Hi, all

As a member of the Bright Futures Infancy Expert Panel--and the only IBCLC
on the entire project, I figured I'd jump in on this discussion....

First of all, the Third Edition of the Bright Futures Guidelines for the
Health Supervision of Infants, Children, and Adolescents is an AAP project.
The previous editions had come through Georgetown and the MCHB, I believe,
but AAP got the grant for the revision. 

This new edition is much improved over the last one, in many ways. It is
much more evidence-based, and much more focused for the health care
professional. There are other aspects of Bright Futures designed more for
parents and others, some of which are still in the works.

It was a fascinating process to be a part of. The infancy panel consisted of
pediatricians, NICU specialist, nurses, mental health professional,
pediatric dentist, registered dietician, a few others, and me. I was
representing both the family side of things as well as breastfeeding. One
thing that Bright Futures emphasizes is the importance of family as partners
in children's health--that families bring important information to the table
as far as determining the best approach for a given child in a given
situation.

I did my best to see that breastfeeding was accurately and adequately
portrayed in the guidelines. Not everything I suggested was accepted, and,
of course, the final version is not necessarily what I would have written if
it had just been up to me. However, overall, I'm very pleased with how far
this book goes in support of breastfeeding. MANY of the suggestions I made
were incorporated in the final draft.

The cosleeping issue was one that we had discussions about, and the final
version is better than earlier drafts. Keep in mind that this is an AAP
publication and so it had to pretty well match the recommendations of the
AAP. 

The guidelines underwent extensive review--both internally by all the people
involved in any aspect of it (there were bunches of us!) and externally by
pretty much anybody who wished to take part in the review. There were a
number of IBCLCs who participated in that external review and who made
suggestions. By the time we got to that point in the process, the committee
co-chairs made final decisions on what to change and what not to. (After the
internal review, the expert panels went through each suggestion and decided
which ones to keep.)

The other big issue that caused a lot of discussion was the starting of
solids--the readiness cues, and even when that should happen. Again, it is
better than earlier drafts, and not exactly what I would have put if it had
just been up to me.

In any case, I'm proud to have my name on this book and pleased to have had
a role in it. I worked with an incredible bunch of folks throughout the
process, and we each approached each topic from our own professional
perspective. Sometimes those perspectives clashed! :-D

Melissa Vickers, IBCLC
Huntingdon, TN  




Date:    Tue, 17 Jun 2008 09:25:43 -0400
From:    Dawn Kersula <[log in to unmask]>
Subject: Bright Futures - Blueprint for care from AAP

I attended an AAP chapter meeting last night as a guest, where they were
rolling out the new Bright Futures guidelines from the AAP, AAFP and beyond.
Completely new book full of guidelines, but you can access the Infancy
guidelines at
http://brightfutures.aap.org/pdfs/Guidelines_PDF/15-Infancy.pdf

So far I've only looked at the Prenatal Appointment guidelines, which DO
address the decision to breastfeed. The stated goal is that these guidelines
will become Standard of Care, so if you have time -- take a look, and share
what you see!

Dawn Kersula MA, RN, IBCLC, FACCE
in Vermont

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