Human milk and breastfeeding: An intervention to mitigate toxic stress


      The American Academy of Nursing has identified toxic stress in childhood as a health policy concern of high priority. Adult diseases (e.g., obesity, diabetes, hypertension and cardiovascular disease) should be viewed as developmental disorders that begin early in life that could be reduced with the alleviation of toxic stress in childhood. The provision of human milk/breastfeeding is an evidence-based intervention that may hold the greatest potential to mitigate the effects of toxic stress from the moment of birth. Assisting families to make an informed choice to initiate and continue breastfeeding from birth has the potential to address both the disparity in the quality of nutrition provided infants and the economic stress experienced by families who purchase formula. The Expert Panel on Breastfeeding endorses initiatives to improve the initiation, duration, and exclusivity of breastfeeding to mitigate the effects of toxic stress in this call to action for research to build the evidence to support these critical relationships.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Nursing Outlook
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Als H.
        • McAnulty G.B.
        The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) with Kangaroo Mother Care (KMC): Comprehensive care for preterm infants.
        Current Womens Health Review. 2011; 7: 288-301
        • American Academy of Family Physicians
        Family physicians supporting breastfeeding.
        2007 (Retrieved from)
        • American Academy of Pediatrics - Section on Breastfeeding
        Breastfeeding and the use of human milk.
        Pediatrics. 2012; 129: e827-e841
        • American College of Nurse-Midwives
        • Division of Women's Health Policy and Leadership
        Breastfeeding statement.
        2011 (Retrieved from)
        • Bartick M.
        • Reinhold A.
        The burden of suboptimal breastfeeding in the United States: A pediatric cost analysis.
        Pediatrics. 2010; 125: e1048-e1056
        • Bethell C.D.
        • Newacheck P.
        • Hawes E.
        • Halfon N.
        Adverse childhood experiences: assessing the impact on health and school engagement and the mitigating role of resilience.
        Health Aff (Millwood). 2014; 33: 2106-2115
        • Bloomfield J.
        • Rising S.S.
        Centering parenting: An innovative dyad model for group mother-infant care.
        Journal of Midwifery & Womens Health. 2013; 58: 683-689
        • Bode L.
        • McGuire M.
        • Rodriguez J.M.
        • Geddes D.T.
        • Hassiotou F.
        • Hartmann P.E.
        • McGuire M.K.
        It's alive: Microbes and cells in human milk and their potential benefits to mother and infant.
        Advances in Nutrition: An International Review Journal. 2014; 5: 571-573
        • Borre Y.E.
        • O'Keeffe G.W.
        • Clarke G.
        • Stanton C.
        • Dinan T.G.
        • Cryan J.F.
        Microbiota and neurodevelopmental windows: Implications for brain disorders.
        Trends in Molecular Medicine. 2014; 20: 509-518
        • Britton J.R.
        • Britton H.L.
        • Gronwaldt V.
        Breastfeeding, sensitivity, and attachment.
        Pediatrics. 2006; 118: e1436-e1443
        • Buckley S.J.
        Hormonal physiology of childbearing: Evidence and implications for women, babies and maternity care.
        Childbirth Connection, New York2015 (Retrieved from)
        • Bundy-Fazioli K.
        • DeLong Hamilton T.A.
        A qualitative study exploring mothers' perceptions of child neglect.
        Child & Youth Services. 2013; 34: 250-266
        • Cao Y.
        • Rao S.D.
        • Phillips T.M.
        • Umbach D.M.
        • Bernbaum J.C.
        • Archer J.I.
        • Rogan W.J.
        Are breastfed infants more resilient?-Feeding method and cortisol in infants.
        The Journal of Pediatrics. 2009; 154: 452-454
        • Carling S.J.
        • Demment M.M.
        • Kjolhede C.L.
        • Olson C.M.
        Breastfeeding duration and weight gain trajectory in infancy.
        Pediatrics. 2015; 135: 111-119
        • Centers for Disease Control and Prevention
        Breastfeeding report card—United States, 2014.
        2014 (Retrieved from)
        • Charpak N.
        • Ruiz J.G.
        • Zupan J.
        • Cattaneo A.
        • Figueroa Z.
        • Tessier R.
        • Worku B.
        Kangaroo mother care: 25 years after.
        Acta Paediatrica. 2005; 94: 514-522
        • Committee on Health Care for Underserved Women, American College of Obstetricians and Gynecologists
        ACOG Committee opinion no. 361: Breastfeeding: Maternal and infant aspects.
        Obstetrics and Gynecology. 2007; 109: 479-480
        • Conde-Agudelo A.
        • Díaz-Rossello J.L.
        Kangaroo mother care to reduce morbidity and mortality in low birthweight infants.
        The Cochrane Database of Systematic Reviews. 2014; 4: CD002771
        • de Jonge L.L.
        • Langhout M.A.
        • Taal H.R.
        • Franco O.H.
        • Raat H.
        • Hofman A.
        • Jaddoe V.W.V.
        Infant feeding patterns are associated with cardiovascular structures and function in childhood.
        The Journal of Nutrition. 2013; 143: 1959-1965
        • Deoni S.C.
        • Dean 3rd, D.C.
        • Piryatinsky I.
        • O'Muircheartaigh J.
        • Waskiewicz N.
        • Lehman K.
        • Dirks H.
        Breastfeeding and early white matter development: A cross-sectional study.
        Neuroimage. 2013; 82: 77-86
        • Eckenrode J.
        • Campa M.
        • Luckey D.W.
        • Henderson Jr., C.R.
        • Cole R.
        • Kitzman H.
        • Olds D.
        Long-term effects of prenatal and infancy nurse home visitation on the life course of youths: 19-year follow-up of a randomized trial.
        Archives of Pediatrics & Adolescent Medicine. 2010; 164: 9-15
        • Garner A.S.
        • Shonkoff J.P.
        • Siegel B.S.
        • Dobbins M.I.
        • Earls M.F.
        • McGuinn L.
        • Wegner L.M.
        Early childhood adversity, toxic stress, and the role of the pediatrician: Translating developmental science into lifelong health.
        Pediatrics. 2012; 129: e224-e231
        • Groër M.W.
        Differences between exclusive breastfeeders, formula-feeders, and controls: A study of stress, mood, and endocrine variables.
        Biological Research For Nursing. 2005; 7: 106-117
        • Hallowell S.G.
        • Spatz D.L.
        • Hanlon A.L.
        • Rogowski J.A.
        • Lake E.T.
        Characteristics of the NICU work environment associated with breastfeeding support.
        Advances in Neonatal Care. 2014; 14: 290-300
        • Hamilton K.E.S.
        • Moore R.
        • Naylor H.
        Developmental care: The carer's perspective.
        Infant. 2008; 4: 190-195
        • Hassiotou F.
        • Hartmann P.E.
        At the dawn of a new discovery: The potential of breast milk stem cells.
        Advanced Nutrition. 2014; 5: 770-778
        • Horta B.L.
        • Victora C.G.
        Long-term effects of breastfeeding: A systematic review.
        World Health Organization, Geneva, Switzerland2013
        • Hurley W.L.
        • Theil P.K.
        Perspectives on immunoglobulins in colostrum and milk.
        Nutrients. 2011; 3: 442-474
        • Ip S.
        • Chung M.
        • Raman G.
        • Chew P.
        • Magula N.
        • DeVine D.
        • Lau J.
        Breastfeeding and maternal and infant health outcomes in developed countries.
        Evidence Report/Technology Assessment. 2007; : 1-186
        • Isaacs E.B.
        • Fischl B.R.
        • Quinn B.T.
        • Chong W.K.
        • Gadian D.G.
        • Lucas A.
        Impact of breast milk on intelligence quotient, brain size, and white matter development.
        Pediatric Research. 2010; 67: 357-362
        • Jarvisalo M.J.
        • Hutri-Kahonen N.
        • Juonala M.
        • Mikkila V.
        • Rasanen L.
        • Lehtimaki T.
        • Raitakari O.T.
        Breast feeding in infancy and arterial endothelial function later in life. The Cardiovascular Risk in Young Finns Study.
        European Journal of Clinical Nutrition. 2009; 63: 640-645
        • Johnson S.B.
        • Riley A.W.
        • Granger D.A.
        • Riis J.
        The science of early life toxic stress for pediatric practice and advocacy.
        Pediatrics. 2013; 131: 319-327
        • Kendall-Tackett K.
        A new paradigm for depression in new mothers: The central role of inflammation and how breastfeeding and anti-inflammatory treatments protect maternal mental health.
        International Breastfeeding Journal. 2007; 2: 6
        • Kim J.H.
        • Froh E.B.
        What nurses need to know regarding nutritional and immunobiological properties of human milk.
        Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2012; 41: 122-137
        • Kitzman H.J.
        • Olds D.L.
        • Cole R.E.
        • Hanks C.A.
        • Anson E.A.
        • Arcoleo K.J.
        • Holmberg J.R.
        Enduring effects of prenatal and infancy home visiting by nurses on children: Follow-up of a randomized trial among children at age 12 years.
        Archives of Pediatrics & Adolescent Medicine. 2010; 164: 412-418
        • Kotey F.O.
        • Spatz D.L.
        White matter injury in preterm infants: Could human milk play a role in its prevention?.
        Advances in Neonatal Care. 2013; 13 (quiz 95–96): 89-94
        • Lahav A.
        • Skoe E.
        An acoustic gap between the NICU and womb: A potential risk for compromised neuroplasticity of the auditory system in preterm infants.
        Frontiers in Neuroscience. 2014; 8: 381
        • Lanier P.
        • Maguire-Jack K.
        • Walsh T.
        • Drake B.
        • Hubel G.
        Race and ethnic differences in early childhood maltreatment in the United States.
        Journal of Developmental and Behavioral Pediatrics. 2014; 35: 419-426
        • Lessen R.
        • Kavanagh K.
        Position of the Academy of Nutrition and Dietetics: Promoting and supporting breastfeeding.
        Journal of the Academy of Nutrition and Dietetics. 2015; 115: 444-449
        • Lind J.N.
        • Perrine C.G.
        • Li R.
        • Scanlon K.S.
        • Grummer-Strawn L.M.
        Racial disparities in access to maternity care practices that support breastfeeding—United States, 2011.
        Morbidity and Mortality Weekly Report. 2014; 63: 725-728
        • MacDorman M.F.
        • Matthews T.J.
        • Declercq E.
        Trends in out-of-hospital births in the United States, 1990-2012.
        (NCHS data brief) National Center for Health Statistics, Hyattsville, MD2014
        • Marik P.E.
        • Fuller C.
        • Levitov A.
        • Moll E.
        Neonatal incubators: A toxic sound environment for the preterm infant?*.
        Pediatric Critical Care Medicine. 2012; 13: 685-689
        • Martin R.M.
        • Gunnell D.
        • Smith G.D.
        Breastfeeding in infancy and blood pressure in later life: Systematic review and meta-analysis.
        American Journal of Epidemiology. 2005; 161: 15-26
        • Mason D.J.
        Toxic stress in childhood: Why we all should be concerned.
        Nursing Outlook. 2014; 62: 382-383
        • Mezzacappa E.S.
        • Katkin E.S.
        Breast-feeding is associated with reduced perceived stress and negative mood in mothers.
        Health Psychology. 2002; 21: 187-193
        • Miller T.R.
        Projected outcomes of nurse-family partnership home visitation during 1996-2013, USA.
        Prevention Science: The Official Journal of the Society for Prevention Research. 2015; 16: 765-777
        • Moore E.R.
        • Anderson G.C.
        • Bergman N.
        • Dowswell T.
        Early skin-to-skin contact for mothers and their healthy newborn infants.
        The Cochrane Database of Systematic Reviews. 2012; 5: CD003519
        • Nandyal R.
        • Owora A.
        • Risch E.
        • Bard D.
        • Bonner B.
        • Chaffin M.
        Special care needs and risk for child maltreatment reports among babies that graduated from the neonatal intensive care.
        Child Abuse & Neglect. 2013; 37: 1114-1121
        • National Scientific Council on the Developing Child
        The science of neglect: The persistent absence of responsive care disrupts the developing brain: Working paper 12.
        2012 (Retrieved from)
        • Olds D.L.
        The nurse-family partnership: An evidence-based preventive intervention.
        Infant Mental Health Journal. 2006; 27: 5-25
        • Olds D.L.
        • Eckenrode J.
        • Henderson C.R.
        • Kitzman H.
        • Powers J.
        • Cole R.
        • Luckey D.
        Long-term effects of home visitation on maternal life course and child abuse and neglect: Fifteen-year follow-up of a randomized trial.
        JAMA. 1997; 278: 637-643
        • Olds D.L.
        • Kitzman H.J.
        • Cole R.E.
        • Hanks C.A.
        • Arcoleo K.J.
        • Anson E.A.
        • Stevenson A.J.
        Enduring effects of prenatal and infancy home visiting by nurses on maternal life course and government spending: Follow-up of a randomized trial among children at age 12 years.
        Archives of Pediatrics & Adolescent Medicine. 2010; 164: 419-424
        • Owen C.G.
        • Martin R.M.
        • Whincup P.H.
        • Smith G.D.
        • Cook D.G.
        Does breastfeeding influence risk of type 2 diabetes in later life? A quantitative analysis of published evidence.
        The American Journal of Clinical Nutrition. 2006; 84: 1043-1054
        • Owen C.G.
        • Martin R.M.
        • Whincup P.H.
        • Smith G.D.
        • Cook D.G.
        Effect of infant feeding on the risk of obesity across the life course: A quantitative review of published evidence.
        Pediatrics. 2005; 115: 1367-1377
        • Parikh N.I.
        • Hwang S.J.
        • Ingelsson E.
        • Benjamin E.J.
        • Fox C.S.
        • Vasan R.S.
        • Murabito J.M.
        Breastfeeding in infancy and adult cardiovascular disease risk factors.
        American Journal of Medicine. 2009; 122: 656-663.e1
        • Pérez-Escamilla R.
        • Martinez J.L.
        • Segura-Pérez S.
        Impact of the Baby-friendly Hospital Initiative on breastfeeding and child health outcomes: A systematic review.
        Maternal & Child Nutrition. 2016; 12: 402-417
        • Pope C.J.
        • Mazmanian D.
        Breastfeeding and postpartum depression: An overview and methodological recommendations for future research.
        Depression Research and Treatment. 2016; 2016: 4765310
        • Rich-Edwards J.W.
        • Stampfer M.J.
        • Manson J.E.
        • Rosner B.
        • Hu F.B.
        • Michels K.B.
        • Willett W.C.
        Breastfeeding during infancy and the risk of cardiovascular disease in adulthood.
        Epidemiology. 2004; 15: 550-556
        • Risch E.C.
        • Owora A.
        • Nandyal R.
        • Chaffin M.
        • Bonner B.L.
        Risk for child maltreatment among infants discharged from a neonatal intensive care unit: A sibling comparison.
        Child Maltreatment. 2014; 19: 92-100
        • Shonkoff J.P.
        • Garner A.S.
        The lifelong effects of early childhood adversity and toxic stress.
        Pediatrics. 2012; 129: e232-e246
        • Singhal A.
        • Cole T.J.
        • Lucas A.
        Early nutrition in preterm infants and later blood pressure: Two cohorts after randomised trials.
        Lancet. 2001; 357: 413-419
      1. Social Determinants of Health | Healthy People 2020. (n.d.). Retrieved from ​

        • Spatz D.L.
        Changing institutional culture to value human milk.
        Advances in Neonatal Care. 2014; 14: 234-235
        • Spatz D.L.
        Ten steps for promoting and protecting breastfeeding for vulnerable infants.
        Journal of Perinatal & Neonatal Nursing. 2004; 18: 385-396
        • Stevens J.
        • Schmied V.
        • Burns E.
        • Dahlen H.
        Immediate or early skin-to-skin contact after a Caesarean section: A review of the literature.
        Maternal & Child Nutrition. 2014; 10: 456-473
        • Tahirkheli N.N.
        • Cherry A.S.
        • Tackett A.P.
        • McCaffree M.A.
        • Gillaspy S.R.
        Postpartum depression on the neonatal intensive care unit: Current perspectives.
        International Journal of Womens Health. 2014; 6: 975-987
        • Tilling K.
        • Davies N.
        • Windmeijer F.
        • Kramer M.S.
        • Bogdanovich N.
        • Matush L.
        • Martin R.M.
        Is infant weight associated with childhood blood pressure? Analysis of the Promotion of Breastfeeding Intervention Trial (PROBIT) cohort.
        International Journal of Epidemiology. 2011; 40: 1227-1237
        • Twigger A.J.
        • Hodgetts S.
        • Filgueira L.
        • Hartmann P.E.
        • Hassiotou F.
        From breast milk to brains: The potential of stem cells in human milk.
        Journal of Human Lactation. 2013; 29: 136-139
        • 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, D.C.2011 (Retrieved from)
        • U.S. Department of Health and Human Services
        • Administration for Children and Families
        • Administration on Children, Youth and Families, Children's Bureau
        Child maltreatment 2013.
        2015 (Retrieved from)
        • United Nations Children's Fund
        Global strategy for infant and young child feeding.
        World Health Organization, Geneva, Switzerland2003
        • Weimer J.
        The economic benefits of breastfeeding: A review and analysis.
        2001 (Food Assistance and Nutrition Research report no. 13 no. no. 13). (E. R. S. Food and Rural Economics Division, Trans.). Retrieved from
        • World Health Organization
        The optimal duration of exclusive breastfeeding: A systematic review.
        2001 (Retrieved from)
        • Yan J.
        • Liu L.
        • Zhu Y.
        • Huang G.
        • Wang P.P.
        The association between breastfeeding and childhood obesity: A meta-analysis.
        BMC Public Health. 2014; 14: 1267