Position of the Academy of Nutrition and Dietetics: Promoting and Supporting Breastfeeding

doi:10.1016/j.jand.2014.12.014

Journal of the Academy of Nutrition and Dietetics

Volume 115, Issue 3, March 2015, Pages 444-449

https://doi.org/10.1016/j.jand.2014.12.014 Get rights and content

Abstract

It is the position of the Academy of Nutrition and Dietetics that exclusive breastfeeding provides optimal nutrition and health protection for the first 6 months of life, and that breastfeeding with complementary foods from 6 months until at least 12 months of age is the ideal feeding pattern for infants. Breastfeeding is an important public health strategy for improving infant and child morbidity and mortality, improving maternal morbidity, and helping to control health care costs. Research continues to support the positive effects of human milk on infant and maternal health, as it is a living biological fluid with many qualities not replicable by human milk substitutes. Recent research advancements include a greater understanding of the human gut microbiome, the protective effect of human milk for premature infants and those born to women experiencing gestational diabetes mellitus, the relationship of breastfeeding with human immunodeficiency virus, and the increased ability to characterize cellular components of human milk. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, should continue efforts to shift the norm of infant feeding away from use of human milk substitutes and toward human milk feeds. The role of registered dietitian nutritionists and nutrition and dietetics technicians, registered, in breastfeeding promotion and support, in the context of the professional code of ethics and the World Health Organization’s International Code of Marketing of Breast-Milk Substitutes, are discussed in the “Practice Paper of the Academy of Nutrition and Dietetics: Promoting and Supporting Breastfeeding,” published on the Academy website at: www.eatright.org/positions.

Section snippets

Human Milk Composition

Human milk contains factors that serve both nutritive and non-nutritive functions,1, 3, 8, 10, 11 and it has been well characterized that the relatively low protein content and high bioavailability of essential minerals are optimally suited to the immature digestive system of the young infant.1, 3 Human milk provides maternal immune factors, appetite-regulating hormones, and factors thought to support development of the healthy infant gut microbiome.10, 11 Mammary-gland−derived stem cells have

Infant and Maternal Health Outcomes

It is important to note that it can be a challenge to rate the strength of breastfeeding research, secondary to inconsistent definitions of breastfeeding (eg, exclusivity, frequency, intensity, duration), and unethical to conduct the randomized controlled trials necessary to answer many questions.3, 17, 18 However, systematic reviews and meta-analyses continue to indicate that infant feeding mode is associated with infant and maternal health outcomes.17, 18, 19, 20, 21, 22, 23 The Figure

Cost of Not Breastfeeding

A recent pediatric cost analysis was conducted to evaluate the economic burden of suboptimal breastfeeding practices.⁵ Both direct and indirect costs for disease and the cost of premature death were included. It was determined that if 90% of families in the United States breastfed exclusively for 6 months, $13 billion per year could be saved. A similar study focused on maternal outcomes.⁴ In this study, direct and indirect health costs and the economic costs of premature death associated with

Emergent Topics

Several issues concerning breastfeeding and the feeding of human milk have emerged that will require additional study. For example, a trending increase in providing human milk exclusively as pumped milk may increase the prevalence of infants receiving human milk for the optimal duration.³⁹ However, little is known about the impact refrigeration/freezing and subsequent thawing might have on the immunologic properties of human milk. In addition, research to tease out the benefits of breastfeeding

Conclusion/Future Needs

Research continues to support the impact of human milk on infant and maternal health outcomes and, as such, federal initiatives supporting the effort to increase national, regional, and local breastfeeding rates continue to be strengthened. Since publication of the 2009 position paper, an effort has been made to quantify the risks of not breastfeeding and to detail the economic costs associated with suboptimal breastfeeding behaviors. Information presented here and in the accompanying practice

References (39)

S.M. Donovan et al.
Host-microbe interactions in the neonatal intestine: Role of human milk oligosaccharides
Adv Nutr
(2012)
E. Bertino et al.
Benefits of donor milk in the feeding of preterm infants
Early Hum Dev
(2013)
E.B. Schwarz et al.
Lactation and maternal risk of type 2 diabetes: A population-based study
Am J Med
(2010)
S.S. Oberhelman et al.
Maternal vitamin D supplementation to improve the vitamin D status of breast-fed infants: A randomized controlled trial
Mayo Clin Proceed
(2013)
L.H. Allen
B vitamins in breast milk: Relative importance of maternal status and intake, and effects on infant status and function
Adv Nutr
(2012)
N.N. Luan et al.
Breastfeeding and ovarian cancer risk: A meta-analysis of epidemiologic studies
Am J Clin Nutr
(2013)
C.M. Dieterich et al.
Breastfeeding and health outcomes for the mother-infant dyad
Pediatr Clin N Am
(2013)
F.P. Turkoz et al.
Association between common risk factors and molecular subtypes in breast cancer patients
Breast
(2013)
Position of the American Dietetic Association: Promoting and supporting breastfeeding
J Am Diet Assoc
(2009)
Academy of Nutrition and Dietetics. Practice Paper of the Academy of Nutrition and Dietetics: Promoting and Supporting...

A.I. Eidelman et al.

Breastfeeding and the use of human milk

Pediatrics

(2012)

M. Bartick

Mothers' costs of suboptimal breastfeeding: Implications of the maternal disease cost analysis

Breastfeed Med

(2013)

M. Bartick et al.

The burden of suboptimal breastfeeding in the United States: A pediatric cost analysis

Pediatrics

(2010)

M.C. Bartick et al.

Cost analysis of maternal disease associated with suboptimal breastfeeding

Obstet Gynecol

(2013)

World Health Organization and the United Nations Children’s Fund. Global Strategy for Infant and Young Child Feeding....

F. Hassiotou et al.

Cells in human milk: State of the science

J Hum Lact

(2013)

M.C. Neville et al.

Lactation and neonatal nutrition: Defining and refining the critical questions

J Mammary Gland Biol Neoplasia

(2012)

Institute of Medicine. Dietary reference intakes for calcium and vitamin D....

D.J. Chapman et al.

Impact of maternal nutritional status on breast milk quality and infant outcomes: An update on key nutrients

Adv Nutr

(2012)

Cited by (88)

Revealing the diversity of endogenous peptides and parent proteins in human colostrum and mature milk through peptidomics analysis
2024, Food Chemistry
Endogenous peptides and their parent proteins are important nutritional components with diverse biological functions. The objective of this study was to analyze and compare endogenous peptides and parent proteins found in human colostrum (HC) and human mature milk (HM) using a 4D label-free technique. In total, 5162 and 940 endogenous peptides derived from 258 parent proteins were identified in human milk by database (DB) search and de novo, respectively. Among these peptides, 2446 differentially expressed endogenous peptides with various bioactivities were identified. The Gene Ontology analysis unveiled the cellular components, biological processes, and molecular functions associated with these parent proteins. Metabolic pathway analysis suggested that neutrophil extracellular trap formation had the greatest significance with 24 parent proteins. These findings will offer a fresh perspective on the development of infant formula powder, highlighting the potential for incorporating these changes to enhance its nutritional composition and benefits.
How does the food matrix affect the provitamin A carotenoid in vitro bioaccessibility in fruit-based baby food?
2023, Journal of Food Composition and Analysis
Carotenoid bioaccessibility is an important predictor of absorption and provitamin A intake. Humans do not synthesize carotenoids which need to be acquired from the diet, mainly from green leafy vegetables and fruits with colors from yellow to red. The carotenoid composition of five industrialized fruit-based baby food (Assorted fruits (AF); Tropical fruits (TF); Apple, mango, and carrot (AMC); Papaya and orange (PO); and Grape and banana (GB)) acquired in Brazil was determined, and the carotenoid bioaccessibility was calculated after in vitro digestion by the Infogest 2.0 protocol. The provitamin A carotenoids were converted to RAE (retinol activity equivalent) to estimate the vitamin A value. (All-E)-β-carotene bioaccessibility ranged from 5% for AF to 24% for AMC baby foods and from 1% for GB to 15.5% for TF baby foods for total carotenoid bioaccessibility. Regarding vitamin A intake, AMC baby food had the highest RAE value, 15 per portion of 120 g, corresponding to 3% of the dietary reference intake (DRI). Lipids and minerals positively affected the bioaccessibility of carotenoids, except for (all-E)-α-carotene. Interestingly, fiber content positively affected the bioaccessibility of (all-E)-α-carotene, while no effect was observed on the other carotenoids’ micellarization.
Use of Galactagogues to Increase Milk Production Among Breastfeeding Mothers in the United States: A Descriptive Study
2023, Journal of the Academy of Nutrition and Dietetics
Perceived insufficient milk is a primary reason for early breastfeeding cessation. Some breastfeeding mothers may use galactagogues (ie, foods, beverages, herbal supplements, and pharmaceuticals) to try to increase milk supply. However, milk production requires frequent and effective milk removal, and there is limited evidence on the safety and efficacy of galactagogues. Additional research on the use of galactagogues is needed to inform breastfeeding support.
Describe the prevalence of use and perceived effects of galactagogues and compare galactagogue use by maternal characteristics.
Cross-sectional online survey.
A convenience sample of 1,294 adult women breastfeeding a singleton child and living in the United States were recruited using paid Facebook advertisements between December 2020 and February 2021.
Self-reported current or previous use of galactagogues and their perceived effects on milk production.
Frequencies and percentages described the use and perceived effects of galactagogues. The χ² test of independence and independent t tests compared galactagogue use by select maternal characteristics.
More than half of participants (57.5%) reported using any galactagogues, 55.4% reported consuming foods or beverages, and 27.7% reported using herbal supplements. Few participants (1.4%) reported using pharmaceuticals. Participants reported varying effects of specific galactagogues on milk production. Reported galactagogue use was higher among participants who reported first-time breastfeeding (yes: 66.7% vs no: 49.3%; P < 0.001), breastfeeding pumped milk (yes: 63.1% vs no: 50.4%; P < 0.001), formula supplementation (yes: 66.8% vs no: 50.4%; P < 0.001), and perceived insufficient milk (yes: 78.8% vs no: 53.8%; P < 0.001).
Breastfeeding mothers in the United States commonly reported using galactagogues to increase milk production, highlighting the need for research on the safety and efficacy of galactagogues and enhanced breastfeeding support.
Feeding Practices and Dietary Diversity in the First Year of Life: PreventADALL, a Scandinavian Randomized Controlled Trial and Birth Cohort Study
2023, Journal of Nutrition
Breastmik is considered the optimal source of nutrition in early infancy. However, recommendations and practices for when and how complementary food should be introduced in the first year of life vary worldwide. Early introduction of allergenic foods may prevent food allergies, but if early food introduction influences infant feeding practices is less known.
We sought to assess infant feeding practices in the first year of life and to determine if early interventional food introduction influences breastfeeding and dietary diversity.
Dietary intake was assessed in infants from the population-based clinical trial Preventing Atopic Dermatitis and ALLergies (PreventADALL) in children study. A total of 2397 infants were cluster-randomized at birth into 4 different groups: 1) control, 2) skin intervention, 3) introduction to 4 allergenic foods between 3 and 4 mo of age: peanut, cow milk, wheat, and egg, as small tastings until 6 mo, and 4) combined skin and food interventions. Dietary data were available from at least one of the 3-, 6-, 9-, and 12-mo questionnaires in 2059 infants. In the present analysis, groups 1 and 2 constitute the No Food Intervention group, whereas groups 3 and 4 constitute the Food Intervention group.
We used the log-rank test and Cox regression to assess the impact of food intervention on age of breastfeeding cessation. Mixed effects logistic regression was used to compare dietary diversity, defined as the number of food categories consumed, between intervention groups.
At 3, 6, 9, and 12 mo, 95%, 88%, 67%, and 51% were breastfed, respectively, and breastfeeding duration was not affected by the food intervention. In the No Food Intervention group, mean age of complementary food introduction was 18.3 wk (confidence interval [CI]: 18.1, 18.5). In the Food Intervention group, the dietary diversity score was 1.39 units (CI: 1.16, 1.62) higher at 9 mo (P < 0.001) and 0.7 units (CI: 0.5, 0.9) higher at 12 mo (P < 0.001) compared to the No Food Intervention group.
Early food intervention did not affect breastfeeding rates and increased dietary diversity at 9 and 12 mo.
Effectiveness of an optional breastfeeding course for multidisciplinary undergraduate healthcare students: A quasi-experimental study
2023, Nurse Education in Practice
This study aimed to examine and quantify the effectiveness of an optional breastfeeding course for multidisciplinary undergraduate healthcare students and to provide advice for education improvement based on students’ characteristics and learning feedback.
Breastfeeding has received global awareness and educating undergraduate healthcare students is a prospective way to promote breastfeeding. This is the first report from mainland China to verify the education effects and formulate a proposal for improvement.
A quasi-experimental study with a one-group pretest-posttest design.
An optional breastfeeding course covering eight topics based on the Health Belief Model was conducted for multidisciplinary students in a medical college. The Breastfeeding Knowledge Questionnaire, Iowa Infant Feeding Attitude Scale and Breastfeeding Promotion Intention Scale were completed for pre- and post-education comparison. The Wilcoxon signed-rank test, MannWhitney U test, KruskalWallis test and chi-square test were used for statistical analysis. The class average normalized gain and individual students’ normalized gain were calculated to quantify the effectiveness from the perspective of learning gain.
From March to November 2021, 102 students specialized mainly in nursing, clinical medicine, medical imaging technology and midwifery took the course. Knowledge, attitudes and intention scores improved significantly (Z = 8.70, 8.72, 7.64, respectively, p < .001) and the class average normalized gains were 81.0%, 52.3% and 70.6%, respectively. Insignificant differences were found for students of different genders and categories of specialties (p > .05). Students of first year had significantly higher individual normalized gains (p < .05). In learning feedback, the top-ranked advice for course improvement was to increase practice and experience (75.5%).
This optional breastfeeding course produced medium to high learning gains for multidisciplinary healthcare undergraduates. Independent breastfeeding education based on behavioral theory for multidisciplinary students is recommended to be conducted in medical colleges. The addition of practice and experience may add value to such education.
How Registered Dietitian Nutritionists Become and Practice as International Board Certified Lactation Consultants: Interviews With RDN Practitioners
2023, Journal of the Academy of Nutrition and Dietetics
Breastfeeding is the normal way to feed human infants. While RDNs are called to support and promote breastfeeding, they receive little professional training in undergraduate programs. Additionally, there are relatively few RDNs who also hold a lactation credential. In order to explore how dietitians can pursue lactation training, 12 RDNs who were International Board Certified Lactation consultants were interviewed about their experiences pursing and using the IBCLC credential. Most RDNs pursued IBLCE pathway 1, had the CLC certification first, and pursued the IBCLC because they were exposed to lactation in their practice setting and had difficulty with breastfeeding a child. Many worked in private practice, outpatient clinics, and public health. Only 1 currently practiced inpatient care. Several RDNs mentioned that they were not able to practice inpatient lactation care because they were not RNs. Private practice and outpatient clinic RDN IBCLCs billed for services. Percent of time spent providing lactation care ranged from 10 – 90% of their practice time. Most of the private practice RDN IBCLCs had clients pay directly, however, billing insurance through a third party was also used. RDNs are s underrepresented in the field of lactation. Additionally, while RDN IBCLCs are prevalent in private practice, they face barriers to practicing inpatient lactation care. Lactation may provide RDNs with opportunities to bill for additional services and promote revenue generation as well. Calls for action include adding lactation to undergraduate education and promoting RDNs in inpatient lactation care.

View all citing articles on Scopus

: This Academy of Nutrition and Dietetics position was adopted by the House of Delegates Leadership Team on March 16, 1997, and reaffirmed on September 12, 1999; June 6, 2003; May 20, 2007; and March 23, 2012. This position is in effect until December 31, 2019. Requests to use portions of the position or republish in its entirety must be directed to the Academy at [email protected].

: Reviewers: Virginia Carney, MPH, RD, IBCLC, FILCA, FADA (St Jude Children’s Research Hospital, Memphis, TN); Public Health Community Nutrition dietetic practice group (DPG) (Phyllis Stell Crowley, MS, RD, IBCLC, Utah Department of Health/WIC, Salt Lake City, UT); Claire Dalidowitz, MS, MA, RD, CD-N (Connecticut Children’s Medical Center, Hartford, CT); Sharon Denny, MS, RD (Academy Knowledge Center, Chicago, IL); Women’s Health DPG (Heather Goesch, MPH, RDN, LDN, Heather Goesch Nutrition, Holly Ridge, NC); Pediatric Nutrition DPG (Stephanie Howard, MPH, RDN, LD, IBCLC Saint Luke’s Hospital, Kansas City, MO); Mary Pat Raimondi, MS, RD (Academy Policy Initiatives & Advocacy, Washington, DC).

: Academy Positions Committee Workgroup: Denise A. Andersen, MS, RDN, LD, CLC (Chair) (Business Consultant in Private Practice, Mendota Heights, MN); Mindy G. Hermann, MBA, RDN (The Hermann Group, Inc, Mount Kisco, NY); Alena M. Clark, PhD, MPH, RD, CLC (Content Advisor) (University of Northern Colorado, Greeley, CO).

: We thank the reviewers for their many constructive comments and suggestions. The reviewers were not asked to endorse this position or the supporting paper.

View full text

From the AcademyPosition PaperPosition of the Academy of Nutrition and Dietetics: Promoting and Supporting Breastfeeding

Abstract

Section snippets

Human Milk Composition

Infant and Maternal Health Outcomes

Cost of Not Breastfeeding

Emergent Topics

Conclusion/Future Needs

Adv Nutr

Early Hum Dev

Am J Med

Mayo Clin Proceed

Adv Nutr

Am J Clin Nutr

Pediatr Clin N Am

Breast

Position of the American Dietetic Association: Promoting and supporting breastfeeding

J Am Diet Assoc

Breastfeeding and the use of human milk

Pediatrics

Mothers' costs of suboptimal breastfeeding: Implications of the maternal disease cost analysis

Breastfeed Med

The burden of suboptimal breastfeeding in the United States: A pediatric cost analysis

Pediatrics

Cost analysis of maternal disease associated with suboptimal breastfeeding

Obstet Gynecol

Cells in human milk: State of the science

J Hum Lact

Lactation and neonatal nutrition: Defining and refining the critical questions

J Mammary Gland Biol Neoplasia

Impact of maternal nutritional status on breast milk quality and infant outcomes: An update on key nutrients

Adv Nutr

From the Academy
Position Paper
Position of the Academy of Nutrition and Dietetics: Promoting and Supporting Breastfeeding