BNew Breastfeeding
Policy Statement from the American Academy of Pediatrics
Lawrence M. Gartner, MD
from Breastfeeding Abstracts,
February 1998, Volume 17, Number 3, pp. 19-20.
The American Academy of Pediatrics
(AAP) published its first new comprehensive statement on breastfeeding
in 15 years in the December 1997 issue of Pediatrics.1 Entitled "Breastfeeding
and the use of human milk," the statement was prepared by the Work
Group on Breastfeeding of the AAP, chaired by Lawrence M. Gartner, and
was approved by the AAP Board of Directors. Nearly all members of the
AAP Work Group are also members of the Academy of Breastfeeding Medicine.
The five-page statement with 111 references clearly defines and supports
the AAP position that "human milk is uniquely superior for infant
feeding " and that "all substitute feeding options differ
markedly from it."
The statement opens with
a brief but extensively referenced section on the benefits of human
milk and breastfeeding for the infant, the mother, the family, society, and
the nation. Contraindications to breastfeeding are also noted. The new
policy statement received extensive attention from physicians, lactation
consultants, the press, and many other organizations because of its very
specific recommendations on breastfeeding practices. Practitioners are
advised to "weigh thoughtfully the benefits of breastfeeding against
the risks of not receiving human milk" when considering advising
against breastfeeding or suggesting premature weaning.
The specific recommendations
for the early neonatal period include initiation of breastfeeding "within
the first hour" of life, frequent breastfeeding 8 to 12 times
per day at the earliest signs of hunger continuing to satiety, continuous
rooming-in, "formal evaluation of breastfeeding performance by
trained observers" during the early days after birth, early follow-up
visits 48 to 72 hours after discharge from the hospital, and avoidance
of all supplements and delay in use of pacifiers until after breastfeeding
is well established. In addition, the policy statement counsels that
adequate breast milk intake be assessed by 5 to 7 days of age with evidence
of at least 6 urinations and 3 to 4 stools per day.
"Exclusive breastfeeding" is advocated for "approximately the first 6 months after
birth" and continuation of breastfeeding "for at least 12
months and thereafter for as long as mutually desired." Supplementation
of breastfeeding with vitamin D and iron are recommended only on a selective
basis for those with specific needs. Fluoride is recommended only for
those infants living in areas deficient in the mineral in the water
supply and only after the sixth month of life.
The policy statement concludes
with a list of 12 recommendations of ways in which pediatricians can
support and promote breastfeeding in their communities. Strong advocacy
by pediatricians is justified by the "extensive published evidence
for improved outcomes in breastfed infants and their mothers."
Improved education of medical students, pediatric residents, and practicing
pediatricians is endorsed, along with encouragement for
pediatricians to collaborate with obstetricians in educating parents
about breastfeeding so that they can make a "fully informed decision
about breastfeeding." Pediatricians are also urged to promote hospital
policies and procedures which "facilitate breastfeeding"
and to work toward eliminating "hospital practices that discourage
breastfeeding " including "infant formula discharge packs."
Improved communications and collaboration with other health care providers,
agencies, employers, and peer support groups in serving the needs of
the breastfeeding mother are strongly urged on AAP members along with
encouraging the media to "portray breastfeeding as positive and
the norm." The statement admonishes pediatricians to provide "enthusiastic
support and involvement" in the "promotion and practice of
breastfeeding" to ensure "optimal infant and child health,
growth, and development."
Although the AAP Policy Statement
on Breastfeeding was written for the Academy's pediatrician members,
it received extensive attention on television and radio and in newspapers
and magazines. Nearly all periodicals for parents have or are planning
on carrying lengthy articles on the policy statement. Coverage was strongly
positive in nearly all cases, but some commentators from other organizations
expressed concern that such a strong advocacy position for breastfeeding,
especially for at least one year, placed an additional burden on the
woman who was employed outside the home. After an initial expression
of dismay directed at the AAP by one spokesperson, the National Organization
for Women released a formal statement supporting the AAP position and
noting the need for employers to provide an environment supportive of
breastfeeding. Several press organizations also published reports which
misread and misquoted portions of the statement. Most noteworthy of these
misstatements were those that thought the AAP was urging women to breastfeed
12 times a day, 30 minutes each time, for the entire first year of life.
The AAP office of public relations attempted to correct each of these
misrepresentations of the policy statement.
The AAP has urged other medical
organizations to utilize the Policy Statement on Breastfeeding as a
basis for developing their own policy statements on breastfeeding for
their specific membership. Copies of the policy statement including
the entire list of references can be obtained directly from the American
Academy of Pediatrics using various modern communication methods as
well as La Leche League International.
Lawrence M.Gartner is Professor
of Pediatrics and Obstetrics/Gynecology at the University of Chicago. He
is a founding memeber of the Academy of Breastfeeding Medicine and is
a member of The LLLI Health Advisory Council. This article is reprinted
from ABM News and Views, The Newsletter of the Academy of Breastfeeding
Medicine, Volume 3, Number 4, 1997.
REFERENCES
1. American Academy
of Pediatrics Work Group on Breastfeeding. Breastfeeding and the use
of human milk. Pediatrics 1997;100:1035-39. The statement is also available
on the AAP web site www.aap.org. Check the "What's New"
area or use the search engine. Or fax the statement via the
AAP FAXback. Call 847/758-0391, follow the prompts and request document
#9729.
Reprints are available from
the LLLI Order Department, P.O.Box 4079, Schaumbug, IL 60168-4079 USA. Ask
for item No.58 at $2.50 each plus $2.00 shipping and handling.
Page last edited Sun Oct 14 09:32:41 UTC 2007.
