At the Tipping Point: A Strength-Based Collaborative Approach

It was an honor and privilege to join the Second Annual Summit on Breastfeeding and to speak on behalf of the Board of Directors of the American Academy of Pediatrics (AAP).

We have come to understand that the AAP is increasingly THE voice for children around the world. Pediatricians were active in disaster relief after Hurricane Katrina and then China, Haiti, and now Chile. AAP policies are increasingly used to improve the welfare of children around the world. In addition to advocacy related to obesity, abuse, neglect, and child safety, the AAP assists with tobacco cessation in Europe and the Philippines, infant resuscitation efforts in China and India, and medical education for many of the world's pediatricians.

We have not lost sight of that fact that improving infant nutrition was to a large degree the basis for the foundation of our profession. In reading materials from the First Summit, I was intrigued by the editorial by Dr. Ruth Lawrence and Dr. Cynthia Howard ¹ that ended with the following comments on the work of the Summit:

… the challenge is to accomplish these goals [based on work group recommendations.] Who will be watching? Who will be working? Who will be reporting? No one, unless breastfeeding becomes part of the nation's health plan for 2020.

That call has been heard—professionals, the private and the public sector, media, and foundations have heard the message and are prioritizing breastfeeding.

In 2005, the AAP published a revised policy statement declaring that breastfeeding ensures the best possible health, as well as developmental and psychosocial outcomes. ² In August 2009, the AAP endorsed the WHO/UNICEF Ten Steps to Successful Breastfeeding. We have created an AAP Residency Breastfeeding Curriculum and improved our website with many references for physicians and families. Check our new consumer website, healthychildren.org.

AAP President Judy Palfrey recently joined First Lady Michelle Obama to announce the “Let's Move” initiative to combat childhood obesity. That program formally recognizes the value of breastfeeding as an effective strategy to prevent obesity and identifies pregnancy as the critical time to educate parents regarding the value of breastfeeding, as well as perinatally and in the community postpartum. The U.S. Preventive Services Task Force has adopted similar recommendations.

Although I suggest that we should be encouraged by the progress to date, I don't mean to imply that the battle is over. Perhaps, however, we are nearing the tipping point in the effort to make First Food, for a minimum of 6 months, the first choice of a majority of moms.

With the kind of support currently being generated, one would think that the rest should be easy. We have clearly made progress, in that more infants are starting to breastfeed at birth. We have a long way to go, however, in that too few start to breastfeed, too few continue for a minimum of 6 months, too few minority moms even try, and too many quit before they have a chance to succeed.

On a personal note, I admit that I get discouraged at times. I am surrounded by lactation consultants and an educated and well-meaning staff with a sincere desire to improve the system in general and assist every mom and baby on their new journey. In spite of that, almost daily, I am confronted with stressed and anxious moms for whom failure means a shattered ego and deflated self-image. I have begun to conceptualize this as a process similar to “posttraumatic stress disorder,” or PTSD. Whatever we call it, it is real, and an issue that must be confronted.

Many moms begin with unrealistic expectations and have difficulty living up to their own personal expectations. Others encounter physiologic and medical barriers that impede success. Whatever the cause we must learn to define the issues and effectively intervene. At times the intervention will be mechanical, on other occasions medical, but frequently it will be emotional.

I personally believe that ultimately, success will only occur if we build a positive strength-based collaborative environment for these dyads that begins prenatally and continues for months after delivery, that starts in the obstetrician's office, is available in hospital, and carries over into the world of work, home, and the community. We must make the process inviting and compelling, attracting them to breastfeeding and then nurturing and adequately supporting them through the process.

I applaud you all for your commitment to First Food and the work you are doing to promote breastfeeding! I believe that success is within our grasp, but that a hard push is still necessary. Public opinion is changing, and support is increasingly available. The AAP looks forward to joining you in those efforts.