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The American Academy of Pediatrics has updated its guidance on breastfeeding – extending the recommended time for parents to breastfeed their children, while calling for policy change and "nonjudgmental support" for all families' feeding choices. In policy recommendations published on Monday, the AAP maintained its guidance to breastfeed infants exclusively in the first six months of their lives, before introducing other foods to complement nutrition. Now, the AAP is also urging pediatricians to support those who choose continued breastfeeding after solid foods are introduced for two years or longer. "We know that any breastfeeding is better than none... and the longer the total duration of breastfeeding the better," Dr. Joan Younger Meek, lead author of the AAP reports and a professor emeritus in clinical sciences at the Florida State University College of Medicine, told USA TODAY, pointing to breastfeeding health benefits for both babies and their parents. Still, Meek and the AAP noted, persisting stigma, lack of support and barriers in the workplace can often be obstacles for parents who choose to breastfeed – especially limiting those who want to breastfeed beyond one year. The authors of the new guidance also acknowledged that some parents can't breastfeed or prefer not to – again advocating for health care professionals to support each family's needs. Voices: Support for breastfeeding moms is already abysmal. The pandemic is making it worse. Monday marked the first time the AAP's breastfeeding guidance has been updated in 10 years. Here's what you need to know about its new recommendations. Why is the AAP extending its recommended time for breastfeeding?In addition to providing key nutrients to infants, research has shown links between breastfeeding and decreased rates of lower respiratory tract infections, obesity, severe diarrhea, ear infections and decreased risk of sudden infant death syndrome, the AAP says. "Breast milk is unique in its nutrients and protective effects, and really quite remarkable when you look at what it does for a child’s developing immune system," Meek said in a statement with Monday's policy recommendations. Breastfeeding beyond one year and for up to two years has been associated with protections for the breastfeeding parent against high blood pressure, diabetes and breast and ovary cancers, according to the AAP. What's everyone talking about?: Sign up for our trending newsletter to get the latest news of the day Meek noted that the AAP's updated guidance aligns with the World Health Organization's recommendations on breastfeeding – which similarly recommends breastfeeding exclusively for the first six months of life and then continuing to breastfeed while supplementing nutrition with complementary foods for up to two years and beyond. Still, it's important to note that breastfeeding isn't an option for everyone – and that many use infant formula or seek out breast milk banks instead, in addition to supplementing their child's nutrition with some solids after six months. According to statistics from the Centers for Disease Control and Prevention, in 2017, about 84% of infants started breastfeeding when they were born. However, around 58% were still breastfeeding at 6 months. What are safe substitutes for baby formula? Amid worsening shortage, avoid homemade recipes Meek underlined the importance of health care professionals supporting each family's decision and needs. "The ultimate decision about how to feed the baby is a family decision and health care providers need to really meet families where they are," Meek said. "We know that not every family is going to be able to do exclusive breastfeeding for six months. We know that not every family is going to continue breastfeeding for up to 24 months... For those families that, either for medical reasons or by choice, decide that breastfeeding isn't right for them, we need to equally support them and not make them feel shamed or bad because they made a different decision." More support needed for breastfeeding, 'chestfeeding'For parents who can and choose to breastfeed, obstacles from persisting stigma and lack of support, especially in the workplace, continue, the AAP notes. In Monday's recommendations, the AAP called for "policies that protect breastfeeding" – including universal paid maternity leave, insurance coverage for breast pumps and lactation support, the right to breastfeed in public, universal break time at workplaces with private locations for expressing milk and on-site child care. “The AAP views breastfeeding as a public health imperative and also as an equity issue,” Dr. Lawrence Noble, co-author of the policy statement and technical report, said in a statement. “Pediatricians and other medical professionals can help mothers meet their intended goals for breastfeeding and provide care that is inclusive, equitable, and culturally sensitive.” Breastfeeding in public: This is why moms breastfeed on flights and in public ... not that we should have to explain The AAP also acknowledged the racial and socioeconomic disparities that persist in breastfeeding – as well as inequities for some gender-diverse parents who may not be able to access breast milk because of both social or biological barriers. "The policy statement calls for addressing implicit bias, structural bias, and structural racism to eliminate disparities in breastfeeding and improve the health and well-being of all children and families," Monday's recommendations read. "When working with gender-diverse families, AAP suggests asking families what terms they use and that the term 'chestfeeding,' may be more accurate and inclusive as it concerns lactation and physiology in gender-diverse families." When I gave birth to my first baby, I was privileged to have every support imaginable to help me breastfeed successfully. I had prenatal breastfeeding classes and access to lactation consultants at the hospital where I delivered, as well as another lactation consultant who did home visits so I didn’t have to leave my apartment during the early newborn days. I had the means to purchase all the gear (nipple shields, nipple cream, a breastfeeding pillow) my lactation consultant recommended to make nursing a little easier and more comfortable. I was fortunate to have paid maternity leave and a free breast pump through my health insurance. Oh, and I worked at What to Expect, which meant I had spent the nine months of my pregnancy absorbing all the information on this website about breastfeeding. Still, like so many new mothers, breastfeeding was difficult for me — more difficult than I could have imagined when I was pregnant. In my first week home from the hospital — while dealing with a painful combination of cracked nipples, thrush, mastitis and a baby who wouldn’t latch — I sobbed to my partner that nursing was “so much harder than labor.” I doubted whether I wanted to continue breastfeeding for six days, let alone the six months that had been my goal. So my initial reaction to the new breastfeeding policy statement from the American Academy of Pediatrics (AAP), which recommends exclusive breastfeeding for the first six months of life and encourages support for mothers to breastfeed into the second year and beyond, was to think about how I might have felt if I’d read those headlines as a brand new parent. I surely would have been overwhelmed, intimidated and a little guilty that I didn’t want my breastfeeding journey to last anywhere near that long. As one mom in the What to Expect Community wrote in reaction to the new guidelines, “[They] just seem to put so much extra stress on women to further breastfeed or feel guilty that they couldn't in the first place.” But experts say the AAP’s policy statement isn’t intended to make parents feel guilty, nor does it mean that you have to breastfeed for two years — rather, it highlights the benefits of breastfeeding for both mothers and babies, and acknowledges that all families need more support. “It’s not meant to be intimidating, nor is it one-size-fits-all,” says Lauren Crosby, M.D., F.A.A.P, a pediatrician in Beverly Hills, California, and member of the What to Expect Medical Review Board. “It is meant to provide a framework and give guidance because there are benefits to breastfeeding and parents should at least be aware of them, then choose what is best for their own situation.” Here are five things parents should keep in mind when considering the AAP’s updated breastfeeding recommendations — whether they breastfed their babies or not. The AAP guidelines now align more closely with what the World Health Organization (WHO) recommends.The biggest change from the previous AAP guidelines issued in 2012 is the recommendation that mothers breastfeed exclusively for the first six months of life and then continue, while adding complementary foods, for up to two years (an increase from the one-year recommendation in 2012) and beyond if desired. This guidance is consistent with what WHO suggests. As was the case with the previous guidelines, breastfeeding for that long (or at all) won’t be feasible or desirable for every family — and that’s okay. “The AAP continues to emphasize that breastfeeding should always be mutually beneficial for both baby and mother,” says Micah Resnick, M.D., F.A.A.P., a pediatrician in Cincinnati, Ohio, and member of the What to Expect Medical Review Board. “If it does not work for one of you, it does not work for both of you.” Parents should feel empowered to breastfeed past the one- or two-year mark if they want to.Extended breastfeeding is wonderful, and mothers who nurse their children into toddlerhood should feel supported in doing so. “[The updated policy statement] is addressing the need to support and not shame mothers who choose to breastfeed beyond a year,” says Dr. Crosby. Still, you don’t need to breastfeed for two years in order to benefit.The latest guidelines highlight the health benefits of long-term breastfeeding for babies as well as moms, such as the lowered risk of breast and ovarian cancer. But you’re not completely missing out on those advantages if you stop breastfeeding before the two-year mark. “Any length of time is good,” says Gina Posner, M.D., F.A.A.P., a pediatrician practicing at MemorialCare Medical Group in Fountain Valley, California, and member of the What to Expect Medical Review Board. Families need more breastfeeding support and protections from policy makers.“The AAP realizes that a lot needs to be done to support moms who do choose to breastfeed,” says Dr. Posner. All mothers, regardless of how long they nurse their babies, need policies that support and protect their right to breastfeed, such as universal paid family leave, access to affordable child care, health insurance that covers lactation consultants and breast pumps, and work breaks to pump breast milk. Health care providers can better support families too by encouraging skin-to-skin contact after birth, delaying the first bath for 12 hours to allow more uninterrupted skin-to-skin time, allowing rooming-in at the hospital or birth center and providing outpatient support when they go home. Breastfeeding isn’t always possible.There are many reasons why breastfeeding doesn’t work out, nor is it an all-or-nothing proposition: Some families breastfeed exclusively; others supplement with formula or exclusively pump and bottle-feed; others formula-feed from day one. All these feeding methods deliver the nourishment a baby needs to grow and thrive. “Being a mom means so much more than breastfeeding and how you feed your baby,” notes Dr. Crosby. “They will bond with you regardless of what you feed them.” While my baby and I eventually got into a happy breastfeeding groove, in no small part thanks to the support I had, I’d be lying if I said I didn’t feel a little relieved when that journey ended. When my son was 9 months old, my supply started to drop and we transitioned to formula. I was proud of how far we’d come, but also, honestly, ready for the next phase. Regardless of their circumstances, all families need nonjudgmental support when navigating the decision around when to stop breastfeeding, as well as whether they do it at all, experts stress. “Having a baby should be an amazing experience, and though there are sometimes tough, tiring times, the key is to feed your baby whatever works for you and your family,” says Dr. Crosby. “Your baby will grow and thrive and do great.” |