Booby Traps series: What happens when pediatricians get good breastfeeding training?

This is the 48th in a series of posts on the Booby Traps, made possible by the generous support of Motherlove Herbal Company.

It’s a frequent lament that physicians get little to no training in breastfeeding, and that this translates into poor care for moms and babies.

There is some positive news to share on this front: a pediatric residency curriculum developed by the American Academy of Pediatrics aimed at improving the skills of the next generations of pediatricians.

I asked Dr. Lori-Feldman Winter, Professor of Pediatrics and Executive Committee member of the American Academy of Pediatrics Section on Breastfeeding, to explain this program, and the effect she found when testing the curriculum it in a randomized controlled trial.

What kind of training to pediatricians typically get on breastfeeding?

The training in both medical school and residency program is very variable.  It really depends on whether or not there are faculty champions. Think about it: most of the faculty trained more than 10 years ago was trained in programs where breastfeeding wasn’t even on the radar screen, so as faculty themselves they are playing catch up and often relying on younger associates who are interested in the field.

Furthermore, many residents train in programs where the hospital policies are not supportive of breastfeeding (not Baby Friendly) and either there are few women breastfeeding at all, or few exclusively breastfeeding. Therefore what the residents are learning about is care that is less optimal.

To improve training two issues need to change, one is that the hospitals in which they train should become Baby Friendly designated, and second faculty need education and training of their own to be effective trainers.

What effect do you think this training has on pediatricians’ ability to support breastfeeding?

Clearly the lack of training makes for pediatricians who are not supportive – particularly if mothers have problems, have poor attitudes, don’t think exclusive breastfeeding can work out for many women, and often refer breastfeeding problems without conducting their own assessment and differential diagnosis.
Can you describe the AAP’s pediatric residency curriculum?

The AAP curriculum was designed by pediatricians, family physicians and obstetricians/gynecologists and is aimed for all three disciplines. It is organized according to the AGGME Core Competencies and has many tools that facilitate implementation and assessment of resident skills. All of the materials are available free of charge on the AAP website.

You measured the effect of this training on pediatricians’ breastfeeding support skills and on breastfeeding rates of the babies in their care. What did you find?

We found that residents in the program where the curriculum was implemented, compared to programs where it wasn’t, were more knowledgeable about breastfeeding, provided breastfeeding care more often and had more confidence in supporting breastfeeding and solving problems.

In addition, mothers who were cared for by the institutions where the curriculum was implemented had higher rates of breastfeeding after vs. before the implementation, and increased rates compared to the institutions where it was not implemented. The most dramatic rise was seen in exclusive breastfeeding at 6 months.

Do you think that your pediatrician has good breastfeeding care skills?  How has that affected your breastfeeding experience?

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