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DOI: 10.1542/peds.2011-3552; originally published online
February 27, 2012; 2012;129;e827Pediatrics
SECTION ON BREASTFEEDINGBreastfeeding and the Use of Human
Milk
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POLICY STATEMENT
Breastfeeding and the Use of Human Milk
abstractBreastfeeding and human milk are the normative standards
for infantfeeding and nutrition. Given the documented short- and
long-term med-ical and neurodevelopmental advantages of
breastfeeding, infant nu-trition should be considered a public
health issue and not onlya lifestyle choice. The American Academy
of Pediatrics reafrms itsrecommendation of exclusive breastfeeding
for about 6 months, fol-lowed by continued breastfeeding as
complementary foods are intro-duced, with continuation of
breastfeeding for 1 year or longer asmutually desired by mother and
infant. Medical contraindications tobreastfeeding are rare. Infant
growth should be monitored with theWorld Health Organization (WHO)
Growth Curve Standards to avoid mis-labeling infants as underweight
or failing to thrive. Hospital routinesto encourage and support the
initiation and sustaining of exclu-sive breastfeeding should be
based on the American Academy ofPediatrics-endorsed WHO/UNICEF Ten
Steps to Successful Breastfeed-ing. National strategies supported
by the US Surgeon Generals Callto Action, the Centers for Disease
Control and Prevention, and TheJoint Commission are involved to
facilitate breastfeeding practices inUS hospitals and communities.
Pediatricians play a critical role intheir practices and
communities as advocates of breastfeeding andthus should be
knowledgeable about the health risks of not breast-feeding, the
economic benets to society of breastfeeding, and thetechniques for
managing and supporting the breastfeeding dyad. TheBusiness Case
for Breastfeeding details how mothers can maintainlactation in the
workplace and the benets to employers who facili-tate this
practice. Pediatrics 2012;129:e827e841
INTRODUCTION
Six years have transpired since publication of the last policy
statementof the American Academy of Pediatrics (AAP) regarding
breastfeeding.1
Recently published research and systematic reviews have
reinforcedthe conclusion that breastfeeding and human milk are the
referencenormative standards for infant feeding and nutrition. The
currentstatement updates the evidence for this conclusion and
serves asa basis for AAP publications that detail breastfeeding
managementand infant nutrition, including the AAP Breastfeeding
Handbook forPhysicians,2 AAP Sample Hospital Breastfeeding Policy
for Newborns,3
AAP Breastfeeding Residency Curriculum,4 and the AAP Safe
andHealthy Beginnings Toolkit.5 The AAP reafrms its
recommendationof exclusive breastfeeding for about 6 months,
followed by continuedbreastfeeding as complementary foods are
introduced, with continuation
SECTION ON BREASTFEEDING
KEY WORDSbreastfeeding, complementary foods, infant nutrition,
lactation,human milk, nursing
ABBREVIATIONSAAPAmerican Academy of PediatricsAHRQAgency for
Healthcare Research and QualityCDCCenters for Disease Control and
PreventionCIcondence intervalCMVcytomegalovirusDHAdocosahexaenoic
acidNECnecrotizing enterocolitisORodds ratioSIDSsudden infant death
syndromeWHOWorld Health Organization
This document is copyrighted and is property of the
AmericanAcademy of Pediatrics and its Board of Directors. All
authorshave led conict of interest statements with the
AmericanAcademy of Pediatrics. Any conicts have been resolved
througha process approved by the Board of Directors. The
AmericanAcademy of Pediatrics has neither solicited nor accepted
anycommercial involvement in the development of the content ofthis
publication.
All policy statements from the American Academy of
Pediatricsautomatically expire 5 years after publication unless
reafrmed,revised, or retired at or before that time.
www.pediatrics.org/cgi/doi/10.1542/peds.2011-3552
doi:10.1542/peds.2011-3552
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online,
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Copyright 2012 by the American Academy of Pediatrics
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of breastfeeding for 1 year or longeras mutually desired by
mother andinfant.
EPIDEMIOLOGY
Information regarding breastfeedingrates and practices in the
United Statesis available from a variety of govern-ment data sets,
including the Centersfor Disease Control and Prevention
(CDC)National Immunization Survey,6 theNHANES,7 and Maternity
Practices andInfant Nutrition and Care.8 Drawing onthese data and
others, the CDC haspublished the Breastfeeding ReportCard, which
highlights the degree ofprogress in achieving the breastfeed-ing
goals of the Healthy People 2010targets as well as the 2020
targets(Table 1).911
The rate of initiation of breastfeedingfor the total US
population based onthe latest National Immunization Sur-vey data
are 75%.11 This overall rate,however, obscures clinically
signi-cant sociodemographic and culturaldifferences. For example,
the breast-feeding initiation rate for the Hispanicor Latino
population was 80.6%, butfor the non-Hispanic black or
AfricanAmerican population, it was 58.1%.Among low-income mothers
(partic-ipants in the Special SupplementalNutrition Program for
Women, Infants,and Children [WIC]), the breastfeedinginitiation
rate was 67.5%, but in those
with a higher income ineligible forWIC, it was 84.6%.12
Breastfeedinginitiation rate was 37% for low-incomenon-Hispanic
black mothers.7 Similardisparities are age-related; mothersyounger
than 20 years initiated breast-feeding at a rate of 59.7%
comparedwith the rate of 79.3% in mothersolder than 30 years. The
lowest ratesof initiation were seen among non-Hispanic black
mothers younger than20 years, in whom the breastfeedinginitiation
rate was 30%.7
Although over the past decade, therehas been a modest increase
in the rateof any breastfeeding at 3 and 6months, in none of the
subgroupshave the Healthy People 2010 targetsbeen reached. For
example, the 6-month any breastfeeding rate forthe total US
population was 43%, therate for the Hispanic or Latino sub-group
was 46%, and the rate for thenon-Hispanic black or African
Ameri-can subgroup was only 27.5%. Ratesof exclusive breastfeeding
are furtherfrom Healthy People 2010 targets, withonly 13% of the US
population meetingthe recommendation to breastfeed ex-clusively for
6 months. Thus, it appearsthat although the breastfeeding
ini-tiation rates have approached the2010 Healthy People targets,
the tar-gets for duration of any breastfeedingand exclusive
breastfeeding have notbeen met.
Furthermore, 24% of maternity serv-ices provide supplements of
com-mercial infant formula as a generalpractice in the rst 48 hours
afterbirth. These observations have led tothe conclusion that the
disparities inbreastfeeding rates are also associ-ated with
variations in hospital rou-tines, independent of the
populationsserved. As such, it is clear that greateremphasis needs
to be placed on im-proving and standardizing hospital-based
practices to realize the newer2020 targets (Table 1).
INFANT OUTCOMES
Methodologic Issues
Breastfeeding results in improved in-fant and maternal health
outcomes inboth the industrialized and developingworld. Major
methodologic issues havebeen raised as to the quality of someof
these studies, especially as to thesize of the study populations,
quality ofthe data set, inadequate adjustmentfor confounders,
absence of distin-guishing between any or exclusivebreastfeeding,
and lack of a denedcausal relationship between breast-feeding and
the specic outcome. Inaddition, there are inherent practicaland
ethical issues that have precludedprospective randomized
interventionaltrials of different feeding regimens.As such, the
majority of publishedreports are observational cohortstudies and
systematic reviews/meta-analyses.
To date, the most comprehensivepublication that reviews and
analyzesthe published scientic literature thatcompares
breastfeeding and com-mercial infant formula feeding as tohealth
outcomes is the report pre-pared by the Evidence-based
PracticeCenters of the Agency for HealthcareResearch and Quality
(AHRQ) of the USDepartment of Health Human Servicestitled
Breastfeeding and Maternal andInfant Health Outcomes in
DevelopedCountries.13 The following sectionssummarize and update
the AHRQ meta-analyses and provide an expandedanalysis regarding
health outcomes.Table 2 summarizes the dose-responserelationship
between the duration ofbreastfeeding and its protective effect.
Respiratory Tract Infections andOtitis Media
The risk of hospitalization for lowerrespiratory tract
infections in the rstyear is reduced 72% if infants
breastfedexclusively for more than 4 months.13,14
Infants who exclusively breastfed for 4
TABLE 1 Healthy People Targets 2010 and2020(%)
2007a 2010Target
2020Target
Any breastfeedingEver 75.0 75 81.96 mo 43.8 50 60.51 y 22.4 25
34.1
Exclusive breastfeedingTo 3 mo 33.5 40 44.3To 6 mo 13.8 17
23.7
Worksite lactation support 25 38.0Formula use in rst 2 d 25.6
15.6a 2007 data reported in 2011.10
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to 6 months had a fourfold increasein the risk of pneumonia
comparedwith infants who exclusively breastfedfor more than 6
months.15 The severity(duration of hospitalization and
oxygenrequirements) of respiratory syncytialvirus bronchiolitis is
reduced by 74%in infants who breastfed exclusively for4 months
compared with infants whonever or only partially breastfed.16
Any breastfeeding compared with ex-clusive commercial infant
formulafeeding will reduce the incidence ofotitis media (OM) by
23%.13 Exclusivebreastfeeding for more than 3 monthsreduces the
risk of otitis media by50%. Serious colds and ear and
throatinfections were reduced by 63% in
infants who exclusively breastfed for 6months.17
Gastrointestinal Tract Infections
Any breastfeeding is associated witha 64% reduction in the
incidence ofnonspecic gastrointestinal tract infec-tions, and this
effect lasts for 2 monthsafter cessation of
breastfeeding.13,14,17,18
Necrotizing Enterocolitis
Meta-analyses of 4 randomized clinicaltrials performed over the
period 1983to 2005 support the conclusion thatfeeding preterm
infants human milk isassociated with a signicant reduction(58%) in
the incidence of necrotizingenterocolitis (NEC).13 A more
recent
study of preterm infants fed an exclu-sive human milk diet
compared withthose fed human milk supplementedwith cow-milk-based
infant formula pro-ducts noted a 77% reduction in NEC.19
One case of NEC could be prevented if10 infants received an
exclusive humanmilk diet, and 1 case of NEC requiringsurgery or
resulting in death could beprevented if 8 infants received an
ex-clusive human milk diet.19
Sudden Infant Death Syndromeand Infant Mortality
Meta-analyses with a clear denition ofdegree of breastfeeding
and adjustedfor confounders and other known risksfor sudden infant
death syndrome(SIDS) note that breastfeeding is as-sociated with a
36% reduced risk ofSIDS.13 Latest data comparing any ver-sus
exclusive breastfeeding reveal thatfor any breastfeeding, the
multivariateodds ratio (OR) is 0.55 (95% condenceinterval [CI],
0.440.69). When com-puted for exclusive breastfeeding, theOR is
0.27 (95% CI, 0.270.31).20 A pro-portion (21%) of the US infant
mortalityhas been attributed, in part, to the in-creased rate of
SIDS in infants whowere never breastfed.21 That the posi-tive
effect of breastfeeding on SIDSrates is independent of sleep
positionwas conrmed in a large case-controlstudy of supine-sleeping
infants.22,23
It has been calculated that more than900 infant lives per year
may be savedin the United States if 90% of mothersexclusively
breastfed for 6 months.24 Inthe 42 developing countries in which90%
of the worlds childhood deaths oc-cur, exclusive breastfeeding for
6 monthsand weaning after 1 year is the mosteffective intervention,
with the potentialof preventing more than 1 million infantdeaths
per year, equal to preventing 13%of the worlds childhood
mortality.25
Allergic Disease
There is a protective effect of exclusivebreastfeeding for 3 to
4 months in
TABLE 2 Dose-Response Benets of Breastfeedinga
Condition % Lower Riskb Breastfeeding Comments ORc 95% CI
Otitis media13 23 Any 0.77 0.640.91Otitis media13 50 3 or 6 mo
Exclusive BF 0.50 0.360.70Recurrent otitis media15 77 Exclusive
BF
6 modCompared with
BF 4 to 6 mo Exclusive BF 0.30 0.180.74
Lower respiratorytract infection13
72 4 mo Exclusive BF 0.28 0.140.54
Lower respiratorytract infection15
77 Exclusive BF6 mod
Compared withBF 4 to 4 mo 0.26 0.0740.9NEC19 77 NICU stay
Preterm infants
Exclusive HM0.23 0.510.94
Atopic dermatitis27 27 >3 mo Exclusive BFnegativefamily
history
0.84 0.591.19
Atopic dermatitis27 42 >3 mo Exclusive BFpositivefamily
history
0.58 0.410.92
Gastroenteritis13,14 64 Any 0.36 0.320.40Inammatory bowel
disease3231 Any 0.69 0.510.94
Obesity13 24 Any 0.76 0.670.86Celiac disease31 52 >2 mo
Gluten exposure
when BF0.48 0.400.89
Type 1 diabetes13,42 30 >3 mo Exclusive BF 0.71 0.540.93Type
2 diabetes13,43 40 Any 0.61 0.440.85Leukemia (ALL)13,46 20 >6 mo
0.80 0.710.91Leukemia (AML)13,45 15 >6 mo 0.85 0.730.98SIDS13 36
Any >1 mo 0.64 0.570.81
ALL, acute lymphocytic leukemia; AML, acute myelogenous
leukemia; BF, breastfeeding; HM, human milk; RSV,
respiratorysyncytial virus.a Pooled data.b % lower risk refers to
lower risk while BF compared with feeding commercial infant formula
or referent groupspecied.c OR expressed as increase risk for
commercial formula feeding.d Referent group is exclusive BF 6
months.
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reducing the incidence of clinicalasthma, atopic dermatitis, and
eczemaby 27% in a low-risk population andup to 42% in infants with
positivefamily history.13,26 There are conict-ing studies that
examine the timing ofadding complementary foods after 4months and
the risk of allergy, includingfood allergies, atopic dermatitis,
andasthma, in either the allergy-prone ornonatopic individual.26
Similarly, thereare no convincing data that delayingintroduction of
potentially allergenicfoods after 6 months has any
protectiveeffect.2730 One problem in analyzingthis research is the
low prevalence ofexclusive breastfeeding at 6 months inthe study
populations. Thus, researchoutcomes in studies that examine
thedevelopment of atopy and the timing ofintroducing solid foods in
partiallybreastfed infants may not be applica-ble to exclusively
breastfed infants.
Celiac Disease
There is a reduction of 52% in the riskof developing celiac
disease in infantswho were breastfed at the time ofgluten
exposure.31 Overall, there is anassociation between increased
dura-tion of breastfeeding and reduced riskof celiac disease when
measured asthe presence of celiac antibodies. Thecritical
protective factor appears tobe not the timing of the gluten
expo-sure but the overlap of breastfeedingat the time of the
initial gluten in-gestion. Thus, gluten-containing foodsshould be
introduced while the infantis receiving only breast milk and
notinfant formula or other bovine milkproducts.
Inammatory Bowel Disease
Breastfeeding is associated with a31% reduction in the risk of
child-hood inammatory bowel disease.32
The protective effect is hypothesizedto result from the
interaction of theimmunomodulating effect of humanmilk and the
underlying genetic
susceptibility of the infant. Differentpatterns of intestinal
colonization inbreastfed versus commercial infantformulafed infants
may add to thepreventive effect of human milk.33
Obesity
Because rates of obesity are signi-cantly lower in breastfed
infants, na-tional campaigns to prevent obesitybegin with
breastfeeding support.34,35
Although complex factors confoundstudies of obesity, there is a
15% to30% reduction in adolescent and adultobesity rates if any
breastfeeding oc-curred in infancy compared with
nobreastfeeding.13,36 The FraminghamOffspring study noted a
relationship ofbreastfeeding and a lower BMI andhigher high-density
lipoprotein con-centration in adults.37 A sibling dif-ference model
study noted that thebreastfed sibling weighed 14 poundsless than
the sibling fed commercialinfant formula and was less likely
toreach BMI obesity threshold.38 Theduration of breastfeeding also
is in-versely related to the risk of over-weight; each month of
breastfeedingbeing associated with a 4% reductionin risk.14
The interpretation of these data isconfounded by the lack of a
denitionin many studies of whether humanmilk was given by
breastfeeding or bybottle. This is of particular importance,because
breastfed infants self-regulateintake volume irrespective of
maneu-vers that increase available milk vol-ume, and the early
programming ofself-regulation, in turn, affects adultweight gain.39
This concept is furthersupported by the observations thatinfants
who are fed by bottle, formula,or expressed breast milk will
haveincreased bottle emptying, poorer self-regulation, and
excessive weight gainin late infancy (older than 6 months)compared
with infants who only nursefrom the breast.40,41
Diabetes
Up to a 30% reduction in the incidenceof type 1 diabetes
mellitus is reportedfor infants who exclusively breastfed forat
least 3 months, thus avoiding expo-sure to cow milk protein.13,42
It has beenpostulated that the putative mechanismin the development
of type 1 diabetesmellitus is the infants exposure to cowmilk
-lactoglobulin, which stimulatesan immune-mediated process
cross-reacting with pancreatic cells. A re-duction of 40% in the
incidence of type2 diabetes mellitus is reported, possi-bly
reecting the long-term positiveeffect of breastfeeding on weight
con-trol and feeding self-regulation.43
Childhood Leukemia andLymphoma
There is a reduction in leukemiathat is correlated with the
duration ofbreastfeeding.14,44 A reduction of 20%in the risk of
acute lymphocytic leuke-mia and 15% in the risk of acute my-eloid
leukemia in infants breastfed for6 months or longer.45,46
Breastfeedingfor less than 6 months is protective butof less
magnitude (approximately 12%and 10%, respectively). The question
ofwhether the protective effect of breast-feeding is a direct
mechanism of humanmilk on malignancies or secondarilymediated by
its reduction of early child-hood infections has yet to be
answered.
Neurodevelopmental Outcomes
Consistent differences in neurodevel-opmental outcome between
breastfedand commercial infant formulafedinfants have been
reported, but theoutcomes are confounded by differencesin parental
education, intelligence, homeenvironment, and socioeconomic
sta-tus.13,47 The large, randomized Pro-motion of Breastfeeding
InterventionTrial provided evidence that adjustedoutcomes of
intelligence scores andteachers ratings are signicantlygreater in
breastfed infants.4850 In
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addition, higher intelligence scoresare noted in infants who
exclusivelybreastfed for 3 months or longer, andhigher teacher
ratings were observedif exclusive breastfeeding was practicedfor 3
months or longer. Signicantlypositive effects of human milk
feedingon long-term neurodevelopment are ob-served in preterm
infants, the pop-ulation more at risk for these
adverseneurodevelopmental outcomes.5154
PRETERM INFANTS
There are several signicant short-and long-term benecial effects
offeeding preterm infants human milk.Lower rates of sepsis and NEC
indicatethat human milk contributes to thedevelopment of the
preterm infantsimmature host defense.19,5559 The ben-ets of feeding
human milk to preterminfants are realized not only in the NICUbut
also in the fewer hospital read-missions for illness in the year
afterNICU discharge.51,52 Furthermore, theimplications for a
reduction in incid-ence of NEC include not only lowermortality
rates but also lower long-termgrowth failure and
neurodevelopmentaldisabilities.60,61 Clinical feeding toler-ance is
improved, and the attainment offull enteral feeding is hastened by
a dietof human milk.51,52,59
Neurodevelopmental outcomes are im-proved by the feeding of
human milk.Long-term studies at 8 years of agethrough adolescence
suggest that in-telligence test results and white matterand total
brain volumes are greater insubjects who had received human milkas
infants in the NICU.53,54 Extremelypreterm infants receiving the
greatestproportion of human milk in the NICUhad signicantly greater
scores formental, motor, and behavior ratings atages 18 months and
30 months.51,52
These data remain signicant afteradjustment for confounding
factors,such as maternal age, education, mar-ital status, race, and
infant morbidities.
These neurodevelopmental outcomesare associated with predominant
andnot necessarily exclusive human milkfeeding. Human milk feeding
in the NICUalso is associated with lower rates ofsevere retinopathy
of prematurity.62,63
Long-term studies of preterm infantsalso suggest that human milk
feedingis associated with lower rates of met-abolic syndrome, and
in adolescents, itis associated with lower blood pres-sures and
low-density lipoprotein con-centrations and improved leptin
andinsulin metabolism.64,65
The potent benets of human milk aresuch that all preterm infants
shouldreceive human milk (Table 3). Mothersown milk, fresh or
frozen, should bethe primary diet, and it should befortied
appropriately for the infantborn weighing less than 1.5 kg.
Ifmothers own milk is unavailable de-spite signicant lactation
support, pas-teurized donor milk should be used.19,66
Quality control of pasteurized donormilk is important and should
be moni-tored. New data suggest that mothersown milk can be stored
at refrigeratortemperature (4C) in the NICU for aslong as 96
hours.67 Data on thawing,warming, and prolonged storage
needupdating. Practices should involve pro-tocols that prevent
misadministrationof milk.
MATERNAL OUTCOMES
Both short- and long-term health ben-ets accrue to mothers who
breast-feed. Such mothers have decreasedpostpartum blood loss and
more rapidinvolution of the uterus. Continuedbreastfeeding leads to
increased childspacing secondary to lactational amen-orrhea.
Prospective cohort studieshave noted an increase in
postpartumdepression in mothers who do notbreastfeed or who wean
early.68 Alarge prospective study on child abuseand neglect
perpetuated by mothersfound, after correcting for potential
confounders, that the rate of abuse/neglect was signicantly
increased formothers who did not breastfeed asopposed to those who
did (OR: 2.6;95% CI: 1.73.9).69
Studies of the overall effect of breast-feeding on the return of
the mothersto their pre-pregnancy weight are in-conclusive, given
the large numbers ofconfounding factors on weight loss(diet,
activity, baseline BMI, ethnicity).13
In a covariate-adjusted study of morethan 14 000 women
postpartum, moth-ers who exclusively breastfed for lon-ger than 6
months weighed 1.38 kg lessthan those who did not breastfeed.70
In mothers without a history of gesta-tional diabetes,
breastfeeding durationwas associated with a decreased riskof type 2
diabetes mellitus; for eachyear of breastfeeding, there was a
de-creased risk of 4% to 12%.71,72 No ben-ecial effect for
breastfeeding wasnoted in mothers who were diagnosedwith
gestational diabetes.
The longitudinal Nurses Health Studynoted an inverse
relationship betweenthe cumulative lifetime duration
ofbreastfeeding and the development ofrheumatoid arthritis.73 If
cumulativeduration of breastfeeding exceeded 12
TABLE 3 Recommendations onBreastfeeding Management forPreterm
Infants
1. All preterm infants should receive human milk. Human milk
should be fortied, with protein,minerals, and vitamins to ensure
optimalnutrient intake for infants weighing
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months, the relative risk of rheuma-toid arthritis was 0.8 (95%
CI: 0.81.0),and if the cumulative duration ofbreastfeeding was
longer than 24months, the relative risk of rheu-matoid arthritis
was 0.5 (95% CI:0.30.8).73 An association betweencumulative
lactation experience andthe incidence of adult
cardiovasculardisease was reported by the WomensHealth Initiative
in a longitudinal studyof more than 139 000 postmenopausalwomen.74
Women with a cumulativelactation history of 12 to 23 monthshad a
signicant reduction in hyper-tension (OR: 0.89; 95% CI:
0.840.93),hyperlipidemia (OR: 0.81; 95% CI: 0.760.87),
cardiovascular disease (OR:0.90; 95% CI: 0.850.96), and
diabetes(OR: 0.74; 95% CI: 0.650.84).
Cumulative lactation experience alsocorrelates with a reduction
in bothbreast (primarily premenopausal) andovarian cancer.13,14,75
Cumulative du-ration of breastfeeding of longer than12 months is
associated with a 28%decrease in breast cancer (OR: 0.72;95% CI:
0.650.8) and ovarian cancer(OR: 0.72; 95% CI: 0.540.97).76 Eachyear
of breastfeeding has been calcu-lated to result in a 4.3% reduction
inbreast cancer.76,77
ECONOMIC BENEFITS
A detailed pediatric cost analysisbased on the AHRQ report
concludedthat if 90% of US mothers would complywith the
recommendation to breastfeedexclusively for 6 months, there would
bea savings of $13 billion per year.24 Thesavings do not include
those related toa reduction in parental absenteeismfrom work or
adult deaths from dis-eases acquired in childhood, such asasthma,
type 1 diabetes mellitus, orobesity-related conditions.
Strategiesthat increase the number of motherswho breastfeed
exclusively for about6 months would be of great economicbenet on a
national level.
DURATION OF EXCLUSIVEBREASTFEEDING
The AAP recommends exclusive breast-feeding for about 6 months,
with con-tinuation of breastfeeding for 1 year orlonger as mutually
desired by motherand infant, a recommendation con-curred to by the
WHO78 and the In-stitute of Medicine.79
Support for this recommendation ofexclusive breastfeeding is
found in thedifferences in health outcomes of in-fants breastfed
exclusively for 4 vs 6months, for gastrointestinal disease,otitis
media, respiratory illnesses,and atopic disease, as well as
dif-ferences in maternal outcomes ofdelayed menses and
postpartumweight loss.15,18,80
Compared with infants who neverbreastfed, infants who were
exclu-sively breastfed for 4 months hadsignicantly greater
incidence of lowerrespiratory tract illnesses, otitis me-dia, and
diarrheal disease than infantsexclusively breastfed for 6 months
orlonger.15,18 When compared with in-fants who exclusively
breastfed for lon-ger than 6 months, those exclusivelybreastfed for
4 to 6 months had a four-fold increase in the risk of
pneumonia.15
Furthermore, exclusively breastfeedingfor 6 months extends the
period oflactational amenorrhea and thus im-proves child spacing,
which reducesthe risk of birth of a preterm infant.81
The AAP is cognizant that for someinfants, because of family and
medicalhistory, individual developmental status,and/or social and
cultural dynamics,complementary feeding, including
gluten-containing grains, begins earlier than6 months of age.82,83
Because breast-feeding is immunoprotective, when suchcomplementary
foods are introduced, itis advised that this be done while
theinfant is feeding only breastmilk.82
Mothers should be encouraged to con-tinue breastfeeding through
the rst
year and beyond as more and variedcomplementary foods are
introduced.
CONTRAINDICATIONS TOBREASTFEEDING
There are a limited number of medicalconditions in which
breastfeeding iscontraindicated, including an infant withthe
metabolic disorder of classic ga-lactosemia. Alternating
breastfeedingwith special protein-free or modiedformulas can be
used in feeding in-fants with other metabolic diseases(such as
phenylketonuria), providedthat appropriate blood monitoring
isavailable. Mothers who are positive forhuman T-cell lymphotrophic
virus typeI or II84 or untreated brucellosis85
should not breastfeed nor provide ex-pressed milk to their
infants Breast-feeding should not occur if the motherhas active
(infectious) untreated tu-berculosis or has active herpes sim-plex
lesions on her breast; however,expressed milk can be used
becausethere is no concern about these in-fectious organisms
passing throughthe milk. Breastfeeding can be re-sumed when a
mother with tubercu-losis is treated for a minimum of 2weeks and is
documented that she isno longer infectious.86 Mothers whodevelop
varicella 5 days before through2 days after delivery should be
sepa-rated from their infants, but theirexpressed milk can be used
for feed-ing.87 In 2009, the CDC recommendedthat mothers acutely
infected withH1N1 inuenza should temporarily beisolated from their
infants until theyare afebrile, but they can provideexpressed milk
for feeding.88
In the industrialized world, it is not re-commended that
HIV-positive mothersbreastfeed. However, in the developingworld,
where mortality is increased innon-breastfeeding infants from a
com-bination of malnutrition and infectiousdiseases, breastfeeding
may outweighthe risk of the acquiring HIV infection
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from human milk. Infants in areaswith endemic HIV who are
exclusivelybreastfed for the rst 3 months are ata lower risk of
acquiring HIV infectionthan are those who received a mixeddiet of
human milk and other foodsand/or commercial infant formula.89
Recent studies document that com-bining exclusive breastfeeding
for 6months with 6 months of antiretroviraltherapy signicantly
decreases thepostnatal acquisition of HIV-1.90,91
There is no contraindication to breast-feeding for a full-term
infant whosemother is seropositive for cytomega-lovirus (CMV).
There is a possibilitythat CMV acquired from mothers milkmay be
associated with a late-onsetsepsis-like syndrome in the
extremelylow birth weight (birth weight
-
concentrations. In addition, data re-garding the long-term
neurobehavioraleffects from exposure to these agentsduring the
critical developmental pe-riod of early infancy are lacking.
Arecent comprehensive review notedthat of the 96 psychotropic
drugsavailable, pharmacologic and clinicalinformation was only
available for 62(65%) of the drugs.116 In only 19 wasthere adequate
information to allowfor dening a safety protocol and thusqualifying
to be compatible for use bylactating mothers. Among the
agentsconsidered to be least problematicwere the tricyclic
antidepressants am-itriptyline and clomipramine and theselective
serotonin-reuptake inhibitorsparoxetine and sertraline.
Detailed guidelines regarding the ne-cessity for and duration of
temporarycessation of breastfeeding after ma-ternal exposure to
diagnostic radio-active compounds are provided by theUS Nuclear
Regulatory Commissionand in medical reviews.117119
Specialprecaution should be followed in thesituation of
breastfeeding infants
withglucose-6-phosphate-dehydrogenasedeciency. Fava beans,
nitrofurantoin,primaquine, and phenazopyridine shouldbe avoided by
the mother to minimizethe risk of hemolysis in the infant.120
HOSPITAL ROUTINES
The Sections on Breastfeeding andPerinatal Pediatrics have
publishedthe Sample Hospital BreastfeedingPolicy that is available
from the AAPSafe and Healthy Beginnings Web site.3,5
This sample hospital policy is basedon the detailed
recommendations ofthe previous AAP policy statementBreastfeeding
and the Use of HumanMilk1 as well as the principles of the1991
WHO/UNICEF publication TensSteps to Successful Breastfeeding(Table
4)121 and provides a template fordeveloping a uniform hospital
policy forsupport of breastfeeding.122 In particular,
emphasis is placed on the need to reviseor discontinue
disruptive hospitalpolicies that interfere with early skin-to-skin
contact, that provide water,glucose water, or commercial
infantformula without a medical indication,that restrict the amount
of time theinfant can be with the mother, thatlimit feeding
duration, or that provideunlimited pacier use.
In 2009, the AAP endorsed the Ten Stepsprogram (see Table 4).
Adherence tothese 10 steps has been demonstratedto increase rates
of breastfeeding ini-tiation, duration, and exclusivity.122,123
Implementation of the following 5 post-partum hospital practices
has beendemonstrated to increase breastfeedingduration,
irrespective of socioeconomicstatus: breastfeeding in the rst
hourafter birth, exclusive breastfeeding,rooming-in, avoidance of
paciers, andreceipt of telephone number for sup-port after
discharge from the hospi-tal.124
The CDC National Survey of MaternityPractices in Infant
Nutrition and Carehas assessed the lactation practices inmore than
80% of US hospitals andnoted that the mean score for
imple-mentation of the Ten Steps was only65%.34,125 Fifty-eight
percent of hospi-tals erroneously advised mothers tolimit suckling
at the breast to a spec-ied length of time, and 41% of thehospitals
gave paciers to more thansome of their newbornsboth prac-tices that
have been documentedto lower breastfeeding rates and du-ration.126
The survey noted that in30% of all birth centers, more thanhalf of
all newborns received supple-mentation commercial infant formula,a
practice associated with shorterduration of breastfeeding and
lessexclusivity.34,125 As indicated in thebenets section, this
early supple-mentation may affect morbidity out-comes in this
population. The surveyalso reported that 66% of hospitals
reported that they distributed tobreastfeeding mothers discharge
packsthat contained commercial infant for-mula, a practice that has
been docu-mented to negatively affect exclusivityand duration of
breastfeeding.127 Fewbirth centers have model hospital pol-icies
(14%) and support breastfeedingmothers after hospital discharge
(27%).Only 37% of centers practice morethan 5 of the 10 Steps and
only 3.5%practice 9 to 10 Steps.34
There is, thus, a need for a majorconceptual change in the
organizationof the hospital services for the motherand infant dyad
(Table 5). This re-quires that medical and nursing rou-tines and
practices adjust to theprinciple that breastfeeding shouldbegin
within the rst hour after birth(even for Cesarean deliveries)
andthat infants must be continuously ac-cessible to the mother by
rooming-in
TABLE 4 WHO/UNICEF Ten Steps toSuccessful Breastfeeding
1. Have a written breastfeeding policy that isroutinely
communicated to all health care staff.
2. Train all health care staff in the skills necessaryto
implement this policy.
3. Inform all pregnant women about the benetsand management of
breastfeeding.
4. Help mothers initiate breastfeeding within therst hour of
birth.
5. Show mothers how to breastfeed and how tomaintain lactation
even if they are separatedfrom their infants.
6. Give newborn infants no food or drink otherthan breast milk,
unless medically indicated.
7. Practice rooming-in (allow mothers and infantsto remain
together) 24 h a day.
8. Encourage breastfeeding on demand.9. Give no articial nipples
or paciers to
breastfeeding infants.a
10. Foster the establishment of breastfeedingsupport groups and
refer mothers to them ondischarge from hospital.
a The AAP does not support a categorical ban on paciersbecause
of their role in SIDS risk reduction and theiranalgesic benet
during painful procedures when breast-feeding cannot provide the
analgesia. Pacier use in thehospital in the neonatal period should
be limited to spe-cic medical indications such as pain reduction
andcalming in a drug-exposed infant, for example. Mothersof healthy
term breastfed infants should be instructed todelay pacier use
until breastfeeding is well-established,usually about 3 to 4 wk
after birth.
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arrangements that facilitate around-the-clock, on-demand feeding
for thehealthy infant. Formal staff trainingshould not only focus
on updatingknowledge and techniques for breast-feeding support but
also should ac-knowledge the need to change attitudesand eradicate
unsubstantiated beliefsabout the supposed equivalency
ofbreastfeeding and commercial infantformula feeding. Emphasis
should beplaced on the numerous benets ofexclusive breastfeeding.
The importanceof addressing the issue of the impactof hospital
practices and policies onbreastfeeding outcomes is highlightedby
the decision of The Joint Commissionto adopt the rate of exclusive
breastmilk feeding as a Perinatal Care CoreMeasure.127 As such, the
rate of exclu-sive breastfeeding during the hospitalstay has been
conrmed as a criticalvariable when measuring the quality ofcare
provided by a medical facility.
Pacier Use
Given the documentation that early useof paciers may be
associated withless successful breastfeeding, pacieruse in the
neonatal period should belimited to specic medical
situations.128
These include uses for pain relief, asa calming agent, or as
part of struc-tured program for enhancing oralmotor function.
Because pacier usehas been associated with a reductionin SIDS
incidence, mothers of healthyterm infants should be instructed
touse paciers at infant nap or sleeptime after breastfeeding is
well es-tablished, at approximately 3 to 4weeks of age.129131
Vitamins and Mineral Supplements
Intramuscular vitamin K1 (phytona-dione) at a dose of 0.5 to 1.0
mgshould routinely be administered toall infants on the rst day to
reducethe risk of hemorrhagic disease of thenewborn.132 A delay of
administration
until after the rst feeding at thebreast but not later than 6
hours ofage is recommended. A single oraldose of vitamin K should
not be used,because the oral dose is variablyabsorbed and does not
provide ade-quate concentrations or stores for thebreastfed
infant.132
Vitamin D deciency/insufciency andrickets has increased in all
infants asa result of decreased sunlight expo-sure secondary to
changes in lifestyle,dress habits, and use of topical sun-screen
preparations. To maintain anadequate serum vitamin D
concen-tration, all breastfed infants routinelyshould receive an
oral supplement ofvitamin D, 400 U per day, beginning athospital
discharge.133
Supplementary uoride should not beprovided during the rst 6
months.From age 6 months to 3 years, uoridesupplementation should
be limited toinfants residing in communities wherethe uoride
concentration in the wateris
-
(Brazil, Ghana, India, Norway, Oman,and the United States).135
As such, theWHO curves are standards and arethe normative model for
growth anddevelopment irrespective of infantethnicity or geography
reecting theoptimal growth of the breastfed in-fant.136 Use of the
WHO curves for therst 2 years allows for more accuratemonitoring of
weight and height forage and, in comparison with use ofthe CDC
reference curves, results inmore accurate (lower) rates of
un-dernutrition and short stature and(higher) rates of overweight.
Fur-thermore, birth to 6-month growthcharts are available where the
curvesare magnied to permit monitoring ofweight trajectories. As
such, the WHOcurves serve as the best guide forassessing lactation
performance becausethey minimize mislabeling clinical sit-uations
as inadequate breastfeeding andidentify more accurately and
promptlyoverweight and obese infants. As of Sep-tember 2010, the
CDC, with the concur-rence of the AAP, recommended the useof the
WHO curves for all childrenyounger than 24 months.137,138
ROLE OF THE PEDIATRICIAN
Pediatricians have a critical role intheir individual practices,
communi-ties, and society at large to serve asadvocates and
supporters of suc-cessful breastfeeding (Table 6).139 De-spite this
critical role, studies havedemonstrated lack of preparation
andknowledge and declining attitudesregarding the feasibility of
breast-feeding.140 The AAP Web site141 pro-vides a wealth of
breastfeeding-relatedmaterial and resources to assist andsupport
pediatricians in their criticalrole as advocates of infant
well-being.This includes the Safe and HealthyBeginnings toolkit,5
which includes re-sources for physicians ofce for pro-motion of
breastfeeding in a busypediatric practice setting, a pocket
guide for coding to facilitate appropri-ate payment, suggested
guidelines fortelephone triage of maternal breast-feeding concerns,
and informationregarding employer support forbreastfeeding in the
workplace.Evidence-based protocols from organ-izations such as the
Academy ofBreastfeeding Medicine provide de-tailed clinical
guidance for manage-ment of specic issues, including
therecommendations for frequent andunrestricted time for
breastfeeding soas to minimize hyperbilirubinemiaand
hypoglycemia.4,142,143 The criticalrole that pediatricians play is
high-lighted by the recommended healthsupervision visit at 3 to 5
days of age,which is within 48 to 72 hours afterdischarge from the
hospital, as wellas pediatricians support of practicesthat avoid
nonmedically indicatedsupplementation with commercial in-fant
formula.144
Pediatricians also should serve asbreastfeeding advocates and
educa-tors and not solely delegate this roleto staff or
nonmedical/lay volunteers.Communicating with families
thatbreastfeeding is a medical priority thatis enthusiastically
recommended bytheir personal pediatrician will build
support for mothers in the early weekspostpartum. To assist in
the educa-tion of future physicians, the AAP rec-ommends using the
evidence-basedBreastfeeding Residency Curriculum,4
which has been demonstrated to im-prove knowledge, condence,
practicepatterns, and breastfeeding rates. Thepediatricians own
ofce-based prac-tice should serve as a model for howto support
breastfeeding in the work-place. The pediatrician should also
takethe lead in encouraging the hospitalswith which he or she is
afliated toprovide proper support and facilitiesfor their employees
who choose tocontinue to breastfeed.
BUSINESS CASE FORBREASTFEEDING
A mother/baby-friendly worksite pro-vides benets to employers,
includinga reduction in company health carecosts, lower employee
absenteeism,reduction in employee turnover, andincreased employee
morale and pro-ductivity.145,146 The return on invest-ment has been
calculated that forevery $1 invested in creating andsupporting a
lactation support pro-gram (including a designated pumpsite that
guarantees privacy, avail-ability of refrigeration and a
hand-washing facility, and appropriatemother break time) there is a
$2 to $3dollar return.147 The Maternal andChild Health Bureau of
the US De-partment of Health and Human Serv-ices, with support from
the Ofce ofWomens Health, has created a pro-gram, The Business Case
for Breast-feeding, that provides details ofeconomic benets to the
employerand toolkits for the creation of suchprograms.148 The
Patient Protectionand Affordable Care Act passed byCongress in
March 2010 mandatesthat employers provide reasonablebreak time for
nursing mothers andprivate non-bathroom areas to express
TABLE 6 Role of the Pediatrician
1. Promote breastfeeding as the norm for infantfeeding.
2. Become knowledgeable in the principles andmanagement of
lactation and breastfeeding.
3. Develop skills necessary for assessing theadequacy of
breastfeeding.
4. Support training and education for medicalstudents, residents
and postgraduatephysicians in breastfeeding and lactation.
5. Promote hospital policies that are compatiblewith the AAP and
Academy of BreastfeedingMedicine Model Hospital Policy and the
WHO/UNICEF Ten Steps toSuccessful Breastfeeding.
6. Collaborate with the obstetric community todevelop optimal
breastfeeding supportprograms.
7. Coordinate with community-based health careprofessionals and
certied breastfeedingcounselors to ensure uniform andcomprehensive
breastfeeding support.
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breast milk during their workday.149
The establishment of these initiativesas the standard workplace
environ-ment will support mothers in theirgoal of supplying only
breast milk totheir infants beyond the immediatepostpartum
period.
CONCLUSIONS
Research and practice in the 5 yearssince publication of the
last AAP policystatement have reinforced the conclu-sion that
breastfeeding and the use ofhuman milk confer unique nutritionaland
nonnutritional benets to the infant
and the mother and, in turn, optimizeinfant, child, and adult
health as well aschild growth and development. Re-cently, published
evidence-based stud-ies have conrmed and quantitated therisks of
not breastfeeding. Thus, infantfeeding should not be considered asa
lifestyle choice but rather as a basichealth issue. As such, the
pediatriciansrole in advocating and supportingproper breastfeeding
practices is es-sential and vital for the achievement ofthis
preferred public health goal.35
LEAD AUTHORSArthur I. Eidelman, MD
Richard J. Schanler, MD
SECTION ON BREASTFEEDINGEXECUTIVE COMMITTEE, 20112012Margreete
Johnston, MDSusan Landers, MDLarry Noble, MDKinga Szucs, MDLaura
Viehmann, MD
PAST CONTRIBUTING EXECUTIVECOMMITTEE MEMBERSLori Feldman-Winter,
MDRuth Lawrence, MD
STAFFSunnah Kim, MSNgozi Onyema, MPH
REFERENCES
1. Gartner LM, Morton J, Lawrence RA, et al;American Academy of
Pediatrics Sectionon Breastfeeding. Breastfeeding and theuse of
human milk. Pediatrics. 2005;115(2):496506
2. Schanler RJ, Dooley S, Gartner LM, Krebs NF,Mass SB.
Breastfeeding Handbook forPhysicians. Elk Grove Village, IL:
AmericanAcademy of Pediatrics; Washington, DC:American College of
Obstetricians andGynecologists; 2006
3. American Academy of Pediatrics Section onBreastfeeding.
Sample Hospital Breastfeed-ing Policy for Newborns. Elk Grove
Village, IL:American Academy of Pediatrics; 2008
4. Feldman-Winter L, Barone L, Milcarek B,et al. Residency
curriculum improvesbreastfeeding care. Pediatrics.
2010;126(2):289297
5. American Academy of Pediatrics. Safe andHealth Beginnings: A
Resource Toolkit forHospitals and Physicians Ofces. ElkGrove
Village, IL: American Academy ofPediatrics; 2008
6. Centers for Disease Control and Pre-vention. Breastfeeding
Among U.S. Chil-dren Born 19992006, CDC NationalImmunization
Survey. Atlanta, GA: Centersfor Disease Control and Prevention;
2010
7. McDowell MM, Wang C-Y, Kennedy-Stephenson J. Breastfeeding in
theUnited States: Findings from the NationalHealth and Nutrition
Examination Surveys,19992006. NCHS Data Briefs, no. 5.Hyatsville,
MD: National Center for HealthStatistics; 2008
8. 2007 CDC National Survey of MaternityPractices in Infant
Nutrition and Care.
Atlanta, GA: Centers for Disease Controland Prevention; 2009
9. Ofce of Disease Prevention and HealthPromotion; US Department
of Health andHuman Services. Healthy People 2010. Avail-able at:
www.healthypeople.gov. AccessedJune 3, 2011
10. Centers for Disease Control and Pre-vention. Breastfeeding
report cardUnited States, 2010. Available at:
www.cdc.gov/breastfeeding/data/reportcard.htm.Accessed June 3,
2011
11. U.S. Department of Health and HumanServices. Maternal,
infant, and childhealth. Healthy People 2020; 2010. Avail-able at:
http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=26.
Accessed December 12, 2011
12. Centers for Disease Control and Pre-vention. Racial and
ethnic differences inbreastfeeding initiation and duration, bystate
National Immunization Survey,United States, 20042008. MMWR
MorbMortal Wkly Rep. 2010;59(11):327334
13. Ip S, Chung M, Raman G, et al; Tufts-NewEngland Medical
Center Evidence-basedPractice Center. Breastfeeding and maternaland
infant health outcomes in developedcountries. Evid Rep Technol
Assess (FullRep). 2007;153(153):1186
14. Ip S, Chung M, Raman G, Trikalinos TA, Lau J.A summary of
the Agency for HealthcareResearch and Qualitys evidence reporton
breastfeeding in developed countries.Breastfeed Med. 2009;4(suppl
1):S17S30
15. Chantry CJ, Howard CR, Auinger P. Fullbreastfeeding duration
and associateddecrease in respiratory tract infection in
US children. Pediatrics. 2006;117(2):425432
16. Nishimura T, Suzue J, Kaji H. Breastfeedingreduces the
severity of respiratory syn-cytial virus infection among young
infants:a multi-center prospective study. PediatrInt.
2009;51(6):812816
17. Duijts L, Jaddoe VW, Hofman A, Moll HA.Prolonged and
exclusive breastfeedingreduces the risk of infectious diseases
ininfancy. Pediatrics. 2010;126(1). Availableat:
www.pediatrics.org/cgi/content/full/126/1/e18
18. Quigley MA, Kelly YJ, Sacker A. Breast-feeding and
hospitalization for diarrhealand respiratory infection in the
UnitedKingdom Millennium Cohort Study. Pedi-atrics. 2007;119(4).
Available at: www.pediatrics.org/cgi/content/full/119/4/e837
19. Sullivan S, Schanler RJ, Kim JH, et al. Anexclusively human
milk-based diet is as-sociated with a lower rate of
necrotizingenterocolitis than a diet of human milkand bovine
milk-based products. J Pediatr.2010;156(4):562567, e1
20. Hauck FR, Thompson JMD, Tanabe KO,Moon RY, Vennemann MM.
Breastfeedingand reduced risk of sudden infant deathsyndrome: a
meta-analysis. Pediatrics.2011;128(1):18
21. Chen A, Rogan WJ. Breastfeeding and therisk of postneonatal
death in the UnitedStates. Pediatrics. 2004;113(5). Availableat:
www.pediatrics.org/cgi/content/full/113/5/e435
22. Task Force on Sudden Infant Death Syn-drome. SIDS and other
sleep-related infantdeaths: expansion of recommendations for
PEDIATRICS Volume 129, Number 3, March 2012 e837
FROM THE AMERICAN ACADEMY OF PEDIATRICS
by guest on September 3,
2013pediatrics.aappublications.orgDownloaded from
-
a safe infant sleeping environment. Pedi-atrics.
2011;128(5):10301039
23. Vennemann MM, Bajanowski T, Brinkmann B,et al; GeSID Study
Group. Does breastfeedingreduce the risk of sudden infant
deathsyndrome? Pediatrics. 2009;123(3). Avail-able at:
www.pediatrics.org/cgi/content/full/123/3/e406
24. Bartick M, Reinhold A. The burden of sub-optimal
breastfeeding in the United States:a pediatric cost analysis.
Pediatrics. 2010;125(5). Available at:
www.pediatrics.org/cgi/content/full/125/5/e1048
25. Jones G, Steketee RW, Black RE, Bhutta ZA,Morris SS;
Bellagio Child Survival StudyGroup. How many child deaths can we
pre-vent this year? Lancet. 2003;362(9377):6571
26. Greer FR, Sicherer SH, Burks AW; Ameri-can Academy of
Pediatrics Committee onNutrition; ; American Academy of Pediat-rics
Section on Allergy and Immunology.Effects of early nutritional
interventionson the development of atopic disease ininfants and
children: the role of maternaldietary restriction, breastfeeding,
timingof introduction of complementary foods,and hydrolyzed
formulas. Pediatrics. 2008;121(1):183191
27. Zutavern A, Brockow I, Schaaf B, et al; LISAStudy Group.
Timing of solid food in-troduction in relation to atopic
dermatitisand atopic sensitization: results froma prospective birth
cohort study. Pediat-rics. 2006;117(2):401411
28. Poole JA, Barriga K, Leung DYM, et al.Timing of initial
exposure to cereal grainsand the risk of wheat allergy.
Pediatrics.2006;117(6):21752182
29. Zutavern A, Brockow I, Schaaf B, et al; LISAStudy Group.
Timing of solid food in-troduction in relation to eczema,
asthma,allergic rhinitis, and food and inhalantsensitization at the
age of 6 years: resultsfrom the prospective birth cohort studyLISA.
Pediatrics. 2008;121(1). Available
at:www.pediatrics.org/cgi/content/full/121/1/e44
30. Nwaru BI, Erkkola M, Ahonen S, et al. Ageat the introduction
of solid foods duringthe rst year and allergic sensitization atage
5 years. Pediatrics. 2010;125(1):5059
31. Akobeng AK, Ramanan AV, Buchan I, Heller RF.Effect of breast
feeding on risk of coeliacdisease: a systematic review and
meta-analysis of observational studies. ArchDis Child.
2006;91(1):3943
32. Barclay AR, Russell RK, Wilson ML, Gilmour WH,Satsangi J,
Wilson DC. Systematic review: therole of breastfeeding in the
developmentof pediatric inammatory bowel disease.J Pediatr.
2009;155(3):421426
33. Penders J, Thijs C, Vink C, et al. Factorsinuencing the
composition of the in-testinal microbiota in early infancy.
Pedi-atrics. 2006;118(2):511521
34. Perrine CG, Shealy KM, Scanlon KS, et al;Centers for Disease
Control and Pre-vention (CDC). Vital signs: hospital prac-tices to
support breastfeedingUnitedStates, 2007 and 2009. MMWR Morb Mor-tal
Wkly Rep. 2011;60(30):10201025
35. U.S.Department of Health and Human Serv-ices, The Surgeon
Generals Call to Action toSupport Breastfeeding. Available at:
www.surgeongeneral.gov/topics/breastfeeding/Accessed March 28,
2011
36. Owen CG, Martin RM, Whincup PH, Smith GD,Cook DG. Effect of
infant feeding on therisk of obesity across the life course:a
quantitative review of published evi-dence. Pediatrics.
2005;115(5):13671377
37. Parikh NI, Hwang SJ, Ingelsson E, et al.Breastfeeding in
infancy and adult cardio-vascular disease risk factors. Am J
Med.2009;122(7):656663, e1
38. Metzger MW, McDade TW. Breastfeedingas obesity prevention in
the United States:a sibling difference model. Am J Hum
Biol.2010;22(3):291296
39. Dewey KG, Lnnerdal B. Infant self-regulationof breast milk
intake. Acta Paediatr Scand.1986;75(6):893898
40. Li R, Fein SB, Grummer-Strawn LM. Asso-ciation of
breastfeeding intensity andbottle-emptying behaviors at early
infancywith infants risk for excess weight at lateinfancy.
Pediatrics. 2008;122(suppl 2):S77S84
41. Li R, Fein SB, Grummer-Strawn LM. Doinfants fed from bottles
lack self-regulationof milk intake compared with directlybreastfed
infants? Pediatrics. 2010;125(6).Available at:
www.pediatrics.org/cgi/content/full/125/6/e1386
42. Rosenbauer J, Herzig P, Giani G. Early in-fant feeding and
risk of type 1 diabetesmellitusa nationwide
population-basedcase-control study in pre-school children.Diabetes
Metab Res Rev. 2008;24(3):211222
43. Das UN. Breastfeeding prevents type 2diabetes mellitus: but,
how and why? Am JClin Nutr. 2007;85(5):14361437
44. Bener A, Hoffmann GF, Afy Z, Rasul K,Tewk I. Does prolonged
breastfeedingreduce the risk for childhood leukemiaand lymphomas?
Minerva Pediatr. 2008;60(2):155161
45. Rudant J, Orsi L, Menegaux F, et al.Childhood acute
leukemia, early commoninfections, and allergy: The ESCALE Study.Am
J Epidemiol. 2010;172(9):10151027
46. Kwan ML, Bufer PA, Abrams B, Kiley VA.Breastfeeding and the
risk of childhoodleukemia: a meta-analysis. Public HealthRep.
2004;119(6):521535
47. Der G, Batty GD, Deary IJ. Effect of breastfeeding on
intelligence in children: pro-spective study, sibling pairs
analysis, andmeta-analysis. BMJ. 2006;333(7575):945950
48. Kramer MS, Fombonne E, Igumnov S, et al;Promotion of
Breastfeeding InterventionTrial (PROBIT) Study Group. Effects
ofprolonged and exclusive breastfeeding onchild behavior and
maternal adjustment:evidence from a large, randomized
trial.Pediatrics. 2008;121(3). Available at:
www.pediatrics.org/cgi/content/full/121/3/e435
49. Kramer MS, Aboud F, Mironova E, et al;Promotion of
Breastfeeding InterventionTrial (PROBIT) Study Group.
Breastfeedingand child cognitive development: new ev-idence from a
large randomized trial.Arch Gen Psychiatry. 2008;65(5):578584
50. Kramer MS, Chalmers B, Hodnett ED,et al; PROBIT Study Group
(Promotion ofBreastfeeding Intervention Trial). Pro-motion of
Breastfeeding Intervention Trial(PROBIT): a randomized trial in the
Re-public of Belarus. JAMA. 2001;285(4):413420
51. Vohr BR, Poindexter BB, Dusick AM, et al;NICHD Neonatal
Research Network. Bene-cial effects of breast milk in the
neonatalintensive care unit on the developmentaloutcome of
extremely low birth weightinfants at 18 months of age.
Pediatrics.2006;118(1). Available at:
www.pediatrics.org/cgi/content/full/118/1/e115
52. Vohr BR, Poindexter BB, Dusick AM, et al;National Institute
of Child Health and Hu-man Development National Research Net-work.
Persistent benecial effects ofbreast milk ingested in the neonatal
in-tensive care unit on outcomes of ex-tremely low birth weight
infants at 30months of age. Pediatrics. 2007;120(4).Available at:
www.pediatrics.org/cgi/content/full/120/4/e953
53. Lucas A, Morley R, Cole TJ. Randomisedtrial of early diet in
preterm babies andlater intelligence quotient. BMJ.
1998;317(7171):14811487
54. Isaacs EB, Fischl BR, Quinn BT, Chong WK,Gadian DG, Lucas A.
Impact of breast milkon intelligence quotient, brain size, andwhite
matter development. Pediatr Res.2010;67(4):357362
55. Furman L, Taylor G, Minich N, Hack M. Theeffect of maternal
milk on neonatal mor-bidity of very low-birth-weight infants.
ArchPediatr Adolesc Med. 2003;157(1):6671
e838 FROM THE AMERICAN ACADEMY OF PEDIATRICS by guest on
September 3, 2013pediatrics.aappublications.orgDownloaded from
-
56. Lucas A, Cole TJ. Breast milk and neonatalnecrotising
enterocolitis. Lancet. 1990;336(8730):15191523
57. Sisk PM, Lovelady CA, Dillard RG, Gruber KJ,OShea TM. Early
human milk feedingis associated with a lower risk of nec-rotizing
enterocolitis in very low birthweight infants. J Perinatol.
2007;27(7):428433
58. Meinzen-Derr J, Poindexter B, Wrage L,Morrow AL, Stoll B,
Donovan EF. Role ofhuman milk in extremely low birth weightinfants
risk of necrotizing enterocolitis ordeath. J Perinatol.
2009;29(1):5762
59. Schanler RJ, Shulman RJ, Lau C. Feedingstrategies for
premature infants: bene-cial outcomes of feeding fortied humanmilk
versus preterm formula. Pediatrics.1999;103(6 pt 1):11501157
60. Hintz SR, Kendrick DE, Stoll BJ, et al; NICHDNeonatal
Research Network. Neuro-developmental and growth outcomes
ofextremely low birth weight infants afternecrotizing
enterocolitis. Pediatrics. 2005;115(3):696703
61. Shah DK, Doyle LW, Anderson PJ, et al.Adverse
neurodevelopment in preterminfants with postnatal sepsis or
necrotiz-ing enterocolitis is mediated by whitematter abnormalities
on magnetic reso-nance imaging at term. J Pediatr.
2008;153(2):170175, e1
62. Hylander MA, Strobino DM, Dhanireddy R.Human milk feedings
and infection amongvery low birth weight infants.
Pediatrics.1998;102(3). Available at:
www.pediatrics.org/cgi/content/full/102/3/e38
63. Okamoto T, Shirai M, Kokubo M, et al.Human milk reduces the
risk of retinaldetachment in extremely low-birthweightinfants.
Pediatr Int. 2007;49(6):894897
64. Lucas A. Long-term programming effectsof early
nutritionimplications for thepreterm infant. J Perinatol.
2005;25(suppl2):S2S6
65. Singhal A, Cole TJ, Lucas A. Early nutritionin preterm
infants and later blood pres-sure: two cohorts after randomised
trials.Lancet. 2001;357(9254):413419
66. Quigley MA, Henderson G, Anthony MY,McGuire W. Formula milk
versus donorbreast milk for feeding preterm or lowbirth weight
infants. Cochrane DatabaseSyst Rev. 2007;(4):CD002971
67. Slutzah M, Codipilly CN, Potak D, Clark RM,Schanler RJ.
Refrigerator storage ofexpressed human milk in the
neonatalintensive care unit. J Pediatr. 2010;156(1):2628
68. Henderson JJ, Evans SF, Straton JA, Priest SR,Hagan R.
Impact of postnatal depression
on breastfeeding duration. Birth. 2003;30(3):175180
69. Strathearn L, Mamun AA, Najman JM,OCallaghan MJ. Does
breastfeeding pro-tect against substantiated child abuseand
neglect? A 15-year cohort study. Pe-diatrics.
2009;123(2):483493
70. Krause KM, Lovelady CA, Peterson BL,Chowdhury N, stbye T.
Effect of breast-feeding on weight retention at 3 and 6months
postpartum: data from the NorthCarolina WIC Programme. Public
HealthNutr. 2010;13(12):20192026
71. Stuebe AM, Rich-Edwards JW, Willett WC,Manson JE, Michels
KB. Duration of lac-tation and incidence of type 2 diabetes.JAMA.
2005;294(20):26012610
72. Schwarz EB, Brown JS, Creasman JM,et al. Lactation and
maternal risk of type 2diabetes: a population-based study. Am JMed.
2010;123(9):863.e1.e6
73. Karlson EW, Mandl LA, Hankinson SE,Grodstein F. Do
breast-feeding and otherreproductive factors inuence future riskof
rheumatoid arthritis? Results from theNurses Health Study.
Arthritis Rheum.2004;50(11):34583467
74. Schwarz EB, Ray RM, Stuebe AM, et al.Duration of lactation
and risk factors formaternal cardiovascular disease. ObstetGynecol.
2009;113(5):974982
75. Stuebe AM, Willett WC, Xue F, MichelsKB. Lactation and
incidence of pre-menopausal breast cancer: a longitudi-nal study.
Arch Intern Med. 2009;169(15):13641371
76. Collaborative Group on Hormonal Factorsin Breast Cancer.
Breast cancer andbreastfeeding: collaborative reanalysis
ofindividual data from 47 epidemiologicalstudies in 30 countries,
including 50302women with breast cancer and 96973women without the
disease. Lancet. 2002;360(9328):187195
77. Lipworth L, Bailey LR, Trichopoulos D.History of
breast-feeding in relation tobreast cancer risk: a review of the
epi-demiologic literature. J Natl Cancer Inst.2000;92(4):302312
78. World Health Organization. The optimalduration of exclusive
breastfeeding: re-port of an expert consultation. Availableat:
hwww.who.int/nutrition/publications/optimal_duration_of_exc_bfeeding_report_eng.pdf.
Accessed December 12, 2011
79. Institute of Medicine. Early childhood obesityprevention
policies. June 23, 2011. Avail-able at:
www.iom.edu/obesityyoungchildren.Accessed December 12, 2011
80. Kramer MS, Kakuma R. Optimal durationof exclusive
breastfeeding [review]. The
Cochrane Library. January 21, 2009.Available at:
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003517/full.Accessed
December 12, 2011
81. Peterson AE, Perez-Escamilla R, Labbok MH,Hight V, von
Hertzen H, Van Look P. Multi-center study of the lactational
amenorrheamethod (LAM) III: effectiveness, duration,and
satisfaction with reduced client-provider contact. Contraception.
2000;62(5):221230
82. Agostoni C, Decsi T, Fewtrell M, et al;ESPGHAN Committee on
Nutrition. Com-plementary feeding: a commentary by theESPGHAN
Committee on Nutrition. J PediatrGastroenterol Nutr.
2008;46(1):99110
83. Cattaneo A, Williams C, Palls-Alonso CR,et al. ESPGHANs 2008
recommendation forearly introduction of complementary foods:how
good is the evidence? Matern ChildNutr. 2011;7(4):335343
84. Gonalves DU, Proietti FA, Ribas JG, et al.Epidemiology,
treatment, and preventionof human T-cell leukemia virus type
1-associated diseases. Clin Microbiol Rev.2010;23(3):577589
85. Arroyo Carrera I, Lpez Rodrguez MJ,Sapia AM, Lpez Lafuente
A, Sacristn AR.Probable transmission of brucellosis bybreast milk.
J Trop Pediatr. 2006;52(5):380381
86. American Academy of Pediatrics. Tuber-culosis. In: Pickering
LK, Baker CJ, Kim-berlin DW, Long SS, eds. Red Book: 2009Report of
the Committee on InfectiousDiseases. 28th ed. Elk Grove Village,
IL:American Academy of Pediatrics; 2009:680-701
87. American Academy of Pediatrics. Vari-cella-zoster
infections. In: Pickering LK,Baker CJ, Kimberlin DW, Long SS, eds.
RedBook: 2009 Report of the Committee onInfectious Diseases. 28th
ed. Elk GroveVillage, IL: American Academy of Pediat-rics;
2009:714-727
88. Centers for Disease Control and Preven-tion. 2009 H1N1 Flu
(Swine Flu) and Feed-ing your Baby: What Parents Should
Know.Available at:
http://www.cdc.gov/h1n1u/infantfeeding.htm?s_cid=h1n1Flu_outbreak_155.
Accessed January 22, 2010
89. Horvath T, Madi BC, Iuppa IM, Kennedy GE,Rutherford G, Read
JS. Interventions forpreventing late postnatal
mother-to-childtransmission of HIV. Cochrane DatabaseSyst Rev.
2009;21(1):CD006734
90. Chasela CS, Hudgens MG, Jamieson DJ,et al; BAN Study Group.
Maternal or in-fant antiretroviral drugs to reduce
HIV-1transmission. N Engl J Med. 2010;362(24):22712281
PEDIATRICS Volume 129, Number 3, March 2012 e839
FROM THE AMERICAN ACADEMY OF PEDIATRICS
by guest on September 3,
2013pediatrics.aappublications.orgDownloaded from
-
91. Shapiro RL, Hughes MD, Ogwu A, et al.Antiretroviral regimens
in pregnancy andbreast-feeding in Botswana. N Engl J
Med.2010;362(24):22822294
92. Hamele M, Flanagan R, Loomis CA, Stevens T,Fairchok MP.
Severe morbidity and mortal-ity with breast milk associated
cytomega-lovirus infection. Pediatr Infect Dis J.
2010;29(1):8486
93. Kurath S, Halwachs-Baumann G, Mller W,Resch B. Transmission
of cytomegalovirusvia breast milk to the prematurely borninfant: a
systematic review. Clin MicrobiolInfect. 2010;16(8):11721178
94. Maschmann J, Hamprecht K, Weissbrich B,Dietz K, Jahn G,
Speer CP. Freeze-thawing ofbreast milk does not prevent
cytomegalo-virus transmission to a preterm infant.Arch Dis Child
Fetal Neonatal Ed. 2006;91(4):F288F290
95. Hamprecht K, Maschmann J, Mller D,et al. Cytomegalovirus
(CMV) inactivationin breast milk: reassessment of pasteur-ization
and freeze-thawing. Pediatr Res.2004;56(4):529535
96. Jansson LM; Academy of BreastfeedingMedicine Protocol
Committee. ABM clini-cal protocol #21: Guidelines for
breast-feeding and the drug-dependent woman.Breastfeed Med.
2009;4(4):225228
97. Garry A, Rigourd V, Amirouche A, Fauroux V,Aubry S, Serreau
R. Cannabis and breast-feeding. J Toxicol. 2009;2009:596149
98. Little RE, Anderson KW, Ervin CH, Wor-thington-Roberts B,
Clarren SK. Maternalalcohol use during breast-feeding and in-fant
mental and motor development at oneyear. N Engl J Med.
1989;321(7):425430
99. Mennella JA, Pepino MY. Breastfeedingand prolactin levels in
lactating womenwith a family history of alcoholism. Pediat-rics.
2010;125(5). Available at:
www.pediatrics.org/cgi/content/full/125/5/e1162
100. Subcommittee on Nutrition During Lac-tation, Institute of
Medicine, National Acad-emy of Sciences. Nutrition During
Lactation.Washington, DC: National Academies Press;1991:113152
101. Koren G. Drinking alcohol while breast-feeding. Will it
harm my baby? Can FamPhysician. 2002;48:3941
102. Guedes HT, Souza LS. Exposure to mater-nal smoking in the
rst year of lifeinterferes in breast-feeding protective ef-fect
against the onset of respiratory al-lergy from birth to 5 yr.
Pediatr AllergyImmunol. 2009;20(1):3034
103. Liebrechts-Akkerman G, Lao O, Liu F, et al.Postnatal
parental smoking: an importantrisk factor for SIDS. Eur J Pediatr.
2011;170(10):12811291
104. Yilmaz G, Hizli S, Karacan C, Yurdakk K,Coskun T, Dilmen U.
Effect of passivesmoking on growth and infection rates ofbreast-fed
and non-breast-fed infants.Pediatr Int. 2009;51(3):352358
105. Vio F, Salazar G, Infante C. Smoking duringpregnancy and
lactation and its effects onbreast-milk volume. Am J Clin Nutr.
1991;54(6):10111016
106. Hopkinson JM, Schanler RJ, Fraley JK,Garza C. Milk
production by mothers ofpremature infants: inuence of
cigarettesmoking. Pediatrics. 1992;90(6):934938
107. Butte NF. Maternal nutrition during lacta-tion. Pediatric
Up-to-Date. 2010. Available
at:http://www.uptodate.com/contents/maternal-nutrition-during-lactation?source=search_result&search=maternal+nutrition&selectedTitle=2%7E150.
Accessed October29, 2010
108. Zeisel SH. Is maternal diet supplementa-tion benecial?
Optimal development ofinfant depends on mothers diet. Am J
ClinNutr. 2009;89(2):685S687S
109. Picciano MF, McGuire MK. Use of dietarysupplements by
pregnant and lactatingwomen in North America. Am J Clin
Nutr.2009;89(2):663S667S
110. Whitelaw A. Historical perspectives: peri-natal proles:
Robert McCance and ElsieWiddowson: pioneers in neonatal
science.NeoReviews. 2007;8(11):e455e458
111. Simopoulos AP, Leaf A, Salem N Jr. Work-shop on the
essentiality of and recom-mended dietary intakes for omega-6
andomega-3 fatty acids. J Am Coll Nutr. 1999;18(5):487489
112. Carlson SE. Docosahexaenoic acid sup-plementation in
pregnancy and lactation.Am J Clin Nutr. 2009;89(2):678S684S
113. Koletzko B, Cetin I, Brenna JT; PerinatalLipid Intake
Working Group; ; Child HealthFoundation; ; Diabetic Pregnancy
StudyGroup; ; European Association of PerinatalMedicine; ; European
Association of Peri-natal Medicine; ; European Society forClinical
Nutrition and Metabolism; ; Euro-pean Society for Paediatric
Gastroenterol-ogy, Hepatology and Nutrition, Committeeon Nutrition;
; International Federation ofPlacenta Associations; ; International
Soci-ety for the Study of Fatty Acids and Lipids.Dietary fat
intakes for pregnant and lac-tating women. Br J Nutr.
2007;98(5):873877
114. Drugs and Lactation Database. 2010. Avail-able at:
http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT. Accessed
September 17,2009
115. Committee on Drugs, American Academyof Pediatrics. The
transfer of drugs and
other chemicals into human milk. Pediat-rics. 2011, In press
116. Fortinguerra F, Clavenna A, Bonati M.Psychotropic drug use
during breast-feeding: a review of the evidence. Pediat-rics.
2009;124(4). Available at:
www.pediatrics.org/cgi/content/full/124/4/e547
117. US Nuclear Regulatory Commission. Con-trol of access to
high and very high ra-diation areas in nuclear power plants.USNRC
Regulatory Guide 8.38. June 1993.Available at:
www.nrc.gov/reading-rm/doc-collections/reg-guides/occupational-health/rg/8-38/08-038.pdf.
118. International Commission on RadiologicalProtection. Doses
to infants from ingestionof radionuclides in mothers milk.
ICRPPublication 95. Ann ICRP. 2004;34(34):1-27
119. Stabin MG, Breitz HB. Breast milk excre-tion of
radiopharmaceuticals: mecha-nisms, ndings, and radiation dosimetry.
JNucl Med. 2000;41(5):863873
120. Kaplan M, Hammerman C. Severe neonatalhyperbilirubinemia. A
potential complicationof glucose-6-phosphate dehydrogenase
de-ciency. Clin Perinatol. 1998;25(3):575590,viii
121. World Health Organization. Evidence forthe Ten Steps to
Successful Breastfeeding.Geneva, Switzerland: World Health
Orga-nization; 1998
122. World Health Organization; United NationsChildrens Fund.
Protecting, Promoting,and Supporting Breastfeeding: The SpecialRole
of Maternity Services. Geneva, Swit-zerland: World Health
Organization; 1989
123. Philipp BL, Merewood A, Miller LW, et al.Baby-friendly
hospital initiative improvesbreastfeeding initiation rates in a US
hos-pital setting. Pediatrics. 2001;108(3):677681
124. Murray EK, Ricketts S, Dellaport J. Hospitalpractices that
increase breastfeeding du-ration: results from a
population-basedstudy. Birth. 2007;34(3):202211
125. Centers for Disease Control and Pre-vention.
Breastfeeding-related maternitypractices at hospitals and birth
centersUnited States, 2007. MMWR Morb MortalWkly Rep.
2008;57(23):621625
126. Dewey KG, Nommsen-Rivers LA, Heinig MJ,Cohen RJ. Risk
factors for suboptimal in-fant breastfeeding behavior, delayed
onsetof lactation, and excess neonatal weightloss. Pediatrics.
2003;112(3 pt 1):607619
127. The Joint Commission: Specications Man-ual for Joint
Commission National QualityCore Measures. Available at:
http://manual.jointcommission.org/releases/TJC2011A/.Accessed
January 12, 2011
128. OConnor NR, Tanabe KO, Siadaty MS,Hauck FR. Paciers and
breastfeeding:
e840 FROM THE AMERICAN ACADEMY OF PEDIATRICS by guest on
September 3, 2013pediatrics.aappublications.orgDownloaded from
-
a systematic review. Arch Pediatr AdolescMed.
2009;163(4):378382
129. Hauck FR, Omojokun OO, Siadaty MS. Dopaciers reduce the
risk of sudden infantdeath syndrome? A meta-analysis.
Pediatrics.2005;116(5). Available at:
www.pediatrics.org/cgi/content/full/116/5/e716
130. American Academy of Pediatrics TaskForce on Sudden Infant
Death Syndrome.The changing concept of sudden infantdeath syndrome:
diagnostic coding shifts,controversies regarding the sleeping
en-vironment, and new variables to considerin reducing risk.
Pediatrics. 2005;116(5):12451255
131. Li DK, Willinger M, Petitti DB, Odouli R, Liu L,Hoffman HJ.
Use of a dummy (pacier)during sleep and risk of sudden infant
deathsyndrome (SIDS): population based case-control study. BMJ.
2006;332(7532):1822
132. American Academy of Pediatrics Commit-tee on Fetus and
Newborn. Controversiesconcerning vitamin K and the
newborn.Pediatrics. 2003;112(1 pt 1):191192
133. Wagner CL, Greer FR; American Academyof Pediatrics Section
on Breastfeeding; ;American Academy of Pediatrics Commit-tee on
Nutrition. Prevention of rickets andvitamin D deciency in infants,
children,and adolescents. Pediatrics. 2008;122(5):11421152
134. American Academy of Pediatric Dentistry.Guidelines for
Fluoride Therapy, Revised2000. Available at:
http://www.aapd.org/pdf/uoridetherapy.pdf. Accessed September
17,2009
135. Garza C, de Onis M. Rationale for de-veloping a new
international growth
reference. Food Nutr Bull. 2004;25(suppl1):S5S14
136. de Onis M, Garza C, Onyango AW, Borghi E.Comparison of the
WHO child growthstandards and the CDC 2000 growthcharts. J Nutr.
2007;137(1):144148
137. Grummer-Strawn LM, Reinold C, Krebs NF;Centers for Disease
Control and Pre-vention. Use of World Health Organizationand CDC
growth charts for children aged059 months in the United States.
MMWRRecomm Rep. 2010;59(RR-9):115
138. Grummer-Strawn LM, Reinold C, KrebsNFCenters for Disease
Control and Pre-vention. Use of World Health Organizationand CDC
growth charts for children aged0-59 months in the United States.
MMWRRecomm Rep. 2010;59(RR-9):115
139. Schanler RJ. The pediatrician supportsbreastfeeding.
Breastfeed Med. 2010;5(5):235236
140. Feldman-Winter LB, Schanler RJ, OConnor KG,Lawrence RA.
Pediatricians and the pro-motion and support of breastfeeding.
ArchPediatr Adolesc Med. 2008;162(12):11421149
141. American Academy of Pediatrics. Ameri-can Academy of
Pediatrics BreastfeedingInitiatives. 2010. Available at:
http://www.aap.org/breastfeeding. Accessed Septem-ber 17, 2009
142. Academy of Breastfeeding Medicine Pro-tocol Committee.
Clinical Protocols. Avail-able at
http://www.bfmed.org/Resources/Protocols.aspx. Accessed January 22,
2010
143. American Academy of Pediatrics Subcom-mittee on
Hyperbilirubinemia. Managementof hyperbilirubinemia in the
newborn
infant 35 or more weeks of gestation.Pediatrics.
2004;114(1):297316
144. American Academy of Pediatrics, Commit-tee on Practice and
Ambulatory Medicineand Bright Futures Steering
Committee.Recommendations for preventive pediatrichealth care.
Pediatrics. 2007;120(6):1376
145. Cohen R, Mrtek MB, Mrtek RG. Comparisonof maternal
absenteeism and infant illnessrates among breast-feeding and
formula-feeding women in two corporations. Am JHealth Promot.
1995;10(2):148153
146. Ortiz J, McGilligan K, Kelly P. Duration ofbreast milk
expression among workingmothers enrolled in an
employer-sponsoredlactation program. Pediatr Nurs.
2004;30(2):111119
147. Tuttle CR, Slavit WI. Establishing the busi-ness case for
breastfeeding. BreastfeedMed. 2009;4(suppl 1):S59S62
148. US Department of Health and HumanServices Ofce on Womens
Health. Businesscase for breast feeding. 2010. Available
at:www.womenshealth.gov/breastfeeding/government-in-action/business-case-for-breastfeeding.
Accessed September 24, 2010
149. Patient Protection and Affordable Care Act2010, Public Law
111-148. Title IV, x4207,USC HR 3590, (2010)
150. Hurst NM, Myatt A, Schanler RJ. Growthand development of a
hospital-based lac-tation program and mothers own milkbank. J
Obstet Gynecol Neonatal Nurs.1998;27(5):503510
151. Schanler RJ, Fraley JK, Lau C, Hurst NM,Horvath L, Rossmann
SN. Breastmilk culturesand infection in extremely prematureinfants.
J Perinatol. 2011;31(5):335338
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