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Comment & Response
March 2017

The Importance of the Baby-Friendly Hospital Initiative—Reply

Author Affiliations
  • 1Harvard Medical School, Boston, Massachusetts
  • 2Department of Pediatrics, Newton-Wellesley Hospital, Newton, Massachusetts
  • 3Massachusetts General Hospital, Boston
JAMA Pediatr. 2017;171(3):305-306. doi:10.1001/jamapediatrics.2016.4795

In Reply We appreciate the comments from the respondents about concerns we expressed regarding the Baby-Friendly Hospital Initiative (BFHI) in our Viewpoint.1 They question our conclusions about the relationship between the BFHI guidelines encouraging skin-to-skin care beyond the first hours of life, in-hospital breastfeeding exclusivity, and pacifier restriction with an increased risk for sudden unexpected postnatal collapse and newborn falls. These relationships are supported by evidence-based citations in the recently published American Academy of Pediatrics clinical guideline2 and our subsequent commentary.3 In addition, the recent US Preventive Services Task Force report on Primary Care Interventions to Support Breastfeeding4 concluded there is a lack of consistent evidence that demonstrates system-level interventions, including the BFHI, improve breastfeeding outcomes. The accompanying editorial by Flaherman and Von Kohorn5 offers further insight into issues raised with the BFHI and provides additional evidence substantiating our Viewpoint.1 Walker’s criticism of pacifier use has been definitively refuted by this evidence.5 We share Flaherman and Von Kohorn’s concern that pacifier restriction might be ethically problematic.

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