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Breast is best but success isn't a given. These guidelines help you encourage mothers to breastfeed and give them the support they need to do well--without short-changing reimbursement.
Widespread research into the properties of human milk and the physiology of breastfeeding has repeatedly shown breastfeeding to be best for babies. Although formula manufacturers strive to duplicate its properties, breast milk has unique and diverse advantages not only for infants, but mothers, families, and society. Benefits for baby range from preventing infectious diseases and chronic conditions to improved neurodevelopment and psychosocial adaptation. For parents, the price and availability of breast milk can't be beat. And it comes with no packaging waste to harm the environment. The American Academy of Pediatrics (AAP) policy statement, "Breastfeeding and the use of human milk" delineates the benefits of breastfeeding and reminds pediatric clinicians that "enthusiastic support and involvement of pediatricians in the promotion and practice of breastfeeding is essential to the achievement of optimal infant and child health, growth, and development."1
Most physicians recognize breastfeeding as the gold standard for infant nutrition, but providing excellent support can require much time, effort, and patience. Easing this burden and maximizing breastfeeding success depends on improving prenatal knowledge of breastfeeding among families,2 promoting hospital practices most likely to encourage effective breastfeeding, and making efficient use of the early newborn follow-up visit. To help you attain these goals, this review summarizes the basics of breastfeeding for the primary care pediatrician, offers tips and resources for effectively supporting families in and out of the hospital, and provides guidance on how to code follow-up visits to obtain adequate reimbursement for your efforts.
Power of suggestion: Prenatal education
Dialogue ideally could begin when meeting parents for a prenatal consultation or caring for the older child of an expectant mother. An open-ended question such as, "How are you planning to feed your new baby?" can initiate conversation about breastfeeding. If the mother is not planning to breastfeed, you might cite a few benefits of breastfeeding. If she has questions or has had breastfeeding problems in the past, you can provide information and resources.
Only a few situations exist in which breastfeeding may not be in the best interest of the infant. Infants with classic galactosemia should not be breastfed; they should receive formula without lactose or galactose. Mothers with active, untreated tuberculosis, HIV, or exposure to radioactive materials, chemotherapeutic agents, or street drugs should not breastfeed. Mothers with an active herpes simplex lesion on a breast should not feed their infant from that breast but may feed from the other breast if it has no lesions.1
Begin with the end in mind. The AAP recommends "exclusive breastfeeding for four to six months and then continued breastfeeding for at least the first year of life and beyond for as long as mutually desired by the mother and child,"1 but you should encourage any duration of breastfeeding. The benefits of even a few weeks of breast milk may be overlooked by women who must return to work. Successful initiation of breastfeeding in these mothers may foster their desire and confidence to address creative back-to-work solutions with employers and increase the duration of breastfeeding (while heightening community awareness of breastfeeding issues).