New Guidelines Encourage Breastfeeding Longer, but Call for More Parental Support

The American Academy of Pediatrics issued a policy statement Monday that extends the period of time for which breastfeeding is recommended to two years or more, but that also acknowledges the obstacles that stand in parents’ way.

“We need societal changes that will help to support this, such as paid leave, more support for breastfeeding in public and child care facilities and workplace support,” said Dr. Joan Meek, a professor emeritus in the department of clinical sciences at the Florida State University College of Medicine and lead author of the new recommendations.

Much of the policy — the group’s first updated guidance on breastfeeding in a decade — is identical to what the A.A.P. has said in the past. The organization continues to recommend that babies be exclusively breastfed for about six months, at which point complementary foods can be introduced. The statement cites research linking breastfeeding to a range of benefits in infants, including decreased rates of lower respiratory tract infections, severe diarrhea and ear infections.

But the group is now calling for pediatricians to support breastfeeding for two years or more — instead of one year or more — if “mutually desired” by mothers and their babies. Dr. Meek said the shift was rooted in research that suggests there are particular health benefits of extended breastfeeding for mothers, like decreased risk for maternal Type 2 diabetes. But it also reflects the A.A.P.’s desire to normalize breastfeeding for longer for parents who choose to do it.

“In the medical community, there has often been this tendency to support breastfeeding up until a child’s first birthday,” Dr. Meek said. “After that, it’s like, ‘Well, there’s no reason to continue breastfeeding.’”

The reality, however, is that a majority of American babies are not breastfed for as long as the A.A.P. recommends. Its new policy statement is in line with guidance from the World Health Organization, which has long endorsed breastfeeding up to a child’s second birthday or past it.

The most recent data available from the Centers for Disease Control and Prevention says 84 percent of babies start out being breastfed, but only 58 percent are breastfeeding at 6 months — and just 25 percent are breastfed exclusively. Thirty-five percent of babies are still breastfed at 1 year, and there are not reliable national estimates beyond that time frame.

The gulf between public health guidelines and what happens in most American families can leave new parents vulnerable to feelings of guilt or disappointment.

“This is the recommendation, but in actuality — in practice — we don’t want parents to feel bad if they can’t get there,” Dr. Dale Lee, a specialist in pediatric gastroenterology and nutrition with Seattle Children’s Hospital, said.

The A.A.P.’s new breastfeeding policy statement acknowledges that many of the barriers parents face in meeting public health recommendations and their own goals are beyond their control. It encourages pediatricians to advocate changes that would help parents, including guaranteed paid leave, flexible work schedules and workplace resources like lactation rooms, universal break time for pumping breast milk and on-site child care.

The recommendations also suggest that pediatricians have “nonjudgmental conversations” with families about their breastfeeding goals and acknowledge that exclusive breastfeeding is not always possible. The A.A.P. notes that children of gender-diverse parents may have less access to human breast milk, and that clinicians should be mindful of using more inclusive language, like “chestfeeding,” when working with those families.

“I think breastfeeding is wonderful, and I want to really highlight the benefits of it,” Dr. Lee said. “But I also want to say to parents that it’s not as though you are mandated to provide breast milk, and that you are a failure if you don’t.” He added that babies can thrive on breast milk, baby formula or a combination of both, and that what matters most is parents’ ability to “lovingly provide nutrition” to their children.

Yet the policy comes at a challenging moment for many American families, amid a monthslong baby formula shortage that has made it more difficult for parents to meet their children’s basic needs.

Dr. Meek noted that the A.A.P. had been at work on its new policy statement for years. She said the timing of the publication should not be interpreted as if the A.A.P. were suggesting in any way that women can breastfeed their way out of the current formula crisis.

Pediatricians should support families in finding a feeding plan that works for them, experts said.

“It’s not one-size-fits-all,” Dr. Natasha Sriraman, an associate professor of pediatrics at Eastern Virginia Medical School/Children’s Hospital of the King’s Daughters, said of the new recommendations. “What may work for mom in X situation is not going to work for mom in Y situation, and I think, sadly, we still have mom guilt and judgment.”

In her practice, she tends to emphasize that whatever amount of breast milk parents are able to give their babies is beneficial, rather than to bluntly apply public health recommendations about duration or exclusivity.

Dr. Sriraman called the idea of breastfeeding for two years “wonderful” — if that is a family’s goal. But, she added, it is “really a stretch in this country.”