The Pediatrician Supports Breastfeeding

The pediatrician is the leader of the infant's healthcare team. In this role, the physician works with several healthcare specialists, such as those in lactation. In doing so, the pediatrician must possess the knowledge to ensure that appropriate counseling is provided to support and promote breastfeeding. A survey of pediatricians' attitudes and practices related to breastfeeding was conducted by the American Academy of Pediatrics (AAP) in 1995. ¹ That survey was discouraging in that the overall outcome could be described by the responses to one of the questions posed to the pediatricians: “breastfeeding and formula feeding are equally acceptable forms of feeding.” Since that time, pediatricians have seen a marked increase in research delineating health benefits of breastfeeding and methods of breastfeeding promotion and support. ² National activities have developed to increase breastfeeding awareness and promotion. These interventions include the creation of an AAP Section on Breastfeeding, educational activities at national meetings of the AAP, Pediatric Academic Societies, and the Academy of Breastfeeding Medicine, publications such as Breastfeeding Medicine, national data collection and hospital monitoring through the Centers for Disease Control and Prevention, and the Blueprint for Action on Breastfeeding.^3,4 This increased attention led to the formation of the United States Breastfeeding Committee and breastfeeding initiatives through the Special Supplemental Nutrition Program for Women, Infants, and Children.^5,6

Most importantly, in this interim there has been an increase in breastfeeding rates in the United States, but AAP recommendations for exclusive breastfeeding are not increasing as rapidly.^7,8 In 2004 the AAP repeated their survey of pediatricians to determine if promotion and support of breastfeeding had changed. ²

Although the comparisons between the 2004 and 1995 AAP surveys revealed significant improvements, some differences in knowledge, attitudes, and practices were concerning. ² An important change observed in 2004 was that more pediatricians believed that they had an influence on the initiation of breastfeeding, which was much less considered in 1995. Despite AAP recommendations to the contrary, only 38% of pediatricians recommended a first office visit for a breastfed newborn within 5 days of birth. ⁹ Recommendations tended to favor more exclusive breastfeeding and the avoidance of any supplements in-hospital, but 11% of pediatricians continued to recommend supplementation in-hospital. Only 50.9% of pediatricians recommended vitamin D supplementation despite AAP recommendations. ¹⁰

In other areas, pediatricians' recommendations were not in concert with the AAP. More than 25% of pediatricians did not recommend exclusive breastfeeding during the first month, and 30% recommend delaying the first breastfeed beyond the first hour. Furthermore, less than 75% of pediatricians recommend unrestricted infant feeding throughout the hospital stay by encouraging rooming-in.

More pediatricians in 2004 reported reasons for recommending against breastfeeding or discontinuing breastfeeding. Significantly more physicians in 2004 did not recommend breastfeeding if the mother was too young or immature, opposed breastfeeding, or had infected nipples or because the mother didn't have enough time. Furthermore, pediatricians in 2004 were less likely to think that the benefits of breastfeeding outweigh any difficulties/inconveniences. Although fewer pediatricians in 2004 commented that formula-fed babies were just as healthy as breastfed babies, 26% still agreed with the statement, and in both years 45% of pediatricians thought both methods of feeding were equally acceptable!

Only 12% of pediatricians were very familiar with the Baby-Friendly Hospital concept. ¹¹ Although pediatricians' compliance with the Ten Steps to Successful Breastfeeding has improved in the last decade, their overall rate of compliance is low. ² For example, written hospital policies were acknowledged by 40% of the respondents in 2004 compared with 38% in 1995. Further comparison of 2004 with 1995 data indicate that 67% versus 44% of respondents agreed with breastfeeding within 1 hour of delivery, 74% versus 65% acknowledged that their hospital supported feeding nothing but breastmilk unless medically indicated, 71% versus 51% noted rooming-in 24 hours per day, 68% versus 59% noted the practice of unrestricted breastfeeding, and 34% versus 23% agreed that no pacifiers be given in the hospital. ²

More pediatricians in 2004 than in 1995 reported receiving education on the management of breastfeeding while in medical school or residency, revealing that almost a third have had no such education. Few pediatricians have attended continuing education programs or grand rounds on breastfeeding topics.

Thus, the latest survey data indicate that despite policy recommendations and educational activities, pediatricians continue to demonstrate gaps in knowledge, attitudes, and practices related to breastfeeding. Many pediatricians, however, do not function in the role of the person educating mothers about breastfeeding and have little experience in the clinical setting with breastfeeding management. ¹² There is evidence that a short training program for practicing physicians followed by breastfeeding support through an early, routine, preventive visit might contribute to improving breastfeeding outcomes. ¹³ The AAP breastfeeding curriculum for residents is helpful in getting trainees involved. ¹⁴

Although current programs and awareness campaigns are necessary, unified authoritative documents are helpful in that they provide unequivocal messages about breastfeeding. The AAP Section on Breastfeeding was organized to advocate for accuracy and consistency in policies, guidelines, and informative publications related to breastfeeding across the AAP. Personal experience is a major factor in how pediatricians formulate their attitudes, practices, and even knowledge about breastfeeding. Thus, it is important to support lactation for healthcare professionals in their offices and hospitals so they become participants with a great interest.