Mixed feeding for infants - podcast episode cover

Mixed feeding for infants

Jun 22, 202540 minSeason 8Ep. 4
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Episode description

Today on the podcast we chat with Nursing Professor, Elizabeth Denny-Wilson.

Elizabeth specialises in obesity prevention research with special focus on infant feeding and primary health care. 

Elizabeth is on the WHO committee writing the guidelines around infant obesity prevention. She has a position on the National health and research council and is a member of their obesity committee. Elizabeth is also a board member of The Sydney Children’s Hospital Network. 

Elizabeth is a remarkable woman and nurse whose empathy and compassion for new mothers and their babies is clearly evident throughout our chat together.

Through all the research she has done and contributed to, she has found a large gap around mixed feeding for mothers.

We all know breast milk for babies is the gold standard, but what if you can’t breast feed, have to return to work, have poor milk supply or baby refusal of breast?

What happens then? 

We discuss this and more! We talk about mixed feeding where breast and formula milk are both used and just how little information there is around this.  Elizabeth discusses the need for us to be supportive of new mums as this can be a very stressful time, especially when there is advice and suggestions coming from loved ones, well meaning friends and even strangers feel they can add their opinions unsolicited.

I felt so privileged to chat with such a remarkable nurse. I hope you enjoy this conversation with Elizabeth.

Bek x

This episode has been sponsored by Nutricia, and my heartfelt thanks goes to their amazing support of our nursing community.

This episode was created independently by the speakers and the views expressed herein are those of the speakers, not of Nutricia. This content is intended for healthcare professionals. Medical professionals should rely on their own skill and assessment of individual patients.

www.nutricia.com.au

www.tendernessfornurses.com.au

Support the show: https://www.patreon.com/tendernessnurses

See omnystudio.com/listener for privacy information.

Transcript

Speaker 1

Appogia production.

Speaker 2

Hi everyone, thank you for tuning back into Tenantus for Nurses. I suspec Woodbine here this season. I am so excited to announce that the podcast as being supported by Nutritia, which is a global leader in medical nutrition. They understand the needs of nurses in the nutrition space and for over one hundred and twenty five years have provided products to support child health. Some of Nutrita's pediatric brands include Neo Kate Junior for children who have food allergies and

app to Grow for those fussy eaters. And those of us who have children know many kids who go through the phases of definite fussiness. For more information and resources, visit the nutritiona Pediatrics hub at nutritia dot com dot au forward slash Pediatrics. I just want to say a huge thank you to Nutritia. Their desire to support nurses is truly appreciated, and they are allowing me to continue this podcast so that we can all grow as nurses.

This season, we have some amazing speakers in the pediatric space which I cannot wait to share with you all. Hi, my name's Beck Woodbine and welcome to Tenderness for nurses.

Speaker 3

I'm grateful for the person that I have the opportunity to.

Speaker 1

Be, so I hit it and parked it for Nellie for years. We always have free will, We always get to choose. We are autonomous.

Speaker 2

Hi everyone, thank you for tuning into Tenderis for Nurses. We are very excited this season to be sponsored by NUTRITIONA and I have the fabulous professor Elizabeth Denny Wilson, who specializes in obesity prevention in babies, but also she has done some significant research into the area of mixed feeding, and probably that is what we're going to address a little bit more today.

Speaker 3

But thank you so much for coming on.

Speaker 2

I know you are super busy as a professor and studying and teaching and researching.

Speaker 1

We're all super busy, so that's no excuse.

Speaker 2

I am just so delighted and reading your bio and watching the videos that are on YouTube about you and what you have done around mixed feeding. We all know breast is best, and we all try to do the right thing by our kids.

Speaker 3

But sometimes you know you've.

Speaker 2

Got to go back to work, you're not well, you don't know the circumstances behind. So I'm making a decision to maybe mix feed. So do you mind explaining exactly what mixed feeding is?

Speaker 1

Yes, certainly, so I completely agree with you Beck. Breastfeeding is an extraordinary thing and an extraordinary thing that we can do for our babies, and it is one hundred percent the best way to feed human infants. But also, as you said, there are reasons why sometimes people don't want to breastfeed, or they feel pressures one way or another to not breastfeed, or they might feel like they have a low supply or that they don't have enough milk, or you know, there are lots of reasons why people

might choose to introduce infant formula. So mixed feeding just means if you're combining breastfeeding with another form of feeding, So you're either feeding with infant formula in a bottle or in a cup, sometimes in a spoon, which would take a long time. So it just means that you're breastfeeding plus something else.

Speaker 2

And do you think there's a higher percentage of people doing that than anyone talks about because I know that if you have a season, you're shamed. If you don't breastfeed, you're shamed. I mean, I had a daughter that just wanted breast milk, and that was great and it suited me, but my second child had total refusal to eat. Ye period was a nasogastrically fed, then just to nuzzle a couple of weeks at some stage, and then we tried to get my breast milk back in and then he

refused again. So I was very lucky that I had some amazing lactation consultants to come in, but in the end he just had to be not even bottle fed.

Speaker 3

He's one of those kids that were spoonfed.

Speaker 1

I had one of each as well, so yes, an enthusiastic breastfeeder who I fed for years and another one who it was pretty challenging. But I think we just don't know is the true answer. We know from our research and from other groups research that about half of babies will have some formula before they're six months old, but we don't have really good data on the proportion of people who were mixed feeding, so who were doing both.

You know, we can kind of extract it from other studies, but we don't have really good data on the proportion

of people who are mixed feeding. And I see this as a terrible gap because if we knew knew more about people who were mixed feeding, and if we knew more about why they were mixed feeding, then we'd be in a better position to develop interventions to support them to continue breastfeeding, to breastfeed more often, to maintain their breast milk supply, and we'd also be able to support our clinicians to support women to prolong breastfeeding, to increase breastfeeding.

But we can't really do those things if we don't really understand who's doing it, why they're doing it, how often, whether their goal is to get through a period of challenge in their breastfeeding that they will then pick back up again. And certainly when I was had my babies and became really interested in the way people feed their babies, I was absolutely devoted breastfeeder and one hundred percent you know, behind breastfeeding being the best food for babies and breastfeeding

at all costs. But I guess what I have come to understand through my research and through the women I've met in my role as a breastfeeding counselor but also in my role as a researcher, is that it's just not always what's right for them and if we could really understand more about why they've made the choices they've made, then we might be able to intervene sooner and help them to continue breastfeeding, or help them to breastfeed more often, or find a way of mixed feeding that doesn't lead

to no breast milk, because some breast milk is better than no breast milk.

Speaker 3

Absolutely.

Speaker 2

Why do you think there is such a huge gap in that research space.

Speaker 1

One of the reasons is that I think for a long time, we've had people who research breastfeeding and we've had people who research other things, and we haven't necessarily communicated very well or done really good multidisciplinary work. And I also think because our health services and our health departments have had extremely strong pro breastfeeding policies, as they should, there hasn't necessarily been a place for doing research about

mixed feeding. And there's also been a really strong sense over my lifetime of working in this field that there's enough information out there in the in the ether or in the way that is accessible to mums into wherever. Yeah, to give mums who are using it formula advice on using it formula. But I think what hasn't been captured well is that, of course, there are mums who exclusively breastfeed and that's fatastic, and there are mums who exclusively

use infant formula, and that's they deserve our support. But when we do our work that was initially focused on obesie prevention, and there's a reason why we're interested in infant formula for obesie prevention, I guess we started to see that. And this work was led by one of my PhD students, and she talked to a lot of mums who were using infant formula, either mixed feeding or exclusively formula feeding, and there were a couple of things that she found that really sort of broke my heart

a little bit. One of them was that mums don't seek health professional advice before they start introducing formula, and that's because they don't think they can, They feel judged, they feel like it's not the right thing to do,

and that they won't necessarily get support. And the second thing that broke my heart was that the place where most people who are introducing infant formula get their information is from the tin, so from the tin of formula, and I just think we can do a lot better than that.

Speaker 3

That's where I got mine from.

Speaker 2

Yep.

Speaker 1

I just think that's a travesty because a lot of mums who are introducing infant formula are doing so at a point of distress or of christ or and we should be wrapping our arms around those mums, just as we should be wrapping our arms around all mums. We should be saying, what's your goal? Is this something you just want to do for a little while, or you know,

have you thought about mixed feeding? Have you thought about this might be something you could do just to take the pressure off for a couple of days, and then you know, here's what you could do to keep your supply up, or here's what you could do to build your supply, or here's how you can do it without say that's it for my breastfeeding journey.

Speaker 2

So when someone decides to mix feed because of say, for example, they're going back and doing some part time work that sort of thing, you know, it might just be easy for them to go, Okay, I'm not going to breastfeed anymore.

Speaker 3

I'm just going to swoop to bottle formal food.

Speaker 2

But if they knew that, say, they could do morning and night exactly, just you know, a bit of a pump at lunchtime. You know, there's a room there that you know at work that you can do that, and then they can take that home and use that on the days off or a weekend when you know Nana and Papa are looking after the kid or something like that. But it's interesting I just found with my daughter, she

just wanted breastpilk, that's it. And then she went straight to a cup because there was no way she was going to give that up.

Speaker 1

Yep.

Speaker 2

Jacob, on the other hand, just hated everything. I was at the end of my tether. I actually said it in a podcast previously. I was so beside my I went to the Maternal and Health Child Service Center, sat there on the steps before it had even opened, with this crying baby that just wouldn't feed, wouldn't stop crying. And I was sitting on those stairs with this baby crying, begging. I was begging for help. Yeah, he's lucky I didn't

throw him in the rubbish bit seriously here. Yeah, and you know, I'm a nurse, so I have a bit of an idea about stuff.

Speaker 3

But imagine being.

Speaker 2

A mum and not having your mum around or being on your own or being a single parent or not having that support.

Speaker 1

Absolutely, and child family health services are not as available as they used to. I mean, if you've got a good child family health nurse, they are like gold, like absolutely salute gold because the relationship that they develop with new mums is just second to none, and they will support mums through thick and thin, and they have just such a beautiful way of you know, telling mums you know you're doing a great job, and that's exactly what mums need to hear. But it's not like when I

had it. You know, when I have my babies, you could turn up for a drop in visit. I think it was every morning and they had appointments in the afternoon, so it was really available and I really needed it and a lot of mums really needed it, and then

at other times I didn't need it at all. But now there aren't enough China family health nurses and there aren't enough Chime family health nursing appointments available or drop ins available, and that again it's not helpful for mums who need I mean, we all support when we're learning something new, don't we And we learn something new every time we have a new baby.

Speaker 2

Oh, breastfeeding just I mean, we all think it's meant to just happen, but it's not that easy, no.

Speaker 1

And I mean I should also say that they're fantastic support services like the Australian Breastfeeding Association, which is absolutely fantastic and is available twenty four hours a day, seven days a week, and that's absolutely fantastic. But if you've been sent home from hospital within forty eight hours of having a baby, your milk hasn't come in yet, and you're only getting a couple of visits from a midwife

from the hospital, it's not enough for every month. Like, we really need to be able to wrap around mums and give them the support they need, and it's not necessarily going to work over the phone or online. And in terms of formula introduction, we know that most mums turn to the internet and in some groups, yeah, and some of the information on the internet is evidence based

and is really reliable, and others is not. And again I've had PhD students who have looked at the quality and the content ofant feeding websites and ofant feeding apps, and the quality is really variable. So it's really tough for mums to know when they're tired, when they've got a crying baby, when they might not have a lot of experience in this area. You know, which website do I.

Speaker 2

Trust because we don't have, you know, the extended family like other cultures do.

Speaker 3

You're quite nuclear.

Speaker 2

And I remember when I did my nursing training and people would go on and do their midi and then they would go on and do family and child health.

Speaker 3

Is that still offered as a.

Speaker 1

Oh yeah, yeah, but you don't have to be a midwife to be a child and family health nurse. You can do that qualification from your bachelor degree. And similarly, a sort of fairly recent change is that you can get a child and family qualification and work as a child and family health nurse if you've done a Bachelor of midway free rather than a Bachelor of nursing. So that, okay, that has been a fairly recent change and has been really welcomed by some in the field and not by

others in the field. So I'm remaining agnostic on that one. I just wanted to be more support from others.

Speaker 3

I couldn't agree more.

Speaker 2

And I just think my milk didn't come in until what day three, and I was a hot mess that day.

Speaker 3

Yeah, and literally a hot.

Speaker 2

Mess, and with these massive boobs, and I was sobbing at the side of the baby and someone came me in and I burst into tea like I was a mess.

Speaker 3

So if I hadn't have.

Speaker 2

Had that support that I had, yeah, you know, from my mom and from the nurses in the hospital, I would have really struggled.

Speaker 1

Yeah, and you need to be told, don't you this is normal, this is just what happens. Everything's temporary. It'll be better tomorrow, it'll be better the day after that. You need to hear that reassurance because it's a pretty phenomenal new thing in your life that's happened to you.

And I think we have to be kind and supportive and make sure that mums have all of the support that they need to feel good about their mother ing and the extraordinary thing that they've just done, grown a human being.

Speaker 2

Do you think, because I feel that there's this big gap in healthcare in this space, you know, in my own clinic, we obviously we can't treat women for anti wrinkle or for lasers and things like that if they're pregnant, and often if they're breastfeeding. And you know, all of them say the same thing. They all wanted to breastfeed, and some did for a period of time, others didn't. But it was very interesting that I hear that some

of them go. You know, I didn't tell anyone I wasn't breastfeeding because you know, I was shamed so badly, or someone had something to say, or someone will make a comment. And I don't think people realize we're very sensitive about our mothering and our mothering skills, especially when we're in umup. We're just looking to be built up and supported. And when you hear these women just going,

I felt shamed or I embarrassed, you know. I just think we're really letting our sisters down by not supporting them in whatever.

Speaker 3

Their choice is.

Speaker 2

And yes, like you said, breast is best, and I had on heart can say it was the best thing.

Speaker 3

It was wonderful, but I couldn't do it for my second child. I tried but couldn't.

Speaker 1

So I sort of think about different layers of breastfeeding kind of feeding, and I feel like an individual mum who has struggled with breastfeeding or has decided not to breastfed for whatever reason, Why are we shaming her when there's all sorts of reasons why she might have made that decision that are kind of out of her control. So does she have the support at home? Did she

receive enough support to breastfeed? Does she have to go back to work in a minute because she's got a huge mortgage, or she's the primary bread winner, or you know one hundred other reasons. Does she get all of the education and support and advice that she needed when she was in hospital? You know that's another layer. Does the society that we live in actually support her to breastfeed? Can she breastfeed in public without feeling uncomfortable?

Speaker 3

Actually?

Speaker 1

You know, is she being bombarded by social media that's suggesting that she should feed with him from formula rather than breastfeeding. I mean, all sorts of things at all sorts of different levels are impacting on that woman. So why would we be shaming her or making her feel uncomfortable when we don't know anything about what's going on with her. We should be telling her you're doing your.

Speaker 3

Great job, or can I give you a hand?

Speaker 1

Exactly if we knew more about why people stop breastfiting or about why they might be mixed feeding and if our clinicians, our time and family health nurses, our GPS, all of the people who see mums a lot, if they knew how to sort of ask mums the right questions, then they might be able to say, actually, you're going back to work in a few weeks time. Did you know that you could mixed feed? Did you know you could keep breastfeeding, you could breastfeed in the morning, you

could breastfeed at night. Or your partners said, isn't it time to stop breastfeeding? Well, here are some things you could say to alleviate their concerns. Or you think your supplies low, Here's how you can tell if your supply is low. And here are some tips for increasing your supply. You know, there's all sorts of things that we could be doing to support that mum that are just not happening in a systematic way. A here's the Health Department's policy.

We're going to see what we can do about increasing people's supply. Or here's the things we can put in place to support mums to continue breastfeeding at work.

Speaker 2

So, statistically, has breastfeeding increased. Our initiation rates of breastfeeding are fantastic. So in Australia, we've got very very high rates of breastfeeding initiations, so people are breastfeeding in hospital, but the drop off in that first month is really high, right. I would argue that the drop off in that first month is high because people are not adequately supported, and they're not adequately supported because they haven't received the support in the education or the.

Speaker 1

Not just verbal education. But you know, here's how you do it, here's physically how you do it, and here's how you could troubleshoot some things that might happen. And that's probably what's causing that big drop off in the first month. And then the drop off later is for all sorts of reasons. But we really need to know a bit more and to understand how to intervene to increase the duration of breastfeeding, make sure people are giving

some breast milk. So if I could tell you my story, please, So when my son was born, he was born in the United States, which doesn't have a strong breast threading culture, and so he was in the nanatal nursery for a month and after about a week I was expressing quite large quantities and one of the doctors said to be oh,

are you still doing that? We yes, I am, and so I persisted, and luckily we had a fantastic nurse who really got breast feeling going because he wasn't particularly interested because he'd lost his suck reflex from being inchbraded

and blah blah. And then because it was the United States and I had to go back to work after three months, I used to have to travel a bit for work, and I would travel with an eskie and I would express while I was away and come home with the eski, and some of the sort of senior men in the company would look at the eski coming around the baggage and say, oh, I don't even want to ask what's in there, you know. So there was sort of this ky thing, and there was nowhere to

express a work except the toilets. So after persisting with this, I just was really determined to exclusively breastfeedd him. After a while, it just came a bit too difficult, and so I did persist with that morning and evening, and that worked really well for us until he was almost a year old, when he chose to end it. So it can be done. But I was just really lucky

that my cousin was a breastpending counselor. I had friends who were midwives and I could get that advice and support because it wasn't available to me in the health system there.

Speaker 2

Because when I had Jacob and I had all those issues. Yeah, lactation consultants were around, but it was fairly new and they were fantastic, but it was expensive, and that is something some people do say that if you get a private lactation consultant, for some.

Speaker 3

People it's just out of their budget.

Speaker 2

Yeah, you know, I understand people have to run a business and you know, everyone needs to make a living, but it does seem a shame that that's not as readily available to maybe people in the lower socioeconomic group who really would benefit from breastfeeding.

Speaker 1

And there certainly are BLACKTAH consultants in public hospitals, but there aren't enough and they're fantastic, but there are only so many hours in the strait and women are in and out of hospital quite quickly, and so they often need that support maybe five or six days down the track, and they're just they're just not enough of them.

Speaker 2

So you have found at that month stage, that's when a lot of mums is just getting too hard and that's when they tend to give up.

Speaker 1

It's in the first month. So we've got national data on the rates of breastfeeding by month, and the biggest drop off is in that first month, and then it's fairly steady out to six months.

Speaker 2

So how many then at six months do you find It would be say there's one hundred percent that leave hospital by that first month, sixty percent of dropped off and then of.

Speaker 1

That about still breastfeeding.

Speaker 3

It one way, okay, and then you find six months.

Speaker 1

From our research. From our study about twenty percent were mixed feeding, so we could figure out how many were mixed feeding, and it was about the same, so forty percent rest freading, forty percent formula that was in our study, so you know, other studies might be different. It was pretty representative, but not a lot of people from lower SOSO economic groups who we know are more likely to use in for formula. So that's probably a good sample.

Speaker 2

Are you currently studying more in that space or other people.

Speaker 3

That are absolutely and I also researching.

Speaker 1

Yeah, So one of my PhD students, her PhD was sort of looking at sources of information for feeding making feeding decisions, and she will go on to have a really strong research program in mixed feeding because she's really decided that's going to be her thing. And I would really encourage that because I think there's a lot to do in that area. You know, for me, this became an interest sort of by accident, because as an obesity prevention person, we're really interested in the way food is

in that first year of life. We really worry about excess growth. So we want kids to sort of follow one of those lines on the growth chart. But some kids sort of jump over lines and keep jumping over lines, and that's called rapid weight gain. And that's more common in babies who are fed with infant formula.

Speaker 3

And so why do you think that is?

Speaker 1

Because they're probably being overfed, so they're probably getting more calories than they need through two mechanisms. So sometimes parents will over concentrate the bottle with a view to that may be making them sleep better. And the other thing is that if a baby's breast fed, when they've finish to feed, they come off the breast, they doze off to sleep. You know, the mum gets to be confident that they've had enough to drink, they've finished the feed,

and that's the end of the feed. But when you are feeding with formula, you tend to make up a certain amount of milk in the bottle, and there's a real tendency to finish that bottle, even if the baby might halfway through be showing all of the signs that

they're full. There's a sort of tendency and a temptation because you've got the information from the tin that says eight bottles of one hundred meals at this age, you think, right, I've got to do that, and so keep that baby feeding for longer than they need or for longer than they want. And so from an obesity prevention point of view, we really try to encourage people if they are using formula, to use it in a way that is similar to

if they were breastfeeding. So you would still hold the baby, you would look into their eyes, make eye contact, and you would watch for signs of fullness, and when fullness is there, you stop.

Speaker 3

But you don't know that, you don't know what, you don't know.

Speaker 1

Exactly right, and that information is not on the tin.

Speaker 2

Because it would be you know, eight times or whatever one hundred meals and I know me when I was feeding Jacob, and I had no other information than the tin minde like he was fussy, but I still made up according to what the tin said.

Speaker 1

Of course you did, what else would you do? And of course you would think he's going to drink all of that. You know, I can't stop. And so the other thing that sometimes happens that we worry about from an obesity prevention point of view is that mums might be breastfeeding, but they might think my baby stopped growing fast enough, or I just want a little insurance policy that they're growing fast enough, so they might top up

with formula even if they don't need it. So sometimes mums could really do with support from their trusted healthcare provider to say, if your baby's having this many wet nappies, and your baby's growing, and your baby seem settled in

between feeds, then they're getting enough to eat. But mums often doubt themselves or second guests themselves, and so they think, oh, I better top up, or I don't trust my body to make everything my baby needs, so I better give some formula as well, and that probably.

Speaker 2

Doesn't need to h and that older generation as well, like my mum, I mean, I was bottlefed on carnation milk.

Speaker 3

You know, I think about it hour, I go oh, my god.

Speaker 2

And they really look at the baby and go oh, if they're a little bit fussy after you take them off the breast of the need a little bit of a top up. And Mum learned pretty quick not to say anything. But you know, if you come from a family that are full of big personal bodies and you know you just want to please everybody and shut everyone up, you are going to do that.

Speaker 1

Absolutely, you're going to do that. And also, some parents from some cultural backgrounds have a really strong preference for a bigger baby, and with a really plentiful supply of food, they will try to get that baby to be bigger than they would automatically be. And that's a real challenge for clinicians because they sort of need to find a culturally sensitive way of saying, baby, it probably doesn't need

that extra top up. But if you've got other family members saying, oh, the baby's too skinny, then of course you're going to You don't want to be labeled a bad mother.

Speaker 3

So oh god, no, Elizabeth.

Speaker 2

If a baby, you know, at three months is sort of in that high percentile weight wise, is that an indication that they may struggle as an adult with obesity.

Speaker 1

Not necessarily. So if a babes weight for age and their length for age is about the same in terms of the centile they're on, then they've probably got tall parents. Yeah, so, yeah, they've probably got tall parents. If their length for age and their weight for age is on the sort of lower level than maybe their parents aren't very tall. There's also a chart called weight for length, and that's sort

of a little bit like BMI. What you like to see is that that is pretty steady, so that they sit on the same centil and they sort of stay on the same centil, so it doesn't matter if they're on the twentieth centile or the eightieth centile. What you want to see is that they stay pretty steady because that means that their length is growing at a similar

rate to their weight. Their weight isn't sort of getting ahead of their length, which is what happens with rapid weight gain, is that their weight is getting ahead of their length. So we would then put stratum is in place to let the baby grow into their weight.

Speaker 2

And one other question I have for you is the big thing when my kids would little, was you present food like at six months and when they start showing interest that sort of thing, you start to introduce food.

Speaker 3

Is that still the situation.

Speaker 1

Yeah, there's a number of different sort of signs of readiness, and that's definitely one of them, that they're taking interest in food or sometimes basically reaching out and almost grabbing the food that you've got. Okay, they need to have reasonable head control, and that's sort of usually around the six month age is what we say. So around six months. It might be a little bit earlier for some babies, it might be a little bit later for some babies,

but around six months is the advice. I just would also just like to remind people that if babies have allergy risks, or they've been premature, or one of those other things, then please remember this is a general advice. Generals that those cases need to be treated carefully with professional advice. And the thing we say is parents provide

child decides. So rather than again preparing a certain amount of food and shoveling that into the baby's mouth until it's gone, what we would recommend now is that you would offer a variety of foods, iron rich foods first, and you would offer those foods and let the baby decide how much they're going to eat. Of course, in the early days, giving breast milk first because that's the sort of major source of neutrasse. Still, yeah, and.

Speaker 2

Just one other question, I'd really be interested to hear academically where you came from and to your point now, just so other nurses can hear what you've achieved. I love hearing that from my colleagues. Yeah, fill us all in one. I started my journey your journey.

Speaker 1

So I'm quite old, so I'm a hospital trained nurse, and I was really interested. I did a critical care certificate and worked in cardiothoracic intensive care, and I started to sort of see people who had calivevascular disease and that some of it could have been prevented. And that

was sort of an early spark. But then I went and worked in industry because I really really wanted to do research, and back then there wasn't a lot of nurse initiative research, and I thought I really wanted to do research, and so I worked in industry for a while and I ended up working in the United States, and then when we came home from the United States, I did my conversion degree, and then I did a master's of public health, and at this DAT had two

little kids, and I was really interested in the way people made decisions about feeding their kids because it just seemed really interesting to me that the way people were influenced and what they thought was important, and the support they received and those sorts of things. I got a small project after my master's that was looking at child obesity, and I ended up doing my PhD with that same person.

So initially I looked at clio vascular risk factors and other disease risk factors in adolescents, and it was really clear that obesity was quite a serious problem even in adolescents. So they had the kids who were living with obesity had lots of risk factors. And after that study, which I loved doing, I thought, well, I want to do

something to prevent this. I want to work in prevention, and I want to work in prevention in primary health care, so with child of family health nurses, with GPS nurses in general practice, because they're the people who have access to everybody. And so I did quite a few different research projects in general practice and over the years, I've been interested in younger and younger and younger children, and so now my focus is the first year of life

and that'll do me. You know, I'm getting close to retime and age. But I'm really happy to say that I think I've had twelve PhD students who I've survised to who have completed, and I've got three more to go. And I can say hand on heart that OBESI prevention research in the primary healthcaret setting is in really good hands because some of the students I've had it just

out of this world. It's so fantastic. And so that's what I've done, and I think the thing I'm most proud of is having worked to co design with parents and with nurses. Told of Hemily Health Nurses an app that we've modified over the years that has supported parents with infant feeding decisions. And the initial app is very out of date now, so it's you know, it's probably on version five or six now.

Speaker 3

Yeah. Yeah.

Speaker 1

And one of the things we found was that the most visited pages on that app were around infant formula and mixed feeding. Wow, so we sort of knew we were onto something. I mean, we had an enormous amount of content about breastfeeding too, but those pages weren't as frequently visited because we think that was being handled by other people. You know, that people had that sorted, whereas the formula pages and the mixed feeding pages were really

highly visited. So that was it was good for us to know.

Speaker 2

That because I truly believe mothers want a breastfeed for as long as they can.

Speaker 3

There's no doubt we would all do that.

Speaker 2

But yeah, there are so many circumstances, so I think even some is better than none.

Speaker 1

Any is better than none, and absolutely the more the better.

Speaker 2

Yeah, And I think it is so valuable because that's what I hear on the street, you know, with my clients that.

Speaker 3

And that a lot of them mixed feed. You have to go back to it.

Speaker 2

I mean, just look at the Economic Times and I think that's wonderful that you have a page.

Speaker 3

Up that helps and guides women.

Speaker 2

And I'm not surprised it's probably the most visited page.

Speaker 1

Yeah, so that's within that app that's what people really sound useful, and that's been a really interesting finding for us.

Speaker 2

Yeah, I think it's wonderful. Well, Elizabeth, I have loved this chat with you and I am very in awe of you know, in my heart I'd like to be a researcher, but I think I'm actually a clinician.

Speaker 1

So yes, but there's a role we need more clinician researchers that is so important that there's it's just not enough of them.

Speaker 3

It's not too late, No, it's never too late.

Speaker 2

One of my colleagues has actually she was in her late sixties doing her PhD.

Speaker 3

And more power to her.

Speaker 2

Lovely, completely love it so and she's a remarkable woman too. But thank you for your wisdom and your knowledge and sharing that. I really appreciate it.

Speaker 1

It's been a pleasure, lovely to chat to you.

Speaker 3

You too, thanks a losten.

Speaker 2

This season. I am so excited to announce that the podcast is being supported by Nutritia, which is a global leader in medical nutrition. They understand the needs of nurses in the nutrition space and for over one hundred and twenty five years have provided products to support child health. Some of Nutrita's pediatric brands include Neo Kate Junior for children who have food allergies, and apt to Grow for

those fussy eaters. And those of us who have children know many kids who go through the phases of definite fussiness. For more information and resources, visit the nutritiona Pediatrics hub at nutritia dot com dot au forward slash pediatrics. I just want to say a huge thank you to Nutritia. Their desire to support nurses is truly appreciated, and they are allowing me to continue this podcast so that we can all grow as nurses.

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