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Introduction: Bedsharing is common but advised against by the American Academy of Pediatrics. It is unknown if breastfeeding physicians bedshare more or less than the general population., Objectives: To determine the prevalence of bedsharing among physicians, their reasons for bedsharing or not, and whether bedsharing was associated with a longer duration of breastfeeding., Methods: An online survey was adapted from surveys administered by the Centers for Disease Control and Prevention. The survey was administered to physicians and medical students who birthed children from October 2020 through August 2021. Respondents were asked to report on a singleton birth, and questions centered around sleep practices and breastfeeding. Survival analysis was used to examine the association between bedsharing and breastfeeding duration., Results: Of 546 respondents with bedsharing data, 68% reported some history of bedsharing, and 77% were in specialties that involved caring for pregnant people and/or infants. Those who bedshared breastfed an average of four months longer than those who never bedshared (18.08 versus 14.08 months p<0.001). The adjusted risk of breastfeeding cessation was markedly lower for those who bedshared compared to those who did not (Hazard Ratio 0.57, 95% Confidence Interval 0.45, 0.71). The primary reason for bedsharing was to breastfeed (73%); the primary reason for not bedsharing was safety concerns (92%). Among those who bedshared (n = 373), 52% did not inform their child's healthcare provider., Conclusions: Bedsharing is common among our sample of mainly breastfeeding physicians, including those who care for pregnant people and/or infants. It is also associated with a longer duration of breastfeeding, which has implications for population health. Practicing bedsharing implies cognitive dissidence and may affect how physicians counsel about bedsharing. Additionally, lack of disclosure of bedsharing practices has implications for practical guidance about having open non-judgmental conversations and may be a missed opportunity to counsel on bedsharing safety., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Louis-Jacques et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The climate crisis is an emerging global challenge that poses potential risks to breastfeeding practices and outcomes. There are multifaceted effects of climate change affecting the breastfeeding dyad across environmental, societal, and human health dimensions. Breastfeeding support in the face of climate change will require solutions at the structural level-healthcare, community, and workplace settings-and at the mother-infant dyad level. Breastfeeding can additionally be an adaptive response to crisis situations and can mitigate some of the environmental challenges associated with climate change. Despite the undeniable significance of climate change on breastfeeding (and vice versa), our perspective as experts in the field is that this topic has not been systematically addressed. Although we highlight some of the challenges, potential solutions, and co-benefits of breastfeeding in the context of climate change, there are numerous issues that could be further explored and necessitate additional preparedness planning., Competing Interests: Disclosures and Conflicts of InterestThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Despite the benefits of breastfeeding, there are significant disparities in rates among various racial, social, and economic groups. Society poses various barriers to breastfeeding, threatening the child's access to a basic human right. Exploring and understanding these issues can ensure that effective interventions are implemented. Objective: To present situations in which the mother's and child's basic human right to breastfeeding is threatened and to highlight opportunities to uphold their rights within social and health care systems. Methods: A literature search of relevant articles was performed via PubMed regarding (1) rights to optimal protections for breastfeeding, (2) situations in which the rights of breastfeeding parents are threatened, and (3) challenges in providing inclusive and equitable breastfeeding care along with strategies to uphold the human right to breastfeed. Results: Maternity leave of at least 12 weeks was associated with higher breastfeeding rates, whereas mandated breaks in the workplace resulted in either positive or inconclusive effects. Peer counseling, institutional initiatives, and mass media campaigns were among the most effective interventions; however, effects on breastfeeding varied among different racial groups. Conclusions: There are clear benefits of breastfeeding for mothers and infants, which highlight the importance of prioritizing breastfeeding as a basic human right. Regardless, there are numerous societal barriers to providing equitable breastfeeding care. Although there are interventions that have proven to be helpful in breastfeeding promotion, protection, and support, further standardized research will be beneficial in identifying effective and inclusive interventions.

A central goal of the Academy of Breastfeeding Medicine (ABM) is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. The ABM empowers health professionals to provide safe, inclusive, patient-centered, and evidence-based care. Pregnant and lactating people identify with a broad spectrum of genders, pronouns, and terms for feeding and parenting. There are two reasons ABM's use of gender-inclusive language may be transitional or inconsistent across protocols. First, gender-inclusive language is nuanced and evolving across languages, cultures, and countries. Second, foundational research has not adequately described the experiences of gender-diverse individuals. Therefore, ABM advocates for, and will strive to use language that is as inclusive and accurate as possible within this framework. For more explanation, please read ABM Position Statements on Infant Feeding and Lactation-Related Language and Gender (https://doi.org/10.1089/bfm.2021.29188.abm) and Breastfeeding As a Basic Human Right (https://doi.org/10.1089/bfm.2022.29216.abm).

Background: Sudden unexpected infant death (SUID) rates remain higher in American Indian/Alaska Native (AI/AN) and non-Hispanic Black (NHB) infants than other demographic groups. Racial disparities are also evident in breastfeeding, which is associated with reduced risk of SUID. Objective: To assess the relationship between racial/ethnic disparities in SUID and breastfeeding beyond the newborn period using U.S. nationally reported public databases. Methods: Data were extracted from Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (WONDER) and the National Immunization Surveys (NISs) 2009-2017. WONDER data were restricted to full-term infants and sorted by death year, race/ethnicity, and other characteristics. NIS breastfeeding data included ever breastfed, breastfed at 6 months, and exclusive breastfeeding at 3 and 6 months. Breastfeeding rates and mortality data were aggregated based on race/ethnicity, and mortality rates were analyzed by weighted (number of births) multivariable linear regression. Results: SUID rates were highest among NHB and AI/AN infants who also had the lowest breastfeeding rates. When breastfeeding and race/ethnicity were included in the analyses, race/ethnicity confounded the relationship between breastfeeding and SUID. When race was excluded, ever breastfeeding and any breastfeeding at 6 months were associated with significantly decreased SUID rates. Conclusion: Race/ethnicity confounded the relationship between breastfeeding and SUID. Analysis was limited because individual SUID rates were available for maternal/birth characteristics but not for breastfeeding. Our study showed a need for adding additional data points to other national databases to better understand the role that breastfeeding plays in the racial/ethnic disparities in SUID.

A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. The Academy of Breastfeeding Medicine recognizes that not all lactating individuals identify as women. Using genderinclusive language, however, is not possible in all languages and all countries and for all readers. The position of the Academy of Breastfeeding Medicine (https://doi.org/10.1089/bfm.2021.29188.abm) is to interpret clinical protocols within the framework of inclusivity of all breastfeeding, chestfeeding, and human milk-feeding individuals .

Sudden unexpected infant death (SUID) disproportionately affects non-Hispanic Black (NHB) and American Indian/Alaskan Native infants, who have lower rates of breastfeeding than other groups. Using 13,077,880 live-birth certificates and 11,942 linked SUID death certificates from 2015 through 2018, we calculated odds ratios and adjusted risk differences of SUID in infants who were not breastfed across 5 racial/ethnic strata in the United States. We analyzed mediation by not breastfeeding in the race/ethnicity-SUID association. The overall SUID rate was 0.91 per 1,000 live births. NHB and American Indian/Alaskan Native infants had the highest disparity in SUID relative to non-Hispanic White infants. Overall, not breastfeeding was associated with SUID (adjusted odds ratio (aOR), 1.14; 95% confidence interval (CI): 1.10, 1.19), and the adjusted risk difference was 0.12 per 1,000 live births. The aOR of not breastfeeding for SUID was 1.07 (95% CI: 1.00, 1.14) in NHB infants and 1.29 (95% CI: 1.14, 1.46) in Hispanic infants. Breastfeeding minimally explained the higher SUID risk in NHB infants (2.3% mediated) and the lower risk in Hispanic infants (2.1% mediated) relative to non-Hispanic White infants. Competing risks likely explain the lower aOR seen in NHB infants of not breastfeeding on SUID, suggesting that social or structural determinants must be addressed to reduce racial disparities in SUID., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Mississippi CHAMPS addressed racial inequities in breastfeeding by implementing community and hospital-based practice changes in accordance with the BFHI and by parallel community work., Competing Interests: CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no conflicts of interest relevant to this article to disclose., (Copyright © 2022 by the American Academy of Pediatrics.)

The nutritional and immunologic properties of human milk, along with clear evidence of dose-dependent optimal health outcomes for both mothers and infants, provide a compelling rationale to support exclusive breastfeeding. US women increasingly intend to breastfeed exclusively for 6 months. Because establishing lactation can be challenging, exclusivity is often compromised in hopes of preventing feeding-related neonatal complications, potentially affecting the continuation and duration of breastfeeding. Risk factors for impaired lactogenesis are identifiable and common. Clinicians must be able to recognize normative patterns of exclusive breastfeeding in the first week while proactively identifying potential challenges. In this review, we provide new evidence from the past 10 years on the following topics relevant to exclusive breastfeeding: milk production and transfer, neonatal weight and output assessment, management of glucose and bilirubin, immune development and the microbiome, supplementation, and health system factors. We focus on the early days of exclusive breastfeeding in healthy newborns ≥35 weeks' gestation managed in the routine postpartum unit. With this evidence-based clinical review, we provide detailed guidance in identifying medical indications for early supplementation and can inform best practices for both birthing facilities and providers., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2020 by the American Academy of Pediatrics.)

Objective: To determine if implementation of skin-to-skin care and the Baby-Friendly Hospital Initiative (BFHI) contributes to sudden unexpected infant death (SUID) and asphyxia in the first 6 days after birth., Study Design: Survey data were used to determine a correlation between BFHI and deaths from SUID and asphyxia among infants <7 days in the US and Massachusetts. Using data from the Centers for Disease Control and Prevention, implementation of BFHI was tracked from 2004-2016 and skin-to-skin care was tracked from 2007-2015. Using data from Centers for Disease Control and Prevention WONDER and the Massachusetts Department of Public Health, SUID and asphyxia were tracked from 2004-2016., Results: Nationally, births in Baby-Friendly facilities rose from 1.8% to 18.3% and the percentage of facilities in which most dyads experienced skin-to-skin care rose from 40% to 83%. SUID prevalence among infants <7 days was rare (0.72% of neonatal deaths) and decreased significantly from 2004-2009 compared with 2010-2016, from 0.033 per 1000 live births to 0.028, OR 0.85 (95% CI 0.77, 0.94). In Massachusetts, births in Baby-Friendly facilities rose from 2.8% to 13.9% and skin-to-skin care rose from 50% to 97.8%. SUID prevalence decreased from 2010-2016 compared with 2004-2009: OR 0.32 (95% CI 0.13, 0.82), with 0 asphyxia deaths during the 13-year period., Conclusion: Increasing rates of breastfeeding initiatives and skin-to-skin care are temporally associated with decreasing SUID prevalence in the first 6 days after birth in the US and Massachusetts., (Copyright © 2019 Elsevier Inc. All rights reserved.)

A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.

Background: Race is a predictor of breastfeeding rates in the United States, and rates are lowest among African American infants. Few studies have assessed changes in breastfeeding rates by race after implementing the Ten Steps to Successful Breastfeeding (hereafter referred to as the Ten Steps), and none have assessed the association between implementation and changes in racial disparities in breastfeeding rates. Our goal was to determine if a hospital- and community-based initiative in the Southern United States could increase compliance with the Ten Steps, lead to Baby-Friendly designation, and decrease racial disparities in breastfeeding., Methods: Hospitals in Mississippi, Louisiana, Tennessee, and Texas were enrolled into the Communities and Hospitals Advancing Maternity Practices initiative from 2014 to 2017 and received an intensive quality improvement and technical assistance intervention to improve compliance with the Ten Steps. Community partners and statewide organizations provided parallel support. Hospitals submitted monthly aggregate data stratified by race on breastfeeding, skin-to-skin care, and rooming in practices., Results: The disparity in breastfeeding initiation between African American and white infants decreased by 9.6 percentage points (95% confidence interval 1.6-19.5) over the course of 31 months. Breastfeeding initiation increased from 66% to 75% for all races combined, and exclusivity increased from 34% to 39%. Initiation and exclusive breastfeeding among African American infants increased from 46% to 63% ( P < .05) and from 19% to 31% ( P < .05), respectively. Skin-to-skin care after cesarean delivery was significantly associated with increased breastfeeding initiation and exclusivity in all races; rooming in was significantly associated with increased exclusive breastfeeding in African American infants only., Conclusions: Increased compliance with the Ten Steps was associated with a decrease in racial disparities in breastfeeding., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2019 by the American Academy of Pediatrics.)

Background and Objectives: The American Academy of Pediatrics (AAP) has affirmed breastfeeding as the preferred method of infant feeding; however, there has been little systematic examination of how pediatricians' recommendations, affiliated hospitals' policies, counseling practices, and attitudes toward breastfeeding have shifted over the past 2 decades. These trends were examined from 1995 to 2014., Methods: Data are from the Periodic Survey (PS) of Fellows, a nationally representative survey of AAP members. PS #30 (1995; response rate = 72%; N = 832), PS #57 (2004; response rate = 55%; N = 675), and PS #89 (2014; response rate = 51%; N = 620) collected demographics, patient and practice characteristics, and detailed responses on pediatricians' recommendations, affiliated hospitals' policies, counseling practices, and attitudes toward breastfeeding. By using bivariate statistics and logistic regression models, the analysis investigated changes over time with predicted values (PVs)., Results: From 1995 to 2014, more pediatricians reported their affiliated hospitals applied for "baby-friendly" designation (PV = 12% in 1995, PV = 56% in 2014; P < .05), and more reported that they recommend exclusive breastfeeding (65% to 76% [ P < .05]). However, fewer respondents indicated that mothers can be successful breastfeeding (PV = 70% in 1995, PV = 57% in 2014; P < .05) and that the benefits outweigh the difficulties (PV = 70% in 1995, PV = 50% in 2014; P < .05). Younger pediatricians were less confident than older pediatricians in managing breastfeeding problems ( P < .01)., Conclusions: Pediatricians' recommendations and practices became more closely aligned with AAP policy from 1995 to 2014; however, their attitudes about the likelihood of breastfeeding success have worsened. These 2 divergent trends indicate that even as breastfeeding rates continue to rise, continued efforts to enhance pediatricians' training and attitudes about breastfeeding are necessary., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2017 by the American Academy of Pediatrics.)

Background and Objective: In response to a low number of Baby-Friendly-designated hospitals in the United States, the Centers for Disease Control and Prevention funded the National Institute for Children's Health Quality to conduct a national quality improvement initiative between 2011 and 2015. The initiative was entitled Best Fed Beginnings and enrolled 90 hospitals in a nationwide initiative to increase breastfeeding and achieve Baby-Friendly designation., Methods: The intervention period lasted from July 2012 to August 2014. During that period, data on process indicators aligned with the Ten Steps to Successful Breastfeeding and outcome measures (overall and exclusively related to breastfeeding) were collected. In addition, data on the Baby-Friendly designation were collected after the end of the intervention through April 2016. Hospitals assembled multidisciplinary teams that included parent partners and community representatives. Three in-person learning sessions were interspersed with remote learning and tests of change, and a Web-based platform housed resources and data for widespread sharing., Results: By April 2016, a total of 72 (80%) of the 90 hospitals received the Baby-Friendly designation, nearly doubling the number of designated hospitals in the United States. Participation in the Best Fed Beginnings initiative had significantly high correlation with designation compared with hospital applicants not in the program (Pearson's r [235]: 0.80; P < .01). Overall breastfeeding increased from 79% to 83% ( t = 1.93; P = .057), and exclusive breastfeeding increased from 39% to 61% ( t = 9.72; P < .001)., Conclusions: A nationwide initiative of maternity care hospitals accomplished rapid transformative changes to achieve Baby-Friendly designation. These changes were accompanied by a significant increase in exclusive breastfeeding., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2017 by the American Academy of Pediatrics.)

Skin-to-skin care (SSC) and rooming-in have become common practice in the newborn period for healthy newborns with the implementation of maternity care practices that support breastfeeding as delineated in the World Health Organization's "Ten Steps to Successful Breastfeeding." SSC and rooming-in are supported by evidence that indicates that the implementation of these practices increases overall and exclusive breastfeeding, safer and healthier transitions, and improved maternal-infant bonding. In some cases, however, the practice of SSC and rooming-in may pose safety concerns, particularly with regard to sleep. There have been several recent case reports and case series of severe and sudden unexpected postnatal collapse in the neonatal period among otherwise healthy newborns and near fatal or fatal events related to sleep, suffocation, and falls from adult hospital beds. Although these are largely case reports, there are potential dangers of unobserved SSC immediately after birth and throughout the postpartum hospital period as well as with unobserved rooming-in for at-risk situations. Moreover, behaviors that are modeled in the hospital after birth, such as sleep position, are likely to influence sleeping practices after discharge. Hospitals and birthing centers have found it difficult to develop policies that will allow SSC and rooming-in to continue in a safe manner. This clinical report is intended for birthing centers and delivery hospitals caring for healthy newborns to assist in the establishment of appropriate SSC and safe sleep policies., (Copyright © 2016 by the American Academy of Pediatrics.)

Objectives: As a method to increase exclusive and overall breastfeeding, the Centers for Disease Control and Prevention funded the National Institute for Children's Health Quality to run a national collaborative designed to accelerate the number of Baby-Friendly-designated hospitals in the United States. A unique aspect of this project was the development of the first ever national quality improvement collaborative of hospital leaders focused on maternity care practices and breastfeeding., Materials and Methods: Members of the Leadership Track were continually engaged and surveyed throughout the project period to provide feedback on the collaborative process and project as a whole., Results: The Leadership Track served as a vital catalyst for change, resulting in an unprecedented number of newly designated Baby-Friendly hospitals., Conclusions: A quality improvement Leadership Track adds value and provides lessons learned that can be applied to other complex healthcare initiatives affecting global policies and public health.

Background: Exclusive breastfeeding (EBF) is recommended until about 6 months of age. Pediatricians are at the forefront of encouraging mothers to achieve this goal, yet pediatricians who parent during their training may face substantial barriers in achieving their own breastfeeding goals., Objectives: This study aimed to assess breastfeeding support available to US pediatricians in training and the effect of trainees' personal experiences on their attitude toward breastfeeding., Methods: An online survey was emailed to American Academy of Pediatrics Section on Medical Students, Residents, and Fellowship Trainees members., Results: There were 927 respondents, of which 421 had children and 346 breastfed their children. Almost 80% agreed that 6 months is the ideal duration for EBF. One in 4 did not have access to or were not aware of a private room to express milk or breastfeed. Forty percent needed to extend the duration of their training for a longer maternity leave, with breastfeeding a factor for longer leave among 44%. One in 4 did not meet their breastfeeding duration goal, and 1 in 3 did not meet their goal for EBF. Negative emotions were common among those not meeting goals. Ninety-two percent felt that their or their partner's experience with breastfeeding affected their clinical interaction with patients' mothers., Conclusion: A majority of respondents cited problems with breastfeeding support during training, and many failed to meet their intended goals. Not meeting personal breastfeeding goals was associated with negative emotions and influenced how they counsel about breastfeeding as a result of personal and often negative attitudes., (© The Author(s) 2015.)

Background: Infant feeding data are often collected retrospectively through maternal report. Validation studies show that maternal report of initiation and duration of any breastfeeding is accurate but that report of duration of exclusive breastfeeding may be less accurate., Objective: This study aimed to compare infant feeding data collected longitudinally throughout the first 6 months of life with maternal report of duration of exclusive breastfeeding collected 2 years postpartum., Methods: Infant feeding data were collected prospectively throughout the first 6 months of life from medical records and maternal report, including maternal 24-hour recall. At 2 years postpartum, we asked mothers of these same infants how long they exclusively breastfed their infants. Their responses were compared to the prospectively collected data. Simple and multiple linear regressions tested for any significant predictors of the difference between the prospectively collected data and maternal report at 2 years., Results: Of the 292 mothers included in the final analysis, only 88 (30.1%) mothers reported a duration of exclusive breastfeeding at 2 years postpartum that matched the prospectively collected data. Sixty-four women reported exclusively breastfeeding for the recommended 6 months (21.9%), but according to the prospectively collected data, only 2 women (0.7%) breastfed exclusively through 6 months. The median difference between the prospectively collected data and maternal report at 2 years was 1 month (IQR, 0-4)., Conclusion: In this sample of mothers, report of exclusive breastfeeding practices 2 years after birth was often inaccurate and mothers tended to overestimate duration.

Considerable progress has been made in the past decade in developing comprehensive support systems to enable more women to reach their breastfeeding goals. Given that most women in the United States participate in some breastfeeding, it is essential that each of these support systems be rigorously tested and if effective replicated. Additional research is needed to determine the best methods of support during the preconception period to prepare women to exclusively breastfeed as a cultural norm., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: In June 2010, the Communities Putting Prevention to Work program (Centers for Disease Control and Prevention) funded a New Jersey (NJ) Office on Nutrition and Fitness, Department of Health and Senior Services project to reduce obesity and increase exclusive breastfeeding by increased implementation of the Baby-Friendly Hospital Initiative in the state of NJ. At baseline, NJ had no Baby-Friendly hospitals and no hospital was using an infant feeding policy that conformed to standards required by Baby-Friendly USA for designation., Goal: To create a model infant feeding policy that would be adaptable for use at multiple NJ hospitals preparing for Baby-Friendly designation., Methods: Project consultants created a policy based on existent policies from the American Academy of Pediatrics, the Academy of Breastfeeding Medicine, certified Baby-Friendly hospitals, and guidance from Baby-Friendly USA. This policy was submitted to Baby-Friendly USA, the US body responsible for Baby-Friendly designation., Results: Baby-Friendly USA requested changes; after adaptations, the policy was made available to targeted NJ hospitals via a statewide portal. The hospitals made relevant adaptations for their setting, and those that were ready submitted the policy during the Baby-Friendly designation process. The policy was acceptable to Baby-Friendly USA., Conclusion: A collaborative initiative can use a single breastfeeding policy template as an aid toward Baby-Friendly designation. Such work streamlines the process and saves time and resources.

Background: Most US hospitals distribute industry-sponsored formula sample packs. No research has examined outcomes associated with sample pack removal as part of a hospital intervention to eliminate sample distribution postpartum., Objective: To examine prospectively hospital-based and breastfeeding outcomes associated with removal of industry-sponsored formula sample packs from the hospital., Methods: We enrolled mothers postpartum at Cooper University Hospital, an urban New Jersey hospital, in 2009-2010. For the first 6 months, all women received industry-sponsored formula samples packs (control group); for the next 6 months, all postpartum women received hospital-sponsored bags with no formula at source (intervention group). Research assistants blinded to the design called subjects weekly for 10 weeks to determine feeding practices., Results: We enrolled 527 breastfeeding women (284 control; 243 intervention). At 10 weeks postpartum, 82% of control and 36% of intervention women (P < .001) reported receiving formula in the "diaper discharge bag." Kaplan-Meyer curves for any breastfeeding showed the intervention was associated with increased breastfeeding (P = .03); however, exclusive breastfeeding was not significantly different between intervention and controls (P = .46). In post hoc analysis, receiving no take-home formula in bottles from the hospital was associated with increased exclusive breastfeeding in control (P = .02) and intervention (P = .03) groups at 10 weeks., Conclusion: Although the hospital-branded replacement contained no formula at source, many women reported receiving bottles of formula from the hospital. Change in practice to remove industry-sponsored formula sample packs was associated with increased breastfeeding over 10 weeks, but the intervention may have had a greater impact had it not been contaminated.

Few if any studies have examined weight loss among term newborns by weighing infants daily for the first week of life. Perhaps because so few data exist, there is no standard in the United States for normal newborn weight loss. Our objective was to investigate normal newborn weight loss among infants born in a US Baby-Friendly hospital, by weighing infants daily for the first week of life. Using a prospective cohort design, infants born at an urban Boston, MA, hospital were enrolled within 72 hours of delivery and weighed daily for the first week of life. In hospital, infant weight was obtained from the medical record; post discharge, a research assistant visited the home daily and weighed the baby. All feeds in week 1 of life were recorded. Birth-related factors potentially affecting weight loss were abstracted from the medical record. Complete data were collected on 121 infants. Mean weight loss was 4.9% (range=0.0% to 9.9%); 19.8% (24 of 121) of infants lost >7% of their birth weight; no infant lost >10%. Maximum percent weight loss was significantly associated with feeding type: exclusively and mainly breastfed infants lost 5.5%, mainly formula-fed infants lost 2.7% and exclusively formula-fed infants lost 1.2% (P<0.001). Type of delivery and fluids received during labor were not associated with weight loss. Clinical practices at a Baby-Friendly hospital, which support and optimize breastfeeding, appear to be associated with only moderate weight loss in exclusively and mainly breastfed infants., (Copyright © 2012 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Objectives: Multiple studies have revealed inadequacies in breastfeeding education during residency, and results of recent studies have confirmed that attitudes of practicing pediatricians toward breastfeeding are deteriorating. In this we study evaluated whether a residency curriculum improved physician knowledge, practice patterns, and confidence in providing breastfeeding care and whether implementation of this curriculum was associated with increased breastfeeding rates in patients., Subjects and Methods: A prospective cohort of 417 residents was enrolled in a controlled trial of a novel curriculum developed by the American Academy of Pediatrics in conjunction with experts from the American College of Obstetricians and Gynecologists, American Academy of Family Physicians, and Association of Pediatric Program Directors. Six intervention residency programs implemented the curriculum, whereas 7 control programs did not. Residents completed pretests and posttests before and after implementation. Breastfeeding rates were derived from randomly selected medical charts in hospitals and clinics at which residents trained., Results: Trained residents were more likely to show improvements in knowledge (odds ratio [OR]: 2.8 [95% confidence interval (CI): 1.5-5.0]), practice patterns related to breastfeeding (OR: 2.2 [95% CI: 1.3-3.7]), and confidence (OR: 2.4 [95% CI: 1.4-4.1]) than residents at control sites. Infants at the institutions in which the curriculum was implemented were more likely to breastfeed exclusively 6 months after intervention (OR: 4.1 [95% CI: 1.8-9.7])., Conclusions: A targeted breastfeeding curriculum for residents in pediatrics, family medicine, and obstetrics and gynecology improves knowledge, practice patterns, and confidence in breastfeeding management in residents and increases exclusive breastfeeding in their patients. Implementation of this curriculum may similarly benefit other institutions.

Background: A woman's decision to breastfeed may be influenced by her health care practitioners, but breastfeeding knowledge among clinicians is often lacking. Project HELP (Hospital Education in Lactation Practices) was an intensive education program designed to increase breastfeeding knowledge among health care practitioners. The purpose of this study was to determine whether educating practitioners affected breastfeeding initiation and exclusivity rates at hospitals with low breastfeeding rates., Methods: Between March 31, 2005, and April 24, 2006, we taught courses at four Massachusetts hospitals with low breastfeeding rates. Each course consisted of three, 4-hour teaching sessions and was offered nine times. The training, taught by public health professionals, perinatal clinicians, and peer counselors, covered a broad range of breastfeeding-related topics, from managing hyperbilirubinemia to providing culturally competent care. Medical records of infants born before and after the intervention were reviewed to determine demographics and infant feeding patterns., Results: Combining data from all hospitals, breastfeeding initiation increased postintervention from 58.5 to 64.7 percent (p = 0.02). An overall increase in exclusive breastfeeding rates was not statistically significant. In multivariate logistic regression for all hospitals combined, infants born postintervention were significantly more likely to initiate breastfeeding than infants born preintervention (adjusted OR 1.32, 95% CI 1.03-1.69)., Conclusions: Intensive breastfeeding education for health care practitioners can increase breastfeeding initiation rates.

Cambodians have the lowest breastfeeding initiation rate of any racial/ethnic group in Massachusetts. One barrier to breastfeeding is a lack of hospital foods that allow women to follow a traditional diet postpartum. We examined whether a culturally acceptable menu for new Cambodian mothers would increase breastfeeding initiation in the hospital. After a staff training program on breastfeeding, and the creation of a Cambodian menu, initiation rates increased significantly more in Cambodians than in non-Cambodians. Pre intervention, breastfeeding initiation was 16.7% (2/12) among Cambodians, compared to 60.6% (106/175) among non-Cambodians (P = 0.003). Post intervention, there was no significant difference between breastfeeding initiation rates among Cambodian women (66.7%; 8/12) compared to non-Cambodians (68.9%; 104/151) (P = 0.874).

The United States has the highest teen birth rate in the industrialized world, and adolescents continue to have the lowest rates of breastfeeding. Although individual pregnancy and parenting experiences in adolescents are modified by a variety of factors, common themes of adolescent psychology and behavior may help plan effective strategies for breastfeeding promotion and support. Breastfeeding promotion and support in adolescents need to be developmentally appropriate, patient centered, and linked to multidimensional support.

Breastfeeding, in spite of proven benefits and energetic promotion, lags behind national goals, is less prevalent in disadvantaged populations, and declines across successive children in a family. Using longitudinally linked data from the New Jersey Electronic Birth Certificate (EBC) from 1996 to 2001, we found considerable fluidity in breastfeeding status at hospital discharge for births to the same mother. Among mothers who breastfed exclusively after the first birth, only 69% did so after the second (we refer to this as recurrence). Among mothers who exclusively formula fed after the first birth, 16% initiated exclusive breastfeeding after the second birth (referred to as recruitment). Combination feeding the first born, i.e., breastfeeding supplemented by formula, was followed by exclusive breastfeeding for 38% of second births. Rates of recurrence and recruitment differed in distinct ways by race/ethnicity and immigrant status. We conclude that breastfeeding initiation is not necessarily or exclusively a matter of fixed preferences, and that opportunities exist to expand breastfeeding to realize national goals by enhancing both recurrence and recruitment.

Background: Healthy breastfeeding practice in the United States depends decisively on high rates of initiation at the delivery hospital. We sought to estimate the component of hospital variation in rates of exclusive breastfeeding at discharge that was dependent on demographic composition. Isolating that component can help to illuminate the potential independent contribution of hospital policies, practices, and staff behaviors., Methods: Electronic birth certificate data in New Jersey from 1996 to 2001 (n = 545,837) were used to measure variations in hospital-level rates of breastfeeding initiation. The method of infant feeding within 24 hours before hospital discharge was reported as exclusive breastfeeding, formula feeding, combination feedings, other methods, and unknown. Rates of exclusive breastfeeding by hospital were standardized to remove sociodemographic differences in hospitals' service populations that influence initiation rates., Results: Sociodemographic variables predicted about 60 percent of the variation in hospital-specific rates of exclusive breastfeeding at discharge. Hospitals that were designated intensive or regional perinatal centers, delivered higher volumes of infants, and served more breastfeeding-prone populations were only slightly more likely to have higher adjusted rates compared with other hospitals; considerable unexplained variation remained., Conclusions: Standardized exclusive breastfeeding rates pointed to the contribution of population demographics to breastfeeding initiation, and other contributions, including hospital practices, are also important. To protect, promote, and support breastfeeding, a more detailed evidence base on hospital policies and practices should be developed, and hospitals should review their policies and practices in light of documented best breastfeeding practice.

Increasing breastfeeding initiation has been a national goal since Healthy People targets were first set in 1979. Sensitive methods used to measure incidence of breastfeeding initiation are important in the evaluation of breastfeeding trends. The authors used the statewide electronic birth certificate (EBC) as a surveillance system to measure breastfeeding initiation rates in New Jersey from 1997 to 2000. Overall breastfeeding initiation rates rose over the 4 years surveyed, yet exclusive breastfeeding rates remained stable. Trends demonstrated persistent racial and ethnic disparities in breastfeeding practices. The EBC was a valuable tool for monitoring breastfeeding initiation rates and evaluating the statewide goal of increasing exclusive breastfeeding.