AAP Breastfeeding Guidelines

Why is it that I'm learning about what the American Academy of Pediatrics is saying from a mother who is currently living in the Ukraine? You'd think I would have heard about it before her...

So anyway, the AAP has released an updated set of breastfeeding guidelines, this replaces those that were released in 1997.

Given my involvement in the Ezzo debate, I found two points very noteworthy in the guidelines. The first involves the frequency of feeds:

During the early weeks of breastfeeding, mothers should be encouraged to have 8 to 12 feedings at the breast every 24 hours, offering the breast whenever the infant shows early signs of hunger such as increased alertness, physical activity, mouthing, or rooting.170

* Crying is a late indicator of hunger.171 Appropriate initiation of breastfeeding is facilitated by continuous rooming-in throughout the day and night.172 The mother should offer both breasts at each feeding for as long a period as the infant remains at the breast.173 At each feed the first breast offered should be alternated so that both breasts receive equal stimulation and draining. In the early weeks after birth, nondemanding infants should be aroused to feed if 4 hours have elapsed since the beginning of the last feeding.

* After breastfeeding is well established, the frequency of feeding may decline to approximately 8 times per 24 hours, but the infant may increase the frequency again with growth spurts or when an increase in milk volume is desired.

"Crying is a late indicator of hunger." Ezzo would have his readers believing that the typical demand feeding mother responds to crying routinely by offering the breast. This simply isn't true. Its not that a demand feeding mother would never offer the breast in response to crying--I certainly do if I think the crying indicates a need for comfort. Its that we generally do not associate crying with hunger and thus we respond to crying by looking for things like a dirty diaper, something causing pain. We learn other cues for hunger in our children--little sounds they make, rooting, waking up from a nap...

"The frequency of feeding may decline to approximately 8 times per 24 hrs, but ... may increase ... with growth spurts...." Hmmm. So does that mean that 6 nursing sessions per day typically would not be expected with an exclusively breastfed infant? My experience with 4 children has been that they do not drop below 8 nursing sessions in a 24 hr span until well after they start eating solid food. But here again, Ezzo would have his readers believing that 4 feeds per day is sufficient.

Mother and infant should sleep in proximity to each other to facilitate breastfeeding.

The reference to support this reccommendation actually indicates that babies who sleep in a bassinet next to the parent's bed (called a "cot" in this research, as it was done in England) have the lowest risk of SIDS. Babies who sleep in the parents' bed have a similar--but slightly lower risk of SIDS as those who sleep in a separate room. The most dangerous place to sleep for the infant is on a couch with an adult. After 14 weeks of age, the risk of SIDS seems to level out in all the groups. The article concludes by saying "There are certain circumstances when bed sharing should be avoided, particularly for infants under four months old. Parents sleeping on a sofa with infants should always be avoided. There is no evidence that bed sharing is hazardous for infants of parents who do not smoke."

Hmmm...so should I take the inclusion of this reccommendation to mean that the AAP is NOT against bedsharing? ;-)

So I wonder...will there be a 2006 edition of Babywise so that Ezzo can continue to claim that his advice lines up with the AAP?