Surprises in New Breastfeeding Guidelines

Adoption, Custody Cases, Culture, and Workplace Issues Addressed

From the WebMD Archives

Feb. 7, 2005 -- Updated breastfeeding guidelines from the American Academy of Pediatrics (AAP) have some new additions that may come as a surprise. The guidelines appear in February's issue of Pediatrics.

The guidelines include information on mother and infant sleeping close together, breastfeeding during custody battles, and breastfeeding for moms who adopt.

Exclusive breastfeeding for the first six months of life is still strongly recommended. The AAP also encourages continued breastfeeding for the next six months and even longer as long as it is mutually desired by mother and child. All breastfeeding moms are encouraged to sleep in close proximity to their newborns. This helps make breastfeeding easier and more convenient.

Breastfeeding isn't always easy or convenient, but when possible, it's optimal for babies and mothers alike. For babies, studies have suggested that breastfeeding can reduce the risk and severity of many infections and may cut risk of sudden infant death syndrome. It reduces the rates of obesity, diabetes, asthma, and other health problems later in life.

For mothers, breastfeeding can reduce uterine bleeding after delivery and may lower risk of breast and ovarian cancer, as well as possibly lowering the risk of hip fractures and osteoporosis after menopause. Breastfeeding is also a valuable chance for mothers and babies to bond.

But the new guidelines don't just list breastfeeding's health benefits. The AAP also takes a stand on social trends and issues that can affect breastfeeding.

Ruth Lawrence, MD, a University of Rochester professor of pediatrics, obstetrics, and gynecology who worked on the committee that wrote the guidelines, says a lot of thought went into the recommendations.

The AAP "does not take these statements lightly," she tells WebMD.

Doctors should tell women who want to adopt about breastfeeding options, says the AAP. "There are lactation consultants that would be able to support the [adopting] woman," says Lawrence.

Her advice for adopting moms: "Start with getting a good pump that pumps both breasts simultaneously."

Doctors might also recommend medications or hormones, says Lawrence. "If a woman has never been pregnant, then hormones are more likely to be needed. If she has had a previous pregnancy, the breasts are primed a little, naturally. If she has had her own children and nursed them, the breast will respond promptly, within a couple of weeks. So each woman has to be managed individually, based on her own history. But [breastfeeding is] possible and worthwhile for women who adopt."


Custody Issues

Courts should also become more sensitive to breastfeeding, says the AAP. Judges may not realize how long babies need to be breastfed, says Lawrence, noting that worldwide, breastfeeding lasts an average of 4.27 years, though social pressures shorten that time considerably in the U.S.

Lawrence says many U.S. women breastfeed babies 12 or 18 months old in the privacy of their own home and that a judge may have "no idea" about that while deciding custody matters.

The new guidelines also address America's changing population. The AAP wants to promote breastfeeding as a cultural norm.

New immigrants might breastfeed "without thinking twice" in their native lands, says Lawrence. But in the U.S., she says newcomers may perceive bottle feeding as being more popular and reconsider their decision. That message may unwittingly be expressed by traditions like including a bottle in baskets for new moms, says Lawrence.

In addition, women from some Southeast Asian cultures traditionally discard early milk, which is loaded with nutrients. "We're trying to teach them that it's very valuable and should not be discarded."

Workplace Sensitivity

The AAP also addresses two work-related issues. The guidelines encourage employers to accommodate breastfeeding or pumping. Childcare providers are also urged to support breastfeeding and the use of breast milk provided by parents.

They also say hospitals should adopt policies and procedures that facilitate breast feeding. They say hospitals should work actively toward eliminating practices that discourage breastfeeding such as the promotion of infant formula, formula discount coupons, and separation of mother and infant.

AAP guidelines are reviewed every five years. The AAP's last breastfeeding recommendations came out in 1997.

WebMD Health News


SOURCES: Pediatrics, February 2005; vol 115: pp 496-506. News release, American Academy of Pediatrics. Ruth Lawrence, University of Rochester.
© 2005 WebMD, Inc. All rights reserved.


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