Breast-feeding Rates United States, 2001 (CDC National Immunization Survey 8/1/11; accessed January 2012)
• 74.5% initiate, 44.3% at 6 mo, 23.8% at 1 yr of age
• Goal for Healthy People 2020: 82% initiate, 60.6% at 6 mo, 34.1% at 1 yo
Infant Benefits (Pediatr Rev 2011;32:267; Pediatrics 2012;129:e827)
• Colostrum known as “first immunization” containing high concentrations of antibodies
• ↑ immunity: ↓ AOM, GI infections, hospitalizations for lower respiratory infections, NEC. Effect of maternal immunoglobulins in human milk at mucosal level in mouth, nasopharynx, and GI by blocking entry of microbes; also has anti-inflammatory and anti-oxidant properties, and probiotics that limit growth of intestinal pathogens
• All benefits magnified in pre-term infants and in the developing world
• Long-term benefits: ↓ SIDS, food allergies, atopic dermatitis, asthma, celiac dz, IBD, obesity, DMII, leukemia, and lymphoma; improved neurodevelopmental outcomes, visual and auditory acuity, intelligence scores, teachers ratings
Maternal Benefits
• ↓ risk of breast and ovarian CA, DMII (if no history of gestational diabetes); cumulative breast-feeding >12 mo: ↓ risk for RA, HTN, hyperlipidemia, CV dz
• May facilitate return to pre-pregnancy weight and reduce osteoporosis and postpartum depression but data less clear
• Benefits for infant and mother correlate with dose and duration of breast-feeding
Contraindications
• Infant with classic galactosemia (galactose 1-phosphate uridyltransferase deficiency), maple syrup urine disease, phenylketonuria
• Certain medications: Search function available on LactMed: http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
• Mother receiving radioactive isotopes until cleared, antimetabolites or chemotherapeutic agents, or those using drugs of abuse. If stable on methadone maintenance OK to BF
• Bacterial mastitis: Allow for maternal comfort and 24 hr of effective antibiotic rx
• HSV, varicella–zoster lesions of the breast (may use other breast if unaffected), consider anti-viral ppx in infant along with anti-viral rx of mother
• HIV infection in developed world (exclusive BFing may provide survival benefit in places where there is lack of clean water, poor availability of formula, and high rate of dehydrating illness)
• Mother w/ HTLV 1 or 2, active untreated pulmonary TB (until infant on INH or mother treated for 2 wk), untreated brucellosis
• Maternal CMV in pre-term or LBW infants: Poss assoc w/ late onset sepsis-like syndrome; antiviral rx may be indicated
NOT Contraindicated
• Maternal Hep B surface antigen positive, Hep C infection (unless co-infected w/ HIV)
• Maternal carriage of CMV for term infants, isolated maternal fever
• Candidal infection of breast; treat both mother and infant and continue BFing
Selected AAP Breast-feeding Recommendations
• Baby Friendly Hospital Initiative (by WHO–UNICEF) endorsed by AAP, promotes 10 steps to successful breast-feeding
• Vitamin D supplementation
• Begin from birth; 400 IU daily
• D/c when daily consumption of Vitamin D-fortified formula or milk >500 mL
• Frequency of feeding
• 8–12 times daily during initiation; 6–8 times daily when well established
• No water needed under 6 mo; no cow’s milk until age 1 yr
• Introduced complementary iron-rich foods at 4–6 mo (AAP recs 6 mo for exclusively breast-fed infants), otherwise supplement 1 mg/kg/d iron starting at 4 mo until then
• Follow-up visits
• Check weight and breast-feeding at 3–5 d and 10–14 d
Breast-feeding Support
• Lactation consultant www.ilca.org, La Leche League www.llli.org
COW’S MILK PROTEIN ALLERGY
See Allergy section.