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Core competencies in human milk and breastfeeding: Policy and practice implications for nurses

      The American Academy of Nursing endorses human milk and breastfeeding as the preferred method of infant feeding and has a long history of policy work and publications from the Expert Panel on Breastfeeding of the Academy. The Academy has members who serve the United States Breastfeeding Committee (USBC), and our members actively participated in the development of the core competencies for health professionals. In 2013, the Academy endorsed these core competencies for health professionals, further underscoring our commitment to improving the landscape of breastfeeding in the United States.
      The American Academy of Pediatrics Position Statement clearly articulates that breastfeeding and the use of human milk are a public health issue, not a lifestyle choice (
      American Academy of Pediatrics, Section on Breastfeeding
      Breastfeeding and the use of human milk.
      ). Their recommendations are that infants should be exclusively breastfed for the first 6 months and that breastfeeding should continue for 1 to 2 years or more as mutually desirable by the mother/child dyad (
      American Academy of Pediatrics, Section on Breastfeeding
      Breastfeeding and the use of human milk.
      ,
      World Health Organization (WHO)
      Fifty-Fifth World Health Assembly. Infant and Young Child Nutrition.
      ). Although 76.5% of women currently initiate breastfeeding (including those who put the infant to the breast just one time), only 16.4% of infants are exclusively breastfed at 6 months (

      Centers for Disease Control and Prevention. (2013a). Breastfeeding Report Card 2013, United States. Retrieved from http://www.cdc.gov/breastfeeding/pdf/2013BreastfeedingReportCard.pdf.

      ,
      • Centers for Disease Control and Prevention
      The CDC guide to strategies to support breastfeeding mothers and babies. Strategies to prevent obesity and other chronic disease.
      ). To achieve optimal health outcomes for children and their mothers, significant efforts must be made to improve the exclusivity and duration of breastfeeding.
      The Surgeon General's Call to Action to Support Breastfeeding details specific actions needed to improve breastfeeding outcomes and the health of our nation (
      • U.S. Department of Health and Human Services
      The Surgeon General's call to action to support breastfeeding.
      ). Action items 9 and 10 address the specific need for health professional education about human lactation and breastfeeding to ensure that all women and families receive evidence-based lactation care, education, and support (
      • U.S. Department of Health and Human Services
      The Surgeon General's call to action to support breastfeeding.
      ). Action item 9 notes that all health professionals should be provided with education and training in order to provide evidence-based lactation support and care, and action item 10 explicitly states that all nurses and midwives should provide basic breastfeeding support as a standard of care.
      In 2007, the American Academy of Nursing's Expert Panel on Breastfeeding published an article advocating that breastfeeding education be integrated with all courses in baccalaureate nursing curricula (
      • Spatz D.L.
      • Pugh L.C.
      • American Academy of Nursing Expert Panel on Breastfeeding
      The integration of the use of human milk and breastfeeding in nursing curricula.
      ). However, expert panel members report that breastfeeding content remains minimally covered in most schools of nursing. An exception is the program at the University of Pennsylvania School of Nursing where an undergraduate seminar course provides 28 hours of didactic and 14 hours of clinical experience/role observation regarding human milk and breastfeeding (
      • Spatz D.L.
      The breastfeeding case study: A model for educating nursing students.
      ). This course was featured as an exemplary program/model in “Strategy 2: Professional Education” in the Centers for Disease Control's recently released Strategies to Support Breastfeeding Mothers and Babies (

      Centers for Disease Control and Prevention. (2013a). Breastfeeding Report Card 2013, United States. Retrieved from http://www.cdc.gov/breastfeeding/pdf/2013BreastfeedingReportCard.pdf.

      ,
      • Centers for Disease Control and Prevention
      The CDC guide to strategies to support breastfeeding mothers and babies. Strategies to prevent obesity and other chronic disease.
      ).
      The USBC also has addressed the need for increased health professional education through their development of core competencies as outlined in Core Competencies in Breastfeeding Care and Services for All Health Professionals (

      United States Breastfeeding Committee. (n.d.). Core competencies in breastfeeding care and services for all health professionals. Retrieved from http://www.usbreastfeeding.org/HealthCare/TrainingforHealthCareProfessionals/CoreCompetencies/tabid/225/Default.aspx.

      ). The USBC core competencies address three specific categories of breastfeeding education, support, and care: knowledge, skills, and attitudes. Table 1 provides a brief summary of their recommendations. The full document is available from the USBC website (

      United States Breastfeeding Committee. (n.d.). Core competencies in breastfeeding care and services for all health professionals. Retrieved from http://www.usbreastfeeding.org/HealthCare/TrainingforHealthCareProfessionals/CoreCompetencies/tabid/225/Default.aspx.

      ). The USBC recommendations state that all health professionals must possess a minimum level of knowledge, skills, and attitudes to support and protect breastfeeding, including, at a minimum, understanding that human milk/breastfeeding is the optimal feeding method for infants and young children (

      United States Breastfeeding Committee. (n.d.). Core competencies in breastfeeding care and services for all health professionals. Retrieved from http://www.usbreastfeeding.org/HealthCare/TrainingforHealthCareProfessionals/CoreCompetencies/tabid/225/Default.aspx.

      ). They also assert that it is essential for practitioners to provide realistic expectations for families and culturally competent breastfeeding care and services (

      United States Breastfeeding Committee. (n.d.). Core competencies in breastfeeding care and services for all health professionals. Retrieved from http://www.usbreastfeeding.org/HealthCare/TrainingforHealthCareProfessionals/CoreCompetencies/tabid/225/Default.aspx.

      ).
      Table 1USBC Core Competencies in Breastfeeding Care and Services for All Health Professionals
      Knowledge
      All health professionals should understand:
      • Basic anatomy and physiology of lactation
      • How human milk prevents disease and illness
      • Why exclusive breastfeeding matters
      • How pregnancy and birth practices influence breastfeeding
      • Societal and cultural factors influencing breastfeeding
      • Risks of formula feeding
      • Contraindications to breastfeeding
      • When and how to refer for lactation services
      • Resources for families
      • Role of formula company marketing
      Skills
      All health professionals should be able to:
      • Protect, promote, and support breastfeeding in their practice
      • Complete a lactation health history and be aware of factors that could influence breastfeeding
      • Refer and seek assistance from lactation professionals
      • Protect confidentiality
      • Use new technologies to ensure evidence-based practice
      Attitudes
      All health professionals should:
      • Value human milk/breastfeeding as a public health issue
      • Recognize and respect cultural differences related to breastfeeding care and support
      • Respect confidentiality
      • Remain free of the influence of formula company marketing
      • Seek collaboration with interdisciplinary lactation care teams
      • Encourage employers to develop employee lactation programs
      • Be aware of personal values that could bias care
      • Support colleagues who are breastfeeding
      • Support family-centered policies at the local, state, and federal levels
      The USBC calls for organizations such as the Academy to prioritize breastfeeding as a critical public health issue (

      United States Breastfeeding Committee. (n.d.). Core competencies in breastfeeding care and services for all health professionals. Retrieved from http://www.usbreastfeeding.org/HealthCare/TrainingforHealthCareProfessionals/CoreCompetencies/tabid/225/Default.aspx.

      ). The American Academy of Nursing already has endorsed the USBC core competencies. Now it is time to take action.
      The Academy Call to Action is for (at a minimum) the adoption and implementation of the USBC's core competencies. These breastfeeding services and care competencies were developed to ensure that health professionals have a framework and guidelines for integrating evidence-based breastfeeding knowledge, skills, and attitudes into daily practices (

      United States Breastfeeding Committee. (n.d.). Core competencies in breastfeeding care and services for all health professionals. Retrieved from http://www.usbreastfeeding.org/HealthCare/TrainingforHealthCareProfessionals/CoreCompetencies/tabid/225/Default.aspx.

      ). Educators are uniquely suited to lead the way by incorporating these core competencies into undergraduate and graduate nursing education curricula (

      United States Breastfeeding Committee. (n.d.). Core competencies in breastfeeding care and services for all health professionals. Retrieved from http://www.usbreastfeeding.org/HealthCare/TrainingforHealthCareProfessionals/CoreCompetencies/tabid/225/Default.aspx.

      ). Nurses already in clinical practice also need opportunities for education to ensure that they can provide evidence-based lactation support and care. Thus, the Academy urges everyone to incorporate these competencies both in academia and clinical practice. After all, educated nurses are the first level of intervention for all breastfeeding women and their infants.

      Author Description

      Diane L Spatz, PhD, RN-BC, FAAN, is chair of the Expert Panel on Breastfeeding for the Academy. Dr. Spatz is a professor of perinatal nursing and the Helen M. Shearer Professor of Nutrition at the University of Pennsylvania School of Nursing and a nurse researcher and manager of the Lactation Program at the Children's Hospital of Philadelphia.

      References

        • American Academy of Pediatrics, Section on Breastfeeding
        Breastfeeding and the use of human milk.
        Pediatrics. 2012; 129: e827-e841https://doi.org/10.1542/peds.2011-3552
      1. Centers for Disease Control and Prevention. (2013a). Breastfeeding Report Card 2013, United States. Retrieved from http://www.cdc.gov/breastfeeding/pdf/2013BreastfeedingReportCard.pdf.

        • Centers for Disease Control and Prevention
        The CDC guide to strategies to support breastfeeding mothers and babies. Strategies to prevent obesity and other chronic disease.
        U.S. Department of Health and Human Services, Atlanta2013 (Retrieved from)
        • Spatz D.L.
        The breastfeeding case study: A model for educating nursing students.
        The Journal of Nursing Education. 2005; 44: 432-434
        • Spatz D.L.
        • Pugh L.C.
        • American Academy of Nursing Expert Panel on Breastfeeding
        The integration of the use of human milk and breastfeeding in nursing curricula.
        Nursing Outlook. 2007; 55: 257-263
      2. United States Breastfeeding Committee. (n.d.). Core competencies in breastfeeding care and services for all health professionals. Retrieved from http://www.usbreastfeeding.org/HealthCare/TrainingforHealthCareProfessionals/CoreCompetencies/tabid/225/Default.aspx.

        • U.S. Department of Health and Human Services
        The Surgeon General's call to action to support breastfeeding.
        U.S. Department of Health and Human Services, Office of the Surgeon General, Washington, DC2011 (Retrieved from)
        • World Health Organization (WHO)
        Fifty-Fifth World Health Assembly. Infant and Young Child Nutrition.
        World Health Organization, 2002 (WHA55.25). Retrieved from