How to support the breastfeeding parent

There are multiple tools that pediatricians can equip themselves with when to comes to supporting breastfeeding, according to a session presented at the 2023 Pediatric Academic Societies meeting held in Washington, DC.

Jennifer Zarit, MD, IBCLC, assistant professor at UPMC, Children’s Hospital of Pittsburgh; Patricia Staley, MD, assistant professor of pediatrics at UPMC Children's Hospital of Pittsburgh; Kristin Hannibal, MD, clinical director of primary care center at the University of Pittsburgh School of Medicine; and Mavis Britwum, DO, pediatric resident at UPMC Children's Hospital, sought to explain the process of breastmilk production, provide the benefits of breastfeeding, and know how to respond to questions about lactation in their presentation. They also aimed to explain hand expression of breastmilk to new parents and show the ideal latch and positioning of an infant for maternal comfort and optimal breastmilk transfer.

Zarit, Staley, Hannibal, and Britum began their presentation with a conversation about incorporating inclusive language when it comes to discussing breastfeeding. This includes the different terminology families prefer to use instead of the term “breastfeeding, such as “chestfeeding.” Additionally, the presenters suggested using the term “parent or “person who gave birth” instead of "mother" if the patient requests it.

They also touched on some of the benefits of breastfeeding mentioned by the presenters included immune system development and has shown a decrease in lower respiratory tract infections, acute otitis media, obesity, and diarrhea. There are also maternal benefits to breastfeeding such as a decrease in the risk of developing type 2 diabetes, hypertension, as well as ovarian and breast cancer.

Despite these benefits to both mother and child, there are some situations when parents should avoid breastfeeding, including when maternal infections are present (HIV, herpes on the breast, and active tuberculosis), inborn errors of metabolism (such as galactosemia), and maternal exposure to drugs of abuse, medications, and environmental agents, according to the presentation. However, they mentioned that it is OK to breastfeed if the mother smokes, ingests CT/MRI contract, or is on opioid maintenance.

The presenters stressed that any amount of breastmilk is beneficial (however the range of benefits is dose-dependent), and while it is ideal that every baby be given 100% breastmilk, any breastmilk is considered good breastmilk. “Any amount of breastmilk or any time spent breastfeeding will be beneficial for the mother and baby,” said Zarit, Staley, Hannibal, and Britum.

Additionally, they provided 2022 updates to the American Academy of Pediatrics Policy Statement “Breastfeeding and the use of human milk.” Some of these updates include promoting exclusive breastfeeding for approximately 6 months of age as well as the continuation of breastfeeding along with the introduction of complementary foods after approximately 6 months. As for patients 2 years and older, the update recommends breastfeeding can continue if it is both desired by the mother and child.

The priority of the presentation was spent providing different case scenarios to the audience regarding what clinicians can do when a patient is breastfeeding, including:

• Know the benefits
• Know what to expect
• Teach hand expression
• Encourage “safe” skin to skin
• Know the basics of latch
• Use Lactmed

The workshop presentation concluded with attendees partaking in a lactation simulation to provide examples of how to help patients breastfeed.

Reference:

Zarit J, Staley P, Hannibal K, Britwum M. Skills to support breastfeeding through simulation. Presented at: Pediatric Academic Societies Meeting, April 27-May 1, Washington, DC.