AAP Changes Breastfeeding Guidelines, Calls For More Support

Paid family leave and the use of the term "chestfeeding" for gender-diverse families are among the recommendations in the AAP's new policy statement on lactation.

Black parent breastfeeding
Photo: Getty

The American Academy of Pediatrics (AAP) updated its breast/chestfeeding recommendations for the first time in a decade on Monday. The new policy statement extended its guidelines for breast/chestfeeding duration from at least one year to two years or more. The AAP also outlined recommendations for inclusivity and structural supports to help families achieve this benchmark, as well as six months of exclusive breast/chestfeeding.

The AAP advised providers to use more inclusive language when discussing lactation when working with gender-diverse families, such as the term "chestfeeding." This language opens the door to all parents who are feeding their children human milk rather than excluding people who are going through the same process but by a different name.

"Human milk is all a baby needs for the first six months of life," Joan Younger Meek, M.D., MS, RD, FAAP, FABM, IBCLC, the lead author of the reports, added in a press release. "Breast milk is unique in its nutrients and protective effects, and really quite remarkable when you look at what it does for a child's developing immune system."

At six months, the AAP says caregivers can introduce complementary solids. The AAP cited research that breast/chestfeeding can reduce a child's risk of:

  • Lower respiratory tract infections
  • Diarrhea
  • Ear infection
  • Obesity
  • Sudden Infant Death Syndrome (SIDS)
  • Diabetes

The organization also called attention to numerous effects of chest/breastfeeding beyond one year for the mother, such as lower risks of:

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

Why Do People Stop Breast/Chestfeeding?

Dr. Meek and the AAP acknowledged not everyone can provide human milk for their baby for various reasons, including societal obstacles.

"In the early days, moms may stop because of pain from issues like engorgement or sore nipples," says Molly Petersen, certified lactation counselor at Lansinoh. "They might also feel like they aren't producing enough breast milk." Both of these issues stem from inadequate breastfeeding support and training in early parenthood.

As the baby ages, parents might also stop chest/breastfeeding because they're simply too busy with other life commitments. "Trying to pump on a proper schedule and keeping your supply intact can be challenging," says Petersen. Indeed, many people decide that formula-feeding is easier than pumping throughout the workday.

Though breast/chestfeeding rates have risen in recent years, there's still an equity gap that healthcare providers, including the AAP, are reckoning with. Black lactating individuals have the lowest rate of chest/breastfeeding initiation (73.6%) and are far less likely to be breast/chestfeeding at the six-month mark than white lactating individuals (44.7% compared to 62%), according to the CDC.

"The AAP views breastfeeding as a public health imperative and also as an equity issue," noted Lawrence Noble, M..D, FAAP, FABM, IBCLC, co-author of the policy statement and technical report.

One potential reason for this equity gap: The lack of paid leave. The U.S. is the only developed country without paid family leave, and Black women have less access to it than white women.

The AAP's policy statement calls for universal paid family leave and workplace protections for lactating individuals, such as a clean and private location to express milk.

Tips for Breast/Chestfeeding Success

If you want to chest/breastfeed for the recommended time frame, there are steps you can take to make everything go smoothly.

Get educated. Signing up for support groups or reading about nursing can help new parents prepare. "Early education and support with breastfeeding issues is key to helping [parents] and babies get a good start," says Petersen. "This can help them avoid potential stumbling blocks and overcome them more confidently."

Reach out to a lactation consultant for any concerns. It's possible you'll experience milk leakage, sore nipples, engorgement, and minimal milk production. To deal with any of these issues, "I would highly recommend working with an IBCLC (International Board Certified Lactation Consultant)," says Petersen. "Most hospitals have them on staff as part of their labor and delivery teams. There are also IBCLCs that work in private practice or as part of health clinics who can help you if issues arise after you leave the hospital."

Seek an online community. If you're struggling, try finding a chest/breastfeeding community online. "It can be incredibly comforting to talk to other [parents] who have been where you are and know that they came out the other side," says Petersen.

Other recommendations the AAP is making include:

  • Universal workplace breaks for people to express milk
  • Rights to breastfeed in public and at child care centers
  • Lactation rooms at schools
  • Insurance coverage for lactation support
  • Support from providers for parents who wish to feed a child human milk after one year
  • Support from staff at hospitals and birthing centers to initiate breast/chestfeeding

"Breastfeeding can be challenging for new parents, and support from their families, doctors, and workplaces is essential," Dr. Meek said. "The health benefits are vast and can be viewed as a long-term investment not only in a child's development but to public health as a whole."

However, formula is also a great alternative if you can't chest/breastfeed, or if you simply don't want to.

Additional reporting by Nicole Harris
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