Abstract
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For decades, the AAP has recommended that all mothers breastfeed for their child's first year of life. The AAP Section on Breastfeeding is home to experts in breastfeeding medicine as well as pediatricians who want to learn more about breastfeeding. The Section on Breastfeeding conducts activities that protect, promote, and support breastfeeding in their state, chapters, and communities. The Section provides resources that will help all pediatricians provide optimal breastfeeding care. A few notable AAP resources include:
• the 2012 AAP policy statement, “Breastfeeding and the Use of Human Milk,”
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which reaffirms its recommendation of exclusive breastfeeding for about 6 months • the Breastfeeding Residency Curriculum Web site • a variety of professional and consumer Web sites • publications such as Breastfeeding Handbook for Physicians,
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New Mother's Guide to Breastfeeding,
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and Breastfeeding Telephone Triage and Advice.
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At present, the AAP Section on Breastfeeding and the AAP Early Brain and Child Development Workgroup are examining opportunities to expand resources that specifically address the benefits of breastfeeding and early brain and child development.
The linkage between breastfeeding and early brain and child development is a new science that is reinforcing the crucial importance of the first 1,000 days of life and redefining the way we look at health across the life span. During the first few years of life, safe, stable, and nurturing relationships promote healthy brains by decreasing toxic stress and encouraging foundational mental skills. Ecology (early social and environmental experiences) and biology (genetic predispositions) influence development of adaptive behaviors, learning capacities, lifelong physical/mental health, and future economic productivity. The prevailing consensus from large epidemiological studies suggests a longer duration of breastfeeding is associated with improved measures of IQ and cognitive functioning in later childhood. 6
New evidence also suggests that human milk has beneficial effects on health via the epigenetic process. Breastfed children have a lower risk of necrotizing enterocolitis, infectious diseases, obesity, and related disorders; breastfeeding mothers may have a lower risk of breast cancer, even if a genetic predisposition for the development of these diseases is present. 7 The different epigenetic mechanisms involved have yet to be defined. Further studies are necessary to provide more explanation about the relationship between human breastmilk and gene expression, particularly regarding prevention of noncommunicable diseases to potentially benefit the infant's health and adult life. The AAP has formed a multidisciplinary leadership group composed of members representing genetics, environmental health, early brain and child development, and bioethics. This team has developed a plan to bring member pediatricians who are not well versed in epigenetics up-to-speed and to help them look at child health and life course issues through a new lens. It is imperative that we translate the advances in developmental science into effective policies and practices for families with children to improve education, health, and lifelong productivity.
Poverty also affects a child's short- and long-term health. Children living in poverty have
• increased emotional problems • decreased intellectual development • suffer from more chronic diseases
Breastfeeding improves cognitive outcomes of preterm and term infants, even when adjusted for family socioeconomic status and educational attainment. Last summer, the AAP added “poverty and child health” as a strategic priority to the AAP Agenda for Children. By designating “poverty and child health” as a strategic priority, the AAP has embarked on a 3-year effort to help pediatricians care for children and families in poverty as well as promote effective state and federal policy strategies.
Federal- and state-level support for breastfeeding is essential to confront challenges and address disparities. The AAP advocates for breastfeeding on the federal level and encourages the efforts of AAP state chapters and local coalitions. Progress has been made with the Patient Protection and Affordable Care Act of 2010, which provides two major provisions that encourage mothers to achieve their breastfeeding goals:
• reasonable break time to express milk and • health insurance benefits to defray the costs associated with providing breastmilk to infants, including coverage of breastfeeding education and supplies.
In addition, the Family Leave Act, sponsored by Representative Rosa DeLauro (D, CT) and Senator Kirsten Gillibrand (D, NY), addresses paid maternal leave to increase likelihood of prolonged breastfeeding. Although these advancements are noteworthy, more is needed. Additional funding for breastfeeding counseling provided through the National WIC Association is crucial to the success of the peer-to-peer counseling program and the rates of breastfeeding. And, health professionals must continue to serve as breastfeeding advocates, educators, and community resources to foster a strong foundation for children's lifelong learning, behavior, and health.
Footnotes
Acknowledgments
Ngozi Onyema-Melton, MPH, CHES is thanked for her expert assistance in preparing this commentary.
Disclosure Statement
No competing financial interests exist.