Leading Lactation Insights - August 2022

Updated AAP Policy Statement: Breastfeeding and the Use of Human Milk

Maria Lennon, MSN, CNM, IBCLC

The American Academy of Pediatrics has updated its Policy on Breastfeeding and the Use of Human Milk for the first time in a decade. Based on current evidence of benefits for both mothers and babies, the policy statement details the benefits of breastfeeding, its true contraindications and those that are not, the challenge of breastfeeding in the US, recommendations for breastfeeding for healthy as well as high risk infants, and the role pediatricians play in protecting, promoting, and supporting breastfeeding.

Since over 80% of women in the Unites States initiate breastfeeding, it has become the cultural norm. Research continues to confirm that breastfeeding and human milk are the normative standards for infant feeding and nutrition and should be considered the standard of reference to which all forms of infant feeding are compared. 

Rates of breastfeeding in the US show certain disparities, especially among non-Hispanic Black mothers and infants. There is a need to address implicit bias, structural bias, and structural racism to improve the health and well-being for all children and families.

The AAP still recommends exclusive breastfeeding for the first six months before adding complementary foods, and now supports continued breastfeeding for two years or longer. Research has shown that breastfeeding for over a year continues to provide immunological benefits for the baby and is associated with decreasing mothers’ risk for diabetes mellitus type 2, hypertension, breast, ovarian and endometrial cancer.

Outcomes are improved for children who were breastfed; data show that otitis media, diarrhea, lower respiratory illness, SIDS, inflammatory bowel disease, childhood leukemia, diabetes mellitus, obesity, asthma, and atopic diseases occur less frequently.

For mothers and families who are unable to exclusively breastfeed, the statement mentions that special support is needed to help the parents overcome the disappointment that comes with difficulty breastfeeding.

The statement goes on to discuss contraindications to breastfeeding - classic galactosemia; in the US, mothers who are infected with HIV, human T-cell lymphotropic virus, untreated brucellosis or Ebola-virus. Special considerations regarding certain infectious diseases are discussed, as is guidance for mothers who use marijuana, alcohol, and tobacco. Other topics covered are maternal medications, radiologic procedures, hospital practices that increase breastfeeding initiation and duration, safe sleep, use of human milk for very low birth weight (VLBW) and late preterm infants, hyperbilirubinemia, adoption, surrogacy, and infants born to gender-diverse families. Due to the increase in rickets, supplementing all breastfed infants with Vitamin D 400 IU continues to be recommended.

At the end of the policy statement, some Key Recommendations are listed. Pediatricians are encouraged to become knowledgeable about breastfeeding management practices that support breastfeeding, to use current evidence-based resources to provide guidance, to advocate for policies that support breastfeeding families and address inequities in care delivery, and to partner with lactation specialists to support breastfeeding parents and children.

For more information and to read the policy statement click here. 

This month we are spotlighting Lydia K. Vasovich-Gmerek, BSN, RNC-NIC, IBCLC

Located in the San Francisco Bay area, Lydia K. Vasovich-Gmerek, BSN, RNC-NIC, IBCLC, is a staff RN at a level III NICU where she provides NICU and high-risk antepartum lactation services and care to families in need. As a NICU RN, she provides care across the continuum to the hospital’s tiniest babies while also providing lactation support and education to NICU parents and parents in the high-risk antepartum unit. When providing lactation care, Lydia offers anticipatory guidance based on each family’s unique needs and shares helpful information to support initiation and their overall lactation journey after their baby is born. 

Lydia also created a NICU pumping log for the families she serves, complete with milk target volumes for parents as many present with comorbidities that often predispose them to delay and decrease in milk supply. Additionally, she created a NICU breast pump prescription form that every NICU parent receives and is used to facilitate obtaining a breast pump through their insurance or WIC. Finally, Lydia also developed a convenient QR code for today’s parents that is used extensively throughout the NICU, antepartum unit, and the mother-baby unit. This code includes evidence-based information to help them learn best practices and techniques for initiating and maintaining lactation, as well as breastfeeding techniques for the preterm through full-term baby.

Lydia originally became a nurse after deciding to go into nursing right out of high school, inspired by a family member who was often ill and spent a lot of time in and out of hospitals. She notes that her first job was at a level III NICU and she is “still enjoying the fast-paced environment and helping parents throughout their baby’s hospitalization.” She also notes that she has been interested in lactation since becoming an RN and decided to pursue her IBCLC designation after her own children were in college. Her goal was to help NICU parents initiate and build their milk supply and be able to breastfeed their baby upon discharge, as she noticed that many NICU parents were unable to maintain their milk supply through a lengthy NICU hospitalization. She enjoys supporting families as well as coworkers throughout women's and children's departments. 

She shares that some current professional challenges include younger and younger parents with multiple comorbidities, difficulties that parents have with becoming and staying pregnant, and difficulties that parents have with providing their own milk for their premature baby. Hospital staffing challenges are also a common issue, with no dedicated IBCLC for the NICU and Lydia herself often pulled away from providing lactation care to instead provide direct patient care. She notes that she would love to see all personnel, including RNs, MDs, NPs, techs, and more, throughout women’s and children’s services receive ample training on the ten steps for the Hospital Infant Feeding Act, which will soon go into effect. Lydia says, “providing human milk, especially the parent’s own milk, is very important and recognized as decreasing Necrotizing Enterocolitis, promoting optimal brain development, growth, bonding, and improved overall outcomes.”

In her free time, Lydia enjoys gardening, hiking, helping Girl Scouts achieve their awards, and volunteering with the Doris Dillon School in Cambodia. Thank you for all that you do for the most vulnerable babies – and their families – throughout Northern California! If you have a question for Lydia you can email her at: Gmereklydia65@gmail.com

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