Monday, March 10, 2008

Letter to the AAP to Align Breastfeeding Reccomendations with WHO

Dear American Academy of Pediatrics,
I am writing to urge you to update your breastfeeding recommendations.

In 1997, the AAP made an effort to clarify the policy statement, to help the public understand your position that breastfeeding ought to continue for at least the first year, and as long as mutually desired after that, not to stop at 6 months or 12 months as many people were misinterpreting the recommendation. Two of your members (Lawrence and Gartner) speaking on this topic stated that they wished in retrospect that they had made the recommendation for a minimum of two years. In 2005, an update to the policy statement was made, including new research on the "benefits" of breastfeeding. However, the breastfeeding rates in the U.S. are dismal. The AAP should take all possible action within its power order to encourage breastfeeding and discourage substandard feeding practices.

Many other countries follow the World Health Organization’s (WHO) lead in recommending a minimum of two years of breastfeeding. The "Global Strategy for Infant and Young Child Feeding", by the World Health Organization in collaboration with UNICEF, states:

"As a global public health recommendation, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. There after, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond."

Furthermore, the American Academy of Family Physicians (AAFP) states:

"Breastfeeding should ideally continue beyond infancy, but this is currently not the cultural norm and requires ongoing support and encouragement. Breastfeeding during a subsequent pregnancy is not unusual. If the pregnancy is normal and the mother is healthy, breastfeeding during pregnancy is the woman's personal decision. If the child is younger than two years of age, the child is at increased risk of illness if weaned. Breastfeeding the nursing child after delivery of the next child (tandem nursing) may help to provide a smooth transition psychologically for the older child."

The AAFP also emphasizes:

"Because breastfeeding is the physiologic norm, we will refer to the risks of not breastfeeding for infants, children, and mothers."

Perhaps if more mothers could receive information about the risks they take by not breastfeeding or by weaning too soon, the societal barriers and lack of support for breastfeeding would vanish. The AAP should reword its literature in terms of the risks of not breastfeeding, rather than leaving it in terms of the "benefits" of mother's milk.

The U.S. has high rates of infant mortality and incredibly low breastfeeding duration and exclusivity rates. Childhood diseases, including obesity, which is becoming an epidemic, have the potential for much better management or prevention if simple improvements in recommendations about breastfeeding are made.

In my opinion, the fact that the AAP recommends the minimum duration of breastfeeding to be only one year means that many women will:

1) shoot for one year and fall short, or 2) breastfeed for one year and then wean for no other reason than that they have met the minimum AAP recommendation for duration of breastfeeding.

Perhaps if a two year minimum or ideal recommendation were set, more women would seek help in proper breastfeeding management in order to meet the new recommendation. If women were making efforts to protect their supply early on in order to make it to two years, more women would reach the current one year recommendation even if they could not make it to two years of breastfeeding ultimately.

Furthermore, bringing your recommendations in line with the rest of the world may help curb some of the inappropriate discrimination against nursing mothers who nurse 1, 2, and 3-year-olds or even older children. Tennessee recently passed a breastfeeding in public protection that only applies if the baby is 12 months of age or younger. I feel that this is because of the misunderstanding of the AAP recommendations, or an assumption that the AAP recommendation implies that there is little to no benefit to the child of breastfeeding past 12 months of age.

The Healthy People 2010 goals are in serious danger of not being met. The AAP is a respected organization with the tremendous responsibility of establishing policies that protect children's health. This role isn't a popularity contest- it's a serious matter than can even mean life or death for some. Unfortunately it has been about ten years since anything truly groundbreaking has been addressed on this subject, despite a tremendous amount of new research. It is time to update, publicize, and promote new recommendations that will ultimately encourage physicians and parents to nurture a healthier nation.

To send a letter to the AAP asking them to revise their breastfeeding recommendations, go to: Action Letter to AAP on It only takes a minute and you can change the letter to reflect your personal views and experiences. The website also gives address to the current AAP president and executive director.

No comments: