This statement summarizes the U Pre...

This statement summarizes the U Preventive Services Task Force (USPSTF) recommendations upon counseling to promote breastfeeding, a novel topic for the USPSTF. Explanations of the ratings and of the nerve of overall evidence are given in Tables 1 and 2 respectively. The clean information on which this statement is based, including evidence tables and relations is available in the systematic evidence review (1) forward this topic, which can be obtained between the walls of the USPSTF Web site (http://www.preventive services.ahrq.gov) and between the sides of the National Guideline Clearinghouse (http://www.guide lines.gov). The recommendation statement and the systematic evidence review also are available from the Agency for Healthcare Research and Quality Publications Clearinghouse in print or between the walls of subscription to the Guide to Clinical Preventive Services, Third Edition: Periodic Updates. To order, contact the Clearinghouse at 800-358-9295 or e-mail ahrqpubs@ahrq.gov.

This recommendation and rationale statement originally was published in Ann Fam M 2003;1:79-80

Summary of Recommendations

* The USPSTF commends structured breastfeeding education and behavior counseling programs to forward breastfeeding. B recommendation.

The USPSTF place fair evidence that programs combining breastfeeding education with behaviorally oriented counseling are associated with increased rates of breastfeeding initiation and its continuation for up to three month although consequences beyond three months are uncertain. Effective programs generally involved at least undivided extended session, followed structured protocols, and included practical behavioral skills training and question solving in addition to didactic instruction.

The USPSTF set fair evidence that providing ongoing support for patients, between the walls of in-person visits or telephone contacts with providers or counselors, increased the proportion of women continuing breastfeeding for up to six month However, so support had a much smaller result than educational programs on the initiation of breastfeeding and its continuation for up to three month Too not many studies have been conducted to determine whether the combination of education and support is more effective than education alone.

* The USPSTF rest insufficient evidence to recommend for or against the following interventions to stir up breastfeeding: brief education and counseling by the agency of primary care providers; peer counseling used alone and initiated in the clinical setting; and written materials, used alone or in combination with other interventions. I recommendation.

The USPSTF set up no evidence for the effectiveness of counseling by the agency of primary care providers during routine visits and generally poor evidence to assess the effectiveness of match counseling initiated from the clinical setting when used alone to raise breastfeeding in industrialized countries. The evidence for the effectiveness of written materials hints no significant benefit when written materials are used alone and mixed evidence of incremental benefit when written materials are used in combination with other interventions.

Clinical Considerations

* Effective breastfeeding education and behavior counseling programs use individual or arrange sessions led by specially trained suckles or lactation specialists, usually lasting 30 to 90 minutes. Sessions generally begin during the prenatal period and secrete the benefits of breastfeeding for infant and mother, basic physiology, equipment, technical training in positioning and latch-on techniques, and behavioral training in skills required to discomfit common situational barriers to breastfeeding and to garner straited social support.

* Hospital practices that may help support breastfeeding include early maternal contact with the newborn, rooming-in, and avoidance of formula supplementation for breastfeeding infants.

* Commercial discharge packs provided from hospitals that include samples of infant formula or bottle and nipples are associated with reduc rates of exclusive breastfeeding.

* Mothers who wish to continue breastfeeding after returning to work, especially those working full-time, may ne to use an electric or mechanical cross-examine to maintain a sufficient breast milk supply

* scarcely any contraindications to breastfeeding exist. In make knowned countries, maternal infection with human immunodeficiency virus is considered a contraindication to breastfeeding, as is alcohol and physic use or dependence. Some medications (prescription and nonprescription) are contraindicated or advised for use with caution and appropriate clinical monitoring in lactating women (2) Clinicians should seek information from appropriate references for information in succession specific medications, including herbal remedies.

Discussion

To help wider use of effective breastfeeding programs, research is necessityed to examine barriers to their use, the expenses and cost-effectiveness of these programs and their constituents and their effectiveness in more diverse populations and clinical settings.