1. Have a written breastfeeding-friendly 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 1 hour of birth.
5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
6. Give infants no food or drink other than breast milk, unless medically indicated.
7. Practice rooming in: allow mothers and infants to remain together 24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no pacifiers or artificial nipples to breastfeeding infants.a
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center.
↵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, calming in a drug-exposed infant, etc. For breastfed infants, pacifier introduction should be delayed until breastfeeding is firmly established. Infants who are not being directly breastfed can begin pacifier use as soon as desired.
Relevant Steps in the US Surgeon General’s Call to Action to Support Breastfeeding
1. Give mothers the support they need to breastfeed their infants.
6. Ensure that the marketing of infant formula is conducted in a way that minimizes its negative impacts on exclusive breastfeeding.
8. Develop systems to guarantee continuity of skilled support for lactation between hospitals and health care settings in the community.
9. Provide education and training in breastfeeding for all health professionals who care for women and children.
10. Include basic support for breastfeeding as a standard of care for midwives, obstetricians, family physicians, nurse practitioners, and pediatricians.
11. Ensure access to services provided by IBCLCs.
Shown are action steps that apply directly to the pediatric outpatient practice, numbered according to the original steps in the Call to Action.8
Summary of Breastfeeding Supportive Office Practices
1. Have a written breastfeeding-friendly office policy
2. Train staff in breastfeeding support skills
3. Discuss breastfeeding during prenatal visits and at each well-child visit
4. Encourage exclusive breastfeeding for ∼6 months
5. Provide appropriate anticipatory guidance that supports the continuation of breastfeeding as long as desired
6. Incorporate breastfeeding observation into routine care
7. Educate mothers on breast-milk expression and return to work
8. Provide noncommercial breastfeeding educational resources for parents
9. Encourage breastfeeding in the waiting room, but provide private space on request
10. Eliminate the distribution of free formula
11. Train staff to follow telephone triage protocols to address breastfeeding concerns
12. Collaborate with the local hospital or birthing center and obstetric community regarding breastfeeding-friendly care