Breastfeeding: Best for Baby and Mother Newsletter
Summer 2010
Inside this issue:
FROM THE CHAI
R
Ruth Lawrence, MD, FA B M ,
FA A P
The Section on Breastfeeding is proud to announce all its recent activities.
Internally, the policy statement update for 2010 is nearing completion.
AAP Publications, Breastfeeding Your Baby: Answers to Common
Questions and the “gold book,” Breastfeeding Handbook for Physicians, are
both being updated. The field of breastfeeding and human lactation is
expanding as the literature provides more and more confirmation
scientifically to support what we have always known, human milk is ideal for
the human infant. The Section is actively communicating with other
sections that have been
From the Chair, A Word 1
from the Editor
New SOBr Chair-elect,
Call for Articles
3
AAP Candidates for
President-elect
4
NCE 2010 Section
Activities
6
Storage of Human Milk in 10
NICU’s
Lectureship Grant
Report—Virginia
12
Academy News:
Medical Home
15
18
General Section
Information
Continued on next page
A WO R D FROM THE EDITOR
Michelle B r enner,
MD, FAAP
S
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m
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New Members 17 breastfeeding
and supporting families
o
children. As I reflect
c on the changes I have made
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and eat locally, pay more
attention to nutritional qua
c
every visit—I realizeythat the demands on our time
promoting breastfeeding. Encouraging families to
U proximate form of nutrition is
educate them that this
p
and that breastfeeding
d helps prevent obesity and m
Kudos to Drs. Ruth Lawrence
a
and Cindy Howard, th
t
W.K. Kellogg Foundation for their investment in the
e
June 16-17 in Washington, DC. Numerous speaker
Breastfeeding: Best for Baby and
5 Mother
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Summer 2010 Page 1
FROM THE CHAIR, CO N T.
generously sharing their policy statements for review. The general membership of the Academy has
become aware of our mission. The Chapter Breastfeeding Coordinators have accepted the charge to
make it happen at the chapter level. Not only are they addressing their task of increasing membership
in the section, but local education and training, support of issues such as the breastfeeding rates
among WIC mothers, and conflicts with formula company support are also being dealt with at the
chapter level. Our goal to reach all pediatricians who care for mothers and infants will only be
accomplished beginning at the chapter level one practitioner at a time. This issue of the newsletter
shares some of our victories. Some of our chapters report their local progress. The grants committee
announces the winner for 2010. We warmly welcome our 31 new section members. Best wishes,
Ruth A. Lawrence, M.D., D.D. (Hon), FABM, FAAP
A WO R D FROM THE EDITOR, CO N T.
representing many facets of our government, including Surgeon General, Regina Benjamin, MD, MBA,
were present to discuss breastfeeding, particularly in relation to health disparities. The Summit was an
excellent example of the collaboration of individuals from across various aspects of breastfeeding.
Medical and federal experts led the discussion, with the important perspectives from the sidelines of
lactation by an economist, a marketer, a lawyer, and a social anthropologist, shaping actions for the
future of breastfeeding promotion. Look for the proceedings of the Summit in a Fall edition of ABM’s
Breastfeeding Medicine journal. Additional breastfeeding highlights to check out: • The Patient
Protection and Affordable Care Act (also known as healthcare reform) that was recently signed into law
by President Obama includes workplace support language for employed breastfeeding mothers. The
provision states that employers shall provide reasonable, unpaid break time and a private,
non-bathroom place for an employee to express breast milk for her nursing child for up to one year after
the child’s birth. • “Surgeon General’s Vision for a Health and Fit Nation” The new Surgeon General’s
report on obesity contains multiple references to breastfeeding as a primary preventive strategy in
reducing overweight and obesity.
http://www.surgeongeneral.gov/library/obesityvision/obesityvision2010.pdf. • The Whitehouse Taskforce
on Childhood Obesity released its report, “Solving the problem of childhood obesity within a generation,”
The Let's Move! Campaign, launched by First Lady Michelle Obama in February 2010. The action plan
defines the goal of ending childhood obesity, returning to a childhood obesity rate of just 5 percent by
2030. Four of the 70 recommendations involve breastfeeding as an obesity preventive measure.
http://www.letsmove.gov/taskforce_childhoodobesityrpt.html Have a wonderful and safe summer, think
globally, eat locally, and get some sand between your toes!
Breastfeeding: Best for Baby and Mother
Summer 2010 Page 2
SECTION NEWS
Congratulations to Chairperson- Elect Richard Schanler, MD, FA B M , FA A P
!
Richard Schanler, MD Richard Schanler, MD, FABM, FAAP was elected as the incoming chairperson for the
Section on Breastfeeding (SOBr). Dr Schanler has served for a number of years in leadership capacity
with the section, and will begin his role as chair on November 1, 2010. “I am excited to Chair the Section
on Breastfeeding and work with our Board and State Coordinators, to improve our promotion, support, and
education in human milk and lactation.” Dr Schanler has been involved with the AAP commitment to
breastfeeding since 1994. He served as the Senior Editor of the AAP/ACOG Breastfeeding Handbook for
Physicians and is working on its revision. He also has contributed to several AAP publications, including
the Textbook of Pediatric Care, Pediatric Nutrition Handbook, Guidelines for Perinatal Care, and the Red
Book. Dr. Schanler is Chief of Neonatal-Perinatal Medicine, Cohen Children's Medical Center of New
York at North Shore, North Shore University Hospital, Manhasset, NY, and Professor of Pediatrics at
Albert Einstein College of Medicine, Bronx, NY. Prior to his move to New York in 2002, Dr. Schanler was
an investigator at the Baylor College of Medicine Children's Nutrition Research Center in Houston where
he focused on the effects of human milk in premature infants. He did his training in Pediatrics at the
University of Colorado and his Fellowship in Neonatal-Perinatal Medicine at Brown University. He is an
elected member of the American Pediatric Society, Society For Pediatric Research, American Society for
Nutritional Sciences, and the European Society for Pediatric Research, and serves on the Health Advisory
Board of La Leche League International. He is a Founding Member and former President of the
Academy of Breastfeeding Medicine, and Past President of the International Society for Research in
Human Milk and Lactation. He recently was appointed to the National Advisory Council on Maternal,
Infant, and Fetal Nutrition and to the American Board of Pediatrics, Sub-Board in Neonatal-Perinatal
Medicine. Dr. Schanler looks forward to continuing his work with the AAP to support pediatricians’
knowledge-base about breastfeeding to enable them to be effective leaders the medical team.
WE WA N T TO HEAR FROM YO U !
The Section on Breastfeeding (SOBr) newsletter is designed to inform members on
activities related to breastfeeding promotion and support, both internal and external to the
AAP. Many of you are leading those activities in your state or even nationally. Consider
submitting an article for the next SOBr newsletter to share with your colleagues the
exciting new developments in breastfeeding promotion. Articles should be 500-1,000
words in length and address the issue of breastfeeding in some way. Logos, tables, and
graphics are welcome. Please include, as well, a picture of the author.
The due date for the next edition is August 12, 2010. Don’t wait—send
your article in now! Submit all articles (and questions or comments) to AAP SOBr
staff person Heather Fitzpatrick at hfitzpatrick@aap.org . We look forward to hearing
from you!
Page 3 Breastfeeding: Best for Baby and Mother Summer 2010
AAP National Elections for President-elect Several Sect
Section on Breastfeeding (SOBr), sponsored a joint telecon
Robert Block, MD, and Wayne Yankus, MD. Several questi
provided responses. The SOBr had submitted the followin
Robert Block, MD, FAAP • All pediatricians
are outlined below:
should be advocates for breastfeeding and resist
How can the Academy most effectively hel
pressure from formula companies. •
regarding breastfeeding?
Pediatricians should encourage mothers via
• We have to remember it is a c
hospital-based lactation programs to at least try
but we can encourage.
breastfeeding. • Important to work with
businesses and all employers to promote
workplaces designating a place for moms to pump
while at work. Personal story: Both daughters were
adopted within days after birth and were not
breastfed. However, when they became moms,
both breastfed their babies. They needed to return
to work and had to formula feed because their
workplaces did not have a place to pump and store
milk. Both moms and grandchildren are doing well.
• Based on these experiences, pediatricians should
advocate for breastfeeding, explain the benefits,
but not create guilt which might be a factor in
post-partum depression. • Pediatricians can set
examples and set up lactation rooms within their
own practices.
NEWS FROM THE AAP
Editors Note: Many same-sex female parents and adoptive parents do breastfeed, and the Section on Breastfeeding
would encourage pediatricians to support all families to breastfeed or provide human milk to infants, in accordance with the
AAP policy statement "Breastfeeding and the Use of Human Milk."
To see the additional questions and responses from
the candidates for President-elect, go to
www.aap.org/moc/vp/eleclink.htm Requires AAP
member ID & log-in
Breastfeeding: Best for Baby and Mother
Summer 2010 Page 4
Elections run August 1—
September 1, 2010
BREA STFEEDING—ADVOCACY UPDATE
Health Care Reform Boosts Support for Employed Breastfeeding Mothers An FAQ from the United
States Breastfeeding Committee With the inclusion of this provision in health care reform legislation,
the U.S. joins the rest of the industrialized world in recognizing breastfeeding as the natural outcome of
pregnancy, and workplace lactation programs as the natural outcome of a society where the majority of
mothers and infants are separated due to work. What does the Reasonable Break Time for Nursing
Mothers law do? Section 4207 of the Patient Protection and Affordable Care Act (also known as
Health Care Reform), states that employers shall provide breastfeeding employees with “reasonable
break time” and a private, non-bathroom place to express breast milk during the workday, up until the
child’s first birthday. What types of employers are covered? All employers are covered but those with
less than 50 workers do not have to comply if they show that complying with the law would cause "an
undue hardship by causing the employer significant difficulty or expense when considered in relation to
the size, financial resources, nature, or structure of the employer’s business." What types of workers
are covered? The law is an amendment to our nation’s existing minimum wage and overtime laws, so it
covers the workers subject to those laws, so-called "non-exempt workers." Generally, this means hourly
workers (many retail workers, factory workers, restaurant workers, and call center workers, for example)
and other employees who work on an hourly basis and who are subject to overtime laws. "Exempt"
workers are those on a salary ("exempt" from overtime), often in managerial positions. They are not
covered by the new federal law. Many of these workers, particularly those employed by large companies,
have workplace accommodation as part of company policy. The National Business Group on Health has
recently published case studies highlighting several of these. When does the law take effect? The
law was effective immediately upon President Obama’s signing of the Patient Protection and Affordable
Care Act, however, the rules for enforcement have not yet been put in place. Breastfeeding employees
should be assured that the Department of Labor is working swiftly to establish these rules, and should
give their employers time to comply once those rules take effect. While the Department of Labor works to
define terms and processes for enforcement of the law, USBC stands ready to support employers and
breastfeeding employees with tools, information, and resources. View resources for employers and
managers and resources for breastfeeding employees.
Used with permission from the United States Breastfeeding Committee. For the most current
information, check back regularly to the online location for this information:
http://www.usbreastfeeding.org/Workplace/WorkplaceSupport/WorkplaceSupportinHealthCareReform/tabid/175/Default.aspx
Breastfeeding: Best for Baby and Mother
Summer 2010 Page 5
NATIONAL CO NFERENCE & EXHIBITION 2010
Congratulations to the Recipients of the 2010 Section on Breastfeeding Abstract Awards!
Joan Meek, MD, FABM, FAAP announced the recipients of the 2010 abstract awards from the
Section on Breastfeeding (SOBr). Amudha Palaniaapan, MD of Camden, NJ was selected to
receive the Best Abstract in Breastfeeding Advocacy and Education Award. Dr Annemieke M.V.
Evelein of Utrecht (Netherlands) was selected to receive the Best Abstract in Breastfeeding
Research Award.
th Ruth Lawrence, MD, FABM, FAAP, the current chair for the Section, and Dr Meek will present the
awards at the 2010 AAP National Conference & Exhibition (NCE) in San Francisco, CA on Monday,
October 4, at 4:15 pm, during the SOBr Section Program. The SOBr section program is currently
scheduled to occur in the San Francisco Marriott Hotel. The award presentation will take place
following the presentation of all the accepted abstracts this year. The award recipients will receive
a check in the amount of $100.00 and a certificate of recognition. Congratulations to Drs
Palaniaapan and Evelein!
Join the Section on Breastfeeding for Its Section Program: Breastfeeding Challenges (H3016)
This year’s Section on Breastfeeding (SOBr) program is scheduled for Monday, October 4, from
8:00—4:30 at the San Francisco Marriott Marquis. All NCE attendees are welcome! The program will
address some challenging situations which arise in breastfeeding support. Experts in the field will
review significant recent breastfeeding literature and discuss clinical management. Time will be allowed
for review of posters and presentation of original research and breastfeeding advocacy projects. There
will be adequate opportunity for audience discussion, facilitated by the program’s moderator (and SOBr’s
chair of the Education Subcommittee), Joan Meek, MD, MS, RD, FABM, FAAP. The schedule for the
day includes: • Keeping Abreast of the Science: A Review of Recent Literature (Richard Schanler, MD,
FAAP) • Is Pumping Out of Hand? (Jane Morton, MD, FAAP) • Resurgence of Late Onset Hemorrhagic
Disease in the Breastfed Baby (Arthur Eidelman, MD, FAAP) • Breastmilk: The Ultimate Prebiotic
(Richard Schanler, MD, FAAP) • The Fussy Baby, Colic, GER, and Breastfeeding (Jatinder Bhatia, MD,
FAAP; Jennifer Thomas, MD, FAAP) • Several abstract presentations and presentation of the SOBr
Abstract Awards for Research and Advocacy and Education Be sure to confirm the meeting location
once on-site for NCE. For more information on sessions related to breastfeeding and nutrition, visit
http://www.AAPexperieNCE.org/2010/downloads/Nutrition-Breastfeeding.pdf
Breastfeeding: Best for Baby and Mother
Summer 2010 Page 6
CHAPTER BREA ST FEEDING COORDINATO RS—ACTIVITIES IN THE STAT ES
Kentucky Chapter Submitted by Beth Doyle, MD, FAAP The Louisville Jefferson County Metro
Health Department received an $8 million dollar stimulus grant for obesity initiatives, with $1.5 million
earmarked for breastfeeding promotion! As part of the grant activities, Beth Doyle, MD, FAAP (Co-CBC)
is co-chairing the Standardized Hospital Breastfeeding Policy committee. A portion of the funds will fund
the opening of three outpatient breastfeeding centers at three local maternity hospitals. Dr Doyle is also
assisting one of the hospitals with that process. Rebecca Collins, MD, FAAP (Co-CBC) and Dr Doyle
spoke at the first ever Kentucky Breastfeeding Summit in April 2010. At this Summit, Drs Doyle and
Collins assisted in writing an action plan to improve breastfeeding support and promotion in the state.
They will both be present at the KY American Academy of Pediatrics Summer Continuing Medical
Education meeting and Obesity Summit in August 2010, being held at Barren River State Park.
Florida Chapter Submitted by Sandra E Sullivan, MD, FAAP University of Florida residents are
working closely with Florida CBC Sandra Sullivan, MD, FAAP to implement the Breastfeeding
Residency Curriculum (www.aap.org/breastfeeding/curriculum ). They are also developing advanced
breastfeeding electives, which they hope to have on-line as official courses. These will provide the basis
for a medical student elective, coming soon. One of the residents will be presenting a poster on the
incorporation of the breastfeeding curriculum at the Section on Breastfeeding section program (see p. 6
) in San Francisco, CA, in October. A second year of funding from W. K. Kellogg Foundation was
given to the University of Florida’s Center for Breastfeeding and Newborns, which continues to grow.
They also received a $15,000 American Academy of Pediatrics Community Pediatrics Training Initiative
grant program. It provides funding for the University of Florida project called Preventing Obesity Through
Breastfeeding Support, which is currently in the planning stages. Dr Sullivan also chairs the Florida
AAP Chapter Breastfeeding Committee, and now serves as regional representative for the chapter, as
well. Her main focus is to increase momentum with pediatricians in Florida outside the University of
Florida residency program. She works closely with local and state coalitions. Dr Sullivan does work
peripherally with the Business Case for Breastfeeding, but there are also two local coalition
representatives very active with that project.
Breastfeeding: Best for Baby and Mother
Summer 2010 Page 7
CHAPTER BREA ST FEEDING COORDINATO RS—ACTIVITIES IN THE STAT ES
, CO N T
Tennessee Chapter Submitted by Julie Ware, MD, FAAP HOPE FOR TENNESSEE! Although we
boast some of the lowest breastfeeding rates in the country in various regions of our state, as well as
some of the highest rates in obesity and infant mortality, there is activity and hope from the east to the
west of Tennessee! Julie Ware, MD, FAAP, from Memphis, and Karen Schetzina, MD, FAAP, a NEW
SECTION MEMBER, from Johnson City, have been working with state leaders on a complex but exciting
Breastfeeding Promotion Project with TIPQC (Tennessee Intervention for Perinatal Quality Care). The
aim of the project is to improve breastfeeding rates and diminish cultural disparities in breastfeeding rates
through utilization of QI projects in the prenatal, hospital, and post-partum realms of maternal and infant
care. Toolkit development for each of the three areas has included many of AAP SOBr materials.
Anyone who has had experience with QI in breastfeeding promotion, please contact Drs Ware or
Schetzina! (julieware2@bellsouth.net or SCHETZIN@mail.etsu.edu) Dr. Schetzina, a faculty member
at ETSU, is also an AAP CATCH grant recipient; funds are being used by BABE (Breastfeeding
Advocacy Benefits Everyone) Coalition members to increase breastfeeding resources and educate
providers in the region. The project will be presented at the upcoming AAP National Conference.
Breastfeeding lectures abound across the state and beyond! Margreete Johnston, MD, FAAP has given
recent lectures at Meharry Medical College, Grand Rounds, and traveled to Washington State University
in Pullman WA to speak to and to undergraduates in women's studies. Activities with the Nashville TN
Lactation coalition included a presentation on new Joint commission guidelines endorsing exclusive
breastfeeding for well newborns. Dr Ware was able to give the first ever lecture to Family Physician
residents, and continue to teach the OB and Peds residents at UT Memphis. Dr Schetzina continues to
teach residents, medical students, and even child care providers about breastfeeding!
Shelby County
is preparing for a big week in August 2010 to celebrate World Breastfeeding Week. Our guest speaker
is the world renowned expert in infant feeding and preventive medicine, Miriam Labbok, MD, MPH,
FACPM, IBCLC, FABM. She will speak at LeBonheur Children’s Hospital in Memphis, August 4, 2010 at
our biannual “Breastfeeding Update 2010: Prevention at Its Finest”, followed by an evening event with
invited community leaders, entitled “The Dream Product for Preventive Health”. She will also speak
about breastfeeding and cancer risk at St. Jude Children’s Research Hospital on August 5th. (We will
try to show her some sights and sounds of Memphis while she’s here, and get a glimpse of Elvis too!)
Ya’ll please come! The Shelby County Breastfeeding Coalition is working hard to liaison with all of our
community partners that are working toward improved maternal and infant health. The Urban Child
Institute of Memphis has published a wonderful “Breastfeeding Policy Brief ” detailing strategies for
improving breastfeeding rates in Memphis and Shelby County. The SCBC has an ever increasing
presence in various home visitation programs, early success programs, and infant mortality initiatives.
It’s a work in progress, but we’re definitely working. The billboard and transit sign project we launched
last year raised community awareness of breastfeeding, and we are now in the process of a new
billboard design with more diversity. (see photo on following page)
Continued on next page
Breastfeeding: Best for Baby and Mother
Summer 2010 Page 8
CHAPTER BREA ST FEEDING COORDINATO RS—ACTIVITIES IN THE STAT ES
, CO N T
Tennessee Chapter, cont.
A goal for Drs. Johnston, Schetzina, and Ware is to revitalize the TN Breastfeeding Coalition, tying all
the smaller breastfeeding coalitions together in our long and skinny state. We welcome you to visit
the Volunteer State and us – anytime, but especially August 4, 2010. Please contact Dr Ware at
julieware2@bellsouth.net for information regarding the conference.
Breastfeeding: Best for Baby and Mother
Summer 2010 Page 9
AAP GRAND RO U N D S REVIEW: STO R AG E OF HUMAN MILK IN NICUs
PICO (Patient, Intervention, Comparison, Outcome) Question: Can expressed human milk for
premature and term infants in a NICU setting safely be stored at refrigerator temperatures for as long
as 96 hours? Question type: Intervention
Study design: Cohort study
Investigators from Schneider Children’s Hospital in New York investigated the safety of human milk
refrigerated for up to 96 hours by analyzing bacterial counts and concentrations of lactoferrin, secretory
(s)IgA, fat, fatty acids, protein, pH, and white blood cell count (WBC). Milk was collected by breast pump
from mothers of infants in a neonatal intensive care unit (NICU), refrigerated at 4° C, and tested after 0,
24, 48, 72, and 96 hours. Milk from 36 mothers was obtained when their infants had a median age of 28
days. These neonates had been born at a median gestational age of 32 weeks. There were no significant
changes in milk osmolality, sIgA, lactoferrin, total fat, total bacterial counts, or gram-negative colony counts
in the milk over the 96 hours of refrigeration. Gram-positive bacteria colony counts declined significantly
over the 96 hours. The WBC decreased by 16%, milk pH declined from 7.21 to 6.68, and total protein
declined by 5% while free fatty acid concentration increased from 1.3% to 4.8% of total fat. There were no
significant associations between gestational age, postpartum age, and other milk component
measurements at baseline or with duration of storage. The authors conclude that human milk can be
safely refrigerated for 96 hours without an increase in the bacterial cell counts or major change in the
macronutrients and immune factors. Source: Slutzah M, Codipilly CN, Potak D, et al. Refrigerator
storage of expressed human milk in the neonatal intensive care unit. J Pediatr. 2010;156(1):26–28;
doi:10.1016/j.jpeds.2009.07.023[CrossRef] [Medline] Commentary by Lawrence M. Noble, MD,
FAAP—Elmhurst, NY
Key Words: breast milk • storage • bacterial cell counts 1 As noted by the
authors, guidelines on the safe storage of refrigerated breast milk have been limited by studies that have
focused solely on bacterial colony counts and have not measured changes in other milk component
concentrations. The current study was done in a NICU with a highly educated, middle class population,
who may have been very careful in pumping and storing the milk under "very clean" conditions. It may not
represent how the average mother expresses and stores her milk. Therefore, one should be careful in
generalizing these results to other NICUs with different populations. One should be even more careful in
applying the results of this study to mothers of infants at home, where cleanliness may be even less of a
concern and refrigeration may not be ideal. Another issue, for mothers of full-term infants, is that this study
was performed in mothers of premature infants. Premature breast milk possibly has more white blood cells
and antibacterial activity than mature milk.Despite these caveats, the overall integrity of milk seems to be
preserved for up to 96 hours of refrigerator storage. Continued on next page
Breastfeeding: Best for Baby and Mother
Summer 2010 Page 10
AAP GRAND RO U N D S REVIEW: STO R AG E OF HUMAN MILK IN NICUs
, CO N T.
Editors’ Note The physical and psychological benefits of breastfeeding for the infant, mother, and
community need not be reiterated to AAP Grand Rounds readers. Breast milk is also recommended as
optimal nutrition for premature infants. As previously reported in these pages (see AAP Grand Rounds,
March 2002;7:292), however, both asymptomatic and symptomatic postnatal cytomegalovirus (CMV)
infections have been transmitted by breast milk resulting in severe morbidity and mortality, especially
among low-birth-weight infants.3 Although the authors of the present study assessed changes in
bacterial counts after refrigeration, persistence of viral particles was not examined. CMV virions can
remain infectious after prolonged storage at 4ºC.4 Freezing has been recommended, but there have
been reports of CMV transmission to infants by their own mother’s frozen milk.5 Short-term
pasteurization is an effective way to inactivate CMV found in breast milk. Similar studies in more diverse
populations, examining the nutritional, immunologic, and infectious aspects of breast milk after varied
modes of treatment could provide the data needed to determine optimal breast milk collection, handling,
and storage practice.
Source: Slutzah M, Codipilly CN, Potak D, et al. Refrigerator storage of expressed human milk in
the neonatal intensive care unit. J Pediatr. 2010;156(1):26–28; doi:10.1016/j.jpeds.2009.07.023
[CrossRef][Medline]
Dr Noble has disclosed no financial relationship relevant to this commentary. This commentary does
not contain a discussion of an unapproved/investigative use of a commercial product/device.
References Schlesinger L, et al. J Pediatr Gastr Nutr. 1989;8:89–94. Maschmann J, et al. Clin Infect
Dis. 2001;33:1998–2003. Hamele M, et al. Pediatr Infect Dis J. 2010;29:84–86. Johansson SC, et al.
Scand J Infect Dis. 1997;29:465–468. Maschmann J, et al. Arch Dis Childhood - Fetal and Neonatal
Edition. 2006;91:F288–F290.
Reproduced with permission from AAP Grand Rounds, Volume 23, Page 60, 2010 by the AAP.
Breastfeeding: Best for Baby and Mother
Summer 2010 Page 11
LECTURESHIP GRANT REPORT —VIRGINIA
Section on Breastfeeding Lectureship Grant Funds Successful Conference Practical Tools for
Promoting and Supporting Breastfeeding: Troubleshooting in a Busy Practice Submitted by Ann
L. Kellams, MD, IBCLC, FAAP; Natasha K. Sriraman, MD, MPH, IBCLC, FAAP VA-AAP Chapter
Breastfeeding Coordinators
Practical Tools for Promoting and Supporting Breastfeeding: Troubleshooting in a Busy Practice came
about because of the Section on Breastfeeding (SOBr) Lectureship Grant, with additional financial
support from the Virginia (VA) Chapter of the American Academy of Pediatrics (AAP). VAAAP Chapter
President Robert Gunther, MD and Executive Director, Jane Davis gave their full support to the project.
Conference organizers prioritized lecture topics that would address issues faced by community
pediatricians each day with breastfeeding mothers in their practices. In addition to medical issues,
payment issues were addressed to attract physicians to the conference. It was recognized early on that
doctors who spend time talking about and promoting breastfeeding to their patients, need to get paid for
their time. The final conference agenda included the following topics and speakers:
• To Supplement or Not To Supplement Ann
• Practical Latch Issues: Baby-led
Kellams, MD, IBCLC, FAAP • Jaundice in the
Breastfeeding • Coding in the Pediatric
Office Christina M. Smillie MD, FAAP •
Breastfeeding Baby: Making Sense of the
Recommendations Natasha K. Sriraman, MD,
Medications and Breastfeeding—Current
MPH, IBCLC, FAAP
Concepts • Special Medication Use During
Breastfeeding Frank Nice, DPA, CPHP
Additional feedback on who the target audience
should be came from the Virginia Breastfeeding Advocates, a LISTSERV® of over 175 people from
various organizations (AAP, ABM, La Leche League, the State Breastfeeding Advisory Committee, the
Breastfeeding Task Force, RN’s, NP’s, LC’s, MD’s and concerned citizens). When asked what they saw
as the biggest barrier to breastfeeding, this group unanimously responded: “The doctors!” This
information helped shape the conference’s target audience. The average, busy pediatrician needed to
be able to look at the brochure and know instantly that they would leave this one-day CME with useful,
practical information that they could go home and immediately start using in their practice. Conference
organizers maximized resources by collaborating with other institutions to have one of speakers give
Grand Rounds and a noon conference at one local academic center and then an evening seminar at
another. This allowed for several things: a larger honorarium, access to a larger audience, and the
ability to pay for travel for an out-of-state speaker. One site acted as the “clearing house” for the
finances, simplifying that piece of the process. Tammy Eberly, the CME Coordinator at UVA made
everything run very smoothly.
Continued on next page
Page 12 Breastfeeding: Best for Baby and Mother Summer 2010
LECTURESHIP GRANT REPORT —VIRGINIA , CO N T.
Many different methods were used to advertise. Online locations for conference promotion included
the AAP SOBr Web site; VA-AAP chapter list-servs and Web site; the University of Virginia CME Web
Site; Academy of Breastfeeding Medicine listserv and Facebook page; IBLCE Facebook page; and the
Best for Babes Facebook page. Emails were also sent to General Pediatric Directors at all five
academic institutions in Virginia, personal and work contacts, and “friends” via the Facebook page
specifically created for the conference. Brochures were also mailed out to physicians in the region.
Conference organizers also utilized the Breastfeeding Champions program to promote the conference.
All members of the Virginia Breastfeeding Advocates listserv were asked to nominate a local physician
in their community who routinely goes above and beyond in their support of breastfeeding.
Twenty-seven names were received from all over the state! All of the physicians named received a
letter of congratulations with an invitation to receive a certificate at the conference. In addition, their
names were listed on the Virginia Department of Health website as well as the VA-AAP Chapter Web
site. They also received a formal letter from the AAP Chapter President recognizing this honor. The
program was very easy to implement and quite successful. Five physicians come to receive their
certificate in person.
Conference Chair Ann Kellams, MD, IBCLC, FAAP (far left)
and VA-AAP Chapter President Robert Gunther, MD, FAAP
(far right) with several of the award recipients, including
Michelle Brenner, MD, FAAP (center), SOBr newsletter editor.
Pictured from left to right are: Lisa Akers—VA Department of
Health, State Breastfeeding Coord. Natasha Sriraman, MD, MPH,
IBCLC, FAAP—Conference Chair Robert Gunther, MD,
FAAP—VA-AAP Chapter President Ann Kellams, MD, IBCLC,
FAAP—Conference Chair
Future directions include expanding the scope of the conference to all aspects of newborn care and
how they relate to breastfeeding. For example: jaundice, prematurity, vitamin D, skin-skin time,
delivery room management, and/or becoming a breastfeeding friendly hospital or office. We plan to do
the Breastfeeding Champions again next year and are considering using the “newborn” angle as a way
to attract more participants who may feel like they do not need to spend an entire day talking about just
breastfeeding. We will keep things practical and “real life” but make even more apparent the link
between promoting and supporting breastfeeding and their other work with newborns and new parents.
We would like to thank the Section on Breastfeeding for awarding the grant to make this conference
possible. We received a great deal of positive feedback, and hope to make this an annual event..
Questions on this report? Contact Dr Sriraman at nksriraman@gmail.com
Page 13 Breastfeeding: Best for Baby and Mother Summer 2010
THE BULLETIN BOARD
The latest event s involving members of
the Section on Breas tfe edi ng
The Memphis Area Lactation Consultants (MALCA), the Shelby County Breastfeeding Coalition
(SCBC) and LeBonheur Children's Hospital invite you to join them in Memphis on August 4, 2010 for
the biannual Breastfeeding Update, "Breastfeeding 2010, Prevention at Its Finest! " with the
internationally known and respected Miriam Labbok, MD, MPH, FACPM, IBCLC, FABM!
A maximum of 7 AMA PRA Category 1 Credits® is available through this course.
View the brochure at http://www.methodistmd.org/pdf/cme/2010_Breastfeeding%20Conference.pdf and
feel free to share it with colleagues, coalitions, and anyone who may be interested!
Register
online at https://secure.methodisthealth.org/secure/2010/2010_breastfeeding.html . General
registration is $75 (MALCA members pay $50). The evening event carries an additional charge of
$45.
Contact SOBr member Julie Ware at julieware2@bellsouth.net with questions.
Re g i st ra t i o n is Now Open fo
r ABM’s Annual International Meeting
Registration is now open for the Academy of Breastfeeding Medicine’s 15 th Annual International
Meeting, October 27 – 30, 2010, in San Francisco. This year’s meeting will include world-class
speakers providing cutting-edge research and clinical information on current issues in breastfeeding
medicine. Our speakers are among leaders of research and clinical medicine in the world of
breastfeeding and human lactation. Go to www.bfmed.org to register online and take advantage of the
early-bird rates for both physician and health team meetings. This year’s meeting will feature the Fifth
Annual Founders’ Lecture by John Queenan, MD, worldrenown authority on perinatal medicine and
management of high-risk pregnancies. As always, the meeting will include “What Every Physician
Needs to Know About Breastfeeding,” the one-day pre-conference course available to all physicians and
health care professionals. Don’t miss out on the most important breastfeeding medicine event of the
year! Visit the ABM website for the most up-to-date information. ABM reminds you to renew your ABM
membership to take advantage of the member registration discount at the annual meeting.
Breastfeeding: Best for Baby and Mother
Summer 2010 Page 14
AC A D E M Y NEWS—MEDICAL HOME WEB SITE
New and Improved National Center for
Medical Home Implementation Web Site
Launched!
The National Center for Medical Home Implementation has launched a new and improved
Web site (www.medicalhomeinfo.org )! The new site features a plethora of resources and
information designed to help you learn more about family-centered medical home and how
practices, families, communities and states are working on implementation. Informational
destinations on the Web site include:
Medical Homes@Work e-Newsletter: Spotlights timely information and resources related to
implementing medical home. How to Implement Tools/Resources: Features an extensive list of
user-friendly tools and resources for implementation of medical home in the pediatric practice. Visit this
section to see how you can adapt these tools to best meet the needs of your patient, client, or child.
Training Resources: Houses a variety of tools and resources targeted towards pediatricians and the
medical home care team that may also be of interest and/or use for families, youth, communities, and
states. State Pages: Highlights information on state pediatric medical home initiatives, key contacts,
partners, and related grant activities and initiatives. Quick Links: Contains links to valuable resources
and information including the Building Your Medical Home toolkit (www.pediatricmedhome.org ),
upcoming conferences, emerging issues and marketing materials. For Families: Presents links to tools
and resources aimed at assisting families including the Building Your Care Notebook, Family-to-Family
Health Information Centers, tips for partnering with your physician, and Title V. National Initiatives:
Consists of information that the National Center tracks on the many national medical home initiatives,
including multi-payor demonstration projects and state grant initiatives that are rapidly increasing across
the country. For additional information about the Web site or the National Center for Medical Home
Implementation, please contact Heather Stob at 847/434-4902 or hstob@aap.org .
Breastfeeding: Best for Baby and Mother
Summer 2010 Page 15
AAP EDUCATIONAL OFFERINGS
Breastfeeding: Best for Baby and Mother
Summer 2010 Page 16
SO, YO U ’ R E A SEC TION MEMBER NOW! CO N TAC T US
Welcome new SOBr members! If you are reading
Daniel Akpalu, MD, FAAP
Stephanie Behnke, MD Mariefirst time, then you are likely a new member of the
Belin, MD, FAAP Danielle
Breastfeeding (SOBr). Welcome! How can you get
Bennett, MD Miriam Blum, DO,
ask? • Enjoy the benefits of membership, includin
FAAP Karen Bodnar, MD
Incorporate the goals in the SOBr Mission and Visi
SOBr EXECUTIVE COMMITTEE Ruth
Lawrence, MD, FABM, FAAP Chairperson Jennifer Brannon, MD, FAAPactivities • Write an article for the next SOBr newsl
Ruth_Lawrence@URMC.Rochester.edu
Florencia, Braier, MD, FAAP CBC in your state to join in local breastfeeding adv
Lori Feldman-Winter, MD, FABM, FAAP
and/or request breastfeeding CME activities locally
winterlb@umdnj.edu Susan Landers, MD, David Cabbad, MD, FAAP
Kimberly Capp, DO Moshe
at the SOBr events at the AAP NCE! Contact AA
FABM, FAAP slanders@austin.rr.com
Lawrence Noble, MD, FAAP
Cohn, MD William Dukart MD, Fitzpatrick or visit our Web site for more ideas!
lnoble613@yahoo.com Kinga Szucs, MD, FAAP Traci Friedman, MD,
FAAP kszucs@iupui.edu Laura Viehmann,
FAAP Kristin Guilonard, DO Welcome to Our New Members!
MD, FAAP LViehmann@Lifespan.org
SUBCOMMITTEE LEADERS Newsletter Dimpy Gupta, MD Laurie Jones,
Dr.Mohammed Khan, MBBS, MPH Jerald King, MD
MD, FAAP
Editor Michelle Brenner, MD, FAAP
Klein, MD, FAAP Despina Lekakis, MD Shaunna
Michelle.brenner@gmail.com Policy
Laura Marks, MD, FAAP Sara Marnell, MD, FAAP
Chairperson Arthur Eidelman, MD, FAAP
MD, FAAP Lisa Parnell, MD, FAAP Celia Quinn,
arthur.eidelman@gmail.com Nominations
MD, MPH, FAAP Steven Snyder, DO Rima Strassm
Chairperson Michelle Brenner, MD, FAAP
Michelle.brenner@gmail.com Education
Lakshmy Vaidyanathan, MD, FAAP Rebecca Whit
Do you have questions or comments
about the newsletter or the Section in
general. Contact us!
Chairperson Joan Meek, MD, MS, FABM,
FAAP Joan.Meek@orlandohealth.com
Chief CBC Jennifer Thomas, MD, FABM,
FAAP jenny@drjen4kids.com STAFF
Manager, Breastfeeding Initiatives
Heather Fitzpatrick, MPH
hfitzpatrick@aap.org
Breastfeeding: Best for Baby and Mother
Summer 2010 Page 17
American Academy of Pediatrics
Section on Breastfeeding 141
Northwest Point Blvd.
Elk Grove Village, IL 60007
Phone: 800/433-9016 ext 4779
Email: lactation@aap.org
SECTION ON BREASTFEEDING
The American Academy of Pediatrics (AAP) is an organization of 60,000
pediatric medical, surgical, and subspecialists committed to the attainment of
optimal physical, mental, and social for all children, adolescents, and young
adults. The Section on Breastfeeding, established in July 2000, offers
networking and educational opportunities for AAP members interested in
Visit our We
breastfeeding promotion and management. Currently, there are almost 500
b site! www.a
members.
ap.org/ breas
tfeeding
SECTION OBJECTIVES
1. Maintain a permanent body for development of AAP policy
recommendations on breastfeeding.
2. Enhance and expand educational efforts of the Academy in the area of
MISSION STATEMENT
breastfeeding, including presentation of educational sessions at AAP national
meetings, coordination of national Continuing Medical Education (CME)
The mission of the Section on
conferences, development of educational publications and curricula, provision of
Breastfeeding is to help all infants,
children, adolescents, and young adults materials and technical assistance to practitioners, and other educational
served by members of the AAP to attain initiatives.
optimal physical, mental, and social
3. Develop liaison and collaborative relationships with other sections and
health through breastfeeding. To this committees of the Academy and with outside organizations.
purpose, the Section dedicates its efforts
SECTION ACTIVITIES Educational and Networking Opportunities : An annual
and resources. The Section will
business
meeting is held as well as other educational sessions and activities at
accomplish this mission by addressing
AAP national, state, and other conferences. The Section also hosts the
the breastfeeding needs of infants,
children, their families and communities Breastfeeding Residency Curriculum for public use. Chapter Breastfeeding
and by supporting AAP members
Coordinators: Encourages membership in the Section and participation in state
through breastfeeding advocacy,
activities related to the support and promotion of breastfeeding. Recognition:
education, research, and service, as wellMembers can highlight their programs and activities in the newsletter, as well as
as promoting the systems through which
participate in the Abstracts presentation at NCE. Development and Publication:
the members deliver breastfeeding care.
The Section develops books and other documents to educate physicians and
others on breastfeeding. Policy Statements: The Section develops policy
VISION STATEMENT
statements and reviews statements relevant to breastfeeding.
Children will have optimal health and
If you would like more information about the many benefits of being a Section
well-being through breastfeeding; and
on
Breastfeeding member, please email lactation@aap.org or visit our Web
breastfeeding will be valued by
site.
society. AAP members will provide
family-centered, culturally-effective,
evidence-based care for breastfeeding
infants and children, as well as for
their families and communities.
NEWSLETTER EDITOR
Michelle Brenner, MD,
FAAP
Disclaimer: The recommendations listed in this newsletter and cited, do not
indicate an exclusive course of treatment or serve as standard of medical care. Variations, taking into
account individual circumstances, may be appropriate. This newsletter and the
materials mentioned within this newsletter discuss titles published by organizations
other than the American Academy of Pediatrics. Statements and opinions expressed
in these publications are those of the authors and not necessarily those of the
American Academy of Pediatrics.