Abstract 443 Poster Session III, Monday, 5/3 (poster 307)

Historically, physicians have played a significant role in counseling mothers regarding infant feeding choices. Earlier in this century, given the concern about milk sterility and the desire to measure intake, physicians counseled mothers to bottlefeed. In contrast, in the late 1950's, physicians began to acknowledge the healthful aspects of breastfeeding (BF) and human milk. Despite the change in philosophy, little resident education occurs on the topic of lactation. We sought to establish the current level of teaching and resident understanding in the management of the BF mother/infant dyad. Residents in Pediatrics (Peds), OB/Gyn, and Family Medicine (FM) were asked to participate in a written survey. There were 51 respondents: 24 OB/Gyn, 17 Peds, and 10 FM. The mean ± S.D. age of the cohort was 30±4 (range 24-43); mean PGY level of 2.7± 1.1 (range 1-4). 27 (53%) residents received <1 hr/yr didactic BF instruction; 20 (39%) received 2-3 hr/yr and 4 (8%) received >4 hr/yr. 26 (51%) had never witnessed a woman BF. The majority of residents (38 [75%]) had little confidence instructing a mother on the use of a breast pump. To the statement, "Breastmilk is the best nutrition for infants," 41 (80%) agreed. 21 (41%) residents correctly identified that most mothers choose feeding type by the end of the 1st trimester. Residents' responses to management questions showed a variable knowledge base: for mastitis and breast abscess, the overwhelming majority of residents chose to cease BF during the first 24 hr of antibiotic tx. In the management of cracked nipples, only 15 (29%) viewed air drying with a drop of milk as a tx option. If a mother felt that her infant rejected her nipple, 20 (39%) chose to seek additional information regarding # wet/dirty diapers, etc., and 29 (57%) chose to observe her BF infant. Management of a mother who is concerned her BF infant is not receiving enough to eat varied: 29 (57%) chose to seek additional information, 20 (39%) chose to advise her to feed more often, while only 2 (4%) chose to observe her BF. When asked for the most common cause of BF failure, 48 (94%) identified maternal frustration as the most likely cause. AAP BF guidelines were correctly identified by 11 (24%) respondents. There was misinformation regarding indications for temporary cessation of BF: e.g., only 28 (55%) identified radionucleotide admin for imaging studies as a contraindication to BF. Knowledge about milk composition also was variable: e.g., 31 (61%) correctly identified hindmilk as having higher fat content. In conclusion, residents at a university hospital had a limited knowledge base about human milk, and when presented with common lactation problems, often made inappropriate management choices.