PEDIATRICIAN INVOLVEMENT IN BREAST-FEEDING PROMOTION - A NATIONAL STUDY OF RESIDENTS AND PRACTITIONERS

Objective. Physician support for breast-feeding mothers has been shown to improve breastfeeding rates, but no evaluation of the adequacy of physicians' breast-feeding-related training has been conducted. This s tudy was designed to assess pediatricians' knowledge, attitudes, train ing and activities related to breast-feeding promotion. Methods. Surve ys were mailed to a national random sample of pediatric residents (n = 999) and practitioners (n = 610) who were board certified within the previous 3 to 5 years. Results. Response rates were 74% for residents and 69% for practitioners. Although more than 90% of respondents agree d that pediatricians should be involved in breast-feeding promotion, t heir clinical. knowledge and experience did not suggest a high degree of competency. For example, practitioners were only slightly more awar e of breast-feeding's protective effect against otitis media (71% vs 6 0%), and more than one quarter of both groups did not agree that exclu sive breast-feeding is the most beneficial form of infant nutrition Cl inical advice often included inappropriate recommendations for breast- feeding termination or formula supplementation; only 64% of practition ers and 52% of residents knew that supplementing during the first few weeks of life may cause breast-feeding failure. For both groups, prior personal breast-feeding experience (ie, respondent or spouse had brea st-fed an infant for 2 or more weeks) was a major determinant of impro ved clinical knowledge, more frequent activity,and greater self-confid ence and perceived effectiveness in the area of breast-feeding promoti on. Residents reported that the breast-feeding instruction provided du ring training was primarily in lecture format, with limited clinical o pportunities to practice skills needed to assist breast-feeding mother s. Reflecting on their own training, more than 70% of practitioners re commended that more time be devoted to direct patient interaction and practice of counseling and problem-solving skills. Conclusions. These results indicate that residency training does not adequately prepare p ediatricians for their role in breast-feeding promotion. Improvements in residency training and innovative continuing education programs sho uld be implemented to help pediatricians meet the needs of their breas t-feeding patients.