By Lori Feldman-Winter, MD, MPH, FAAP
The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for about the first six months. We support continued breastfeeding after
solid foods are introduced as long as you and your baby desire, for 2 years or beyond.
Our breastfeeding recommendations, updated in the AAP's "Breastfeeding and the Use of Human Milk" policy statement and technical report, now more closely align with guidance from the
World Health Organization. The United States has set ambitious goals to increase the number of babies receiving only breastmilk up to 6 months of age, with continued breastfeeding as part of the diet after that.
AAP's breastfeeding recommendations
The AAP recommends that babies consume only breast milk for about the first 6 months. There is no need to give your baby infant formula or other sources of nutrition.
Beyond 6 months, we recommend continued breastfeeding along with other nutritious foods. Your baby does not need any infant or toddler formula.
Why AAP recommends breastfeeding
There are so many benefits to breastfeeding! Breastfeeding improves the health of nursing parents and their babies. Breastfeeding can reduce risks for Sudden Infant Death Syndrome (SIDS) by up to 64% and overall infant death risks by as much as 40%.
Breastfeeding can also help protect your baby against lower respiratory tract infections and severe or persistent diarrhea, asthma, eczema, Crohn's and ulcerative colitis, obesity, type 1 and 2 diabetes, leukemia, tooth decay and other problems that can require orthodontia later. Studies also link breastfeeding with higher IQ scores.
Nutrition during your baby's first 1,000 days is so important—and breastmilk is perfectly formulated for your baby's brain development and long-term health.
There are continued benefits from breastfeeding beyond 1 year, and up to 2 years especially for the breastfeeding parent's health. This includes protection against diabetes, high blood pressure, and cancers of the breast and ovaries.
Other benefits of breastfeeding:
Breastfeeding provides warmth and closeness between parent and child. This physical contact helps create special bonds between you and your baby.
Breast milk is easy for your baby to digest.
Breast milk doesn't need to be prepared. It is already ready and free!
Breast milk has all the nutrients, calories and fluids your baby needs!
Breastfeeding can also release hormones that promote healthy parenting behavior.
Breastfeeding can help return your uterus to its pre-pregnancy size more quickly.
- It can also provide contraception if you meet these 3 conditions:
You are exclusively breastfeeding at day and nighttime and not giving your baby any supplements;
It is within six months of birth, and
Your period has not returned.
How can I raise my chances of breastfeeding success?
Before leaving the hospital or birthing center, ask for help to make sure your baby is latching on and getting milk during breastfeeding. The amount of milk a baby will get during each breastfeeding attempt is small during the first day (about 1 teaspoon) and increases on the second and third days.
We support hospitals and health care centers as resources to help breastfeeding parents get off to a good start. Breastfeeding is most successful when started during the first hour after birth, along with
skin-to-skin contact, lactation counseling and frequent breastfeeding during the early days. Skilled lactation support in maternity care facilities can be a huge support to breastfeeding parents.
What should breastfeeding parents know as they get started?
Remember that it is normal for breastfeeding babies to lose some weight in the first days. Your pediatrician will assess if there is a problem with excessive weight loss. Do not worry—breast milk is all your baby needs the first six months of life. The size of your breasts has nothing to do with the amount of milk they will produce.
Also keep in mind that nipple pain is common and needs to be assessed by your pediatrician. Often simple techniques to address position and latch can help resolve your pain.
Newborns should nurse whenever they show signs of hunger—approximately 8 to 12 times every 24 hours. Every parent and baby is different, so the amount of time you nurse and how frequently you nurse will be different as well.
Who should not breastfeed?
Babies with a condition called
galactosemia should not breastfeed. Your pediatrician will let you know if this is an issue.
Parents with HIV who live in the United States should not breastfeed due to the risk of passing this infection to their child. Your healthcare provider will let you know any other conditions that may be problematic with breastfeeding.
What are some challenges I may face in reaching my breastfeeding goals?
Societal pressures can get in the way of breastfeeding goals. For example, a lack of universal paid maternity leave to establish breastfeeding can be a challenge. Parents may lack adequate workplace support to pump. Ask your pediatrician about ways they can support you at your workplace. They may be able to help you identify accommodations as well as identify insurance coverage for breast pumps and supplies.
Many parents face stigma when they choose to breastfeed, especially if they nurse in public or choose to breastfeed older children. However, breastfeeding is a human right. Pediatricians and families can work together to make sure this right is protected.
If you choose to breastfeed beyond the first year, seek out support from your community and health care provider. Some families will choose not to breastfeed, to breastfeed for shorter durations, or combine breastfeeding with the use of infant formula. Your pediatrician can guide you on how best to safely meet your goals and the nutritional needs of your baby. No two mothers share the same goals in breastfeeding. But every parent deserves nonjudgmental support and help in feeding their infant.
About Dr. Feldman-Winter
Lori Feldman-Winter, MD, MPH is Chair of the American Academy of Pediatrics (AAP) Section on Breastfeeding, the AAP representative to the United States Breastfeeding Committee and member of the AAP Task Force on SIDS.