Child Development and Public Health-Breastfeeding

            There is widespread agreement among organizations such as the World Health Organization, UNICEF, the American Academy of Pediatrics, the U.S. Department of Health and Human Services, and the Center for Disease Control that breastfeeding is best in most situations.  Numerous studies have been carried out and research indicates and supports “the use of breast milk as the optimal choice for infant nutrition, citing several health benefits to both infant and mother for breastfeeding” (Thurman & Allen, 2008).

            There are many well-known benefits to breastfeeding.  Berger, page 152, in the textbook has an extensive list of benefits to the infant, the mother, and the family (2012).  The baby benefits from nutrition balanced to its age, micronutrients and antibodies in the breast milk, experiences less illness as an infant and as an adult, higher IQ, and a lower incidence of SID’s (Berger, 2012).  The mother enjoys the convenience of and satisfaction from breastfeeding, a natural form of contraception, easier bonding process, and a reduced chance of osteoporosis and breast cancer (Berger, 2012).  Berger lists as family benefits a decreased level of paternal stress, monetary savings, and raised levels of sibling survival due to births occurring further apart (2012).

Breastfeeding raises many different emotions and responses from people depending upon their culture, education, support, and experiences.  In my personal experience I had three children and breastfeed each for different lengths of time and with different rates of success.  My first experience lasted only a couple of months.  My son and I could not seem to get the hang of it.  He had difficulty latching on and as a very new, inexperienced mother I was very concerned with if he was getting enough breast milk for healthy growth and development, so I switched to formula. 

 My second son had no difficulty at all and I was an at-home mother at the time and exclusively breastfed.  At about 9 months I tried to introduce bottle feeding and he would have no part of the bottle.  I continued to breastfeed until one year of age at which time I was encouraged by my pediatrician to take the bottle away and begin whole milk.

 I was working in a child development center when I gave birth to my third son, so worried about refusing a bottle I did introduce breast milk feedings in a bottle occasionally from very early on.  I wanted to be sure he would accept a bottle feeding while I was at work.  We both seemed to do well with this arrangement and it allowed his father to participate in feedings as well.

The rate of breastfeeding in the United States has increased over the years, but has room for improvement.  The U.S. DHHS published a Healthy People 2010 goal which includes reaching a 75% breastfeeding rate just after birth and maintaining a rate of 50% breastfeeding still at 6 months of age (Chertok & Hoover, 2009).  The United States currently recommends exclusive breastfeeding for the first 6 months of life and to continue with breastfeeding for months 6-12 with solid foods as a supplement if needed (Chertok & Hoover, 2009).

During the research of this topic I have come across several areas surrounding the subject of breastfeeding that I found to be especially interesting and relevant.  First is the concern over lack of professional support and information from healthcare providers. Thurman and Allen point out how “misinformation from health care providers and minimal discussion about the process and benefits of breastfeeding compared with formula feeding contribute to low breastfeeding rates and increase maternal frustration and confusion regarding breastfeeding” (2008).  They also state it was the end of the 20^th century before “the International Board of Lactation Consultant Examiners was formed, initiating the new professional role of lactation consultant” (Thurman & Allen, 2008).   

A study performed in Puerto Rico by Leavett, Martinez, Ortiz, and Garcia describes a “reported lack of knowledge in areas related to breastfeeding and little practical experience in the management of breastfeeding among both pediatricians and obstetricians in Puerto Rico” (2009).  Examples of this given were that physicians lacked knowledge of the benefits of breastfeeding to raising immunity levels, were known to recommend the combination of breastfeeding and formula, and of breastfeeding contraindications (Leavett, Martinez, Ortiz, & Garcia, 2009).   There is a recent AAP Policy Statement  that makes recommendations to address and correct these concerns (Leavett, Martinez, Ortiz, & Garcia, 2009).

The next study I will address concerns the level of early childhood center staff knowledge on breastfeeding and the need for education uncovered.  Manhire, Horrocks, and Tangiora have concerns over the raised number of infants in out of home childcare arrangements and the impact on the rate of breastfeeding, (2012).  There is limited research done in this area and what has been done led researchers to believe “although there was a supportive attitude by staff, there remained a need for breastfeeding to be considered the norm in terms of administration, staff, and parental expectations” and “there was a need for breastfeeding policy, education about breastfeeding and improvement in physical childcare facilities to better support breastfeeding families” (Manhire, Horrocks, & Tangiora, 2012).  Staff at the centers were open to education on breastfeeding if provided (Manhire, Horrocks, & Tangiora, 2012).  Manhire, Horrocks and Tangiora concluded that “The ideal environment  to support the breastfeeding relationship while returning to paid work needs a three pronged approach:  first, breastfeeding should be well established through a paid parental leave policy; second, there should be a flexible and supportive workplace environment to encourage breastfeeding; and finally, ECC staff who are knowledgeable about breastfeeding are essential” (2012).

There has been much concern over the risk and rate of AIDs transmission through breastfeeding and this led to research into practices to help lower the rate of transmission  (Moland, van Esterik, Sellen, de Paoli, Leshabon, & Blystad, 2010; Coovadia, Rollins, Bland, Little, et al, 2007).  It was thought not long ago that breastfeeding was not a viable choice but research has shown that “existing evidence of the superiority of breastfeeding in terms of infant survival, and the 2010 infant feeding guidelines promoting breastfeeding as the first choice of infant feeding method…replacement feeding has substantial negative unintended consequences for the individual mother, for her infant, for households and for health systems” (Moland, van Esterik, Sellen, de Paoli, Leshabon, & Blystad, 2010).  The study by  Coovadia, Rollins, Bland, Little, et al reinforces the findings supporting exclusive breastfeeding also (2007).  They state:  

Exclusive breastfeeding ordinarily protects the integrity of the intestinal mucosa, which

thereby presents a more effective barrier to HIV.  Exclusive breastfeeding is associated

with fewer breast health problems than is mixed feeding, such as subclinical mastitis

and breast abscesses, which in turn are associated with increased breastmilk viral load.

The effect that small departures from exclusive breastfeeding have on the risk of HIV

transmission is uncertain, although  predominant breastfeeding (the introduction of non-

milk fluids) was associated with reduced transmission in one study.  Why is the

addition of solids especially hazardous?  Perhaps large and complex proteins found

in solid foods precipitate greater damage than do modified cows’ milk proteins to

gastrointestinal mucosa, which ease viral entry between cells, or regulate gut receptors

differently, thereby increasing the likelihood of virus adherence and infection

(Coovadia, Rollins, Bland, Little, et al, 2007).

            Complications surrounding exclusive breastfeeding are that custom calls for the introduction of additional foods and fluids to the infant’s diet; economic circumstances require the mother to work, and there may not be social support from their peers or partner. 

The last study concerns the legislation that led to change in how breastfeeding is viewed and supported in areas of the United States (Chertok & Hoover, 2009).  Not only was breastfeeding not supported as a woman’s right, but it was considered a criminal act of indecent exposure in many states.  Chertok & Hoover list New York as being “one of the first to exempt breastfeeding from being a criminal offense in 1984, and later recognized the inadequacy of the law regarding the support of breastfeeding.  As such, in 1994, the state of New York proceeded to amend its Civil Rights Act to include breastfeeding” (2009).  Many states have gone beyond just addressing the right to breastfeed and making it legal and have passed legislation that will support it.  For example, “accommodating pumping breaks, provision of a private place for pumping, use of refrigerators for the safe storage of milk, and the definition or commendation of supportive employment setting” (Chertok & Hoover, 2009).  There are  allowances for excusal from jury duty when it would interfere with feeding requirements of the infant (Chertok & Hoover, 2009). 

            Each of these studies has looked at different aspects related to the issue of breastfeeding.  The one thing I saw repeatedly was the importance of promoting and accommodating exclusive breastfeeding for at least the first six months of a child’s life.  Each agreed upon the listed positive effects and had very little negative if any, to report.  Each has increased my level of knowledge and understanding of the very critical and personal choice that breastfeeding is.  Increased knowledge and understanding has enabled me to be more supportive and better able to articulate the positive and critical nature of breastfeeding to parents and other professionals I work with. 

 I have eight infants in my classroom at this time and three of the eight were breastfed for at least the first few months of life.  One continued until about 7 months and felt her milk supply was not enough and with her pediatrician made the decision to supplement with formula and ended up switching completely to formula within a few weeks.  I have one infant who has just turned one year old and mom continues to breastfeed.  She has decided to not continue the breast milk at the center and has introduced whole milk and that is what she receives now.  Each has their own reasons and preferences that led to their own personal decisions about breastfeeding.

The children in my care and their parents look to me and depend on me to be educated and knowledgeable about best practices and current research in the field of child development.  They need to be able to count on my using my knowledge to enhance the environment and foster development not only in their child but with them also.  I need to be able to look at issues from many perspectives and be open to new ideas.  The more informed I become, the better able I am to care for and serve the children and families that depend upon me.

References

Berger, K.S. (2012). The developing person through childhood. New York, NY. Worth Publisher.

Chertok, I., &Hoover, M. (2009). Breastfeeding legislation in states with relatively low breastfeeding rates compared to breastfeeding legislation of other states. Journal of Nursing Law, 13(2), 45-53. Retrieved from http://search.proquest.com/docview/206516990?accountid=14872

Coovadia, H., Rollins, N., Bland, R.M., Little, K., et al. (2007). Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: An intervention cohort study. The Lancet, 369(9567), 1107-16. Retrieved from http://search.proquest.com/docview/199055199?accountid=14872

Leavitt, G., Martínez, S., Ortiz, N., & García, L. (2009). Knowledge about breastfeeding among a group of primary care physicians and residents in puerto rico. Journal of Community Health, 34(1), 1-5. doi: http://dx.doi.org/10.1007/s10900-008-9122-8

Manhire, K.M., Horrocks, G., & Tangiora, A. (2012). Breastfeeding knowledge and education needs of early childhood centre staff. Community Practitioner, 85(9), 30-3. Retrieved from http://search.proquest.com/docview/1039540520?accountid=14872

Moland,K., van Esterik, P., Sellen, D., de Paoli, M.,Leshabari, S., & Blystad, A. (2010). Ways ahead: Protecting, promoting and supporting breastfeeding in the context of HIV. International Breastfeeding Journal, 5(1), 19. doi: http://dx.doi.org/10.1186/1746-4358-5-19

Thurman, S. E., & Allen, P. J. (2008). Integrating lactation consultants into primary health care services: Are lactation consultants affecting breastfeeding success? Pediatric Nursing, 34(5), 419-25. Retrieved from http://search.proquest.com/docview/199436749?accountid=14872