by Joan Younger Meek, M.D., M.S., FAAP
Breastfeeding initiation rates in
the U.S. are the highest in decades at
81%, yet less than a quarter of infants
are breastfed exclusively at 6 months.
In addition, there are significant disparities based on
race, ethnicity, education and socioeconomic status,
according to the Centers for Disease Control and Prevention (CDC).
Pediatricians are positioned to play a pivotal role in
supporting breastfeeding families in the office practice.
Recommendations on creating a breastfeeding-sup-portive environment are highlighted in a new clinical
report The Breastfeeding-Friendly Pediatric Office Practice from the AAP Section on Breastfeeding. The report is available at https://doi.org/10.1542/peds.2017-
0647 and is published in the May issue of Pediatrics.
The Academy has long supported breastfeeding as
the optimal infant nutrition. It recommends exclusive
breastfeeding for about six months and continued
breastfeeding for at least one year. Among its many
benefits, breastfeeding helps prevent acute infectious
disease and development of chronic disease, reduces
risk of sudden infant death syndrome, and promotes
optimal outcomes for both mothers and children. The
Academy advocates that breastfeeding should be considered a public health imperative and not merely a
Why is office support important?
Pediatric care professionals see healthy infants frequently in the office during the first year of life, giving them many opportunities to provide anticipatory
guidance that supports and encourages breastfeeding.
Pediatricians must be trained to assess breastfeeding adequacy in the mother-baby pair, troubleshoot
problems and refer mothers to community resources,
as needed. Pediatricians also must be knowledgeable
about how over-the-counter and prescription drugs
may affect the breastfeeding infant (see resources).
It is important that breastfeeding be evaluated formally with observation during the first office visit,
when any issues can be identified early. Mothers who
note difficulty with latch, pain or milk supply need
timely intervention, as do infants with inadequate
Pediatricians should advise mothers on breastfeeding
after returning to work and refer to community-based
support personnel such as lactation consultants, nutrition staff from the Special Supplemental Nutrition
Program for Women, Infants and Children, peer counselors and support groups.
A culture of breastfeeding support in the pediatric
office begins with a welcoming environment that encourages mothers to breastfeed in the waiting room or
separate area, if privacy is desired.
All staff must understand the practice’s support of
breastfeeding mothers and babies, and clinical staff
should be trained in breastfeeding support and telephone triage guidelines. At least one person trained in
lactation support, such as a nurse or other staff member, should routinely provide breastfeeding support
under the guidance of the pediatrician. If possible,
consider employing a board-certified lactation consultant in the office.
Pediatricians should make sure that formula is not
being advertised through posters, publications and other materials in the office, and should not distribute free
formula or coupons for formula.
Federal initiatives support breastfeeding
In 2011, then-Surgeon General Regina M. Benjamin, M.D., M.B.A., issued the first Call to Action
to support breastfeeding, urging greater support for
breastfeeding women; education and training for all
health care providers; and systems to ensure continuity
of care between the hospital and community settings.
The CDC supports breastfeeding by providing tools
for providers and families, collecting statistics and promoting population health measures.
The CDC monitors hospital maternity care practices and provides funding to improve these practices
through assistance to facilities in implementing the
WHO/UNICEF Ten Steps to Successful Breastfeeding. The number of births in hospitals that have implemented the Ten Steps and become designated as Baby-Friendly Hospitals increased from 2.9% in 2007 to
20.1% as of January 2017, according to Baby-Friendly
Due to the impact of federal programs, as well as state
and local initiatives, many newborns leave the hospital
breastfeeding after their brief postpartum stays.
Most mothers want to breastfeed, but many do not
meet their personal breastfeeding goals. The breast-
feeding-friendly pediatric office practice is well-suited
to provide the support that women need to meet their
goals and to improve the health outcomes of their pedi-
atric patients. It even can be a way to grow and market
the practice to new mothers.
• Have a written breastfeeding-friendly office policy.
• Train staff in breastfeeding support skills.
• Discuss breastfeeding during prenatal visits and at
each well-child visit.
• Encourage exclusive breastfeeding for about six
months and provide anticipatory guidance that
supports the continuation of breastfeeding as long
• Incorporate breastfeeding observation into routine
• Educate mothers on breast milk expression and
return to work.
• Provide noncommercial breastfeeding educational
resources for parents.
• Encourage breastfeeding in the waiting room, but
provide private space on request.
• Eliminate distribution of free formula.
• Train staff to follow telephone triage protocols to
address breastfeeding concerns.
• Collaborate with the local hospital or birthing
center and obstetric community regarding breastfeeding-friendly care.
• Link with breastfeeding community resources.
• Monitor breastfeeding rates in the
Dr. Meek is co-author of the clinical
report and chair of the AAP Section on
Breastfeeding Executive Committee.
How to establish a breastfeeding-friendly pediatric office
• LactMed, federal database on medications and breastfeeding, http://bit.ly/2nS YaV6
• Coding and billing information from AAP Section on
Breastfeeding, http://bit.ly/2nIOag T
• Health professional resources, http://bit.ly/2nERZlr
An office staff trained in breastfeeding support skills
and telephone triage guidelines is essential to creating a welcoming environment for breastfeeding
families, according to a new AAP clinical report.