CE/CME

Breastfeeding

Welcome to the training on Breastfeeding provided by the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS).

Credit Hours: 1.75 CE

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Goal

The goal of this module is to equip Texas Health Steps providers and other health-care providers to routinely communicate clear and consistent messages about the importance of breastfeeding and ensure that families have the support needed to achieve their breastfeeding goals.

Target Audience

Texas Health Steps providers and other interested health-care professionals.

Specific Learning Objectives

After completing the activities of this module, you will be able to:

  1. Evaluate the short- and long-term maternal and child health outcomes associated with infant feeding.
  2. Integrate clear and consistent breastfeeding information and messages into routine clinical encounters.
  3. Recommend strategies and resources that assist families in meeting their breastfeeding goals. 

Please note this module expires on 9/1/2025.

This module was released on 9/1/2022.

Featured

Academy of Breastfeeding Medicine Clinical Protocols (in numerical order):

Academy of Breastfeeding Medicine. (2022) Recommended Core Competencies for Specialists Practicing Breastfeeding and Lactation Medicine. Breastfeeding Medicine, 17(7).

Academy of Breastfeeding Medicine. (2021). Special Issue on Breastfeeding and the Black/African American Experience: Cultural, Sociological, and Health Dimensions Through an Equity Lens—Part 2. Breastfeeding Medicine, 16(6).

Academy of Breastfeeding Medicine. (2019). Educational Objectives and Skills for the Physician with Respect to Breastfeeding, Revised 2018. Breastfeeding Medicine, 14(1).

Academy of Breastfeeding Medicine. (2015). ABM Position on Breastfeeding—Revised 2015. Breastfeeding Medicine, 10(9).

American Academy of Pediatrics. (2022). Technical Report: Breastfeeding and the Use of Human Milk.

American Academy of Pediatrics. (2022). Policy Statement: Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment.

American Academy of Pediatrics. (2022). Technical Report: Evidence Base for 2022 Updated Recommendations for a Safe Infant Sleeping Environment to Reduce the Risk of Sleep-Related Infant Deaths. 

American Academy of Pediatrics, healthychildren.org. (2022). Providing Breast Milk for Premature and Ill Newborns.

American Academy of Pediatrics. (2021). Breastfeeding Overview.

American Academy of Pediatrics. (2021). Breastfeeding Guidance Post Hospital Discharge for Mothers or Infants with Suspected or Confirmed SARS-Co V-2 Infection.

American Academy of Pediatrics. (2021). Breastfeeding Practice Tools for Health Professionals.

American Academy of Pediatrics. (2018). Clinical Report: "Late-preterm" Infants: A Population at Risk. Pediatrics, 120(6), 1390-1401.

American Academy of Pediatrics. (2017). Policy Statement: Donor Human Milk for the High-Risk Infant: Preparation, Safety, and Usage Options in the United States. Pediatrics, 139(1): e20163440.

American Academy of Pediatrics. (2017). Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents [pocket guide], 4th edition.

American College of Nurse-Midwives. (2016). Breastfeeding Position Statement.

American College of Obstetricians and Gynecologists. (2019.) Committee Opinion, No. 569: Oral Health Care During Pregnancy and Through the Lifespan.

American College of Obstetricians and Gynecologists. (2019.) Committee Opinion, No. 766: Approaches to Limit Interventions During Labor and Birth.

American College of Obstetricians and Gynecologists. (2018.) Committee opinion No. 756: Optimizing Support for Breastfeeding as Part of Obstetric Practice.

American College of Obstetricians and Gynecologists. (2018). Committee Opinion No. 757: Screening for Perinatal Depression.

American College of Obstetricians and Gynecologists. (2017.) Committee Opinion No. 711: Opioid Use and Opioid Use Disorder in Pregnancy.

American College of Obstetricians and Gynecologists. (2016). Committee Opinion No. 533: Lead Screening During Pregnancy and Lactation.

American Heart Association. (2022). Breastfeeding reduces mothers’ cardiovascular disease risk. ScienceDaily, January 11.

Anstey, E. H., Chen, J., Elam-Evans, L. D., & Perrine, C. G. (2017). Racial and Geographic Differences in Breastfeeding — United States, 2011–2015. Morbidity and Mortality Weekly Report (MMWR), 66: 723–727.

Asiodu, I. V., Bugg, K., & Palmquist, A. E. L. (2021). Achieving Breastfeeding Equity and Justice in Black Communities: Past, Present, and Future. Breastfeeding Medicine, 447-451.

Association of Women's Health, Obstetric and Neonatal Nurses. (2016). Healthy Term Newborn After Birth: AWHONN Practice Brief Number 5. AWHONN Practice Brief, 45(6), 842-844.

Association of Women’s Health, Obstetric and Neonatal Nurses. (2014). Breastfeeding Position Statement.

Aydin, D., & Inal, S. (2019). Effects of breastfeeding and heel warming on pain levels during heel stick in neonates. International Journal of Nursing Practice, 25(3).

Azad, M. B., Vehling, L., Chan, D., Klopp, A., Nickel, N. C., McGavock, J. M., . . . Subbaraoz, P. (2018). Infant Feeding and Weight Gain: Separating Breast Milk From Breastfeeding and Formula From Food. Pediatrics, 142(4):e20181092.

Baby-Friendly USA. (2018). Guidelines and Evaluation Criteria for Facilities Seeking Baby-Friendly Designation.

Baby-Friendly USA. (2012). Baby-friendly hospital initiative.

Balogun, O. O., O'Sullivan, E. J., McFadden, A., Ota, E., Gavine, A., Garner, C. D., Renfrew, M. J., & MacGillivray, S. (2016). Interventions for promoting the initiation of breastfeeding. Cochrane Database of Systematic Reviews, 11,  CD001688.

Bartick, M. C., Schwarz, E. B., Green, B. D., Jegier, B. J., Reinhold, A. G., Colaizy, T. T., Bogen, D. L., Schaefer, A. J., & Stuebe, A. M. (2017). Suboptimal breastfeeding in the United States: Maternal and pediatric health outcomes and costs. Maternal & Child Nutrition, 13(1).

Bertrand K. A., Hanan, N. J., Honerkamp-Smith, G., Best, B. M., & Chambers, C. D. (2018). Marijuana Use by Breastfeeding Mothers and Cannabinoid Concentrations in Breast Milk. Pediatrics, 142(3):e20181076.

Burnham, L., Knapp, K., Bugg, K., Nickel, N., Beliveau, P., Feldman-Winter, L., & Merewood, A. (2022). Mississippi CHAMPS: Decreasing Racial Inequities in Breastfeeding. Pediatric, 149 (2): e2020030502.

Centers for Disease Control and Prevention. (2022). COVID-19: Pregnant and Recently Pregnant People.

Centers for Disease Control and Prevention. (2022) Women and Heart Disease.

Centers for Disease Control and Prevention. (2021). Vaccination Safety for Breastfeeding Mothers.

Centers for Disease Control and Prevention. (2021). Herpes Simplex Virus (HSV).

Centers for Disease Control and Prevention. (2021). Maternity Practices in Infant Nutrition and Care (mPINC) Scoring Algorithm.

Centers for Disease Control and Prevention. (2021). Texas 2020 Report, CDC Survey of Maternity Practices in Infant Nutrition and Care.

Centers for Disease Control and Prevention. (2021). Breastfeeding Initiation Rates by County or County Equivalent in Texas.

Centers for Disease Control and Prevention. (2021). 2020 CDC Breastfeeding Report Card.

Centers for Disease Control and Prevention. (2021) Racial and Ethnic Disparities in Breastfeeding Initiation – United States, 2019. Morbidity and Mortality Weekly Report (MMWR), 70(21);769-774.

Centers for Disease Control and Prevention. (2020). Make Shots Less Stressful.

Centers for Disease Control and Prevention. (2019). Breastfeeding.

Centers for Disease Control and Prevention. (2019). Racial Disparities in Breastfeeding Initiation and Duration Among U.S. Infants Born in 2015. Morbidity and Mortality Weekly Report (MMWR), 68(34);745–748.

Centers for Disease Control and Prevention. (2021). Vaccination Safety for Breastfeeding Mothers.

Centers for Disease Control and Prevention. (2018). Breastfeeding Among U.S. Children Born 2009–2015, CDC National Immunization Survey.

Centers for Disease Control and Prevention. (2018). Contraindications to Breastfeeding or Feeding Expressed Breast Milk to Infants.

Centers for Disease Control and Prevention. (2018). Vitamin Supplementation.

Centers for Disease Control and Prevention. (2018). Tobacco and E-Cigarettes.

Centers for Disease Control and Prevention. (2017). Trends in Postpartum Depressive Symptoms — 27 States, 2004, 2008, and 2012. Morbidity and Mortality Weekly Report (MMWR), 66:153–158.

Centers for Disease Control and Prevention. (2013). The CDC Guide to Strategies to Support Breastfeeding Mothers and Babies.

Centers for Disease Control and Prevention. (2011). Hospital Support for Breastfeeding. Preventing Obesity Begins in Hospitals.

Centers for Disease Control and Prevention. (n.d.). How Doctors Can Help: The Surgeon General’s Call to Action to Support Breastfeeding.

Chaudron, L. H., Szilagyi, P. G., Tang, W., Anson, E., Talbot, N. L., Wadkins, H. I. M., ... Wisner, K. L. (2010). Accuracy of Depression Screening Tools for Identifying Postpartum Depression Among Urban Mothers. Pediatrics, 125(3): e609-e617.

Consumer Product Safety Commission. (2021). CPSC Approves Major New Federal Safety Standard for Infant Sleep Products.  (Press Release).

Crenshaw, J. (2007). Care practice #6: No separation of mother and baby, with unlimited opportunities for breastfeeding. Journal of Perinatal Education, 16(3), 39-43.

Crowe, S., & Wright, T. (2021). Alcohol and breastfeeding: What are the risks? Contemporary OB/GYN Journal, 66(8).

Dennis, C. L., & McQueen, K. (2009). The relationship between infant-feeding outcomes and postpartum depression: A qualitative systematic review. Pediatrics, 123(4), e736-51.

Duke Department of Pediatrics, Duke University School of Medicine. (2018). ABCs of Neonatal Jaundice: AAP guidelines, Bilirubin Basics, and Cholestasis.

Feldman-Winter, L., Kellams, A., Peter-Wohl, S., Taylor, J. S., Lee, K. G, Terrell, M. J., Noble, L., Maynor, A. R., Meek, J. Y., Stuebe, A. M. (2020). Evidence-Based Updates on the First Week of Exclusive Breastfeeding Among Infants Greater than/equal to 35 Weeks. Pediatrics, 145.

Feldman-Winter, L., & Goldsmith, J. P. (2106). Safe Sleep and Skin-to-Skin Care in the Neonatal Period for Healthy Term Newborns. Pediatrics, 138(3): e20161889.

Feldman-Winter, L. B., Schanler, R. J., O’Connor, K. G., & Lawrence, R. A. (2008). Pediatricians and the promotion and support of breastfeeding. Archives of Pediatrics & Adolescent Medicine, 162(12), 1142–1149.

Feltner, C., Weber, R. P., Stuebe, A., Grodensky, C. A., Orr, C., & Viswanathan, M. (2018). Breastfeeding Programs and Policies, Breastfeeding Uptake, and Maternal Health Outcomes in Developed Countries. Comparative Effectiveness Review, 210, Agency for Healthcare Research and Quality.

Gunderson, E. P, Jacobs, D. R., Jr., Chiang, V., Lewis, C. E., Feng, J., Quesenberry, C. P., Jr., & Sidney, S. (2010). Duration of lactation and incidence of the metabolic syndrome in women of reproductive age according to gestational diabetes mellitus status: A 20-Year prospective study in CARDIA (Coronary Artery Risk Development in Young Adults). Diabetes, 59(2), 495-504.

Hassan, B., & Zakerihamidi, M. (2017). The correlation between frequency and duration of breastfeeding and the severity of neonatal hyperbilirubinemia. Journal of Maternal & Fetal Neonatal Medicine, 31(4):457-463.

Institute of Medicine. Early Childhood Obesity Prevention Policies. (2011).

Islam, J., Broidy, L., Baird, K., Rahman, M., & Zobair, K. M. (2021). Early exclusive breastfeeding cessation and postpartum depression: Assessing the mediating and moderating role of maternal stress and social support. PLoS ONE, 16(5): e0251419.

Jones, K. M., Power, M. L., Queenan, J. T., & Schulkin, J. (2015). Racial and Ethnic Disparities in Breastfeeding. Breastfeeding Medicine, 10(4): 186-196.

Kim, K. M., & Choi, J-W. (2020). Associations between breastfeeding and cognitive function in children from early childhood to school age: a prospective birth cohort study. International Breastfeeding Journal, 15(83).

Krol, K. M., & Grossman, T. (2018). Review article: Psychological Effects of Breastfeeding on Children and Mothers. Bundesgesundheitsblatt - Gesundheitsforschung – Gesundheitsschutz, 61(8): 977–985. (Translates from German to Federal Health Gazette, Health Research-Health Protection).

La Leche League International. (2015). Islamic and Cultural Practices in Breastfeeding.

Lawrence, R., & Lawrence, R. (2021). Breastfeeding: A guide for the medical profession, 9th Edition. Amarillo, TX: Hale Publishing.

Lee, J. (2017). Supporting Breastfeeding Moms at Work: How a Doctor's Note Can Make the Difference. Breastfeeding Medicine, 12(8):470-472.

Linares, A. M., Cartagena, D., & Rayens, M. K. (2020). Las dos cosas” versus exclusive breastfeeding: A culturally and linguistically exploratory intervention study in Hispanic mothers living in Kentucky. Journal of Pediatric Health Care, 33(6): e46–e56.

Lu, MC., Kotelchuck, M., Hogan, V., Jones, L., Wright, K., & Halfon, N. Closing the Black-White gap in birth outcomes: a life-course approach. Ethnicity and Disease. 2010 Winter; 20(1 0 2): S2–62-76.

Mahesh, P., Gunathunga, M. W., Arnold, S. M., Jayasinghe, C., Pathirana, S., Makarim, M. F., . . . Senanayake, S. J. (2018). Effectiveness of targeting fathers for breastfeeding promotion: systematic review and meta-analysis. BMC Public Health, 18(1), 1140.

Maisels, J. M., Clune, S., Coleman, K., Gendelman, B., Kendall, A., McManus, S., & Smyth, M. (2014). The Natural History of Jaundice in Predominantly Breastfed Infants. Pediatrics, 134(2), e340-e345.

Mayo Clinic. (2022). Infant and Toddler Health.

Mayo Clinic. (2020). Female breast anatomy.

Mehrpisheh, S., Memarian, A., Ameri, M., & Saberi Isfeedvajani, M. (2020). The Importance of Breastfeeding Based on Rules and Qur’an. Hospital Practice Research, 5(2):37-41

Mennella, J. A., Yourshaw, L. M., & Morgan, L. K. (2007). Breastfeeding and smoking: short-term effects on infant feeding and sleep. Pediatrics, 120(3): 497-502.

National Archives and Records Administration. (2010). Department of Labor, Wage and Hour Division, RIN 1235–ZA00, Reasonable Break Time for Nursing Mothers. Federal Register,  75(244): 80073.

National Association of County and City Health Officials & United States Breastfeeding Committee. (2021). Continuity of Care in Breastfeeding Support: A Blueprint for Communities.

Odom, E. C., Li, R., Scanlon, K. S., Perrine, C. G., & Grummer-Strawn, L. (2013). Reasons for earlier than desired cessation of breastfeedingPediatrics, 131(3), e726–e732.

Oxford University Press USA. (2015). Breastfeeding may prevent postpartum smoking relapseScienceDaily, April 16.

Parker, M. G., Stellwagen, L. M., Noble, L., Kim, J. H., Poindexter, B. B., & Puopolo. (2021). Promoting Human Milk and Breastfeeding for the Very Low Birth Weight Infant. Pediatrics, 148(5):e2021054272.

Peres, K. G., Cascaes, A. M., Peres, M. A., Demarco, F. F., Santos, I. S., Matijasevich, A., & Barros, A. J. D. (2015). Exclusive Breastfeeding and Risk of Dental Malocclusion. Pediatrics, 136(1), 2014-3276.

Pérez-Escamilla, R., Martinez, J. L., & Segura-Pérez, S. (2016). Impact of the Baby-friendly Hospital Initiative on Breastfeeding and Child Health Outcomes: A Systematic Review. Maternal and Child Nutrition, 12(3): 402-417.

Pope, C. J. & Mazmanian, D. (2016). Breastfeeding and Postpartum Depression: An Overview and Methodological Recommendations for Future ResearchDepression Research and Treatment:4765310.

Preer, G., & Philipp, B. (2011). Understanding and managing breast milk jaundice. Archives of Disease in Childhood - Fetal and Neonatal Edition, 96: F461-F466.

Ramírez, D. S. R., Pérez, M. M. L., Pérez, M. C., Hernández, M. I. S., Pulido, S. M., Villacampa, L. P.  . . . Bello, M. A. G. (2021). SARS-CoV-2 Antibodies in Breast Milk after Vaccination. Pediatrics, 148(5): e2021052286.

Robinson, K., Fial, A., & Hanson, L. (2019). Racism, Bias, and Discrimination as Modifiable Barriers to Breastfeeding for African American Women: A Scoping Review of the Literature. Journal of Midwifery and Women’s Health, 64(6): 734-742.

Rosenberg, A. (2022). Breastfeeding isn’t “free.” Here’s what it cost me. Washington Post, May 31.

Schiavo, J. H. (2011). Oral Health Literacy in the Dental Office: The Unrecognized Patient Risk Factor. Journal of Dental Hygiene, 85(4), 248-255.

Shah, M. H., Roshan, R., Parikh, T., Sathe, S., Vaidya, U., & Pandit, A. (2021). LATCH Score at Discharge: A Predictor of Weight Gain and Exclusive Breastfeeding at 6 Weeks in Term Healthy Babies. Journal of Pediatric Gastroenterology and Nutrition, 72(2): 48-52.

Shisler, S., Homish, G. G., Molnar, D. S., Schuetze, P., Colder, C.R., & Eiden, R.D. (2016). Predictors of Changes in Smoking from Third Trimester to 9 Months PostpartumNicotine & Tobacco Research, 18(1), 84–87.

Sowjanya, S. V. N. S., & Venugopalan, L. (2018). LATCH Score as a Predictor of Exclusive Breastfeeding at 6 Weeks Postpartum: A Prospective Cohort Study. Breastfeeding Medicine, 13(6).

Stuebe, A. M. (2015). Does breastfeeding prevent the metabolic syndrome, or does the metabolic syndrome prevent breastfeeding? Seminars in Perinatology, 39(4): 290-295.

Tamburini S., Shen N., Wu H. C., & Clemente J.C. (2016). The microbiome in early life: implications for health outcomesNature Medicine, 22:713–22.

Texas Department of State Health Services. (2021). Texas Position Statement on Infant Feeding, updated 2010.

Texas Department of State Health Services. (2021). Lead Questionnaires and Reporting Forms.

Texas Department of State Health Services. (2014). Cumulative Research on Breastfeeding Disparities Impacting African American & Hispanic Women.

Texas Health and Human Services Commission. (2022). Breastmilkcounts.com.

Texas Health and Human Services Commission. (2022). Breastmilkcounts.com, Working Moms web page.

Texas Health and Human Services Commission. (2022). Texas WIC: Breast Pumps.

Texas Health and Human Services Commission. (2019). 2018 Texas WIC Infant Feeding Practices Survey State Report.

Texas Health Steps, Anticipatory Guidance Provider Guide.

Texas Health Steps Periodicity Schedule.

Thompson, J., Tanabe, K., Moon, R. Y., Mitchell, E. A., McGarvey, C., Tappin, D., Blair, P. S., & Hauck, F. R. (2017). Duration of Breastfeeding and Risk of SIDS: An Individual Participant Data Meta-analysis. Pediatrics,140(5), e20171324.

Tschiderer, L., Seekircher, L., Kunutsor, S. K., Peters, S. A. E., O’Keefe, L. M., & Willeit, P. (2022). Breastfeeding Is Associated with a Reduced Maternal Cardiovascular Risk: Systematic Review and Meta‐Analysis Involving Data From 8 Studies and 1 192 700 Parous Women. Journal of the American Heart Association, 11:e022746.

U.S. Congress, Congress.gov. H.R.866 - 116th Congress (2019-2020): Fairness For Breastfeeding Mothers Act of 2019.

U.S. Congress, Congress.gov. H.R.3182 - 117th Congress (2021-2022): Safe Sleep for Babies Act of 2021.

U.S. Department of Agriculture. (2019). The Economic Impacts of Breastfeeding: A Focus on USDA’s Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).  Economic Research Report, Number 261.

U.S. Department of Agriculture. (n.d.). WIC Breastfeeding Support.

U.S. Department of Agriculture. (n.d.). WIC Breastfeeding Support, Common Questions and Challenges.

U.S. Department of Health and Human Services, Healthcare.gov. (2022). Breastfeeding benefits.

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA). (2022). Marijuana and Pregnancy.

U.S. Department of Health and Human Services, Office on Women’s Health. (2021). Supporting Nursing Moms at Work.

U.S. Department of Health and Human Services, Office on Women’s Health. (2021). Business Case for Breastfeeding.

U.S. Department of Health and Human Services, Office on Women’s Health. (2021). Making the decision to breastfeed.

U.S. Department of Health and Human Services. (2020). The Surgeon General’s Call to Action to Improve Maternal Health.

U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. (2018). Breastfeeding Programs and Policies, Breastfeeding Uptake, and Maternal Health Outcomes in Developed Countries.

U.S. Department of Health and Human Services, National Institute on Drug Abuse. (2018). Marijuana. What are Marijuana’s Long-Term Effects on the Brain?

U.S. Department of Health and Human Services, National Institute of Child Health and Human Development. (2017). What is weaning and how do it do it?

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. (2011). The Surgeon General’s Call to Action to Support Breastfeeding.

U.S. Department of Labor, Wage and Hour Division. (2010). Fair Labor Standards Act: Break Time for Nursing Mothers Provision.

U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (n.d.). Healthy People 2030, Infants.

U.S. Department of Labor, Women’s Bureau. (n.d.). Employment Protections for Workers Who Are Pregnant or Nursing

U.S. Equal Employment Opportunity Commission, Policy Guidance Related to Pregnancy Discrimination.

U.S. National Library of Medicine, MedlinePlus. (2015). Breastfeeding vs. Formula Feeding.

Victora, C. G., Bahl, R., Barros, A. J. D., França, G . V. A., Horton, S., Krasevec, J., . . . Rollins, N. C. (2016). Breastfeeding in the 21st Century: epidemiology, mechanisms, and lifelong effect. Lancet Series, Breastfeeding, 387(10017): 475-490.

Wagner, C. L., & Greer, F. R. (2008). Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents. Pediatrics, 122(5): 1142-1152.

Walker, M. (2018). Mammary Dysbiosis. Clinical Lactation, 9 (3).

Washington State Department of Health. (2010). Nutrition Interventions for Children with Special Health Care Needs, Third Edition.

Watchmaker, B., Boyd, B., & Dugas, L. R. (2020). Newborn feeding recommendations and practices increase the risk of development of overweight and obesity. BMC Pediatrics, 20(104).

Weaver, J. M., Schofield, T. J., & Papp, L. M. (2018). Breastfeeding Duration Predicts Greater Maternal Sensitivity Over the Next Decade. Developmental Psychology, 54(2), 220–227.

Widstrom, A. M., Brimdyr, K., Svensson, K., Cadwell, K., & Nissen, E. (2019). Skin-to-skin contact the first hour after birth, underlying implications and clinical practice. Acta Paediatrica, 108(7): 1192-1204.

Widstrom A. M., Lilja G., Aaltomaa-Michalias P., Dahllöf, A., Lintula, M., & Nissen, E. (2011). Newborn behaviour to locate the breast when skin-to-skin: A possible method for enabling early self-regulation. Acta Paediatrica, 100:79–85.

World Health Organization. (2020). Skin-to-skin contact helps newborns breastfeed.

World Health Organization/UNICEF. (n.d.). Ten steps to successful breastfeeding.

Xue, Y., Morris, M., Ni, L., Guthrie, S. K., Zubieta, J. K., Gonzalez, K., McConnell, D. S., Domino, E. F. Venous plasma nicotine correlates of hormonal effects of tobacco smoking. Pharmacology Biochemistry Behavior, 95(2):209-15.

Definitions

The medical definitions provided in this module were obtained or adapted from the American Academy of Pediatrics, Centers for Disease Control and Prevention, Clinical Lactation, Johns Hopkins Medicine, KidsHealth from Nemours, Mayo Clinic and National Library of Medicine.

Continuing Medical Education

The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians. 

The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of 1.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Continuing Professional Development

The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of Nursing Continuing Professional Development by the American Nurses Credentialing Center’s Commission on Accreditation.

Texas Department of State Health Services, Continuing Education Service has awarded 1.75 contact hours of Nursing Continuing Professional Development.

Social Workers

The Texas Department of State Health Services, Continuing Education Service, the continuing education provider, ensures that the education provided is directly related to the practice of social work; and that the individuals presenting the information have the necessary experience and knowledge in the topics presented. The Texas Department of State Health Services, Continuing Education Service has awarded 1.75 hours of credit.

Certificate of Attendance

The Texas Department of State Health Services, Continuing Education Service has designated 1.75 hour(s) for attendance.

Certified Community Health Worker

The Texas Department of State Health Services, Promotor(a)/Community Health Worker Training and Certification Program has certified this course for 1.75 contact hour(s) of continuing education for Certified Community Health Workers and Community Health Worker Instructors.

General Disclosure

One of the requirements of continuing education is disclosure of the following information to the learner:

  1. Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
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    • Complete on-line registration process.
    • Thoroughly read the content of the module.
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    • Complete the evaluation.
  2. Commercial Support.
    The THSTEPS Web-based Continuing Education Series has received no commercial support.
  3. Disclosure of Relevant Financial Relationships.
    The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose.
  4. Non-Endorsement Statement.
    Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center.
  5. Off-Label Use.
    Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).

The following are policies and definitions of terms related to continuing education disclosure:

The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.

All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.

Glossary of Terms

Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.

Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.

Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).

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Health-Care Providers

Breastfeeding and General Health

Academy of Breastfeeding Medicine. (2015). ABM Position on Breastfeeding—Revised 2015. Breastfeeding Medicine, 10(9).

American Academy of Pediatrics. (2022). Policy Statement: Breastfeeding and the Use of Human Milk.

American Academy of Pediatrics. (2022). Technical Report: Breastfeeding and the Use of Human Milk.

Academy of Breastfeeding Medicine, website with Position Statements on core topics related to breastfeeding medicine.

Academy of Breastfeeding Medicine, website with Clinical Protocols for best practices in breastfeeding.

Academy of Breastfeeding Medicine. (2010). ABM clinical protocol #7: Model Breastfeeding Policy—Revised 2010.   Breastfeeding Medicine, 5(4).

Academy of Breastfeeding Medicine. (2016). ABM Clinical Protocol #26: Persistent Pain with Breastfeeding. Breastfeeding Medicine, 11(2).

Academy of Breastfeeding Medicine. (2020). ABM Clinical Protocol #32: Management of Hyperlactation. Breastfeeding Medicine, 15(3).

American Academy of Pediatrics. (2022). Technical Report: Breastfeeding and the Use of Human Milk.

American Academy of Pediatrics. (2022). Oral Health Campaign Toolkit (download from website).

American Academy of Pediatrics. (2021). Breastfeeding Resources for Health Professionals.

American College of Obstetricians and Gynecologists. (2019). Committee Opinion No. 766, Approaches to Limit Intervention During Labor and Birth.

American College of Obstetricians and Gynecologists. (2018). Committee Opinion No. 756, Optimizing Support for Breastfeeding as Part of Obstetric Practice.

Breastfeeding Medicine. (2021) Special Issue on Breastfeeding and the Black/African American Experience: Cultural, Sociological, and Health Dimensions Through an Equity Lens—Part 1. (16)2.

Breastfeeding Medicine. (2021). Special Issue on Breastfeeding and the Black/ African American Experience: Cultural, Sociological, and Health Dimensions Through an Equity Lens—Part 2. (16)6.

Centers for Disease Control and Prevention, breastfeeding web page.

Centers for Disease Control and Prevention. (n.d.). How Doctors Can Help: The Surgeon General’s Call to Action to Support Breastfeeding.

Centers for Disease Control and Prevention. Growth Charts.

Centers for Disease Control and Prevention. Growth Chart Training: Using the WHO Growth Charts, provider training that explains how, when and why to use the WHO growth charts.

The Lancet, Breastfeeding series from the journal. (2016). Offers editorials, comments, series papers, podcasts and related content.

The Surgeon General’s Call to Action to Support Breastfeeding.

Texas Department of State Health Services Maternal and Child Health. (2022).  Posters about COVID-19 vaccines and pregnancy are available in English and Spanish. They can be ordered at no cost or downloaded in color or black and white.

Texas Department of State Health Services. Childhood Lead Poisoning Forms, including 2019 Texas Childhood Blood Lead Screening Guidelines (Pb-120).

Texas Health and Human Services Commission. WIC Breastfeeding, Help and Information for Health-care Partners.

Texas Health and Human Services Commission. Human Donor Milk New Reimbursement information.

Texas Health Steps, Anticipatory Guidance Provider Guide.

Texas Health Steps Periodicity Schedule.

Texas Medicaid Provider Procedures Manual (TMPPM). (2022).

W.K. Kellogg Foundation. Breastfeeding resources, including reports about advancing racial equity in maternal and child health and an advocate’s toolkit for lactating mothers.

Courses, Tips and Tools for Breastfeeding

BiliTool. Online tool that helps providers assess the risk toward development of jaundice in newborns.

Breastfeeding | Human Medicine. Inspire Health. Online Inter-professional (IPE) training for health profession students with video scenarios, interactive Q&A and slides focused on improving patient outcomes and ensuring equitable access to “human medicine.”

CHEER. Breastfeeding IPE training.

First Droplets. Electric Pump and Hands-on Pumping (video). (2018).

Newt Newborn Weight Tool. Free downloadable newborn weight tool for pediatric health-care providers and parents to compare a baby’s weight with a research sample of birth weights from more than 100,000 other breastfed newborns. Newt helps identify newborns who may be at risk for excess weight loss so their mothers can get extra breastfeeding support. Newt was developed at Penn State College of Medicine.

Stanford Children’s Health. Premie BiliRecs tool.

The Melanated Mammary Atlas. A mobile-friendly web application that features a searchable directory of images of various breast-related conditions on brown skin. The tool offers the single largest collection of such images for diagnostics, assessment and education purposes.

Texas Women, Infants and Children (WIC), breastfeeding web page for women and families.

U.S. Lactation Consultant Association. (2020). Who’s Who: An at-a-glance look at lactation support in the United States (PDF).

Medications, Supplements and other Substances (Use and Abuse)

Briggs, G. G., Freeman, R. K., Towers, C. V., & Forinash, A. B. (2021). Briggs Drugs in Pregnancy and Lactation. Wolters Kluwer/Lippincott Williams & Wilkins..

Hale’s Medications & Mother’s Milk. (2021). Provides information about the transmission of drugs into breast milk.

Herbal Medicines in Pregnancy and Lactation: An Evidence-Based Approach. (2006). A book for health-care providers that focuses on the safety and risk information of herbs and supplements used during pregnancy and lactation.

LactMed Database, from the National Library of Medicine.
Contains information on medications and other chemicals that may affect breastfeeding mothers, including information about the levels of substances in breast milk and infant blood.

Texas Department of State Health Services. Provider Toolkit to Treat Tobacco Use and Dependence.

Hospital Quality Improvement Initiatives

Baby-Friendly USA. (2012). Baby-friendly hospital initiative.

Carolina Global Breastfeeding Institute. Research-based training focused on the “Three B’s” – birth, breastfeeding and birthspacing.

Texas WIC. Learn more about the Texas 10 Step designation.

W.K. Kellogg Communities and Hospitals Advancing Maternity Practices (CHAMPS), grant program.

Maternal Mental Health

Edinburgh Postnatal Depression Scale (EPDS). A free, 10-item screening tool. A score of 10 or more suggests depressive symptoms. A score of 13 or more indicates a high likelihood of major depression. A score of 1 or more on question 10 is an automatic positive screen because it indicates possible suicidal ideation and requires immediate further evaluation.

Patient Health Questionnaire—9 (PHQ-9). A free, 9-item screening tool in multiple languages. A score of 10 or more indicates a high risk of having or developing depression. A score of 2 or more on question 9 is an automatic positive screen because it indicates possible suicidal ideation and requires immediate further evaluation.

Postpartum Depression Screening Scale. A 35-item, self-report screening tool available for purchase. The tool takes 5-10 minutes to administer and is written at a 3rd grade reading level. A positive score identifies women who should be referred for definitive diagnosis and treatment.

The Surgeon General’s Call to Action to Improve Maternal Health.

Returning to Work and School

Texas Department of State Health Services. Mother-Friendly Worksite program and outreach toolkit for providers.

Texas Mother-Friendly Worksite website.

U.S. Department of Health and Human Services, Office on Women’s Health. Supporting Nursing Moms at Work.

U.S. Department of Labor, Break Time for Nursing Mothers.

U.S. Equal Employment Opportunity Commission, Policy Guidance Related to Pregnancy Discrimination.

Safe Sleep

American Academy of Pediatrics. (2022). Policy Statement: Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment.

American Academy of Pediatrics. (2022). Technical Report: Evidence Base for 2022 Updated Recommendations for a Safe Infant Sleeping Environment to Reduce the Risk of Sleep-Related Infant Deaths. 

American Academy of Pediatrics. Safe Sleep website for health-care providers and families. Includes resources and tools.

Patients and Families

Courses, Tips and Tools for Breastfeeding

American Academy of Pediatrics, healthychildren.org (2022). Breastfeeding: Articles and resources for breastfeeding mothers and families.

Baby-Friendly USA. Exclusive Breastfeeding, Pacifiers and Safe Sleep.

Breastmilkcounts.com from the Texas Health and Human Services Commission:

Texas Lactation Support Centers:

La Leche League International articles:

La Leche League of Texas.

Stanford School of Medicine. Maximizing Milk Production with Hands-On Pumping.

Stanford School of Medicine. (2013). Hand expression of breastmilk (video).

Texas Lactation Support Directory. 

Texas WIC Program. Breastfeeding and Family Planning. Flyer about the Lactational Amenorrhea Method (LAM) and other forms of contraception that can be used while breastfeeding. Available in English and Spanish.

Texas WIC, How do I know if breastfeeding is going well? A self-questionnaire for mothers to determine whether breastfeeding is off to a good start.

Texas Home Visiting. In-home parent education for families with children ages birth through 5 years.

Texas WIC publications that can be ordered by community providers (limited quantities) through the WIC online catalog:

Colostrum Flyer (English) (Spanish)

Poster: How Do I Make Enough Milk? (English) (Spanish)

Texas  Lactation Support  Hotlines. 855-550-6667.

Texas WIC. First Week Daily Breastfeeding Log.

Text4Baby, a helpful resource for breastfeeding mothers from a national public-private partnership that includes the Texas Department of State Health Services and the U.S. Department of Health and Human Services.

UNICEF UK Baby-Friendly Initiative Hand Expression video.

UNICEF UK Baby-Friendly Initiative. Foreign language resources. Information sheets on breastfeeding and bottle feeding available in multiple language to support parents with the basics of feeding and responding to their baby.

U.S. Department of Health and Human Services, WomensHealth.gov. Breastfeeding website.

Medications, Supplements and other Substances (Use and Abuse)

Centers for Disease Control and Prevention. Marijuana Use and Pregnancy, fact sheet.

MommyMeds app. Information from the Infant Risk Center, Texas Tech University Health Sciences Center. Subscription is required.

Texas Department of State Health Services, smoking cessation resources:

Texas Tech University Health Sciences Center, Infant Risk Center. Website with information about medications and breastmilk as well as smartphone apps for breastfeeding mothers and health-care providers.

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. Marijuana – Is it safe during pregnancy or breastfeeding? (video).

Family Support

U.S. Department of Health and Human Services, Women’s Health.gov: Daddy Duty (video)

U.S. Department of Health and Human Services, Women’s Health.gov: Dealing with Lack of Family Support (video)

WIC Partner Resources. (2022).

WIC. Roles for Dads and Grandmas, (video).

WIC Dads Website.

Feeding: Pumping and Formula Preparation

Centers for Disease Control and Prevention. (2022). Infant Formula Preparation and Storage.

Centers for Disease Control and Prevention. (2022). Cleaning Infant Feeding Items (FAQs).

Texas WIC, Breast Pump Program web page.

Pump Program Coordinator: WIC.breastpumps@hhs.texas.gov

Texas WIC, BreastmilkCounts.com, video blog page.

Texas WIC, How to Mix Infant Formula.

U.S. Food and Drug Administration. Breast Pumps website, provides general information about types of breast pumps as well as choosing, buying or renting, and cleaning a breast pump.

Maternal Health Resources

Texas Department of State Health Services. Hear Her Texas. Maternal health materials for pregnant and postpartum women.

Texas Department of State Health Services. Smiles for Moms program, helps women improve their oral health and access dental services during pregnancy.

Texas Department of State Health Services. Tips for Good Oral Health During Pregnancy (fact sheet flier).

Texas Health and Human Services Commission, Medical Transportation Program. May provide non-emergency transportation to patients and families to get to a medical or dental checkup or to a drug store.

Mental Health Resources

National Maternal Health Hotline: 833-943-5746 (833-9-HELP4MOMS). A 24/7, free, confidential hotline to call or text to obtain information or help for pregnant women and mothers, in English and Spanish. TTY users can use a preferred relay service or dial 711 and then 833-943-5746.

Texas Department of State Health Services. Pregnancy, Parenting and Depression Resource List.

U.S. Department of Health and Human Services, Office on Women’s Health. Postpartum Depression.

Milk Banking

Human Milk Banking Association of North America, Find a Milk Bank.

Mothers' Milk Bank at Austin.

Mothers’ Milk Bank of North Texas.

Texas Health and Human Services Commission, policy on reimbursement for human donor milk.

Returning to Work and School

National Conference of State Legislatures, Breastfeeding State Laws.

Texas WIC, Breastmilkcounts.com’s Working Moms section. Offers resources for mothers, including peer counseling, lactation support, videos, interactive educational activities, and tips for combining breastfeeding and working.

Texas Government Code Title 6, Right to Express Breast Milk in the Workplace.

Texas Health and Human Services Commission, Texas WIC. Breastfeeding: The Law, a downloadable wallet card that states Texas law allowing mothers to breastfeed and express milk in any location in which a mother is authorized to be.

Texas Health and Safety Code. Breast-feeding Rights and Policies.

U.S. Department of Labor. (2018). Fact Sheet #73: Break Time for Nursing Mothers under the FLSA.

Support Groups

Baby Café USA. Find A Baby Café by State & Town/City.

Support Groups for Black, Brown, Asian and Indigenous families:

Texas WIC Breastfeeding Peer Counselor Program.

U.S. Department of Health and Human Services, Office on Women’s Health. It’s Only Natural, information for African-American women and their families about the health benefits of breastfeeding.

Traveling with Children and/or Breastmilk

Centers for Disease Control and Prevention. (2021). Travel Recommendations for Nursing Families.

U.S. Transportation Security Administration. Traveling with Children (web page).