Evidence can help pediatricians explain why moms should breastfeed
JoanYounger Meek, M.D., M.S., IBCLC, FAAP
Focus on Subspecialties
The Academy recommends exclusive breastfeeding for about six months and continued
breastfeeding after the introduction of complementary solids for at least the first
year of life and as long thereafter as desired by mother and child (http://pediatrics.aappublications.org/content/129/3/e827).
Pediatricians play a key role in helping parents understand not only what is recommended,
The Agency for Healthcare Research and Quality (AHRQ) recently published an updated
review outlining current evidence that continues to show the benefits of breastfeeding.
In 2007, AHRQ published its first comprehensive reviews of breastfeeding literature
titled Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries(https://www.ncbi.nlm.nih.gov/books/NBK38337/), which described benefits of breastfeeding for infants and mothers.
A history of breastfeeding was associated with a reduction in the risk of acute otitis
media, nonspecific gastroenteritis, severe lower respiratory tract infections, atopic
dermatitis, asthma in young children, obesity, type 1 and 2 diabetes, childhood leukemia,
sudden infant death syndrome (SIDS) and necrotizing enterocolitis.
For mothers, breastfeeding was associated with a reduced risk of type 2 diabetes,
breast cancer and ovarian cancer. Early cessation of breastfeeding, or not breastfeeding,
was associated with an increased risk of postpartum depression.
Since 2007, several evidence-based reviews have been published taking a more global
A 2015 supplement to Acta Paediatrica included a series of meta-analyses and systematic reviews. A summary by Grummer-Strawn
and Rollins noted that the health benefits of breastfeeding are substantial (doi:10.1111/apa.13136). There were higher rates of mortality among infants never breastfed compared to
those exclusively breastfed in the first six months of life and who continued to breastfeed
beyond six months. Children who were breastfed had lower rates of otitis media, obesity
and asthma, and higher intelligence quotients. Breastfeeding mothers experienced lower
rates of breast and ovarian cancer, type 2 diabetes and postpartum depression.
Grummer-Strawn noted that the benefits of breastfeeding demonstrate the “contribution
and relevance of breastfeeding as a global public health issue for low- and high-income
A 2016 evidence review showed that breastfeeding provides children with protection
against infections, especially gastrointestinal and respiratory, SIDS and malocclusion,
may reduce overweight and diabetes, and was associated with increases in intelligence
(Victora CG, et al. Lancet. 2016;387:475-490). In addition, longer duration of breastfeeding reduced mothers’
risks of breast and ovarian cancer. Each year of breastfeeding decreased a woman’s
chance of developing invasive breast cancer by 6%.
The review also showed that women were 2.5 times more likely to breastfeed where it
is protected, promoted and supported. The authors estimated that more than 820,000
lives a year could be saved globally by improving breastfeeding practices (i.e., through
longer exclusivity and duration of breastfeeding and better support for breastfeeding
The 2018 AHRQ evidence-based review, Breastfeeding Programs and Policies, Breastfeeding Uptake, and Maternal Health Outcomes
in Developed Countries (http://bit.ly/2y54FrH), evaluated 128 studies and 10 systematic reviews. The evidence showed that breastfeeding
is associated with reduced maternal risk of breast and ovarian cancer, hypertension
and type 2 diabetes.
The review also found that implementation of the Baby-Friendly Hospital Initiative
(BFHI) is associated with increased rates of breastfeeding initiation and duration.
Baby-Friendly USA administers BFHI, with its Ten Steps to Successful Breastfeeding
(http://bit.ly/2P40TWE), in this country. In September, more than 26% of all births in the U.S., accounting
for more than 1 million newborns, occurred in maternity facilities designated as Baby-Friendly
(https://www.babyfriendlyusa.org/find-facilities). This is an increase from only 2.9% of births in Baby-Friendly designated facilities
in 2007. There is at least one Baby-Friendly maternity facility in every state, Washington,
D.C., and Puerto Rico.
Additional findings from the 2018 AHRQ review were that health care staff education,
when combined with postpartum home visits, may increase breastfeeding duration. Peer-support
programs for women enrolled in the Special Supplemental Nutrition Program for Women,
Infants, and Children (WIC) also may improve rates of breastfeeding initiation and
duration. The WIC Program has shown a steady increase in breastfeeding rates among
the infants for which it provides services (http://bit.ly/2y44MDQ).
The Centers for Disease Control and Prevention’s National Immunization Survey results
released this year reported that 83.2% of U.S. infants born in 2015 were breastfed
initially, but only 24.9% were breastfed exclusively through 6 months as recommended
Up-to-date evidence can help pediatricians educate patients, support mothers and advocate
for overcoming barriers that mothers face in meeting their breastfeeding goals. Through
the support of informed pediatricians, more mothers and children will achieve the
optimal health outcomes from breastfeeding described above.
Dr. Meek is chair of the AAP Section on Breastfeeding Executive Committee.