Although nearly 80% of mothers initiate breastfeeding, only 50% of mothers are still breastfeeding at 6 weeks, and less than 15% are exclusively breastfeeding at 6 months. The United States lags significantly behind Healthy People 2020 goals despite the health risks of not breastfeeding.1
The American Academy of Pediatrics (AAP) and other organizations support breastfeeding policies and practices. In a 2012 policy statement “Breastfeeding and the use of human milk,”2 the AAP supports exclusive breastfeeding for 6 months and continued breastfeeding for a year or longer as foods are introduced. The statement emphasizes that pediatricians should advocate for breastfeeding as well as be knowledgeable and skillful in its management.
Lack of knowledge, skills, and time all have been cited as barriers to breastfeeding care by pediatricians.3-5 Given an ever-changing practice environment, time pressures, and the societal/patient benefit of breastfeeding, pediatricians need to be knowledgeable in evidence-based practices that may impact breastfeeding in their patients. Physicians are less likely to educate, promote, and encourage activities in which they do not believe themselves knowledgeable or skilled. Physician education programs, however, can increase exclusivity and duration of breastfeeding and decrease problems associated with the practice.6
Decision to breastfeed
Recommendation: Education and guidance for new parents should occur before and during pregnancy.
The decision to breastfeed is often made before encountering the pediatrician—often before becoming pregnant or early in the first trimester. Prenatal education is one of the most successful interventions for increasing both the initiation and duration of breastfeeding.7 For every 3 to 5 women participating in prenatal education, 1 woman will initiate and continue breastfeeding for up to 3 months.8
The prenatal visit is an excellent opportunity for the pediatrician to provide anticipatory guidance about breastfeeding. Although these visits often focus on practice philosophy—the workings of a particular practice—and have not been studied extensively as a tool to promote breastfeeding, primary care counseling has been noted to be a successful promotion intervention in very similar practice settings,9-11 and there is no reason to suspect breastfeeding cannot be similarly promoted.