Parents should breastfeed their children for up to two years or longer “as mutually desired by parent and child,” the American Academy of Pediatrics (AAP) recommends, as stated in the news release featuring new policy recommendations published this week. This is the first time this policy has been updated since 2012.
In this recommendation, the AAP maintained its advice that infants should be exclusively breastfed in the first six months of their lives but urges pediatricians to support parents in breastfeeding for two or more years in addition to eating solid foods, rather than the previous one year that was recommended.
The guidance is based on research that extended periods of breastfeeding may benefit the health of parents and infants. For parents, breastfeeding longer than 12 months can help decrease the risk of maternal type 2 diabetes mellitus, hypertension, breast cancer and ovarian cancer rates.
For infants, data confirms that otitis media, acute diarrheal disease, lower respiratory illnesses, sudden infant death syndrome (SIDS), inflammatory bowel disease, childhood leukemia, diabetes mellitus, obesity, asthma, and atopic dermatitis occur less frequently among those who were breastfed.
AAP addresses disparities in breastfeeding
However, the AAP recognizes that breastfeeding — especially for an extended period — may be challenging for a lot of families.
“The AAP views breastfeeding as a public health imperative and also as an equity issue,” said Lawrence Noble, MD, FAAP, FABM, IBCLC, co-author of the policy statement and technical report. “Pediatricians and other medical professionals can help mothers meet their intended goals for breastfeeding and provide care that is inclusive, equitable and culturally sensitive.”
The report states there are disparities in access and initiation to breastfeeding, such as:
- White, Latino and Asian families initiate breastfeeding at higher rates than Black families in the U.S., according to the CDC’s 2018 National Immunization Survey (NIS).
- Mothers who are low income.
- Women under the age of 20 years.
- Those with a high school education or less.
- Gender-diverse parents may have less access to human milk because of both social and biological constraints.
If parents are unable to breastfeed or choose not to, the AAP recommends for healthcare providers to support the decisions and needs of their individual patient families.
Of course, the ongoing formula shortage still poses a challenge for both breastfeeding and non-breastfeeding families, but the AAP also notes obstacles to breastfeeding like persisting stigma and lack of support for mothers, specifically in the workplace.
“We need societal changes that will help to support this, such as paid leave, more support for breastfeeding in public and child care facilities and workplace support,” says Joan Younger Meek, MD, MS, RD, FAAP, FABM, IBCLC, lead author of the policy statement, to The New York Times.
Recommendations for breastfeeding equity and support
To combat these stigmas and challenges, the AAP recommends:
- Better implementation of maternity care practices that improve breastfeeding initiation, duration and exclusivity at birth hospitals or centers.
- Support from medical care providers and protections against workplace barriers for mothers who choose to breastfeed beyond the first year.
- Policies that protect breastfeeding, including universal paid maternity leave; the right of a person to breastfeed in public; insurance coverage for lactation support and breast pumps; on-site childcare; universal workplace break time with a clean, private location for expressing milk; the right to feed expressed milk; and the right to breastfeed in childcare centers and lactation rooms in schools are all essential to supporting families in sustaining breastfeeding.
The AAP offers advice for parents on this new policy at healthychildren.org. Learn more about the APP’s updated policy on breastfeeding here.