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Improving breastfeeding care & support in a large, urban, pediatric primary care practice

Published:November 21, 2022DOI:https://doi.org/10.1016/j.pedn.2022.10.007

      Highlights

      We sought to implement AAP clinical guidelines on breastfeeding in primary care
      • Our goals were to improve breastfeeding measurement and outcomes.
      • Accurate, consistent primary care breastfeeding measurement is feasible.
      • Breastfeeding rates did not improve in our network, despite interventions.
      • Our work can serve as a call to action for pediatric primary care centers.

      Abstract

      Background and specific aims

      Human milk/breastfeeding is the gold standard for infant nutrition. Interventions in pediatric primary care could improve breastfeeding exclusivity and duration. Our specific aims were two-fold: 1) Accurately measure breastfeeding indicators and 2) Implement AAP Breastfeeding-Friendly Pediatric Office Practice Recommendations.

      Materials and methods

      In 2018, a single, urban, large primary care pediatric practice initiated a Quality Improvement project to improve breastfeeding outcomes. Stakeholders met to discuss metrics of interest, develop documentation templates, review data capture, and plan interventions to support breastfeeding. Practice based interventions to improve measurement included: piloting documentation templates, incorporation of default templates office-wide, and developing tracking tools for both use of templates and breastfeeding outcomes. Interventions to support breastfeeding occurred simultaneously and included workflow redesign to increase nurse-provided breastfeeding education, partnering with community-based lactation consultants for outpatient support, staff education, and National Breastfeeding Month activities.

      Results

      Since initiation of the data analytic tool, breastfeeding data has been analyzed from over 30,000 visits (86% Medicaid-insured, 82% Black race). Currently, 80% of providers use default templates that allow standardized data capture. At first newborn visit, 74% of infants were breastfed. At six months, 36% of infants were breastfed; 23% exclusively. Standardized documentation of infant feeding status improved and has remained consistent. Breastfeeding duration did not significantly improve despite practice interventions.

      Conclusions

      Pediatric primary care measurement tools are feasible and critical to understand breastfeeding continuation. Increased resources and interventions to support breastfeeding in Primary Care are necessary to improve outcomes.

      Keywords

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      References

        • Breastfeeding Awareness and Empowerment
        Retrieved on October 14, 2021, from.
        • Bunik M.
        Breastfeeding telephone triage and advice.
        34d ed. FAAP. American Academy of Pediatrics, By Maya Bunik, MD, MSPH, FABM2018
        • Center for Disease Control
        Breastfeeding Report Card 2021. Retrieved on 2/14/2022 from.
        • Chiang K.V.
        • Li R.
        • Anstey E.H.
        • Perrine C.G.
        Racial and ethnic disparities in breastfeeding initiation United States, 2019.
        MMWR. Morbidity and Mortality Weekly Report. 2021; 70: 769-774https://doi.org/10.15585/mmwr.mm7021a1
        • Corriveau S.K.
        • Drake E.E.
        • Kellams A.L.
        • Rovnyak V.G.
        Evaluation of an office protocol to increase exclusivity of breastfeeding.
        Pediatrics. 2013; 131: 942-950
        • Froh E.B.
        • Flynn-Roth R.
        • Barton S.
        • Spatz D.L.
        The voices of breastfeeding resource nurses.
        Journal of Obstetric, Gynecologic, and Neonatal Nursing : JOGNN. 2015; 44: 419-425
        • Gregory E.F.
        • White E.
        • Wu K.K.
        • McPeak K.E.
        • Fiks A.G.
        Implementing team-based newborn well care: Perspectives of nurses and physicians.
        Journal of Pediatric Nursing. 2022; 65: 22-28
        • Latorre G.
        • Martinelli D.
        • Guida P.
        • Masi E.
        • De Benedictis R.
        • Maggio L.
        Impact of COVID-19 pandemic lockdown on exclusive breastfeeding in non-infected mothers.
        International Breastfeeding Journal. 2021; 16: 36
        • Meek J.Y.
        • Hatcher A.J.
        • Section on Breastfeeding
        The breastfeeding-friendly pediatric office practice.
        Pediatrics. 2017; 139e20170647
        • Odom E.C.
        • Li R.
        • Scanlon K.S.
        • Perrine C.G.
        • Grummer-Strawn L.
        Reasons for earlier than desired cessation of breastfeeding.
        Pediatrics. 2013; 131: e726-e732
        • Schmitt B.D.
        Pediatric telephone protocols: Office version.
        American Academy of Pediatrics, Elk Grove Village, IL2012
        • Spatz D.L.
        Report of a staff program to promote and support breastfeeding in the care of vulnerable infants at a children's hospital.
        Journal of Perinatal Education. 2005; 14: 30-38
        • Spatz D.L.
        Changing the prenatal care paradigm to improve breastfeeding outcomes.
        MCN. The American Journal of Maternal Child Nursing. 2020; 45: 186
        • Spatz D.L.
        2020 Breastfeeding Report Card: We Must Do More!.
        MCN. The American Journal of Maternal Child Nursing. 2021; 46: 58
        • Spatz D.L.
        • Froh E.B.
        • Flynn-Roth R.
        • Barton S.
        Improving practice at the point of care through the optimization of the breastfeeding resource nurse model.
        Journal of Obstetric, Gynecologic, and Neonatal Nursing : JOGNN. 2015; 44: 412-418
        • Vanguri S.
        • Rogers-McQuade H.
        • Sriraman N.K.
        • Academy of Breastfeeding Medicine
        ABM clinical protocol #14: Breastfeeding-friendly physician’s office-optimizing care for infants and children.
        Breastfeeding Medicine : The Official Journal of the Academy of Breastfeeding Medicine. 2021; 16: 175-184
        • World Health Organization
        Implementation guidance: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services – the revised Baby-friendly Hospital Initiative.
        World Health Organization, Geneva2018 (Licence: CC BY-NC-SA 3.0 IGO. Retrieved on October 3. 2022 from)
        • Zanardo V.
        • Tortora D.
        • Guerrini P.
        • Garani G.
        • Severino L.
        • Soldera G.
        • Straface G.
        Infant feeding initiation practices in the context of COVID-19 lockdown.
        Early Human Development. 2021; 152105286