Babies recommended to have human milk and families should have more support, guidance says

By Madeline Holcombe, CNN

Families who breastfeed their children need support, according to guidance from the American Academy of Pediatrics, and that requires social and systemic changes when it comes to workplace access and feeding stigma.

The pediatricians association’s most recent guidance stressed the recommendation that infants be fed exclusively with human milk for the first six months of life before other nutritious foods are introduced.

“Human milk is all a baby needs for the first six months of life,” said Dr. Joan Younger Meek, lead author of the reports, written by the AAP section on breastfeeding. “Breast milk is unique in its nutrients and protective effects, and really quite remarkable when you look at what it does for a child’s developing immune system.” Meek is professor emeritus of clinical sciences at Florida State University College of Medicine.

Research suggests the benefits of feeding human milk include decreased rates of lower respiratory tract infections, severe diarrhea, ear infections and obesity. Babies given breast milk also have a lower risk of sudden infant death syndrome, according to the AAP.

But not everyone can nourish their babies using exclusively human milk, the organization acknowledged.

Some parents may have trouble producing enough milk or having their infant latch properly, or the parent may not lactate at all, said Dr. Jason Jackson, a neonatologist at Nationwide Children’s Hospital in Columbus, Ohio. Their workplace or societal stigmas may make it impossible to breastfeed, Meeks said.

In all cases, it’s the job of health care providers to give the best evidence-based information, while also addressing the individual needs of each family.

“Families deserve nonjudgmental support, information and help to guide them in feeding their infant,” Meeks said.

Structural and policy changes can bolster much of that support, the guidance said.

Breastfeeding is already a medical norm, and community leaders and health care providers need to work together to make it a societal norm, Jackson said.

Medical support and workplace protection

Families should get the support they need from medical professionals and protection against workplace barriers when choosing to feed their infants human milk for at least the first six months — and even up to two years, the AAP said.

The unfortunate reality is that there is stigma around breastfeeding, Jackson said.

Western society considered formula feeding a luxury because a parent didn’t need to be at home to feed the infant, but could hire someone else, he said.

This cultural perception became a major factor in much of the world not being set up to support families who want to breastfeed.

If families in the United States get parental leave at all, the time is often short, Jackson said. The early weeks with an infant are important for establishing a milk supply, because the act of latching and nursing helps stimulate production, he said.

And if parents choose to pump, it’s important that they have access to comfortable and safe places to do so in the workplace, he added.

The guidance recommends policies that address these issues as well as rights to breastfeed in public, on-site childcare; and the right to breastfeed in childcare centers and lactation rooms in schools.

Insurance coverage is another crucial policy area the AAP sees as necessary to supporting breastfeeding. That coverage should extend to pumps and lactation assistance, according to the guidance.

It should also extend to more families who want to provide their infants with human milk from milk banks, Jackson added.

Chestfeeding

Gender diverse families may have an even more difficult time accessing a human milk diet for their infants, according to the guidance.

One important change that could help facilitate better collaboration with these families is to be aware of what language the individual family prefers when it comes to feeding. For example, the term “chestfeeding” may be more accurate when talking about lactation in gender-diverse families, the guidance said.

While all humans have breasts, the term has become associated with one gender, Jackson said. And there are some people who transition but maintain their reproductive organs and can carry and produce milk for a baby, he added.

Having a baby as a trans man can contribute to gender dysphoria as it is, but a major part of that feeling comes from breastfeeding, Jackson said.

“We’re not saying to always call it chestfeeding,” Jackson said. But “a way to help eliminate some of the gender dysphoria is talking to the transmasculine or genderqueer community, asking them what (term they use) as they’re lactating if they choose to produce human milk.”

For parents who choose not to feed human milk or who don’t lactate, there are still benefits to the physical act of holding your baby as they eat, Jackson said.

The skin-to-skin contact bonds the infant and parent, lactating or not, and has been shown to have positive impacts like reducing stress levels and pain in the baby, he said.

Overcoming barriers

With all the social and biological considerations in mind, it’s important to talk about your infant feeding plan early, even before the baby has arrived, Jackson said.

Knowing what you hope to do and what the plan is if there are barriers can help give families a head start, he added.

Breastfeeding is often a challenge, with more than 80% of families initiating breastfeeding but more than 60% not reaching their goals, said Dr. Lori Feldman-Winter, chair of the AAP section on breastfeeding. But finding support can help you feed your baby in the way you want to, she added in an email. Feldman-Winter is professor of pediatrics at Cooper Medical School of Rowan University in Camden, New Jersey.

That challenge is more complicated by the systemic racism that has contributed to disparities in the use of human milk, she said. None of the United States targets for breastfeeding were met for people of color and Indigenous families for Healthy People 2020, the 10-year objectives for improving health put out by the US Office of Disease Prevention and Health Promotion, Feldman-Winter said.

For those who are having trouble getting enough milk supply to feed their baby, Feldman-Winter stressed that any use of human milk is better than none.

“The benefits of breastfeeding and use of human milk are ‘dose dependent’ meaning that any is good and more is better,” she said in an email.

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