Even The AAP Agrees: Pediatricians Need To Be More Breastfeeding-Friendly

by Wendy Wisner
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Let me start by saying that there are some truly amazing pediatricians out there. In fact, almost anyone who is willing to deal with baby poop, weird rashes, hysterical new parents, and screaming toddlers is pretty much saintly. Let’s also not forget that pediatricians save lives on the daily, work long-ass hours, are swimming in medical school student loans, and just plain old sacrifice a lot to take care of the health and well being of the next generation of humans.

But as a mom who breastfed a couple of tykes, and a lactation consultant who has worked with a ton of new moms, I can say that lots (but not all!) of pediatricians have a bit to learn when it comes to supporting moms who want to breastfeed.

When I took my first son to the pediatrician at a few days old, I was told that I needed to drink a quart of cow’s milk per day to produce enough breast milk (this is categorically untrue!). My son had lost a normal amount of weight for a 3-day-old baby, but the pediatrician immediately started discussing formula supplements with me. I was engorged with milk, full of cascading hormones, and wanted to cry. (We immediately switched pediatricians, found one who was much more supportive of breastfeeding, and my son put on plenty of weight as soon as my milk came in.)

I have heard much worse stories, too, including pediatricians who told mothers they could not breastfeed while taking certain medications that were in fact compatible with breastfeeding; pediatricians who told mothers to wean once they became pregnant (pregnancy is rarely a reason to wean); and pediatricians whose office staff scoffed at moms who breastfed in the waiting room (yes, really, this happens).

I don’t think it’s that these pediatricians don’t care about breastfeeding, but they just don’t always have the proper training (a few doctor friends have told me that MDs only receive an hour of breastfeeding education in medical school, if that). Others just haven’t made supporting breastfeeding moms a top priority in their practice, or perhaps have their own bias or discomfort with breastfeeding.

Well, even the Academy of American Pediatrics (AAP) has taken note of this problem. This month, the AAP released a new set of guidelines for pediatricians about how to support breastfeeding families in their practices. Published in Pediatrics, the authors discuss the reason why these guidelines are needed, and then lay out 19 practice ideas for pediatric offices to adopt so that they can become more “breastfeeding friendly.”

First, the AAP explains the fact that increasing our country’s somewhat dismal breastfeeding rates is a matter of public health and that pediatricians are on the forefront of that effort. It makes sense if you think about it: Moms get a few days of breastfeeding help in the hospital (if they are lucky to have a lactation consultant on staff or a knowledgeable nurse), but the pediatrician is the health care provider they see the most after these first few days. So it’s super important that pediatricians be up to speed on breastfeeding support and their offices warmly accommodate a breastfeeding mom’s needs.

The AAP then goes on to cite a 2004 survey that said pediatricians were “less likely to believe that the benefits of breastfeeding outweighed the difficulties or inconvenience, and fewer believed that almost all mothers were able to succeed.” Ouch, huh? Again, I don’t think anyone is saying that 100% of pediatricians have this issue, but it is a problem that many mothers encounter, and it’s pretty great that the AAP is taking it seriously.

The 19-point plan of action the AAP lays out for “baby-friendly” pediatric offices is pretty awesome too. Highlights include recommending all pediatric offices have a lactation consultant on staff; training all staff members in breastfeeding basics; making sure that waiting rooms are welcoming of breastfeeding; limiting formula recommendations unless medically necessary; eliminating unnecessary formula marketing; and helping mothers balance breastfeeding and pumping when they return to work. (Check out the article in Pediatrics for the rest of the guidelines and for more specific explanations).

Now, obviously this advice pertains to pediatricians who are helping mothers who want to breastfeed. There are certainly mothers who decide for whatever reason not to breastfeed, or who want to wean sooner than the AAP guidelines recommend (the AAP recommends breastfeeding exclusively for a six months, and then for a year or more, according to a mother and child’s wishes). I don’t think anyone is saying that they should be pushed to breastfeed against their will or that formula is not a good alternative in those cases.

But for any mom who has felt unsupported or unheard by her pediatrician in terms of breastfeeding, these guidelines are an absolute breath of fresh air. Of course, with any recommendation like this, it remains to be seen if pediatricians everywhere will jump on board and implement it. It certainly won’t happen overnight. But either way, I think we should be rejoicing that these guidelines are out there and a major medical organization is coming out in such strong and unwavering support of breastfeeding moms everywhere.