Family Matters

Why Pediatricians Say Breast-Feeding is About Public Health, Not Just Lifestyle

The American Academy of Pediatrics subtly turns the tables on the breast-feeding conversation with its updated guidelines. No longer is infant nutrition simply a lifestyle choice; it's now a public health issue.

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In a quietly worded statement released this week, the American Academy of Pediatrics (AAP) has recalibrated the national dialogue on breast-feeding, deeming it a “public health issue and not only a lifestyle choice.”

Much of the statement on infant nutrition doesn’t differ radically from previous versions. But the recognition on behalf of the group’s 60,000 pediatricians that breast is best for mom, baby and the nation’s general well-being is creating buzz in the breast-feeding community.

“By recognizing that breastfeeding is much more than a personal choice, the AAP is sending a strong message that supporting breastfeeding is an important public health issue that merits societal support from the hospital to the workplace,” writes Hygeia, a breast-feeding site.

At Best for Babes, which promotes support for breast-feeding, co-founder Danielle Rigg praised the AAP for equating breast-feeding with public health. “In framing it that way, it becomes all of our responsibility — not just moms — to provide both the infrastructure and the social support to see to it that as many moms and babies as possible can do it,” she says. “If we can do it for breast cancer, we can do it for breastfeeding.”

Dr. Richard Schanler, chair of the AAP’s section on breast-feeding and director of neonatology at Cohen Children’s Medical Center in Long Island, is even more candid. “It’s not should I or shouldn’t I?” says Schanler. “Of course you should. It’s important for the health of your baby. And it’s important for your health too.”

MORE: Target Nurse-In: Did It Change Perceptions of Public Breast-Feeding?

The wealth of new data about the effects of breast-feeding influenced the AAP to update its guidelines. Researchers have found that breast-fed babies have a decreased risk of dying of SIDS, fewer ear infections, less likelihood of obesity or cardiovascular disease And fewer hospitalizations for pneumonia; mothers benefit from decreased risk of breast, ovarian and uterine cancers. Duration is important: “The longer you do it and the more exclusive it is, some of these effects become even more significant,” says Schanler. “Hospitalization for pneumonia is significantly reduced if you exclusively breast-feed for six months as opposed to less than four months. How can you say that’s not important?”

It’s taken about five years, but there’s now consensus from the entire academy. When the previous guidelines were released, exclusive breast-feeding was recommended for six months, followed by an asterisk that directed those devoted souls who actually read policy papers to a footnote: while the AAP’s breast-feeding committee subscribed to a six-month duration, other members supported a time frame of four to six months.

Again what’s changed, says Schanler, is the prevalence of new data. The current policy calls for exclusive breast-feeding for “about 6 months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant.”

MORE: What the U.S. Can Learn from Indonesia About Breastfeeding

Breast-feeding past one year, notes Schanler, is “not necessarily nutritive.” But it’s certainly psychological. For toddlers, it’s like their security blanket. “We see nothing wrong with it,” says Schanler. “But we are really trying to get the ball rolling so in a sense we are more interested in the early phase to get everyone on track.”


Good sign, that breastfeeding get some public recognition.


Breast-feeding past one year, notes Schanler, is “not necessarily nutritive.” 

That's not correct. A mother's breastmilk does not suddenly become devoid of nutrients when her baby turns one year old! In fact, breastmilk continues to naturally morph into the perfect balance of nutrients and disease fighting antibodies as baby grows. It's composition is an exact, personalized formula based on a choreography of hormones that communicate between mother and baby. If baby is sick, mother's milk automatically contains more antibodies for the duration of the illness. As baby grows older and needs less fat or more protein, the mother's body senses this and adjusts the milk accordingly. This is such a delicate phenomenon that science can't even really explain it. Each and every day, every time the baby nurses, subtle cues and information are being exchanged between the mother's body and the baby's body, and the milk is constantly in flux, changing to meet those changing needs. 

Of course, breastfeeding any baby of any age is also a psychological event. The same hormones that are released when falling in love are the ones released each time a mother puts baby to breast. It is a peaceful, warm feeling for both mother and child. It creates a loving, trustful relationship between mother and baby, even in those first few months when caring for a newborn is exhausting. That's why breastfeeding mothers report a much lower rate of postpartum depression. And when baby is older, breastfeeing can help avoid tantrums, keep little ones calm on airplanes or in waiting rooms, and stop tears from all the bumps and bruises of toddlerhood.

My daughter is 28 months and still nursing. She is getting both nutritional and emotional value from my milk. This morning she woke up on the wrong side of the bed and couldn't find her favorite toy train. As her lip began to tremble, she came over and asked for milk. One minute later (that's all it took!), she was ready to face the day, a much improved attitude and a fresh start. Most likely, besides the emotional comfort, she needed a drink since she had just woken up and we had not eaten or drunk anything.

Medical professionals should get their facts straight. Breastmilk is always perfectly nutritious, specifically formulated for each individual baby or toddler. Someone needs to educate Dr. Schanler. I fear he is spreading misinformation. With all the bad advice and negative social pressure on breastfeeding mothers in this country, at least those who claim to be experts or professionals should be careful about the "facts" they are tossing out.


I am a mother of a 6 month old, and He is exclusively breast milk feed.. He has never latched, but I felt that it was important for him to get breast milk, so I've pumped, and pumped and pumped... I know so many mothers who have had babies that latch just fine, stop breast feeding around 3 months due to convenience~ and it breaks my heart for their babies. Prior to my son's birth, I committed myself to breastfeeding through the first year. It was not optional. Its my duty to provide the very best. Thanks for posting this story. With all the adverse media and looks you get from hooking up the a pump, This kind of article makes a mother like me feel great... (especially reading it while pumping!) :D


I only wish that the AAP would write the statement with breastfeeding as the NORM.  So instead it should read this way, "Formula-fed babies have an increased risk of dying of SIDS, more ear infections, more likelihood of obesity or cardiovascular disease, and more hospitalizations for pneumonia; mothers who do NOT breastfeed have increased risk of breast, ovarian and uterine cancers."  Then it would be a true statement...