(P23-33-26) Predictors of Adherence to the 2022 American Academy of Pediatrics Recommendation to Breastfeed for at Least 24 Months

Objectives: In 2022, the American Academy of Pediatrics (AAP) updated its guidance to recommend breastfeeding for ≥24 months (previously ≥12 months). We examined adherence to this updated recommendation and identified experiential barriers associated with not achieving ≥24 months of breastfeeding among U.S. mothers.

Methods: We conducted a cross-sectional online survey of U.S. mothers with children aged ≤3 years who were recruited from ten maternity-focused Facebook groups. Participants reported breastfeeding duration and perceived barriers. The primary outcome was failure to meet the AAP ≥24-month recommendation ( < 24 vs. ≥24 months). Maternal experience–specific barriers included perceived breastfeeding inconvenience, breast soreness, dislike of breastfeeding, and concerns about milk supply. Adjusted models controlled for maternal education (college vs. no college) and employment status (employed vs. unemployed). Because meeting the ≥24-month recommendation was rare, Firth penalized logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).

Results: Among 221 respondents, 6 (2.7%) reported breastfeeding for ≥24 months, whereas 215 (97.3%) did not meet the recommendation. Perceiving breastfeeding as inconvenient was associated with higher odds of not meeting the ≥24-month recommendation in unadjusted analyses (OR = 8.42; 95% CI: 1.64–83.32) and after adjustment (aOR = 8.12; 95% CI: 1.55–81.10). Breast soreness, dislike of breastfeeding, and milk supply concerns were not significantly associated with breastfeeding duration.

Conclusions: Adherence to the AAP ≥24-month breastfeeding recommendation was rare in this sample, even among highly motivated and educated mothers. Perceived inconvenience was strongly associated with shorter breastfeeding duration. These findings underscore the need for initiatives that disseminate the updated breastfeeding guidelines and make breastfeeding more convenient for women in the U.S.

Funding Sources: No external funding