10 Steps to Promote & Protect Human Milk and Breastfeeding in Vulnerable Infants

10 Steps to Promote and Protect Human Milk and Breastfeeding in Vulnerable Infants

Background & Goal

The World Health Organization, as well as numerous other worldwide professional groups, recommend that infants are exclusively breastfed for the first six months. In 2014, in the United States, less than 19% of infants were exclusively breastfed for the first six months. The World Health Organization states that millions of infants continue to die from lack of access to human milk/breastfeeding. With the advent of lactation consultants in 1985, many nurses in the United States abdicated their former role as counselor to breastfeeding families. But the continuity of care nurses share with patients is significant, and provides nurses with a unique opportunity to play a critical role in helping breastfeeding families achieve the recommended goal of exclusive breastfeeding for the first 6 months and continued breastfeeding for a year or more.

To increase breastfeeding in the United States, the current focus has been the implementation of the Baby Friendly Hospital Initiative (BFHI). Unfortunately, the BFHI designation neither addresses the needs of vulnerable infants nor includes NICU’s as part of its process. The goal of 10 Steps to Promote & Protect Human Milk and Breastfeeding in Vulnerable Infants is to close the current gap in care that results in our most vulnerable infants, who start life in a NICU and are most in need of human milk, being the least likely to receive human milk at discharge from the NICU.

Program Description

Dr. Spatz has developed a model of care that has been implemented in hospitals throughout the United States and abroad (including all NICU’s in Thailand) to educate health professionals on the best practices for the use of human milk and breastfeeding in vulnerable infants.

For More Information Contact:

Diane L. Spatz, PhD, RN-BC, FAAN

Professor of Perinatal Nursing
Helen M. Shearer Professor of Nutrition 
University of Pennsylvania School of Nursing 
Nurse Researcher-Lactation 
The Children's Hospital of Philadelphia 
418 Curie Boulevard 
Philadelphia, PA 19104-4217

Dr. Spatz provides clinicians with the framework and tools to change practice and achieve measurable results that are personalized, convenient, cost-effective, and innovative. This program addresses the significant health disparity/lack of human milk & breastfeeding culture in the United States and around the world, as well as the critical role of nurses in lactation support. Dr. Spatz has developed training programs for health professionals on strategies for implementing the model.

Evidence of Success

  • In 2000, prior to the implementation of Dr. Spatz’s program, the percentage of NICU infants at Children’s Hospital of Philadelphia (CHOP) receiving human milk at discharge was approximately 30%. Since 2008, because of the implementation of 10 Steps to Promote & Protect Human Milk and Breastfeeding in Vulnerable Infants, over 99% of mothers who deliver in the hospital’s Special Delivery Unit initiate pumping for their critically ill infants.  In 2014, of infants born at CHOP and discharged from the NICU, over 86% were discharged on human milk
  • Furthermore, recent research at CHOP demonstrated that mothers of surgical NICU infant graduates breastfeed on average for 8 months (range 0.25 to 30 months) and provide more exclusive human milk to their infants than both state and national statistics. 
  • Where there were previously no breastfeeding trained staff nurses, CHOP now has over 600 staff nurses trained to provide evidence based lactation support and care so that mothers can reach their personal breastfeeding goals.