ARTICLE

Breastfeeding and Human

Lactation: Education and
Curricular Issues for
Pediatric Nurse Practitioners
Allison E. Boyd, BA, BSN, RN, & Diane L. Spatz, PhD, RN-BC, FAAN

ABSTRACT of research-based lactation education into PNP curricula will

Introduction: This study explores the breastfeeding and hu-
man lactation education offered in pediatric nurse practi-
tioner (PNP) masters-level nursing programs.
Methods: An online survey about breastfeeding and human
lactation education offered in the PNP curriculum was sent
to all PNP programs in the United States with viable contact
information (N = 84). The response rate was 42.9%.
Results: All of the respondents indicated that their PNP pro-
gram curriculum includes the promotion of breastfeeding.
However, 5.9% of programs do not offer any courses that in-
corporate these topics, and 73.5% teach this content in only
one to two courses. More than three quarters of programs
(81.8%) offer opportunities to counsel expectant mothers
on infant feeding choices, promote breastfeeding in the clin-
ical setting, and teach breastfeeding techniques. However,
18.2% of programs do not offer any of these opportunities.
Discussion: The breastfeeding and lactation education of-
fered in PNP programs is inconsistent. Formal incorporation
Allison E. Boyd, MSN Student, University of Pennsylvania School
of Nursing, Philadelphia, PA.
Diane L. Spatz, Helen M. Shearer Associate Professor of Nutrition
& Associate Professor of Healthcare of Women and Childbearing
Nursing, Faculty Advisor to Student Nurses, University of
Pennsylvania School of Nursing & The ChildrenÕs Hospital of
Philadelphia, Philadelphia, PA.
Conflicts of interest: None to report.
Correspondence: Diane L. Spatz, PhD, RN-BC, FAAN, University
of Pennsylvania School of Nursing & The ChildrenÕs Hospital of
Philadelphia, Office 413, 418 Curie Blvd, Philadelphia, PA 19104-
4217; e-mail: spatz@nursing.upenn.edu.
0891-5245/$36.00
Copyright Q 2013 by the National Association of Pediatric
Nurse Practitioners. Published by Elsevier Inc. All rights
reserved.
Published online August 16, 2011.
http://dx.doi.org/10.1016/j.pedhc.2011.03.005
help to standardize knowledge and aid in the PNP clinical
role. J Pediatr Health Care. (2013) 27, 83-90.
KEY WORDS
Breastfeeding, breastfeeding education, nursing education
The lack of breastfeeding education incorporated
into undergraduate nursing programs has been well re-
viewed within nursing literature, and recommenda-
tions have been made on how to improve this
education (Spatz, Pugh, & the American Academy of
Nursing Expert Panel on Breastfeeding, 2007). Other ar-
ticles addressing the need for additional breastfeeding
education are directed toward undergraduate nursing
curriculum, but not toward graduate level nursing edu-
cation (Howett, Spangler, & Cannon, 2006; Spatz,
2005). Additionally, the 2011 Surgeon GeneralÕs Call
to Action to Support Breastfeeding identifies the
need for breastfeeding education for all health
professionals who provide care to women and
children, as well as the need for ‘‘support for
breastfeeding as a standard of care for midwives,
obstetricians, family physicians, nurse practitioners,
and pediatricians’’ (U.S. Department of Health &
Human Services [DHHS], 2011, p. 47). In its position
statement on breastfeeding, the National Association
of Pediatric Nurse Practitioners (NAPNAP, 2007) recog-
nizes that breastfeeding is the ideal form of nutrition for
infants and recommends that infants be exclusively
breastfed for the first 6 months of life. NAPNAPÕs state-
ment offers ways in which pediatric nurse practitioners
(PNPs) can promote and support breastfeeding in clin-
ical practice.
PNPs are in an ideal position to promote exclusive
breastfeeding as an infant feeding choice and to

www.jpedhc.org March/April 2013 83

support breastfeeding mothers; however, little is
known about the amount of evidence-based breast-
feeding and human lactation education that is incorpo-
rated into masters-level nursing education for pediatric
NP programs (Hellings & Howe, 2004; Riordan, 2003;
Spatz et al., 2007). This research examines the extent
of the breastfeeding and human lactation content
offered in PNP programs across the United States.
REVIEW OF THE LITERATURE
A 2004 study by Hellings and Howe examined breast-
feeding knowledge and education in 77 PNPs. Their re-
sults indicated that 97.4% of these PNPs believe that
their role includes recommending breastfeeding to ex-
pectant mothers. However, when these PNPs were
asked about the education they received with regard
to breastfeeding in their PNP programs, the degree of
perceived adequacy of that education and of breast-
feeding experiences ranged widely. For example,
whereas 35.1% of respondents never observed a breast-
feeding woman during their educational program,
about one third (33.8%) of respondents observed five
or more breastfeeding women. Similar trends emerged
regarding the opportunity to teach breastfeeding tech-
niques and to counsel mothers about breastfeeding
problems. More than half of the respondents (60%)
felt adequately prepared by their programs, but about
32% did not feel very well prepared (Hellings &
Howe, 2004). These findings indicate that not only is
the breastfeeding education inconsistent, but it is also
potentially inadequate.
The American Nurses Credentialing Center (ANCC)
collected responses from 395 pediatric nurse practi-
tioners for their national survey about the roles of
PNPs (ANCC, 2009a). Assessing conditions related to
nutrition/hydration was included in the top 20 most
critical work activities performed by PNPs. In the PNP
Board Certification test content outline, nutrition is
mentioned as a subcategory under health promotion
guidelines (AANC, 2009b). On average, PNPs spend
33% of their time during an average week providing
health care for infants (i.e., children from birth to 2 years
of age). Providing care to the infant group is second
only to providing care to children (i.e., those 3 to 12
years of age; AANC, 2009b).
The Pediatric Nursing Certification Board (PNCB)
and the ANCC are the two bodies that certify PNPs
through certification examinations. The PNCB includes
‘‘providing instruction on breastfeeding’’ as one of its
106 certification examination items (PNCB, 2008). The
ANCC does not specifically include breastfeeding in
its Pediatric NP Board Certification test content outline.
However, it does include questions associated with cat-
egories of infancy (birth to 11 months) and early child-
hood (1 to 4 years), all body systems, immune function,
and health promotion, including Healthy People 2020
and resources from the American Academy of Pediatrics
84 Volume 27  Number 2
(AAP; ANCC, 2009b). Breastfeeding is a critical compo-
nent of nutrition and hydration for infants and some
young children, and the benefits of breast milk relate
to all body systems and immune function in children
(Riordan & Wambach, 2010). In addition, Healthy Peo-
ple 2020 and the AAP have set goals specific to the use
of breastfeeding as the primary form of infant nutrition
and the promotion of breastfeeding in the clinical set-
ting (AAP, 2005; U.S. DHHS, 2010b). Healthy People
2020 increased the target for the proportion of infants
who are breastfed ever, at 6 months, at 1 year, at 3
months exclusively, and at 6 months exclusively
(DHHS, 2010b).
With regard to education, Spatz (2010) stresses the
importance of in-depth breastfeeding and human lacta-
tion education for students who plan to work with
childbearing families and children, such as PNP stu-
dents. Furthermore, NAPNAPÕs position statement on
breastfeeding recommends that all PNP programs pro-
vide evidence-based classroom education and clinical
experience in breastfeeding and lactation that is both
comprehensive and culturally appropriate (NAPNAP,
2007). Most recently, Action 9 in the Surgeon GeneralÕs
Call to Action to Support Breastfeeding states that inad-
equate breastfeeding education and training of clini-
cians is a major barrier to breastfeeding, and it calls
for improving the breastfeeding content provided in
both undergraduate and graduate educational pro-
grams in all areas of health care. These factors indicate
that PNPs should be educated and tested on breastfeed-
ing and human lactation knowledge and should be able
to provide evidence-based lactation support.
For an advocacy project conducted at the University
of Pennsylvania in 2010 through the course ‘‘A Case
Study in Breastfeeding and Human Lactation’’ (Spatz
& Sternberg, 2005), three PNP programs in the greater
Philadelphia area were surveyed about the incorpora-
tion of evidence-based breastfeeding and lactation con-
tent within their curricula. The purpose of the advocacy
project was to promote breastfeeding awareness in the
community (Spatz & Sternberg, 2005). The program di-
rectors of these local institutions had the opportunity to
examine their PNP programs for breastfeeding-specific
content and clinical experiences. The survey results
showed that all three of the programs offer breastfeed-
ing education, and all agreed that various breastfeeding
and lactation topics were important in PNP education.
These topics included the anatomy and physiology of
lactation, biological aspects of breast milk, the role of
culture in breastfeeding, the promotion of breastfeed-
ing, and specific management strategies for common
breastfeeding problems. All of the institutions also con-
sidered the promotion of breastfeeding as an infant
feeding choice to be an important role for PNPs. How-
ever, although all of the institutions reported that their
students receive practical breastfeeding experience in
the clinical setting, only two of the programs offer
Journal of Pediatric Health Care
 TABLE 1. Amount of breastfeeding and human lactation content offered in pediatric nurse
practitioner programs
Variable None (%)
No. of courses that incorporate breastfeeding 5.9
and human lactation
No. of hours of breastfeeding and human 9.7
lactation education in curriculum
specific clinical breastfeeding experience outside of
regularly scheduled clinical hours. In addition, the
breastfeeding content is taught by the primary course
instructors. Only one institution used a lactation consul-
tant for a 3-hour workshop. The variety of responses
from just these three institutions illustrates a number
of inconsistencies between the breastfeeding and hu-
man lactation education offered in PNP programs.
In summary, evidence shows that PNPs need to be
equipped with comprehensive evidence-based breast-
feeding and human lactation knowledge during their
educational experience in order to be clinically pre-
pared to manage these issues. Currently this type of ed-
ucation appears to be inconsistent and potentially
inadequate. The purpose of this study is to explore
the breastfeeding and human lactation content in PNP
programs across the United States. Specifically, this
study examines the breastfeeding and human lactation
topics taught to students, the number of courses that
incorporate this education, the type of breastfeeding-
related experiences offered, and breastfeeding re-
sources used to provide education.
METHODS
The Institutional Review Board at the University of
Pennsylvania reviewed and approved this study. An on-
line survey about breastfeeding and human lactation
education offered in PNP programs was created using
Surveymonkey.com. A total of 96 PNP programs at 91
institutions in the United States were identified through
a list accessible at PNCBÕs Web site. Contact information
for the program director or course coordinator was ob-
tained online through each institutionÕs Web site. For
seven of the 91 institutions, incorrect or no contact in-
formation was available online; therefore, a total of 84
institutions were contacted by e-mail to complete the
survey questionnaire. One month after the initial con-
tact attempt was made, an e-mail reminder to complete
the survey questionnaire was sent to those who had not
yet responded. Thirty-six institutions completed the
survey, for an overall response rate of 42.9%. The sur-
vey questions were not all mandatory; therefore,
some individual questions have a lower response rate
than the overall response rate.
Thirty-two out of the 36 institutions provided geo-
graphical data. Every geographical region of the United
States was represented, with the greatest concentration
of respondents in the Midwest (14; 43.7%). Of the
www.jpedhc.org
1-2 (%) 3-4 (%) 5-6 (%) 7+
73.5 14.7 5.9 0
22.6 41.9 16.1 9.7
remaining respondents, 9.4% (3) were from the North-
east, 12.5% (4) were from the Mid-Atlantic region,
12.5% (4) were from the South, 9.4% (3) were from
the Southwest, and 12.5% (4) were from the West.
Enrollment information was obtained from the PNP
program coordinators or via a telephone call to the
nursing school administration office. Programs that
completed the study and provided geographical infor-
mation were contacted for enrollment data; 27 of 32
programs responded. The majority of programs (44%,
12 out of 27) had between 11 and 20 students; however,
enrollment ranged from 10 to 68 total students per uni-
versity. Eleven percent of programs (3 out of 27) had
between 1 and 10 students, 11% had between 21 and
30 students, and 11% programs had between 31 and
40 students. Four percent of programs (1 out of 27)
had between 41 and 50 students, and 19% (5 out of
27) had more than 61 to 70 students.
RESULTS
PNP Education
Program directors and course coordinators were
queried regarding the breastfeeding and human
lactation-related educational topics and experiences
that their institutions provided in their PNP programs.
Table 1 summarizes the responses to questions regard-
ing the total number of courses in the program that in-
corporate breastfeeding and human lactation, as well as
the total number of hours of education related to breast-
feeding and human lactation. A total of 5.9% of the pro-
grams (2 out of 34 that responded) indicated that they
do not offer any courses that incorporate these topics.
However, nearly three quarters (73.5%) of programs in-
clude this education in one to two courses. A total of
9.7% of programs (3 out of 31 that responded) indicated
that they do not offer any hours of breastfeeding and
human lactation education in the curriculum. Nearly
half of programs (41.9%) include 3 to 4 hours of this ed-
ucation in the curriculum, with only 9.7% of programs
including 7 or more hours. In addition, when asked
whether students have the option of taking a course spe-
cific to breastfeeding and human lactation, 82.4% of pro-
grams indicated that they offered no such courses. Only
six programs (17.6%) offer a course of this type.
Table 2 refers to the educational topics related to
breastfeeding and human lactation in the curriculum.
A total of 72.7% of PNP programs indicated that they
teach about the anatomy and physiology of human
March/April 2013 85
 lactation specialists to gain practical experience related
TABLE 2. Educational topics related to
to breastfeeding and human lactation. In addition,
breastfeeding and human lactation in pediatric
31.6% of programs utilize postpartum breastfeeding
nurse practitioner programs
classes, 31.6% utilize Women, Infants, and Children
Does not Does teach (WIC) programs, 15.8% utilize breastfeeding support
Topic teach (%) (%) groups, and 10.5% utilize antepartum breastfeeding
Anatomy and physiology 27.3 72.7 classes to give their students additional experience.
of human lactation Table 4 summarizes the types of resources that PNP
Biological aspects of 18.2 81.8 programs use for the breastfeeding and human lactation
breast milk
education incorporated into their curriculum. More than
Culture and breastfeeding 12.9 87.1
Promotion of breastfeeding 0 100 three quarters of programs use current research (84.8%)
Management strategies for 3.1 96.9 and clinical guidelines (78.8%) to provide education.
breastfeeding problems More than half of the programs use books (54.4%) and
Historical perspectives on 66.7 33.3 Web sites (60.6%). Other sources of information used in-
breastfeeding
clude personal experiences (36.4%), published manuals
and pamphlets (36.4%), classic research (33.3%), dem-
lactation, 81.8% indicated that they teach about the bio- onstrations (27.3%), and videos (21.2%).
logical aspects of breast milk, 87.1% indicated that they Notably, only 12.5% of programs indicated that their
include the aspect of culture in relation to breastfeeding, curriculum does not take into account either PNCB or
96.9% indicated that they teach management strategies ANCC content about infant feeding and breastfeeding
for common breastfeeding problems, and 33.3% indi- on PNP certification examinations. The majority of pro-
cated that they include historical perspectives on breast- grams (46.9%) account for both PNCB and ANCC exam-
feeding. Most notably, 100% of the 32 programs that ination content, with 43.8% of programs accounting
answered the question indicated that they include the only for PNCB examination content and 3.1% of pro-
promotion of breastfeeding in their curriculum. grams accounting only for ANCC examination content.
When asked about the breastfeeding-related experi-
ences offered in their PNP program, 81.8% of programs Qualitative Responses
indicated that they offer opportunities to counsel ex- The survey included the following qualitative question
pectant mothers on infant feeding choices, promote for completeness: ‘‘Do you have any additional
breastfeeding in the clinical setting, and teach breast- thoughts or comments regarding breastfeeding educa-
feeding techniques. However, 18.2% of programs do tion in PNP programs?’’ The responses demonstrated
not offer any of these opportunities. Table 3 summa- an overwhelming acknowledgement of the importance
rizes these results. of and need for specific breastfeeding and lactation ed-
ucation in PNP programs. One program responded,
Sources of Education ‘‘Should be a major initiative of all PNP programs,’’
Institutions were asked to indicate which types of edu- while another program stated, ‘‘Your survey has height-
cators deliver information on breastfeeding and human ened my awareness that we need to include more spe-
lactation in the course curricula. The most common cific content and clinical experience related to
instructor was a member of the nurse practitioner breastfeeding.’’ The responses identified a lack of
faculty (78.8%), followed by a lactation specialist time during the PNP program to include breastfeeding
(45.5%). Two programs (6.1%) indicated that they uti- and lactation content: ‘‘I think this is a wonderful
lize breastfeeding mothers and families. Outside of
the clinical environment, 78.9% of programs (15 of
19 responses) indicated that their students shadow TABLE 4. Resources used to provide
breastfeeding and human lactation education
TABLE 3. Educational experiences related to in pediatric nurse practitioner programs
breastfeeding and human lactation in pediatric Programs that
nurse practitioner programs Type of resource utilize (%)

Does not Offers Current research 84.8

Topic offer (%) (%) Classic research 33.3
Clinical guidelines 78.8
Counsel expectant mothers 18.2 81.8 Books on lactation and breastfeeding 54.5
on infant feeding choices Published manuals/pamphlets 36.4
Promote breastfeeding in 18.2 81.8 Web sites 60.6
clinical setting Videos 21.2
Teach breastfeeding 18.2 81.8 Demonstrations 27.3
techniques Personal experiences 36.4

86 Volume 27  Number 2 Journal of Pediatric Health Care

subject for the students, and they are interested in it, but programs. Although all geographic areas of the coun-
it is tough finding more time for it.’’ The responses also try were represented in this survey, it is important
identified the need for additional resources in the pro- to note that the majority of respondents were from
vision of this content, as evidenced by the statement, the Midwest. The potential for response bias exists
‘‘If you could offer a free stand along online module in the study, because the programs that are more
that PNP or FNP students and/or programs could use, breastfeeding-friendly may be more likely respond.
this would be awesome.’’ Thus the results of the study may be representative
of a sample that provides a greater amount of breast-
DISCUSSION feeding and human lactation education than do the re-
The findings of this study illustrate inconsistencies in mainder of the PNP programs.
evidence-based human lactation and breastfeeding
content incorporated into PNP program curricula. Recommendations for Changes in PNP
Almost all the programs that responded to the survey in- Curricula
dicated that they incor- In 2007, Spatz and colleagues outlined ways in which
porate breastfeeding .while PNP breastfeeding and lactation content could be incorpo-
and human lactation programs believe rated into a baccalaureate nursing curriculum. Typi-
content into their cur- that breastfeeding cally, information about breastfeeding in the nursing
riculum. However, al- curriculum is found in courses that focus on nutrition,
most three quarters of and lactation obstetrics, maternal/child health, or pediatrics. In the
programs teach this education is PNP programs, the majority of breastfeeding content
content in only one to important, and is found in lectures on infant nutrition. Some programs
two courses. This num- offer an elective course in lactation, and some programs
ber of courses is small, while many utilize lactation consultants as guest lecturers. How-
considering that PNP programs provide ever, not all students are able to shadow a lactation con-
students generally some of this sultant, and opportunities to observe and work with
must take at least 12 breastfeeding mothers are dependent on the clinical
courses to complete content, a great setting. With differences in breastfeeding rates among
their MSN degree. It is need exists for geographic areas in the United States and among
encouraging that all of specific some ethnic groups, clinical exposure to breastfeeding
the programs include could be rather variable for PNP students across the
the promotion of breastfeeding country (Spatz et al., 2007). Therefore it is essential
breastfeeding in their content. that breastfeeding and lactation content be incorpo-
curriculum and that al- rated throughout the curriculum of a masterÕs-level
most all of the programs teach management strategies PNP program.
for breastfeeding problems. However, the fact that In a typical PNP masterÕs-level program, students re-
more than one quarter of programs do not teach the ceive instruction in general advanced nursing practice,
anatomy and physiology of human lactation is a cause advanced pharmacotherapeutics, advanced patho-
for concern. It is also discouraging that almost one quar- physiology, and in research for advanced nursing prac-
ter of programs do not offer students any opportunity to tice. Additionally, they complete theoretical and clinical
counsel expectant mothers on infant feeding choices, coursework for making clinical decisions in pediatric
to promote breastfeeding in the clinical setting, or to advanced practice nursing. Box 1 summarizes impor-
teach breastfeeding techniques. Overall, the qualitative tant breastfeeding and lactation topics to include in
responses illustrate that while PNP programs believe core courses of a PNP curriculum.
that breastfeeding and lactation education is important, A number of published resources, including text-
and while many programs provide some of this content, books, evidence-based clinical guidelines, online
a great need exists for specific breastfeeding content. breastfeeding and lactation education materials, and
Additionally, supplemental resources for teaching this Web sites, are useful in delivering breastfeeding and hu-
content would benefit PNP programs significantly, as man lactation education in nursing curriculum. Box 2
was indicated by a number of respondents. provides a comprehensive list of these resources.
Course instructors should provide this list to their stu-
Study Limitations dents and utilize these resources when teaching this
Although the study resulted in new information about content. In addition, as recommended in Action 9 of
breastfeeding and human lactation education in PNP the Surgeon GeneralÕs Call to Action to Support Breast-
programs, the study had several limitations, including feeding (DHHS, 2011), PNP students should be encour-
the small response rate of 42.9%. Only 36 of a total aged to complete online breastfeeding and lactation
of 84 PNP programs completed the survey, which education (Breastfeeding Support Consultants, 2010;
makes it difficult to generalize the results across all Lactation Education Resources, n.d.; OÕConnor, 2010),

www.jpedhc.org March/April 2013 87

 BOX 1. Breastfeeding and lactation topics to include in pediatric nurse practitioner courses

Advanced Pharmacology and Therapeutics for Pediatric Nursing

 Mechanisms of drug entry into human milk
 Risks of drug therapy during lactation
 Drugs that are incompatible with breastfeeding
 Drugs that decrease maternal milk supply
 How to access appropriate resources and recommendations for the use of drugs and other substances during breastfeed-
ing (Briggs, Freeman, & Yaffe, 2008; Hale, 2010)

Advanced Developmental Pathophysiology

 Anatomy of the human female breast
 Stages of lactation: mammogenesis, lactogenesis (Stages I and II), galactopoiesis, and involution
 Concepts of milk volume and breast storage capacity
 Anatomy of the infantÕs oral structures
 Physiologic mechanisms of infant suckling
 Pathophysiology of milk production and suckling dysfunction
 Pathophysiology of breastfeeding-related infant conditions
 Infant conditions that can lead to feeding problems and the potential for inadequate weight gain

Research for Advanced Practice Nursing

 Evidence-based practice guidelines related to breastfeeding
 The role of the advanced practice nurse in implementing the guidelines
 Evaluation of clinical guidelines related to breastfeeding
 Critical synthesis of breastfeeding research
 Translation of breastfeeding research into advanced nursing practice

Comprehensive Assessment and Clinical Decision Making for the Advanced Practice Nurse
 Including questions about breastfeeding as a component of nutrition
 Evaluating if the family is having any problems with breastfeeding
 Evaluation of maternal and infant risks for delayed lactogenesis II, failed lactogenesis II, and low milk supply
 Identifying mothers with potential lactation insufficiency
 Identifying the unique risks of late preterm infants for poor lactation outcomes
 Use of breastfeeding scales & tools for completing a breastfeeding assessment

Clinical Practice with Select Pediatric Populations for the Advanced Practice Nurse
 Opportunities to identify actual or potential feeding problems
 Utilize breastfeeding assessment tools: The Infant Breastfeeding Assessment Tool (Matthews, 1988), the LATCH Assess-
ment Tool (Jensen, Wallace, & Kelsay, 1994), and the Preterm Infant Breastfeeding Behavior Scale (Nygvist, Rubertsson,
Eqald, & Sjoden, 1996)
 Observe and manage breastfeeding and lactation issues
 Use breastfeeding equipment (i.e., hospital-grade and non–hospital-grade breast pumps, nipple shields, and
supplemental nurser systems)
 Utilize the American Academy of Pediatrics and National Association of Pediatric Nurse Practitioner recommendations
 Promote the breastfeeding goals of Healthy People 2020
 Support mothers to continue breastfeeding
 Counsel mothers regarding infant feeding choices
 Encourage expectant mothers to initiate breastfeeding

as well as continuing education credits related to
breastfeeding (Pugh & Spatz, 2007).
SUMMARY
A disparity exists regarding the role of a PNP and breast-
feeding. Although research shows that PNPs believe
that the promotion and management of breastfeeding
is an important use of their clinical time, the findings of
this study illustrate that evidence-based breastfeeding
and lactation education offered in PNP programs is in-
consistent. As recommended by the Surgeon GeneralÕs
Call to Action to Support Breastfeeding (DHHS, 2011)
and NAPNAP (2007), PNPs should be equipped with
evidence-based lactation knowledge and skills so
they can provide optimal support to the breastfeeding
dyad. The results of this study support those of
Hellings and Howe (2004), which indicate that PNPs
are often in a critical position to counsel and influence

88 Volume 27  Number 2 Journal of Pediatric Health Care

 BOX 2. Evidence-based breastfeeding and lactation resources for pediatric nurse practitioner
education

Books
Briggs, G., Freeman, R., & Yaffe, S. (2008). Drugs in pregnancy and lactation (8th ed.). Baltimore, MD: Williams & Wilkins.
Hale, T. (2010). Medications and motherÕs milk (12th ed.). Amarillo, TX: Pharmasoft Publishing.
Hanson, L. (2004). Immunobiology of breastmilk. Amarillo, TX: Pharmasoft Publishing.
Riordan, J., & Wambach, K. (2010). Breastfeeding and human lactation (4th ed.). Sudbury, MA: Jones & Bartlett.

Clinical Guidelines
Association of WomenÕs Health, Obstetric, and Neonatal Nurses. (2007). Breastfeeding support: Prenatal care through the
first year (2nd ed.). Washington, DC: Johnson & Johnson Pediatric Institute.
National Association of Neonatal Nurses. (2009). NANN position statement #3046: The use of human milk and
breastfeeding in the neonatal intensive care unit. Glenview, IL: National Association of Neonatal Nurses.
National Association of Pediatric Nurse Practitioners. (2007). NAPNAP position statement on breastfeeding. Journal of
Pediatric Health Care, 21(7), 39A–40A.
Spatz, D. L., & Goldschmidt, K. A. (2006). Preserving breastfeeding for the rehospitalized infant: A clinical pathway. MCN
American Journal of Maternal and Child Nursing, 31(1), 45–51.

Supplemental Education
Pugh, L. C., & Spatz, D. L. (2007). Breastfeeding the healthy newborn (2nd ed.). White Plains, NY: March of Dimes
Foundation.
Wellstart International. (2009). Lactation management self-study modules: Level I (3rd ed., revised). Shelburne, VT:
Wellstart International.
Breastfeeding Basics (http://www.breastfeedingbasics.org)
Breastfeeding Support Consultants/Center for Lactation Education (http://www.bsccenter.org)
Lactation Education Resources (http://www.leron-line.com)

Web Sites
Academy of Breastfeeding Medicine: http://www.bfmed.org
Baby Friendly USA: http://www.babyfriendlyusa.org
CDC Breastfeeding Data: http://www.cdc.gov/breastfeeding
Healthy People 2020: Maternal, Infant, & Child Health: http://www.healthypeople.gov/2020/topicsobjectives2020/
objectiveslist.aspx?topicid=26
International Lactation Consultant Association: http://www.ilca.org
Medela: http://www.medela.com
National WomenÕs Health Information Center: http://www.4woman.gov/breastfeeding
National Association of Pediatric Nurse Practitioners: http://www.napnap.org
U.S. Breastfeeding Committee: http://www.usbreastfeeding.org
Special Supplemental Nutrition Program for Women, Infants and Children: http://www.fns.usda.gov/wic
Wellstart International: http://wellstart.org

mothers about infant feeding choices. Formal incorpo-
ration of research-based lactation education and practi-
cum into PNP curriculum will not only help to
standardize knowledge but will also be an asset to the
PNP clinical role in ensuring better health outcomes
for children. Areas for future research should include
student feedback on their preparedness for managing
breastfeeding in the clinical setting, as well as further
exploration of PNP programs that offer specific learning
opportunities related to breastfeeding and lactation.
REFERENCES
American Academy of Pediatrics. (2005). Breastfeeding and the use
of human milk. Pediatrics, 115(2), 496-506.
American Nurses Credentialing Center. (2009a). 2008 role delinea-
tion study: Pediatric nurse practitioner national survey results.
Retrieved from http://www.nursecredentialing.org/NurseSpeci
alties/PediatricNP.aspx
American Nurses Credentialing Center. (2009b). Pediatric nurse
practitioner board certification test content outline—effective
date: March 1, 2010. Retrieved from http://www.nursecreden
tialing.org/NurseSpecialties/PediatricNP.aspx
Briggs, G., Freeman, R., & Yaffe, S. (2008). Drugs in pregnancy and
lactation (8th ed.). Baltimore, MD: Williams & Wilkins.
Breastfeeding Support Consultants. (2010). Center for Lactation Ed-
ucation. Retrieved from http://www.bsccenter.org/index.html
Hale, T. W. (2010). Medications and mothersÕ milk (14th ed.). Ama-
rillo, TX: Pharmasoft Medical Publishing
Hellings, P., & Howe, C. (2004). Breastfeeding knowledge and prac-
tice of pediatric nurse practitioners. Journal of Pediatric Health
Care, 18(1), 8-14.
Howett, M., Spangler, A., & Cannon, R. B. (2006). Designing a
university-based lactation course. Journal of Human Lactation,
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