Today the American Academy of Pediatrics (AAP) released its new policy statement on breastfeeding, making several key changes to its 2005 statement. Because the AAP’s recommendations carry significant weight with moms and health care providers, we wanted to share some of the important changes to the AAP’s recommendations as well as the shift in its overall message.
Timing of introducing solids
The new AAP statement recommends exclusive breastfeeding for “about six months,” bringing the AAP’s recommendations in line with the World Health Organization (WHO). This is a change from the 2005 statement that supported introduction of complementary foods between 4 and 6 months of age. The question of when to introduce solids can be confusing, so we hope the new guidelines will help clarify this issue for new moms.
Duration of breastfeeding
The AAP’s new recommendation for duration of breastfeeding is “1 year or longer as mutually desired by mother and infant,” which is very similar to its 2005 statement. However, the AAP has removed the statement that “there is no upper limit to the duration of breastfeeding and no evidence of psychologic or developmental harm from breastfeeding into the third year of life or longer.” It’s important to note that the World Health Organization continues to recommend breastfeeding up to 2 years or beyond.
WHO growth charts
The new statement supports the use of the World Health Organization’s growth curve standards that reflect the growth patterns of breastfed infants. This is an important distinction as growth charts that are not patterned on breastfed infants (such as the CDC “reference” growth charts) can lead to mislabeling of breastfed babies as underweight or failing to thrive.
Hospital practices to support breastfeeding
In 2009, the AAP endorsed the WHO/UNICEF “10 Steps to Successful Breastfeeding” which is designed to provide a uniform hospital framework for supporting breastfeeding. The 10 Steps are the backbone of UNICEF’s Baby Friendly Hospital Initiative, and have been proven to increase breastfeeding initiation, duration and exclusivity. The AAP’s new policy statement reinforces support for the 10 Steps and the important role hospitals play in supporting breastfeeding.
With its new statement, the AAP has clarified its position on giving pacifiers to breastfeeding infants, stating that it:
“does not support a categorical ban on pacifiers…[but] pacifier use in the hospital in the neonatal period should be limited to specific medical indications…Mothers of healthy term breastfed infants should be instructed to delay pacifier use until breastfeeding is well-established, usually about 3 to 4 weeks after birth.”
While the AAP’s 2005 statement acknowledged the role of workplace lactation support and encouraged employers to support breastfeeding moms, the new statement goes further, highlighting the Business Case for Breastfeeding. Supporting breastfeeding in the workplace provides many benefits to employers including lower health care costs, improved productivity, and lower employee turnover.
Breastfeeding as a public health Issue rather than “lifestyle choice”
One of the more subtle but important changes to the new policy statement is the shift in language that now refers to the risks of not breastfeeding.
“Published evidence-based studies have confirmed and quantitated the risks of not breastfeeding. Thus, infant feeding should not be considered as a lifestyle choice but rather as a basic health issue. As such, the pediatrician’s role in advocating and supporting proper breastfeeding practices is essential and vital for the achievement of this preferred public health goal.”
By recognizing that breastfeeding is much more than a personal choice, the AAP is sending a strong message that supporting breastfeeding is an important public health issue that merits societal support from the hospital to the workplace.
What do you think about these changes? How do you think pediatricians can better support breastfeeding moms and babies?