Breastfeeding is the Cornerstone of Childhood Nutrition


Not breastfeeding has undisputable risks for infants and mothers. Infants that are not breastfed have increased incidence and severity of infections, including respiratory tract infections, urinary tract infection, otitis media, diarrhea, bacterial meningitis and sepsis; increased rates of sudden infant death syndrome, necrotizing enterocolitis, and postneonatal death; and increased risk of chronic illness as adults, such as obesity and diabetes (Spatz & Lessen, 2011). Mothers who do not breastfeed are at increased risk of breast and ovarian cancers, less postpartum weight loss, and increased chronic illnesses such as diabetes and cardiovascular disease (Spatz & Lessen).

In the United States only 14.8% of infants are exclusively breastfed for the first 6 months (Centers for Disease Control and Prevention, 2011), despite this being the gold standard of infant nutrition and the recommendation of all professional organizations, including the World Health Organization, the American Academy of Pediatrics, and the Association of Women's Health, Obstetric, and Neonatal Nursing. The low breastfeeding rates in the United States must be viewed as a public health crisis, and nurses are the health professional that can ensure mothers are successful in not only initiating breastfeeding, but also continuing to breastfeed. This In Focus series provides nurses with evidence-based lactation and breastfeeding information.

In the first article, Kent and colleagues address the issue of milk supply. The primary concern of mothers around the world is, “How do I know my baby is getting enough?” Nurses and other health professionals often advise mothers to supplement their infants with formula, a practice that has no supporting research evidence. The authors provide critical information on the anatomy and physiology of milk production, the critical concept of storage capacity, and management strategies for working with mothers.

Kim and Froh provide a necessary read for all health professionals on the nutritional and immunobiological components of breast milk. Nurses in particular should understand the science of how human milk protects the infant from disease and illness and promotes optimal development. Nurses have the ability to educate mothers and their families on the unique properties of human milk so that they can make a truly informed decision regarding feeding.

In the third article, I discuss innovations in lactation support of infants requiring intensive care and provide the latest strategies to ensure success for the nurse working with high-risk mothers and infants. Although all infants benefit from human milk, infants who start their lives in intensive care may benefit the most from human milk. These infants are at high risk for not receiving their mothers’ milk due to a variety of reasons that include a lack of knowledge of health professionals. This article provides concrete interventions for the nurse to change practice and ensure human milk and breastfeeding success even in the most vulnerable infants.

Finally, Frick and colleagues provide a unique research perspective on the cost of providing breastfeeding support. Low-income women and women enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) continue to have lower initiation, exclusivity, and duration of breastfeeding than higher income women. Although providing breastfeeding support is not without cost, the long-term health advantages for mothers and infants are clear. In fact, Bartick and Reinhold (2010) reported that if 90% of families could comply with the recommendations to breastfeed exclusively for 6 months, the United States would save $13 billion per year and prevent an excess of 911 infant deaths. Clearly, investing in breastfeeding support and care is of paramount importance.

Nurses play a critical role in breastfeeding support. The Surgeon General's Call to Action to Support Breastfeeding specifically addresses the need for health professionals to receive adequate education to support mothers with evidence-based care (U.S. Department of Health and Human Services, 2011). In addition, further research in all aspects surrounding human milk and breastfeeding is warranted (U.S. Department of Health and Human Services), and there is a clear need for more nurse scientists in this field. I hope this series inspires you to seek more breastfeeding education and training and that you make it a personal goal to support, teach, and advocate breastfeeding so that all families can receive expert research based breastfeeding care.


  • Diane L. Spatz, PhD, RN-BC, FAAN, is Helen M. Shearer associate professor of nutrition; associate professor of healthcare of women and childbearing nursing; faculty advisor at the University of Pennsylvania School of Nursing; and nurse researcher at The Children's Hospital of Philadelphia, Philadelphia, PA.