Breastfeeding: Common Questions and Answers

 

All major health organizations recommend breastfeeding as the optimal source of infant nutrition, with exclusive breastfeeding recommended for the first six months of life. After six months, complementary foods may be introduced. Most organizations recommend breastfeeding for at least one year, and the World Health Organization recommends a minimum of two years. Maternal benefits of breastfeeding include decreased risk of breast cancer, ovarian cancer, postpartum depression, hypertension, cardiovascular disease, and type 2 diabetes mellitus. Infants who are breastfed have a decreased risk of atopic dermatitis and gastroenteritis, and have a higher IQ later in life. Additional benefits in infants have been noted in observational studies. Clinicians can support postdischarge breastfeeding by assessing milk production and milk transfer; evaluating an infant's latch to the breast; identifying maternal and infant anatomic variations that can lead to pain and poor infant weight gain; knowing the indications for frenotomy; and treating common breastfeeding-related infections, dermatologic conditions, engorgement, and vasospasm. The best way to assess milk supply is by monitoring infant weight and stool output during wellness visits. Proper positioning improves latch and reduces nipple pain. Frenotomy is controversial but may reduce pain in the short term. The U.S. Preventive Services Task Force recommends primary care interventions to support breastfeeding and improve breastfeeding rates and duration.

Breastfeeding is beneficial for both the mother and infant. Although more than 80% of women in the United States initiate breastfeeding, many stop before the recommended 12 to 24 months.1 Any amount of breastfeeding is better than none, and greater benefits accrue with increased duration.2 Postdischarge primary care support for breastfeeding mothers and infants can increase breastfeeding rates and duration.

WHAT IS NEW ON THIS TOPIC: BREASTFEEDING

A 2015 systematic review and meta-analysis of 17 studies found that breastfed infants performed better on intelligence tests later in life than those who were not breastfed, even after controlling for maternal IQ.

The UK Infant Feeding Survey of 2010 found that concerns about insufficient milk supply (31%), inadequate latch (19%), and painful nipples or breasts (12%) were the top three reasons women stopped breastfeeding.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Exclusive breastfeeding is recommended to reduce the risk of infant gastrointestinal infection and atopic dermatitis.

B

2, 5

Primary care interventions to support breastfeeding are recommended.

B

15

Adequate milk supply during breastfeeding should be monitored through test weighing (the clothed infant is weighed under identical conditions before and after a feeding, and the two measurements are subtracted; 1 g of weight gain = 1 mL of milk intake).

C

21

Frenotomy to treat ankyloglossia in infants reduces breastfeeding-related nipple pain in the short term.

C

31


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Exclusive breastfeeding is recommended to reduce the risk of infant gastrointestinal infection and atopic dermatitis.

B

2, 5

Primary care interventions to support breastfeeding are recommended.

B

15

Adequate milk supply during breastfeeding should be monitored through test weighing (the clothed infant is weighed under identical conditions before and after a feeding, and the two measurements are subtracted; 1 g of weight gain = 1 mL of milk intake).

C

21

Frenotomy to treat ankyloglossia in infants reduces breastfeeding-related nipple pain in the short term.

C

31


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

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BEST PRACTICES IN NEONATOLOGY

Recommendations from the Choosing Wisely Campaign

RecommendationSponsoring organization

Do not separate mothers and newborns at birth unless medically necessary. Instead, help the mother to place her newborn in skin-to-skin contact immediately after birth and encourage her to keep her newborn in her room during hospitalization after the birth.

American Academy of Nursing


Source: For more information on the Choosing Wisely Campaign, see http://www.choosingwisely.org. For supporting citations

The Authors

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KATIE L. WESTERFIELD, DO, IBCLC, is an assistant program director in the Department of Family Medicine at Martin Army Community Hospital, Fort Benning, Ga., and an assistant professor of family medicine at the Uniformed Services University of the Health Sciences, Bethesda, Md. She is also an international board-certified lactation consultant....

KRISTEN KOENIG, MD, is an assistant program director in the Department of Family Medicine at Martin Army Community Hospital, and an assistant professor of Family Medicine at the Uniformed Services University of the Health Sciences.

ROBERT OH, MD, MPH, is director of the faculty development fellowship at Madigan Army Medical Center, Joint Base Lewis-McCord, Wash., and an associate professor of family medicine at the Uniformed Services University of the Health Sciences. At the time this article was written, he was chief medical officer at Martin Army Community Hospital

Address correspondence to Katie L. Westerfield, DO, Martin Army Community Hospital, 6000 Van Aalst Blvd., Fort Benning, GA 31905 (e-mail: kwesterfield@atsu.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

show all references

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