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.”

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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.”