O3187: Introduction of lactation consultant at a pediatric primary care site

Purpose/Objectives: Breastfeeding in the US falls rapidly after birth with disparities noted by race and income. Pediatric primary care may support sustained breastfeeding. One office in a hospital-owned primary care system hired a full-time lactation consultant (LC) 2/2024. The LC office is in an urban location and primarily serves Medicaid-insured families who report Black race. Our objective was to improve 2-month breastfeeding rates by 10% within 1 year.

Design/Methods: We hired an LC with Black race and experience in other roles at our office to promote race-concordant, culturally competent breastfeeding support. To minimize the need for separate visits for lactation support, 80% of her time was devoted to as-needed consultation during visits scheduled for other reasons and 20% to lactation-specific visits. She also initiated monthly drop-in groups. The LC prioritized visits with Medicaid-insured infants < 1 month. We requested feedback from families who interacted with the LC using a QR-code-linked survey.

An existing tool pulls structured infant feeding data from well visit templates, creating control charts of breastfeeding rates at 2-month visits, aggregated monthly. We examined rates of any breastfeeding (exclusive and partial) at 2-months before (4/2022 – 3/2023) and after (4/2023 – 3/2024) the LC started. The post period started 2 months after LC start to capture 2-month outcomes for infants seen as newborns. We also used chi-square tests to compares 2-month breastfeeding before and after the LC started. Finally, we examined 2-month breastfeeding at the nearest site in our network, which did not have an LC, to consider whether any changes might be related to local secular trends.

Results: In her first year, the LC engaged with 739 families and facilitated 4 groups. The LC saw most families only once. During the 2-year study period, 83% of 2675 2-month visits were with Medicaid-insured families, of whom 76% reported Black race. Our centerline for 2-month breastfeeding was 48%. Starting 6/2023 we observed a run of 9 points above our centerline. Two-month breastfeeding improved from 48% in the pre-period to 53% in the post-period (chi-squared p-value 0.005). Among Medicaid insured patients, two-month breastfeeding increased from 45% to 47% (chi-squared p-value 0.17), and among privately insured from 70% to 77% (chi-squared p-value 0.16). At the comparison site, 2-month breastfeeding was 51% in the pre-period and 52% in the post-period (chi-squared p-value 0.93).

We received 12 survey responses, all positive. Respondents highlighted help with latch, access to breastfeeding supplies, and increased confidence after engaging with the LC.

Conclusion/Discussion: Introducing an LC into a primary care site led to small improvements in 2-month breastfeeding but did not eliminate disparities between Medicaid and privately insured families. Addressing disparities may require further expanding access to LCs or considering other barriers to breastfeeding among Medicaid-insured families.