US Pharm. 2021;46(8):14.

The American Academy of Pediatrics recommends that infants be exclusively breastfed for the first 6 months, with breastfeeding continuing to at least age 1 year while complementary foods are being introduced. According to the National Immunization Survey, among infants born in 2017, 84.1% were ever breastfed, whereas 58.3% and 35.3%, respectively, were still being breastfed at ages 6 months and 12 months; these rates were higher than for infants born in 2014. However, the proportion of breastfed infants dropped from 84.1% at birth to 14.6% by 18 months. The Healthy People 2030 target is to increase the exclusive-breastfeeding rate in infants through age 6 months to 42.4% and the rate of infants breastfed at 1 year to 54.1%.

Formula Feeding: The risk of hospitalization for lower respiratory tract disease in the first year of life is more than 250% higher in formula-fed infants than in those who are exclusively breastfed for at least 4 months. Just over 19% of breastfed infants born in 2017 received formula supplementation within the first 2 days of life—an increase from 16.9% of infants born in 2016. Breastfeeding was supplemented with formula before ages 3 months and 6 months in 30.9% and 36.2% of infants, respectively.

Exclusive Breastfeeding: Among infants born in 2017, exclusive-breastfeeding rates at ages 6 months and 3 months were 25.6% and 46.9%, respectively. With age progression, there was a 59.7% decrease in exclusive breastfeeding, from 63.6% at 7 days old to 25.6% at age 6 months. The rate of exclusive breastfeeding was higher among infants aged 6 months who were not firstborn children (27.5%) than in infants who were firstborn children (22.3%).

Disparities: In terms of ethnicity, the CDC’s 2020 Breastfeeding Report Card noted that Asians had the greatest number of breastfed infants (90%), followed closely by whites (86.7%) and Hispanics (84.1%); the rate for non-Hispanic black infants was 73.7%. Among black infants, 58% were breastfed initially and 28% at 6 months, with 8% exclusively breastfed at 6 months. Infants receiving Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefits were less likely to ever be breastfed (77%) compared with infants eligible for but not receiving WIC (82.1%) and infants ineligible for WIC (92.1%). Less disparity in breastfeeding infants occurred between mothers aged 20 to 29 years (82.4%) and those aged 30 years and older (85.2%). Infants in the Southeast were less likely to be breastfed at 6 months than those in other areas, and infants in rural areas were less likely to ever be breastfed than those in urban areas.

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