American Academy of Family Physicians (AAFP) – Breastfeeding (Position Paper)

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Introduction

The American Academy of Family Physicians (AAFP) has long supported breastfeeding. All family physicians, whether or not they provide maternity care, have a unique role in the promotion of breastfeeding. Family physicians understand the advantages of family-centered care and are well positioned to provide breastfeeding support in that context. Because they provide comprehensive care to the whole family, family physicians have an opportunity to provide breastfeeding education and support throughout the life cycle to all members of the family.

Family physicians may provide prenatal care and labor support, deliver the infant, help in the prompt initiation and continuation of breastfeeding, and continue caring for the baby and family.
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Medications in the Breast-Feeding Mother

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Jeanne P. Spencer, Luis S. Gonzalez, Donna J. Barnhart

Am Fam Physician 2001;64:119-26.

Prescribing medications for a breast-feeding mother requires weighing the benefits of medication use for the mother against the risk of not breast-feeding the infant or the potential risk of exposing the infant to medications. A drug that is safe for use during pregnancy may not be safe for the nursing infant. The transfer of medications into breast milk depends on a concentration gradient that allows passive diffusion of nonionized, non­protein-bound drugs. The infant’s medication exposure can be limited by prescribing medications to the breast-feeding mother that are poorly absorbed orally, by avoiding breast-feeding during times of peak maternal serum drug concentration and by prescribing topical therapy when possible.
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Maternity care practices: implications for breastfeeding

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DiGirolamo AM, Grummer-Strawn LM, Fein S.
Birth. 2001 Jun;28(2):94-100.

Abstract

BACKGROUND: Many United States mothers never breastfeed their infants or do so for very short periods. The Baby-Friendly Hospital Initiative was developed to help make breastfeeding the norm in birthing environments, and consists of specific recommendations for maternity care practices. The objective of the current study was to assess the impact of the type and number of Baby-Friendly practices experienced on breastfeeding.

METHODS: A longitudinal mail survey (1993-1994) was administered to women prenatally through 12 months postpartum. The study focused on the 1085 women with prenatal intentions to breastfeed for more than 2 months who initiated breastfeeding, using data from the prenatal and neonatal periods.
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Quinapril and its metabolite quinaprilat in human milk

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Begg EJ, Robson RA, Gardiner SJ, Hudson LJ, Reece PA, Olson SC, Posvar EL, Sedman AJ.
Br J Clin Pharmacol. 2001 May;51(5):478-81.

Abstract

Aims To measure the milk to plasma ratio (M/P) of quinapril and its active metabolite quinaprilat in lactating mothers and to assess likely infant exposure.

Methods A single dose of quinapril 20 mg was administered to six healthy mothers who had been breastfeeding their infants for at least 2 weeks. Blood was sampled for the measurement of quinapril and quinaprilat at 0, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 16 and 24 h. Milk was collected for measurement of quinapril and quinaprilat concentrations over the periods −4–0, 0–4, 4–8, 8–12, 12–18, 18–24 h.
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Drug Safety in Lactation

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Sharon Gardiner and Evan Begg

Prescriber Update No.21:10-23

Many mothers are required to use drugs during breastfeeding. Almost all drugs transfer into breast milk and this may carry a risk to a breastfed infant. Factors such as the dose received via breast milk, and the pharmacokinetics and effect of the drug in the infant need to be taken into consideration. Problems should not be overstated however, as many drugs are considered ‘safe’ during breastfeeding.

Transfer of drugs into breast milk is influenced by protein binding, lipid solubility and ionisation

Nearly all drugs transfer into breast milk to some extent. Notable exceptions are heparin and insulin which are too large to cross biological membranes.
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Breastfeeding determinants and a suggested framework for action in Europe.

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Abstract

This is a background paper for the EURODIET initiative. A number of international initiatives and documents were identified, such as the Baby-Friendly Hospital Initiative, the International Code of Marketing of Breast Milk Substitutes and a number of consensus reports from professional groups, that propose ways forward for breastfeeding promotion. These point at a range of initiatives on different levels. The determinants for successful breastfeeding have to be identified. They can be categorised into five groups; socio-demographic, psycho-social, health care related, community- and policy attributes. A framework for future breastfeeding promoting efforts on European level is suggested, within which these determinants are considered.
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Developmental Readiness of Normal Full Term Infants to Progress from Exclusive Breastfeeding to the Introduction of Complementary Foods

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Audrey J. Naylor, Ardythe L Morrow
Wellstart International and the LINKAGES Project/Academy for Educational Development, Washington, D.C. 2001.

Introduction and Background

This review of the developmental readiness of normal full term infants to progress from exclusive breastfeeding to the introduction of complementary foods has been undertaken as a result of the international debate regarding the best age to introduce complementary (semi-solid and solid) foods into the diet of the breastfed human infant. Since 1979 the World Health Organization has recommended that normal full term infants should be exclusively breastfed for „four to six months.” Over the two decades since this recommendation was established further evidence regarding the benefits of breastmilk and breastfeeding has accumulated.
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Human milk antibacterial factors: the effect of temperature on defense systems

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Chen HY, Allen JC.

Adv Exp Med Biol. 2001;501:341-8.

Bovine milk will eventually spoil at refrigeration temperatures, but endogenous or exogenous pathogenic or spoilage bacteria in human milk stored for delayed feeding will die. We investigated the mechanism for these antibacterial properties and their response to high-tempertature, short-time (HTST, 72 degrees C-75 degrees C, 15 sec) and low-temperature long-time (LTLT, 65 degrees C, 30 min) pasteurization.

Nonpathogenic Listeria innocua (10(6) cfu/mL) was inoculated into raw and processed bovine and human milk; bacterial plate counts twice weekly determined antibacterial activities. Up to 99% of L. innocua were killed and further growth was inhibited in raw and pasteurized human milk for at least 60 days at 4 degrees C.
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Infant Feeding in Emergencies

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Manual for orientation, reading and reference

The agencies whose staff contributed to this draft material include WHO, UNICEF, LINKAGES, IBFAN, and ENN. – March, 2001

Introduction

In emergencies, children under five are more likely to become ill and die from malnutrition and disease than anyone else. In general, the younger they are, the more vulnerable they are. Inappropriate feeding increases their risks.

This module covers how to feed infants, by breastfeeding and, when necessary, other options. It also addresses existing recommendations and protective policies, and gives guidance on how to provide adequate support for appropriate infant feeding.
Although we shall be talking about infants, that is babies under one year, breastfeeding can and should continue with other foods up to two years or beyond.
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The Economic Benefits of Breastfeeding: A Review and Analysis

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JonWeimer
Food and Rural Economics Division, Economic Research Service, U.S. Department of Agriculture. Food Assistance and Nutrition Research Report No. 13.

Summary

Successfully promoting and supporting breastfeeding in the United States may depend on persuading both mothers and society that breastfeeding is not only nutritionally sound but economically beneficial as well. Current U.S. rates of breastfeeding are 64 percent for mothers in-hospital and 29 percent at 6 months postpartum, below the recommendations of the Surgeon General (75 and 50 percent, respectively). This analysis concludes that a minimum of $3.6 billion would be saved if the prevalence of exclusive breastfeeding increased from current rates to those recommended by the Surgeon General.
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