Breastfeeding Support and Promotion Joan Younger Meek, MD, FAAP AAP Section on Breastfeeding AAP Policy Statement • Human milk is the normative standard for infant feeding and nutrition • Breastfeeding should be considered a public health issue and not a lifestyle choice AAP Pediatrics 2012;129;e827-41. AAP Policy Statement • Evidence-based benefits of breastfeeding • Guidance for initiation and maintenance of breastfeeding for health care professionals • Hospital and community advocacy American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the Use of Human Milk. Pediatrics. 2012:129:e827-841. AAP Policy Statement • Human milk is species-specific, uniquely superior for infant feeding, and promotes optimal growth, health, and development. • Direct breastfeeding is best, but expressed breast milk, fortified when appropriate for premature infants, is next best. AAP Policy Statement • Pediatricians should provide complete, current information on the benefits of breastfeeding and promote breastfeeding as a cultural norm. • A decision to choose not to breastfeed should occur only after the family has been fully informed about the benefits of breastfeeding and potential risk of not receiving human milk. Photo © Roni M. Chastain, RN U.S. Surgeon General’s Call to Action to Support Breastfeeding “I believe that we as a nation are beginning to see a shift in how we think and talk about breastfeeding,” said Dr. Benjamin. “With this ‘Call to Action,’ I am urging everyone to help make breastfeeding easier.” The Surgeon General’s Call to Action to Support Breastfeeding http://www.surgeongeneral.gov/library/index.html U.S. Surgeon General’s Call to Action to Support Breastfeeding • Communities • Health care systems • • • • Clinicians Employers Families Leadership Healthy People 2020 Objectives • Increase the proportion of mothers who breastfeed their babies. • Decrease the percentage of breast-fed newborns who receive formula supplementation within the first 2 days of life. • Increase the percentage of live births that occur in facilities that provide recommended care for lactating mothers and their babies. Healthy People 2020 Healthy People Maternal, Infant, and Child Health 2020 Objectives: http://www.healthypeople.gov/2020/topicsobjectives2020/objectives National Immunization Survey Infants Born in 2008 in US HP 2020 Goals (%) US (%) 81.9% 74.6 6 mo (any) 60.6 44.3 12 mo (any) 34.1 23.8 3 mo (exclusive) 46.2 35.0 6 mo (exclusive) 25.5 14.8 Initiation http://www.cdc.gov/breastfeeding/data/NIS_data/ 2011 Breastfeeding Report Card Breastfeeding Report Card: http://www.cdc.gov/breastfeeding/data/reportcard.htm Percent of Children Ever Breastfed by State (2007) http://www.cdc.gov/breastfeeding/data/NIS_data/2007 Supplementation Rates in the US • Within 2 days of birth: 25% • Within 3 months: 36% • Within 6 months: 43% CDC, 2011 Data, for cohort born in 2008 http://www.cdc.gov/breastfeeding/data/nis_data/ Percentage of Any and Exclusive Breastfeeding by Month Since Birth among US infants Born in 2008 *Exclusive breastfeeding = infant receives only breast milk and vitamins or medications, but no other solids or liquids. SOURCE: CDC National Immunization Survey The CDC Guide to Breastfeeding Interventions www.cdc.gov/breastfeeding/pdf/breastfeeding_interventions.pdf http://www.letsmove.gov/ http://www.letsmove.gov/ US Department of Health and Human Services Publications http://www.womenshealth.gov/pub/bf.cfm American Academy of Pediatrics Breastfeeding Initiatives • • • • Section on Breastfeeding New Mother’s Guide to Breastfeeding (2nd Edition, 2011) Breastfeeding Handbook for Physicians (2006) Breastfeeding Promotion in Physician Office Practices (BPPOP) – Breastfeeding Curriculum for Residents • “Breastfeeding Your Baby” (pamphlet) United States Breastfeeding Committee www.usbreastfeeding.org Contraindications to Breastfeeding • • • • • Infant with classic form of galactosemia Maternal HIV, HTLV-I, HTLV-II in U.S. Herpes simplex lesions (active) of breast Mothers with active, untreated tuberculosis Mothers receiving antimetabolite or chemotherapeutic agents • Mothers with active radioisotopes • Maternal illicit substance use • Medications incompatible (rare)* Drugs and Lactation Database (LACTMED) (http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT American Academy of Pediatrics. Pickering LK (ed). Red Book: Report of the Committee on Infectious Diseases, 28th ed., 2009. Maternal Medications • Most are compatible with breastfeeding. • Medication use in pregnancy is not the same as medication use in lactation. • Weigh benefits against risks. Drugs and Lactation Database (LACTMED) (http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT) Hale T. Medications and Mothers’ Milk 2010, 14th ed.. http://www.ibreastfeeding.com/ Maternal Medications • Choose the safest drug available. • Prescribe medications for the shortest length of time appropriate. • Use short-acting formulations. • Administer just after breastfeeding. • Monitor infant for side effects. • Report adverse effects. • See LactMed for up-to-date reference materials Drugs and Lactation Database (LACTMED) (http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT) Breastfeeding and Human Lactation Study Center, University of Rochester, NY Hale T. Medications and Mothers’ Milk 2010, 14th ed. Briggs, Freeman, and Yaffe: Drugs in Pregnancy and Lactation, 9th Edition, Lippincott, Williams & Wilkins, 2011. Conditions Not Contraindicated During Lactation • • • • Hepatitis B • Maternal use of - Caffeine Hepatitis C - Tobacco Cytomegalovirus - Alcohol (however, caution advised) Maternal fever AAP Pediatrics 2012;129:e827-841. American Academy of Pediatrics. Pickering LK (ed). Red Book: Report of the Committee on Infectious Diseases, 28th ed., 2009. Patient Protection and Affordable Care Act • Employers must provide reasonable break times and a private, nonbathroom place for nursing mother to express milk • Applies to non-exempt (hourly) wage earners http://www.dol.gov/whd/nursingmothers/ Business Case for Breastfeeding www.womenshealth.gov Summary • Breastfeeding is the preferred feeding for almost all infants. • Breastfeeding should be considered a public health issue. • Breastfeeding should be actively supported and promoted in the medical community and society.