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Expanding Clinicians' Roles in Breastfeeding Support: Continuing Medical Education (CME) Online Tutorial

  • Section 1
  • Section 2
  • Section 3
  • Section 4
  • Section 5
  • Section 6
  • Section 7
  • References
  • Post Test

Section 1: Current AAP Guidelines on Breastfeeding

"Breastfeeding and human milk are the normative standards for infant feeding and nutrition. Given the documented short- and long-term medical and neurodevelopmental advantages of breastfeeding, infant nutrition should be considered a public health issue and not only a lifestyle choice...Pediatricians play a critical role in their practices and communities as advocates of breastfeeding and thus should be knowledgeable about the health risks of not breastfeeding, the economic benefits to society of breastfeeding, and the techniques for managing and supporting the breastfeeding dyad."

There is overwhelming support of breastfeeding by prominent healthcare organizations and agencies. The American Academy of Pediatrics (AAP) recently issued an updated policy statement regarding breastfeeding in February 2012.1

The AAP guidelines should be followed to ensure infants and mothers receive all the benefits breast milk and breastfeeding has to offer:

  • Exclusive breastfeeding with no supplemental fluids or solid foods is the best practice for about the first 6 months of life for optimal infant growth and development.
    • Newborns should receive a one-time dose of 0.5mg-1mg of vitamin K1 oxide intramuscularly after the first feeding is completed and within the first 6 hours of life.
    • 400 IU of oral vitamin D drops given daily is recommended beginning at hospital discharge, continuing through the first 2 months of life or until the infant is exposed to natural sunlight enabling synthesis of his/her own vitamin D.
  • In the limited situations in which infants cannot, or should not, be breastfed, there are several recommended alternatives:
    • These options include expressed breast milk from an infant’s own mother or breast milk from a human-milk bank.
    • There is no single preferred alternative; while the substitute feeding method depends on the individual mother and child circumstances, the least preferred alternative is bottle nipples.
  • Infant formula, juices, or water are not needed in the first six months and may only introduce contaminants or allergens.
  • Solid foods may be introduced around 6 months, but should not completely replace breastfeeding and should serve as iron-rich complements to breast milk.
  • Breastfeeding1Breastfeeding should be continued through the first year of life and beyond as mutually desired by mother and child.
  • If a baby is weaned before 12 months of age, the child should receive iron-fortified infant formula, not cow’s milk.
  • Pediatricians have a critical role in their individual practices, communities, and society at large to serve as advocates and supporters of successful breastfeeding.
  • The entire AAP 2012 publication regarding breastfeeding can be accessed here.
  • Previous
  • Section 2: Breastfeeding Background
  • Current AAP Guidelines on Breastfeeding

Role of the Pediatrician

According to the AAP Policy Statement:

  1. Promote breastfeeding as the norm for infant feeding.
  2. Become knowledgeable in the principles and management of lactation and breastfeeding.
  3. Develop skills necessary for assessing the adequacy of breastfeeding.
  4. Support training and education for medical students, residents and post-graduate physicians in breastfeeding and lactation.
  5. Promote hospital policies that are compatible with the AAP and Academy of Breastfeeding Medicine Model Hospital Policy and the WHO/UNICEF "Ten Steps to Successful Breastfeeding."
  6. Collaborate with the obstetric community to develop optimal breastfeeding support programs.
  7. Coordinate with community-based health care professionals and certified breastfeeding counselors to ensure uniform and comprehensive breastfeeding support.

Health Resources in Action logo

Roger A. Edwards, ScD
Consultant
Massachusetts Department of Public Health
508-472-0406
rogeredwards2002@hotmail.com

Rachel Colchamiro, MPH, RD, LDN, CLC
Director of Nutrition Services
Nutrition Division
Massachusetts Department of Public Health
617-624-6153
rachel.colchamiro@state.ma.us

massachusetts department of health logo

Rachel Colchamiro, MPH, RD, LDN, CLC
Director of Nutrition Services
Nutrition Division
Massachusetts Department of Public Health
617-624-6153
rachel.colchamiro@state.ma.us

Ellen Tolan, RD, LDN, IBCLC
State Breastfeeding Coordinator
Nutrition Division
Massachusetts Department of Public Health
617-624-6128
ellen.tolan@state.ma.us

Julie Forgit, LDN, CLC
State WIC Breastfeeding Peer Counselor Program Coordinator
Nutrition Division
Massachusetts Department of Public Health
617-624-6139
julie.forgit@state.ma.us

american academy of pediatrics logo

Susan Browne, MD
Breastfeeding Coordinator
MA Chapter
American Academy of Pediatrics
978-685-0977
brnfaap@mac.com

Mary Foley, RN, BSN, IBCLC
Lactation Program Coordinator
Melrose-Wakefield Hospital
Hallmark Health System
791-507-1980
mfoley@hallmarkhealth.org

Lucia Jenkins, RN, IBCLC, RLC
Melrose-Wakefield Hospital
Hallmark Health System
791-507-1980
luciansla@aol.com

Hallmark Health System logo

Lauren E. Hanley, MD, FACOG, IBCLC
Assistant Professor of Obstectrics, Gynecology
and Reproductive Biology
Harvard University School of Medicine
Massachusetts General Hospital
617-724-2229
lehanley@partners.org

Mary Ellen Boisvert, MSN, CLC, CCE
Six Sigma Black Belt
University of Massachusetts Dartmouth
Assistant Clinical Professor, College of Nursing
maryellen.boisvert@umassd.edu

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