Baby-Friendly Hospitals Could be Dangerous for Infants

The UNICEF (New York, NY, USA) and World Health Organization (WHO, Geneva, Switzerland) Baby-Friendly Hospital Initiative (BFHI) may have unintended consequences for newborns, according to a new study.

The initiative includes a list of 10 rules for hospitals to follow to promote breastfeeding during the first six months of life. The rules include a written breastfeeding policy that is routinely communicated to all health care staff; training all health care staff in skills necessary to implement the policy; informing pregnant women about the benefits and management of breastfeeding; helping mothers to initiate breastfeeding within one half-hour of birth; and showing mothers how to breastfeed and maintain lactation, even if they should be separated from their infants.

The other five rules of the BFHI are intended to encourage newborns to suckle. These include giving newborn infants no food or drink other than breastmilk – not even sips of water – unless medically indicated; allowing mothers and infants to remain together 24 hours a day; encouraging breastfeeding on demand; giving no pacifiers (dummies) to breastfeeding infants; and fostering the establishment of breastfeeding support groups upon discharge from the hospital or clinic.

But researchers at Newton-Wellesley Hospital (NWH; MA, USA) suggest that following the 10 steps may lead to hazardous, and even fatal, issues for babies. For example, evidence suggests that pacifier use may decrease a baby’s risk of sudden infant death syndrome (SIDS). Other studies have linked unsupervised neonatal time in the hospital to an increased risk for sudden postnatal collapse, a potentially fatal condition that often requires full resuscitation. The researchers also suggest that using formula early on in an infant’s life may make things easier for new mothers as their milk comes in. The study was published on August 22, 2016, in JAMA Pediatrics.

“Full compliance with the 10 steps of the initiative may inadvertently be promoting potentially hazardous practices and/or having counterproductive outcomes. Some of the rules may prioritize breastfeeding over infant health, which makes a critical look at the guidelines key,” concluded study author Joel Bass, MD, chair of the department of pediatrics at NWH, and colleagues. “More attention should also be placed on ensuring compliance with established safe sleep programs, emphasizing the need to integrate safe sleep practices with breastfeeding.”

The BFHI was introduced in the early 1990s, and since inception approximately 15,000 facilities in more than 152 countries have been inspected and accredited as "Baby-Friendly.” The BFHI was endorsed by the U.S. Department of Health and Human Services (HHS) in 2010, and current U.S. hospital participation stands at 17%.

Related Links:
UNICEF
World Health Organization
Newton-Wellesley Hospital