In the Journals

AAP: Support breastfeeding as 'public health imperative,' not lifestyle choice

To avoid creating barriers for breastfeeding mothers and families or overly promoting infant formula, the AAP’s Section on Breastfeeding has released a series of recommendations to improve breastfeeding rates in the pediatric offices as well as meet or surpass the goals set in place by the AAP and Healthy People 2020.

“The rate of initiation of any breastfeeding in the U.S. population is 81.1% according to data from the National Immunization Survey,” Joan Younger Meek, MD, MS, FAAP, IBCLC, and Amy J. Hatcher, MD, FAAP, wrote. “Although the rate of breastfeeding initiation approaches the Healthy People 2020 target of 81.9%, only 22.3% of U.S. infants are breastfed exclusively at age 6 months.”

According to the clinical report, minorities demonstrated lower percentages of breastfeeding, with blacks only breastfeeding at all 66.3% of the time and Native American and Alaska Natives breastfeeding 68.3% of the time.

Notable efforts have been made to produce a “Baby-Friendly” clinical environment that promotes breastfeeding, including Best Fed Beginnings, a partnership comprised of the National Initiative for Children’s Healthcare Quality, the CDC and Baby-Friendly USA. This program used Ten Steps to Successful Breastfeeding, and evidence-based and AAP-approved program.

Meek and Hatcher noted the minimal experience of pediatricians in managing clinical breastfeeding, a belief supported by an AAP Periodic Survey of Fellows. This 2004 survey revealed that fewer pediatricians believed that the benefits of breastfeeding outweighed the inconvenience when compared to the results of a 1995 survey. Additionally, fewer believed that almost all mothers could successfully breastfeed. As of the results collected in 2014, some of these attitudes are still prevalent among pediatricians.

To meet or exceed the AAP recommendations and the Healthy People 2020 goals regarding breastfeeding, the authors provided a set of additional evidence-based recommendations to assist in pediatric outpatient practice improvement and increase breastfeeding rates, including:

  • Establishing a written breastfeeding-friendly office policy, and providing a lactation room with supplies for employees who breastfeed or express breast milk at work.
  • Training staff in the skills necessary to support breastfeeding, especially nurses and medical assistants. If possible, consider employing an International Board Certified Lactation Consultant or a nurse or other staff member trained in lactation support.
  • Becoming knowledgeable regarding the rare but true contraindications to breastfeeding, which include infants with the classic form of galactosemia, maternal HIV or ART, untreated active tuberculosis, human T-cell lymphotropic virus type I or II, use of illicit drugs or mothers undergoing chemotherapy or radiation treatment.
  • Introducing the subject of breastfeeding as early as possible, ideally with prenatal and early postpartum visits.

“With national goals as outlined in Healthy People 2020, an increase in overall breastfeeding initiation, and more Baby-Friendly-designated hospitals, the need for increased support from all members of the health care team is clear,” Meek and Hatcher wrote. “The pediatric care provider is well suited to play a primary role in this effort.” — by Katherine Bortz

Disclosure: The authors report no financial disclosures or conflicts of interest.

To avoid creating barriers for breastfeeding mothers and families or overly promoting infant formula, the AAP’s Section on Breastfeeding has released a series of recommendations to improve breastfeeding rates in the pediatric offices as well as meet or surpass the goals set in place by the AAP and Healthy People 2020.

“The rate of initiation of any breastfeeding in the U.S. population is 81.1% according to data from the National Immunization Survey,” Joan Younger Meek, MD, MS, FAAP, IBCLC, and Amy J. Hatcher, MD, FAAP, wrote. “Although the rate of breastfeeding initiation approaches the Healthy People 2020 target of 81.9%, only 22.3% of U.S. infants are breastfed exclusively at age 6 months.”

According to the clinical report, minorities demonstrated lower percentages of breastfeeding, with blacks only breastfeeding at all 66.3% of the time and Native American and Alaska Natives breastfeeding 68.3% of the time.

Notable efforts have been made to produce a “Baby-Friendly” clinical environment that promotes breastfeeding, including Best Fed Beginnings, a partnership comprised of the National Initiative for Children’s Healthcare Quality, the CDC and Baby-Friendly USA. This program used Ten Steps to Successful Breastfeeding, and evidence-based and AAP-approved program.

Meek and Hatcher noted the minimal experience of pediatricians in managing clinical breastfeeding, a belief supported by an AAP Periodic Survey of Fellows. This 2004 survey revealed that fewer pediatricians believed that the benefits of breastfeeding outweighed the inconvenience when compared to the results of a 1995 survey. Additionally, fewer believed that almost all mothers could successfully breastfeed. As of the results collected in 2014, some of these attitudes are still prevalent among pediatricians.

To meet or exceed the AAP recommendations and the Healthy People 2020 goals regarding breastfeeding, the authors provided a set of additional evidence-based recommendations to assist in pediatric outpatient practice improvement and increase breastfeeding rates, including:

  • Establishing a written breastfeeding-friendly office policy, and providing a lactation room with supplies for employees who breastfeed or express breast milk at work.
  • Training staff in the skills necessary to support breastfeeding, especially nurses and medical assistants. If possible, consider employing an International Board Certified Lactation Consultant or a nurse or other staff member trained in lactation support.
  • Becoming knowledgeable regarding the rare but true contraindications to breastfeeding, which include infants with the classic form of galactosemia, maternal HIV or ART, untreated active tuberculosis, human T-cell lymphotropic virus type I or II, use of illicit drugs or mothers undergoing chemotherapy or radiation treatment.
  • Introducing the subject of breastfeeding as early as possible, ideally with prenatal and early postpartum visits.

“With national goals as outlined in Healthy People 2020, an increase in overall breastfeeding initiation, and more Baby-Friendly-designated hospitals, the need for increased support from all members of the health care team is clear,” Meek and Hatcher wrote. “The pediatric care provider is well suited to play a primary role in this effort.” — by Katherine Bortz

Disclosure: The authors report no financial disclosures or conflicts of interest.