What is the relationship between parity
and breastfeeding? No grade given
As parity has become a difficult variable to study no evidence statement has been developed.
What is the association between maternal
age and breastfeeding outcomes? B Younger maternal age, particularly less than 20 years, may be negatively associated with both the initiation of breastfeeding and breastfeeding duration.
What is the association between maternal
education and breastfeeding outcomes? C In Australia, and other Western countries, higher levels of education are associated with better breastfeeding outcomes. In Asian countries, such as China the reverse is the case.
Breastfeeding: early days
Question
Grade
Statement
What is the association between demand
feeding and ‘rooming in’? No grade given Demand feeding and the associated “Rooming Policies” are now standard practice in Australian hospitals. Due to the lack of variation in exposure variable no evidence statement has been developed. Does exercise by mothers in the postpartum
period affect breastfeeding performance? B Exercise by mothers does not affect breastfeeding performance. Is the implementation of the Baby Friendly
Hospital Initiative (BFHI) associated with breastfeeding performance and duration?
B Implementation of the BFHI improves breastfeeding outcomes.
What is the impact of pacifier use on the
prevention of SIDS? B The use of a pacifier reduces the risk of SIDS. Is pacifier use negatively associated with
breastfeeding duration? C The use of a pacifier before 4 weeks is associated with a reduced duration of breastfeeding (any, predominant and exclusive).
Breastfeeding: common problems and their management
Question
Grade
Statement
What are the best forms of treatment for women who experience nipple pain/trauma during lactation?
D No single intervention offers a significant improvement in the symptoms or duration of nipple pain/trauma.
What interventions are recommended for the prevention of nipple pain/trauma during lactation?
D No single intervention provides a significant effect in preventing nipple pain/trauma.
What is the prevalence of nipple variation (at least one flat, inverted or non-protractile nipple) in lactating women?
D Approximately 8–10% of lactating women have at least one flat, inverted or non-protractile nipple.
What is the physiological response to nipple
shield use? D Nipple shield use is associated with a decrease in milk transfer however more research investigating this association is required. Management of eczema and dermatitis of
the nipple. No grade given Insufficient evidence to develop a body of evidence statement. Nipple piercings during breastfeeding. No grade
given Insufficient evidence to develop a body of evidence statement. Nipple vasospasm (Raynaud’s phenomenon) No grade
given Insufficient evidence to develop a body of evidence statement How does a mother’s perceived breast milk
insufficiency affect breastfeeding level and duration?
D Approximately 25–35% of lactating women reduce breastfeeding duration or level due to perceived breast milk insufficiency.
Question
Grade
Statement
What are the best forms of treatment for women who experience breast engorgement during lactation?
D No pharmacological or non-pharmacological treatments for breast engorgement are associated with significant improvement in symptoms.
What is the prevalence of breast
engorgement in lactating women? D Approximately 40% of lactating women experience moderate-severe symptoms of breast engorgement. What is the prevalence of mastitis in
lactating women? D Approximately 10–25% of lactating women experience at least one episode of mastitis. What preventative strategies are effective
in reducing the incidence and recurrence of mastitis in lactating women?
D No pharmacological or non-pharmacological preventative methods are associated with a reduced occurrence of mastitis in breastfeeding women.
What is the prevalence of breast abscess in
lactating women? D Approximately 0.1 – 0.5% of lactating women develop a breast abscess in developed countries, including Australia. What is the incidence of breast abscess
in lactating women with inflammatory symptoms of the breast??
D Approximately 3–10% of lactating women with inflammatory symptoms of the breast later developed a breast abscess. What is the prevalence of maternal
postnatal depression? B Approximately 10–15% of women experience depression (EPDS score ≥ 12) within 12 months of delivery. What is the association between postnatal
depression and shorter breastfeeding duration?
C Postnatal depression is associated with shorter breastfeeding duration.
What is the relationship between infant breast refusal and breastfeeding duration?
No grade given
Evidence was not strong enough to develop a body of evidence statement.
Prevalence and management of infant crying. No grade given
Evidence was not strong enough to develop a body of evidence statement.
Regurgitation, gastro-oesophageal reflux and feeding related behaviours.
No grade given
No evidence statement developed. What is the prevalence of ankyloglossia
(tongue-tie) in infants?
D Approximately 4–10% of infants are born with ankyloglossia. Does ankyloglossia (tongue-tie) affect
breastfeeding outcomes?
D Ankyloglossia is associated with an increased risk of breastfeeding difficulties.
How effective is frenotomy in the treatment of ankyloglossia (tongue-tie)?
D Frenotomy is an effective treatment for ankyloglossia. What impact does breastfeeding have on
postpartum weight loss?
No grade given
Insufficient evidence to make a statement on the effects of breastfeeding alone on postpartum weight loss.
Breastfeeding in specific situations
Question
Grade
Statement
What is the effect of maternal and paternal
smoking on breastfeeding outcomes? A Maternal and paternal smoking is negatively associated with breastfeeding outcomes. What is the association between mothers
returning to work and breastfeeding outcomes? B Intention to work or return to paid employment is negatively associated with both the initiation of breastfeeding and breastfeeding duration.
What is the risk of mother-to-child-transmission of
hepatitis C through breastfeeding? C There is no association between transmission of hepatitis C and mode of infant feeding. What is the risk of mother-to-child-transmission
of hepatitis C through breastfeeding in hepatitis C and HIV co-infected mothers?
D Hepatitis C mothers co-infected with HIV are at an increased risk of transmitting hepatitis C through breast milk.
Expressing and storing breast milk
Question
Grade
Statement
What is the optimum storage time of expressed breast milk?
C The maximum (optimum) storage time of breast milk under clean conditions in a refrigerator 0–4°C is around 96 hours.
What is the association between breast milk expression and breastfeeding outcomes?
No grade given
An insufficient number of studies were available to make a formal evidence statement.
Introducing solid foods
Question
Grade
Statement
Is the age of solid food introduction in children associated with the development of overweight later in life?
C Introducing solid foods before 4 months is associated with increasing risk of overweight in children.
Foods not suitable or that should be used with care
Question
Grade
Statement
How many infants are fed unmodified cow’s milk
before 12 months of age? D The majority of infants are given cow’s milk before the recommended age of 12 months. What factors are predictive of the introduction of
cow’s milk before 12 months of age? C Low maternal educational and low socioeconomic status are associated with the introduction of unmodified cow’s milk to infants less than 12 months of age.
What are the risks associated with feeding unmodified cow’s milk to infants less than 12 months of age?
D Feeding infants with whole cow’s milk before 12 months of age is associated with an increased incidence of iron deficiency.
Infant feeding and later outcomes
Question
Grade
Statement
What are the benefits of breastfeeding (partial and exclusive) and the risks of not breastfeeding (any and exclusive), to infants and mothers, both in the short term and long term?
C Breastfeeding is associated with a reduced risk of asthma and atopic disease.
Is the duration of breastfeeding associated with lower rates of development of Inflammatory Bowel Disease and Coeliac Disease?
C Breastfeeding is associated with lower rates of coeliac disease and inflammatory bowel disease (Crohn’s disease and ulcerative colitis).