Booby Traps Series: Pediatrician training and attitudes can stand in the way of breastfeeding

This is the 47th post in a series on Booby Traps, made possible by the generous support of Motherlove Herbal Company.

Of all the health are providers involved in your motherhood journey, you’d expect that pediatricians would be the most supportive of breastfeeding

After all, their job is to ensure the health of your infant.  And they’re the providers you see when you’re home from the hospital and the rubber hits the road.

Pediatricians are also highly influential in mothers’ decisions to initiate and sustain breastfeeding, and to breastfeed exclusively.

We know of many, many pediatricians who are supportive of breastfeeding, practice evidence-based care, and even champion the cause.  Many pediatricians have led the way in improving breastfeeding care (and you can find some of them associated with the Academy of Breastfeeding Medicine).

But research has shown that pediatricians are often Booby Trapped by inadequate training, and that their personal experience and attitudes can also stand in the way.

Consider these sobering research findings:

The American Academy of Pediatrics does periodic surveys of physicians’ skills and attitudes toward breastfeeding.  The most recent one, published in 2008, found that compared to the prior survey done in 1999, pediatricians were:

  • Less likely to believe that the benefits of breastfeeding outweigh the difficulties or inconvenience
  • Less likely to believe that almost all mothers are able to succeed
  • More likely to report reasons to recommend against breastfeeding
  • Up to 5 times more likely than pediatricians in 1995 to recommend weaning for inappropriate reasons
  • Most respondents to a 1999 AAP survey reported that breastfeeding and formula feeding were equally acceptable
  • (Fortunately, they were  more likely to recommend exclusive breastfeeding and follow supportive hospital policies.)

The study concluded that pediatricians’ “attitudes and commitment have deteriorated.”

Other studies have found similar problems:

  • 70% of  physicians surveyed in this Mississippi study said they received no training at all in breastfeeding management during their residency.
  • This 2002 study reports on inadequacies in the training pediatricians get to help breastfeeding mothers.
  • Pediatric textbooks, says this 2004 study, contain information which, “when not omitted, is highly variable and at times inaccurate and inconsistent.”  To wit:  “The breastfeeding chapter in a widely used, general pediatric textbook addresses 11 of 15 basic breastfeeding criteria, and information on 6 of those 11 areas is incorrect or inconsistent.”

This has real consequences for mothers and babies.  One study found that “mothers whose pediatric providers recommended formula supplementation if an infant was not gaining enough weight or who considered their advice to mothers on breastfeeding duration to be not very important were more likely to have discontinued exclusive breastfeeding by 12 weeks postpartum.”

There is hope on the horizon in this area, and I’ll soon be writing about a new curriculum for residents which has shown excellent results.  But for now, it’s important that mothers understand that not all pediatricians have the skills or attitude necessary to help you meet your breastfeeding goals.

Was your pediatrician knowledgeable and skilled when it came to breastfeeding?  How did your pediatrician influence your breastfeeding experience?



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4 Comments | Last revised on 07/05/2012


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4 Responses to Booby Traps Series: Pediatrician training and attitudes can stand in the way of breastfeeding

  1. Anne Campbell says:

    When my daughter was a newborn, our regular pediatrician was out of town and we saw his partner for one visit. She told us that I shouldn’t bother to nurse the baby for more than ten minutes per breast, because “after ten minutes, there’s no more nutritional value in the milk.” This rang false to me, and I’m REALLY glad I double-checked with my midwife. She confirmed that it was hogwash and that I needed to nurse long enough on each side for the hindmilk to kick in. And she sent a strongly worded letter to the pediatrician’s office!

    If I had followed that advice, I have no doubt that my baby would have ended up with “failure to thrive.” I didn’t have an enormous milk supply, and I listened to my baby’s need for very frequent nursing. She knew much better than the doctor did. :)

    Incidentally, this doctor also told us in the same visit that our baby could catch Hepatitis B (a blood-borne illness, transmitted in the same ways as HIV) by “sitting next to someone in a restaurant who sneezes!”

  2. We love our pediatrician in every other way – She was my doctor and very relaxed through my low-risk pregnancy, she asks IF we want the vaccinations at every visit, she’s OK with giving out real drugs as needed but doesn’t push them when they are not, and just generally trusts us to make our own choices as parents. So basically we turn our ears off when she makes comments about breastfeeding. She was very supportive for the first year, but after that has said things like, “It’s just for comfort at this point.” Not the worst comments, not telling me to wean, but clearly she isn’t educated on the benefits past one year. I don’t say anything – I assume that other moms who have made it past a year will know she’s wrong and blow off the comments as well – but I may anonymously send her a packet of info on breastfeeding an older child at some point. She works at a low-income clinic and I really love that, but it’s also a place she could do the most good when it comes to breastfeeding. (She did talk to me about breastfeeding at my prenatal visits and never gave or offered formula samples, ever.) I feel like pediatricians have a lot on their plate, it’s hard to be an expert in everything, but breastfeeding needs to me one of the top things they’re qualified in. I do wonder what the experience is like in that clinic from a different perspective, if I hadn’t been so educated, headstrong and vocal about my choices.

  3. Celeste says:

    My twin boys’ first pediatrician was very biased against breastfeeding. I expressed my desire to breastfeed my twins, she went on a rant that her daughter was formula fed and at the top of her class, that she sees many sick breastfed babies and that none of her twin moms breastfed.

    I found a breastfeeding friendly pedi with the help of my friend who is an IBCLC. She never suggested that I supplement for any reason and was thrilled that I nursed them beyond 1. She is fantastic

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