Patient-centered approach to updated AAP breastfeeding guidelines


Allison Scott, DNP, CPNP-PC, IBCLC, reviews the updated breastfeeding guidelines from the American Academy of Pediatrics.


Allison Scott, DNP, CPNP-PC, IBCLC:

The new AAP breastfeeding guidelines of 2022 differed in really 4 main ways. One is the length of breastfeeding, so the prior guidelines, they recommended exclusive breastfeeding for approximately six months and then complementary foods introduced with continued breastfeeding as long as mutually desired by mother and child up to 1 year and beyond. The new guidelines, state recommendation of exclusive breastfeeding for 6 months, they removed approximately, and continued breastfeeding with addition of complementary foods at 6 months and beyond, with continuation as long as mutually desired by child and mother for 2 years and beyond. So that's one of the main differences is the length of time. The primary reason that the length is different, like why is it now 2 years all of a sudden, is because we have a lot better research. We have more robust data to support the fact that long-term breastfeeding is actually very beneficial. One of the other pieces of the guideline that is emphasized is the benefits for the mother. We have long focused on the nutrition benefits for the baby. So it is now recommended that we look at this through a public health lens looking at the mother, the baby the family, the breastfeeding family as a whole. We have solid research that supports long-term breastfeeding is advantageous for the mother, specifically with the cardiovascular health with decreased rates of breast and ovarian cancer, diabetes. There's some emerging evidence on decreased rates of depression, like postpartum depression. The statement in the AAP guideline itself is long-term breastfeeding is associated with protections against diabetes, high blood pressure, and cancers of the breast and ovaries. So even The American Heart Association has come out with a recommendation that breastfeeding be a preventative measure that we encourage for mothers because the United States is number one in heart disease and maternal mortality and all of that is is very high. But heart disease is one of the number one reasons why women die, specifically Black women. So another piece of emphasis of the AAP guidelines is the health inequities. We need to focus much more on the populations that have lower rates of breastfeeding, which includes Black women in the United States. We can impact their health by encouraging and supporting breastfeeding, which is really the whole heart of the new guideline, is support providers should be knowledgeable, follow evidence-based guidelines and support mothers in their whatever their goals are. Whether that is 4 weeks of breastfeeding, 12 months of breastfeeding or 2 years of breastfeeding, we should be encompassing their cultural values. We need to do a better job of finding out what are their goals, how can we support those goals. The final piece of the emphasis of the new guidelines is increased emphasis on support for policy change. We have to have policy change to really accomplish increased rates of breastfeeding as intended. The other thing that is stronger in the AAP guideline, the AAP has long been a significant supporter of breastfeeding, but formula was designed to be a substitute for infant nutrition when economically or physically breast feeding was not possible, which it is not possible for 100% of the population. So it is emphasizing returning to that thinking in that realm, where breast milk direct from the mother is our first choice, donor milk as our second choice and formula is our third choice.

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