, Breastfeeding
Handbook
for Physicians
3rd Edition
00 Front Matter BHFP i-xiv.indd 1 9/14/22 12:26 PM
, American Academy of Pediatrics Publishing Staff
Mary Lou White, Chief Product and Services Officer/SVP, Membership, Marketing, and Publishing
Mark Grimes, Vice President, Publishing
Heather Babiar, MS, Senior Editor, Professional/Clinical Publishing
Jason Crase, Senior Manager, Production and Editorial Services
Theresa Wiener, Production Manager, Clinical and Professional Publications
Peg Mulcahy, Manager, Art Direction and Production
Linda Smessaert, Director, Marketing
Mary Louise Carr, MBA, Marketing Manager, Clinical Publications
Published by the American Academy of Pediatrics
345 Park Blvd
Itasca, IL 60143
Telephone: 630/626-6000
Facsimile: 847/434-8000
www.aap.org
The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical
subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, chil-
dren, adolescents, and young adults.
The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of
medical care. Variations, taking into account individual circumstances, may be appropriate.
Statements and opinions expressed are those of the authors and not necessarily those of the American Academy of
Pediatrics.
While the terminology used in this publication often reflects the dyad of “mother” and newborn or infant, the
intent is to be inclusive of all parents, regardless of sex, gender, or sexual orientation.
Any websites, brand names, products, or manufacturers are mentioned for informational and identification
purposes only and do not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not
responsible for the content of external resources. Information was current at the time of publication.
The persons whose photographs are depicted in this publication are professional models. They have no relation to
the issues discussed. Any characters they are portraying are fictional.
The publishers have made every effort to trace the copyright holders for borrowed materials. If they have inadver-
tently overlooked any, they will be pleased to make the necessary arrangements at the first opportunity.
This publication has been developed by the American Academy of Pediatrics. The contributors are expert
authorities in the field of pediatrics. No commercial involvement of any kind has been solicited or accepted in
development of the content of this publication. Disclosures: Pamela Berens discloses a speaker bureau relationship
with the Texas Department of State Health Services and a site principal investigator relationship with a Duke
University study. Susan Crowe discloses a previous advisory board relationship with Sage Therapeutics. Gabriela
Maradiaga Panayotti discloses a consulting relationship with Aveeno, a speaker’s bureau relationship with Carolina
Global Breastfeeding Institute, and a spouse/partner with a speaker relationship with Boehringer Ingelheim and an
advisory board relationship with Genentech.
Every effort has been made to ensure that the drug selection and dosages set forth in this text are in accordance
with the current recommendations and practice at the time of publication. It is the responsibility of the health
care professional to check the package insert of each drug for any change in indications or dosage and for added
warnings and precautions.
Every effort is made to keep Breastfeeding Handbook for Physicians consistent with the most recent advice and
information available from the American Academy of Pediatrics.
Please visit www.aap.org/errata for an up-to-date list of any applicable errata for this publication.
Special discounts are available for bulk purchases of this publication. Email Special Sales at
for more information.
© 2023 American Academy of Pediatrics and The American College of Obstetricians and Gynecologists
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in
any form or by any means—electronic, mechanical, photocopying, recording, or otherwise—without prior permis-
sion from the publisher (locate title at https://publications.aap.org/aapbooks and click on © Get Permissions; you
may also fax the permissions editor at 847/434-8780 or email ). First edition published 2006;
second, 2014.
Printed in the United States of America
4-99/1122 1 2 3 4 5 6 7 8 9 10
MA0980
ISBN: 978-1-61002-442-6
eBook: 978-1-61002-443-3
Library of Congress Control Number: 2020932408
00 Front Matter BHFP i-xiv.indd 2 9/14/22 12:26 PM
, Editorial Committee
Editor in Chief
Richard J. Schanler, MD, FAAP, FABM
Coeditors
Lori Feldman-Winter, MD, MPH, FAAP, FABM
Sharon B. Mass, MD, FACOG
Joan Younger Meek, MD, MS, RD, FAAP, FABM, IBCLC
Lawrence Noble, MD, FAAP, FABM, IBCLC
Staff
American Academy of Pediatrics
Mark Grimes
Jeff Mahony
Sunnah Kim, MS, RN, CPNP
Ngozi Onyema-Melton, MPH, CHES
Heather Babiar, MS
The American College of Obstetricians and Gynecologists
Christopher M. Zahn, MD
Jennifer Walsh
Ije Obidegwu, MPH
Syeda Lamiya Ahmed
Martha Hawley-Bertsch
Jennifer Hicks, MS
iii
00 Front Matter BHFP i-xiv.indd 3 9/14/22 12:26 PM
Handbook
for Physicians
3rd Edition
00 Front Matter BHFP i-xiv.indd 1 9/14/22 12:26 PM
, American Academy of Pediatrics Publishing Staff
Mary Lou White, Chief Product and Services Officer/SVP, Membership, Marketing, and Publishing
Mark Grimes, Vice President, Publishing
Heather Babiar, MS, Senior Editor, Professional/Clinical Publishing
Jason Crase, Senior Manager, Production and Editorial Services
Theresa Wiener, Production Manager, Clinical and Professional Publications
Peg Mulcahy, Manager, Art Direction and Production
Linda Smessaert, Director, Marketing
Mary Louise Carr, MBA, Marketing Manager, Clinical Publications
Published by the American Academy of Pediatrics
345 Park Blvd
Itasca, IL 60143
Telephone: 630/626-6000
Facsimile: 847/434-8000
www.aap.org
The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical
subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, chil-
dren, adolescents, and young adults.
The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of
medical care. Variations, taking into account individual circumstances, may be appropriate.
Statements and opinions expressed are those of the authors and not necessarily those of the American Academy of
Pediatrics.
While the terminology used in this publication often reflects the dyad of “mother” and newborn or infant, the
intent is to be inclusive of all parents, regardless of sex, gender, or sexual orientation.
Any websites, brand names, products, or manufacturers are mentioned for informational and identification
purposes only and do not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not
responsible for the content of external resources. Information was current at the time of publication.
The persons whose photographs are depicted in this publication are professional models. They have no relation to
the issues discussed. Any characters they are portraying are fictional.
The publishers have made every effort to trace the copyright holders for borrowed materials. If they have inadver-
tently overlooked any, they will be pleased to make the necessary arrangements at the first opportunity.
This publication has been developed by the American Academy of Pediatrics. The contributors are expert
authorities in the field of pediatrics. No commercial involvement of any kind has been solicited or accepted in
development of the content of this publication. Disclosures: Pamela Berens discloses a speaker bureau relationship
with the Texas Department of State Health Services and a site principal investigator relationship with a Duke
University study. Susan Crowe discloses a previous advisory board relationship with Sage Therapeutics. Gabriela
Maradiaga Panayotti discloses a consulting relationship with Aveeno, a speaker’s bureau relationship with Carolina
Global Breastfeeding Institute, and a spouse/partner with a speaker relationship with Boehringer Ingelheim and an
advisory board relationship with Genentech.
Every effort has been made to ensure that the drug selection and dosages set forth in this text are in accordance
with the current recommendations and practice at the time of publication. It is the responsibility of the health
care professional to check the package insert of each drug for any change in indications or dosage and for added
warnings and precautions.
Every effort is made to keep Breastfeeding Handbook for Physicians consistent with the most recent advice and
information available from the American Academy of Pediatrics.
Please visit www.aap.org/errata for an up-to-date list of any applicable errata for this publication.
Special discounts are available for bulk purchases of this publication. Email Special Sales at
for more information.
© 2023 American Academy of Pediatrics and The American College of Obstetricians and Gynecologists
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in
any form or by any means—electronic, mechanical, photocopying, recording, or otherwise—without prior permis-
sion from the publisher (locate title at https://publications.aap.org/aapbooks and click on © Get Permissions; you
may also fax the permissions editor at 847/434-8780 or email ). First edition published 2006;
second, 2014.
Printed in the United States of America
4-99/1122 1 2 3 4 5 6 7 8 9 10
MA0980
ISBN: 978-1-61002-442-6
eBook: 978-1-61002-443-3
Library of Congress Control Number: 2020932408
00 Front Matter BHFP i-xiv.indd 2 9/14/22 12:26 PM
, Editorial Committee
Editor in Chief
Richard J. Schanler, MD, FAAP, FABM
Coeditors
Lori Feldman-Winter, MD, MPH, FAAP, FABM
Sharon B. Mass, MD, FACOG
Joan Younger Meek, MD, MS, RD, FAAP, FABM, IBCLC
Lawrence Noble, MD, FAAP, FABM, IBCLC
Staff
American Academy of Pediatrics
Mark Grimes
Jeff Mahony
Sunnah Kim, MS, RN, CPNP
Ngozi Onyema-Melton, MPH, CHES
Heather Babiar, MS
The American College of Obstetricians and Gynecologists
Christopher M. Zahn, MD
Jennifer Walsh
Ije Obidegwu, MPH
Syeda Lamiya Ahmed
Martha Hawley-Bertsch
Jennifer Hicks, MS
iii
00 Front Matter BHFP i-xiv.indd 3 9/14/22 12:26 PM
