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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. The American Academy of Pediatrics (AAP) recommends that infants be exclusively breastfed for about the first 6 months with continued breastfeeding alongside introduction of appropriate complementary foods for 1 year or longer. The World Health Organization also recommends exclusively breastfeeding up to 6 months of age with continued breastfeeding along with appropriate complementary foods up to 2 years of age or beyond.

According to the 2018 Breastfeeding Report Card published by the Centers for Disease Control and Prevention, among infants born in 2015 in the United States, four (83.2%) of five started to breastfeed, over half (57.6%) were breastfeeding at 6 months, and over one-third (35.9%) were breastfeeding at 12 months. Compared to rates for infants born in 2014, rates for infants born in 2015 increased for breastfeeding at 6 and 12 months. Efforts to alter knowledge, attitudes, and behaviors regarding breastfeeding must effectively address the numerous psychosocial barriers to breastfeeding and continuance. Healthcare providers are critical conduits for maternal and familial education. All members of the healthcare 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. A 2015 systematic review and meta-analysis of 17 studies found that breastfed infants performed better on intelligence tests later in life than those who were not breastfed, even after controlling for maternal IQ. The literature has shown that infants who are breastfed have fewer episodes of diarrheal illness, ear infections, and allergies. 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, 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 looking at the relationship between breastfeeding and rates of postpartum depression and cardiovascular disease. Most importantly, however, is the bonding relationship breastfeeding promotes between mother and infant.

The 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 ...

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