Breastfeeding Handbook for Physicians

453 Pages·2023·11.085 MB·English

by  Richard Schanler, Lori Feldman-Winter, Joan Younger Meek, Sharon B. Mass, Lawrence Noble

Breastfeeding
Handbook
for Physicians
3rd Edition
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Published by the American Academy of Pediatrics
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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical
subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, chil-
dren, adolescents, and young adults.
The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of
medical care. Variations, taking into account individual circumstances, may be appropriate.
Statements and opinions expressed are those of the authors and not necessarily those of the American Academy of
Pediatrics.
While the terminology used in this publication often reflects the dyad of “mother” and newborn or infant, the
intent is to be inclusive of all parents, regardless of sex, gender, or sexual orientation.
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This publication has been developed by the American Academy of Pediatrics. The contributors are expert
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development of the content of this publication. Disclosures: Pamela Berens discloses a speaker bureau relationship
with the Texas Department of State Health Services and a site principal investigator relationship with a Duke
University study. Susan Crowe discloses a previous advisory board relationship with Sage Therapeutics. Gabriela
Maradiaga Panayotti discloses a consulting relationship with Aveeno, a speaker’s bureau relationship with Carolina
Global Breastfeeding Institute, and a spouse/partner with a speaker relationship with Boehringer Ingelheim and an
advisory board relationship with Genentech.
Every effort has been made to ensure that the drug selection and dosages set forth in this text are in accordance
with the current recommendations and practice at the time of publication. It is the responsibility of the health
care professional to check the package insert of each drug for any change in indications or dosage and for added
warnings and precautions.
Every effort is made to keep Breastfeeding Handbook for Physicians consistent with the most recent advice and
information available from the American Academy of Pediatrics.
Please visit www.aap.org/errata for an up-to-date list of any applicable errata for this publication.
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© 2023 American Academy of Pediatrics and The American College of Obstetricians and Gynecologists
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Printed in the United States of America
4-99/1122 1 2 3 4 5 6 7 8 9 10
MA0980
ISBN: 978-1-61002-442-6
eBook: 978-1-61002-443-3
Library of Congress Control Number: 2020932408
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Editorial Committee
Editor in Chief
Richard J. Schanler, MD, FAAP, FABM
Coeditors
Lori Feldman-Winter, MD, MPH, FAAP, FABM
Sharon B. Mass, MD, FACOG
Joan Younger Meek, MD, MS, RD, FAAP, FABM, IBCLC
Lawrence Noble, MD, FAAP, FABM, IBCLC
Staff
American Academy of Pediatrics
Mark Grimes
Jeff Mahony
Sunnah Kim, MS, RN, CPNP
Ngozi Onyema-Melton, MPH, CHES
Heather Babiar, MS
The American College of Obstetricians and Gynecologists
Christopher M. Zahn, MD
Jennifer Walsh
Ije Obidegwu, MPH
Syeda Lamiya Ahmed
Martha Hawley-Bertsch
Jennifer Hicks, MS
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Committees
American Academy of Pediatrics Section on Breastfeeding
Executive Committee, 2019–2020
Lori Feldman-Winter, MD, MPH, FAAP, FABM (Chair)
Maya Bunik, MD, MPH, FABM, FAAP
Ann Kellams, MD, IBCLC, FAAP, FABM
Lisa Stellwagen, MD, FAAP
Jennifer Thomas, MD, MPH, IBCLC, FABM, FAAP
Julie Ware, MD, MPH, FAAP, FABM, IBCLC
Committee Chairpersons
Joan Younger Meek, MD, MS, RD, FAAP, FABM, IBCLC
Lawrence Noble, MD, FAAP, FABM, IBCLC
Margaret G. Parker, MD, MPH, FAAP
Rose St. Fleur, MD, FAAP, FABM, IBCLC
The American College of Obstetricians and Gynecologists
Breastfeeding Expert Work Group, 2020–2021
Lauren E. Hanley, MD, IBCLC, FACOG (Chair)
Pamela D. Berens, MD, IBCLC, FABM, FACOG
Meredith Lee Birsner, MD, FACOG
Andrea Braden, MD, IBCLC, FACOG
Susan D. Crowe, MD, FABM, FACOG
Victoria L. Green, MD, JD, MBA, FACOG
Gail Herrine, MD, IBCLC, FABM, FACOG
Adetola F. Louis-Jacques, MD, FABM, FACOG
Sharon Mass, MD, FACOG
Edward R. Newton, MD, FABM, FACOG
Victoria Nichols-Johnson, MD, MS, FACOG
Susan D. Rothenberg, MD, IBCLC, FACOG, FABM
Alison Stuebe, MD, MSc, FACOG
Joan Younger Meek, MD, MS, RD, FAAP, FABM, IBCLC (AAP Liaison)
Jamie H. Bardwell, MPP (Public Member)
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Contributors
Philip O. Anderson, PharmD, FCSHP, FASHP
University of California, San Diego, Skaggs School of Pharmacy and
Pharmaceutical Sciences
La Jolla, CA
Pamela D. Berens, MD, FACOG, IBCLC, FABM
McGovern Medical School at UT Health
Houston, TX
Maya Bunik, MD, MPH, FABM, FAAP
University of Colorado School of Medicine
Children’s Hospital Colorado
Aurora, CO
Cindy Calderon, MD, FAAP
Past President, Puerto Rico Chapter, American Academy of Pediatrics
Clinical Director, COVID-19 Vaccination, Puerto Rico College of Physicians
San Juan, PR
Susan D. Crowe, MD, FACOG
Stanford University School of Medicine
Stanford, CA
Lori Feldman-Winter, MD, MPH, FAAP, FABM
Cooper University Health Care
Cooper Medical School of Rowan University
Camden, NJ
Lauren Hanley, MD, FACOG, IBCLC, FABM
Harvard Medical School
Massachusetts General Hospital
Boston, MA
Daniel S. Hirsch, MD, FAAP
Columbia University Irving Medical Center
New York, NY
Ann Kellams, MD, IBCLC, FAAP, FABM
University of Virginia School of Medicine
Charlottesville, VA
Michelle L. Leff, MD, FAAP, IBCLC
University of California, San Diego, School of Medicine
San Diego, CA
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Contributors
Adetola F. Louis-Jacques, MD, FABM, FACOG
University of Florida College of Medicine
Gainesville, FL
Sharon Mass, MD, FACOG
Sidney Kimmel Medical College of Thomas Jefferson University
Philadelphia, PA
Kathryn S. McLeod, MD, FAAP, IBCLC
Medical College of Georgia at Augusta University
Augusta, GA
Joan Younger Meek, MD, MS, RD, FAAP, FABM, IBCLC
Florida State University College of Medicine
Orlando, FL
Edward R. Newton, MD, FABM, FACOG
East Carolina University Brody School of Medicine
Greenville, NC
Lawrence Noble, MD, FAAP, FABM, IBCLC
Icahn School of Medicine at Mount Sinai and New York City
Health+Hospitals/Elmhurst
Elmhurst, NY
Gabriela Maradiaga Panayotti, MD, FAAP, IBCLC
Duke University Medical Center
Durham, NC
Margaret G. Parker, MD, MPH, FAAP
Boston Medical Center
Boston University School of Medicine
Boston, MA
Susan Rothenberg, MD, IBCLC, FACOG, FABM
Icahn School of Medicine at Mount Sinai
New York, NY
Richard J. Schanler, MD, FAAP, FABM
Cohen Children’s and Northwell Health
Zucker School of Medicine at Hofstra/Northwell
New Hyde Park, NY
Emily K. Scott, MD, MS, FAAP, IBCLC
Indiana University School of Medicine
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Contributors
Indianapolis, IN
Rose St. Fleur, MD, FAAP, FABM, IBCLC
Jersey Shore University Medical Center
Neptune, NJ
Lisa Stellwagen, MD, FAAP
University of California, San Diego, School of Medicine
San Diego, CA
Jennifer Thomas, MD, MPH, IBCLC, FABM, FAAP
Advocate Aurora Healthcare
Milwaukee, WI
Julie Ware, MD, MPH, FAAP, FABM, IBCLC
Cincinnati Children’s Hospital Medical Center
Cincinnati, OH
Michal A. Young, MD, FAAP, FABM
Howard University College of Medicine/Howard University Hospital
Washington, DC
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American Academy of Pediatrics Reviewers
Board of Directors Reviewer
Michelle D. Fiscus, MD, FAAP
Committees, Councils, and Sections
Committee on Child Health Financing
Committee on Drugs
Committee on Fetus and Newborn
Committee on Infectious Diseases
Committee on Medical Liability and Risk Management
Committee on Nutrition
Committee on Pediatric and Adolescent HIV
Committee on Practice and Ambulatory Medicine
Committee on Psychosocial Aspects of Child and Family Health
Council on Children and Disasters
Council on Children With Disabilities
Council on Community Pediatrics
Council on Environmental Health and Climate Change
Council on Genetics
Council on Injury, Violence, and Poison Prevention
Council on Quality Improvement and Patient Safety
Section on Administration and Practice Management
Section on Allergy and Immunology
Section on Early Career Physicians
Section on Endocrinology
Section on Epidemiology, Public Health, and Evidence
Section on Gastroenterology, Hepatology, and Nutrition
Section on Hospital Medicine
Section on Lesbian, Gay, Bisexual, and Transgender Health and Wellness
Section on Neonatal-Perinatal Medicine
Section on Nicotine and Tobacco Prevention and Treatment
Section on Obesity
Section on Oral Health
Equity, Diversity, and Inclusion Statement
The American Academy of Pediatrics is committed to principles of equity,
diversity, and inclusion in its publishing program. Editorial boards, author
selections, and author transitions (publication succession plans) are designed to
include diverse voices that reflect society as a whole. Editor and author teams are
encouraged to actively seek out diverse authors and reviewers at all stages of the
editorial process. Publishing staff are committed to promoting equity, diversity,
and inclusion in all aspects of publication writing, review, and production.
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Contents
Preface ...................................................................................................................xiii
1 Evidence for Breastfeeding: Importance for Newborns and Infants,
Mothers, and Society ..........................................................................1
Risk Reductions in Breastfeeding Newborns and Infants .......................1
Risk Reductions of Breastfeeding for the Mother .................................13
Societal Effects of Breastfeeding ............................................................17
2 The Scope of Breastfeeding ..................................................................23
Categories of Breastfeeding ....................................................................24
Breastfeeding in the United States ........................................................25
Breastfeeding Education .........................................................................36
Ethics ......................................................................................................44
Custody Rights .......................................................................................47
Recommended Practices ........................................................................52
3 Composition of Human Milk ...............................................................55
Nutritional Components .......................................................................55
Nitrogen ..................................................................................................59
Whey and Casein ...................................................................................60
Carbohydrates .........................................................................................60
Lipids .......................................................................................................60
Variability of Fat Content ......................................................................61
Components of the Lipid System ..........................................................61
Fat Absorption ........................................................................................61
Bile Salt-Stimulated Lipase ....................................................................61
Fatty Acids ..............................................................................................62
Too Much Foremilk ................................................................................62
Minerals and Trace Elements .................................................................62
Vitamins ..................................................................................................63
4 Nonnutritive Components in Human Milk .......................................65
Bioactive Proteins ..................................................................................65
Osteopontin ............................................................................................68
Bioactive Lipids ......................................................................................69
Bioactive Carbohydrates ........................................................................69
Cellular Elements ...................................................................................70
Human Milk Microbiota ........................................................................70
Nucleotides .............................................................................................72
MicroRNA .............................................................................................72
Hormones and Growth Factors .............................................................72
Entero-mammary and Broncho-mammary Immune Pathways ............73
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