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Am Fam Physician. 2002;66(2):209-210

to the editor: This letter is in response to the article published in American Family Physician, “Initial Management of Breast-feeding.”1 This article stresses the importance of breastfeeding and suggests ways “in which family physicians can facilitate the early initiation and long-term success of breastfeeding in their patients.”1 One of the keys noted in this article1 to improve breastfeeding rates relies on the breastfeeding education of medical professionals.1 I agree that breastfeeding education for all health care professionals that provide care for new mothers and their infants is an important aspect of encouraging breastfeeding in American families.

Breastfeeding is undoubtedly beneficial to the baby, mother, and society at large. Infants who are breastfed are less likely to develop common childhood illnesses, such as otitis media, lower respiratory tract infections, bacterial meningitis, chronic constipation, allergies and asthma, and infantile eczema.1 Women who breastfeed also gain health benefits, including reduced postpartum bleeding, earlier return to prepregnant weight, reduction in postmenopausal hip fractures, and decreased risk of developing some types of cancer.2 Finally, the cost of formula feeding over breastfeeding is another consideration; a single family could potentially save over $400 during a child's first year of life breastfeeding instead of formula feeding.2

The American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) recommend exclusive breastfeeding during the first six months of life, and they advise continued breastfeeding during months 6 to 12.1,2 Despite these strong recommendations, the number of women in the United States who choose to initiate and continue breastfeeding is significantly below the breastfeeding goals set by Healthy People 2010.3 These objectives state that by 2010, 75 percent of new mothers will initiate breast-feeding, 50 percent of these women will breastfeed until their babies are five to six months old, and 25 percent will continue breastfeeding until their babies are one year of age.3 In 1998, only 64 percent of new mothers initiated breastfeeding at birth, and just 29 percent of mothers continued to breastfeed at six months.4

Despite the many benefits derived from breast milk compared with formula, many health care professionals are not encouraging mothers to breastfeed. A study5 conducted by the AAP found that only 65 percent of pediatricians recommend exclusive breastfeeding for the first month after birth and only 37 percent encourage breastfeeding for the entire first year. Most of these pediatricians stated that they needed more education on breastfeeding and had not attended a presentation on breastfeeding in the previous three years.6 This lack of proper breastfeeding education of health care professionals who provide care for infants may be directly contributing to the poor breastfeeding rates in the United States.

It is vital that the training curriculum of physicians and advanced practice nurses include breastfeeding education. This education should include why breastfeeding is optimal for infants and ways for physicians to assist their patients with breastfeeding. Improved education of health care practitioners is vital to attaining the infant nutrition goals set by Healthy People 2010.

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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