New AAP Policies: What You Need to Know

The American Academy of Pediatrics has 67,000 members — 67,000 physicians who serve the same new families you serve as a lactation care provider.

Do you know what the AAP is telling its members about lactation? We’re here to bring you up to speed.

This past year, for the first time in a decade, the AAP issued a new Policy Statement on Breastfeeding and the Use of Human Milk. Below, we’ll give you the key take-aways from the new AAP policy statement and explore how they apply to your lactation practice today.

When a newborn needs phototherapy for jaundice, it’s common for healthcare providers to start considering supplementation as well. But does a need for phototherapy equal a need for supplementation? The AAP’s new statement says no.

The AAP’s new statement explicitly states that the need for phototherapy in an otherwise healthy infant without signs of dehydration and/or insufficient intake is not an indication for supplementation with formula, unless bilirubin levels are approaching transfusion levels.

What’s more, the policy statement specifies that infants who require phototherapy benefit from remaining in close proximity to their lactating parent to facilitate cue-based feeding and additional breastfeeding support.

Sekeita Lewis-Johnson, DNP, FNP,-BC, IBCLC, Accredited Provider Program Director at LER, expects the APP’s new position on hyperbilirubinemia to make some waves.

“This is one area that will probably cause a lot of distress for a lot of care providers,” she says. “However, it is imperative that we use infant formula only when there is a true medical indication and the benefits outweigh the risks – and we are learning more and more about the microbiota and the risks associated with commercially prepared infant formula.”

In busy facilities, it’s common to rely on parents’ recollections or self-assessments of how feedings are going.

According to the new AAP policy statement, however, this practice needs to change – and dyads need to be formally assessed at least once every 8 to 12 hours throughout their stay.

A formal assessment means a lactation care provider is at the bedside, attentive during the feeding, and providing support.

“This is an explicit call to action to make sure we are safeguarding the health and wellbeing of newborns,” Lewis-Johnson notes. “A formal assessment helps us to identify concerns so that no infant falls through the cracks, at risk for dehydration, hyperbilirubinemia, or rehospitalization.”

In another change worth celebrating, the AAP’s new policy statement recommends parents provide human milk to their babies for 2 years and beyond, bringing its guidance into line with World Health Organization recommendations. Prior to the new statement, the AAP recommended breast/chest feeding for at least 1 year.

As a lactation care provider, you can now share this support from the AAP to encourage the families they serve that keeping on going is a great thing to do – and lactating families can point to the AAP’s advice in conversations with others in their lives regarding continuing their lactation journey.

The AAP’s new statement also sends a very direct new message to pediatricians: Strongly discourage your lactating patients from supplementing their babies with commercially prepared infant formula unless there is a clear medical indication.

The statement further urges pediatricians to engage in direct communication with families about breastfeeding as a medical and health priority, and to partner with lactation specialists to provide their patients with skilled breastfeeding counseling.

Significantly, the new AAP statement highlights the critical issue of breastfeeding inequities, and calls for greater efforts to address it.

The AAP states that implicit bias, structural bias, and structural racism should be addressed to eliminate disparities in breastfeeding and improve the health and well-being of children and families, and provides evidence of racial disparities and well as the associated cost of suboptimal breastfeeding.

The AAP’s new Policy Statement on Breastfeeding and the Use of Human Milk covers many more areas, including lactation management when a parent needs contrast dye for imaging, marijuana use during lactation, and much more. Read the whole policy statement here.

News from the AAP is just one of the areas covered in our new course, Annual Update 2023. In this course, you’ll find everything you need to bring your practice into line with the latest in evidence-based lactation care, including user-friendly breakdowns of more than 30 key lactation-related research studies, protocols, and position statements published in 2022.