UCSF Commentary: Pediatricians’ Breastfeeding Advice Should Rely on Evidence, Not Social Advocacy

Breastfeeding offers important health benefits for mothers and babies, and also meets the goals of certain social movements including environmentalism and anti-commercialism. But according to a new commentary in JAMA Pediatrics, Social and Public Health Perspectives of Promotion of Breastfeeding, it’s important for pediatricians to balance their roles as social advocates with the need to provide the most accurate medical information when counseling women on the benefits of breastfeeding.

“There are real and very important health benefits that come from breastfeeding,” said Valerie Flaherman, MD, co-author and pediatrician at UCSF Benioff Children’s Hospital San Francisco. “However, some social advocacy organizations present breastfeeding as a panacea and can stigmatize mothers who choose not to breastfeed. Pediatricians should avoid adopting the more extreme tactics used by some advocacy groups and should instead focus on current medical evidence.” 

Breastfeeding benefits include a reduction in the risk of gastroenteritis, eczema, and sudden infant death syndrome, which the researchers say is important information for mothers to hear from their pediatricians. However, many diseases initially thought by researchers to be reduced by breastfeeding have since been shown to be unaffected, including obesity, hypertension and dental caries.

“Social organizations or movements may choose to emphasize certain studies that have not been subsequently substantiated, because the studies advance the social organizations’ goals or priorities,” said Flaherman. “But as pediatricians, we have a responsibility to educate parents with up-to-date information so each mother can make her own decision about how to feed her baby and then support her decision. Breastfeeding is very important, but it’s not an excuse to abandon our role as medical providers and slip into social advocacy.”

Exclusive breastfeeding has global importance, especially in areas where mothers do not have access to clean water, which is necessary to safely prepare infant formula. However, studies in countries like the United States, that have almost universal access to clean water, have not shown a difference in health outcomes for babies who are exclusively breastfed compared to those who have been given small amounts of supplemental formula.

“Pediatricians are important advisors for parents and need to elicit parents’ concerns in order to provide appropriate counseling,” said Elena Fuentes-Afflick, MD, MPH, co-author and chief of pediatrics at San Francisco General Hospital.

Flaherman is the lead author of several studies focusing on how breastfeeding and breastfeeding duration is affected by early infant weight loss, small amounts of formula and breast milk expression. Fuentes-Afflick’s area of research is in perinatal outcomes, with a focus on the role of ethnicity, acculturation and immigration status.

UCSF Benioff Children’s Hospital San Francisco creates an environment where children and their families find compassionate care at the forefront of scientific discovery, with more than 150 experts in 50 medical specialties serving patients throughout Northern California and beyond. The hospital admits about 5,000 children each year, including 2,000 babies born in the hospital.

UCSF is the nation’s leading university exclusively focused on health. Now celebrating the 150th anniversary of its founding as a medical college, UCSF is dedicated to transforming health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy; a graduate division with world-renowned programs in the biological sciences, a preeminent biomedical research enterprise and two top-tier hospitals, UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco.