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Every infant should begin life with six months of exclusive breastfeeding, followed by another six months or longer with other foods gradually added to the child's diet, according to an updated policy statement from the American Academy of Pediatrics.

The update reaffirms the AAP's position on breastfeeding, originally stated in 2005 (Pediatrics 2005; 496-506). The organization also reiterated its support for hospital initiatives to encourage and facilitate breastfeeding of newborns and for national strategies supported by the CDC, Office of the Surgeon General, and Joint Commission.

"Recently, published evidence-based studies have confirmed and quantitated the risks of not breastfeeding," authors representing the AAP Section on Breastfeeding wrote in conclusion in the March issue of Pediatrics.

"Thus, infant feeding should not be considered as a lifestyle choice, but rather as a basic health issue. As such, the pediatrician's role in advocating and supporting proper breastfeeding practices is essential and vital for the achievement of this preferred public health goal."

Some estimates have suggested that more than 900 infant deaths per year in the United States could be prevented if 90% of mothers breastfeed exclusively for six months, the authors wrote. The effect on infant mortality is one of several positive outcomes linked to breastfeeding:

• 72% reduction in hospitalization for respiratory infections
• 64% reduction in the incidence of gastrointestinal infections
• 58% to 77% reduction in the incidence of necrotizing enterocolitis
• 36% to 45% reduction in the risk of sudden infant death syndrome
• 27% to 42% reduction in the incidence of asthma, atopic dermatitis, and eczema
• 52% reduction in the risk of celiac disease
• 31% reduction in the risk of inflammatory bowel disease
• 15% to 30% reduction in the incidence of obesity in adolescences and adulthood
• 15% to 20% reduction in the risk of childhood leukemia and lymphoma

The authors cited evidence that breastfeeding improves neurodevelopmental outcomes and facilitates development of host defenses in preterm infants.

Other studies have linked breastfeeding to improved postpartum blood loss and recovery of the uterus in the mother. Mothers who breastfeed have been reported to have a greater likelihood of return to pre-pregnancy weight and a reduced risk of type 2 diabetes, rheumatoid arthritis, hypertension, cardiovascular disease, and breast and ovarian cancer.

In addition to reaffirming its support for exclusive breastfeeding, the AAP policy statement included four other recommendations:

• Adherence to peripartum policies and practices that optimize initiation and maintenance of breastfeeding and that are compatible with those previously set forth by the AAP and the Academy of Breastfeeding Medicine Model Hospital Policy
• Evaluation of every newborn by a pediatrician at three to five days of age (usually 48 to 72 hours after hospital discharge)
• Mother and infant should sleep near each other to facilitate breastfeeding
• Do not begin offering a pacifier when placing an infant down to sleep before three to four weeks of age

By way of the policy, the AAP again urged pediatricians to be advocates for breastfeeding. The new policy statement also provides pediatricians with a review of evidence suggesting that a breastfeeding-friendly work environment helps reduce employers' healthcare expenditures, employee absenteeism and turnover, and improve employee morale and productivity.

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