New AAP Policy Statement: Breastfeeding and the Use of Human Milk

Breast milk is the ideal nutrition

Feeding decisions go well beyond what your child will be eating. Breast milk is the ideal nutrition for your baby, and it provides many short and long term medical and developmental benefits, including important immune support for your growing child. Studies have shown that babies who are exclusively breastfed for 6 months have decreased rates of:

• lower respiratory tract infections
• severe diarrhea
• ear infections
• obesity
• Sudden Infant Death Syndrome

Mothers also benefit when they choose to breastfeed. There is a decreased risk of:

• Breast cancer
• Ovarian cancer
• High blood pressure
• Type 2 Diabetes

Most women in the United States are choosing to breastfeed and they are breastfeeding longer. Breastfeeding has been established as the cultural norm in the United States. There are both federal and state laws protecting a woman’s right to breastfeed as well as the right to breastfeed in public and to continue breastfeeding or to express milk in the workplace.

Exclusive breastfeeding to 6 months

“Breastfeeding can be hard for many families in the beginning. Families need to know that they are not alone! Seeking help from peer counselors, pediatric healthcare providers and trained lactation consultants can help families achieve their breastfeeding goals” says Rachelle Lessen, MS, RD, IBCLC, lactation consultant and pediatric dietitian at CHOP.

Things you can do to promote exclusive breastfeeding with your baby during the first 6 months:

• skin-to-skin contact immediately after birth
• breastfeeding in the first hour after birth
• rooming-in
• breastfeeding on demand, at least 8 to 10 times in 24 hours
• if unable to directly breastfeed, express milk at least 8 to 10 times in 24 hours
• get help from a knowledgeable lactation professional, if needed
• avoid supplementation unless medically indicated

Two years and beyond: complementary foods and continued breastfeeding

The AAP recommends exclusive breastfeeding for about 6 months. Complementary foods should be introduced at about 6 months for most infants. Your baby may be ready for complementary foods when they are:

• able to sit upright without support
• opens their mouth when food is offered
• swallows the food rather than push it back out onto their chin
• tries to grasp small objects such as toys or food
• able to transfer food from the front to the back of their tongue to swallow

Breastfeeding allows your child to control their food intake. This helps to create healthy eating habits as your child learns to eat when hungry and stop when satisfied. You may choose to transition to complementary foods by allowing your child to participate in family meals and feed themselves appropriate foods that are soft and easy to grasp. Foods rich in iron, protein, and zinc such as meat, eggs, fish, beans, and leafy greens are good choices for breastfed babies.

Your breast milk may not contain enough vitamin D if you do not have adequate vitamin D stores.  This is very common as most of us avoid prolonged sun exposure and use sunscreen which interferes with vitamin D production in our skin. You can boost the vitamin D content of your milk  by taking 6400 IU per day. Otherwise, it is recommended that breastfed babies receive 400 IU vitamin D per day.

The first two years of your baby’s life are an important time for brain development. Your milk has special nutrients that support this rapid growth and development. Breast milk will still be a major part of your baby’s diet even after starting complementary foods. 

As your older baby or toddler increases their intake of family foods their breastfeeding patterns may change. Breastfeeding continues to nurture and offer comfort in addition to important immune support for the growing child.

Supporting families

“The AAP’s policy statement on breastfeeding calls for increased support from all levels for breastfeeding families. The intention is not to apply more pressure on families to extend their breastfeeding but increase access to help” says Meghan Devine RN, BSN, IBCLC, clinical supervisor of the CHOP Lactation Team.

Your pediatrician is a great resource to help you understand the importance of breast milk, assess how breastfeeding is going, manage common problems, provide guidance for protecting your milk production if supplementation is needed, and provide appropriate referrals.

Breastfeeding exclusively for about 6 months is an evidence-based recommendation. However, you should never feel judged for your personal desires around breastfeeding. Despite the best intentions, you may feel some disappointment if you run into difficulties. Your pediatrician can provide support. Remember, as healthcare professionals, we care about the wellbeing of both your baby and you.

How CHOP works to support and promote breastfeeding

We understand that breastfeeding or pumping milk can be challenging for new parents, thus support from healthcare providers is essential.

CHOP offers:

• Prenatal education (virtual and in-person) for families and patients delivering in the Garbose Family Special Delivery Unit
• Pasteurized donor human milk for sick and premature babies admitted to CHOP while they are in the hospital
• Inpatient and outpatient (virtual and in-person) consultations with lactation consultants
• Nurses and Dietitians (in both inpatient and ambulatory settings) who have undergone additional training in the field of lactation
• An abundance of on-site lactation rooms dedicated to providing a private space for breastfeeding and/or pumping; most are equipped with a hospital grade pump

To learn more, see the following resources:

• Policy Statement: Breastfeeding and the Use of Human Milk, by the American Academy of Pediatrics
• Technical Report: Breastfeeding and the Use of Human Milk, by the American Academy of Pediatrics
• CHOP’s Breastfeeding and Lactation Program
• CHOP’s Outpatient Lactation Clinic
• CHOP Mothers’ Milk Bank