A review of scientific evidence on breastfeeding out Tuesday found that some long-held advice is worth ditching, including that babies should avoid pacifiers and moms should breastfeed exclusively in the first days after birth.
Individual interventions to help expectant and new moms breastfeed are still recommended, but systematic or hospital-wide policies tend to show little benefit, said the report by the US Preventive Services Task Force (USPSTF), an independent panel of experts.
The benefits of breastfeeding include providing optimal nutrition and an immune system boost for babies, while helping mothers bond with infants and speeding maternal weight loss after birth.
"There is convincing evidence that breastfeeding provides substantial health benefits for children and adequate evidence that breastfeeding provides moderate health benefits for women," said the report in the Journal of the American Medical Association (JAMA).
"However, nearly half of all mothers in the United States who initially breastfeed stop doing so by six months."
The American Academy of Pediatrics urges women to breastfeed for at least the first year if possible, while the World Health Organization recommends up to two years of age or beyond.
Just 22 percent of US babies are breastfed exclusively for six months, even though 80 percent were breastfed at some point in their young lives, suggesting that women face challenges in continuing to breastfeed.
Although the process is natural, getting started can be complicated, and babies often need help learning how to latch on and feed.
For some mothers, the demands of returning to work can make breastfeeding impossible. Others may be physically unable, or may prefer the convenience of formula.
Tailored approaches work best
To update its 2008 recommendations, which also urged breastfeeding support for women, the task force reviewed evidence from dozens of studies, both new and old, on the effectiveness of various kinds of interventions on whether women took up breastfeeding, and how long they continued.
They found that the most effective interventions were one-on-one assistance provided by trained personnel, particularly when delivered at multiple points in time.
Hospital policies designed to encourage breastfeeding by implementing a series of pre-determined steps did not show any significant effect on improving breastfeeding.
Some of the policies in place even have the potential to be harmful, an accompanying editorial in JAMA by doctors Valerie Flaherman and Isabelle Von Kohorn warned.
For instance, step nine of the World Health Organization's Baby-Friendly Hospital Initiative urges parents to avoid giving pacifiers to babies, on the basis that they could deter breastfeeding.
However, the evidence review "showed that avoiding pacifiers was not associated with any breastfeeding outcomes."
Since pacifiers are recommended as a way to help reduce the risk of sudden infant death syndrome (SIDS), the leading killer of young babies in the United States, "routine counseling to avoid pacifiers may very well be ethically problematic," the editorial added.
Another source of controversy is the advice -- contained in step six of the WHO plan -- that new mothers should not feed their babies formula in their first days of life, but only provide breast milk unless medically necessary.
Not only did this advice show no evidence of a benefit for breastfeeding practice, it can raise the risk of dehydration complications and rehospitalization in babies in their first week of life because mothers' milk does not always come in right away, but can take four to seven days.
"Although these conditions are generally mild and often resolve rapidly, their frequency is high; one to two percent of all US newborns require readmission in the first week after birth, and the risk is approximately doubled for those exclusively breastfed," said the JAMA editorial.
Finally, the long-held recommendations that babies should be fed only breast milk for their first six months of life may need to be reconsidered in light of recent research that shows some babies could benefit from small introductions of highly allergenic foods like crushed or ground peanuts in their first four to six months.
The editorial urged medical professionals to exercise their individual judgment and pursue tailored approaches to helping women with their personal breastfeeding needs.
"A single, uniform approach is ineffective at improving breastfeeding duration of the population," it said.