Breastfeeding Support
and Promotion
Joan Younger Meek, MD, FAAP
AAP Section on Breastfeeding
Benefits of Breastfeeding
• Children
• Maternal
• Societal
Benefits of Breastfeeding
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Species specific
Organic
Norm for infant feeding
Minimizes exposure to
foreign protein
• Host protection
• Optimal development
outcomes
AAP Pediatrics 2012;129:e827-841.
Photo © Roni M. Chastain, RN
Benefits of Breastfeeding
• Customized
• Promotes appropriate
growth pattern
• Provides multiple hormones
and growth
factors
• Promotes mother-infant
attachment
Photo © Roni M. Chastain, RN
Immune Benefits
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Secretory IgA and other immunoglobulins
Antiviral and antibacterial factors
Cellular immune components
Cytokines, including interleukins
Enzymes
Nucleotides
Childhood Growth
Photo © Joan Younger Meek, MD, FAAP
Breastfeeding and Maternal Infant Health
Outcomes in Developed Countries
Current evidence demonstrates breastfeeding
associated with reduction in risk of:
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Acute otitis media
Non-specific gastroenteritis
Severe lower respiratory tract infections
Atopic dermatitis
Asthma in young children
Obesity
Type 1 and type 2 diabetes
Childhood leukemia
Sudden infant death syndrome (SIDS)
Necrotizing enterocolitis
Ip S, et al: Breastfeeding and Maternal and Infant Health Outcomes in
Developed Countries, April 2007. Agency for Healthcare Research
and Quality, Rockville, MD. http://www.ahrq.gov/clinic/tp/brfouttp.htm
Benefits of Breastfeeding
“Dose Dependency”
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Acute otitis media 50% less with EBF > 3-6 months
Atopic dermatitis 42% less with EBF > 3 months
Gastroenteritis 64% less with any BF vs. none
Lower respiratory tract disease and hospitalization 72% less
with EBF > 4 months
Asthma 40% less with BF > 3 months with positive family history
Obesity 24% less with any BF
Type 1 DM 30% less with BF > 3 months
Type 2 DM 40% less with any BF vs. None
Cancer:
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EBF=Exclusive breastfeeding
BF=Breastfeeding
Acute lymphocytic leukemia 20% less with BF >6 months
Acute myelogenous leukemia 15% less with BF >6 months
SIDS 36% less with any BF > 1 month
Ip S, Chung M, Raman G, et al. Breastfeeding and Maternal and Infant Health Outcomes in
Developed Countries. Rockville, MD: Agency for Healthcare Research and Quality, 2007.
http://www.ahrq.gov/clinic/tp/brfouttp.htm
AAP Pediatrics 2012;129;e827-41.
Child Health Benefits
Decreased rates of:
• Celiac disease
• Inflammatory bowel disease
• Hypertension
• Hypercholesterolemia
AAP Pediatrics 2012;129;e827-41.
Childhood Obesity
• One of the most significant childhood
health problems in the U.S.
• Affects 20% of children in the U.S., with
up to 30% classified as overweight for
age
• Incidence decreased in the breastfed
population
Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries, Structured Abstract. April
2007. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/tp/brfouttp.htm
AAP Section on Breastfeeding: Breastfeeding and the Use of Human Milk, Pediatrics 2005;115:496-506.
Evidence on the Long Term Effects of Breastfeeding: Systematic Reviews and Meta-analyses, World Health
Organization 2007, Geneva, Switzerland.
http://www.who.int/child-adolescent-health/publications/NUTRITION/ISBN_92_4_159523_0.htm
Breastfeeding and Obesity
• Obesity defined as a BMI > 95%ile for age
• Data from the Pediatric Nutrition Surveillance
System
• 177,304 children followed up to 60 months
• Controlled for gender, ethnicity/race, BW
• Dose-responsive protective effect against obesity at
age 4 years in non-Hispanic whites
• Greatest protection with breastfeeding for > 12
months
Grummer-Strawn LM, Mei Z: Does Breastfeeding Protect Against Pediatric Overweight?
Analysis of Longitudinal Data From the Centers for Disease Control and Prevention Pediatric
Nutrition Surveillance System. Pediatrics 2004;113:81-86.
Obesity Prevention
• Encourage breastfeeding
• “Extent and duration of breastfeeding have
been found to be inversely associated with
risk of obesity in later childhood, possibly
mediated by physiologic factors in human
milk as well as by the feeding and parenting
patterns associated with nursing.”
AAP Policy Statement, Committee on Nutrition, Pediatrics 2003; 112:424-430.
Cognitive Benefits
• Human milk
– Contains fatty acids, nucleotides,
oligosaccharides, and taurine
to enhance neural and retinal
development
– Enables child to reach full
developmental potential
• Human milk fat
– Provides essential fatty acids
– Provides long-chain polyunsaturated fatty acids,
including docosahexaenoic acid
(DHA) and arachidonic acid (ARA)
Breastfeeding Outcomes for
Premature Infants
• Lower rates of
• Improved
– Sepsis
– Leptin and insulin
metabolism
– Nectrotizing enterocolitis
– Neurodevelopmental
– Retinopathy of
outcomes
prematurity
– Metabolic syndrome
– Blood pressure
– Low-density lipoprotein
levels
AAP Pediatrics 2012;129:e827-841.
Maternal Health Outcomes
from Breastfeeding
• Decreased postpartum
bleeding
• More rapid uterine
involution
• Decreased menstrual
blood loss
• Increased child spacing
Photo © Amy Kotler, MD, FAAP
AAP Pediatrics 2012;129:e827-841.
Maternal Benefits of
Breastfeeding
BF=Breastfeeding
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Type 2 diabetes mellitus 4-12% less for each year of
BF for women w/out history gestational DM
Pre-menopausal breast cancer 4.3-28% less for each
year of BF
Ovarian cancer 21% less for any vs. no BF and
evidence for dose response
Postpartum depression less for short term BF vs. no
breastfeeding
Ip S et al: Breastfeeding and Maternal and Infant Health Outcomes in
Developed Countries, April 2007. Agency for Healthcare Research and
Quality, Rockville, MD. http://www.ahrq.gov/clinic/tp/brfouttp.htm
Maternal Outcomes
• Breastfeeding associated with decreased
risk of
• rheumatoid arthritis
• obesity
• cardiovascular disease
AAP Pediatrics 2012;129:e827-841.
Lactational Amenorrhea Method
Have mother’s
menses returned?
No
Is mother supplementing
regularly or allowing long
periods without breastfeeding?
Yes
Yes
No
Is the baby older than
6 months?
No
There is a 1%–2% risk
of pregnancy.
Advise
another method
of family
planning.
Yes
Reprinted from Contraception. 1997;55:328, Multicenter study
of the Lactational Amenorrhea Method (LAM): I. Efficacy,
duration,and implications for clinical application,
Labbok MH et al, with permission from Elsevier
The Economic Benefits of
Breastfeeding
• U.S. Department of Agriculture
• $3.6 billion dollars would be saved annually
if US breastfeeding rates increased to that
recommended in Healthy People 2010
guidelines
• Projected figures were based on analysis of
decreased otitis media, gastroenteritis, and
necrotizing enterocolitis cost savings only
J Weimer: U.S.D.A., Food Assistance and Nutrition Research Report No. 13, March 2001
http://www.ers.usda.gov/publications/fanrr13
Burden of Suboptimal
Breastfeeding in the US
• Analyzed saving for those conditions validated by
the AHRQ report:
– necrotizing enterocolitis
– otitis media
– gastroenteritis
– hospitalization for lower respiratory tract infections
– atopic dermatitis
– sudden infant death syndrome
– childhood asthma
– childhood leukemia
– type 1 diabetes mellitus (type 2 DM excluded)
– childhood obesity
Bartick M: The Burden of Suboptimal Breastfeeding in the United
States: A Pediatric Cost Analysis. Pediatrics online April 2010.
Burden of Suboptimal
Breastfeeding in the US
• Results: If 90% of US families could comply with
medical recommendations to breastfeed
exclusively for 6 months, the United States would
save $13 billion per year and prevent an excess
911 deaths, nearly all of which would be in infants
($10.5 billion and 741 deaths at 80% compliance).
• Conclusions: Current US breastfeeding rates are
suboptimal and result in significant excess costs
and preventable infant deaths. Investment in
strategies to promote longer breastfeeding
duration and exclusivity may be cost-effective.
Bartick M, Reinhold A. The Burden of Suboptimal Breastfeeding in the United
States: A Pediatric Cost Analysis. Pediatrics. 2010;125:e1048.
Community Benefits
• Breastfeeding is convenient, saves money,
and is “green”
• Reduced health care costs
• Lower employee absenteeism
• Convenient and cost effective
• Environmentally friendly
• Decreased energy demands for production
and transport of infant formula
Summary of Breastfeeding Benefits
• Promotes optimal health outcomes for
mothers and children
• Prevents infectious diseases for children
• Assures that children meet their full
developmental potential
• Reduces health care costs
• Is environmentally conscious