Design and Implementation of a Physician-Run Breastfeeding Medicine Clinic for High-Risk Dyads Embedded Within a Pediatric Practice

BACKGROUND: Breastfeeding and the feeding of human milk is widely accepted as the standard for infant nutrition, but early discontinuation or mixed feeding with human milk substitutes is common in the United States. Breastfeeding difficulties from complex health needs including chronic illness of the mother or infant, and infant prematurity can play a role in early discontinuation. Improving breastfeeding support can improve breastfeeding duration. Physicians with expertise in management of chronic health conditions, infant prematurity, and breastfeeding medicine distinct from the lactation consultant's scope of practice are uniquely equipped to address the needs of medically complex dyads. Integrating a breastfeeding medicine clinic within the general pediatric clinic potentially allows for more timely breastfeeding medicine support in a familiar setting where newborns usually receive care within the first few days of their life. Physicians with expertise in breastfeeding medicine have been providing this care, but it is not widely available, and there are few reports documenting this model, or the impact of this model, including the care of adult patients within a pediatric practice. INNOVATION: Our aim was to design and implement a physician-run breastfeeding medicine clinic caring for both adult and pediatric patients, embedded within a pediatric practice specializing in high-risk dyads, and to begin the work of documenting use and successes of this type of care. CONCLUSION: The establishment of this breastfeeding medicine clinic increased access to breastfeeding medicine care and provides a first step towards describing clinical models and their impact in the growing field of breastfeeding medicine.