August 25, 2009, Dr. David Tayloe, President of the American Academy of Pediatrics (AAP) acting on behalf of the Executive Committee of the Board of Directors of the AAP issued an official endorsement of the WHO/UNICEF Ten Steps to Successful Breastfeeding.

Dr. Tayloe noted in his letter to the directors of the WHO and UNICEF, “As you are well aware, the endorsement of these Ten Steps is integral to improving the overall care that mothers and babies receive in maternity facilities in the United States and is particularly helpful to our national effort to promote breastfeeding.”

The endorsement process was initiated by the AAP Section on Breastfeeding, currently under the direction of Dr. Ruth Lawrence. The Section has been active over the years, coordinating the development of breastfeeding publications, conducting educational sessions at the AAP National Conference and Exhibition, and most recently releasing the AAP Breastfeeding Residency Curriculum, which includes a Sample Hospital Breastfeeding Policy for Newborns. Based on the release of the curriculum, the Section felt the time was right to move forward as an organization in supporting the Ten Steps to Successful Breastfeeding.

Dr. Audrey Naylor was instumental in getting the endorsement process underway, presenting the idea for endorsing the Ten Steps to the AAP’s Executive Director. The document was then reviewed by those AAP Sections and Committees with a vested interest in the Ten Steps and its impact on perinatal care.

The AAP endorsement came with one footnote after concerns were raised about the 9th step which states, “Give no artificial teats or pacifiers to breastfeeding infants.” In November of 2005, the AAP Task Force on Sudden Infant Death Syndrome released a policy statement entitled, “The Changing Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding the Sleeping Environment, and New Variables to Consider in Reducing Risk.” A review of the available literature suggested that pacifier use may decrease the risk of SIDS.  Therefore the following statements were included in the 2005 SIDS prevention policy:

• “Consider offering a pacifier at nap time & bedtime.  The pacifier should be used when placing infant down to sleep and not be reinserted once the infant falls asleep.”

• “For breastfed infants, delay pacifier introduction until 1 month of age to ensure that breastfeeding is firmly established.”

As a result, the AAP asked that a footnote be added to its endorsement. It’s important to note that the AAP is not suggesting that WHO/UNICEF revise the original document. Because there is sufficient scientific evidence to support the use of pacifiers for medical indications, this footnote will be included whenever the Ten Steps are referenced in AAP materials.

The AAP’s endorsement of the Ten Steps is particularly important in view of ongoing efforts to promote residency breastfeeding education. While field testing the Breastfeeding Residency Curriculum it became evident that the ability of residents to learn and implement appropriate breastfeeding care requires an environment that is supportive of breastfeeding. Ensuring that the Ten Steps are in place is a vital step towards creating such an environment.

Kudos to the AAP for viewing the Ten Steps as as a win-win-win for mother, babies and pediatricians!