It is well established that exclusive breastfeeding for the first six months of life and then breastfeeding combined with complementary solid foods for at least the first year of life is the ideal infant diet. As pediatricians, we need to promote breastfeeding and understand how to do this effectively.
Breastfed infants have a decreased risk of a multitude of diseases including asthma, obesity, type 1 and 2 diabetes, severe lower respiratory disease, acute otitis media, sudden infant death syndrome, gastrointestinal infections, bacteremia, urinary tract infection, lymphoma, leukemia, Hodgkins disease, and necrotizing enterocolitis (1,2). Interestingly, the breastfeeding mother also has many benefits including decreased postpartum bleeding, more rapid uterine involution, decreased menstrual blood loss, increased child spacing, earlier return to pregnancy weight, and decreased risk of breast and ovarian cancers (2). And on top of that, it is free! So why are only 1 in 3 infants getting breastfed at 12 months (3) and what can we do about it?
Over 80% of moms start off breastfeeding their infants. However, by three months of age, less than 50% are still exclusively breastfeeding. Barriers to breastfeeding include lack of knowledge, social norms, poor family and social support, embarrassment, lactation problems, employment and child care, and barriers related to health services (4). We need to understand these barriers and how we can help to alleviate at least some of them at our clinic visits.
Increasing rates of breastfeeding starts with proper education about the benefits of breastfeeding. Unfortunately, a national survey clearly demonstrated lack of understanding about the benefits of breastfeeding. It found that only a quarter of the US public believed that formula feeding could increase the risk of an infant getting sick (4). While it may be time consuming, we need to take the initiative to help moms understand the long list of benefits both them and their babies will receive from breastfeeding. Moms of lower socioeconomic status, and particularly less education, are less likely to breastfeed their children (5). Educating about this topic is our responsibility, especially for more vulnerable populations. We also need to educate our mothers about the laws that protect them including the ones that allow them to breastfeed in public or private locations and workplace laws that require employers to provide mothers with reasonable break time and a private, non-bathroom space to express breast milk (1). Breastfeeding while working is intimidating, and knowing the laws is vital.
Additionally, although breastfeeding is amazing, it is not always easy. We need to give realistic expectations about what the process looks likes. Unrealistic expectations lead to mothers believing that breastfeeding is not going well for them specifically and that they should stop. If there are issues occurring, lactation consultants are invaluable resources in helping a mother overcome these. We need to educate ourselves about the proper way to breastfeed so that we ourselves can also be a resource to our mothers. Finally, we need to promote breastfeeding by guiding our mothers to resources like free breast pumps from WIC instead of free formula.
As pediatricians, we want what is best for our patients. Too often, we ask what an infant is being fed, but we don’t help guide that decision. We are in a uniquely special position to help our patients’ mothers navigate this vital time in their child’s life. Together, we can increase rates of breastfeeding and improve infant health.
Kelly Lawson, MD
1) “Frequently Asked Questions (FAQs).” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 4 Nov. 2019, https://www.cdc.gov/breastfeeding/faq/index.htm.
2) “Benefits of Breastfeeding.” AAP.org, https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Breastfeeding/Pages/Benefits-of-Breastfeeding.aspx.
3) “CDC Releases 2018 Breastfeeding Report Card.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 20 Aug. 2018, https://www.cdc.gov/media/releases/2018/p0820-breastfeeding-report-card.html.
4) Office of the Surgeon General (US). “Barriers to Breastfeeding in the United States.” The Surgeon General’s Call to Action to Support Breastfeeding., U.S. National Library of Medicine, 1 Jan. 1970, https://www.ncbi.nlm.nih.gov/books/NBK52688/.
5) Heck, Katherine E, et al. “Socioeconomic Status and Breastfeeding Initiation among California Mothers.” Public Health Reports (Washington, D.C. : 1974), Association of Schools of Public Health, 2006, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497787/.