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Controversies in Pediatrics session to focus on Baby-Friendly Hospital Initiative :

August 15, 2019

Editor's note:The2019 AAP National Conference & Exhibition will take place from Oct. 25-29 in New Orleans.

There’s no denying breastfeeding has myriad short- and long-term benefits for infants. So much so that the AAP has expressed support for the Ten Steps to Successful Breastfeeding (excluding pacifier restriction) developed by the World Health Organization and UNICEF. Facilities can receive official Baby-Friendly Hospital designation by engaging the services of Baby-Friendly USA.

However, some take issue with the criteria for designation in the U.S., saying they may put infants at risk.

Those issues are among the topics to be discussed by Alison Holmes, M.D., M.P.H., FAAP, and Joel L. Bass, M.D., FAAP, during a session titled “Controversies in Pediatrics: Baby-Friendly Hospital Initiative: Challenges of the Breastfeeding Program” (S4064) from 8:30-10 a.m. Monday, Oct. 28 in rooms R02-R03 of the convention center. 

Numerous studies have been published since the Ten Steps were introduced in 1991. Dr. Holmes and Dr. Bass will provide an update on research in five areas: skin-to-skin contact, the use of formula to supplement breastfeeding, rooming-in practices, pacifier use and the Baby-Friendly designation process.

“I think it’s pretty amazing that most of them (the Ten Steps) are still fairly correct in terms of trying to get to the best breastfeeding outcomes when you think about the kinds of data limitations you had … in the 1970s and ’80s when the evidence to build the steps was being developed,” said Dr. Holmes, associate professor of pediatrics at Geisel School of Medicine at Dartmouth.

Dr. Bass, however, points to research showing an association between sudden unexplained postnatal collapse and unmonitored skin-to-skin contact beyond the first hours of life and newer evidence from the WHO contradicting current Baby-Friendly USA criteria.

“I consider myself a dedicated breastfeeding advocate,” said Dr. Bass, chair of pediatrics at Newton-Wellesley Hospital and professor of pediatrics (part time) at Harvard Medical School. “Our hospital has a greater than 90% breastfeeding initiation rate, and every mother is seen by a lactation consultant every day of her hospital stay. Mothers also have access to a hospital-supported breastfeeding clinic and peer support group after discharge. I think this is where disconnect often happens: the feeling that if you don’t support designation, you’re not in favor of breastfeeding. Nothing could be further from the truth.”

Dr. Holmes works at Dartmouth Hitchcock Medical Center, which received the Baby-Friendly designation, and helped bring Concord Hospital in New Hampshire through the designation process about 10 years ago. Receiving the designation may be especially important for hospitals that care for mothers and babies who are underserved and at higher risk for health issues, she said.

“The regions of the country that really need this are the states where (breastfeeding) rates are low and the hospitals have not kept up with breastfeeding supportive policies,” said Dr. Holmes, a member of the AAP Section on Breastfeeding and Council on Quality Improvement and Patient Safety (COQIPS).

Dr. Bass, a member of COQIPS, maintains that instead of designation, hospitals should determine the best way to support breastfeeding in a manner most compatible with their own patient population.

For more coverage of the 2019 AAP National Conference & Exhibition, visit

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