Abstract
The American Academy of Pediatrics (AAP), the World Health Organization (WHO), and the American Academy of Family Physicians (AAFP) all currently advise against the initiation of breastfeeding for a variety of reasons. Prior to breastfeeding, the nursing parent should make a list of any medical history circumstances that could in some way make it impossible to continue breastfeeding over the advised time frame. Since there are several safe counterparts available, the necessity to take drugs frequently does not become an adequate reason for ceasing breastfeeding. The use of antimetabolites is necessary during the treatment of cancer, which is an exception. HIV patients are also not recommended to breastfeed due to the possible risk of transmission of the disease to the infant through emerging wounds. If the patient’s state of health is still suspicious, the possibility of breastfeeding remains under consideration until consultation with a specialist and receiving new advice, considering the identified factors.
In the paper, the advantages and disadvantages of the institutions’ propositions on breastfeeding are described, analyzed, and critiqued. The organizations recommend taking no less care of the well-being of a mother considering the need for breastfeeding. First and primarily, this entails acknowledging cultural traits that the consulting physician should take into consideration while assessing the patient’s health. To impact the expecting mother’s prenatal intention to breastfeed favorably, she should be in a friendly and secure setting. To prevent future lifestyle choices from affecting the quality of mother’s milk, the decision to begin breastfeeding should be made before to conception or as early as feasible during pregnancy. According to the results of the research, the benefits of the recommendations are prevalent in comparison with the negative aspects.
Introduction
The World Health Organization (WHO), the American Academy of Family Physicians (AAFP), and the American Academy of Pediatrics (AAP) issued a new list of guidelines in 2022 that advocates for extending the breastfeeding period for babies. After a year of breastfeeding, the mother’s milk retains the same amount of protein, lysozyme, and lactoferrin overall, and in some cases, even more. This is despite the decreased levels of potassium and zinc (Cuffari 2022). The suggested feeding period is two years, with the possibility of adding supplementary meals gradually after the first six months. All of the initial standards were in part created to ensure the mother and child’s maximum safety throughout the feeding process as well as the newborn’s greatest benefit. The American Academy of Pediatrics advises that during the initial six months of life, infants should only be breastfed or given expressed mother’s milk. After this time, continuing nursing is also preferred, although the choice should be made based on the mother’s and child’s unique qualities.
Methods
Breastfeeding, its characteristics, advantages, and disadvantages in terms of healthcare and social life elements have been the subject of several studies that have been published in the literature field. The strategy used in this paper’s techniques of analysis applies three specific methods for a systematic search of the essential and relevant publications. Firstly, creation of a methodology, secondly, filtration of scientific articles by topic, tags, and description, and, finally, data and information retrieval from the selected studies.
Referring to methodology elaboration, using a keyword basic search, pertinent and credible publications from the literature were identified and emphasized. In fact, the inquiry was not limited to publications that have undergone peer review process since the official websites of different organizations and institutions related to the topic were utilized. The concrete terms “lactation” and “breastfeeding” or “breastfeeding recommendations” or “maternal health” or “infant health” and “breastfeeding advantages and disadvantages” were all examined using various keyword searches across multiple databases. In addition, exclusively scholarly articles and website sources that were issued or published within a concrete and acceptable timeframe were included in the research. In this case, the timeframe for the sources was set using the duration of five years and only sources that were published in the period of 2017-2022 were included in the strategy.
The particular databases chosen for this study contain a substantial number of documents from different titles and authors. As a consequence, a sizable fraction of the peer-reviewed research articles that have been published in the field of breastfeeding exploration may be searched for and located using the databases. The examples of the most sufficient and relevant academic journals used in this research paper include Journal of Human Lactation, Breastfeeding Medicine, Current Developments in Nutrition, Breastfeeding Medicine, Breastfeeding: Support, Challenges, and Benefits, and Pediatrics.
Furthermore, by utilizing internet resources and digital databases to perform an organized literature search, the exploration was in accordance with the conception of the current topic awareness. In other terms, the results of the search can be underlined with a variety of publications on the socioeconomic and environmental elements of breastfeeding. Particular publications, including peer-reviewed studies that were issued in English, were taken into consideration from the databases previously stated. The search approach produced 25 final articles and sources in total, which were deemed appropriate for inclusion in the final study. By using a thorough search approach, it was possible to reduce source prejudice and bias and find relevant papers for an in-depth analysis.
Regarding the filtration of scientific articles by topic, tags, and description, it is reasonable to highlight several essential notions. The extensive quantities of material classified in the significant healthcare databases are sorted via using filtering options, which are attempted methods for locating the better-quality information. There are filters available for the majority of experimental and research design forms, and they are primarily composed of terms relevant to the theoretical definition of effective experimental architecture as well as study type-related key phrases. To guarantee validity and importance, all publications were processed, analyzed, and assessed depending on the title, keywords, and summary descriptions. It was necessary to ensure that the findings contributed to the discourse on breastfeeding’s implications for risk, healthcare, safety, and reliability. After reviewing the publications and web sources, 25 were chosen as having relevance and significance for this research focusing on the criteria for inclusion.
Concerning data and information retrieval from the selected studies, the accompanying information was gathered from each work: the academic paper’s year or period of publication and the title of the journal where it appeared. Furthermore, a literature reference should include the scientific paper’s name, year, creator, and source as well as its primary goal and outcomes. The selected publications have been reported in 16 various journals, including four journals that have issued two or more sources relevant to breastfeeding elements in healthcare or in social contexts. In addition, it is necessary to mention that each of the additional twelve journals only provided one paper. The detected papers were grouped into broad and major breastfeeding-related main themes in order to consistently give academic perspectives on the study issues.
Considering the basic methodology regarding the search for relevant and credible scholarly articles and other types of literature, it is essential to underline the need for specifically analyzing abstracts. In this paper, the abstracts for all of the 21 scholarly articles were combined, reviewed and assessed since the other four sources represent websites and public portals. In this case, abstracts are highly valuable since they generally contain the major information, results, methodologies, limitations, key notions, data sets, and future implications of the study. With the help of reviewing the abstracts of the articles during the stage of searching for relevant literature it became possible to recognize common points in the researches that were useful for the paper. The inclusion of concrete words and phrases related to the particular part of the paper enabled a more efficient way of identifying whether the study was relevant.
Results
Considering the outcomes of the search strategy elaboration and the analysis of the corresponding literature, it is firstly obligatory to emphasize the contribution of the sources that are not categorized as scholarly articles. In this paper, four sources out of the total of 25 are related to separate websites or governmental and public portals. These digital networks include essential data and information for the research on breastfeeding recommendations, as well as governmental and institutional policies and guidelines. In fact, the set of the websites used contained U.S. Department of Health and Human Services, American Academy of Pediatrics, American Academy of Family Physicians, and Centers for Disease Control and Prevention.
The abovementioned sources provided important information since official organizations and institutions publish specific recommendations, guidelines, and statements that can be used, examined, and discussed. Particularly, the digital sources connected to American Academy of Pediatrics and American Academy of Family Physicians were identified initially due to the fact that they contained all necessary information linked to the breastfeeding notions, recommendations. Furthermore, it is needed to describe the main findings in benefits and negatives of breastfeeding recommendations as they are the results of the literature search and review methodologies.
The continuation of breastfeeding for up to two years has a substantial positive value for the body of the newborn. The effect of such feeding remains long-term and persists until the child reaches adulthood. The continuation of breastfeeding after six months and the refusal to add infant formula to the diet supply the child’s body with protein, lactose, and fat (Cuffari, 2022). This helps to reduce the risk of developing leukemia, develops a strong immune system and protects the child from cardiovascular diseases. In addition, it has a positive effect on the development of the respiratory tract, asthma and diarrhea. Moreover, the positive effect of breastfeeding is reflected in the reduction of the risk of sudden infant death syndrome, which was reduced by 64% in children who have been breastfed for more than six months (Cuffari, 2022). Consequently, it is feasible to assume that a major positive repercussion of a systematized and organized process of breastfeeding can firstly cause health improvements both among mothers and their children.
Furthermore, breastfeeding benefits the mother, who in this way increases her emotional and psychological attachment to the baby. Prolonged presence next to the child helps the mother to better recognize the nonverbal signals of the child in the future, which improves their relationship and builds trust at the initial stage. Additionally, studies find a medical justification for the need for breastfeeding. Thus, mothers significantly reduce their risk of developing diabetes, hypertension and thyroid or breast cancer (Cuffari, 2022). In this case, it is compulsory to note that mothers’ health and wellbeing should not be disregarded since a considerable amount of attention is dedicated solely to the health aspects of breastfeeding in infants.
Concerning the drawbacks and disadvantages of the recommendations provided by the AAFP, AAP, and WHO organizations, it is feasible to state that ethical issues are not totally covered. Considering various questions regarding breastfeeding, ethical issues and dilemmas that can potentially arise are not addressed well due to the lack of clarity and specification of the problems. Despite laws stating the necessity for lactation intervals and sufficient room to pump, US doctors who are parents may be especially significant at risk for not actually completing their breastfeeding objectives (Perumalswami & Laventhal, 2018). Merely 19.7% of the pediatrician mothers interviewed in a study conducted by Melnitchouk and associates indicated they utilized lactation facilities at workplace to release breast milk (Melnitchouk et al., 2018b). Ethics-related concerns should be taken into account since other participants utilized their offices, conference rooms, unoccupied patient rooms, restrooms, shower facilities, closets, and automobiles (Perumalswami & Laventhal, 2018). Hence, the presence of the negative part of the recommendations is proved by evidence from scholarly sources, which underlines the occurrence of ethical concerns.
The major dilemma that was detected using methods of literature review and further analysis is whether it is ethically correct for both parent and child to be at danger from poor institutional breastfeeding assistance. The threat of physical damage to the mother increases when she is unable to handle the ongoing physical requirements of breastfeeding (Oosterhoff et al., 2022). In addition to clogged ducts and abscesses, postponed milk secretion can cause fever, discomfort, missed productivity, and, in exceptionally serious forms, life-threatening problems (Oosterhoff et al., 2022). Further hazards are posed by pumping while riding, driving or in locations where security and hygiene are not guaranteed. It is advised to feed newborns exclusively human milk to promote their well-being and development, and breastfeeding can actually be life-saving for certain children, particularly those with immunodeficiencies or dairy allergies. Accordingly, improper weaning might pose a health danger to the children, including the infants of doctors. Therefore, the methods of literature search and review assisted in forming the abovementioned key features of breastfeeding that were then used in the discussion section.
Discussion
The accepted guidelines for baby feeding and health are breastmilk and natural types of human development. According to the overall propositions of the AAP, WHO, and AAFP, human milk distribution is essential for public wellbeing due to breastfeeding’s short- and long-lasting medicinal and neurodevelopmental benefits (Meek & Noble, 2022a). For almost six months following childbirth, the American Academy of Pediatrics advises continuous breastfeeding (Meek & Noble, 2022a). The AAP generally encourages mothers to remain breastfeeding their children for as long as both parties wish, which is generally for two years or longer, coupled with the introduction of suitable complementary meals around six months (Meek & Noble, 2022a). These suggestions are in line with those officially declared by the World Health Organization, and there are seldom any medical reasons not to breastfeed (Meek & Noble, 2022a). The AAP advises maternity hospitals or facilities to employ prenatal care procedures that have been proved to increase breastfeeding start, intensity, and length (Meek & Noble, 2022a). Hence, considering the fundamental part of the recommendations, it is feasible to state that they are mostly based on medical and biological advantages provided by breastfeeding consequences.
One of the major benefits regarding the united recommendations connected to breastfeeding and its positive health implications is the highlighted need for improving training, education, and development procedures among pediatricians. The AAP encourages mothers to continue breastfeeding their children for as long as both parties wish, which is typically for two years or longer, coupled with the introduction of suitable complementary meals at six months (Meek et al., 2022b). Breastfeeding procedures in United States hospitals are monitored by The Joint Commission and the Centers for Disease Control and Prevention (CDC) (Meek et al., 2022b). As breastfeeding supporters, pediatricians and physicians in the field of pediatrics play a vital role in institutions, their organizations, and communities (Meek et al., 2022b). As a result, they require instruction in regulating breastfeeding as well as the advantages of breastfeeding for women and infants (Meek et al., 2022b). In fact, due to the importance of pediatrics specialists in working with mothers that would potentially prefer breastfeeding or are currently hesitating, their expertise is crucial.
The workers in the field of healthcare possess different kinds of practical tools and skills that can assist them in dealing with a wide range of questions linked to breastfeeding, its benefits and shortcomings. In actuality, breastfeeding has long been endorsed by the American Academy of Family Physicians (AAFP) and the necessity of discussing this concept was approved (Chuisano & Anderson, 2020). There is practically no distinction if pediatricians and specialists deliver maternity care or not, all family doctors play a special role in supporting breastfeeding (Esselmont et al., 2018). They appreciate the benefits of family-centered healthcare and are qualified to promote breastfeeding in that setting.
In other terms, emphasizing family practitioners, the recommendations of various institutions regarding breastfeeding aspects initially influence this segment of healthcare personnel. Family doctors have the chance to inform and encourage all members of various family about breastfeeding all across their lives since they offer adequate services to the entire family (Chuisano & Anderson, 2020). Nevertheless, doctors, even family doctors, do not obtain enough instruction in promoting breastfeeding regardless of the increasing proof of the health effects of the absence of breast-feeding (Chuisano & Anderson, 2020). In overall, this aspect of the breastfeeding recommendations can be assessed as both a benefit and a drawback since it underlines the lack of competences and training among specialists that can possibly influence the society. At the same time, this issue represents a benefit of the recommendations since it offers a clear vision regarding the probable perspectives that occur in the sphere of educating professionals in the questions of breastfeeding.
Family doctors need to be knowledgeable about how breastfeeding affects both parents’ and infants’ wellness. The amount of information and grade of the study on health consequences begin to expand, and multiple review papers outlining the data for breastfeeding’s contribution to the best possible health results have been released (Centers for Disease Control and Prevention, 2020). Infants who are not breastfed are more likely to develop common illnesses such as acute otitis medium, diarrhea, and contact dermatitis (Centers for Disease Control and Prevention, 2020). Moreover, after the period of breastfeeding has ended, the positive impacts on health continue due to the influence on the immune system, which tends to possess long-term effects (Louis-Jacques & Stuebe, 2020). Hence, the recommendations regarding the promotion of breastfeeding are linked to the benefits that underline the increased risk of the occurrence of various illnesses in children that were not breast fed, as per the researches.
Moreover, it is obligatory to turn to the part of the proposals encouraged by the World Health Organization since this international institution generates multiple studies and data reviews on a regular basis. A WHO assessment revealed that children who were not breastfed had poorer IQ test performance, greater average blood pressure, an increased likelihood of type 2 diabetes, and a risen probability of obesity (Ross & Desai, 2021When contrasted to three to four months, the data base similarly demonstrates the value of six months of total breastfeeding as a means of preventing digestive and respiratory illnesses (Pattison et al., 2019). Therefore, a substantial number of sicknesses and infections can potentially occur in case essential breastfeeding methods are not applied, according to the scholars and their analysis.
In terms of other benefits connected to AAP, WHO, and AAFP breastfeeding conclusions and recommendations, it is possible to state that socioeconomic, ecological, and political factors should be considered due to the direct relationship, correlation. Additionally, breastfeeding has wider economic and social advantages, and inadequate breastfeeding length or non-breastfeeding result in higher healthcare expenses for both youngsters and their parents (Pérez‐Escamilla et al., 2022). Furthermore, breastfeeding is eco-friendly since it generates no pollution and waste, requires no product shipping or packaging, and does not need the use of pasture space for cows (Miller, 2020). Thus, in this situation, economic implications can include logistic and supply chain aspects that can heavily impact socioeconomic processes.
Furthermore, it is necessary to emphasize the notions linked to milk manufacturing and production facilities since they are initially influenced by the breastfeeding initiatives and deviations in the level of the support of the conception. Enhanced newborn and adult health is correlated with higher breastfeeding levels, which in addition contribute to lower greenhouse gas emissions and diminish the environmental effect of dietary alternatives (Samiee et al., 2019). Relative to breastfeeding, milk manufacturing has a higher carbon output and utilizes a significant amount of water (Soti-Ulberg et al., 2020). In relation to promoting the health of both parents and children, breastfeeding has positive effects on the economy and the ecosystem (González de Cosío et al., 2018). Mother’s milk is a continuously natural resource that does not need to be packaged, shipped, or disposed of, therefore breastfeeding does not squander limited resources or cause pollution (Natan et al., 2018). Ecological aspects are essential in this scenario since currently they comprise a separate part of the world’s socioeconomic network and are connected to the recommendations regarding the promotion of breastfeeding.
As an important part of the organizations’ propositions and pieces of advice, it is necessary to mention the benefit that is directed to the calls to actions for pediatricians and family physicians. Approximately all infants should indeed be solely breastfed or given mother’s milk during the first six months of their lives (American Academy of Family Physicians, 2017). Breastfeeding can be prolonged for the minimal period of the first year, along with the proper supplementary diets, such as meals high in iron (American Academy of Family Physicians, 2017). When breastfeeding is continued for totally several years, health results for mothers and newborns are at their optimum. Family doctors should keep themselves informed on the most recent research and recommended procedures to properly guide individuals that are breastfeeding (U.S. Department of Health and Human Services, 2019). Families should be directed to a specialist with relevant training when difficulties transcend the family physician’s scope of practice.
It is obligatory to highlight the benefits of the recommendations for the practice level in terms of healthcare professionals and family physicians that have a possibility to contribute to the promotion of breastfeeding. Infant-friendly practices should be implemented at birthing facilities and hospitals, and infants should be remained close to their parents until at minimum the initial successful breastfeeding (American Academy of Family Physicians, 2017). Procedures in maternity care should encourage breastfeeding, ideally by adhering to the detailed guidelines for effective breastfeeding (Melnitchouk et al., 2018a). Additionally, mothers and infants should be monitored by medical specialists who are familiar with breastfeeding and nursing activities (Meek & Hatcher, 2018). Breastfed infants should exclusively get supplement products when medically necessary (Green et al., 2021). By offering breastfeeding mothers free formula trials or discounts, family doctors should not promote breastfeeding (American Academy of Family Physicians, 2017). Family doctors should support breastfeeding and instruct patients and their families on the benefits of breastfeeding at all stages of lifecycle.
In contrast, a major negative concern connected to breastfeeding recommendations is how women who are doctors should handle the conflict between personal demands and their fiduciary responsibility to patients, especially when multitasking is impossible. Entering a code, finishing an operation, reacting to a shift in clinical characteristics, or caring for a patient who is starting to die of natural causes are a few examples of situations. Organizational strategies for improving breastfeeding activities are required to assist doctors without sacrificing patient results (Hoskins & Schmidt, 2021). These, nevertheless, will not properly alleviate worries concerning how, for example, mothers who are doctors should combine their demands with the requirements of their infants and patients.
Another negative part of the overall recommendations is connected to the presence of various contraindications and special considerations that can impose potential risks and threats. During infants’ stay in the medical facility and in the aftercare environment, they should to be closely watched for indications of withdrawal and for healthy weight growth (Weld et al., 2022). Marijuana usage by pregnant women is not advised since there is not enough research to determine the consequences of newborn exposure. Women should be made aware of the possible risks, especially the dangers of passive smoking (Weld et al., 2022). Thus, in this particular case, healthcare issues should be clearly addressed in a detailed manner due to the severity of possible harmful consequences both for the mother and the child.
Conclusion
In conclusion, the AAP, AAFP, and WHO organizations’ recommendations encompass the current barriers to breastfeeding and requirements. Given the advantages, it is possible to underline the chances and needs for strengthening the system of pediatricians’ and doctors’ training and development, which might have a positive impact on breastfeeding procedures. Furthermore, given their close connection to the findings and recommendations of the AAP, WHO, and AAFP about breastfeeding, it is plausible to assert that social, ecological, and political elements should be taken into consideration. Concerning the drawbacks, more attention must be paid to ethical challenges and issues because they are not well treated. Furthermore, if health contraindications are not identified and appropriately handled, they might result in major problems.
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