Updated American Academy of Pediatrics Policy Statement
As of June 27, 2022, the American Academy of Pediatrics (AAP) published an updated policy statement on Breastfeeding and the use of human milk to recommend exclusive breastfeeding for approximately 6 months after birth, and support continued breastfeeding, along with appropriate complementary foods introduced at about 6 months of age, for as long as mutually desired by mother and child for 2 years or beyond. The updated recommendations are now consistent with those of the World Health Organization (WHO).
Breastmilk provides all the energy and nutrients the infant needs for the first months of life, and breastmilk contains a variety of biologic factors that protect against many common childhood illnesses. The type of sugar in breastmilk is perfect for infant brain growth, and the types of protein in breastmilk are easily digested, provide essential amino acids for growth, protect against bacterial and viral infection in the form of antibodies and enzymes, and act as a carrier for hormones and vitamins. The living leukocytes in expressed milk give further immunity to infants and specialized sugars promote good gut bacterial growth encouraging a healthy infant gut microbiome.
Table 2 in the statement summarizes the studies and meta-analyses that have confirmed the association of 6 months of exclusive breastfeeding with decreased rates of sudden infant death syndrome, lower respiratory tract infections, severe diarrhea, otitis media, inflammatory bowel disease, childhood leukemia, asthma, atopic dermatitis, diabetes mellitus, and obesity.
Beyond infancy, breastmilk continues to offer health benefits to the infant. The ratios of its components vary through the various stages of child life to respond to the child’s current needs.
Me and B, 2½ years old
Additionally, breastfeeding offers a multitude of health benefits for mothers. Studies and meta-analyses have confirmed that breastfeeding longer than 12 months on maternal health is associated with a decrease in maternal type 2 diabetes mellitus, hypertension, breast cancer, ovarian cancer, and endometrial cancer rates. See Table 3 in the statement for a compilation of these studies and meta-analyses. I also encourage you to look into the research performed by Dr. Adetola Louis-Jacques, who gave a fantastic podium presentation at the 2021 Academy of Breastfeeding Medicine Annual Meeting highlighting the research she has done demonstrating the change in maternal gene expression as a result of lactation. Amazing!!
The AAP policy states, “Mothers who decide to breastfeed beyond the first year need support. They often report feeling ridiculed or alienated in their choice and conceal their breastfeeding behavior to minimize unsolicited judgment and comments.” When my pediatrician colleagues, who are experienced and excellent pediatricians, hear that I am nursing my two and a half year old, there is a pause. It isn’t ill-intentioned or malicious in any way, but it is real and it is there. This statement is needed to help eliminate the societal stigma ingrained into our collective consciousness that nursing into toddlerhood is odd.
The policy statement received some backlash because it recommends something that most American parents don’t feel is reasonably attainable, at least with the existing parental leaves and societal expectations. I totally understand that. There is no denying that governments need to do better for women and child health and well being. I am hopeful that this updated statement will help enact policies making maintaining the breastfeeding relationship more feasible. We have a way to go.
