Pediatricians & Breastfeeding

A trip to the pediatrician for a well-baby visit is one that I always enjoy. I do hold my breath in the early days when frequent weight and color checks may be necessary-- but once positive weight gain is established and jaundice has cleared, I actually look forward to these visits. It’s a time when I focus on my baby, take pride in our accomplishments on the growth chart and delight in the attention we get from the nurses. I know my pediatricians respect my parenting decisions and I always learn something from them- despite having pediatric experience myself. I really appreciate this because with my eldest child, I had encounters that were quite the opposite. The baby was growth restricted in utero- despite 3 months of strict bedrest—and born feisty, yet slightly small for gestational age. Once we were home from the hospital and dealing with pediatricians in an outpatient setting, I was pressured to start formula to fatten him up. There was no talk of offering him supplements of pumped breastmilk, no back-and-forth with me about what I thought could help. Needless to say, that doctor-patient relationship was severed early on!

A recent study in Pediatrics, revealed that the attitudes of pediatricians towards breastfeeding are somewhat confusing. The percentage of pediatricians who advise exclusive breastfeeding during the first month rose from 66% in 1995 to 75% in 2014. Doctors were also less likely to recommend formula supplementation and more likely to report that their hospitals had applied to become baby-friendly hospitals or that their practices were more considerate of the “Ten Steps to Successful Breastfeeding” policy.

Nevertheless, while many practices try to align themselves with the American Academy of Pediatrics policy on breastfeeding (https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Breastfeeding/Pages/AAP-Policy-on-Breastfeeding.aspx) the study notes that numerous pediatricians doubt the likelihood of breastfeeding success. Pediatric residency training for breastfeeding is not widespread and some feel that is the culprit for these attitudes. While I do believe as well, that breastfeeding education should be part of the curriculum, I understand that physicians who think that the difficulties of breastfeeding may outweigh the benefits-- could have adopted this philosophy because they are still attempting to solve these challenges themselves. In the 15 minutes a pediatrician has with a new breastfeeding dyad, they simply don’t have the time to tease out and resolve breastfeeding issues and when weight gain is precarious, a bottle is visually quantifiable!

So, in addition to teaching pediatric residents about the benefits of breastfeeding, teach them that they can form partnerships with board certified lactation consultants—that while they will wear many hats as a general pediatrician, they can collaborate with another group of medical professionals who have specialized training and the time to make breastfeeding special for that family.