Pediatricians and the promotion and support of breastfeeding.

OBJECTIVES To survey pediatricians on their breastfeeding knowledge, attitudes, and practices and to compare these results with those of a 1995 study. DESIGN Cross-sectional follow-up survey. SETTING The Periodic Survey of Fellows survey conducted by the American Academy of Pediatrics. PARTICIPANTS The survey was completed by 875 pediatrician members of the American Academy of Pediatrics from November 1, 2003, through May 21, 2004. MAIN OUTCOME MEASURES Pediatricians' recommendations on management, opinions about the benefits and promotion of breastfeeding, and relationship to personal breastfeeding experience were compared with the results of the 1995 survey. RESULTS Compared with the results of the 1995 survey, in 2004, pediatricians were less likely to believe that the benefits of breastfeeding outweigh the difficulties or inconvenience (adjusted odds ratio, 0.60; 95% confidence interval, 0.47-0.76), and fewer believed that almost all mothers are able to succeed. More pediatricians in 2004 reported reasons to recommend against breastfeeding. Pediatricians in 2004 were more likely to recommend exclusive breastfeeding (adjusted odds ratio, 1.55; 95% confidence interval, 1.23-1.94) and follow supportive hospital policies. Respondents with personal breastfeeding experience were 2.3 times more likely to recommend supportive policies (adjusted odds ratio, 2.3; 95% confidence interval,1.74-3.08) in 2004 than in 1995. Those with no personal breastfeeding experience were also slightly more likely in 2004 to recommend these policies (adjusted odds ratio, 1.49; 95% confidence interval, 1.09-2.03). CONCLUSIONS Although pediatricians seem better prepared to support breastfeeding, their attitudes and commitment have deteriorated. Personal experience mitigates poor attitudes and seems to enhance breastfeeding practices among those surveyed.