Abstract
For many years, I have participated in endless discussions regarding the question of what is the major pediatric public health nutrition issue other than obesoty in the United States and other developed countries. The usual responses of many of my colleagues have been comments regarding the low exclusive breastfeeding at age 6 months (only 25%), when and with what to begin complementary food, and the very low “any breastfeeding” rate at 1 year (only 36%). 1 Recently the focus of much of the recent discussions has been how to support the new recommended duration of breastfeeding of 2 years and beyond. 2 This emphasis of the discussion regarding encouraging breastfeeding an infant beyond 1 year, is also reflected in the movement to label toddler formulas and milks as breast milk substitutes as part of a breastfeeding support program. 3
To my surprise, these discussions frequently ignored the reality that a lower than desired breastfeeding rate already exists in the first weeks and months after the birth of the infant. As a result, as I have previously argued, 4 we have ended up all too often fighting the wrong war and to boot all too late. One must remember that while breastfeeding initiation rates in the hospital are well over 80%, by 3 months the exclusive breastfeeding rate drops by nearly half to only 45%. Simply put, the war to support breastfeeding is already being lost in the immediate weeks and months after the birth of the infant, even in mothers whose intention from the start was to breastfeed. 4 Clearly, debating if duration should be 1, 2, or 3 years is irrelevant to the majority of mothers who have long stopped nursing, especially those who terminate breastfeeding well before the infant is 3 months old.
As such, the journal Breastfeeding Medicine welcomes the publication of this special issue that focuses on “Early, Unplanned Cessation of Lactation in Healthy and at-Risk Dyads”: edited by Drs Paula Meier and Leslie Parker. Without a doubt, they should be complimented for addressing this phenomenon seriously and comprehensively, fully understanding the population public health issues on the one hand while not ignoring the consequences and implications for the individual maternal-infant dyad. Clearly, we need to stop lamenting about an undesired situation after the fact and focus our attention where it should be with the aid of the framework provided by Drs. Meier and Parker and their colleagues in this landmark special issue of Breastfeeding Medicine.