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Breastfeeding Support and Promotion Joan Younger Meek, MD, FAAP AAP Section on Breastfeeding.

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Presentation on theme: "Breastfeeding Support and Promotion Joan Younger Meek, MD, FAAP AAP Section on Breastfeeding."— Presentation transcript:

1 Breastfeeding Support and Promotion Joan Younger Meek, MD, FAAP AAP Section on Breastfeeding

2 Benefits of Breastfeeding Children Maternal Societal

3 Benefits of Breastfeeding Species specific Organic Norm for infant feeding Minimizes exposure to foreign protein Host protection Optimal development outcomes Photo © Roni M. Chastain, RN AAP Pediatrics 2012;129:e827-841.

4 Benefits of Breastfeeding Customized Promotes appropriate growth pattern Provides multiple hormones and growth factors Promotes mother-infant attachment Photo © Roni M. Chastain, RN

5 Immune Benefits Secretory IgA and other immunoglobulins Antiviral and antibacterial factors Cellular immune components Cytokines, including interleukins Enzymes Nucleotides

6 Childhood Growth Photo © Joan Younger Meek, MD, FAAP

7 Breastfeeding and Maternal Infant Health Outcomes in Developed Countries Current evidence demonstrates breastfeeding associated with reduction in risk of: Acute otitis media Non-specific gastroenteritis Severe lower respiratory tract infections Atopic dermatitis Asthma in young children Obesity Type 1 and type 2 diabetes Childhood leukemia Sudden infant death syndrome (SIDS) Necrotizing enterocolitis Ip S, et al: Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries, April 2007. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/tp/brfouttp.htm

8 Benefits of Breastfeeding “Dose Dependency” Acute otitis media 50% less with EBF > 3-6 months Atopic dermatitis 42% less with EBF > 3 months Gastroenteritis 64% less with any BF vs. none Lower respiratory tract disease and hospitalization 72% less with EBF > 4 months Asthma 40% less with BF > 3 months with positive family history Obesity 24% less with any BF Type 1 DM 30% less with BF > 3 months Type 2 DM 40% less with any BF vs. None Cancer: –Acute lymphocytic leukemia 20% less with BF >6 months –Acute myelogenous leukemia 15% less with BF >6 months SIDS 36% less with any BF > 1 month Ip S, Chung M, Raman G, et al. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. Rockville, MD: Agency for Healthcare Research and Quality, 2007. http://www.ahrq.gov/clinic/tp/brfouttp.htm AAP Pediatrics 2012;129;e827-41. EBF=Exclusive breastfeeding BF=Breastfeeding

9 Child Health Benefits Decreased rates of: Celiac disease Inflammatory bowel disease Hypertension Hypercholesterolemia AAP Pediatrics 2012;129;e827-41.

10 Childhood Obesity One of the most significant childhood health problems in the U.S. Affects 20% of children in the U.S., with up to 30% classified as overweight for age Incidence decreased in the breastfed population Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries, Structured Abstract. April 2007. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/tp/brfouttp.htm AAP Section on Breastfeeding: Breastfeeding and the Use of Human Milk, Pediatrics 2005;115:496-506. Evidence on the Long Term Effects of Breastfeeding: Systematic Reviews and Meta-analyses, World Health Organization 2007, Geneva, Switzerland. http://www.who.int/child-adolescent-health/publications/NUTRITION/ISBN_92_4_159523_0.htm

11 Breastfeeding and Obesity Obesity defined as a BMI > 95%ile for age Data from the Pediatric Nutrition Surveillance System 177,304 children followed up to 60 months Controlled for gender, ethnicity/race, BW Dose-responsive protective effect against obesity at age 4 years in non-Hispanic whites Greatest protection with breastfeeding for > 12 months Grummer-Strawn LM, Mei Z: Does Breastfeeding Protect Against Pediatric Overweight? Analysis of Longitudinal Data From the Centers for Disease Control and Prevention Pediatric Nutrition Surveillance System. Pediatrics 2004;113:81-86.

12 Obesity Prevention Encourage breastfeeding “Extent and duration of breastfeeding have been found to be inversely associated with risk of obesity in later childhood, possibly mediated by physiologic factors in human milk as well as by the feeding and parenting patterns associated with nursing.” AAP Policy Statement, Committee on Nutrition, Pediatrics 2003; 112:424-430.

13 Cognitive Benefits Human milk –Contains fatty acids, nucleotides, oligosaccharides, and taurine to enhance neural and retinal development –Enables child to reach full developmental potential Human milk fat –Provides essential fatty acids –Provides long-chain polyunsaturated fatty acids, including docosahexaenoic acid (DHA) and arachidonic acid (ARA)

14 Breastfeeding Outcomes for Premature Infants Lower rates of –Sepsis –Nectrotizing enterocolitis –Retinopathy of prematurity –Metabolic syndrome –Blood pressure –Low-density lipoprotein levels Improved –Leptin and insulin metabolism –Neurodevelopmental outcomes AAP Pediatrics 2012;129:e827-841.

15 Maternal Health Outcomes from Breastfeeding Decreased postpartum bleeding More rapid uterine involution Decreased menstrual blood loss Increased child spacing Photo © Amy Kotler, MD, FAAP AAP Pediatrics 2012;129:e827-841.

16 Maternal Benefits of Breastfeeding Type 2 diabetes mellitus 4-12% less for each year of BF for women w/out history gestational DM Pre-menopausal breast cancer 4.3-28% less for each year of BF Ovarian cancer 21% less for any vs. no BF and evidence for dose response Postpartum depression less for short term BF vs. no breastfeeding Ip S et al: Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries, April 2007. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/tp/brfouttp.htm BF=Breastfeeding

17 Maternal Outcomes Breastfeeding associated with decreased risk of rheumatoid arthritis obesity cardiovascular disease AAP Pediatrics 2012;129:e827-841.

18 Lactational Amenorrhea Method Have mother’s menses returned? Is mother supplementing regularly or allowing long periods without breastfeeding? Is the baby older than 6 months? There is a 1%–2% risk of pregnancy. Yes Advise another method of family planning. No Reprinted from Contraception. 1997;55:328, Multicenter study of the Lactational Amenorrhea Method (LAM): I. Efficacy, duration,and implications for clinical application, Labbok MH et al, with permission from Elsevier No Yes

19 The Economic Benefits of Breastfeeding U.S. Department of Agriculture $3.6 billion dollars would be saved annually if US breastfeeding rates increased to that recommended in Healthy People 2010 guidelines Projected figures were based on analysis of decreased otitis media, gastroenteritis, and necrotizing enterocolitis cost savings only J Weimer: U.S.D.A., Food Assistance and Nutrition Research Report No. 13, March 2001 http://www.ers.usda.gov/publications/fanrr13

20 Burden of Suboptimal Breastfeeding in the US Analyzed saving for those conditions validated by the AHRQ report: –necrotizing enterocolitis –otitis media –gastroenteritis –hospitalization for lower respiratory tract infections –atopic dermatitis –sudden infant death syndrome –childhood asthma –childhood leukemia –type 1 diabetes mellitus (type 2 DM excluded) –childhood obesity Bartick M: The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis. Pediatrics online April 2010.

21 Burden of Suboptimal Breastfeeding in the US Results: If 90% of US families could comply with medical recommendations to breastfeed exclusively for 6 months, the United States would save $13 billion per year and prevent an excess 911 deaths, nearly all of which would be in infants ($10.5 billion and 741 deaths at 80% compliance). Conclusions: Current US breastfeeding rates are suboptimal and result in significant excess costs and preventable infant deaths. Investment in strategies to promote longer breastfeeding duration and exclusivity may be cost-effective. Bartick M, Reinhold A. The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis. Pediatrics. 2010;125:e1048.

22 Community Benefits Breastfeeding is convenient, saves money, and is “green” Reduced health care costs Lower employee absenteeism Convenient and cost effective Environmentally friendly Decreased energy demands for production and transport of infant formula

23 Summary of Breastfeeding Benefits Promotes optimal health outcomes for mothers and children Prevents infectious diseases for children Assures that children meet their full developmental potential Reduces health care costs Is environmentally conscious


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