Breastfeeding Support and Promotion

Joan Younger Meek, MD, FAAP AAP Section on Breastfeeding

AAP Policy Statement

Role of Pediatricians and Other Health Care Professionals in Protecting, Promoting, and Supporting Breastfeeding • Strong position of support based on published evidence of improved outcomes • Knowledgeable and skilled in physiology and management of breastfeeding • Collaboration with the obstetric community • Age-appropriate breastfeeding education in the office and in the school system

AAP Policy Statement

Role of Pediatricians and Other Health Care Professionals in Protecting, Promoting, and Supporting Breastfeeding

• Promote hospital policies that facilitate breastfeeding • Eliminate mother infant separation • Eliminate formula discharge packs Photo © La Leche League International

AAP Policy Statement

Role of Pediatricians and Other Health Care Professionals in Protecting, Promoting, and Supporting Breastfeeding

• Promote community resources • Communicate with lactation support personnel • Encourage third-party payer coverage for breastfeeding services and supplies • Encourage child care providers to support breastfeeding and feeding expressed breast milk • Support breastfeeding in the workplace • Advocate for supportive legislation

AAP Policy Statement

Role of Pediatricians and Other Health Care Professionals in Protecting, Promoting, and Supporting Breastfeeding

• Positive media image of breastfeeding • Breastfeeding education during medical training • Family and societal support for breastfeeding • Breastfeeding as cultural norm Photo © La Leche League International

Opportunities to Promote Breastfeeding Preconception

– Education in school systems – Pediatric and adolescent visits – Gynecologic visits – Breast examinations

Opportunities to Promote Breastfeeding Early pregnancy

– Perform breast examination. – Discuss normal anatomy and physiology.

– Assess previous surgeries, scars, biopsies.

– Talk about previous breastfeeding experiences.

– Provide positive support for benefits of breastfeeding.

Opportunities to Promote Breastfeeding Prenatal visits

– Provide appropriate literature, resources.

– Refer for prenatal and breastfeeding classes.

– Refer to pediatrician for prenatal visit.

– Avoid formula coupons or products.

Opportunities to Promote Breastfeeding Peripartum/postpartum

– Provide supportive delivery environment.

– Facilitate early skin-to-skin contact.

– Place on mother’s abdomen and dry.

– Have trained professionals to assist mother if needed.

– Initiate breastfeeding within the first hour after delivery.

Baby Friendly Hospital Initiative Ten Steps to Successful Breastfeeding Hospital Policies to Support Breastfeeding

1. Have a written breastfeeding policy that is routinely communicated to all health care staff.

2. Train all health care staff in skills necessary to implement this policy.

3. Inform all pregnant women about the benefits and management of breastfeeding.

4. Help mothers initiate breastfeeding within the first hour of birth.

5. Show mothers how to breastfeed and maintain lactation, even if separated from infants.

http://www.babyfriendlyusa.org/eng/10steps.html

Baby Friendly Hospital Initiative Ten Steps to Successful Breastfeeding

Hospital Policies to Support Breastfeeding

6. Give newborn infants nothing other than breast milk,

unless

medically indicated.

7. Practice rooming-in 24 hours a day.

8. Encourage breastfeeding on demand.

9. Give no artificial nipples or pacifiers.

10.Foster the establishment of breastfeeding support groups.

http://www.babyfriendlyusa.org/eng/10steps.html

Percentage of US hospitals with Recommended Policies and Practices to Support Breastfeeding, 2007 and 2009

SOURCE: CDC National Survey of Maternity Practices in Infant Nutrition and Care (mPINC)

Percentage of hospitals by number of recommended policies and practices to support breastfeeding in 2009

The Joint Commission Perinatal Care Core Measure on Exclusive Breast Milk Feeding • The Joint commission defines exclusive breast milk feeding as: – “a newborn receiving only breast milk and no other liquids or solids except for drops or syrups consisting of vitamins, minerals, or medicines” – includes expressed mother’s milk as well as donor human milk, both of which may be fed to the infant by means other than suckling at the breast http://www.jointcommission.org/perinatal_care/

• The Joint Commission assesses how many non NICU babies without a contraindication to breastfeeding were exclusively breast milk fed.

• Exceptions: – Discharged from the NICU – ICD-9 code for Galactosemia – ICD-9 code for Parenteral infusion – Experienced Death – Length of stay > 120 days – Enrolled in clinical trials – Documented Reasons for not exclusively feeding breast milk ( See next slide ) http://www.jointcommission.org/perinatal_care/

The only acceptable maternal reasons for which “breast milk should be avoided” are as follows: – HIV infection – Human t-Lymphotrophic virus type I or II – Substance abuse and/or alcohol abuse – Active, untreated tuberculosis – Taking certain meds: chemotherapy, radioactive isotopes, antimetabolites, antiretroviral meds, and other medications where the risk of morbidity outweighs the benefits of breast milk feeding.

– Undergoing radiation therapy – Active, untreated varicella – Active herpes simplex virus breast lesions ** In some of these cases the infant can and should be exclusively breast milk fed

The Breastfeeding Friendly Doctor’s Office

• Encourage women/staff to breastfeed in the office.

• Display pictures of breastfeeding infants.

• Avoid distributing infant formula or coupons.

Photo © Joan Meek, MD, FAAP

Community Support

• Knowledgeable physicians • Lactation specialists • Hospital support groups • WIC programs • La Leche League International

How Long to Breastfeed?

• Exclusively for the first 6 months of life • Continuing for at least the first year of life, with addition of solids • Thereafter, for as long as mutually desired by mother and child Photo © Mary Boyd, MD, FAAP AAP

Pediatrics

2012;129;e827-41

Summary

• Breastfeeding is the preferred feeding for almost all infants.

• Mothers should be informed of the benefits of breastfeeding.

• Supplementation is rarely indicated and interferes with successful lactation. • Breastfeeding should be actively supported and promoted in the medical community and society.

• Women should feel comfortable continuing to breastfeed for as long as desired.