USPSTF, AAFP Statements Encourage Physicians to Support Breastfeeding

Both the U.S. Preventive Services Task Force, or USPSTF, and the AAFP have released documents encouraging physicians and other clinicians to support breastfeeding. Each document cites a growing body of evidence that breastfeeding benefits the health of both mothers and their infants.

The USPSTF last month recommended interventions to promote and support breastfeeding.

"There is convincing evidence that breastfeeding provides substantial health benefits for children and adequate evidence that breastfeeding provides moderate health benefits for women," the recommendation statement said.

Evidence concluded that mothers who breastfeed are less likely to develop breast or ovarian cancer. Breastfed infants have fewer ear infections and fewer lower respiratory tract and gastrointestinal infections. Moreover, young children who were breastfed have a reduced likelihood of developing asthma, diabetes type 2 and obesity.

Specifically, the task force recommends prenatal interventions to promote breastfeeding, as well as interventions after birth to support breastfeeding. Breastfeeding is contraindicated only in rare circumstances, such as for mothers with HIV infection or infants with galactosemia.

Studies indicate that interventions can improve breastfeeding initiation, duration and exclusivity, the USPSTF report found. Clinicians may use a variety of strategies to improve breastfeeding initiation rates and the duration of breastfeeding. The recommended interventions include:

No published studies have focused on potential harm from breastfeeding interventions, said the statement's authors, and their literature review did not include a search for possible harms of breastfeeding itself. In addition, the authors caution against making women feel guilty for not breastfeeding.

An updated AAFP position paper, "Family Physicians Supporting Breastfeeding," was published shortly after the USPSTF report and is consistent with the task force's recommendations. The paper provides in-depth guidance on how physicians can support breastfeeding women and their families in a variety of situations.

"What I hear from my patients is that initiation rates for breastfeeding are higher than they have been in a long time," said Julie Wood, M.D., chair of the AAFP Commission on Health of the Public and Science, which generated the position paper. "The challenge is improving the breastfeeding duration rate. However we can support moms to breastfeed longer will be key to happier and healthier moms and babies."

Although 77 percent of U.S. mothers initiate breastfeeding, according to CDC data published in 2008, the percentage of moms still breastfeeding at least some of the time six months later varies from 20 percent to 40 percent. Healthy People 2010 set national goals of 75 percent of infants breastfed at birth, 60 percent of infants exclusively breastfed at age 3 months and 25 percent exclusively breastfed at age 6 months.

"We're in the ideal position to help mothers breastfeed because we have the continuum of care: prenatal care, delivery and taking care of the child," Wood said. "Even family physicians who don't provide maternity care have a great opportunity to be supportive in their office and teach their patients about breastfeeding."

It's never too early to talk about breastfeeding and breast function, Wood said, especially in light of research that reveals many women make decisions about breastfeeding before becoming pregnant.

A positive step all family physicians should take, Wood said, is to create a breastfeeding-friendly office. Mothers should feel comfortable breastfeeding in the waiting room or a private area so young children learn early that breastfeeding is the norm, she said.

New sections were added to the paper to address special issues that can sometimes interrupt breastfeeding, including medication use while breastfeeding, occupational or environmental exposure to pollutants, employment issues, and women in the military. Discussions of the role of the father and the special nutritional needs of the near-term infant also are included in the update.

The AAFP recommends all infants, with a few rare exceptions, be breastfed or receive human milk exclusively for the first six months of life. Mothers should continue breastfeeding throughout the first year of life while adding complementary foods to the infant's diet.