How to establish a breastfeeding-friendly pediatric office
JoanYounger Meek, M.D., M.S., FAAP
AAP Clinical Report
Breastfeeding initiation rates in the U.S. are the highest in decades at 81%, yet
less than a quarter of infants are breastfed exclusively at 6 months. In addition,
there are significant disparities based on race, ethnicity, education and socioeconomic
status, according to the Centers for Disease Control and Prevention (CDC).
Pediatricians are positioned to play a pivotal role in supporting breastfeeding families
in the office practice. Recommendations on creating a breastfeeding-supportive environment
are highlighted in a new clinical report The Breastfeeding-Friendly Pediatric Office Practice from the AAP Section on Breastfeeding. The report is available at https://doi.org/10.1542/peds.2017-0647 and will be published in the May issue of Pediatrics.
The Academy has long supported breastfeeding as the optimal infant nutrition. It recommends
exclusive breastfeeding for about six months and continued breastfeeding for at least
one year. Among its many benefits, breastfeeding helps prevent acute infectious disease
and development of chronic disease, reduces risk of sudden infant death syndrome,
and promotes optimal outcomes for both mothers and children. The Academy advocates
that breastfeeding should be considered a public health imperative and not merely
a lifestyle choice.
Why is office support important?
Pediatric care professionals see healthy infants frequently in the office during the
first year of life, giving them many opportunities to provide anticipatory guidance
that supports and encourages breastfeeding.
Pediatricians must be trained to assess breastfeeding adequacy in the mother-baby
pair, troubleshoot problems and refer mothers to community resources, as needed. Pediatricians
also must be knowledgeable about how over-the-counter and prescription drugs may affect
the breastfeeding infant (see resources).
It is important that breastfeeding be evaluated formally with observation during the
first office visit, when any issues can be identified early. Mothers who note difficulty
with latch, pain or milk supply need timely intervention, as do infants with inadequate
Pediatricians should advise mothers on breastfeeding after returning to work and refer
to community-based support personnel such as lactation consultants, nutrition staff
from the Special Supplemental Nutrition Program for Women, Infants and Children, peer counselors and support groups.
A culture of breastfeeding support in the pediatric office begins with a welcoming
environment that encourages mothers to breastfeed in the waiting room or separate
area, if privacy is desired.
All staff must understand the practice’s support of breastfeeding mothers and babies,
and clinical staff should be trained in breastfeeding support and telephone triage
guidelines. At least one person trained in lactation support, such as a nurse or other
staff member, should routinely provide breastfeeding support under the guidance of
the pediatrician. If possible, consider employing a board-certified lactation consultant
in the office.
Pediatricians should make sure that formula is not being advertised through posters,
publications and other materials in the office, and should not distribute free formula
or coupons for formula.
Federal initiatives support breastfeeding
In 2011, then-Surgeon General Regina M. Benjamin, M.D., M.B.A., issued the first Call
to Action to support breastfeeding, urging greater support for breastfeeding women;
education and training for all health care providers; and systems to ensure continuity
of care between the hospital and community settings.
The CDC supports breastfeeding by providing tools for providers and families, collecting
statistics and promoting population health measures.
The CDC monitors hospital maternity care practices and provides funding to improve
these practices through assistance to facilities in implementing the WHO/UNICEF Ten
Steps to Successful Breastfeeding. The number of births in hospitals that have implemented
the Ten Steps and become designated as Baby-Friendly Hospitals increased from 2.9%
in 2007 to 20.1% as of January 2017, according to Baby-Friendly USA.
Due to the impact of federal programs, as well as state and local initiatives, many
newborns leave the hospital breastfeeding after their brief postpartum stays.
Most mothers want to breastfeed, but many do not meet their personal breastfeeding
goals. The breastfeeding-friendly pediatric office practice is well-suited to provide
the support that women need to meet their goals and to improve the health outcomes
of their pediatric patients. It even can be a way to grow and market the practice
to new mothers.
Have a written breastfeeding-friendly office policy.
Train staff in breastfeeding support skills.
Discuss breastfeeding during prenatal visits and at each well-child visit.
Encourage exclusive breastfeeding for about six months and provide anticipatory guidance
that supports the continuation of breastfeeding as long as desired.
Incorporate breastfeeding observation into routine care.
Educate mothers on breast milk expression and return to work.
Provide noncommercial breastfeeding educational resources for parents.
Encourage breastfeeding in the waiting room, but provide private space on request.
Eliminate distribution of free formula.
Train staff to follow telephone triage protocols to address breastfeeding concerns.
Collaborate with the local hospital or birthing center and obstetric community regarding
Link with breastfeeding community resources.
Monitor breastfeeding rates in the practice.
Dr. Meek is co-author of the clinical report and chair of the AAP Section on Breastfeeding