Table of contents
Breastfeeding
Background
Overview
Definition
Breastfeeding is nursing a child with breast milk, which is recommended as the exclusive source of nutrition for the first six months of infants life.
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Pathophysiology
The stages of lactation include mammogenesis (growth of breast tissue) and lactogenesis.
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Disease course
Breast milk contains antibodies, enzymes, and hormones and breastfeeding promote infants growth and neurodevelopment, and maternal health too. Breastfed infants have a decreased incidence of gastrointestinal infection, acute otitis media, hypertension, total cholesterol, pain during procedures, atopic dermatitis, asthma, respiratory tract infections, childhood obesity, type 1 and T2DM, leukemia, necrotizing enterocolitis in premature infants, and sudden infant death syndrome. Breastfeeding mothers also have decreased incidence of breast cancer, postnatal depression, ovarian cancer, retained gestational weight, T2DM.
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Prognosis and risk of recurrence
Breastfeeding initiation is associated with a significant reduction in total infant mortality with OR 0.81 (95% CI 0.68-0.97).
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of breastfeeding are prepared by our editorial team based on guidelines from the American Academy of Pediatrics (AAP 2022), the American College of Obstetricians and Gynecologists (ACOG 2019,2018), the American College of Radiology (ACR 2018), the U.S. Preventive Services Task Force (USPSTF 2016), and the Academy of Breastfeeding Medicine (ABM 2013).
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Diagnostic investigations
Considerations for diagnostic imaging: as per ACOG 2019 guidelines, do not interrupt breastfeeding after gadolinium administration.
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Considerations for cancer screening imaging
Nonpharmacologic interventions
Patient education
Follow-up and surveillance
Follow-up assessment: as per ABM 2013 guidelines, in many areas of the world, the first follow-up visit will be done by non-physician healthcare workers. In most European countries midwives care for the mother and infant in the days and weeks after discharge from the hospital. Mothers contact their pediatrician within the first 3 weeks of delivery for the infant's first check-up, which is covered by insurance. In this system, this is the first opportunity the pediatrician has to support breastfeeding. In other countries, such as Australia and New Zealand, routine medical care of infants is undertaken by general practitioners (family physicians), and infants may never visit a pediatrician. In countries such as the US, where the postpartum care of the mother and infant is done by physicians or physician extenders (such as physician assistants, nurse practitioners), schedule a first infant follow-up visit 48-72 hours after hospital discharge or earlier if breastfeeding-related problems, such as excessive weight loss of > 7% or jaundice, are present at the time of hospital discharge.
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Quality improvement
Coordinated care: as per ABM 2013 guidelines, establish a written breastfeeding-friendly office. Collaborate with colleagues and office staff during development. Inform all new staff about the policy. Provide copies of your practice's policy to hospitals, physicians, and all healthcare professionals covering your practice for you.
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Policies
Clinician training