Media Statement: AAP Statement on Breastfeeding
In response to questions about the American Academy of Pediatrics (AAP) Section on Breastfeeding’s Policy Statement, Breastfeeding and the Use of Human Milk,1 the Infant Nutrition Council of America* (INCA) offers the following statement:
The INCA agrees with the American Academy of Pediatrics (AAP) and other health care professional organizations that breastfeeding is the ideal infant feeding method and offers specific infant and maternal health benefits. The INCA supports the positive promotion of breastfeeding, and notes breastfeeding rates have continued to increase over the past decade. We also support addressing true barriers to breastfeeding, such as lack of workplace support, and commend AAP for addressing this important issue in its new breastfeeding policy statement.
We are concerned, however, that the new statement differs from the previous AAP breastfeeding statements and those of other organizations in several significant ways. For example, the new statement:
- Does not support a mother’s right to choose how to feed her infant.
- Does not recognize the role of many healthcare professionals in providing infant feeding advice.
- Overstates the infant health outcomes associated with breastfeeding.
- Does not provide guidance for mothers who do not breastfeed.
No support for mothers’ infant feeding choice
The AAP statement advises: “…infant feeding should not be considered as a lifestyle choice but rather as a basic health issue.” This comment is of concern because it may be interpreted that a mother’s choice is not a valid reason for not exclusively feeding breast milk and thus, hospitals and health care professionals may not recognize, support, or respect mothers who choose not to exclusively breastfeed their infants. Research shows that mothers know breastfeeding is the ideal infant feeding method and most plan to nurse their new baby – in fact, breastfeeding initiation rates are at their highest levels with nearly 80 percent of new mothers breastfeeding in the hospital.2 However, some mothers, for various reasons, have difficulty continuing to breastfeed once they leave the hospital or when they return to work, and other mothers have their own personal reasons for not breastfeeding. All parents should be trusted and supported in making the best feeding choices for their babies according to their life circumstances.
Further, the AAP statement’s approach regarding a mother’s infant feeding decision does not reflect the recommendations of global and other national health authorities. The World Health Organization’s Global Strategy for Infant and Young Child Feeding3 states moms should be supported in their feeding decision. Additionally, in the recent Call to Action to Support Breastfeeding, both the Surgeon General and the Secretary of Health and Human Services advocate no mother should be made to feel guilty if she cannot or chooses not to breastfeed.4 At the January 2010 California Breastfeeding Summit, a representative from The Joint Commission gave a presentation that stated, “The Joint Commission recognizes and supports the right of a woman to refuse breast milk feeding” and “A mother’s choice to breastfeed is a decision to be respected.”
Role of other health care professionals not recognized
We are concerned with the diminished role of many healthcare professionals and patients themselves in the updated AAP statement. The physician-centric model presented in the statement is a departure from the patient-centered model of care many hospitals strive to provide. And it is also at odds with today’s health care reforms that are focused on more, not less, collaboration among health care providers. Health care that establishes a partnership among physicians, nurses, lactation consultants, and new mothers is more likely to yield positive outcomes than narrow directives from health care professionals. New mothers need education and support on all infant feeding options to be able to best provide for their infants, and they need to know that there can be a variety of health professionals who can be resources for this information and support.
Results of scientific research on chronic disease overstated
The AAP statement overstates the infant health outcomes associated with breastfeeding. Comments are made throughout the statement suggesting that breastfeeding reduces risks of several serious and chronic diseases without acknowledging that the overall weight of scientific evidence indicates no such associations. The INCA agrees that with the AAP statement’s discussion of the limitations of breastfeeding research, which state: “Major methodologic issues have been raised as to the quality of some of these studies, especially as to the size of the study populations, quality of the data set, inadequate adjustment for confounders, absence of distinguishing between ‘any’ or ‘exclusive’ breastfeeding, and lack of a defined causal relationship between breastfeeding and the specific outcome. In addition, there are inherent practical and ethical issues that have precluded prospective randomized interventional trials of different feeding regimens.”1 Given these limitations of breastfeeding research, statements on health effects in the AAP statement should have been more balanced to reflect the current body of science.
No guidance offered except exclusive breastfeeding
Finally, the INCA is disappointed by the lack of guidance for mothers who do not breastfeed nor do not fully breastfeed. Health professionals concur that infant formula is the only safe, nutritious, and recommended alternative to breastmilk. In their 2005 statement,5 the AAP noted “Infants weaned before 12 months of age should not receive cow’s milk but should receive iron-fortified infant formula….” It is of concern that such direction was omitted from the 2012 statement. Breast milk supplies the proper balance of nutrients required for the term infant’s growth and development, minimizing the likelihood of excesses or deficiencies. Parents should be made aware, however, that if the decision is made not to breastfeed or fully breastfeed for whatever reason, iron-fortified infant formula is the safest, most nutritious and only recommended alternative. Without such guidance, infant health and growth and development may be at risk. Scientific literature suggests parents also need education on the proper preparation and storage of infant formula.6
In summary, mothers should be encouraged to breastfeed and fully supported in their decision. At the same time, parents today are faced with many child rearing decisions. All parents deserve access to accurate information about all appropriate infant feeding options to help ensure optimal nutrition and overall wellbeing, regardless of whether they choose to breastfeed or formula feed their infants.
- American Academy of Pediatrics, Section on Breastfeeding. Breastfeeding and the Use of Human Milk. Pediatrics. 2012;129:827-841.
- Centers for Disease Control and Prevention. Breastfeeding Report Card—United States, 2012. Available at: http://www.cdc.gov/breastfeeding/data/reportcard.htm. Accessed on August 2, 2012.
- World Health Organization; Global Strategy for Infant and Young Child Feeding. Available at: http://apps.who.int/gb/archive/pdf_files/WHA54/ea547.pdf
- The Surgeon General’s Call to Action to Support Breastfeeding; January 2011. Available at: http://www.surgeongeneral.gov/topics/breastfeeding/calltoactiontosupportbreastfeeding.pdf
- American Academy of Pediatrics, Section on Breastfeeding. Breastfeeding and the Use of Human Milk. Pediatrics. 2005;115:496-506.
Lakshman R OD, Ong K. Mothers’ experiences of bottle feeding: a systematic review of qualitative and quantitative studies. Arch Dis Child. 2009.
Robin Applebaum Morgan Dukes
* The Infant Nutritian Council of America is an association of manufacturers and marketers of formulated nutrition products, e.g., infant formulas and adult nutritionals, whose members are based predominantly in North America. INCA members are Abbott Nutrition, Mead Johnson Nutrition, Nestlé Infant Nutrition, Perrigo Nutritionals and Pfizer Nutrition.