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4 Signs of a Breastfeeding-Friendly Pediatrician

American women find themselves in the crosshairs of a cultural tug-of-war, where on one hand they are told "breast is best" and on the other almost everyone around them is advocating formula as an easy solution for any problem. Nowhere do these mixed messages become more confusing than in a doctor's office, where mothers are looking to trusted healthcare providers to help them reach their personal breastfeeding goals. Unfortunately, the messaging encountered there is not always consistent. Ideally, the pediatrician's office is spin-free zone where evidence-based information and support is shared in a way that encourages parents to make informed decisions for their families. Support can take many forms, but here are four ways we've seen pediatricians be instrumental in helping families successfully breastfeed:

4. The Pediatrician Promotes Exclusive Breastfeeding

"The American Academy of Pediatrics supports continued breastfeeding, along with appropriate complementary foods introduced at about 6 months, as long as mutually desired for 2 years or beyond."¹ Despite these official recommendations, its not unusual for moms to report their pediatrician discouraged them from exclusive breastfeeding or suggested introducing solids too soon. Studies suggest a doctor's personal infant feeding history has a strong influence on their advice. In 2004, only 37% of pediatricians reported exclusively breastfeeding their own children which significantly impacted how they felt about breastfeeding and the advice they gave.² Personal experience aside, a breastfeeding-friendly physician will build women's confidence in their ability to breastfeed and in the immense value of breastfeeding for both mother and baby's well-being...for as long as mother and baby wish to breastfeed. When your pediatrician is cheerleading your breastfeeding efforts and providing a consistent message of support in the office (no freebie formula cans or formula advertising plastered on the walls) it helps you confidently achieve your own breastfeeding goals.

3. The Pediatrician Encourages Small, Frequent, Responsive Feedings

Nothing dooms a mother to low milk supply as surely as long spaces between breastfeedings/pumpings. The average woman will need to empty her breasts (via pumping or breastfeeding) around 7-10 times to maintain a full milk supply until her baby is well established on solid foods (usually around 9 months).^{3, 4} Many pediatricians are unaware that this is necessary beyond the newborn weeks and will give mothers the impression their babies are nursing too often or should be sleeping through the night. In fact, most breastfed babies need at least one nightfeeding in order to grow well and for mothers to maintain milk supply. Often, if baby starts sleeping through the night it is still necessary to pump once at night or wake baby for one nightfeeding - otherwise mother's milk supply will gradually diminish. Breastfeeding-knowledgable pediatricians understand milk supply is driven by frequent breast-emptying and encourage mothers to respond to their baby's "feeding cues." A breastfed baby's frequent feeding pattern also translates into small bottlefeedings. Breastfed babies average 27oz of breastmilk per day, and this quantity does not change between months 1-9 (after 9 months it gradually decreases).³ Simply divide 27oz by baby's average daily number of feedings and you'll have the correct bottle quantity. Example: 27oz ÷ 8 feedings = 3.3oz per feed. Pediatricians can reassure pumping mothers that 3-4oz bottles are normal and healthy, unlike the 5-8oz bottles that formula-fed babies often consume. Which brings us to the next point...

2. The Pediatrician Uses the World Health Organization Growth Chart

Breastfed babies grow differently than formula-fed babies, and a breastfeeding-knowledgable pediatrician will be prepared for this. At first, formula-fed babies grow at a slower rate than breastfed babies until around 4 months, when they begin to put on weight faster than breastfed babies for the remainder of their lives. Unlike breastfed babies who tend to thin out over time, formula-fed babies tend to retain their "baby fat" - increasing their risk for childhood obesity. Unfortunately, many pediatricians use growth charts made by the Center for Disease Control (CDC) that were based on formula-fed babies growth patterns. Several years ago the CDC recognized this problem and now recommends using the World Health Organization's (WHO) growth charts for children under 2 years, not CDC charts. (How often does an organization recommend against their own material?!) According to the CDC, "Breastfeeding is the recommended standard for infant feeding. The WHO charts reflect growth patterns among children who were predominantly breastfed for at least 4 months and still breastfeeding at 12 months. The WHO standards provide a better description of physiological growth in infancy."⁵ If the faulty CDC charts are used, pediatricians may not be alerted to a slowly growing infant under four months, and may have unwarranted concern about a breastfed baby's slower growth during the second half of the year. For example at 2 months a boy who weighs 11lbs 10oz is 50% on the CDC chart but is 33% on the WHO chart. The opposite happens later. A baby boy who at 9 months weighs 19lbs 10oz is 35% on the CDC chart but is 50% on the WHO chart. Ask your pediatrician which chart they use for children under 2 years of age. (Click here to learn more about infant growth.)

If There's a Problem, the Pediatrician Refers You to a Lactation Consultant

You bring your breastfeeding baby in for a well check, and the pediatrician tells you your baby is not gaining enough weight. Or, perhaps you explain to her that breastfeeding is painful for you and you need relief. Does the doctor send you home with formula or does she refer you to a lactation consultant so that the underlying problem can be addressed? This is the most tell-tale sign of whether a pediatrician is truly supportive of breastfeeding. Doctors are pressed for time, and a ten minute appointment is not likely to be sufficient time to fix breastfeeding challenges. Besides, surveys indicate only 67% of pediatricians received breastfeeding management training in med school, and only 44% have pursued continuing education on the topic.² A breastfeeding-friendly doctor will recognize her limitations (be it time or specialized training) and when concerns arise will refer mothers to a breastfeeding specialist so that a care plan can be developed that helps address the problem while supporting successful breastfeeding. A few doctors take it a step further, by collaborating with the lactation consultant to provide a consistent care plan that everyone can feel good about. This team approach to infant wellness helps mothers feel confident and supported and ensures the best outcomes for their babies.

If your pediatrician is not breastfeeding-friendly, try asking around in local breastfeeding groups for recommendations. Or, ask a local lactation consultant who she recommends. If your pediatrician is breastfeeding-friendly, be sure to let them know how much their support means to you!

Mamas in the north Charlotte and Lake Norman area, we encourage you to setup a home visit so we can help you in collaboration with your pediatrician. If you are out of our travel area, you can setup a virtual consult with us or google "lactation consultant near me" to find local help.