Breastfeeding an Infant or Young Child with Insulin-Dependent Diabetes
Publication Date: January 1, 2017
Last Updated: March 14, 2022
Recommendations
Breastfeeding is the optimal form of infant nutrition for infants and it should be promoted as such by healthcare providers for infants with diabetes. ()
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When calculation of carbohydrate intake is utilized for insulin dosing, a carbohydrate count of 70 g/L can be used for breast milk. (IA)
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The norms for 24-hour total volumes of breast milk can be used in determining the amount of breast milk consumed by the infant at a single feed. ()
(IIB, IV)
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For infants who have a small volume frequent style of food consumption, blood glucose levels should be measured every 3 hours and insulin doses given for correction of levels above the glycemic target. (IV)
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When feasible, infant weights before and after a breastfeed can be used to determine the amount of milk usually consumed by the infant at each feed. (IV)
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The use of continuous subcutaneous insulin infusion (insulin pumps) should be considered for infants and young children with diabetes as desired by their caregivers. (III)
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Support should be provided to the families of infants and young children diagnosed with diabetes along with tailoring the diabetes management plan to the patterns of breastfeeding and the needs of the mother–infant dyad. ()
(III/IV)
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Recommendation Grading
Overview
Title
Breastfeeding an Infant or Young Child with Insulin-Dependent Diabetes
Authoring Organization
Academy of Breastfeeding Medicine
Publication Month/Year
January 1, 2017
Last Updated Month/Year
January 16, 2024
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
To provide guidance for the care of breastfeeding infants or young children with insulin-dependent diabetes mellitus and their families.
Target Patient Population
Breasting mothers of infants or children with insulin-dependent diabetes mellitus
Inclusion Criteria
Female, Adult, Child, Infant
Health Care Settings
Childcare center, Home health, Hospital, Outpatient
Intended Users
Nurse midwife, nurse, nurse practitioner, physician, physician assistant
Scope
Counseling, Prevention, Management
Diseases/Conditions (MeSH)
D001942 - Breast Feeding, D064186 - Prenatal Education, D003922 - Diabetes Mellitus, Type 1
Keywords
Breastfeeding, infantile diabetes
Methodology
Number of Source Documents
30
Literature Search Start Date
January 1, 1984
Literature Search End Date
December 31, 2016
Description of External Review Process
Yes. The draft protocol is peer reviewed by individuals outside of contributing author/expert panel, including specific review for international applicability. The Protocol Committee's sub-group of international experts recommends appropriate international reviewers. The Chair and/or protocol resource person institutes and facilitates this process. Reviews are submitted to the committee Chair and resource person. The contributing author/expert panel and/or designated members of protocol committee work to amend the protocol as needed.
The draft protocol is submitted to the Academy of Breastfeeding Medicine (ABM) Board for review and approval. Comments for revision will be accepted for three weeks following submission. The Chair, resource person and protocol contributor(s) amend the protocol as needed. Following all revisions, the protocol has the final review by original contributor(s) to make final suggestions and ascertain whether to maintain contributing authorship.
The final protocol is submitted to the Board of Directors of ABM for approval. A two-thirds majority of Board members' positive vote is required for final approval.
Specialties Involved
Family Medicine, Obstetrics And Gynecology, Pediatrics, Pediatric Endocrinology, Pediatrics
Description of Systematic Review
Yes. Expert Consensus from systematic reviews with evidence tables.
List of Questions
Yes. (1) The basis of insulin dosing for carbohydrate intake for breastfeeding infants (2) The basis of assessing the amount of carbohydrate for expressed breast milk (3) Insulin dosing in infants who have the style of small volume, frequent feeds (4) Goals and methods for glycemic control in breastfeeding infants and young children with diabetes (5) Guidance on counseling parents of breastfeeding infants and young children with diabetes, addressing the guilt associated with poor glycemic control and providing support to continue breastfeeding after diagnosis
Description of Study Criteria
Yes. Inclusion: age, insulin – and more.
Description of Search Strategy
Yes. See methods used below.
Description of Study Selection
Yes. Consensus-based. Led by Chair.
Description of Evidence Analysis Methods
General Methods
An initial search of relevant published articles written in English in the past 21 years in the fields of medicine, psychiatry, psychology, and basic biological science is undertaken for a particular topic. Once the articles are gathered, the papers are evaluated for scientific accuracy and significance.
Specific Methods
The search was conducted using PubMed. In addition, a search of the original references and literature searches (from the previous version) were used to look for additional supportive articles. The time frame for the literature search was January 1984 to December 2016. The inclusion criteria used for the searched were: humans, review articles, primary research articles, and English. The specific search terms used were: breastfeeding, primary care, physician, pediatrician, obstetrician, family physician.
Description of Evidence Grading
U.S. Preventative Services Taskforce Recommendations. An expert panel is identified and appointed to develop a draft protocol using evidence-based methodology. An annotated bibliography (literature review), including salient gaps in the literature, is submitted by the expert panel to the Protocol Committee.