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.
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.