By Paige Minemyer

Hospitals designed to be “baby-friendly” may have unintended consequences for newborns.

UNICEF and the World Health Organization introduced the Baby-Friendly Hospital Initiative in the early 1990s, and it was endorsed by the U.S. Department of Health and Human Services in 2010. Since then, the number of U.S. hospitals participating in the program has increased to 17 percent, according to the study.

The program includes a list of 10 rules for hospitals to follow, including promoting breastfeeding, a ban on pacifiers and allowing babies to sleep next to their mothers instead of in nurseries. But, following the 10 steps may lead to hazardous, and even fatal, issues for babies, according to the commentary, penned by Joel L. Bass, M.D., chair of the department of pediatrics at Newton-Wellesley Hospital; Tina Gartley, M.D., a pediatric hospitalist at Newton-Wellesley; and Ronald Kleinman, M.D., physician-in-chief at MassGeneral Hospital for Children.

For instance, according to the article, hospitals are discouraged from allowing babies to use pacifiers as it may discourage breastfeeding. But according to the authors, evidence suggests that pacifier use may decrease a baby’s risk of sudden infant death syndrome. There is also no evidence to suggest that using formula early on in an infant’s life will decrease his or her likelihood of future breastfeeding, and instead may make things easier for new moms as their milk comes in.

The article also notes that skin-to-skin contact between mother and child should be encouraged, but supervised. Studies have linked that unsupervised time to an increased risk for sudden unexpected postnatal collapse, a potentially fatal condition that often requires full resuscitation, according to the article.

The authors conclude that there are ways for hospitals to encourage breastfeeding without participating in the Baby-Friendly Hospital Initiative. Some of the rules may prioritize breastfeeding over infant health, which makes a critical look at the guidelines key, they write.

In addition, they write, “more attention should also be placed on ensuring compliance with established safe sleep programs, emphasizing the need to integrate safe sleep practices with breastfeeding.”