Pediatricians' Support Of Breast-Feeding Is Linked To Their Experience with It

Sandhya Ramashwar, Guttmacher Institute

First published online:

Pediatricians' attitudes toward breast-feeding have worsened over time, according to a national study.1 Although a higher proportion of pediatricians surveyed in 2004 than in 1995 recommended exclusive breast-feeding (74% vs. 65%), lower proportions believed that all mothers could successfully breast-feed and that the benefits of breast-feeding were worth the potential inconvenience. However, in 2004, pediatricians who had breast-fed their children were more likely to provide support for breast-feeding than were those with no personal experience.

Since the mid-1990s, the proportion of U.S. mothers who ever breast-fed and the number of initiatives aimed at promoting breast-feeding have increased substantially. To examine whether pediatricians' support of breast-feeding also has changed, researchers analyzed data from surveys conducted by the American Academy of Pediatrics (AAP) in 1995 and 2004. Each survey used a closed-ended questionnaire mailed to a random sample of academy members. Respondents provided information on their demographic characteristics (including their number of children and personal breast-feeding experience) and their pediatrics practice. Pediatricians who provided primary care for children up to two years old were asked about their counseling and management practices for breast-feeding and their opinions of breast-feeding's benefits. The final sample consisted of 1,133 pediatricians in 1995 and 875 pediatricians in 2004.

Pediatricians surveyed in 2004 were generally similar to those surveyed in 1995. They were, on average, 42 years old; 58% were female (compared with 46% in 1995). In both years, about eight in 10 worked in a group practice, hospital, clinic or medical school. In 1995 and 2004, four in 10 pediatricians had patients aged 0–2, and seven in 10 were parents. The two samples diverged on the proportion whose children were ever exclusively breast-fed. The 2004 proportion was about twice that of 1995 (72% vs. 37%).

Pediatricians in 2004 were more likely than those in the earlier sample to have had professional breast-feeding training; 68% and 58%, respectively, had been instructed on this topic during medical school or residency. Interestingly, far higher proportions of pediatricians in 2004 than in 1995 indicated that they would recommend against breast-feeding for "unnecessary reasons," including the mother's immaturity (26% vs. 7%) and the inconvenience of breast-feeding (15% vs. 4%).

The researchers also assessed how consistent breast-feeding recommendations were with the World Health Organization's breast-feeding policies among pediatricians with patients who were 0–2 years old. A higher proportion of pediatricians in 2004 than in 1995 correctly counseled mothers to breast-feed exclusively (74% vs. 65%) and had mothers and infants stay in the same hospital room to make breast-feeding easier (71% vs. 51%). Moreover, smaller proportions in 2004 than in 1995 made recommendations not supported by the AAP—supplementing breast-feeding with formula (8% vs. 13%) or water (8% vs. 12%), or giving exclusively breast-fed infants multivitamins (29% vs. 41%) or fluoride (9% vs. 34%).

Similarly, higher proportions of pediatricians in 2004 than in 1995 gave advice matching the AAP's 10 criteria for successful breast-feeding in hospitals, even though only 12% were aware of the policies. For example, more than two-thirds encouraged breast-feeding within one hour of delivery and unrestricted feeding thereafter, compared with no more than three in five of those surveyed in 1995.

Though some positive changes occurred, pediatricians' attitudes toward breast-feeding deteriorated overall between surveys. For example, smaller proportions of respondents in 2004 than in 1995 agreed that formula-fed and breast-fed babies would be equally healthy (26% vs. 35%), and that pediatricians had little influence on breast-feeding initiation (6% vs. 18%). In contrast, just 58–62% in 2004 believed that breast-feeding's benefits offset its potential difficulty or that almost any mother could successfully breast-feed—lower proportions than in 1995.

In 2004, personal experience with breast-feeding, while not significantly related to most attitudes, was linked to pediatricians' decision to teach or counsel their patients to do the same. For example, much higher proportions of those who had breast-fed their children than of others had managed breast-feeding problems (89% vs. 64%) or taught breast-feeding techniques to a new mother (47% vs. 20%) at least five times in the last year.

Although pediatricians may have supported breast-feeding using methods not covered by the surveys, the results of this analysis indicate that knowledge was often not enough to overcome "concerns about the sustainability of breast-feeding," according to the investigators. Many pediatricians surveyed in 2004 had little clinical experience with breast-feeding, the researchers observe, but personal breast-feeding experience was associated with improved practices. Noting that new educational materials have been developed since 2004, the researchers suggest that these resources, combined with support in the workplace for pediatricians choosing to breast-feed and early training, could help change attitudes and create "a culture in which breast-feeding is the norm."

—S. Ramashwar


1. Feldman-Winter LB et al., Pediatricians and the promotion and support of breastfeeding, Archives of Pediatrics and Adolescent Medicine, 2008, 162(12):1142–1149.