what they do is turn 27 bubbles into one bubble. And if the baby is laying on its back, you can't get one bubble out or 27. So it's a question of having the baby up. Right? And a lot of this comes back to where does your baby actually spend the majority of their time you know, have you thought about maybe baby wearing pop them in a sling and see if that works?
Emma Pickett 37:42
Yeah. So that business about the bubbles coming into one big bubble. And the sound of a very large bubble coming out is quite reassuring. And I remember I read you talking about how some older colic measures created burping
Shel Banks 38:00
Oh, it's not even old. It's felt better today and saying No, it's It's and I'm not going to name them because I wouldn't like you to get into any litigated issues with the lovely podcast. But the number one selling great water in the UK. In my day, when I was a baby, I would say I was given quite a lot of it because it smells of one particular herb. And whenever I smell that herb in cooking, I still am transported to a happy place. Because when I was a little girl it had alcohol and sugar in it as well. And it doesn't anymore. It is just the herb and a chemical which breaks down to sodium bicarb and water. And if you can transport yourself back to GCSE chemistry. And think about stomach acid, hydrochloric acid and sodium bicarb and you put a spoonful of sodium bicarb into your hydrochloric acid. You make carbon dioxide.
Emma Pickett 38:58
Is that how you make a volcano isn't it when you hide your paper?
Shel Banks 39:01
Yeah, so instead of a paper mache cup volcano, you have a baby and you are making bubbles. And I have met parents who will swear up and down that their baby cannot burp without great water it's all I can do not to go you're making the bubble but honestly when I've explained it to people health professionals parents one at a time groups of health professionals and you get that oh what really? Oh my goodness we've been spending so much money on this the best snake oil ever.
Emma Pickett 39:36
I think we're so sort of trusting we sort of think they wouldn't be allowed they wouldn't sell it if it surely Yeah, somebody some government body there must be a bunch of people in some room somewhere that wouldn't let that happen. Gosh, but it happens. So we're selling products that don't work yet or literally make babies potentially more uncomfortable and Yikes. Okay, but that's satisfying birth. Parents will pay Lots of money for that because they think that's solving the problem. Yeah. And then the parent is calmer. The baby is calmer.
Shel Banks 40:06
Yeah, there we go. It's the magic pill.
Emma Pickett 40:08
Yeah. Yeah. So someone else when they got there first but yeah, okay. So that's a bit scary. So okay, let's talk about reflux. So you just talked about how 60% of babies roughly, will reflux at some point, what does that actually mean, when babies are bringing milk up?
Shel Banks 40:26
Reflux just describe something going through an aperture the wrong way. So you can have reflux in your kidney, you can have reflux in your car engine. In this instance, we're talking about gastro esophageal reflux, something coming from your gastro your stomach, into your oesophagus, we tend to mean it's coming up and out of the baby. So posit or a little bit of milk, dribble, or, you know, maybe a full on laundry change for that child or maybe even hitting the TV on the other side of the room if the baby's really forcefully refluxing. But it just means the milk is coming back up. And so yes, of course, so many babies do it every day because we as adults, quite often have a burp have a little bit, you know, have a bourbon. Thank goodness, that was that was a bit of my lunch there. I'll swallow that back down again. So with babies, they're full of liquid and we lie them down. So they're going to do it more often than we are. So that little muscle at the top of the stomach. That little sphincter muscle is not helping the situation. Well to lift there's a lot of pressure in the stomach and no pressure at all in the oesophagus. So it's very easy for it to release thinking it's letting out a burp, but actually let out some liquid. And it's no big deal completely physiologically normal for almost all babies to do a bit of that.
Emma Pickett 41:46
Yeah. And when does it veer into not being normal?
Shel Banks 41:51
Yeah, well, then we have this gastroesophageal reflux disease, about which helpfully there is a nice guideline, which means that all of the essentially a nice guideline is maybe 10, or 15, systematic reviews all group together to give recommendations about all sorts of aspects around a particular topic. And that's really clear that it says there are clear guidelines on what is standard physiological reflux in an infant and what is serious. So it would include things like bringing up bile having little brown bits in the milk that the baby brings up. So that's a bit of blood that's come from the oesophagus because the stomach acid has damaged it. A baby that's got hoarseness, or bronchitis or you know, a continuous cough because they've been bringing up stomach acid and it's damaging the vocal cords. Babies who are weighed faltering because they cannot hold in enough milk. Babies who are just inconsolable or refuse to feed because they're clever little brains have figured out the connection between the lovely warm, snuggly feed and that nice warm milk in their tummies. And a few minutes later, the pain and the discomfort of regurgitating. So there's a whole cluster of things that would suggest that it's more serious. And then the nice guideline says at that point, we should review feeding, and then consider track treatment, if the review of the feeding doesn't work, but that's not what we do. Within our society at the moment.
Emma Pickett 43:23
People go to the GP and they say I'm worried about reflux. And the GP says, Here's a screw up. Yeah, has GPS are not trained, well trained an infant feeding that's not that individual GPS fault. No, absolutely they go. Here's a thick nub. that'll that'll do the trick for you. So...
Shel Banks 43:37
and then fairly immediately the family say, Gosh, my child's really constipated now. And so the GP says, Well, you can have a laxative, and when the parents look perplexed and say, so now I'm giving two medications, they kind of go, oh, well, you can have an acid suppressant drug. And I'll write a prescription for that instead. And often there's absolutely no need for these and I, you know, it's a really serious drug to be given to these tiny babies two week old sometimes. And sometimes the parents don't even say reflux, they say crying. So back to colic, being medicated.
Emma Pickett 44:09
So the acid suppressant drug that has given us a sort of second, I mean, it sounds really complicated to get these medications different. Yeah, I mean, babies for a start. Yeah, both the thickener around the acid suppressant stuff, but don't we sort of need acid in our stomach?
Shel Banks 44:23
Exactly. Yeah, well, long term in adults. Again, again, we've got so much science and research based on what we do in adults that we can apply and, you know, put onto babies in some way. But we know that those acids are presence in adults long term. The effect of that means you have less stomach acid. We need that to process the food we eat, we need it to help break down and metabolise the components of that and if we don't have the acid, we don't break down enough of the fat soluble vitamins and minerals and release them to our bodies, which means long term in adults. If you're taking an acid suppressant, you should have been told Old that it leads to a rise in your risk of bone demineralization and osteoporosis. And that's in full grown adults. So there is a cutoff point at which they stop giving that medication and they start looking at surgery instead, in adults. In babies, we simply do not have long term research that shows what giving this as acid suppressants to healthy babies, because we've been giving them in neonatal units for years to very, you know, Prem vulnerable babies already who, without which they would have all sorts of other issues. But giving them to basically healthy term babies over a long period of time, you know, if we're starting at two weeks of age, for example, they might have that for nine months, or even 18 months before the baby sort of grows out, quote, unquote, grows out of their reflux, and they're regurgitation. And we can wean them back off the drug again. And we don't know what it's doing at that really vulnerable developmental time, you know, that first 1000 days when they're really, really vulnerable. We're deliberately making it so they can't metabolise fat soluble vitamins or minerals. Yeah. scares me.
Shel Banks 46:15
Yeah, and I must say, if a parents listen to this, and the child has got that prescription, and they're thinking that we're saying, You never give a child this drug? No, no, that's not the message. Absolutely not. This is about healthy babies who are refluxing normally, and everything else is fine. weight goes fine. Nothing else ominous going on. Yeah, baby's not even in pain at the point of refluxing. And but yet you are being given medications to stop what is Yeah, normal. That's what we're talking about. If your baby is really in pain, and reflux has been diagnosed, and there are other complications, we know that we're not saying that medication. And we're not medical professionals, we can't actually prescribe or diagnose or any of those things. However, my concern is that lots of parents are being told that this is the thing to do. And the we go back to that beautiful mnemonic that's used in in birthing that brain mnemonic that we should be told about the benefits, the risks, the alternatives, be asked about what our intuition or gut is telling us about things. And what happens if we do nothing. So whenever somebody makes a suggestion about an intervention, we shouldn't just be told this is the thing you do, we should be making a decision with the benefit of knowing about the benefits and the risks. And I don't know of a parent who's ever been told about the risks of using these assets depressants. So that's the number one thing for me not, goodness, stop taking that immediately. But actually, have you talked to you, as your doctor who prescribed this for you talk through the reasons why and why not? Because that's the place to start. And it may be there's some really compelling, as you say, this is chat. This is a child who's who's unwell and needs it. There may be some really compelling, then then find that's the right thing for this child. But if not, was that the right decision for you? And do you want to change your mind? Go and speak to your practitioner, and we'll find another practitioner who knows about lactation and feeding and who sits alongside your doctor conversation. So the doctor is not the only person to talk to about reflux, of course, but you know, what's going on with your positioning management?
Shel Banks 48:20
Management is the first thing that the NICE guidelines suggests and yet I see that step skipped with huge regularity.
Emma Pickett 48:30
Gosh, the amount of people that come to me and they've they've obviously got oversupply they've got hyper lactation, baby can barely cope with the flow. And they've been given an acid suppressant and so obviously about hyper like, yeah, it's scary. That could be another conversation. Okay, a PhD, Emma, maybe you? Yeah, I'm not sure I'm clear on okay. Right. So that's another conversation. So thank you for the vote of confidence. I might do a PhD. Okay, so babies can be unsettled because of colic. They can be unsettled because of reflux. Most obvious statement of the century they can be unsettled because they're hungry, as they're struggling with growth. What is faltering growth? How do we define that?
Shel Banks 49:12
Oh, there's some beautiful thresholds. We've got in the UK, the UK who grows charts, and in the rest of the world, they have the WHO gross charts. So the World Health Organisation, plotted the weights of, you know, 10s of 1000s of babies, breastfed babies, to look at what normal looks like for different sizes, starter sizes and different ages and, and also whether they're male or female babies, and have these beautiful charts with these curves on that the baby's weight should be plotted on as they grow as they age not grow. And the the thresholds that the nice guideline came up with for faltering growth are things like losing more than 10% in the first week. of life. So that's your first threshold. And then there are some thresholds to do with the actual lines, the centile lines that are drawn onto the graph. And in the UK ones, they're the equidistant these lines. So it makes a beautiful pattern curve. On the HU chart, they're not quite the same, they're not in the same place, but they follow the same curve. So the 50th, one is the same on both, but they follow different numbers up the chart. So then the threshold, it depends on the weight of the baby when it's born. So if the baby is within the middle part of the chart, so it's between the 91st percentile and the ninth centre, when it's born, the vast majority of the babies, the threshold is met for faltering growth when the baby has fallen through two of the lines on the chart. So if the baby was neatly born on the 50th percentile, which you know, some babies are, but most aren't most will be all over the chart, that's why we have 100 cent tiles, if they're born on the 50s, they could fall from the 50s to the 25th. And that would be fine. And they could fall from the 25th, down to the 14th. And at that point, they would meet the threshold for having weight faltered. So that might be that the if they did that, in two weeks, it would be scary, it will be very swift weight drop, if they did it, and there would actually be a weight drop, so that would be a concern. But if they do that over six months, it's very slow. But the point at which they meet that threshold, that's the point of concern. Now, I would argue that you can see it coming a mile off. And if it does happen over, you know, nine months or something, somebody should probably have said something earlier, if it was inevitable that that line was going to cross. But more often than not, because of the gaps between waiting, it'll be picked up at some stage, and somebody will say, Oh, your baby's falling down the chart. And parents can quite understandably, really worry about that, it doesn't mean that the child is suddenly vulnerable. And, you know, at risk of anything, it just means we're watching their weight. And they're not keeping up with the expected growth for a child of that age, that size, that sex and so on. So it's not super scary. And what we do if there are breastfeeding mamas, as I'm sure you've you've covered before, is we just make sure they're breastfeeding as effectively as possible. And maybe up the frequency a bit. And maybe if she consider expressing occasionally to just supplement that would be helpful.
Emma Pickett 52:41
Yeah. It used to be failure to thrive. Why did anyone ever think that was a good idea? Why did anyone use that phrase?
Shel Banks 52:49
When I first joined the nice guideline development committee, it was called the failure failure to thrive guideline, and we changed the name. So you're part of the team that changed the name? Oh, fantastic. The name was changed as a part of that process. Yeah, goodness, goodness for that, because that is one of the worst. Horrible, yeah, you did this! Awful.
Emma Pickett 53:09
So that 2017 Nice guidance. I'm just going to read a sentence from that guidance. It says, If supplementation with an infant formula is given to a breastfed infant, support the mother to continue breastfeeding, advise expressing breast milk to promote milk supply, and feed the infant with any available breast milk before giving any infant formula. So it's now 2023. Yeah, and I can't tell you how many times I meet families where growth is a worry, and they've just been told to give formula.
Shel Banks 53:39
But no, just stop for a moment and say, I'm so glad you like that sentence because we spent hours arguing to get that in. And actually that last part where it said and give the X breast milk to the baby. We added that after peer review, because we realised that just saying this should express would result in people stockpiling in the freezer as formula supplemented. You're quite right, though.
Emma Pickett 54:07
Oh, how can we how can we get people to follow the guidance?
Shel Banks 54:10
I have the advantage of having sat on the committee. So when I talk to someone I say, listen, here's a piece I've written about, you know, like a layperson version of this, which you can actually absolutely share the link for in your blurb for this podcast, and I hope everybody will get a chance to read it because the whole guideline is fairly wordy, and a layperson version is useful. And then I say, tell your typical health professional that I actually sat on a guideline committee and I outrank them on this because I know what it says. I don't know what do we do wear T shirts that say, have you read recommendation, blah, blah, blah, oh, we locally in my area we have with one of my NHS hats on. We have a policy and guidelines suite that cover, the whole of the LM ins use it. So all the hospitals and all the local authorities and all of the health testing services all use the same policy and guidelines. And we obviously have quite a good faltering growth guideline in there because I don't write it. And still we have GPS who haven't read it. And it's a perennial issue to get into the GPS and to the paediatricians as well, and to get them to recognise that they need to follow the nice guideline, we can only empower the parents, I think,
Emma Pickett 55:30
yeah, that probably is a good step, isn't it? Because we can use Instagram, we can use social media, we can use the parallelization and we can get that message out there. But also, it's great organisations like breastfeeding for doctors and hospital infant feeding network, these kinds of salutely fighting the good fight as well. Yeah, the T shirts, I get those made on it. Okay, so. So if someone is dealing with a baby with faltering growth, and in the short term, they're doing what we call triple feeding, so they're breastfeeding, they're expressing they're giving supplementation as well. What do you say to a parent that that helps that to make more to feel more manageable? Or more doable? What do you what practical suggestions? Can we have to make triple feeding easier to go with?
Shel Banks 56:11
I got a comment from somebody who, and I know we're going to come on to the annual app, but she was in the new app. And she'd asked a question about a new baby. And, and I jumped into answer. And she said, gosh, is this really shell? And I said, Yes, it is because my name pops up. Yes, it is. And she said, Oh, my goodness, you supported me four years ago. And my baby was wait, faltering, and I was triple feeding. And the first thing you said to me before trying to fix anything was, Oh, my goodness, you are working so hard, you must be exhausted. And she said that, I actually said something like you're working your tits off. That's what she actually said. I'd said, and, and I don't remember, you know, four years ago, how many families but she said, that was the thing that made that made the most difference to me. So the absolute first thing I do before I make any suggestions about how they can make it easier on themselves is tell them what they're doing is not normal. And that's why it's so hard. And actually, if we can just get the baby to feed more effectively. And if we could get to these families before, it is a critical thing, where they suddenly need loads of extra milk, because otherwise the baby is gonna get really poorly. If we can get to them sooner, that will be great. But otherwise, let's really concentrate on the breastfeeding rather than on the expressing and how many mills and how many hours has it been and all of that. I tend to get people to try and take it easy on themselves. To be honest, that babies are obviously well, you know, yeah, if the medical professional has checked this baby over on the well, but a little bit scrawny. I feel like we've got a week to play with.
Emma Pickett 57:58
So you've it's really about focusing on the positioning attachment. Yeah, feeding frequency, I often the second breast, are you switching switching sides?
Shel Banks 58:06
First, we learn Emma, the more, you know, I read a list of I do this PhD. I'm involved in all this stuff. It just comes down to PNa. Doesn't it comes back to supporting parents to know how to just breastfeed.
Emma Pickett 58:20
Yeah, I mean, the numbers of times, somebody's gone down the road route Rhodus supplementation, and they just didn't get support about PNA, of course, get support with positioning attachment. And that has to be number one, let's get that on the back of the t shirt of the same T shirt that says about the guidelines and supplementation at the front. Okay, okay, same sort of conversation, you're having a conversation with somebody whose babies really struggling, let's imagine we've had the week supporting with the positioning attachment, something's going on. And this baby really isn't putting on weight. And we could have a whole nother whole episode about sort of primary milk supply issues. Yeah, issues with the mother possibly hyperplasia or doesn't have breast about metabolic issues in the child, all of those all these things. So sometimes, a parent is not going to produce enough milk, and they may need to use supplementation. And I know, you will have had this conversation as well, when a parent is devastated that they can't exclusively breastfeed. And they, they are miserable at the idea of ending exclusive breastfeeding and starting to use formula. Obviously, that conversation is going to be individual and every situation. But what are some of the kinds of things you might say to a parent, if, if it looks like adding in something else is going to be needed? I suggest that they think of it as a medication.
Shel Banks 59:37
In that case, they're still breastfeeding, that breastfeeding, potentially they're breastfeeding exclusively if they're giving as much milk as they can, if that's how they it's helpful to them to reframe it, and that we are providing other calories for this child in some other way. So I don't tend to talk about supplementing so much on top ups, I like the idea that we're just providing additional calories for a child that needs additional calories.
Emma Pickett 1:00:09
Yeah, the idea about it being medicine, I think is a really useful concept. That's something I say as well. And, and sometimes a baby just needs a bit more fat on those cheeks, and they're going to be able to create better negative pressure inside the mouth and you're going to be more effective breastfeed is and that spiral will start going in the opposite direction formula can start salutely some people feel once they've started formula, that's it forever. Yeah. And you and I will both know families where that really really hasn't been the case. And it's gonna be different for every individual situation. Do you talk about donor milk with your you cam hat on? What do you talk about donor milk with parents?
Shel Banks 1:00:42
I don't really. And the reason for that is the majority of these families where its weight faltering with my UKAMB hat. And so I'm not really involved in milk banking and vice chair of a charity that supports the milk banks. I'm obviously very aware of milk banking. And again, I sat on the nice guideline for for donor milk banking, however, I'm very aware that we have a lot of very sick, very vulnerable Prem. Really, you know, it needy babies in the UK who aren't able to receive donor milk either. And that's who our donor milk is for principally. And yes, absolutely. In the beginning, when I got involved in this, I thought, if we can have enough donor milk for all the babies, no one will need to use formula. But that's not the situation we're in. So I don't, I don't suggest milk banks, because they should be supplying the neck neck is. And largely they are all families where, you know, maybe there's a cancer diagnosis or something like that. And you know, it's an acute, serious issue for that vulnerable family. And I'm really wary, and I'm saying this carefully. I'm not judging anyone who does peer to peer donor milk sharing between friends or whatever, I'm absolutely not judging that. But I don't want to know about that. I mean, as a lactation consultancy, we get into a slightly grey area where Yeah, become liable if something did go.
Emma Pickett 1:02:05
It's not that we don't think it's a concept that is helping families around the world. It has helped families for 1000s of years, we just can't give you the badge. Because it's not something we're able to necessarily do. That doesn't mean we're anti it by any means. Yeah, and there obviously, is informal milk sharing out there and there. And there are ways to make that safer, that you can research and look into if that's something
Shel Banks 1:02:26
and I'm happy to signpost to those resources. But I, you know, again, with an NHS hat on as well as my private practice hat, I absolutely wouldn't want to be documenting that in somebody's notes that I'd that I'm happy to have to document that I've had the note the conversation with them at which I've counselled them about the risks of that, and about how to improve their own milk supply. But I don't want to be saying, and I've told you that Emma from down the road can give you some a McDonald's car park on Friday at five o'clock? Because that is yeah, the the grey area gets really murky.
Emma Pickett 1:02:58
Yeah. And actually, also, I would just like that some people go straight to that. Having had the time and looking at their own milk supply without having to sell positioning and attachment supplementation of anything is not the answer if the first questions got to be about your own milk supply and your own breastfeeding. So I know you work with families that aren't breastfeeding at all, you worked with formula feeding families, and your book is about formula feeding. And you've you've helped develop guidance around bottle feeding. If a formula fed baby is really unsettled, and really struggling, what are some of the things that you talk about in those situations?
Shel Banks 1:03:34
Kind of the same? Actually. There's a lot around what kind of birth did they have? And, you know, and how you're holding them? How are they being? How are they burping? How are they being fed? What are they being fed? And how much are they being fed if they'd been given a six ounce feed when they're only three weeks old, and their little tummies just can't handle it. So it's a lot about feeding technique. And I do ask what milk they're using. And I do make suggestions about ways that they could make the milk simpler for their baby, because they everyone always says so you know so much about formula, which one's the best one, there isn't the best one. They're all nutritionally appropriate. But in my experience, and definitely in my book, and as I know, you know, the more I know about it, the more I see that the expensive ones tend to have more ingredients that aren't necessary. And without doing any science at all. If they have things in that aren't necessary, potentially that's putting more of a strain on the digestive system and causing more problems. So I wouldn't recommend one over another. But I would suggest that people steer clear of the ones that make all sorts of claims about the formula.
Emma Pickett 1:04:47
Yeah, seems logical. Keep it simple. And what about some of these special products?
Shel Banks 1:04:51
I think I can predict what you're going to say here, but let's just wait. What about some of these special milks that say they are for babies with colic or for babies with reflux? Yeah, they're not well, so babies should only be receiving as per recommendation, they should only be receiving first stage infant milk unless they have had something prescribed for a specific dietary need, or metabolic need, you know, they can't process protein or if they can't process lactose or if they can't process a cow's milk protein, and they need a specialist formula prescribed by a paediatrician and abused under the use of the under the oversight of a consultant in hospital. Otherwise, they should be on a basic first stage infant formula. Everything else is neither infant formula nor medicine. It's a thing called Food for special medical purposes. And it is less regulated than either medicine or infant formula. And they shouldn't exist, in my opinion, because there is no need for them. There is a market for them. And that's not the same.
Emma Pickett 1:06:02
Yeah, so it's coming down to vulnerable families again, looking for answers and the desperate word on the tin. Sounds like it's what your baby has. Let's Yeah, the 10 even though the tins expensive, and you might be able to get the same 10 tomorrow. Yeah, so lots of people exploiting families, which is super scary. Yeah, that's another t shirt, we have a lot of data to one label on the front, one on the back. And a hat was on the hat as well. Okay, so I realise we've been talking for over an hour, and we could do another three hours of there. So let's, let's just think about some of the recommended resources and places where you do signpost, parents, I want to ask you a bit more about Anya, which I know you're doing a lot of work with at the moment, tell us what Anya isn't it and how it helps the families that you support.
Shel Banks 1:06:48
So now, it is a parenting app from conception to two years. And it aims to support all parents or all stages with all sorts of questions about parenting and feeding. It began life as a breastfeeding support app. And we quite quickly realised that you can't make the changes that we wanted to make in the world where we have more people breastfeeding and breastfeeding for longer and having more success with breastfeeding and feeling less rubbish about their lack of success with breastfeeding, if you don't get to them until they're having a problem. So it's an antenatal app so that folks can join and ask questions in pregnancy and can learn about you know, while they're learning about what they might want to pack in the hospital bag, the app can prompt them to think about feeding choices to think about optimal cord clamping to think about skin to skin and make better informed choices. So it's evidence based, it's got a load of specialist spiff behind it and in it. And my hope is that it means that you and I are gonna have a job. I don't think we're actually under any threat, I think we're gonna continue to be busy. But it does it because of the way it works. Because it's an app rather than an individual person. There's stuff in there that's written the stuff in there to read the stuff in there to watch their videos, there are animations you can play with. And there's an AI component like a chatbot. That's got my brain and the brains of many of my colleagues kind of sewn into it. And it answers questions at two o'clock in the morning when I'm asleep. And it potentially could answer 1000 questions in a millisecond. So the scalability of it is massive. And we are not, you know, we're not overrun with peer supporters, midwives, health visitors and all of the other practitioners that we might want to support these families. And while we've got a shortage of humans, the AI, doing our jobs, for us, at least to some level, takes a lot of that burden away. And you're right, I spent a huge amount of time on it, I'm super passionate about it, I really hope that it's the, you know, it's the great golden hope to change things so that people can find it in their little phone shops. And why a an ya, it's free to download, it's free to use but the use the version you get, if you are just downloading it and using it and you don't live in an area where it's been commissioned by the local authority, you get a freemium version of it, that you can have a look around, and it will, it will help you with you know, crucial time sensitive things like pain, or bleeding nipples or weight faltering and so on. But it won't give you that kind of wider, richer, deeper involvement and you don't you only get five conversations with the AI a day, not unlimited numbers, you can only see some of the webinars and some of the content because what we want is for it to be commissioned by the local authorities in the in the community health health services. And so that's that's what's we're Okay, so currently, I in my mind, I have a little map and I'm colouring it in. We've got a large amount of the northwest of England, and bits of London and we've got bits to the south, where am I, southwest, we've got little bits in the Midlands, all over the place, there's little dots, and I'm trying to join them into other bits.
Emma Pickett 1:10:22
So anyone thats ever followed me or listened to any of my staff knows that I do not recommend products, I do not recommend things that cost money. But Anya is an exception to that.
Shel Banks 1:10:33
I don't want people to have to pay for it.
Emma Pickett 1:10:35
No, I can, I can hear that too. But even if they live in an area where it's doesn't exist, it's uncomfortable with us talking about the fact that exists in those areas,
Shel Banks 1:10:43
I gather, it's £17.99 for a month of the premium access. So that is, you know, you can buy formula, a 10 a formula that's not much more than that. And certainly when you talked about the the electricity and the water and the cleaning of the bottles and everything, you're probably talking about a week's worth of formula for the price of a month's worth of using the app and and getting loads of information on how to breastfeed more effectively and get support in there. And if the AI doesn't know what to do, or the parents want to speak to somebody else, a specialist will pop up if they ask for it. And it's not just for mommies, for daddies, for aunties, uncles, grandparents, health professionals, lots of health professionals in there.
Emma Pickett 1:11:26
And you've got a great team. You've got a great team, right? Yeah, well working with that one year. And the very cool thing is Chen was a digital special effects film person who worked on the film gravity and so some of the she has an Oscar faster. Some of the animations breastfeeding animations are made by an Oscar winner of CGI person, he doesn't want that. Yeah, that's that's the cool thing, too. Okay, thank you very much for describing any any other resources that you use a lot and a burnt out on your laptop because you're constantly sending links to them any other places.
Shel Banks 1:11:57
Yeah, that's a really good hand expressing video from Best beginnings that was part of their small wonders suite that I use all the time, because hand expressing is such a useful skill, and midwives don't have time to teach it. So you can learn it for antenatal colostrum banking, you can learn it to deal with any issues, you can learn it to tempt a baby. And the very best version of an explainer video that I've ever seen is actually part of the suite that's aimed at neonatal parents. But such a good, such a good resource just a few minutes long, and I'll make sure that your folk have that too.
Emma Pickett 1:12:36
Thank you. That's really cool. Thank you. So I have a feeling we've been a bit naughty and crammed for podcasts into one podcast today, we've done one on reflux and one on allergy and one on filtering growth. But so I really appreciate you allowing me to cheat and squeeze everything into one podcast and write or have all your knowledge and all the expertise that you share with families. I'm really grateful and I'm gonna nag you for some of those links to pop in the show notes if I can't find them myself. Thank you very much for your time shell really appreciated.
Shel Banks 1:13:04
No problem. It's been awesome.
Emma Pickett 1:13:11
Thank you for joining me today. You can find me on Instagram @EmmaPickettIBCLC and on Twitter @MakesMilk. It would be lovely if you subscribed because that helps other people to know I exist. And leaving a review would be great as well. Get in touch if you would like to join me to share your feeding or weaning journey, or if you have any ideas for topics to include in the podcast. This podcast is produced by the lovely Emily Crosby Media. One final thing, I have a discount code for my podcast listeners for my last two books, the one on supporting breastfeeding past the first six months and beyond and the one on supporting weaning or the transition from breastfeeding. If you go to the UK Jessica Kingsley press website which is uk.jkp.com and put in the code MMPE10. That's mm for makes milk P for Pickett E for Emma one zero, you'll get a 10% discount on checkout. Thank you