Last year, we submitted evidence, questions and comments to a consultation on new Maternal and Child Nutrition guidelines from NICE.
The new guidelines were published last month. However, we were just as interested to read NICE’s responses to our submissions…
In this blog, which started life as a thread on X, we review the replies NICE made to us. Denial, gaslighting and deflection?
Read our analysis and then you decide: Are we being gaslit, or just oversensitive?
EXHIBIT A: Would you like to stop using formula? NICE’s new guidelines instruct healthcare workers to ask parents who are combination feeding if they want to ‘re-establish exclusive breastfeeding’. This is code for: stop the bad formula stuff.
We asked: Using what evidence? How realistic is this? Many parents will have switched to combination feeding because of insufficient supply or medical issues. Can exclusive breastfeeding even be re-established? What are the physical and psychological demands on the mother?
They replied: We’ve added language about making discussions ‘non-judgmental’ and ‘tailored to preferences’.
How does that answer our questions? They didn’t tell us where the evidence for the recommendation can be found. They didn’t address our concerns about informed consent.
Is their response fair? Is it gaslighting? You decide. (Again, you can read their full responses here.)
EXHIBIT B: Not our job! The guidelines recommend informing parents of the supposed benefits of breastfeeding in vague terms such as ‘improving your baby’s long term health’ or ‘helping with digestion of solid foods’. They recommend the NHS Start for Life resources for more information. These include statements such as, ‘once you’ve mastered it, breastfeeding is the easiest and most satisfying way to feed’ and ‘breastfeeding is a lovely way to feel close and bond’.
We said: This is not what informed decision making looks like! We asked: Where is the absolute risk data? What are the real probabilities of different health outcomes for different feeding methods? Can you reference a more evidence-based source than government PR?
They replied: Oh, we didn’t review that! They said: ‘The scope of this guideline did not include a review question about absolute risks and benefits of different feeding methods so evidence on this has not been reviewed’. We just went with existing government messaging!
This is pure deflection! They recommend a policy without even looking at the evidence. And when questioned, they shrug and pass the buck to government guidance.
Is this just bad policymaking, or a deliberate refusal to take responsibility? You decide.
EXHIBIT C: It’s all in your head. NICE’s guidelines warn parents that formula supplementation harms milk supply, a claim rooted in the ideological belief that breastfeeding is flawless and any issues stem from interference, not biology.
We said: ‘The reality is that mothers turn to formula because their milk supply is insufficient, not the other way around. There is substantial evidence that delayed or insufficient milk supply is common’ (Wilde, 2021). In other words, formula supplementation isn’t just a choice – it’s often essential to prevent dehydration, jaundice and hospital readmission.
We said: Hospital readmissions for feeding related complications are rising – evidence that current guidelines are failing (Keeble and Kossorova, 2017; Jones et al., 2018; Keeble and Fisher, 2021; Nuffield Trust, 2024). Framing supplementation as a problem blames mothers and erodes trust in healthcare professionals.
They replied: ‘The committee’s expert view is that problems with breast milk supply when exclusively breastfeeding are actually uncommon in practice’, but they recognise that there can be a ‘perception of insufficient milk supply’.
Translation: Your milk supply is probably fine, you just think it’s not. This is ideology over evidence and it is gaslighting. Hunger, dehydration and weight loss? Not a failure of breastfeeding, just a failure to believe in it hard enough.
NICE rejected our suggestion that their guidance blames mothers, at the same time they continue to push a narrative that minimises the risks of insufficient milk and shields breastfeeding itself from scrutiny.
When ‘expert opinion’ dismisses medical evidence, what do we call it? Denial, dogma or just bad policy? You decide.
EXHIBIT D: Support for what, exactly? NICE says its guidelines aim to ‘support breastfeeding’. But what does that actually mean?
We said: The research behind these recommendations is shallow, focusing only on the format of breastfeeding support, for example interventions delivered as a group vs individually, while ignoring the core issue: what is the support actually supposed to achieve?
Women stop breastfeeding due to real and distressing difficulties, such as pain, latching issues and milk supply concerns (McAndrew et al., 2012). Yet the guidance offers vague, substance-free recommendations. Is the goal to help women overcome breastfeeding challenges? Or is it to prevent formula use at all costs? Women deserve transparency. Are they being offered real help with breastfeeding or just pressure to continue?
They replied: Problems, what problems? They said: ‘It seems the comment assumes there are problems with breastfeeding and that is why support is needed’. Wait a second…if there are no problems, why is support needed?
They said: ‘the guideline starts from the position that support is needed even if there are no problems as such – just to help parents feed their babies in the best possible way’. (Yes, you read that correctly: the ‘best possible way’.)
Translation: Support isn’t actually about solving breastfeeding related problems. Real struggles like pain, latching difficulties or low milk supply are secondary and probably in your head. If you do have problems, well, NICE didn’t really ‘start from that position’.
When guidelines focus on perfecting breastfeeding instead of addressing real struggles, what do we call it? Denial, deflection or just bad policy? You decide.
EXHIBIT E: Breastfeeding champions for some, silence for others. NICE don’t just recommend breastfeeding support, they go a step further. If you’ve been a good mummy and breastfed your baby, NICE have detailed instructions for your employer to support you when you return to work, including establishing ‘breastfeeding champions’ in the workplace.
But if you want to stop breastfeeding when you return to work? We asked NICE to include recommendations on reducing and stopping breastfeeding comfortably and safely.
They replied: ‘The topic of how to reduce or stop breastfeeding was not within the scope of this guideline’.
Translation: Breastfeeding champions to help you continue? Yes! Guidance to help you stop safely? Not our problem! Support is only for continuing breastfeeding, never for stopping.
Do you feel supported? Or, after reading all of that, do you feel like you have just been gaslit by NICE? Let us know on X.