Writing thank you note for baby gift

I work for a group of pediatricians in New Jersey and also act as a board-certified lactation consultant for a large inner-city hospital. I have respected the American Academy of Pediatrics' (AAP) support of breastfeeding and have used their documents over and over when giving seminars to pediatricians and obstetricians. Recently, a Ross representative left a promotional gift pack at the office. The pack, called "Baby's First Office Visit," included formula, of course, and the AAP book Your Baby's First Year. The book included the Ross/ Similac logo on the cover. There was also advertising for "to-your-door" formula inside the box. I was literally shocked to see that the AAP would endorse formula, so I wrote to them. The response I got intimated that AAP did not know of this promotion and asked for specifics, which I sent. I have yet to receive a response. If you hear of any news of this, please let me know!

DIANE B. PROCACCINI, RN, IBC/C

Peggy O'Mara's letter:

I am writing to ask for clarification regarding the breastfeeding position of the American Academy of Pediatrics. Your December 1997 statement reads, in part, "Pediatricians are encouraged to work actively toward eliminating hospital practices that discourage breastfeeding (e.g. infant formula discharge packs and separation of mother and infant)."

Last week we received in the mail a formula discharge pack that had recently been given to a reader at the hospital where she gave birth. The pack is from the makers of Similac and includes a 14.1-ounce container of powdered formula and the book Your Baby's First Year by the American Academy of Pediatrics. On the cover of the box containing the formula is a photo of a baby clearly under one year of age. Also on the box is a photo of Your Baby's First Year, with "American Academy of Pediatrics" clearly visible on its cover. The names Similac and Ross are printed on the cover of the AAP book.

In Your Baby's First Year, published in 1988, there is no mention of an AAP policy on breastfeeding. Throughout the book are sidebars entitled "Where We Stand;" however, no such sidebar exists in the "Feeding Your Baby: Breast and Bottle" section. The language in the book, in fact, is quite different from the language of your 1997 statement. The book reads, "But it's important not to feel guilty if you decide to bottle-feed your baby. Infant formula is a nutritious and acceptable alternative to human milk."

In contrast, your 1997 statement says, "The AAP identifies breastfeeding as the ideal method of feeding and nurturing infants and recognizes breastfeeding as primary in achieving optimal infant and child health, growth, and development." Further, the AAP website states, "From its inception, the AAP has been a staunch advocate of breastfeeding as the optimal form of nutrition for infants."

Unfortunately, I understand that there is another situation in which the AAP will allow its name to be associated with hospital formula discharge packs. Is it true that the rights to the American Academy of Pediatrics' New Mother's Guide to Breastfeeding have recently been purchased by Ross Laboratories? Will the book be distributed to new mothers in hospital formula discharge packs? Will it be given to breastfeeding mothers? Like Your Baby's First Year, will the book also have the names Similac and Ross on the cover and the name of the American Academy of Pediatrics prominently visible on the discharge pack itself?

What is the actual position of the AAP on breastfeeding? Does your membership support the 1997 statement? Publications of the AAP such as Your Child's Sleep and participation in hospital formula discharge practices undermine the effectiveness of your 1997 statement. The statement recognizes that hospital discharge packs of formula undermine breastfeeding, and yet five years after the statement, the AAP still lends its name to these efforts. Your 1997 statement encourages pediatricians to work toward eliminating these packs at the same time that your organization participates in their distribution. What is the AAP doing to eliminate the distribution of hospital discharge packs of formula?

Please let me know at your earliest convenience what your actual breastfeeding policy is and how it is implemented in practice. Also, please explain the participation of the AAP in the distribution of infant formula hospital discharge packs.

Response from Joe M. Sanders, Jr., MD, AAP executive director:

On behalf of Dr. Cooper, thank you for contacting the American Academy of Pediatrics and sharing your concerns about the distribution of the New Mother's Guide to Breastfeeding. We appreciate and share your passion for the health and well-being of children, especially on the issue of breastfeeding.

This book is part of ongoing AAP educational efforts to provide parents and caregivers with high-quality information on a broad spectrum of children's health issues. What distinguishes the New Mother's Guide to Breastfeeding from other reference books on this topic is that it has been written and extensively reviewed by pediatricians. Under the direction of lactation expert Joan Younger Meek, MD, MS, RD, FAAP, IBCLC, editor in chief, the material in this book was developed with the assistance of numerous reviews and contributors from AAP technical committees and sections. As with all AAP educational materials and policies, there was no commercial involvement in the development of this book.

The New Mother's Guide to Breastfeeding is being distributed in a variety of ways such as through the AAP publications catalog, AAP online bookstore, medical book distributors, exhibits at AAP and other association meetings, and through other organizations. It is also available in bookstores nationwide.

In addition to the distribution methods described above, companies also purchase AAP peer-reviewed and credentialed information and distribute it to physicians and consumers. Ross Pediatrics has purchased a quantity of the New Mother's Guide to Breastfeeding to use in place of a breastfeeding booklet it had previously developed and distributed. It is our understanding that these books will be distributed to new mothers by healthcare professionals in hospitals and pediatric offices. As with other educational materials, hospitals can decide whether or not they want to distribute these books. The appearance of a company's name on the cover of a book indicates only that the book is a free copy given by the company. The Ross Pediatrics name only appears on the quantity of books purchased by Ross Pediatrics. No formula advertisement appears in any copies of this book.

You have also mentioned the 1997 AAP policy statement, "Breastfeeding and the Use of Human Milk," and the 1998 book Your Baby's First Year. For your information, although these documents have different publication dates, the book was actually in the process of being printed before the policy statement was published. Both publications are currently under revision, and your comments will be shared with the AAP members and staff who are working on these revisions. In future publications, it is our intention that the revised versions be consistent with each other.

We certainly support your commitment to breastfeeding. The AAP is committed to the promotion of breastfeeding via policy, educational materials, and ongoing medical education projects.

AAP phone: 847-434-4000 AAP e-mail: kidsdocs@aap.org

Editor's note: I was shocked to find this out as well and wrote to AAP president Louis A. Cooper, MD. My letter and the AAP response follow.