Initiation of breastfeeding
- 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 breastfeeding for the first six months of life [1-4]. (See "Infant benefits of breastfeeding" and "Maternal and economic benefits of breastfeeding".)
In the United States, the Goals for Healthy People 2020 include the initiation of breastfeeding in 82 percent of newborns, and any continued breastfeeding in 61 percent of six month old infants . Successful achievement of these goals is dependent upon health care professionals providing antenatal and postnatal breastfeeding education and support. In particular, the delivery and hospital experience should promote and support initiation of breastfeeding to enhance the probability of successful breastfeeding.
The initiation of breastfeeding during the birth hospitalization will be reviewed here. Factors that influence the parental decision on whether to breastfeed, parental educational and supportive programs for breastfeeding, the composition of human milk, and complications of breastfeeding are discussed separately. (See "Breastfeeding: Parental education and support" and "Nutritional composition of human milk for full-term infants" and "Common problems of breastfeeding and weaning".)
During the birth hospitalization, higher initiation rates of breastfeeding occur in facilities with clinical practice policies that promote breastfeeding [6-13].
These policies are best summarized by the Ten Steps to Successful Breastfeeding developed by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) as criteria for a Baby-Friendly Hospital [4,7,14,15]. The Ten Steps are (table 1):
- 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).
- U.S. Preventive Services Task Force. Primary care interventions to promote breastfeeding: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2008; 149:560.
- 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.
- Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2012; 129:e827.
- Healthy People maternal, infant and child health 2020 goals http://healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicid=26 (Accessed on February 14, 2011).
- Philipp BL, Merewood A, Miller LW, et al. Baby-friendly hospital initiative improves breastfeeding initiation rates in a US hospital setting. Pediatrics 2001; 108:677.
- Saadeh R, Akré J. Ten steps to successful breastfeeding: a summary of the rationale and scientific evidence. Birth 1996; 23:154.
- 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.
- Merewood A, Mehta SD, Chamberlain LB, et al. Breastfeeding rates in US Baby-Friendly hospitals: results of a national survey. Pediatrics 2005; 116:628.
- Merten S, Dratva J, Ackermann-Liebrich U. Do baby-friendly hospitals influence breastfeeding duration on a national level? Pediatrics 2005; 116:e702.
- Kramer MS, Chalmers B, Hodnett ED, et al. Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of Belarus. JAMA 2001; 285:413.
- Perrine CG, Scanlon KS, Li R, et al. Baby-Friendly hospital practices and meeting exclusive breastfeeding intention. Pediatrics 2012; 130:54.
- Brodribb W, Kruske S, Miller YD. Baby-friendly hospital accreditation, in-hospital care practices, and breastfeeding. Pediatrics 2013; 131:685.
- World Health Organization, Division of Child Health and Development. Evidence for the ten steps to successful breastfeeding, World Health Organization, Geneva 1998.
- Baby-friendly hospital initiative: Revised, updated and expanded for integrated care. World Health Organization and UNICEF, 2009. Available at: http://www.who.int/nutrition/publications/infantfeeding/bfhi_trainingcourse/en/ (Accessed on August 07, 2015).
- Chantry CJ, Dewey KG, Peerson JM, et al. In-hospital formula use increases early breastfeeding cessation among first-time mothers intending to exclusively breastfeed. J Pediatr 2014; 164:1339.
- Centers for Disease Control and Prevention (CDC). Breastfeeding-related maternity practices at hospitals and birth centers--United States, 2007. MMWR Morb Mortal Wkly Rep 2008; 57:621.
- Perrine CG, Galuska DA, Dohack JL, et al. Vital Signs: Improvements in Maternity Care Policies and Practices That Support Breastfeeding - United States, 2007-2013. MMWR Morb Mortal Wkly Rep 2015; 64:1112.
- Baby-friendly USA. Available at: https://www.babyfriendlyusa.org/find-facilities (Accessed on November 23, 2015).
- Hauk L. AAFP Releases Position Paper on Breastfeeding. Am Fam Physician 2015; 91:56.
- Feldman-Winter L, Goldsmith JP, COMMITTEE ON FETUS AND NEWBORN, TASK FORCE ON SUDDEN INFANT DEATH SYNDROME. Safe Sleep and Skin-to-Skin Care in the Neonatal Period for Healthy Term Newborns. Pediatrics 2016; 138.
- Prior E, Santhakumaran S, Gale C, et al. Breastfeeding after cesarean delivery: a systematic review and meta-analysis of world literature. Am J Clin Nutr 2012; 95:1113.
- McDonald SD, Pullenayegum E, Chapman B, et al. Prevalence and predictors of exclusive breastfeeding at hospital discharge. Obstet Gynecol 2012; 119:1171.
- Zanardo V, Pigozzo A, Wainer G, et al. Early lactation failure and formula adoption after elective caesarean delivery: cohort study. Arch Dis Child Fetal Neonatal Ed 2013; 98:F37.
- Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2012; 129:e827.
- Hospital stay for healthy term newborns. American Academy of Pediatrics Committee on Fetus and Newborn. Pediatrics 1995; 96:788.
- American Academy of Pediatrics. Breastfeeding. In: Nutrition Handbook, 6th ed, Kleinman RE (Ed), American Academy of Pediatrics, Elk Grove 2009. p.29.
- Garbin CP, Deacon JP, Rowan MK, et al. Association of nipple piercing with abnormal milk production and breastfeeding. JAMA 2009; 301:2550.
- Brownell E, Howard CR, Lawrence RA, Dozier AM. Delayed onset lactogenesis II predicts the cessation of any or exclusive breastfeeding. J Pediatr 2012; 161:608.
- Neville MC, Morton J, Umemura S. Lactogenesis. The transition from pregnancy to lactation. Pediatr Clin North Am 2001; 48:35.
- Baildam EM, Hillier VF, Menon S, et al. Attention to infants in the first year. Child Care Health Dev 2000; 26:199.
- Hammer LD, Bryson S, Agras WS. Development of feeding practices during the first 5 years of life. Arch Pediatr Adolesc Med 1999; 153:189.
- Flaherman VJ, Schaefer EW, Kuzniewicz MW, et al. Early weight loss nomograms for exclusively breastfed newborns. Pediatrics 2015; 135:e16.
- Oddie SJ, Craven V, Deakin K, et al. Severe neonatal hypernatraemia: a population based study. Arch Dis Child Fetal Neonatal Ed 2013; 98:F384.
- Pelleboer RA, Bontemps ST, Verkerk PH, et al. A nationwide study on hospital admissions due to dehydration in exclusively breastfed infants in the Netherlands: its incidence, clinical characteristics, treatment and outcome. Acta Paediatr 2009; 98:807.
- Oddie S, Richmond S, Coulthard M. Hypernatraemic dehydration and breast feeding: a population study. Arch Dis Child 2001; 85:318.
- Shroff R, Hignett R, Pierce C, et al. Life-threatening hypernatraemic dehydration in breastfed babies. Arch Dis Child 2006; 91:1025.
- Moritz ML, Manole MD, Bogen DL, Ayus JC. Breastfeeding-associated hypernatremia: are we missing the diagnosis? Pediatrics 2005; 116:e343.
- Iyer NP, Srinivasan R, Evans K, et al. Impact of an early weighing policy on neonatal hypernatraemic dehydration and breast feeding. Arch Dis Child 2008; 93:297.
- Neville MC. Anatomy and physiology of lactation. Pediatr Clin North Am 2001; 48:13.
- Becker GE, Remmington T. Early additional food and fluids for healthy breastfed full-term infants. Cochrane Database Syst Rev 2014; :CD006462.
- The Academy of Breastfeeding Medicine. www.bfmed.org (Accessed on April 14, 2009).
- Flaherman VJ, Aby J, Burgos AE, et al. Effect of early limited formula on duration and exclusivity of breastfeeding in at-risk infants: an RCT. Pediatrics 2013; 131:1059.
- Furman L. Early limited formula is not ready for prime time. Pediatrics 2013; 131:1182.
- Hörnell A, Hofvander Y, Kylberg E. Solids and formula: association with pattern and duration of breastfeeding. Pediatrics 2001; 107:E38.
- Holmes AV, Auinger P, Howard CR. Combination feeding of breast milk and formula: evidence for shorter breast-feeding duration from the National Health and Nutrition Examination Survey. J Pediatr 2011; 159:186.
- Jaafar SH, Jahanfar S, Angolkar M, Ho JJ. Pacifier use versus no pacifier use in breastfeeding term infants for increasing duration of breastfeeding. Cochrane Database Syst Rev 2011; :CD007202.
- Kair LR, Kenron D, Etheredge K, et al. Pacifier restriction and exclusive breastfeeding. Pediatrics 2013; 131:e1101.
- HOSPITAL ENVIRONMENT
- DELIVERY ROOM
- Cesarean delivery
- OVERVIEW OF POSTPARTUM CARE
- MECHANICS OF FEEDING
- - Ankyloglossia
- - Inverted nipples
- Milk transfer
- DEMAND FEEDING
- Parental expectations
- Nursing frequency
- - Feeding cues
- - Signs of satiety
- ASSESSMENT OF INTAKE
- Frequency and duration of feeding
- Weight loss
- - Excessive weight loss
- - Prevention of excessive weight loss
- Urine output
- - Green frothy stools
- VITAMIN D
- PACIFIER USE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS