Objective: To know recommendations on breastfeeding by Mexican pedia-tricians. Methods: Cross-sectional, descriptive study conducted through a survey of Mexican pediatricians. Results: Two hundred and fifty-four pedi-atricians (range 27 to 72 years) were surveyed. Most of them worked in public hospital or private practice or both. Among them 94.5% recom-mended newborn early contact with mother and 54.3% rooming. Exclusive breastfeeding was suggested by 89.8%, out of them 51.9% for 6 months. Breastfeeding on demand was counseled by 88.2% and 84.6% without fixed schedules. Pacifier use was rejected by 86.6%. 51.2% used iron supplements and 59.5% used other vitamins. Stopping breastfeeding in special situations was suggested by 87.4%; of them, 86.6% in case of infection with AIDS; 74.4% if the mother used drugs; 74.4% by infection with hepatitis B virus; 49.6% in case of mastitis; 17.3% in newborns with jaundice; and 18.5% in other situations. Finally, 93.3% of pediatricians surveyed reported interest in breastfeeding; 54.7% obtained information in medical journals; 54.7% through medical courses, and 31.9% in books. 58.3% of respondents oriented on breastfeeding according to WHO recommendations; 31.5% did so regularly and 10.2% did not. Conclusions: Pediatricians play a major role in breastfeeding promotion, but their formation is scarce and they are not prepared to counsel patients. Governments of developing countries should promote breastfeeding to ensure the health and proper development of infants.
Breastfeeding (BF) is vital for survival, health and child development; however, Mexico has a low percentage of breastfeed women. Percentage of exclusive breastfeeding (EBF) children has fallen dramatically from 21% in 2006 to 14% in 2012 [
The World Health Organization (WHO) and the American Academy of Pediatrics (AAP) recommend EBF during the first six months of life. Then, complementary feeding should start and keeping breastfeeding during the first two years of life [
In rural areas and in low socioeconomic groups, prolonging breastfeeding for the first year of life is associated with a better chance of surviving in this period [
Mexico has published several practices of breastfeeding and weaning studies. Results show that, over time, EBF has lost importance and mixed feeding, resulting from the combination of breast milk and administration of industrialized milk, it has become more frequent [
Despite the already noted, they are insufficient studies on breastfeeding and infant feeding characteristics in Mexico, as well as its determinants. The following discussion is intended to document the recommendations of pediatricians, over breastfeeding, because they are, in most cases, the first contact with mothers and those responsible for giving the necessary information on human milk.
In May 2012, it was carried out a cross-sectional, descriptive, open study through a survey conducted in May to 254 Mexican pediatricians. The population registered in the congress of pediatricians, at the moment of carrying out the survey, was of 2500 doctors, for which, with a sample of 254 doctors surveyed, a margin of error of 5.8% is obtained. With a confidence interval of 95% and a heterogeneity of 50%. Responsible for obtaining the information were doctors who had no role in the resolution of the survey. The questionnaire includes data on: age and gender of physicians, type of medical practice, work area, and recommendations: prenatal visits, early mother-infant contact, rooming, EBF time, vitamin supplements and pacifier use; as well as a place of information. Univariate analysis of the data was done to calculate prevalence and percentages. At the start of the survey, the interviewees signed their authorization to answer the questions.
Demographic characteristics of respondents’ pediatricians are shown in
From the 254 physicians surveyed pediatricians, 143 (56.3%) had not usual do a prenatal visit. Once the baby was born, 240 (94.5%) recommended early contact with mother and 138 (54.3%) rooming. The EBF was recommended by 228 (89.8%) and 132 (51.9%) suggested it for 6 months. 224 pediatricians (88.2%) recommended BF, 215 (84.6%) recommended it on demand, without fixed schedules. 52.8% (134) of pediatricians, recommended the first medical visit at 7 days old.
Regarding the pacifier use, it is interesting that 220 (81.1%) respondents rejected its use, while 12.5% (34) advised its use. Recommendations on supplements use are shown in
When pediatricians believe that BF posed a medical problem, most of them 91.3%, decided to suspend it without going to another specialist. Similarly, most respondents pediatricians recommended to stop breastfeeding if mothers have HIV, hepatitis or addictions. These doctors believe that almost 40% of mothers did not breastfeeding for different reasons (simply refuse, flat nipple, low birth weight, teenage mother, decreased milk production, gastroesophageal reflux). This data indicate that more than third part of recommendations made by referees pediatricians regarding the continuation or BF withdrawal, were incorrect (
Medical behavior was highly variable to indicate the cessation of breastfeeding if the mother takes any drugs. Mainly with the most commonly used drugs as: antineoplastic drugs, metronidazole, anticonvulsants, chloramphenicol, antihypertensive drugs, antipsychotics, antithyroid drugs and ciprofloxacin as shown in
Pediatricians | Total N = 254 | (%) | |
---|---|---|---|
Gender Male | 163 | (64.2) | |
Female | 91 | (35.8) | |
Age (years) | |||
26 - 29 | 1 | (0.4) | |
30 - 39 | 61 | (24) | |
40 - 49 | 115 | (45.3) | |
50 - 59 | 64 | (25.2) | |
≥60 | 13 | (5.1) | |
Work area | |||
Urban | 223 | (87.8) | |
Suburban Rural | 26 5 | (10.2) (1.9) | |
Pediatric practice | |||
Without practice | 33 | (12.9) | |
With Clinical Practice: Public Individual In group In hospital | 221 128 15 5 108 | (87.1) (50.3) (5.9) (1.9) (42.5) | |
Private Individual In group In hospital | 93 59 23 11 | (36.6) (23.2) (9.1) (4.3) | |
Mixed practice | 113 | (44.5) | |
Supplements | Recommended | Not recommended |
---|---|---|
Vitamins | 151 (59.44%) | 103 (40.55%) |
Iron | 118 (46.45%) | 136 (53.54%) |
Situation | Percentage of incorrect recommendation (%) |
---|---|
HIV infection | 12.6 |
HBV infection | 74.4 |
Drug users | 13.4 |
Mastitis | 49.6 |
Jaundice infants | 17.3 |
Mother denial | 31.5 |
Other | 18.5 |
Average | 36.2 |
Drug | Breastfeeding contraindication n (%) | |
---|---|---|
Antineoplastic | 93 | (36.61%) |
Metronidazole | 40 | (15.74%) |
Anticonvulsant | 28 | (11%) |
Chloramphenicol | 25 | (9.8%) |
Antihypertensive | 25 | (9.8%) |
Antidepressant | 24 | (9.4%) |
Antithyroid | 24 | (9.4%) |
Antipsychotic | 16 | (6.2%) |
Ciprofloxacin | 15 | (5.9%) |
Finally 237 (93.3%) of pediatricians surveyed referred breastfeeding interest in, 139 (54.7%) obtain information from medical supplies; 139 (54.7%) in courses and 81 (31.9%) of books. As for the knowledge self-perception; 58.3% (148) of respondents mentioned proper management of BF, 31.5% (80) referred self-rated handling as fair and 10.2% (26) said that does not properly handle it.
Breastfeeding is the natural way to provide the newborn with necessary nutrients for normal growth and somatic and brain development, protecting it from infectious disease, obesity and other no communicable diseases such as diabetes. Overall only 38% of children receive EBF in the first 6 months of life [
Among the demographic characteristics of the surveyed population, often males (1.6:1) were found. 96.4% were older than 30 years; almost 90% had mixed and work in urban areas, so we can infer that the pediatrician who works in the city, has increased access to academic events, in which BF is promoted; but assumes importance that in rural areas between 2006 and 2012, EBF dropped from 36.9% to 18.5%, proportionately greater decline, than in the urban area [
Regarding the EBF duration, both WHO [
Although 56.3% of pediatricians did not perform prenatal visit, 94.5% recommended early contact with mother, and 54.3% rooming. Studies in Mexico City maternities, have been shown that this practice promotes EBF management, regardless of whether the product was obtained by delivery or cesarean [
81.1% pediatricians Mexicans surveyed, reject the use of pacifier. In a Portuguese study, pacifier use, discouraged the EBF in 41% of mothers [
Iron supplements, folic acid and vitamins during pregnancy and lactation reduce the risk of anemia in mother. However these supplements in breastfed babies before 6 months life do not increase their hemoglobin levels. The prevalence of iron deficiency anemia in breastfed children who do not receive supplements is very low (<3%) [
A common reason for suspending BF is the fear of maternal transmission of infection through the milk. It is known that both HIV and HBV are secreted in breast milk. In HIV, BF is contraindicated, since transmission depends on the maternal viral load, mother immune status and BF pattern and duration [
For drug-addicted mothers, BF is contraindicated [
A recent meta-analysis reported that risk of becoming infected with HBV is similar in-BF from her own mother children, than in children receiving maternalized formulations [OR = −0.8% (95% CI: −1.6%, 0.1%)] [
74.4% of respondents’ Mexican pediatricians recommended suspending BF in case of hepatitis B. This recommendation is similar to that made of 25% Australian gynecologists [
The use of medications in BF is not a contraindication to continue it. Unjustified recommendation comes from a doctor or nurse. Most medicines that are prescribed in BF have no effect on the baby [
It is recommended to continue BF by manually removing milk and review newborn suction technique [
Antineoplastic drugs, because they alter the nucleic acid synthesis in both, mother and therefore the child, properly considered contraindicated by the 36.61% of pediatricians. Although only thalidomide and methotrexate are absolutely contraindicated during pregnancy and lactation, alternatives to ciprofloxacin and sodium phosphate should also be considered for pregnant and BF women.
BF is also recommended during treatment with cyclosporine, metronidazole and ciprofloxacin. However, in some cases, treatment with preparations of 5-aminosalicylic acid, corticosteroids, thiopurines and TNF inhibitors, can be accepted during pregnancy and lactation [
Metronidazole is excreted into breast milk in insignificant quantities and there are not reported problems in infants whose mothers were administered. Metronidazole is compatible and safe for BF and infant, yet it was contraindicated for 15.7% of pediatricians [
25 doctors contraindicated chloramphenicol use, it is unsafe and you need to carefully assess their use. It’s excreted in breast milk and there is a possibility of occurrence of neonatal gray syndrome, besides the possibility of aplastic anemia, dose independent, so that the use of other safer antimicrobial is recommended, although topically has not been outlawed [
25 respondents pediatricians contraindicated antihypertensive drugs. There are really few antihypertensive drugs contraindicated in infancy such as acebutolol, atenolol, prazocin and diazoxide, others are not contraindicated to breastfeeding and have a wide safety margin [
On the issue of antidepressants, most of them there are not a contraindication to breastfeeding. However, in the 1st. month of life can cause cramps, irritability, insomnia, outside this period have no side effects [
Antithyroid drugs in general have not been reported side effects in infants whose mothers take them for long time, with thyroid hormones levels and psychomotor development, normal in infants. No contraindications to BF, they are safe in the long and short term, but 24 doctors banned them [
Antipsychotics, some as lithium, are at high risk, and reaching levels up to 50% in infants, there have been toxicity reports with cyanosis and hypotony. As alternatives lamotrigine, carbamazepine or valproic acid, are recommended [
Misinformation has been worldwide documented. In 1999, the AAP conducted a BF survey self-administered to 1602 pediatricians. 71% of respondents; 65% recommended the BF as the only food for the first month. 37% recommended prolonging BF for one year. Most pediatricians felt that formulas were equally convenient that maternal breast to feeding a baby, but recognized that they needed more education on this topic. Most doctors recommended suspending the breast with treatments that are known not to oppose BF [
In a national survey in North America participated 3115 residents and 1920 pediatricians, family physicians and obstetricians, attended the response rate was 68%. All groups showed ignore BF benefits. Less than 50% of residents know what to do in special situations. More than 30% of doctors advised incorrectly. Residents reported that their knowledge came from theoretical sources. Only 55% of residents reported on occasion have addressed the issue and less than 20% had shown the techniques at least 5 times during residency. 50% of physicians reported inadequate training. 90% reported promote BF, but only 50% did so effectively [
Supported by pediatricians, it is essential to promote EBF. Among respondents’ Mexican pediatricians, 93.3% reported interest in BF. 54.7% obtained medical information from articles; 54.7% in courses and 31.9% in books. In Canada were randomly questioned 999 pediatric residents and 610 pediatricians to assess knowledge and skills. They answered 74% and 69% respectively. 90% said the pediatrician should support BF, but the experience and knowledge they received at residence were scarce. More than 25% of each group felt that BF was not more beneficial to feed the baby. Advices to suspend BF or start the formula were inadequate in most. Only 64% of pediatricians and 52% of residents knew that giving supplemental formula in early weeks, favored BF failure. For both groups, personal experiences (own or with wife) were so determined to gain knowledge and confidence in promoting breast. Residents had acquired knowledge in books. 70% of pediatricians recommended devoting more time to training in this topic. The study showed that residents’ training to promote BF is inadequate; it is urgent implement academic programs [
In general, knowledge, attitudes and doctors beliefs of regarding the BF are bad. A Canadian study assessed these topics via a questionnaire completed by 397 pediatricians. The concepts were adequate in 67.8%. 74.2% was declared with jurisdiction to give advice on skills to BF. 49.6% said that BF was a family doctor responsibility. Only 5.3% watched the process in the mother-son binomial. [
Between the strengths of this study are, the choice of the surveyed population (pediatricians only), anonymity and that being a closed questionnaire, prevents the spread of information, which helps to get specific, useful and reliable data. Among its weaknesses it is a closed questionnaire, limiting the possible response options. The lack of flexibility will make the responses lack depth in specific points.
BF promotion is a multidisciplinary work that includes pediatricians, family doctors, gynecologists, nurses, social workers and residents. Pediatricians, given its proximity with mother-son binomial, need to receive more information during their training, in order that they can promote BF effectively. There is not really a suitable substitute for BF. Governments from economically vulnerable countries should encourage BF practice, promoting and facilitating this to working mothers, to ensure health and infants well being.
The limitations of this study include the fact that issuing a recommendation depends on the physician's preparation and expertise, an item that was not included in the survey.
Participation did so freely and voluntarily. We (all the authors) declare, that there is no conflict of interest.
This research received No specific grant from any funding agency in the public, commercial or not for profit sectors.
Thanks to APROLAM (Asociación Pro-lactancia Materna), CONAPEME (Confederación Nacional de Pediatría de México), CPDF (Colegio de Pediatría del Distrito Federal).
Reyes-Vázquez, H., Lopez-Enriquez, C., Bribiesca-Godoy, F., Espinosa-Aguilera, A., Morfin-Maciel, B.M. and Martínez-Aguilar, N.E. (2019) Breast- feeding Recommendations. Pediatricians Mexicans Survey. Open Access Library Journal, 6: e2816. https://doi.org/10.4236/oalib.1102816