By: Mariellen Lane, MD
Learning Objectives:
1. Understand the role of the pediatrician in promoting and protecting breastfeeding.
2. Know the benefits of breastfeeding
3. Recognize common breastfeeding problems in the postpartum period and danger signs of impending medical complications.
Primary References:
1. Chandran L, Gelfer P. Breastfeeding: the essential principles. Pediatrics in Review. 2006: 27 (11): 409-16. (link)
2. American Academy of Pediatrics Section of Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2005: 115 (2):496-506. (link)
3. City Health Information (NYC DOMNH) 2008 - Breastfeeding
Secondary References:
1. Gartner LM, Greer FR. Prevention of rickets and vitamin D deficiency: new guidelines for vitamin D intake. Pediatrics 2003: 111:908.
2. Gartner LM, Morton J, Laurence RA et al. Breastfeeding and the use of human milk. Pediatrics 2005: 115:496.
3. Schanler RJ. Benefits of Breastfeeding. UpToDate Online 15.2.2007.
4. Hopkinson J, Schanler RJ, Common problems of breastfeeding in the postpartum period. UpToDate Online 15.2 2007.
5. Slusser W, Powers N. Breastfeeding update 1: Immunology, Nutrition and Advocacy. Pediatrics in Review. 1997: 18(4): 111-119.
6. Powers N, Slusser W. Breastfeeding update 2: Clinical Lactation Management. Pediatrics in Review. 1997; 18(5): 147 – 161.
7. USA Baby-Friendly initiative: www.babyfriendlyusa.org
8. Breastfeeding resource handout – see attachment from Audubon QI project in 2007
Resource: Breastfeeding Page from PDSA Audubon
To check whether a medication is compatible with breastfeeding: http://www.toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
QUESTIONS/CASES
1. Parents present in the 8th month of pregnancy to the pediatrician’s office for a prenatal visit. They are ambivalent about breastfeeding citing concerns about the risks of breastfeeding they read about in the local newspaper. In addition, no one in their family has ever breastfed an infant. However they have heard there are many health benefits to breastfeeding and in addition want to know if the hospital they are to deliver at is a Baby Friendly Hospital? Are there some situations when breastfeeding is contraindicated?
2. You have been notified by the obstetrics nurse that a mother is in labor who wants to breastfeed her new infant. The nurse asks you when is it safe to first nurse the baby? When you arrive to see the new infant on day of life one, what are some signs of successful early nursing? What are your expectations of nursing in the first 48 hours?When should you plan to see them after discharge?
3. The new mother and infant arrive in your office on DOL 4 with many concerns. The infant is fussy all night long, feeds constantly and mom can’t tell if he is getting enough breastmilk. She inquires if she should start supplementation and how will she know if her milk is in?
4. The new mother calls your nurse because her breasts are swollen and she feels like she has “the flu”. She wants to know if she should be concerned and can she keep nursing?
5. At the two month visit, the mother indicates that she is planning on returning to work but wants to keep breastfeeding. She notes that her baby seems to be feeding more frequently in the last 5 days. Has her milk supply dropped off? When is it okay to start the bottle? How long can she store expressed breastmilk? You discuss strategies for returning to work and give her a prescription for Vitamin D supplementation. The mother wonders if breast is best, why does she need to supplement? Should she worry about other vitamins or minerals? What if she were a vegan?
6. A medical student who is with you in clinic asks what are the differences between formula and breastmilk? He also wonders if premature infants receive breastmilk.
