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GENERAL CONSIDERATIONS

Nutrition is a critical capstone for the proper growth and development of infants. Breastfeeding of term infants by healthy mothers is the optimal mechanism for providing the caloric and nutrient needs of infants. Preterm infants can also benefit from breast milk and breastfeeding, although supplementation and fortification of preterm breast milk may be required. Barring some unique circumstances, human breast milk can provide nutritional, social, and motor developmental benefits for most infants.

Despite increased emphasis on breastfeeding education, according to the 2012 Breastfeeding Report Card published by the Centers for Disease Control, breastfeeding initiation 6- and 12-month continuance rates rose by only approximately two percentage points. Most women presently of childbearing age were not breastfed and report having no maternal relatives who breastfed their children. Because evidence clearly suggests familial influences in the development of infant feeding practices, practitioners may find it difficult to encourage breastfeeding behaviors among women with no direct familial breastfeeding experience. Efforts to alter knowledge, attitudes, and behaviors regarding breastfeeding must effectively address the numerous psychosocial barriers. Health care providers are critical conduits for maternal and familial education. All members of the health care team, including physicians, midwives, and nurses, are valuable sources of important evidence-based information as well as psychological support for mothers in search of guidance regarding infant feeding practices. Numerous studies have shown the superiority of breast milk and the health advantages that breastfed children have. Literature has shown a lower incidence of diarrheal illness, ear infections, and allergies among breastfed infants Exclusive breastfeeding for at least 4 months in infants at risk for developing atopic disease decreases the cumulative incidence of atopic dermatitis. Lower rates of childhood obesity, type 2 diabetes, sudden infant death syndrome (SIDS), and leukemia have also been associated with breastfeeding. There are likewise financial advantages to breastfeeding. Other, somewhat controversial, investigations suggest higher intelligence among breastfed infants.

There are also maternal benefits to breastfeeding. Mothers who breastfeed are less likely to develop premenopausal breast cancer. An association with decreased rates of type 2 diabetes and ovarian cancer also exists. Studies are also focusing on the relationship between breastfeeding and the rates of postpartum depression and cardiovascular disease. Most importantly, however, is the bonding relationship that breastfeeding promotes between mother and infant.

All major maternal-child health professional organizations recommend exclusive breastfeeding for the first 6 months of life prior to the introduction of age-appropriate solid foods, followed by continued breastfeeding for the next 6 months.

The American Academy of Pediatrics (AAP) Committee on Nutrition recommends breastfeeding for the first year of life with supplemental vitamin D at birth and the addition of supplemental iron at age 4 months and possible addition of fluoride at age 6 months for infants living in regions of fluoride-poor water. Vitamin D supplementation is particularly applicable in regions with limited sunlight and for infants of mothers with decreased daily intake of cow’s milk. ...

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