To the Editor The Viewpoint in JAMA Pediatrics, “Unintended Consequences of Current Breastfeeding Initiatives,”1 is extremely disturbing. I am puzzled by the hazardous designation given to steps 4 (skin-to-skin care), 6 (breastfeeding exclusivity), 7 (24-hour rooming in), and 9 (elimination of pacifier use) of the Baby-Friendly Hospital Initiative (BFHI). All of these practices are based on years of research and millions of infants being safely and successfully breastfed throughout the world. I always wonder why a health care professional would wish to make a newborn infant dependent on the use of a pacifier to breathe, especially because breastfed infants have a lower risk of sudden infant death syndrome2 and there is little if any data recommending routine pacifier use during the first 3 days of life. I would postulate that it is hazardous for infants to not experience the care practices associated with the BFHI. Supplementation with infant formula for nonmedical reasons has negative consequences on both breastfeeding duration and exclusivity and on the perturbation of the infant gut microbiome. Such perturbations have been associated with an inflammatory state indicative of a risk for obesity and autoimmune disease.3 Safe sleep and skin-to-skin care in the hospital have been addressed by the American Academy of Pediatrics with guidelines for the safe practice of both.4 A sidecar bassinet that attaches to the adult bed has been shown to provide the best opportunities for breastfeeding with the safest conditions.4
Walker M. The Importance of the Baby-Friendly Hospital Initiative . JAMA Pediatr. 2017;171(3):304. doi:10.1001/jamapediatrics.2016.4802
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