Practice Guideline Briefs
Am Fam Physician. 2005 May 1;71(9):1819-1820.
AAP Releases Updated Breastfeeding Recommendations
The American Academy of Pediatrics (AAP) has issued a revised policy statement on “Breastfeeding and the Use of Human Milk” that reflects new research on the importance of breastfeeding. This statement replaces the policy developed by the AAP in 1997.
Studies have shown that breastfeeding can decrease the incidence and severity of conditions such as diarrhea, bacterial meningitis, and ear infections. Some studies suggest that breastfeeding may offer protection against sudden infant death syndrome, obesity, diabetes, and asthma. Research also indicates that breastfeeding can be beneficial for the mother by possibly reducing the risk of ovarian cancer, breast cancer, and hip fractures and osteoporosis in the postmenopausal period. Other benefits include the potential to decrease annual health costs in the United States by $3.6 billion; decreasing employee absenteeism; and reducing the environmental burden of disposal of formula cans and bottles and energy demands for production and transportation of formula.
Although breastfeeding initiation rates have increased steadily since 1990, the rate of exclusive breastfeeding (i.e., no water, juice, nonhuman milk, or food) has shown little or no increase. The proportion of infants who are breastfed exclusively until six months of age also has increased at a much slower rate than that of infants who received mixed feedings (i.e., breast milk plus infant formula).
Highlights of the AAP policy statement recommendations are listed in the accompanying box.
American Academy of Pediatrics Breastfeeding Recommendations
•Exclusive breastfeeding is recommended for approximately the first six months; breastfeeding should be supported for the first year and beyond as long as mutually desired by the mother and child.
•The mother and infant should sleep near each other to facilitate breastfeeding.
•Self-examination of the mother’s breasts for lumps is recommended throughout lactation, not just after weaning.
•Physicians should support efforts of parents and the courts to ensure continuation of breastfeeding in cases involving separation, custody, and visitation.
•Adoptive mothers should be counseled on the benefits of induced lactation through hormonal therapy or mechanical stimulation.
•Physicians should recognize and incorporate cultural diversity in breastfeeding practices.
•A pediatrician or other knowledgeable and experienced health care professional should evaluate a newborn breastfed infant at three to five days of age and again at two to three weeks to be sure the infant is feeding and growing well.
Cesarean and Vaginal Birth After Previous Cesarean Delivery
Data from the National Center for Health Statistics on the total and primary cesarean rates and vaginal birth after previous cesarean delivery (VBAC) rate in the United States from 1989 to 2003 were published in the January 21, 2005, recommendations and reports series of Morbidity and Mortality Weekly Report.
Preliminary data from 2003 indicated that 27.6 percent of all U.S. births resulted from cesarean deliveries, representing the highest percentage ever reported in the United States and a 6 percent increase from 2002. The total cesarean delivery rate and the primary cesarean delivery rate (i.e., percentage among women with no previous cesarean delivery) have increased every year since 1997 after declines during 1989 to 1996. The rate of VBAC decreased by 63 percent to 10.6 percent in 2003, after increasing from 1989 to 1996. Among women with previous cesarean deliveries, the likelihood of future cesarean deliveries was approximately 90 percent in 2003. The accompanying figure shows the trends in rates of VBAC, total cesarean deliveries, and primary cesarean deliveries from 1989 to 2003.
Copyright © 2005 by the American Academy of Family Physicians.
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