{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T20:54:10Z","timestamp":1788296050134,"version":"build-2803163510"},"reference-count":29,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,10,1]]},"abstract":"<jats:sec>\n                  <jats:title>BACKGROUND AND OBJECTIVES:<\/jats:title>\n                  <jats:p>The American Academy of Pediatrics (AAP) has affirmed breastfeeding as the preferred method of infant feeding; however, there has been little systematic examination of how pediatricians\u2019 recommendations, affiliated hospitals\u2019 policies, counseling practices, and attitudes toward breastfeeding have shifted over the past 2 decades. These trends were examined from 1995 to 2014.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS:<\/jats:title>\n                  <jats:p>Data are from the Periodic Survey (PS) of Fellows, a nationally representative survey of AAP members. PS #30 (1995; response rate = 72%; N = 832), PS #57 (2004; response rate = 55%; N = 675), and PS #89 (2014; response rate = 51%; N = 620) collected demographics, patient and practice characteristics, and detailed responses on pediatricians\u2019 recommendations, affiliated hospitals\u2019 policies, counseling practices, and attitudes toward breastfeeding. By using bivariate statistics and logistic regression models, the analysis investigated changes over time with predicted values (PVs).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS:<\/jats:title>\n                  <jats:p>From 1995 to 2014, more pediatricians reported their affiliated hospitals applied for \u201cbaby-friendly\u201d designation (PV = 12% in 1995, PV = 56% in 2014; P &amp;lt; .05), and more reported that they recommend exclusive breastfeeding (65% to 76% [P &amp;lt; .05]). However, fewer respondents indicated that mothers can be successful breastfeeding (PV = 70% in 1995, PV = 57% in 2014; P &amp;lt; .05) and that the benefits outweigh the difficulties (PV = 70% in 1995, PV = 50% in 2014; P &amp;lt; .05). Younger pediatricians were less confident than older pediatricians in managing breastfeeding problems (P &amp;lt; .01).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS:<\/jats:title>\n                  <jats:p>Pediatricians\u2019 recommendations and practices became more closely aligned with AAP policy from 1995 to 2014; however, their attitudes about the likelihood of breastfeeding success have worsened. These 2 divergent trends indicate that even as breastfeeding rates continue to rise, continued efforts to enhance pediatricians\u2019 training and attitudes about breastfeeding are necessary.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2017-1229","type":"journal-article","created":{"date-parts":[[2017,9,18]],"date-time":"2017-09-18T09:10:15Z","timestamp":1505725815000},"source":"Crossref","is-referenced-by-count":40,"title":["National Trends in Pediatricians\u2019 Practices and Attitudes About Breastfeeding: 1995 to 2014"],"prefix":"10.1542","volume":"140","author":[{"given":"Lori","family":"Feldman-Winter","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Children\u2019s Regional Hospital, Cooper University Health Care, Cooper Medical School, Rowan University, Camden, New Jersey;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kinga","family":"Szucs","sequence":"additional","affiliation":[{"name":"Private Practice, Indianapolis, Indiana;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aubri","family":"Milano","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children\u2019s Regional Hospital, Cooper University Health Care, Cooper Medical School, Rowan University, Camden, New Jersey;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Gottschlich","sequence":"additional","affiliation":[{"name":"Department of Research, American Academy of Pediatrics, Elk Grove Village, Illinois; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blake","family":"Sisk","sequence":"additional","affiliation":[{"name":"Department of Research, American Academy of Pediatrics, Elk Grove Village, Illinois; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J.","family":"Schanler","sequence":"additional","affiliation":[{"name":"Cohen Children\u2019s Medical Center, Northwell Health and Hofstra, Hofstra Northwell School of Medicine, Hofstra University, Hempstead, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2017,10,1]]},"reference":[{"issue":"2","key":"2021121021483620100_B1","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1542\/peds.2004-2491","article-title":"Breastfeeding and the use of human milk.","volume":"115","author":"Gartner","year":"2005","journal-title":"Pediatrics"},{"issue":"3","key":"2021121021483620100_B2","article-title":"Breastfeeding and the use of human milk.","volume":"129","author":"Eidelman","year":"2012","journal-title":"Pediatrics"},{"issue":"3","key":"2021121021483620100_B3","doi-asserted-by":"crossref","DOI":"10.1542\/peds.103.3.e35","article-title":"Pediatricians\u2019 practices and attitudes regarding breastfeeding promotion.","volume":"103","author":"Schanler","year":"1999","journal-title":"Pediatrics"},{"issue":"16","key":"2021121021483620100_B4","doi-asserted-by":"crossref","first-page":"1694","DOI":"10.1001\/jama.2016.8882","article-title":"Primary care interventions to support breastfeeding: updated evidence report and systematic review for the US Preventive Services Task Force.","volume":"316","author":"Patnode","year":"2016","journal-title":"JAMA"},{"issue":"12","key":"2021121021483620100_B5","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1001\/archpedi.162.12.1142","article-title":"Pediatricians and the promotion and support of breastfeeding.","volume":"162","author":"Feldman-Winter","year":"2008","journal-title":"Arch Pediatr Adolesc Med"},{"key":"2021121021483620100_B6","volume-title":"Updating the USDA National Breastfeeding Campaign: Workshop Summary","author":"Whitacre","year":"2011"},{"issue":"2","key":"2021121021483620100_B7","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1542\/peds.2009-3250","article-title":"Residency curriculum improves breastfeeding care.","volume":"126","author":"Feldman-Winter","year":"2010","journal-title":"Pediatrics"},{"key":"2021121021483620100_B8","unstructured":"Tayloe\u2008D\n          ; AAP Endorsement of the WHO\/UNICEF Ten Steps to Successful Breastfeeding. August 2009. Available at: http:\/\/www.aap.org\/breastfeeding\/files\/pdf\/TenStepswosig.pdf. Accessed May 1, 2011"},{"key":"2021121021483620100_B9","doi-asserted-by":"crossref","first-page":"S119","DOI":"10.2105\/AJPH.2013.301360","article-title":"Effect of primary care intervention on breastfeeding duration and intensity.","volume":"104","author":"Bonuck","year":"2014","journal-title":"Am J Public Health"},{"issue":"1","key":"2021121021483620100_B10","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.pcl.2012.10.001","article-title":"Overcoming clinical barriers to exclusive breastfeeding.","volume":"60","author":"Neifert","year":"2013","journal-title":"Pediatr Clin North Am"},{"issue":"1","key":"2021121021483620100_B11","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.pcl.2012.09.007","article-title":"Evidence-based interventions to support breastfeeding.","volume":"60","author":"Feldman-Winter","year":"2013","journal-title":"Pediatr Clin North Am"},{"issue":"4","key":"2021121021483620100_B12","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2013-0724","article-title":"Breastfeeding concerns at 3 and 7 days postpartum and feeding status at 2 months.","volume":"132","author":"Wagner","year":"2013","journal-title":"Pediatrics"},{"key":"2021121021483620100_B13","unstructured":"Centers for Disease Control\n          . Breastfeeding report card: progressing toward national breastfeeding goals. 2016. Available at: https:\/\/www.cdc.gov\/breastfeeding\/pdf\/2016breastfeedingreportcard.pdf. Accessed August 27, 2016"},{"issue":"39","key":"2021121021483620100_B14","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.15585\/mmwr.mm6439a5","article-title":"Vital signs: improvements in maternity care policies and practices that support breastfeeding - United States, 2007-2013.","volume":"64","author":"Perrine","year":"2015","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"2","key":"2021121021483620100_B15","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1089\/jwh.2012.4158","article-title":"Maternity care practices that support breastfeeding: CDC efforts to encourage quality improvement.","volume":"22","author":"Grummer-Strawn","year":"2013","journal-title":"J Womens Health (Larchmt)"},{"key":"2021121021483620100_B16","volume-title":"Regression Models for Categorical Dependent Variables Using Stata","author":"Long","year":"2006"},{"issue":"1","key":"2021121021483620100_B17","doi-asserted-by":"crossref","first-page":"e20163121","DOI":"10.1542\/peds.2016-3121","article-title":"Best fed beginnings: a nationwide quality improvement initiative to increase breastfeeding.","volume":"140","author":"Feldman-Winter","year":"2017","journal-title":"Pediatrics"},{"issue":"4","key":"2021121021483620100_B18","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1177\/0890334415585977","article-title":"Online continuing education for expanding clinicians\u2019 roles in breastfeeding support.","volume":"31","author":"Edwards","year":"2015","journal-title":"J Hum Lact"},{"issue":"4","key":"2021121021483620100_B19","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1089\/bfm.2016.0003","article-title":"Lessons learned from hospital leaders who participated in a national effort to improve maternity care practices and breastfeeding.","volume":"11","author":"Feldman-Winter","year":"2016","journal-title":"Breastfeed Med"},{"key":"2021121021483620100_B20","unstructured":"World Health Organization; UNICEF. 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Accessed February 18, 2017"},{"issue":"11","key":"2021121021483620100_B21","first-page":"22","article-title":"Hospitals should balance skin-to-skin contact with safe sleep policies.","volume":"34","author":"Goldsmith","year":"2013","journal-title":"AAP News"},{"issue":"3","key":"2021121021483620100_B22","doi-asserted-by":"crossref","first-page":"e20161889","DOI":"10.1542\/peds.2016-1889","article-title":"Safe sleep and skin-to-skin care in the neonatal period for healthy term newborns.","volume":"138","author":"Feldman-Winter","year":"2016","journal-title":"Pediatrics"},{"issue":"1","key":"2021121021483620100_B23","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2014-1532","article-title":"Early weight loss nomograms for exclusively breastfed newborns.","volume":"135","author":"Flaherman","year":"2015","journal-title":"Pediatrics"},{"issue":"3","key":"2021121021483620100_B24","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1016\/j.jada.2011.10.024","article-title":"Neonatal weight loss at a US Baby-Friendly Hospital.","volume":"112","author":"Grossman","year":"2012","journal-title":"J Acad Nutr Diet"},{"issue":"9","key":"2021121021483620100_B25","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1089\/bfm.2016.0072","article-title":"The impact of hospital resources and availability of professional lactation support on maternity care: results of breastfeeding surveys 2009-2014.","volume":"11","author":"Dennison","year":"2016","journal-title":"Breastfeed Med"},{"issue":"2","key":"2021121021483620100_B26","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1177\/0890334414568119","article-title":"\u201cFrustrated,\u201d \u201cdepressed,\u201d and \u201cdevastated\u201d pediatric trainees: US academic medical centers fail to provide adequate workplace breastfeeding support.","volume":"31","author":"Dixit","year":"2015","journal-title":"J Hum Lact"},{"issue":"1","key":"2021121021483620100_B27","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1177\/0002716212456834","article-title":"Explaining rising nonresponse rates in cross-sectional surveys.","volume":"645","author":"Brick","year":"2013","journal-title":"Ann Am Acad Pol Soc Sci"},{"issue":"2","key":"2021121021483620100_B28","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1093\/poq\/nfn011","article-title":"The impact of nonresponse rates on nonresponse bias: a meta-analysis.","volume":"72","author":"Groves","year":"2008","journal-title":"Public Opin Q"},{"issue":"1","key":"2021121021483620100_B29","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1111\/j.1475-6773.2005.00350.x","article-title":"Response rates and response bias for 50 surveys of pediatricians.","volume":"40","author":"Cull","year":"2005","journal-title":"Health Serv Res"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2017-1229\/1095658\/peds_20171229.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2017-1229\/1095658\/peds_20171229.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,11]],"date-time":"2021-12-11T07:13:19Z","timestamp":1639206799000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/140\/4\/e20171229\/38082\/National-Trends-in-Pediatricians-Practices-and"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,10,1]]},"references-count":29,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2017,10,1]]},"published-print":{"date-parts":[[2017,10,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2017-1229","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,10,1]]},"article-number":"e20171229"}}