What Is the AAP Statement on Breastfeeding?

My review of “Breastfeeding and the Use of Human Milk”

Published March, 2012 in PEDIATRICS Volume 129

Policy Statement by AAP

This is the policy statement from the American Academy of Pediatrics. It was six years ago since they made a public policy statement on breastfeeding. I love that they feel breastfeeding is a public health issue not just a life style or parenting choice. They make an affirmation on exclusive breastfeeding for six months. And they encourage it to continue after other foods have been added up to a year or as long as it is a relationship that the dyad of mother and baby desire.

The national average for women who begin by breastfeeding their infant is at 75%. Hispanic population is higher and the black population is much lower. The government supplemental programs like WIC show a low rate of initiation of breastfeeding if the mom’s income was lower. And the very poor black population was the lowest. The studies also show women under 20 are lower at initiating breastfeeding and moms over 30 are the higher at initiating.

In ten years this initiative to try to promote breastfeeding has had little change in the moms who begin to breastfeed. I can’t help but wonder if the PSA ads that are not ever shown during daytime or primetime hours on television are considered a promotion of sorts by the government. If this is truly a public health issue, it is certainly not being covered by the media. I think the concerns of making women feel bad if they are not breastfeeding and making the formula companies angry seem to be of more concern. So the targets to get more women nursing seems to have had a little effect but the cessation of breastfeeding early on seems to be the norm in the US regardless.

One quarter of all women’s maternity services provide formula to moms in those crucial first two days after birth. Until the government steps in and really treats this as a public health issue, nothing much will change. The formula companies will continue to promote their artificial breast milk and moms will continue to get mixed messages from the maternity centers. The AAP notes that until the practices of hospitals change, the targets will not be met.

We know hands down that the studies of the comparison between formula fed infants and breastfed infants these are the diseases that are increased by artificial breast milk being used:

  • Respiratory infections (pneumonia) would be decreased 72% if the infants were breastfed exclusively for four months
  • Ear infections would be decreased 50% if the baby is nursed exclusively for three months
  • Serious colds and ear and throat infections would be reduced by 63% if the baby is exclusively breastfed for six months
  • Any breastfeeding reduces gastrointestinal infections by 64% and continues for two months following weaning
  • If preterm infants are given strictly human milk, it decreased their chance of having necrotizing enterocolitis by 77%. (This makes me scream at the knowledge I have of preterm infants still being given formula with little support for the mom of that preterm infant being guided on how to pump for her infant.)
  • SIDS was decreased by 36% for babies breastfed- exclusive breastfeeding increased that even more. That means if moms would breastfeed that would save over 900 babies a year if only 90% of moms would exclusively breastfeed for six months.
  • For infants whose families have a history of allergies, exclusive breastfeeding may decrease the incidence of allergies as high as 42% on certain allergic issues like asthma, eczema and dermatitis. Other allergies were not as affected.
  • Celiac disease- those folks running around not being able to eat gluten- would be reduced by 52% if the babies were breastfed when gluten was introduced.
  • Inflammatory bowel disease would be decreased by 31% if the baby was nursed.
  • Obesity would be decreased by between 15 and 30% but there was a difference between breastfed and breast milk fed infants- thus indicating that breast milk fed babies can be overfed.
  • Diabetes Type 1 is reduced by 50% if the baby is exclusively fed breastmilk for three months. Diabetes Type 2 was reduced by 40% in infants who were breastfed, the thought is less over eating is done.
  • Leukemia and Lymphoma was reduced by 20% and 15% in infants breastfed for at least six months.
  • And if you want a smarter baby- breastfeed them exclusively for at least three months- there was a difference in breastfed infants and formula fed infants.
  • Preterm infants were less likely to become septic and had less colon issues, due to the immune factors in breast milk. And they had fewer admissions after discharge for illnesses. The long term effects on motor skills, behavior and developmental issues were seen into toddlerhood. And although it is determined that the preterm infant should be given only breast milk it made me even more cognoscente of how often I see formula bottles given in the NICU at my every visit.

Moms who breastfeed bless less and their uteruses become involuted quicker. There is also a decrease in postpartum depression. And they are less likely to become abusive with their infants if they breast feed. Weight loss seems to be easier for these moms as well. There was even an indication that the cumulative effect of breastfeeding may be decreasing the mom’s risk of rheumatoid arthritis.

The economic benefits are huge. If 90% infants were breastfed in the US were breastfed exclusively for six months, there is a savings of $13 billion dollars a year! The AAP recommends breastfeeding for six months exclusively and recommend extending to breastfeeding for at least a year and longer if mom and baby both desire to do so. The differences in health for both the mom and the baby are seen over so many areas.

There are  few contraindications to breastfeeding: metabolic conditions for the infant, the moms who have high t-cell lymphotrophic viruses or infectious diseases should not, but should resume when well, and the mom who is HIV+ is recommended to not breastfeed by the CDC- this is in the US but may differ when breastfeeding is more beneficial than the risk of acquiring the disease.

Moms who are breastfeeding should increase their calories to 450 to 500 more calories a day. She should try to have a good diet that is rich in fatty acids and DHA and not contaminated and can supplement her diet with vitamins if needed.

LactMed is the resource for helping moms know what medications are safe while breastfeeding.  If moms are taking amphetamines, chemotherapy drugs, ergotamines and statins she should not be nursing her infant. There is concern if the mom has had radioactive exposure as well.

Hospitals can make a change in breastfeeding being initiated and terminated early. There is a ten steps to successful breastfeeding program that is recommended that they follow. But only 80% of the US hospitals are not following these guidelines. Giving pacifiers to newborns- which is being done 40% of the time and should only be limited to specific medical conditions for pain relief-  is known to lower breastfeeding rates as well as limiting length of time at the breasts- which is being done 58% of the time in most US hospitals. 30% of the hospitals are supplementing with formula with newborns! And 66% of the hospitals gave supplemental formula to the breastfeeding moms.  In fact only 3.5% of US hospitals meet 9 of the 10 steps! Moms and babies need to be able to be together for breastfeeding in the first hour, even if born surgically by cesarean birth.

The AAP does recommend the use of a pacifier after 3 to 4 weeks of age to decrease SIDS. They do recommend Vitamin K but after breastfeeding is done is fine- as long as it is given in the first six hours. They do recommend Vitamin D after discharge of the hospital. They do not recommend fluoride until six months and then limited in the first three years if the water is not fluoridated in their communities.

It is noted that the growth of a breastfed baby is different than their formula fed counterpart.  The recommendation is to use the WHO growth chart.

It notes that the role of the pediatrician can make or break the breastfeeding relationship. They encourage pediatricians to hand out breastfeeding supportive material and assist the mom in helping to breastfeed. They suggest this role is not one for the other employees but that the doctor herself be supportive in this way postpartum. Ironically they suggest they follow evidence based information!

And they make a final plea to businesses to be supportive of breastfeeding. They encourage mother baby friendly worksites and share that the added benefit to their employees are worth their effort in doing so. For every $1 invested in supporting this work environment they get $2 to $3 in return!  There is mention of the acts that promote reasonable break times for nursing moms and places outside of a bathroom in order to pump.

In conclusion is makes me sad to be in a urban area with great resources that still do not support breastfeeding properly. The hospitals in our area all fall short of being a mother baby friendly hospital. Pediatricians in our area still do not regard breastfeeding much differently than just a different way to feed our babies.

I do not think our government is truly promoting this effort. I do not think that it has changed much in my area at all. I wish the AAP would really promote this along with the government in ads that show during prime time- showing the risks of formula feeding in full truth without regard to a back lash!