LCW2022: Pediatricians
Lactation Celebration Week: Day 3
Today is the day to chat about how pediatric care providers can support lactation. There are a variety of professions that work with the pediatric population and though you may not be a medical doctor, this post may apply to your profession or office as well.
“Pediatric care providers need to be aware of the strong influence they have on parents over infant health issues.
Any advice they give on lactation would have a great impact on the choices parents make about feeding their baby.”
Nurse practitioners, naturopaths, physician’s assistants, chiropractors, body workers, occupational therapists, physical therapists, speech pathologists, nurses, social workers, mental wellness therapists (and so many other professions) are well positioned to support and advocate for lactating families.
Primary care providers (PCPs) need to be especially vigilant about how they support lactation because parents hold your words tightly.
Families often hear your words about infant feeding and believe every word to be true…particularly if parents are anxious. It’s essential to be mindful about how you speak to and support your families.
There are many ways to support your families:
Always ask about lactation and infant feeding during consults
In addition to asking about feeding, take the time to listen. If you don’t have time to fully answer questions or address concerns, refer to someone who can (IBCLC)
Give all lactating parents the name of a trusted IBCLC they can call when lactation problems arise
Lactation problems need lactation solutions
IBCLCs can manage issues for the parent and the baby
If there are no local IBCLCs, find a few who do virtual visits. There are many options and lack local access to an IBCLC is not an excuse to take on problems you are not trained to and don’t have adequate time to manage.
Don’t normalize common feeding issues
Common is not normal
Latch pain is not normal
Extreme fussiness (colic) is not normal
Not back to birth weight by 2 weeks is not normal
When in doubt, refer out.
It’s ok to tell a family you can’t help them with latching. Refer them to someone who can.
Families don’t expect you to know everything. IBCLCs don’t either.
Babies and parents are the people who get hurt the most when incorrect or inadequate information is given.
Hire or contract with an IBCLC for your office for easy referrals
This can be done virtually, too!
Inform parents and other family members about the importance of giving babies human milk for the short- and long-term health of the baby and lactating parent
Talking to parents about feeding is a given but don’t forget to take a few sentences to acknowledge all the people in the room
Grandparents, aunts, uncles, and close friends are all part of a family’s lactation support system and it is essential that they also understand the positive impact of human milk and negative consequences of not giving human milk
Many parents don’t realize, particularly if they skipped a prenatal lactation class, that producing milk has health benefits for them as well
Be culturally sensitive
Cultural traditions are deeply important but may not promote health for the parent or baby (ie beliefs around giving babies colostrum)
Educate without judgement or shaming
Ask questions to find out more about their traditions and help families identify ways to support their culture while also promoting lactation
Use evidence-based information to address queries about how medications pass through human milk
Most medications and medical procedures are compatible with lactation
Look it up; don’t assume it’s unsafe.
IABLE runs the Trash the Pump and Dump website which lists medications (but also refers to the resources below), infant medical conditions, parental medical conditions, and medical procedures, and their compatibility with lactation
Search the med on e-lactancia, LactMed, or Mother to Baby
Call Infant Risk to ask about medications and milk
Have a copy of Medications and Mother’s Milk (book or app) in your clinic and available to your staff
Refer to an IBCLC. Don’t tell people to pump and dump.
If you can’t find an answer about a medication, tell the parent to pump, save, and label that milk w/ the date, time, and medication in question
Even saving milk for the next day can be very stressful for someone who barely makes enough milk for their baby
Be cautious with your advice. It’s not easy to pump. It’s not easy to discard milk.
The lactation information you learned in med school (if any at all) is probably out of date
Take continuing education courses specific to lactation
The Institute for the Advancement of Breastfeeding & Lactation Education (IABLE) offers continuing education for physicians. Anyone can watch and learn but the content is often directed at physicians.
Gold Learning has a variety of education available, including the Gold Lactation Conference
Do not prescribe infant formula without a proper medical indication
Prescribe. Like a medication.
No samples to parents because they ask to have it as back up. They need help from a human, not formula.
If families are worried about feeding, help them with feeding or refer to an IBCLC; giving formula dismisses the family’s concerns and avoids the problem.
Using formula without an evidence-based medical indication undermines lactation and goes against the AAP’s Breastfeeding Policy
Empower parents with strategies to enable them to combine pumping and work
In the first couple pediatric appointments, ask parents what their work/childcare situation will be
Many parents need to go back to work at just 2 weeks postpartum. They have not physically recovered from birth and need all the feeding support they can get while they’re home
Find out what the family’s needs are and identify points where you can support them to continue lactating
Do they need a note for daycare for special feeding accommodations?
Do they need documentation to get a pump?
Let parents know there are laws (nationwide; here’s Oregon's) protecting their right to pump at work
Work together with others to ensure a continuum of care for the lactating dyad
Communicate with the IBCLCs who work with your patients.
Ask us why we recommend seeing a particular specialist or why we wrote the care plan the way we did
We want to build a relationship with you so we can ensure families are well supported from all of the providers
We’re a team!
Don’t recommend starting solids at 4 mo
Starting solids before a baby (and their gut) is ready undermines human milk feeding
The AAP recommends starting solids around 6 months of age
Use milestones to gauge baby’s readiness, not age.
Can they sit mostly unassisted on the floor?
Do they have head control while sitting for the duration of a meal (15 min ish)?
While sitting, can they pick up objects and bring them to their mouth?
Is the baby interested in food?
Human milk is complete nutrition and NEVER loses its health benefits.
Prescribed weaning is rarely necessary and should be done with the help of an IBCLC to ensure safety for parent and baby.
Remember, as babies age, milk composition adapts to their needs. The volume may be lower but the contents is just right.
It is not necessary to start giving cow’s milk to replace human milk at 1 year of age. We’re humans. We just need human milk.
Ask the family if they have an idea of how long they would like to nurse their baby
Ask questions when a family chooses to switch to formula or combo feed in the first year
Be curious. Ask more questions about their answer to gather information.
Don’t judge. Parents have many reasons for switching but many of those reasons come from a lack of understanding of the human body. They should be able to make a fully informed choice.
Ask if they’d like to talk to someone to a feeding expert to support them and refer to an IBCLC.
Combo feeding or exclusive formula feeding babies can still see an IBCLC.
Network with lactation consultants in your community to see which ones are the most open to helping formula feeding babies….hint…it’s most of us.
Vote for people, measures, and laws that support universal paid family leave
We need laws in place to allow parents to stay home with their babies and still be able to buy food and pay rent
We need private and state insurance companies to cover lactation care at 100% for as long as it’s needed
When we catch problems early on, they are smaller and easier to fix, thus taking less time and money
We need a government who values health promotion and illness prevention rather than disease management
Do not accept any gifts, samples, sponsorship or displays of infant formula, bottles, or teats from companies
Also read the info on this topic that I wrote for yesterday’s blog for midwives. No need for me to copy and paste the info.
If you have not heard of the World Health Organization’s International Code of Marketing of Breast-milk Substitutes (AKA “the Code”), read it. It explains why this step is important in supporting lactation.
Pay for the formula you keep in your clinic
This doesn’t mean parents must pay for it, however, staff will be more thoughtful about saving it for families who truly need free formula
Don’t take continuing education or attend events sponsored by formula, bottle, or non-Code compliant pump companies.
Pediatricians need to be cautious with the resources they give parents
Example: Healthy Children
Run by the AAP
The HALF program (Health Active Living for Families) claims to “partner with parents to encourage healthy habits right from the start.”
I’m purposely not linking to the website because it’s not Code compliant and does not benefit this post…google it if you’re curious.
HALF was started in order to address early childhood obesity prevention
It’s funded by Nestle
Nestle owns Häagen-Dazs, Hot Pockets, Stouffers, Gerber (Goodstart formula), Cheerios, KitKat (among many other foods) yet has “generously supported” a physician run organization’s program on childhood obesity…………………………….wtf.
How can a “health” program funded by a $89 billion formula company can provide unbiased information to families?
All the major USA formula companies donate money to the AAP. Parent companies for Gerber, Similac, and Enfamil all give major financial donations to the AAP.
And all of those companies know they are donating to people who have great influence on their target market…it’s all about advertising and making more money.
In addition to the suggestions above, check out the AAP’s Summary of Breastfeeding-Supportive Office Practices from the Breastfeeding and the Use of Human Milk Policy.
Ok all you pediatricians who finished reading this whole thing….
How do you support your lactating families?
Do you have an IBCLC in your office?
Did you know about the Code? Is your office Code compliant?
What changes can you make to your practice after reading this?