The current recommendations of the American Academy of Pediatrics (AAP) on the beginning of breastfeeding cover a fairly wide range of restrictions and requirements. All of them are to various extents aimed at ensuring the maximum safety of the mother and child during the feeding process, as well as at achieving maximum benefit for the newborn. The main recommendations of the American Academy of Pediatrics are that children should be exclusively breastfed or receive expressed mother’s milk during the first six months of life. Continuation of breastfeeding after this period is also desirable, but the decision should be made depending on the individual characteristics of the mother and child.
In 2022, the AAP, together with the World Health Organization (WHO) and the American Academy of Family Physicians (AAFP), published a new list of recommendations, according to which the breastfeeding time for newborns is extended. Despite the reduced level of potassium and zinc in the mother’s milk after a year of feeding, the total content of protein, lysozyme and lactoferrin remain unchanged, and sometimes even increase (Cuffari, 2022). In this regard, the recommended feeding time increases to two years with the possible gradual introduction of complementary foods after six months.
Before starting breastfeeding, the nursing parent should identify all factors in their medical history that may somehow prevent the continuation of breastfeeding after the recommended period. The need to take medications often does not become a sufficient reason for stopping breastfeeding, since it is possible to use a number of safe analogues. The exception is cancer treatment, which requires the use of antimetabolites. HIV patients are also not recommended to breastfeed because of the possible risk of transmission of the disease to the infant through emerging wounds. If the patient’s state of health is still suspicious, the possibility of breastfeeding remains under consideration until consultation with a specialist and receiving new advice, taking into account the identified factors.
The AAP recommends taking no less care of the well-being of a mother considering the need for breastfeeding. This includes, first of all, recognizing cultural characteristics that should not be ignored by the consulting doctor when analyzing the patient’s health. The expectant mother should be in a comfortable and safe environment to positively influence the prenatal intention to breastfeed. For the same purpose, the decision to start breastfeeding should be made before conception or as early as possible during pregnancy, so that the subsequent lifestyle does not affect the quality of mother’s milk.
The continuation of breastfeeding for up to two years has a substantial positive value for the body of the newborn. The effect of such feeding remains long-term and persists until the child reaches adulthood. The continuation of breastfeeding after six months and the refusal to add infant formula to the diet supply the child’s body with protein, lactose, and fat (Cuffari, 2022). This helps to reduce the risk of developing leukemia, develops a strong immune system and protects the child from cardiovascular diseases. In addition, it has a positive effect on the development of the respiratory tract, asthma and diarrhea. Moreover, the positive effect of breastfeeding is reflected in the reduction of the risk of sudden infant death syndrome, which was reduced by 64% in children who have been breastfed for more than six months (Cuffari, 2022). Consequently, it is feasible to assume that a major positive repercussion of a systematized and organized process of breastfeeding can firstly cause health improvements both among mothers and their children.
Furthermore, breastfeeding benefits the mother, who in this way increases her emotional and psychological attachment to the baby. Prolonged presence next to the child helps the mother to better recognize the nonverbal signals of the child in the future, which improves their relationship and builds trust at the initial stage. Additionally, studies find a medical justification for the need for breastfeeding. Thus, mothers significantly reduce their risk of developing diabetes, hypertension and thyroid or breast cancer (Cuffari, 2022). In this case, it is compulsory to note that mothers’ health and wellbeing should not be disregarded since a considerable amount of attention is dedicated solely to the health aspects of breastfeeding in infants.
The accepted guidelines for baby feeding and health are breastmilk and natural types of human development. According to the overall propositions of the AAP, WHO, and AAFP, human milk distribution is essential for public wellbeing due to breastfeeding’s short- and long-lasting medicinal and neurodevelopmental benefits (Meek & Noble, 2022a). For almost six months following childbirth, the American Academy of Pediatrics advises continuous breastfeeding (Meek & Noble, 2022a). The AAP generally encourages mothers to remain breastfeeding their children for as long as both parties wish, which is generally for two years or longer, coupled with the introduction of suitable complementary meals around six months (Meek & Noble, 2022a). These suggestions are in line with those officially declared by the World Health Organization, and there are seldom any medical reasons not to breastfeed (Meek & Noble, 2022a). The AAP advises maternity hospitals or facilities to employ prenatal care procedures that have been proved to increase breastfeeding start, intensity, and length (Meek & Noble, 2022a). Hence, considering the fundamental part of the recommendations, it is feasible to state that they are mostly based on medical and biological advantages provided by breastfeeding consequences.
One of the major benefits regarding the united recommendations connected to breastfeeding and its positive health implications is the highlighted need for improving training, education, and development procedures among pediatricians. The established criteria for infant feeding and nourishment are breastfeeding solutions or other types of milk replacer (Meek et al., 2022b). The AAP encourages mothers to continue breastfeeding their children for as long as both parties wish, which is typically for two years or longer, coupled with the introduction of suitable complementary meals at six months (Meek et al., 2022b). Breastfeeding procedures in United States hospitals are monitored by The Joint Commission and the Centers for Disease Control and Prevention (CDC) (Meek et al., 2022b). As breastfeeding supporters, pediatricians and physicians in the field of pediatrics play a vital role in institutions, their organizations, and communities (Meek et al., 2022b). As a result, they require instruction in regulating breastfeeding as well as the advantages of breastfeeding for women and infants (Meek et al., 2022b). In fact, due to the importance of pediatrics specialists in working with mothers that would potentially prefer breastfeeding or are currently hesitating, their expertise is crucial.
The workers in the field of healthcare possess different kinds of practical tools and skills that can assist them in dealing with a wide range of questions linked to breastfeeding, its benefits and shortcomings. In actuality, breastfeeding has long been endorsed by the American Academy of Family Physicians (AAFP) and the necessity of discussing this concept was approved (Chuisano & Anderson, 2020). There is practically no distinction if pediatricians and specialists deliver maternity care or not, all family doctors play a special role in supporting breastfeeding (Esselmont et al., 2018). They appreciate the benefits of family-centered healthcare and are qualified to promote breastfeeding in that setting.
In other terms, emphasizing family practitioners, the recommendations of various institutions regarding breastfeeding aspects initially influence this segment of healthcare personnel. Family doctors have the chance to inform and encourage all members of various family about breastfeeding all across their lives since they offer adequate services to the entire family (Chuisano & Anderson, 2020). Nevertheless, doctors, even family doctors, do not obtain enough instruction in promoting breastfeeding regardless of the increasing proof of the health effects of the absence of breast-feeding (Chuisano & Anderson, 2020). In overall, this aspect of the breastfeeding recommendations can be assessed as both a benefit and a drawback since it underlines the lack of competences and training among specialists that can possibly influence the society. At the same time, this issue represents a benefit of the recommendations since it offers a clear vision regarding the probable perspectives that occur in the sphere of educating professionals in the questions of breastfeeding.
Family doctors need to be knowledgeable about how breastfeeding affects both parents’ and infants’ wellness. The amount of information and grade of the study on health consequences begin to expand, and multiple review papers outlining the data for breastfeeding’s contribution to the best possible health results have been released (Centers for Disease Control and Prevention, 2020). Infants who are not breastfed are more likely to develop common illnesses such as acute otitis medium, diarrhea, and contact dermatitis (Centers for Disease Control and Prevention, 2020). In addition, it is possible to mention conditions that pose a risk of mortality, including acute lower and upper respiratory infections, gastrointestinal bleeding, and sudden infant death syndrome (SIDS) (Louis-Jacques & Stuebe, 2020). Moreover, after the period of breastfeeding has ended, the positive impacts on health continue due to the influence on the immune system, which tends to possess long-term effects (Louis-Jacques & Stuebe, 2020). Hence, the recommendations regarding the promotion of breastfeeding are linked to the benefits that underline the increased risk of the occurrence of various illnesses in children that were not breast fed, as per the researches.
Moreover, it is obligatory to turn to the part of the proposals encouraged by the World Health Organization since this international institution generates multiple studies and data reviews on a regular basis. A WHO assessment revealed that children who were not breastfed had poorer IQ test performance, greater average blood pressure, an increased likelihood of type 2 diabetes, and a risen probability of obesity (Ross & Desai, 2021). An infant who is not fed with maternal milk additionally has a higher chance of developing type 1 diabetes, eczema, and pediatric leukemia (Louis-Jacques & Stuebe, 2020). When contrasted to three to four months, the data base similarly demonstrates the value of six months of total breastfeeding as a means of preventing digestive and respiratory illnesses (Pattison et al., 2019). Therefore, a substantial number of sicknesses and infections can potentially occur in case essential breastfeeding methods are not applied, according to the scholars and their analysis.
In terms of other benefits connected to AAP, WHO, and AAFP breastfeeding conclusions and recommendations, it is possible to state that socioeconomic, ecological, and political factors should be considered due to the direct relationship, correlation. Additionally, breastfeeding has wider economic and social advantages, and inadequate breastfeeding length or non-breastfeeding result in higher healthcare expenses for both youngsters and their parents (Pérez‐Escamilla et al., 2022). Furthermore, breastfeeding is eco-friendly since it generates no pollution and waste, requires no product shipping or packaging, and does not need the use of pasture space for cows (Miller, 2020). Thus, in this situation, economic implications can include logistic and supply chain aspects that can heavily impact socioeconomic processes.
Furthermore, it is necessary to emphasize the notions linked to milk manufacturing and production facilities since they are initially influenced by the breastfeeding initiatives and deviations in the level of the support of the conception. Enhanced newborn and adult health is correlated with higher breastfeeding levels, which in addition contribute to lower greenhouse gas emissions and diminish the environmental effect of dietary alternatives (Samiee et al., 2019). Relative to breastfeeding, milk manufacturing has a higher carbon output and utilizes a significant amount of water (Soti-Ulberg et al., 2020). In relation to promoting the health of both parents and children, breastfeeding has positive effects on the economy and the ecosystem (González de Cosío et al., 2018). Mother’s milk is a continuously natural resource that does not need to be packaged, shipped, or disposed of, therefore breastfeeding does not squander limited resources or cause pollution (Natan et al., 2018). Ecological aspects are essential in this scenario since currently they comprise a separate part of the world’s socioeconomic network and are connected to the recommendations regarding the promotion of breastfeeding.
As an important part of the organizations’ propositions and pieces of advice, it is necessary to mention the benefit that is directed to the calls to actions for pediatricians and family physicians. Approximately all infants should indeed be solely breastfed or given mother’s milk during the first six months of their lives (American Academy of Family Physicians, 2017). Breastfeeding can be prolonged for the minimal period of the first year, along with the proper supplementary diets, such as meals high in iron (American Academy of Family Physicians, 2017). When breastfeeding is continued for totally several years, health results for mothers and newborns are at their optimum. Family doctors should keep themselves informed on the most recent research and recommended procedures to properly guide individuals that are breastfeeding (U.S. Department of Health and Human Services, 2019). Doctors, healthcare practitioners, and any other medical personnel who routinely treat mothers and infants should be equipped to offer support for both routine breastfeeding and typical breastfeeding difficulties (U.S. Department of Health and Human Services, 2019). Families should be directed to a specialist with relevant training when difficulties transcend the family physician’s scope of practice.
It is obligatory to highlight the benefits of the recommendations for the practice level in terms of healthcare professionals and family physicians that have a possibility to contribute to the promotion of breastfeeding. Infant-friendly practices should be implemented at birthing facilities and hospitals, and infants should be remained close to their parents until at minimum the initial successful breastfeeding (American Academy of Family Physicians, 2017). Procedures in maternity care should encourage breastfeeding, ideally by adhering to the detailed guidelines for effective breastfeeding (Melnitchouk et al., 2018a). Additionally, mothers and infants should be monitored by medical specialists who are familiar with breastfeeding and nursing activities (Meek & Hatcher, 2018). Breastfed infants should exclusively get supplement products when medically necessary (Green et al., 2021). By offering breastfeeding mothers free formula trials or discounts, family doctors should not promote breastfeeding (American Academy of Family Physicians, 2017). Especially it is crucial in case they do not offer prenatal care family doctors should set up a breastfeeding-friendly practice (American Academy of Family Physicians, 2017). Family doctors should support breastfeeding and instruct patients and their families on the benefits of breastfeeding at all stages of lifecycle.
Concerning the section of the paper dedicated to the drawbacks and disadvantages of the recommendations provided by the AAFP, AAP, and WHO organizations, it is feasible to state that ethical issues are not totally covered. Considering various questions regarding breastfeeding, ethical issues and dilemmas that can potentially arise are not addressed well due to the lack of clarity and specification of the problems. Despite laws stating the necessity for lactation intervals and sufficient room to pump, US doctors who are parents may be especially significant at risk for not actually completing their breastfeeding objectives (Perumalswami & Laventhal, 2018). Merely 19.7% of the pediatrician mothers interviewed in a study conducted by Melnitchouk and associates indicated they utilized lactation facilities at workplace to release breast milk (Melnitchouk et al., 2018b). Ethics-related concerns should be taken into account since other participants utilized their offices, conference rooms, unoccupied patient rooms, restrooms, shower facilities, closets, and automobiles (Perumalswami & Laventhal, 2018). Hence, the presence of the negative part of the recommendations is proved by evidence from scholarly sources, which underlines the occurrence of ethical concerns.
One dilemma is whether it is ethically correct for both parent and child to be at danger from poor institutional breastfeeding assistance. The threat of physical damage to the mother increases when she is unable to handle the ongoing physical requirements of breastfeeding (Oosterhoff et al., 2022). In addition to clogged ducts and abscesses, postponed milk secretion can cause fever, discomfort, missed productivity, and, in exceptionally serious forms, life-threatening problems (Oosterhoff et al., 2022). Further hazards are posed by pumping while riding, driving or in locations where security and hygiene are not guaranteed. It is advised to feed newborns exclusively human milk to promote their well-being and development, and breastfeeding can actually be life-saving for certain children, particularly those with immunodeficiencies or dairy allergies. Accordingly, improper weaning might pose a health danger to the children, including the infants of doctors.
Another concern is how women who are doctors should handle the conflict between their personal demands and their fiduciary responsibility to patients, especially when multitasking is practically impossible. Entering a code, finishing an operation, reacting to a shift in clinical characteristics, or caring for a patient who is starting to die of natural causes are a few examples of situations. Organizational strategies for improving breastfeeding activities are required to assist doctors without sacrificing patient results (Hoskins & Schmidt, 2021). These, nevertheless, will not properly alleviate worries concerning how, for example, mothers who are doctors should combine their demands with the requirements of their infants and patients.
Another negative part of the overall recommendations is connected to the presence of various contraindications and special considerations that can impose potential risks and threats. During infants’ stay in the medical facility and in the aftercare environment, they should to be closely watched for indications of withdrawal and for healthy weight growth (Weld et al., 2022). Marijuana usage by pregnant women is not advised since there is not enough research to determine the consequences of newborn exposure. Women should be made aware of the possible risks, especially the dangers of passive smoking (Weld et al., 2022). Mothers who are breastfeeding should be aggressively urged to refrain from smoking and reduce exposure to the surroundings (Weld et al., 2022). However, U.S. mothers should not breastfeed or pump milk to children if they suffer from infectious disease, uncontrolled brucellosis, or proven Ebola virus illness, even though the majority of maternal diseases are consistent with nursing. Thus, in this particular case, healthcare issues should be clearly addressed in a detailed manner due to the severity of possible harmful consequences both for the mother and the child.
To summarize, the present constraints and prerequisites for starting breastfeeding are covered by the AAP, AAFP, and WHO organizations’ guidelines. Each of them aims, in varying degrees, to provide the mother and child’s optimal protection and the newborn’s highest degree of benefit during the feeding procedure. Throughout the initial six months of life, infants should either be exclusively breastfed or given expressed mother’s milk, according to the primary standards. Considering the benefits, it is feasible to emphasize the highlighted need and opportunities for improving and advancing the system of pediatricians and physicians training and development, which will potentially positively influence breastfeeding processes. Moreover, it is conceivable to say that social, ecological, and political aspects should be acknowledged due to direct association with the AAP, WHO, and AAFP breastfeeding results and recommendations. Regarding the negatives, ethical issues and dilemmas are not fully covered and additional focus on these problems is required. Furthermore, health contraindications can cause serious concerns if not recognized and dealt with properly.
American Academy of Family Physicians. (2017). Hospital use of infant formula in breastfeeding infants. Web.
Centers for Disease Control and Prevention. (2020). Key breastfeeding indicators. Web.
Chuisano, S. A., & Anderson, O. S. (2020). Assessing application-based breastfeeding education for physicians and nurses: a scoping review. Journal of Human Lactation, 36(4), 699-709. Web.
Cuffari, B. (2022). AAP recommends breastfeeding for 2 years. News Medical. Web.
Esselmont, E., Moreau, K., Aglipay, M., & Pound, C. M. (2018). Residents’ breastfeeding knowledge, comfort, practices, and perceptions: results of the Breastfeeding Resident Education Study (BRESt). BMC Pediatrics, 18(1), 1-7. Web.
González de Cosío, T., Ferré, I., Mazariegos, M., Pérez-Escamilla, R., & BBF Mexico Committee. (2018). Scaling up breastfeeding programs in Mexico: Lessons learned from the becoming breastfeeding friendly initiative. Current Developments in Nutrition, 2(6). Web.
Green, V. L., Killings, N. L., & Clare, C. A. (2021). The historical, psychosocial, and cultural context of breastfeeding in the African American community. Breastfeeding Medicine, 16(2), 116–120. Web.
Hoskins, K., & Schmidt, H. (2021). Breastfeeding, personal responsibility and financial incentives. Public Health Ethics, 14(3), 233-241. Web.
Louis-Jacques, A. F., & Stuebe, A. M. (2020). Enabling breastfeeding to support lifelong health for mother and child. Obstetrics and Gynecology Clinics, 47(3), 363-381. Web.
Meek, J. Y., & Hatcher, A. J. (2018). The breastfeeding-friendly pediatric office practice. Breastfeeding: Support, Challenges, and Benefits, 10–18. Web.
Meek, J. Y., & Noble, L. (2022a). Policy statement: Breastfeeding and the use of human milk. Pediatrics, 150(1). Web.
Meek, J. Y., & Noble, L. (2022b). Technical report: Breastfeeding and the use of human milk. Pediatrics, 150(1). Web.
Melnitchouk, N., Scully, R. E., & Davids, J. S. (2018a). Barriers to breastfeeding for us physicians who are mothers. JAMA Internal Medicine, 178(8), 1130. Web.
Melnitchouk, N., Scully, R. E., & Davids, J. S. (2018b). Ethical issues related to breastfeeding for us physicians who are mothers—reply. JAMA Internal Medicine, 178(7), 1002. Web.
Miller, E. M. (2020). The ecology of breastfeeding and mother-infant immune functions. The Mother-Infant Nexus in Anthropology, 85-101. Web.
Natan, M. B., Haikin, T., & Wiesel, R. (2018). Breastfeeding knowledge, attitudes, intentions, and perception of support from educational institutions among nursing students and students from other faculties: A descriptive cross-sectional study. Nurse Education Today, 68, 66-70. Web.
Oosterhoff, A. T., Sellen, D., & Haisma, H. (2022). The content and sources of breastfeeding knowledge for new mothers in the Netherlands. The Open Nursing Journal, 16(1). Web.
Pattison, K. L., Kraschnewski, J. L., Lehman, E., Savage, J. S., Downs, D. S., Leonard, K. S., Adams, E. L., Paul, I. M., & Kjerulff, K. H. (2019). Breastfeeding initiation and duration and child health outcomes in the first baby study. Preventive Medicine, 118, 1–6. Web.
Pérez‐Escamilla, R., Dykes, F. C., & Kendall, S. (2022). Gearing to success with national breastfeeding programmes: The Becoming Breastfeeding Friendly (BBF) initiative experience. Maternal & Child Nutrition, e13339. Web.
Perumalswami, C. R., & Laventhal, N. T. (2018). Ethical issues related to breastfeeding for US physicians who are mothers. JAMA Internal Medicine, 178(7), 1001. Web.
Ross, M. G., & Desai, M. (2021). Association of breastfeeding and child IQ score at age 5 years. Obstetrics & Gynecology, 138(1), 135. Web.
Samiee, F., Vahidinia, A., Javad, M. T., & Leili, M. (2019). Exposure to heavy metals released to the environment through breastfeeding: A probabilistic risk estimation. Science of the Total Environment, 650, 3075-3083. Web.
Soti-Ulberg, C., Hromi-Fiedler, A., Hawley, N. L., Naseri, T., Manuele-Magele, A., Ah-Ching, J., & Pérez-Escamilla, R. (2020). Scaling up breastfeeding policy and programs in Samoa: application of the Becoming Breastfeeding Friendly initiative. International Breastfeeding Journal, 15(1), 1-10. Web.
U.S. Department of Health and Human Services. (2019). Supporting nursing moms at work. Web.
Weld, E. D., Bailey, T. C., & Waitt, C. (2022). Ethical issues in therapeutic use and research in pregnant and breastfeeding women. British Journal of Clinical Pharmacology, 88(1), 7-21. Web.