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
• Guidance for initiation and
maintenance of breastfeeding
for health care professionals
• Hospital and community
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
• 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
U.S. Surgeon General’s
Call to Action to Support Breastfeeding
• Communities
• Health care systems
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:
National Immunization Survey
Infants Born in 2008 in US
HP 2020
Goals (%)
US (%)
6 mo (any)
12 mo (any)
3 mo (exclusive)
6 mo (exclusive)
2011 Breastfeeding Report Card
Breastfeeding Report Card:
Percent of Children Ever Breastfed by
State (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
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
US Department of Health and
Human Services Publications
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
– Breastfeeding Curriculum for Residents
• “Breastfeeding Your Baby” (pamphlet)
United States
Breastfeeding Committee
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) (
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
Drugs and Lactation Database (LACTMED) (
Hale T. Medications and Mothers’ Milk 2010, 14th ed..
Maternal Medications
• Choose the safest drug available.
• Prescribe medications for the shortest length of time
• 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) (
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
- 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
Business Case for Breastfeeding
• 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.

Management of Common Breastfeeding Problems