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Multiple medical organizations recommend that mothers worldwide exclusively breastfeed newborns and infants for the first 6 months of life to achieve optimal growth, development, and health. The World Health Organization recommends continuation of breastfeeding, with the addition of complementary foods, for at least 2 years. Despite this guidance, while most newborns and infants in the United States receive some breast milk, most are not exclusively breastfed, and breastfeeding frequently is discontinued earlier than recommended. The reasons for noninitiation or early cessation of breastfeeding are multifactorial. Commonly cited reasons for early discontinuation of breastfeeding include lactation and latching issues, concerns about infant nutrition and weight, concerns about taking drugs while breastfeeding, milk pumping, unsupportive work policies, and lack of social support. Racial and ethnic disparities exist regarding the initiation and duration of breastfeeding.

Case 1. Parker, a 28-year-old woman, comes to your office for a prenatal visit (gravida 3, para 1, aborta 1). She asks about breastfeeding. She says she “did not make enough milk” with her 2-year-old daughter and began supplementing with formula in the hospital. By 2 weeks postpartum, she was feeding her daughter exclusively with formula.

Parker says she wants to try breastfeeding again but is worried about a similar situation. After her last delivery, she was diagnosed with chronic hypertension, which has been managed with drugs during this pregnancy. She also has a history of postpartum depression that required drug treatment. She is worried that if she needs to take antidepressants, she will not be able to breastfeed.

Breastfeeding and human milk are the standards for newborn and infant feeding and nutrition.1 The American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), and World Health Organization (WHO) all recommend exclusive breastfeeding for the first 6 months of life.1,2,3 The AAP and AAFP recommend that breastfeeding continue for at least 1 year with the addition of complementary foods, and the WHO recommends continuation for at least 2 years with addition of complementary foods. Best health outcomes for babies and mothers are documented when breastfeeding continues for at least 2 years.2

There are infant and maternal benefits of breastfeeding. One meta-analysis showed that children who were breastfed for at least 4 to 6 months were less likely to be overweight in later childhood, compared with children who were formula fed (odds ratio [OR] = 0.76; 95% CI = 0.67-0.86).4 A cohort study showed that exclusive breastfeeding for at least 4 months, with partial breastfeeding until 6 months reduced the risk of upper respiratory tract infections (URTIs) and gastrointestinal (GI) infections until age 6 months (adjusted OR for URTI = 0.65; 95% CI = 0.51-0.83; adjusted OR for GI = 0.41; 95% CI = 0.26-0.64).5

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