Concordant Women, Infants, and Children Staff and Pediatrician Recommendations Associated with Improved Breastfeeding

Participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) may perceive different recommendations for breastfeeding from their pediatricians and the WIC staff.

This study aimed to examine how the concordance between perceived pediatricians' and WIC staff's breastfeeding recommendations was associated with WIC participants' breastfeeding outcomes.

We analyzed 1344 participants in the WIC Infant and Toddler Feeding Practices Study-2 and examined the concordance between pediatricians' and WIC staff's breastfeeding recommendations. Concordance was defined as mothers' perception of whether both pediatricians and WIC staff recommended exclusive breastfeeding (EBF) at 1 mo postpartum. The outcome variables were EBF at 1, 3, and 5 mo postpartum and any breastfeeding at 1, 3, 5, 7, 9, and 11 mo postpartum. Generalized estimating equations were used to examine longitudinal disparities in breastfeeding between participants who received concordant recommendations and those who did not.

A higher proportion of mothers reported that WIC staff recommended EBF (88.5%) than pediatricians (39.3%). Conversely, a lower proportion of mothers reported being advised by WIC staff that formula and breastfeeding were equivalent (7.0%) than by pediatricians (50.7%). The odds ratios of EBF among mothers with concordant recommendations were 2.83 [95% confidence interval (CI): 2.06, 3.88], 2.00 (95% CI: 1.45, 2.76), and 2.12 (95% CI: 1.49, 3.00) at 1, 3, and 5 mo, respectively. Similar patterns were observed regarding any breastfeeding as well.

Concordant breastfeeding recommendations from both WIC staff and pediatricians are associated with better breastfeeding outcomes, underscoring the need for greater alignment between care teams' breastfeeding guidance.