Campaign promotes exclusive
breastfeeding for 6 months
Lori
Feldman-Winter, M.D., FAAP
For the second time in
U.S. history, a national breastfeeding
campaign has been launched.
The goal of the National Breastfeeding
Awareness Campaign is to encourage mothers to commit to
exclusive breastfeeding for the first 6 months of their
child's life in order to reduce morbidity and mortality.
Contemporary science has demonstrated
unequivocally an increased disease burden in children who
were not breastfed, with maximal benefit occurring in those
who were exclusively breastfed for the first 6 months of
life. Epidemiological data, however, demonstrate that
exclusive breastfeeding rates have remained very low, despite
the rise in overall breastfeeding (combination of breastfeeding
plus formula feeding).
Thus, while almost 70%
of American mothers initiated breastfeeding in 2001, less than half
initiated exclusive breastfeeding, and only 17.2% were exclusively
breastfeeding at 6 months (Ryan AS, et al. "Breastfeeding continues to
increase into the new millennium." Pediatrics.2002 ;110:1103 -1109
[Abstract/Free
Full Text]).
Breastfeeding promotion efforts have been
successful in getting women to breastfeed, but the payoffs of
better health remain less than optimal without the commitment
to exclusive breastfeeding for 6 months (Kramer MS, Kakuma R.
"Optimal duration of exclusive breastfeeding."
Cochrane Database Systematic Reviews.2002
;CD003517).
The U.S. Department of Health and Human
Services through the Office on Women's Health (OWH) worked
with the Advertising Council to create public service
announcements for television and radio on the importance of
exclusive breastfeeding for the first 6 months of life. In
addition, print advertisements were created for newspapers,
magazines and billboards.
Specific requirements were established
for the selection of information used in the advertising
campaign: well-designed studies published after 1990, studies
from developed countries, breastfeeding duration of at least
six months and sample sizes of 100 children or more. The
studies looked at the effects of breastfeeding on the
incidence of diarrhea, hospitalization for respiratory
illness, obesity/overweight and otitis media. For a reference
list, see end of story.
Public health experts are hopeful the
campaign will go far to shift the American norm from formula
feeding with and without breastfeeding to breastfeeding
without the need for supplementing with formula.
A campaign dealing with any aspect of
child health and welfare requires the cooperative support of
pediatricians to make it a success. This campaign is no
different. The U.S. public
health system is counting on pediatricians to provide the
necessary support for women who respond to the campaign and
choose to breastfeed, as well as women who have questions,
problems or want the campaign's message validated.
Members of the AAP Section on
Breastfeeding Leadership Team worked with the OWH to provide
scientific expertise for the campaign. In addition, several
pediatricians are involved in 18 community demonstration
projects (CDP) funded by the OWH to enhance the campaign's
impact. To find a CDP near you, call 1-800-994-WOMAN (9662).
There are a number of steps pediatricians
can take to get involved. The first is to be prepared to
validate the campaign. Mothers should feel the messages they
hear or read are shared by all of the professionals who care
for them and their babies. Pediatricians also can support the
campaign by:
- affirming to
mothers that the Academy supports breastfeeding as the
optimal nutrition for infants;
- explaining why a
campaign is needed in the
United States at this time. For instance,
tell mothers that that despite high initiation
rates of breastfeeding, low duration rates persist.
Also, explain the importance of exclusive
breastfeeding;
- encouraging all
mothers, with rare exceptions, to breastfeed
exclusively for about six months, which means delaying
other foods or fluids, and to continue breastfeeding
thereafter for as long as mother and child desire
it;
- coordinating
community resources to support mothers, such as the
CDPs, or referring them to the OWH-funded free
Breastfeeding Helpline (1-800-994-WOMAN) or
Web site (www.4woman.gov),
which has extensive information and help for
breastfeeding mothers;
- working
collaboratively with members of your health care team
to assess and manage breastfeeding support;
- scheduling the
first ambulatory visit by a qualified observer
for all breastfed newborns at 3 to 5 days of life;
- enhancing your
knowledge about breastfeeding and skills for assessment
of breastfeeding by attending continuing medical
education (CME) courses dedicated to breastfeeding topics, joining
the AAP Section on Breastfeeding and hosting CME in your
community; and
- giving grand
rounds on breastfeeding promotion and management at your
community hospital.
The Academy always has promoted
breastfeeding as the best way to nourish and nurture infants.
Pediatricians were an integral part of the first
U.S. public health campaign at the
turn of the century to promote breastfeeding, but at the same
time they were campaigning to purify cow's milk. There is no
need to launch a public health campaign to improve infant
formula.
For those who cannot breastfeed, infant
formula is an acceptable solution. But the solution to
improved health status for the majority can be achieved by
promoting and supporting exclusive breastfeeding for the
first 6 months of life and continued breastfeeding for at
least 12 months and thereafter for as long as mutually
desired.
It is time to embrace exclusive
breastfeeding as ideal behavior and find ways to eliminate
unnecessary use of infant formula. The National Breastfeeding
Awareness Campaign may create the catalyst for change, and
pediatricians are an essential link to the campaign's
success.
Dr.
Feldman-Winter chairs the AAP Section on Breastfeeding education
committee.
For diarrhea:
Scariati PD, et al.
Pediatrics.1997; 99:e5[Abstract/Free
Full Text] Raisler J, et al. Am
J Public Health.1999; 89:25 -30[Abstract]
Dockerty JD, et al. Br J Cancer.1999;
80:1483 -1489[Medline]
Beaudry M, et al. J Pediatr.1995;
126:191 -197[Medline]
For
hospitalization for respiratory illness:
Bachrach VR, et al.
Arch Pediatr Adolesc Med.
2003;157:237 -243[Abstract/Free
Full Text] Ball TM, Wright AL.
Pediatrics.1999; 103:870 -876[Abstract/Free
Full Text] Beaudry M, et al. J
Pediatr.1995; 126:191 -197[Medline]
Hoey C, Ware JL. Am J Manag Care.1997;
3:861 -865[Medline]
Howie PW, et al. BMJ.1990;
300:11 -16[Medline]
Oddy WH, et al. BMJ.1999;
319:815 -819[Abstract/Free
Full Text]
For
obesity/overweight:
Gillman MW, et al.
JAMA.2001; 285:2461 -2467[Abstract/Free
Full Text] Hediger ML, et al.
JAMA.2001; 285:2453 -2460[Abstract/Free
Full Text] Toschke AM, et al. J
Pediatr.2002; 141:764 -769[Medline]
Liese AD, et al. Int J Obesity.2001;
25;1644 -1650 O'Callaghan MJ, et al.
J Paediatr Child Health.
1997; 33:311 -316[Medline]
Dewey KG. J Hum Lact.2003;
19:9 -18[Medline]
For otitis
media:
Dockerty JD, et al.
Br J Cancer.1999; 80:1483
-1489[Medline]
Scariati PD, et al. Pediatrics.1997;
99:e5[Abstract/Free
Full Text] Raisler J, et al. Am
J Public Health.1999; 89:25 -30[Abstract]
Duncan B, et al. Pediatrics.1993;
91:867 -872[Abstract]
Owen MJ, et al. J Pediatr.1993;
123:702 -711.[Medline]
