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Breast-feeding 2005

Highlights from the AAP's policy statement

The Section on Breastfeeding of the American Academy of Pediatrics recently released a policy statement. Such statements, which the AAP issues far more often than guidelines, are often accompanied by extensive references, but the level of evidence supporting each recommendation is unrated. Many policy statements contain important information for practitioners. Here are highlights of the statement on breast-feeding:

• Numerous benefits of breast-feeding for both child and mother (e.g., decreased risk for breast cancer) are well documented.
  
• There are few contraindications for breast-feeding; it is not contraindicated for mothers who are hepatitis-B surface antigen-positive, infected with hepatitis C virus, or seropositive for cytomegalovirus infection (see article for complete list).
  
• Infants should be placed in direct skin-to-skin contact with their mothers immediately after birth.
  
• Breast-feeding newborns should not receive supplements (water, glucose water, formula, etc.) unless medically necessary.
  
• Pacifiers should be avoided until breast-feeding is well established.
  
• At first, mothers should be encouraged to breast-feed infants 8 to 12 times each day.
  
• All breast-feeding infants should be seen at 3 to 5 days of age by a pediatrician or nurse knowledgeable about breast-feeding.
  
• Exclusive breast-feeding is sufficient for optimal growth until about 6 months of age.
  
• Complementary iron-rich foods should be introduced gradually beginning around 6 months of age.
  
• Introduction of complementary foods as early as 4 months of age may be indicated by unique needs or feeding behaviors of individual infants.
  
• Vitamin D drops containing 200 IU should be given to all breast-fed infants starting in the first 2 months of life.
  
• Breast-fed infants do not require supplementary fluoride during the first 6 months; after that, the need for supplementation depends on the fluoride concentration in the water supply.
  

Comment: We continue to fall short of the Healthy People 2010 breast-feeding goals: an initiation rate of 75%; breast-feeding rates of 50% at 6 months and 25% at 1 year. Although initiation rates approach 70%, rates at 6 months (33%) and 1 year (18%) remain low. Although it is difficult to argue with most of these AAP recommendations, there are areas of controversy: First, many breast-feeding experts are uncomfortable with the recommendation that all breast-fed babies receive vitamin D, particularly those who are light-skinned and receive sunlight exposure during the first few months of life. Second, iron sufficiency may not be as good in breast-fed infants as in formula-fed infants at 9 months, so adequate provision of iron-rich complementary food is important. Third, the statement clearly supports the adequacy of breast milk alone until 6 months of age, but I believe that eating is a learned behavior and that introducing some solids sooner may help infants master this complicated behavior. Finally, follow-up at 3 to 5 days after birth may not be soon enough for first-time breast-feeding mothers. As I have cautioned before (see JW Pediatr Adolesc Med Aug 9 2004), keep an eye on breast-fed babies with a gestational age of 35-37 weeks born to new moms who are discharged on Thursday or Friday -- these infants are at high risk for hyperbilirubinemia. I believe it is safer to have some contact with the mother within 2 days of discharge to ensure breast-feeding adequacy.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine March 28, 2005

Citation(s):

Gartner LM et al. Breastfeeding and the use of human milk. Pediatrics 2005 Feb; 115:496-506.

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• Medline abstract (Free)