Dec. Pediatric Journal- Vol. 100, #6
"The AAP emphasizes the essential role of the pediatrician in promoting, protecting, and supporting breastfeeding and recommends the following breastfeeding policies."
1. Human milk is the preferred feeding for all infants, including premature and sick newborns, with rare exceptions.
2. Breastfeeding should begin as soon as possible after birth, usually within the first hour. Except under special circumstances, the newborn infant should remain with the mother throughout the recovery perid. Prodedures that may interfere with breastfeeding or traumatize the infant should be avoided or minimized.
3. Newborns should be nursed whenever they show signs of hunger, such as increased alertness or activity, mouthing, or rooting. Crying is a LATE indicator of hunger. Newborns should be nursed approximately 8 to 12 times every 24 hours until satiety, usually 10 to 15 minutes on each breast. In the early weeks after birth, nondemanding babies should be aroused to feed if 4 hours have elapsed since the last nursing. Appropriate initiation of breastfeeding is facilitated by continuous rooming-in.
4. No supplements (water, glucose water, formula, and so forth) should be given to breastfeeding newborns unless a medical indication exists. Supplements and pacifiers should be avoided whenever possible, if used at all, only after breastfeeding is well established.
5. When discharged <48hrs after delivery, all breastfeeding mothers and their newborns should be seen by a pediatrician or other knowledgeable health care practitioner when the newborn is 2-4 days of age.
6. Exclusive breastfeeding is ideal nutrition and sufficient to support optimal growth and development for approximately the first 6 months after birth. Infants weaned before 12 months of age should not receive cow's milk feedings but should receive iron-fortified infant formula. Gradual introduction of iron-enriched solid foods in the second half of the first year should complement the breast milk diet. It is recommended that breastfeeding continue for at least 12 months, and thereafter for as long as mutually desired.
7. In the first 6 months, water, juice, and other foods are generally unnecessary for breastfed infants. Vitamin D and iron may need to be given before 6 months of age in selected groups of infants. (vitamin D for infants whose mothers are vitamin D-deficient or those infants not exposed to sunlight: iron for those who have low iron stores or anemia). Fluoride should not be administered to infants during the first 6 months after birth, whether they are breast or formula-fed. During 6 months to 3 years of age, breastfed infants (formula-fed) require fluoride supplementation only if the water supply is severely deficient in fluoride (<0.3ppm).
8. Should hospitalization of the breastfeeding mother or infant be necessary, every effort should be made to maintain breastfeeding, preferably directly, or by pumping the breasts and feeding expressed breast milk, if necessary.
1. Promote and support breastfeeding enthusiastically.
2. Become knowledgeable and skilled in both the physiology and the clinical management of breastfeeding.
3. Work collaboratively with the obstetric community to ensure that women receive adequate information throughout the perinatal period to make a fully informed decision about infant feeding.
4. Promote hospital policies and procedures that facilitate breasfeeding. Electric breast pumps and private lactation areas should be available to all breastfeeding mother in the hospital, both on ambulatory and inpatient services.
5. Become familiar with local breastfeeding resources.
6. Encourage routine insurance coverage for necessary breastfeeding services and supplies, including breast pump rental and the time required by pediatricians and other licensed health care professionals to assess and manage breastfeeding.
7. Promote breastfeeding as a normal part of daily life, and encourage family and societal support for breastfeeding.
8. Develop and maintain effective communications and collaboration with other health care providers to ensure optimal breastfeeding education, support, and counsel for mother and infant.
9. Advise mothers to return to their physician for a thorough breast examination when breastfeeding is terminated.
10. Promote breastfeeding education as routine component of medical school and residency education.
11. Encourage the media to portray breastfeeding as positive and the norm.
12. Encourage employers to provide appropriate facilities and adequate time in the workplace for breast-pumping.