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Establishing a Breastfeeding Medicine Practice or Academic Department

Key Points Breastfeeding is unique in medicine as a process that occurs at the juncture of (at least) two interdependent physiologies, those of the lactating parent and of the child. Although much can be known about lactation by all types of providers, expert breastfeeding medicine providers have a role in treating complex problems facing lactating families. There are increasing numbers of breastfeeding medicine clinics and programs…

Infant Feeding After a Disaster

Key Points The care and feeding of infants and young children after any disaster is an important priority, because they are vulnerable as a result of their total dependence on adults for survival. Breastfeeding is the recommended way to feed all infants, and after a disaster it is often the safest way available. Even with maternal dehydration, malnutrition, or limited food intake, mothers’ milk will provide…

The Collection and Storage of Human Milk and Human Milk Banking

Key Points Electric pumps are not necessarily more effective than manual pumps or hand expression. Pumped milk volume can be increased with low cost interventions such as listening to music, relaxation, warming or massaging the breast, frequent pumping and starting to pump sooner after birth. Milk can be stored at room temperature for 4 hours, but under optimal conditions for 6 to 8 hours. Milk kept…

Reproductive Function During Lactation

Key Points Optimal birth spacing is essential to the health of mothers and children. The suppression of ovulation contributes to birth spacing. Return of menses and fecundity are affected by lactation (exclusivity and duration) and maternal energy balance. At the molecular level, there is evidence that the neuropeptide kisspeptin plays a role in lactation-associated fertility suppression through prolactin receptors and sensory input from suckling. Ovulation suppression…

Chestfeeding and Lactation Care for LGBTQ+ Families (Lesbian, Gay, Bisexual, Transgender, Queer, Plus)

Key Points LGBTQ+families may have unique experiences in providing human milk for their infants. LGBTQ+individuals may face particular barriers related to their ability to provide human milk for their infants related to discriminatory policies, restricted donor milk regulations, or anatomic/functional limitations. Appropriate care for LGBTQ+families includes the use of both respectful and affirming language and background knowledge of the physiologic impacts of any past or current…

Induced Lactation and Relactation (Including Nursing an Adopted Baby) and Cross-Nursing

Key Points Induced lactation is the process through which a nonpuerperal woman is stimulated to breastfeed an infant without a preceding pregnancy. Relactation is when a woman who has given birth but stopped breastfeeding or never initially breastfed is stimulated to lactate. Induced lactation and relactation are important processes for assisting women to nourish infants (their own or others) when circumstances have changed and there is…

Breastfeeding and Return to Work or School

Key Points Although it is not easy, mothers need not make any choice between their employment and the optimal nutrition of their infant through breastfeeding. As women’s role in the workplace continues to assert itself, employers and policy makers must ensure that proper accommodations are available to breastfeeding employees; it is good for business. Physicians must advocate for child health and parental well-being by providing sound…

Human Milk and Atopic Disease

Key Points The prevalence of allergy is increasing across the world, and asthma is the most common chronic disease in children. The exact role of genetics and epigenetics in the development of allergy are being explored with newer research techniques. Exclusive breastfeeding does decrease the occurrence of eczema in the first 2 years of life, and a longer duration of breastfeeding decreases wheezing in the first…

Breast Conditions in the Breastfeeding Mother

Key Points The breast is a complex organ with growth, evolution, and regression over life. Its functional capacity changes dramatically throughout pregnancy and lactation. Many benign and malignant conditions affect the breast in general, and some conditions occur specifically during lactation. A careful and complete history, physical examination, and documentation remain essential to understanding, diagnosing, and managing breast disease. A good understanding of the anatomy and…

Medical Complications of Mothers

Key Points Lactation is a two-person system, and breastfeeding both affects and is affected by the mother’s physiology. Both acute maternal health conditions and chronic disorders may have an impact on the mother–baby dyad. Often, the mother’s acute health condition itself does not affect breastfeeding physiology, but the process of navigating the health care system disrupts lactation. It is the healthcare professional’s responsibility to assist her…

Premature Infants and Breastfeeding

Key Points Mother’s own milk, appropriately fortified, is the standard for feeding premature infants. Provision of mother’s own milk for hospitalized premature infants provides short- and long-term health benefits. Neonatal providers play an important role supporting lactation in the neonatal intensive care unit with education, milk expression, skin-to-skin care, and breastfeeding. Pasteurized human donor milk is recommended instead of formula when mother’s own milk is not…

Breastfeeding Infants With Problems

Key Points Infants with special problems may require procedures, surgeries, or hospitalization to maintain and optimize their health or development. Breastfeeding and breast-milk feeding should be protected throughout these interruptions in an infant’s health routine because human milk may offer unique benefits to their health in this period. Breastfeeding is the ideal and preferred feeding method for a newborn. Occasionally infant problems interfere with breastfeeding and…

Transmission of Infectious Diseases Through Breast Milk and Breastfeeding

Key Points The basic tenet concerning breastfeeding and infection is that breastfeeding is rarely contraindicated in maternal infection. The few exceptions relate to specific infectious agents with strong evidence of transmission via breast milk and for the development of illness with infection in the infant leading to significant morbidity and mortality. The frequency and duration of breastfeeding, along with the “amount” of infectious agent in breast…

Medications, Herbal Preparations, and Natural Products in Breast Milk

Key Points Medication use during lactation occurs in almost 50% of breastfeeding women. The most common medications reported include oral contraceptives, systemic antibiotics, “cold preparations,” analgesics/antipyretics, and nonsteroidal antiinflammatory agents. The benefits of continued breastfeeding with maternal medication use almost always outweigh the potential risk to the infant. Every clinical situation is different, based on the specifics for the mother–infant dyad. A careful, informed risk–benefit assessment…

Normal Growth, Growth Faltering, and Obesity in Breastfed Infants

Key Points Optimal growth can be achieved only through the interaction of genetic potential and optimal nutrition at the appropriate times (intrauterine, infancy, childhood, and adolescence) to immediately effect timely active growth and “program” organogenesis and metabolism to optimize future growth and health. The World Health Organization (WHO) growth standards represent appropriate growth references for assessing the optimal growth of breastfeeding infants and children through 24…

Weaning

Key Points Simply stated, weaning is the transition of the infant from dependence on mother’s milk to reliance on other sources of nourishment for nutrition, health and growth, and development. Current recommendations are for 6 months of exclusive breastfeeding and initiation of complementary foods at 4 to 7 months of age with continued breastfeeding through 12 months and beyond. The “how to” for transition to complementary…

Maternal Nutrition and Supplements for Mother and Infant

Key Points Exclusive breastfeeding for 4 to 6 months is capable of nourishing an infant for appropriate growth and development even when the mother’s nutrition is “less than perfect.” The quantity of breast milk produced can be affected by maternal dehydration (when severe, >10% weight loss) or severe maternal malnutrition, but the quality of breast milk as adequate nutrition for the infant is maintained. Maternal conditions…

Practical Management of the Nursing “Dyad”

Key Points Breastfeeding units are best conceived of as physiologically interrelated, or “dyads,” although each family may include multiple interdependent dyads (e.g., those with multiples or more than one lactating parent). Supporting lactation and breastfeeding requires understanding a rich tapestry, including the physiology of milk production, the mechanics of milk transfer, normal infant behavior and growth, and the multiple social forces that enable or prevent achieving…

Population Health and Informed Feeding Decisions

Key Points Breastfeeding is a women’s health issue. Disruption of breastfeeding is associated with higher rates of maternal breast and ovarian cancer, diabetes, hypertension, myocardial infarction, and stroke. Breastfeeding is also a children’s health issue. Not being breastfed is associated with higher rates of infectious morbidity, childhood leukemia, sudden infant death syndrome, and necrotizing enterocolitis, as well as higher rates of obesity and diabetes and lower…

Host-Resistance Factors and Immunologic Significance of Human Milk

Key Points Bioactive factors in human breast milk are not only numerous but they also act in a variety of mechanisms to affect the development, growth, and ongoing health of the infant. Some of those factors also confer benefits for the mother’s breast health. The study of the cells within breast milk has expanded to include the complete hierarchy of breast cells, hematologic cells, and the…