5. There are no data to support routinely culturing human milk for bacterial or other organisms.151
WHO/UNICEF Ten Steps to Successful Breastfeeding
1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
2. Train all health care staff in the skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within the first hour of birth.
5. Show mothers how to breastfeed and how to maintain lactation even if they are separated from their infants.
6. Give newborn infants no food or drink other than breast milk, unless medically indicated.
7. Practice rooming-in (allow mothers and infants to remain together) 24 h a day.
8. Encourage breastfeeding on demand.
9. Give no artificial nipples or pacifiers to breastfeeding infants.a
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospital.
↵a The AAP does not support a categorical ban on pacifiers because of their role in SIDS risk reduction and their analgesic benefit during painful procedures when breastfeeding cannot provide the analgesia. Pacifier use in the hospital in the neonatal period should be limited to specific medical indications such as pain reduction and calming in a drug-exposed infant, for example. Mothers of healthy term breastfed infants should be instructed to delay pacifier use until breastfeeding is well-established, usually about 3 to 4 wk after birth.
Recommendations on Breastfeeding Management for Healthy Term Infants
1. Exclusive breastfeeding for about 6 mo
• Breastfeeding preferred; alternatively expressed mother’s milk, or donor milk
• To continue for at least the first year and beyond for as long as mutually desired by mother and child
• Complementary foods rich in iron and other micronutrients should be introduced at about 6 mo of age
2. Peripartum policies and practices that optimize breastfeeding initiation and maintenance should be compatible with the AAP and Academy of Breastfeeding Medicine Model Hospital Policy and include the following:
• Direct skin-to-skin contact with mothers immediately after delivery until the first feeding is accomplished and encouraged throughout the postpartum period
• Delay in routine procedures (weighing, measuring, bathing, blood tests, vaccines, and eye prophylaxis) until after the first feeding is completed
• Delay in administration of intramuscular vitamin K until after the first feeding is completed but within 6 h of birth
• Ensure 8 to 12 feedings at the breast every 24 h
• Ensure formal evaluation and documentation of breastfeeding by trained caregivers (including position, latch, milk transfer, examination) at least for each nursing shift
• Give no supplements (water, glucose water, commercial infant formula, or other fluids) to breastfeeding newborn infants unless medically indicated using standard evidence-based guidelines for the management of hyperbilirubinemia and hypoglycemia
• Avoid routine pacifier use in the postpartum period
• Begin daily oral vitamin D drops (400 IU) at hospital discharge
3. All breastfeeding newborn infants should be seen by a pediatrician at 3 to 5 d of age, which is within 48 to 72 h after discharge from the hospital
• Evaluate hydration (elimination patterns)
• Evaluate body wt gain (body wt loss no more than 7% from birth and no further wt loss by day 5: assess feeding and consider more frequent follow-up)
• Discuss maternal/infant issues
• Observe feeding
4. Mother and infant should sleep in proximity to each other to facilitate breastfeeding
5. Pacifier should be offered, while placing infant in back-to-sleep-position, no earlier than 3 to 4 wk of age and after breastfeeding has been established
Role of the Pediatrician
1. Promote breastfeeding as the norm for infant feeding.
2. Become knowledgeable in the principles and management of lactation and breastfeeding.
3. Develop skills necessary for assessing the adequacy of breastfeeding.
4. Support training and education for medical students, residents and postgraduate physicians in breastfeeding and lactation.
5. Promote hospital policies that are compatible with the AAP and Academy of Breastfeeding Medicine Model Hospital Policy and the WHO/UNICEF “Ten Steps to Successful Breastfeeding.”
6. Collaborate with the obstetric community to develop optimal breastfeeding support programs.
7. Coordinate with community-based health care professionals and certified breastfeeding counselors to ensure uniform and comprehensive breastfeeding support.