Below you will find background informaton on the BPPOP Program.

In January 2000, the US Public Health Service set forth national health objectives to begin the new millenium entitled Healthy People 2010. This document includes the breastfeeding health objective carried over from the Healthy People 2000 National Health Promotion and Disease Prevention Objectives:² "Increase to at least 75% the proportion of mothers who breastfeed their babies in the early postpartum period and increase to at least 50% the proportion who continue breastfeeding until their babies are 5 to 6 months old." An additional breastfeeding health objective setting a continuation rate of breastfeeding at 1 year of 25% is included in Healthy People 2010. The baseline for this objective was 54% at discharge from the birth site and 21% at 5 to 6 months in 1988. Unfortunately, the nation is far short of achieving this objective. In the early 1990s, the proportion of mothers choosing to breastfeed actually fell below the baseline level. Baseline rates of initiation and duration in 1998 reached to only 64% of women breastfeeding at hospital discharge, only 29% still breastfeeding at 6 months, and 16% still breastfeeding at 12 months (see table below).³

Research has shown that the unique composition of human milk enhances cognitive and visual development and lowers the risk and severity of a variety of acute childhood illnesses and chronic diseases, including diarrhea, lower respiratory infection, otitis media, bacteremia, bacterial meningitis, urinary tract infection, necrotizing enterocolitis, lymphoma, and digestive diseases. There are also significant benefits to women who breastfeed, such as reduced risk of breast and ovarian cancer and osteoporosis. As more information on the benefits of breastfeeding continues to emerge, it will be important for pediatricians to be well versed in the science of breastfeeding.

Most professional physician associations recognize breastfeeding as the preferred method of feeding for infants during and beyond the first year of life. Despite this consensus among physicians, there is often a sense that breastfeeding management is not within their domain of practice. Inconsistent practice standards related to breastfeeding and the lack of adequate scientifically based postgraduate education tend to undermine support for this area of practice within the professional medical community. A 1995 survey conducted by the American Academy of Pediatrics (AAP) established that most pediatricians believe breastfeeding should be actively encouraged to all mothers, but that confusion and conflict were apparent in pediatricians' practices and attitudes regarding breastfeeding promotion.⁵
The Academy has taken steps to provide its members with education regarding the promotion of breastfeeding and the management of breastfeeding infants through chapter initiatives and educational programs at AAP national meetings. With the financial support of the federal Maternal and Child Health Bureau and the United States Department of Agriculture, the Academy held a 1 1/2-day training session for 53 state chapter breastfeeding coordinators in April 1997 and for 122 professionals from various professional and other health organizations in August 1999. The AAP Work Group on Breastfeeding, established in 1994 to oversee AAP breastfeeding activities, finalized a policy statement entitled Breastfeeding and the Use of Human Milk, published in Pediatrics in December 1997.⁴ The work group, now the Section on Breastfeeding Executive Committee, also prepared a breastfeeding exercise for the 1998-99 AAP Ambulatory Care Quality Improvement Program. Currently, the Provisional Section is developing the Breastfeeding Manual for Physicians with the American College of Obstetricians and Gynecologists, an AAP Speaker's Kit on Breastfeeding Promotion and Management, and working with the AAP Division of Public Education to produce the New Mother's Illustrated Guide to Breastfeeding.
Given these AAP activities, along with the nationally focused Baby-Friendly Hospital Initiative and WIC National Breastfeeding Promotion Project, parents and health care professionals are looking to physicians, specifically pediatricians, for support and medical guidance related to breastfeeding promotion and management. The Academy has implemented the Breastfeeding Promotion in Pediatric Office Practices program to prepare its members to respond to these inquiries in their practice settings, to better prepare current and future practitioners to support new mothers and manage the care of breastfeeding infants, and to collaborate with other health professionals in developing complementary breastfeeding promotion programs.
"The Breastfeeding Promotion in Pediatric Office Practices program is the next step in pediatric breastfeeding education and support, following closely on the heels of the widely publicized and well received December 1997 AAP policy statement, Breastfeeding and the Use of Human Milk, says Betty L. Crase, IBCLC, Manager, AAP Division of Community Health Services. "Pediatricians are eager to put the policy statement into action by providing more effective breastfeeding services to their patients. Participation in this program will help to make this happen."

The Chairperson of the Project Advisory Committee for the Breastfeeding Promotion in Pediatric Office Practices program, Linda Sue Black, MD, FAAP, states "Effectively supporting breastfeeding is as important to preventive pediatric health care as promoting immunizations, car seat use, and proper infant sleep position. It is difficult for a busy pediatrician to stop and think through his or her daily routine and identify all of the potential opportunities for offering anticipatory guidance regarding breastfeeding concerns. It also is difficult to know which questions to ask to identify what type of intervention may help a mother with a breastfeeding problem. By developing easy to use brochures and reference materials and providing skilled staff support, the Academy intends to facilitate this process for office-based pediatricians. We hope the program will attract participants who have frequently thought they would like to be more supportive of breastfeeding but have not had the time or the resources to develop this interest."

References:

1. Healthy People 2010. Washington, DC: US Department of Health and Human Services, Public Health Service; 2000.

2. Healthy People 2000 National Health Promotion and Disease Prevention Objectives. Washington, DC: US Department of Health and Human Services, Public Health Service; 1990. DHHS publication (PHS) 91-50212

3. Mothers survey, Ross Products Division, Abbott Laboratories; 1997; Columbus, OH

4. American Academy of Pediatrics, Work Group on Breastfeeding. Breastfeeding and the Use of Human Milk. Pediatrics 1997; 100(6):1035-39.

5. American Academy of Pediatrics, Division of Child Health Research. Findings from Periodic Survey of Fellows #30: Pediatricians' Practices and Attitudes Regarding Breastfeeding Promotion; February 1996; Elk Grove Village, IL