Breastfeeding: Parental education and support
- Richard J Schanler, MD
Richard J Schanler, MD
- Hofstra Northwell School of Medicine
- Debra C Potak, RN, BSN, IBCLC
Debra C Potak, RN, BSN, IBCLC
- Lactation Consultant
- Cohen Children's Medical Center of New York at North Shore
- Section Editors
- Steven A Abrams, MD
Steven A Abrams, MD
- Section Editor — Neonatology
- Professor, Department of Pediatrics
- Dell Medical School at the University of Texas at Austin
- Teresa K Duryea, MD
Teresa K Duryea, MD
- Section Editor — General Pediatrics
- Associate Professor of Pediatrics
- Baylor College of Medicine
Human milk is recognized as the optimal feeding for all infants because of its proven health benefits to infants and their mothers. The World Health Organization (WHO), the American Academy of Pediatrics (AAP), the American College of Obstetricians and Gynecologists (ACOG), and the United States Preventive Services Task Force all recommend exclusive breastfeeding for the first six months of life [1-4]. (See "Infant benefits of breastfeeding" and "Maternal and economic benefits of breastfeeding".)
The factors that influence the parental decision on whether to breastfeed and the professional support required for successful initiation and maintenance of breastfeeding will be reviewed here. The initiation of breastfeeding at birth, the composition of human milk, and complications of breastfeeding are discussed separately. (See "Initiation of breastfeeding" and "Nutritional composition of human milk for full-term infants" and "Common problems of breastfeeding and weaning".)
PARENTAL FACTORS IN FEEDING CHOICE
Understanding what factors are important in the parents' decision in choosing and maintaining breastfeeding over formula feeding enables health care professionals to provide education and support that promotes breastfeeding. In particular, identifying and addressing the factors that impede initiation of breastfeeding and the reasons for early termination will improve breastfeeding rates.
Barriers to breastfeeding — Identifying barriers to breastfeeding helps to direct efforts to address the factors that negatively impact breastfeeding and to focus programmatic resources on families that are most likely not to breastfeed.
Initiation of breastfeeding — About 80 percent of women in the United States initiate breastfeeding, a substantial increase since 2000 [5,6]. Failure to initiate breastfeeding is associated with the following maternal characteristics :
- Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2012; 129:e827.
- World Health Organization. Global Strategy for Infant and Young Child Feeding (2003). www.who.int/nutrition/publications/infantfeeding/en/index.html (Accessed on April 10, 2009).
- Committee on Health Care for Underserved Women, American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 361: Breastfeeding: maternal and infant aspects. Obstet Gynecol 2007; 109:479.
- US Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, et al. Primary Care Interventions to Support Breastfeeding: US Preventive Services Task Force Recommendation Statement. JAMA 2016; 316:1688.
- Centers for Disease Control and Prevention, Breastfeeding Report Card, 2014. Available at: http://www.cdc.gov/breastfeeding/data/reportcard.htm (Accessed on September 10, 2015).
- Herrick KA, Rossen LM, Kit BK, et al. Trends in Breastfeeding Initiation and Duration by Birth Weight Among US Children, 1999-2012. JAMA Pediatr 2016; 170:805.
- Rates of Any and Exclusive Breastfeeding by Socio-demographics among Children Born in 2012. CDC National Immunization Survey. Available at: http://www.cdc.gov/breastfeeding/data/NIS_data/index.htm (Accessed on August 07, 2015).
- Centers for Disease Control and Prevention (CDC). Progress in increasing breastfeeding and reducing racial/ethnic differences - United States, 2000-2008 births. MMWR Morb Mortal Wkly Rep 2013; 62:77.
- Lind JN, Perrine CG, Li R, et al. Racial disparities in access to maternity care practices that support breastfeeding - United States, 2011. MMWR Morb Mortal Wkly Rep 2014; 63:725.
- McKinney CO, Hahn-Holbrook J, Chase-Lansdale PL, et al. Racial and Ethnic Differences in Breastfeeding. Pediatrics 2016; 138.
- Taylor JS, Cabral HJ. Are women with an unintended pregnancy less likely to breastfeed? J Fam Pract 2002; 51:431.
- Callen J, Pinelli J, Atkinson S, Saigal S. Qualitative analysis of barriers to breastfeeding in very-low-birthweight infants in the hospital and postdischarge. Adv Neonatal Care 2005; 5:93.
- Lau C. Effects of stress on lactation. Pediatr Clin North Am 2001; 48:221.
- Lau C, Hurst NM, Smith EO, Schanler RJ. Ethnic/racial diversity, maternal stress, lactation and very low birthweight infants. J Perinatol 2007; 27:399.
- Dennis CL, McQueen K. The relationship between infant-feeding outcomes and postpartum depression: a qualitative systematic review. Pediatrics 2009; 123:e736.
- Lutsiv O, Giglia L, Pullenayegum E, et al. A population-based cohort study of breastfeeding according to gestational age at term delivery. J Pediatr 2013; 163:1283.
- Ogbuanu C, Glover S, Probst J, et al. The effect of maternity leave length and time of return to work on breastfeeding. Pediatrics 2011; 127:e1414.
- van Rossem L, Oenema A, Steegers EA, et al. Are starting and continuing breastfeeding related to educational background? The generation R study. Pediatrics 2009; 123:e1017.
- Yang Z, Lai J, Yu D, et al. Breastfeeding rates in China: a cross-sectional survey and estimate of benefits of improvement. Lancet 2016; 388 Suppl 1:S47.
- Ahluwalia IB, Morrow B, Hsia J. Why do women stop breastfeeding? Findings from the Pregnancy Risk Assessment and Monitoring System. Pediatrics 2005; 116:1408.
- Odom EC, Li R, Scanlon KS, et al. Reasons for earlier than desired cessation of breastfeeding. Pediatrics 2013; 131:e726.
- Baxter J, Cooklin AR, Smith J. Which mothers wean their babies prematurely from full breastfeeding? An Australian cohort study. Acta Paediatr 2009; 98:1274.
- Ertem IO, Votto N, Leventhal JM. The timing and predictors of the early termination of breastfeeding. Pediatrics 2001; 107:543.
- McCarter-Spaulding DE, Kearney MH. Parenting self-efficacy and perception of insufficient breast milk. J Obstet Gynecol Neonatal Nurs 2001; 30:515.
- Li R, Fein SB, Chen J, Grummer-Strawn LM. Why mothers stop breastfeeding: mothers' self-reported reasons for stopping during the first year. Pediatrics 2008; 122 Suppl 2:S69.
- Taveras EM, Capra AM, Braveman PA, et al. Clinician support and psychosocial risk factors associated with breastfeeding discontinuation. Pediatrics 2003; 112:108.
- Ladomenou F, Kafatos A, Galanakis E. Risk factors related to intention to breastfeed, early weaning and suboptimal duration of breastfeeding. Acta Paediatr 2007; 96:1441.
- Gerd AT, Bergman S, Dahlgren J, et al. Factors associated with discontinuation of breastfeeding before 1 month of age. Acta Paediatr 2012; 101:55.
- Wagner EA, Chantry CJ, Dewey KG, Nommsen-Rivers LA. Breastfeeding concerns at 3 and 7 days postpartum and feeding status at 2 months. Pediatrics 2013; 132:e865.
- Gagliardi L, Petrozzi A, Rusconi F. Symptoms of maternal depression immediately after delivery predict unsuccessful breast feeding. Arch Dis Child 2012; 97:355.
- Jones JR, Kogan MD, Singh GK, et al. Factors associated with exclusive breastfeeding in the United States. Pediatrics 2011; 128:1117.
- Palda VA, Guise JM, Wathen CN, Canadian Task Force on Preventive Health Care. Interventions to promote breast-feeding: applying the evidence in clinical practice. CMAJ 2004; 170:976.
- Chung M, Raman G, Trikalinos T, et al. Interventions in primary care to promote breastfeeding: an evidence review for the U.S. Preventive Services Task Force. Ann Intern Med 2008; 149:565.
- Renfrew MJ, McCormick FM, Wade A, et al. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev 2012; :CD001141.
- Balogun OO, O'Sullivan EJ, McFadden A, et al. Interventions for promoting the initiation of breastfeeding. Cochrane Database Syst Rev 2016; 11:CD001688.
- Su LL, Chong YS, Chan YH, et al. Antenatal education and postnatal support strategies for improving rates of exclusive breast feeding: randomised controlled trial. BMJ 2007; 335:596.
- Anderson AK, Damio G, Young S, et al. A randomized trial assessing the efficacy of peer counseling on exclusive breastfeeding in a predominantly Latina low-income community. Arch Pediatr Adolesc Med 2005; 159:836.
- Kronborg H, Vaeth M, Olsen J, et al. Effect of early postnatal breastfeeding support: a cluster-randomized community based trial. Acta Paediatr 2007; 96:1064.
- Coutinho SB, de Lira PI, de Carvalho Lima M, Ashworth A. Comparison of the effect of two systems for the promotion of exclusive breastfeeding. Lancet 2005; 366:1094.
- Graffy J, Taylor J, Williams A, Eldridge S. Randomised controlled trial of support from volunteer counsellors for mothers considering breast feeding. BMJ 2004; 328:26.
- Pisacane A, Continisio GI, Aldinucci M, et al. A controlled trial of the father's role in breastfeeding promotion. Pediatrics 2005; 116:e494.
- Breastfeeding among US children born 1999-2005, CDC National Immunization Survey. Available at: www.cdc.gov/breastfeeding/data/NIS_data/index.htm (Accessed on April 10, 2009).
- Howard C, Howard F, Lawrence R, et al. Office prenatal formula advertising and its effect on breast-feeding patterns. Obstet Gynecol 2000; 95:296.
- Donnelly A, Snowden HM, Renfrew MJ, Woolridge MW. Commercial hospital discharge packs for breastfeeding women. Cochrane Database Syst Rev 2000; :CD002075.
- American Academy of Pediatrics. Breastfeeding. In: Nutrition Handbook, 6th ed, Kleinman RE (Ed), American Academy of Pediatrics, Elk Grove 2009. p.29.
- ACOG Committee on Obstetric Practice, Opinion #658. Optimizing support for breastfeeding as part of obstetric practice. Available at: http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Optimizing-Support-for-Breastfeeding-as-Part-of-Obstetric-Practice (Accessed on February 16, 2016).
- Lawrence RM, Lawrence RA. Given the benefits of breastfeeding, what contraindications exist? Pediatr Clin North Am 2001; 48:235.
- American Academy of Pediatrics. Human milk. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th, Kimberlin DW, Brady MT, Jackson MA, Long SS. (Eds), American Academy of Pediatrics, Elk Grove Village IL 2015. p.125.
- Shi Z, Yang Y, Wang H, et al. Breastfeeding of newborns by mothers carrying hepatitis B virus: a meta-analysis and systematic review. Arch Pediatr Adolesc Med 2011; 165:837.
- Sachs HC, Committee On Drugs. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics 2013; 132:e796.
- Alexander JM, Grant AM, Campbell MJ. Randomised controlled trial of breast shells and Hoffman's exercises for inverted and non-protractile nipples. BMJ 1992; 304:1030.
- American College of Obstetricians and Gynecologists. Breastfeeding: maternal and Infant Aspects. ACOG Educational Bulletin #258, Washington, DC, July 2000.
- Wardinsky TD, Montes RG, Friederich RL, et al. Vitamin B12 deficiency associated with low breast-milk vitamin B12 concentration in an infant following maternal gastric bypass surgery. Arch Pediatr Adolesc Med 1995; 149:1281.
- Schanler RJ. Water soluble vitamins: C, B, B2. B6, niacin, biotin, and pantothenic acid. In: Nutrition During Infancy, Tsang RC, Nichols BL (Eds), Hanley & Belfus, Philadelphia 1998. p.236.
- Prosser CG, Saint L, Hartmann PE. Mammary gland function during gradual weaning and early gestation in women. Aust J Exp Biol Med Sci 1984; 62 ( Pt 2):215.
- PARENTAL FACTORS IN FEEDING CHOICE
- Barriers to breastfeeding
- - Initiation of breastfeeding
- - Maintenance of breastfeeding
- SUPPORT AND EDUCATIONAL INTERVENTIONS
- Effectiveness of promotion interventions
- - Lactation support
- - Educational resources
- - Maintaining breastfeeding
- CLINICIAN'S ROLE
- - Contraindications
- - Prenatal breast assessment
- Maternal diet
- Subsequent pregnancy
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS