On Monday, February 27, 2012, the American Academy of Pediatrics (AAP) published its revised policy statement, Breastfeeding and the Use of Human Milk. Since presenting the best, evidence based information to our students, clients and patients is paramount, we suggest you read the publication thoroughly. In this article I will highlight some of the key things to note.

'The AAP reaffirms its recommendation of exclusive breastfeeding for about 6 months, allowed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant.'

This is current to what we've been teaching. However the note at the end about 'as mutually desired by the mother and infant' is encouraging with regards to the WHO's recommendations:'Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond.' So, the AAP doesn't go as far with regards to extended breastfeeding as does the WHO, but they acknowledge that there are benefits to breastfeeding longer than one year.

Breastfeeding rates over all have increased slightly over the last decade, but we still have a huge disparity with regards to the age of the mother, as well as the racial and socio-economic background of the mother. Strikingly:

'Furthermore, 24% of maternity services provide supplements of commercial infant formula as a general practice in the first 48 hours after birth. These observations have led to the conclusion that the disparities in breastfeeding rates are also associated with variations in hospital routines, independent of the populations served. As such, it is clear that greater emphasis needs to be placed on improving and standardizing hospital based practices to realize the newer 2020 targets.'

That said, it would appear that we need to encourage our hospitals to become Baby Friendly. In the policy statement, they give us the statistics on the lack of Baby Friendly compliance in the U.S. The AAP encourages hospitals to practice the 10 Steps and says 'the rate of exclusive breastfeeding during the hospital stay has been confirmed as a critical variable when measuring the quality of care provided by a medical facility.'

The publication addresses a wide range of illnesses ameliorated by breastfeeding. It is noted whether the percent lower risk was with regards to any breastfeeding, or by number of months of breastfeeding. Unsurprisingly, a fair number of conditions had reduced risk the longer the mother breastfed. Please refer back to the policy statement for details.

SIDS:

'...note that breastfeeding is associated with a 36% reduced risk of SIDS.'

Pacifier Use:

'Given the documentation that early use of pacifiers may be associated with less successful breastfeeding, pacifier use in the neonatal period should be limited to specific medical situations. These include uses for pain relief, as a calming agent, or as part of structured program for enhancing oral motor function. Because pacifier use has been associated with a reduction in SIDS incidence, mothers of healthy term infants should be instructed to use pacifiers at infant nap or sleep time after breastfeeding is well established, at approximately 3 to 4 weeks of age.'

Is your baby smarter because you breastfed her? The short answer is yes for infants exclusively breastfed for 3 months or longer as well as for preterm infants, however:

'Consistent differences in neurodevelopmental outcome between breastfed and commercial infant formula-fed infants have been reported, but the outcomes are confounded by differences in parental education, intelligence, home environment, and socioeconomic status.'

Guidelines for premature infants include:

'The potent benefits of human milk are such that all preterm infants should receive human milk. Mother's own milk, fresh or frozen, should be the primary diet, and it should be fortified appropriately for the infant born weighing less than 1.5 kg. If mother's own milk is unavailable despite significant lactation support, pasteurized donor milk should be used.'

Maternal outcomes are also discussed - everything from breastfeeding aiding the involoution of the uterus after birth, to reduced rates of many diseases, including breast cancer and ovarian cancer:

'Cumulative duration of breastfeeding of longer than 12 months is associated with a 28% decrease in breast cancer (OR: 0.72; 95% CI: 0.65'0.8) and ovarian cancer (OR: 0.72; 95% CI: 0.54'0.97). Each year of breastfeeding has been calculated to result in a 4.3% reduction in breast cancer.'

With regards to vitamin and mineral supplements, the AAP recommends the Vit. K shot over the oral version because 'the oral dose is variably absorbed and does not provide adequate concentrations or stores for the breastfed infant'. They do, however, recommend delaying the shot until after the baby's first breastfeeding.

Vit. D supplements are suggested for all breastfed infants upon release home because:

'Vitamin D deficiency/insufficiency and rickets has increased in all infants as a result of decreased sunlight exposure secondary to changes in lifestyle, dress habits, and use of topical sunscreen preparations.'

Supplementary fluoride is not recommended under 6 months of age.

There are many other good data points of note in this policy statement, including information on the economic benefits of breastfeeding, contraindications to breastfeeding, charting normal infant growth and specific data points on individual diseases, etc.

I'll leave you with this concluding statement:

'Pediatricians also should serve as breastfeeding advocates and educators and not solely delegate this role to staff or nonmedical/lay volunteers. Communicating with families that breastfeeding is a medical priority that is enthusiastically recommended by their personal pediatrician will build support for mothers in the early weeks postpartum.'

.....

'Thus, infant feeding should not be considered as a lifestyle choice but rather as a basic health issue.'

How do we as educators and birth professionals address this? We support evidence-based practices, yet at the same time we say we support a parent's right to make an informed choice. How will you incorporate what you've read here, and in the AAP's policy statement, into your classes?

Published: February 29, 2012

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