AAP RELEASES NEW BREASTFEEDING RECOMMENDATIONS

The American Academy of Pediatrics (AAP) recently issued sweeping guidelines stressing breastmilk as the foundation of good infant nutrition. The AAP, an organi-zation of 53,000 primary care pediatri-cians, pediatric medical subspecialists, and pediatric surgical specialists, recog-nizes that pediatricians and hospitals are crucial in supporting and promoting breastfeeding.

This revolution in infant feeding is being driven by a three-page paper pub-lished in the December issue of Pediatrics, the journal of the AAP. Simply called "Breastfeeding and the Use of Human Milk," this paper contains 111 references and is the result of years of work by 11 of the country’s top breastfeeding experts. These doctors, four men and seven women, who work both in clinical prac-tice and research, have extensively reviewed the latest publications and developed new policies to ensure optimal infant health.

"The research supporting these find-ings about the importance of breastfeed-ing is compelling," explains Lawrence M. Gartner, MD, professor of pediatrics, obstetrics, and gynecology at the University of Chicago and head of the AAP Workgroup on Breastfeeding. "There has been so much new data on the diverse advantages to infants, mothers, families and society from breastfeeding that we felt it was time to seriously review our breastfeeding policies."

Ruth A. Lawrence, MD, author of Breastfeeding: A Guide for the Medical Profession and one of the authors of the paper, explains: "Increasing both the rates of breastfeeding initiation and duration is a national health objective. We now have about 60 percent of mothers breastfeeding their newborns. We’d like to see that num-- ber rise to 75 percent. Currently only 21 percent of 5-month-olds are getting any breastmilk at all. That number needs to more than double. These new policy guide-lines should help us meet those goals."

The physicians note that there are many obstacles to breastfeeding. These include physician apathy, disruptive hos-pital policies, commercial promotion of ,infant formula, and lack of support in the community.

Here’s what you can expect as a result of the new policies: Hospitals are now recommending breastmilk for all infants. "We now know that all babies, including premature and sick newborns, need breastmilk," Says Gartner.

Not only do the AAP physicians rec-ommend that all babies receive breast-milk, they recommend babies get it immediately. The new guidelines call for breastfeeding to begin as soon as possible after birth, preferably within the first hour. Not only should the newborn feed, but he or she should also remain with the mother throughout the recovery period. Rooming-in with mother is recom-mended, and any procedures that inter-fere with breastfeeding or traumatize the newborn should be postponed.

Newborns should be nursed when-ever they show signs of hunger. The guidelines stress that newborns should be nursed eight to 12 times every 24 hours until the baby is satisfied, usually ten to 15 minutes on each breast.

In a major change of existing hospital practices, the new guidelines call for no supplements to breastfeeding - no sterile water, glucose water, or infant formula. Hospital discharge packs containing free infant formula should be eliminated. Similarly, in a big departure from the past, the AAP pediatricians now say that for about the first six months nothing should be given to the baby other than breast-milk - no vitamins, iron, fluoride, or juice.

Ideally, says Lawrence, "Breastfeeding should be the sole food for baby for the first six months. Alter that, breastfeeding should continue for at least a year along with complementary foods. I’d like to see mothers nurse well past the first year. My rule is keep it going as long as baby and Mother are comfortable with it."

The AAP now recommends that breastfeeding be continued even if baby or mother need to be hospitalized. Hospitals should now provide electric breast pumps and private lactation areas to all breastfeeding mothers throughout the hospital, not just in the maternity ward. Moreover, insurance companies will be encouraged to cover breastfeeding ser-vices and supplies.

The AAP lists medications and treat-ments mothers may need that are not safe for the breastfeeding child. The pediatri-cians emphasize that breastfeeding may only need to be halted temporarily while contraindicated medications are taken.

Says Gartner, "As pediatricians, we need to promote, protect, and support breastfeeding. The ultimate decision on feeding of an infant is the mother’s, but enthusiastic support and involvement of pediatricians and other physicians with these new policies should help us do a better job of seeing that our nation’s babies get the care they need to grow and develop optimally and stay as healthy as they possibly can."

(Dia Michels. DiaMichels@aol.com or wwwparentsplace.com/read/room/dia)

From "Breastfeeding and the Use of Human Milk," Pediatrics 100, no.6, December 1997:

Role of Pediatricians in Promoting
and Protecting Breastfeeding

• Promote and support breastfeeding enthusiastically.
• Become knowledgeable and skilled in both the physiology and the clinical management of breastfeeding.
• Work collaboratively with the obstetric community to fully inform women about infant feeding.
• Promote hospital policies and pro-cedures that facilitate breastfeeding.
• Become familiar with local breast-feeding resources.
• Encourage routine insurance cover-age for necessary breastfeeding services and supplies.
• Promote breastfeeding as a normal part of daily life.
• Promote breastfeeding education as a routine component of medical school and residency education.
• Encourage the media to portray breastfeeding as positive and the norm.
• Encourage employers to provide appropriate facilities and adequate time in the workplace for breastpumping.

1997: THE YEAR OF BREASTFEEDING LEGISLATION

In 1997, more states passed laws pro-tecting a woman’s right to breastfeed in public than in all previous years com-bined. California - the most populous state - and Delaware - the least popu-lous - both guaranteed a woman’s right to breastfeed anywhere she is allowed to be. And Philadelphia became the first city in the nation to pass breastfeeding legisla-tion. Philadelphia legislators passed an ordinance prohibiting segregation of breastfeeding mothers.

Amazing Breastfeeding Facts

Women can successfully breastfeed triplets as evidenced by the mother who breastfed her triplet sons for 13 months. The babies were born at 32 weeks by cesarean and fed expressed breastmilk by tube at first. By their due date, all were fully breastfed. No supplements were ever given, and solids were intro-duced at seven months. (Breastfeeding Review 2, no. 10)

Women in Norway breastfeed everywhere in shops, in restaurants, on trains, and on television. Breastmilk is included in the nation’s report on food production and costed at 50 pounds per liter. In the 1970s, breastfeeding rates were nearly as low as they are in the UK today, but now more than 80 percent of Norway’s mothers are still breastfeeding at three months. (New Generation 15, no. 4)