American Academy of Pediatrics on Breastfeeding
Every few years the AAP changes their stand on issues. This is the comparison on what they used to say about breastfeeding and how they changed it from 1997 to 2005. They have a website that is a link to their initiative to promote breastfeeding as well. Here is the link to the overview of the current policy. And here is the actual link to the policy.
Summary of Changes
AAP policy statement:
|1997 Policy Statement||2005 Policy Statement|
|The breastfed infant is the reference or normative model against which all alternative feeding methods must be measured with regard to growth, health, development, and all other short and long term outcomes.
|Exclusive breastfeeding is the referenceor normative model against which all alternative feeding methodsmust be measured with regard to growth, health, development,and all other short- and long-term outcomes.
They also state that exclusive breastfeeding: “has been shown to provide improved protectionagainst many diseases and to increase the likelihood of continuedbreastfeeding for at least the first year of life.”
Exclusive breastfeeding is considered
|Exclusive breastfeeding is ideal nutrition and sufficient to support optimal growth and development for approximately thefirst 6 months after birth.100
It is recommended that breastfeedingcontinue for at least 12 months, and thereafter for as long asmutually desired.104
|Exclusive breastfeeding has been shown to provide improved protectionagainst many diseases and to increase the likelihood of continuedbreastfeeding for at least the first year of life.
Breastfeeding should be continued for at least the first yearof life and beyond for as long as mutually desired by motherand child.185
|When direct breastfeeding is not possible, expressed human milk, fortified when necessary for the premature infant, should be provided.||[The] humanmilk-fed premature infants receive significant benefits withrespect to host protection and improved developmental outcomescompared with formula-fed premature infants.13–22A full section on ADDITIONAL RECOMMENDATIONS FOR HIGH-RISK INFANTS was added.
It addresses issues such as the importance of skin to skin contact and the use of BANKED human milk.
|Benefits listed were:incidence and/orseverity of diarrhea,1-5 lower respiratory infection,6-9 otitismedia,3,10-14 bacteremia,15,16 bacterial meningitis,15,17 botulism,18 urinary tract infection,19 and necrotizing enterocolitis.20,21 … a possible protectiveeffect of human milk feeding against sudden infant death syndrome,22-24 insulin-dependent diabetes mellitus,25-27 Crohn’s disease,28,29 ulcerative colitis,29 lymphoma,30,31 allergic diseases,32-34 and other chronic digestive diseases.35-37 Breastfeeding has alsobeen related to possible enhancement of cognitive development.38,39
… health benefits for mothers [include] lesspostpartum bleeding and more rapid uterine involution.40 Lactationalamenorrhea, an earlier return to prepregnant weight,41 delayed resumptionof ovulation with increased child spacing,42-44 improved bone remineralizationpostpartum45 with reduction in hip fractures in the postmenopausalperiod,46 and reduced risk of ovarian cancer47 and premenopausalbreast cancer.48
|Additional benefits identified
|Social and economic benefits to the nation,including reduced health care costs and reduced employee absenteeismfor care attributable to child illness [which] allows the parentsmore time for attention to siblings and other family duties andreduces parental absence from work and lost income.||The cost benefit of breastfeeding is identified as “decreased annual healthcare costs of $3.6 billion in the United States”|
|It has been estimated that the 1993 cost of purchasing infant formula for the first year after birth was $855.||Decreasedcosts for public health programs such as the Special SupplementalNutrition Program for Women, Infants, and Children (WIC)99;|
|Breastfeeding has environmental benefits. Nothing specific mentioned.||“Decreasedenvironmental burden for disposal of formula cans and bottles;Decreased energy demands for production and transport ofartificial feeding products|
|Encourage routine insurance coverage for necessary breastfeeding services and supplies, including breast pump rental and thetime required by pediatricians and other licensed health careprofessionals to assess and manage breastfeeding.||The savings to the country and the families would be offset to some unknown extent by increased costs for
Costs should be covered by insurance paymentsto providers and families.
|The infant in the US whose mother has been infected with HIV should not breastfeed. In countries with populations at increased risk for other infectious diseases and nutritional deficiencies resulting in infant death, the mortality risks associated with not breastfeeding may outweigh the possible risks of acquiring HIV.||
|Hepatitis was not mentioned.Despite the demonstrated benefits of breastfeeding, there are some situations in which breastfeeding is not in the best interestof the infant. These include the infant with galactosemia,53,54 the infant whose mother uses illegal drugs,55 the infant whosemother has untreated active tuberculosis, and the infant in theUnited States whose mother has been infected with the human immunodeficiencyvirus.56,57 Although most prescribed and over-the-countermedications are safe for the breastfed infant, there are a fewmedications that mothers may need to take that may make it necessaryto interrupt breastfeeding temporarily. These include radioactiveisotopes, antimetabolites, cancer chemotherapy agents, and a smallnumber of other medications.||
|Should hospitalization of the breastfeeding mother or infant be necessary, every effort should be made to maintain breastfeeding,preferably directly, or by pumping the breasts and feeding expressedbreast milk, if necessary.||
consider whether the contraindication may betemporary, and if so, advise pumping to maintain milk production.
|Father not mentioned||The new policy has acknowledged the evidence of the importance of the father in supporting breastfeeding and encourages “education for both parents before and after delivery … as an essential component”|
|Procedures that may interfere withbreastfeeding or traumatize the infant should be avoided or minimized.||
Avoid procedures that interfere with breastfeeding or may traumatize the infant including unnecessary, excessive, and overvigoroussuctioning of the oralcavity, esophagus, and airways to avoidoropharyngeal mucosalinjury that may lead to aversive feedingbehavior
|Skin to skin is not mentioned||Immediate postpartum care:
|Supplements and pacifiers shouldbe avoided whenever possible and, if used at all, only after breastfeedingis well established.93-98||The appropriate and inappropriate use of pacifiers are clearly listed|
|10 to 15 minutes on each breast||Timing of infant feeding is now more flexible – as the feeding should be from both breasts “for as long a period as the infant remains at the breast:”|
|…all breastfeeding mothers and their newborns should be seen by a pediatrician orother knowledgeable health care practitioner when the newbornis 2 to 4 days of age. In addition to determination of infantweight and general health assessment, breastfeeding should beobserved and evaluated for evidence of successful breastfeedingbehavior.
All newborns should be seen by 1 month of age.99
|The AAP continues to urge their members to see infants at around 3 – 5 days of ageThisvisit should includeinfant weight; physical examination,especiallyfor jaundiceand hydration; maternal history of breastproblems(painfulfeedings, engorgement); infant eliminationpatterns(expect3–5 urines and 3–4 stools per dayby 3–5daysof age; 4–6 urines and 3–6 stoolsper day by5–7days of age); and a formal, observed evaluationofbreastfeeding,including position, latch, and milk transfer.Weight loss inthe infant of greater than 7% from birth weightindicates possiblebreastfeeding problems and requires moreintensive evaluationof breastfeeding and possible interventionto correct problemsand improve milk production and transfer.
Breastfeedinginfants should have a second ambulatory visitat 2 to 3 weeksof age so that the health care professionalcan monitor weightgain and provide additional support and encouragementto themother during this critical period.
|Gradual introduction of iron-enrichedsolid foods in the second half of the first year should complementthe breast milk diet.102,103||They encourage the delay of solids until after 6 months, explaining:“Introductionof complementary feedings before 6 months of agegenerally doesnot increase total caloric intake or rate ofgrowth and onlysubstitutes foods that lack the protective componentsof humanmilk.”|
|No mention of benefit or risk of breastfeeding beyond 12 months.||In order to protect mothers who breastfeed for longer than what is usually seen in the US, they state: “There is no upper limit to the duration of breastfeedingandno evidence of psychologic or developmental harm from breastfeedinginto the third year of life or longer.”|
|(vitamin D for infants whose mothers are vitamin D-deficientor those infants not exposed to adequate sunlight; iron for thosewho have low iron stores or anemia).||Vitamin K (1.0 mg IM) and Vitamin D (200 IU daily from 2 months of age) are recommended, but not fluoride treatment.|
|Appropriateinitiation of breastfeeding is facilitated by continuous rooming-in.91||In order to encourage frequent and cue-led infant feeding, they recommend, even after hospital discharge that: “Mother and infant should sleepin proximity to each other tofacilitate breastfeeding.”|
|Human milk is the preferred feeding for all infants, including premature and sick newborns, with rare exceptions.75-77 When direct breastfeeding isnot possible, expressed human milk, fortified when necessary forthe premature infant, should be provided.78,79||A new section on the High Risk Infant: Hospitals and physicians should recommend human milk for prematureand other high-risk infants either by direct breastfeeding and/orusing the mother’s own expressed milk.13 Maternal support andeducation on breastfeeding and milk expression should be providedfrom the earliest possible time. Mother-infant skin-to-skincontact and direct breastfeeding should be encouraged as earlyas feasible.204,205 Fortification of expressed human milk isindicated for many very low birth weight infants.13 Banked humanmilk may be a suitable feeding alternative for infants whosemothers are unable or unwilling to provide their own milk. Humanmilk banks in North America adhere to national guidelines forquality control of screening and testing of donors and pasteurizeall milk before distribution.206–208 Fresh human milkfrom unscreened donors is not recommended because of the riskof transmission of infectious agents.|
|Before advisingagainst breastfeeding or recommending premature weaning, the practitionershould weigh thoughtfully the benefits of breastfeeding againstthe risks of not receiving human milk.|
|ROLE OF PEDIATRICIANS IN PROMOTING AND PROTECTING BREASTFEEDING
|ROLE OF PEDIATRICIANS AND OTHER HEALTH CARE PROFESSIONALS IN PROTECTING, PROMOTING, AND SUPPORTING BREASTFEEDING is long and very specific. In addition to the recommendations from the 1997 policy they added:
U:BFPoliciesAAP Policy Statementscomparison chart.doc