The pediatrician plays a major role in advocating, promoting, and managing breastfeeding, beginning in the prenatal period by providing facts and discussing questions and concerns regarding breastfeeding with the expectant mother and continuing after delivery in the hospital and during infant health supervision visits. The early weeks after birth require education, support, and encouragement. The pediatrician sets the standard that breastfeeding is norm. The pediatrician is in the optimal place to advocate and formulate hospital policies conducive to lactation and the provision of human milk and must be knowledgeable about the breastfeeding support provided by the office and community.
Key points
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The pediatrician champions children’s health.
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The encouragement of breastfeeding to families and to the community at large is an important aspect of the pediatrician’s profession.
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The pediatrician must be equipped with optimal resources to achieve this goal.
Introduction
Breastfeeding is beneficial to the health of the maternal–infant dyad; it improves psychosocial interactions, reduces economic burdens, and is valuable to society. The American Academy of Pediatrics (AAP) and the World Health Organization (WHO) strongly endorse breastfeeding. How is breastfeeding supported in the hospital, in the home, and in the community? It is the responsibility of the leader of the health care team, the pediatrician, to understand the importance of breastfeeding, advocate for breastfeeding, and be comfortable in directing its assessment and management, to enable mothers to achieve their breastfeeding goals.
In the 2012 policy statement, “Breastfeeding and the Use of Human Milk” the AAP supports the recommendation of exclusive breastfeeding for about 6 months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant. The policy statement emphasizes the critical role that pediatricians play in their practices and communities:
To advocate for breastfeeding
To optimize their knowledge about the health risks of not breastfeeding
To promote the economic benefits to society of breastfeeding
To train mothers and health care providers in the management of the breastfeeding dyad
To train health care providers in the support of the breastfeeding dyad
The AAP recommendations for breastfeeding stress that all breastfed newborns be seen by a knowledgeable health care provider at 3 to 5 days of age, which is within 48 to 72 hours after discharge from the hospital. This visit should stress hydration, body weight changes, and elimination patterns; additionally the pediatrician should discuss maternal and/or infant issues and observe a breastfeeding. The pediatrician is the optimal person to promote breastfeeding as the norm for infant feeding. To do so, the physician must be knowledgeable in the principles and management of lactation and breastfeeding, and have developed the skills necessary for assessing the adequacy of breastfeeding. Pediatricians are in the prime position to support lactation education and training for medical students, residents, and postgraduate physicians. As members of their medical staffs, they are in positions to promote hospital policies that are compatible with the AAP and Academy of Breastfeeding Medicine Model Hospital Policy and the WHO/United Nations Children’s Fund (UNICEF) “Ten Steps to Successful Breastfeeding.” In the community, the pediatrician should collaborate with the obstetricians to develop optimal breastfeeding programs and encourage community-based uniform and comprehensive breastfeeding.
Introduction
Breastfeeding is beneficial to the health of the maternal–infant dyad; it improves psychosocial interactions, reduces economic burdens, and is valuable to society. The American Academy of Pediatrics (AAP) and the World Health Organization (WHO) strongly endorse breastfeeding. How is breastfeeding supported in the hospital, in the home, and in the community? It is the responsibility of the leader of the health care team, the pediatrician, to understand the importance of breastfeeding, advocate for breastfeeding, and be comfortable in directing its assessment and management, to enable mothers to achieve their breastfeeding goals.
In the 2012 policy statement, “Breastfeeding and the Use of Human Milk” the AAP supports the recommendation of exclusive breastfeeding for about 6 months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant. The policy statement emphasizes the critical role that pediatricians play in their practices and communities:
To advocate for breastfeeding
To optimize their knowledge about the health risks of not breastfeeding
To promote the economic benefits to society of breastfeeding
To train mothers and health care providers in the management of the breastfeeding dyad
To train health care providers in the support of the breastfeeding dyad
The AAP recommendations for breastfeeding stress that all breastfed newborns be seen by a knowledgeable health care provider at 3 to 5 days of age, which is within 48 to 72 hours after discharge from the hospital. This visit should stress hydration, body weight changes, and elimination patterns; additionally the pediatrician should discuss maternal and/or infant issues and observe a breastfeeding. The pediatrician is the optimal person to promote breastfeeding as the norm for infant feeding. To do so, the physician must be knowledgeable in the principles and management of lactation and breastfeeding, and have developed the skills necessary for assessing the adequacy of breastfeeding. Pediatricians are in the prime position to support lactation education and training for medical students, residents, and postgraduate physicians. As members of their medical staffs, they are in positions to promote hospital policies that are compatible with the AAP and Academy of Breastfeeding Medicine Model Hospital Policy and the WHO/United Nations Children’s Fund (UNICEF) “Ten Steps to Successful Breastfeeding.” In the community, the pediatrician should collaborate with the obstetricians to develop optimal breastfeeding programs and encourage community-based uniform and comprehensive breastfeeding.
Norm
On January 20, 2011, Surgeon General Regina M. Benjamin released “The Surgeon General’s Call to Action to Support Breastfeeding,” which outlined steps that should be taken to remove obstacles faced by women who want to breastfeed their infants. The call to action states that families, communities, employers, and health care professionals (pediatricians) can improve breastfeeding rates and increase support for breastfeeding by the following actions:
Educate mothers and their families on the importance of breastfeeding
Provide ongoing support to the mothers and their families
Encourage communities to support breastfeeding
Provide and train peer counseling support
Promote breastfeeding in the community organizations and media
Remove commercial barriers to breastfeeding
Adopt evidence-based practices (baby-friendly hospital initiative)
Provide health professional education
Assure access to lactation services
Support the increased availability of banked donor milk
Encourage paid maternity leave
Encourage worksite accommodations for breastfeeding
Allocate more resources for research
Address disparities in breastfeeding
Support the use of surveillance methods to highlight the economic impact of breastfeeding
Support national campaigns to promote breastfeeding
Advocate for enhanced national leadership of breastfeeding
It should be emphasized that national leadership for promotion of breastfeeding is emerging. First Lady Michelle Obama’s “Let’s Move” campaign begins the obesity prevention initiative by noting that the odds of being overweight are reduced by 30% with breastfeeding for 9 months.
The rates of breastfeeding initiation continue to increase in the United States. This shift is based on the knowledge of breastfeeding as the optimal nutrition for infants. The choice to breastfeed is not merely a lifestyle choice but rather a key health issue and should receive strong endorsement and support. The risks of not breastfeeding should be discussed:
There should be no encouragement of formula feeding as an acceptable alternative to breastfeeding.
Formula feeding interferes with the establishment of maternal milk supply
Formula feeding delays lactogenesis
Formula feeding increases the risk of engorgement
Formula feeding undermines maternal confidence
Formula feeding shortens the duration of exclusive or any breastfeeding
Formula feeding alters infant intestinal flora
Formula feeding affects bioactive factor interactions within the intestine
Formula feeding is associated with increased childhood acute and chronic illnesses
In brief, breastfeeding should be advocated as the norm and not the exception. “The Surgeon General’s Call to Action to Support Breastfeeding” outlines steps to promote breastfeeding. Pediatricians can ensure increments in breastfeeding rates by following these guidelines.
Scope of problem
Breastfeeding statistics are collected via the Centers for Disease Control and Prevention (CDC) National Immunization Survey ( http://www.cdc.gov/breastfeeding/ ). From these data, the CDC produces a yearly Breastfeeding Report Card for the United States that provides national statistics for breastfeeding. In 2011, 74.6% of infants were ever breastfed, and 14.6% of infants were breastfeeding exclusively at 6 months. It should be noted that average rates do not reflect wide disparities in breastfeeding among racial/ethnic groups and by socioeconomic status. The United States may be approaching the targets for The Healthy People 2020 goals for breastfeeding initiation rates, but remains far behind the other targets ( http://www.cdc.gov/breastfeeding/policy/hp2010.htm ). The Healthy People 2020 target for breastfeeding initiation is approximately 82%, and for exclusive breastfeeding at 6 months, the goal is 26%. By 2020, the goal is to increase births in a baby-friendly center from 2.9% (2007) to 8%, increase worksite lactation support facilities from 25% (2009) to 38%, and reduce formula use in breastfed newborns in the first 48 hours from 24% (2006) to 14%.
The biannual CDC National Survey of Maternity Practices in Infant Nutrition and Care (mPINC) identifies major practices in hospitals and birth centers that warrant changes to more fully support breastfeeding. For example, the 2009 survey reported that
25% of the birth facilities routinely provide formula supplementation to breastfeeding infants
Few/some mothers have more than 30 minutes of skin-to-skin contact with their infant
Fewer than 50% mothers begin feeding within 1 hour after a vaginal delivery
Fewer than 50% mothers begin feeding 2 hours after a Cesarean delivery
Most hospitals separate mothers and babies in the first 30 minutes for routine procedures
Healthy newborns room-in with mother 24/7 in less than 50% of facilities
Only 44% of facilities have policies about pacifiers
Formula is provided to breastfeeding infants in 74% of facilities
More than 50% of the facilities give discharge packs containing formula samples
Almost all facilities receive formula at no cost
Breastfeeding training of new and existing staff is inadequate
Few hospitals have a written breastfeeding policy
Few US births occur in a baby-friendly hospital
The mPINC report serves as a background for pediatricians to use to develop and advocate for a specific breastfeeding policy in their hospital. The joint commission also has added the measurement of exclusive breastfeeding in their perinatal care core measures. They have initiated a “Speak-Up Campaign” to encourage mothers to let their plan for exclusive breastfeeding be known to hospital staff and to speak up if they find obstacles.
In brief, the CDC breastfeeding report card and mPINC study indicate areas that need improvement to achieve the Healthy People 2020 goals.
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