breastfeeding benefits essay

Breastfeeding Benefits Both Baby and Mom

Breast milk antibodies help protect a baby from illness.

Breastfeeding has health benefits for both babies and mothers. Breast milk provides a baby with ideal nutrition and supports growth and development. Breastfeeding can also help protect baby and mom against certain illnesses and diseases.

Five great benefits of breastfeeding

• Breast milk is the best source of nutrition for most babies. As the baby grows, the mother’s breast milk will change to meet the baby’s nutritional needs.
• Breastfeeding can help protect babies against some short- and long-term illnesses and diseases. Breastfed babies have a lower risk of asthma, obesity, type 1 diabetes, and sudden infant death syndrome (SIDS). Breastfed babies are also less likely to have ear infections and stomach bugs.
• Breast milk shares antibodies from the mother with her baby. These antibodies help babies develop a strong immune system and protect them from illnesses.

Check out these links to learn more:

• CDC’s Breastfeeding pages
• Office on Women’s Health—Breastfeeding
• CDC’s Infant and Toddler Nutrition pages

Mothers can breastfeed anytime and anywhere. Mothers can feed their babies on the go without worrying about having to mix formula or prepare bottles. When traveling , breastfeeding can also provide a source of comfort for babies whose normal routine is disrupted.

• Breastfeeding can reduce the mother’s risk of breast and ovarian cancer, type 2 diabetes, and high blood pressure. Breastfeeding has health benefits for the mother too! Some cancers, type 2 diabetes, and high blood pressure are less common among women who breastfeed.

The American Academy of Pediatrics recommends exclusive breastfeeding  for about 6 months, and then continuing breastfeeding while introducing complementary foods until a child is 2 years old or older. You can read the full recommendation from the American Academy of Pediatrics.

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The Importance of Breastfeeding Essay

Physical benefits, mental benefits.

Breastfeeding is a particularly important process for both the baby and the mother. This is due to the fact that this procedure has several benefits at once, which every woman who has the opportunity to provide valuable substances and food to her child needs to know. These can be both psychological and physical factors that are especially valuable in the first years of life. Therefore, breastfeeding has a significant positive impact on both mother and child, and knowledge of these aspects is critical.

One of the main benefits of breastfeeding is the provision of essential nutrients. This is due to the fact that the mother’s milk contains all the necessary components that ensure the complete and correct development of the baby (1, 6). In addition, they help to reduce the possibility of problems with the digestive system, such as colic (3). A large amount of essential nutrients also contributes to building a more robust and stronger immunity in infants. This process occurs due to antibodies in the mother’s milk, which help protect babies from infections and illnesses. Another benefit of breastfeeding is assistance in detecting allergic reactions a child might have. This is due to the fact that infants immediately react to any changes in the mother’s diet; thereby, it is possible to timely determine the food to which the child’s body can react.

Considering the health of new mothers, breastfeeding also has some advantages. There is an opinion that it allows new mothers to lose weight gained during pregnancy faster. Moreover, it helps to reduce the uterus to its pre-pregnancy size and significantly reduces bleeding after delivery. On the other hand, it is worth remembering that there may be some deviations in health as breastfeeding lumps (2).

Breastfeeding, in addition to physical benefits, also has psychological benefits for the mother and child. Hence, it is one of the leading agents in establishing a bond between them, which can help foster a close relationship. This is because during this process, there is a crucial skin-to-skin connection, which is strengthened every time. In addition, this time, that mother and baby spend together, can help women to get the rest and relax they need.

It is also worth noting that breastfeeding helps with postpartum recovery. Research stated that “depression and anxiety disorders represent the most common obstetric complications during pregnancy and the first-year post-partum, reducing the mother’s ability to effectively perceive, decipher, and respond to their infant needs” (4). On the other hand, it is noted that “elucidating the relationship between breastfeeding and postpartum depression is challenging because women with depression may have difficulty sustaining breastfeeding, and women who experience breastfeeding difficulties may develop depression” (5). However, despite this factor, many women experience mental problems due to the lack of communication with their children. Therefore, when breastfeeding, they get this precious time and thereby significantly reduce the risk of postpartum depression.

In conclusion, breastfeeding provides a large number of benefits for both the baby and the mother, which women who have the opportunity to feed a newborn in this way should be aware of. Henceforth, among the physical benefits is strengthening the baby’s immunity and providing multiple critical nutrients. On the psychological side, breastfeeding helps strengthen the bond between mother and child and, in some cases, can help with postpartum depression. It is also worth remembering about some complications that may occur, such as lumps in the breasts of women. However, this problem is easily treated in specialized medical facilities.

• Breastfeeding benefits both baby and mom . Centers for Disease Control and Prevention [Internet]. Web.
• Hazell, T. Benign breast disease: Causes, symptoms, and types . Patient [Internet]. 2022. Web.
• Marshall J, Ross S, Buchanan, P, Gavine A. Providing effective evidence-based support for breastfeeding women in primary care . Bmj [Internet], 2021; 375. Web.
• Postpartum depression . Centers for Disease Control and Prevention [Internet]. Web.
• Rivi V, Petrilli G, Blom JMC. Mind the mother when considering breastfeeding . Frontiers [Internet]. 2020; Web.
• The importance of breastfeeding . HSE [Internet]. Web.
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Ages & Stages

Why Breastfeed: Benefits for You & Your Baby

Getting ready for the birth of your baby is an exciting and busy time. One of the most important decisions you will make is how to feed your baby. What matters most is having the information, options and support you need to choose what truly works for you and your family.

Breastfeeding: a natural gift

Breastfeeding provides a lot of perks for babies and nursing parents. That’s why the American Academy of Pediatrics recommends exclusive breastfeeding for a newborn’s first six months, and continued breastfeeding as long as parent and baby like after introducing solid foods. But every family’s situation is different. Not everyone can breastfeed or continue breastfeeding for as long they’d like for various reasons. You may choose to breastfeed for a shorter time or combine breastfeeding with baby formula. Others may nurse their little ones for two years or more.

It's not an all-or-nothing choice

Giving your child at least some breast milk delivers real benefits. And even though exclusive breastfeeding is best in the beginning, this is not an all-or-nothing choice. In general, the longer you breastfeed, the greater the benefits will be to you and your baby, and the longer these benefits will last.

Here are some of the reasons breastfeeding is good for babies:

Human milk provides all the nutrients, calories, and fluids needed for your baby health. It supports your baby’s brain development and growth and is easiest for your little one to digest. Breastfeeding continues to deliver the healthy antibodies your infant naturally received in the womb. This boosts your baby’s immunity to everything from the common cold to more serious conditions. In fact, research shows that breastfeeding offers protection from asthma, eczema, diabetes, obesity, leukemia, tooth decay, ear infections, persistent diarrhea and much more. Studies also show that breastfeeding reduces your child’s risks for Sudden Infant Death Syndrome (SIDS) as well as other causes of infant death, and even is linked to higher IQ. After giving your baby only breast milk for the first six months, nursing can continue as long as you and your baby wish. Nutritious solid foods , those with iron and zinc, should be introduced around six months. The only other thing you will need to give your baby is vitamin D drops, beginning soon after birth.

Feeding your baby will always provide snuggle time. But the physical, skin-to-skin contact of nursing helps create a special bond between you and your baby. Your baby will be comforted by the scent of your skin, the sound of your heartbeat and even the flavor of your milk. Breast milk has a naturally sweet taste, but also changes flavors depending on what you eat. No two meals are the same for your baby. This can have the added bonus of making them more likely to enjoy new foods you offer once they start eating solids.

Why is breastfeeding good for me?

Here are some of the ways breastfeeding benefits parents:

If you’re the parent producing milk, your own health will benefit. It can help you recover from childbirth more quickly and easily. Hormones released during breastfeeding help the uterus to its regular size more quickly and can reduce postpartum bleeding.

Likely because of hormonal changes, breastfeeding protects you against diabetes, high blood pressure and cancers of the breast and ovaries. It may also help keep bones strong, which helps protect against bone fractures in older age. It also triggers the release of oxytocin, a hormone that has been linked with feelings of empathy, affection, calmness and positive communication—all of which can help you be the warm, attentive parent you want to be.

Breastfeeding can save money & prep time

Unlike formula, breast milk requires no purchase or preparation. Breastfeeding is also good for the environment, since there are no bottles to wash or formula cans to throw away. It’s wonderful, too, to be able to pick up the baby and go out—whether around town or on longer trips—without having to pack and carry a bag full of feeding equipment.

And while you may want to invest in a breast pump to make feeding more convenient, the cost of buying or renting a pump will likely be less than a year’s supply of formula. Plus, it is often reimbursed by insurance plans.

Breastfeeding supports contraception

Breastfeeding parents often find that their period does not return, especially during the first six months after birth. This can help keep iron in your body and may offer some natural contraceptive benefits. If you are giving your child only breast milk during this time, the baby is not yet six months, AND your period has not returned chances are good that you will not ovulate. (No ovulation, no pregnancy!) In fact, if you meet all three of these conditions, the level of contraceptive protection approaches 98%.

Overcoming challenges to breastfeeding

Finding expert support.

For many nursing parents and babies, breastfeeding goes smoothly from the start. For others, it takes a little time and several attempts to get the process going effectively. Sore nipples, milk supply issues, not to mention the need to sit still for hours every day are very real issues. Talking with a midwife, lactation consultant, or doctor trained in breastfeeding right after birth can help. They can show you helpful techniques and breastfeeding positions that can help relieve nipple pain. Your pediatrician or OB-GYN can check your breasts during your postpartum visit and suggest ways to ease any discomfort you’re feeling.

Community & workplace support

There’s also the time and space it can take to breastfeed or pump your milk. It can be challenging to step away to do this, and there are some jobs that can make near impossible. This is one reason why support from partners, families, employers and communities is key. More and more employers are adopting breastfeeding-friendly policies, and laws in all 50 states protect parents’ right to breastfeed in public. By seeking the support that you need, including hands-on help at home and work, chances are good you may find the time and space to breastfeed successfully.

• Breastfeeding: AAP Policy Explained
• Breastfeeding Benefits Your Baby's Immune System
• Why Breastfeeding Parents Need More Support

The Radical Joy of Breastfeeding My 3-Year-Old

I’m not supposed to say that I breastfeed my 3-year-old because I like it. I’m supposed to say he needs it, he won’t quit. That I’m surrendering my body and time on the altar of attentive, attached motherhood. He enjoys it too, of course. He usually asks. I rarely offer. We do it a couple of times a day. More on weekends or when he’s hurt, sick, or just wants to. It also feels good. To me. It eases my anxiety. It is sentimental, sensory, and sensual. It fills me with love.

My son is large—in the 99th percentile for weight and height—so when he sits in my lap, his legs extend off the furniture, though he tries to curl them to become the smaller baby he once was. He squeals, then smushes my breast to his face with both hands, sometimes sucking and looking at me, sometimes drinking while driving a Matchbox car along my collarbone.

Years earlier, back in college, I sat beside a mother on an airplane who asked if I minded as she nursed her toddler. I said no, of course not. She schooled me on benefits for babies and the politics of nursing in public. I nodded, tried not to look. I remember feeling a blend of sympathy and discomfort as I tried on a mother identity in my mind—imagined whether I would ever breastfeed in that way, in public, a kid old enough to run, to feed himself, to speak multiclause sentences. It was my first exposure to a person nursing in front of me. I would barely experience that again until my own baby was at my breast.

More from TIME

Read More: I Thought I Had to Breastfeed My Babies. Then I Lost My Breasts

Breastfeeding is necessary and magical, yet American society stymies it from go. Babies need near constant access to their mothers’ bodies and uninterrupted time to figure out feeding, all but impossible in a country that sends a quarter of moms back to work two weeks after birth, denies postpartum support and paid leave, and assaults women’s autonomy. Any modicum of breastfeeding tolerance is for infants doing it, “breast is best” and all. It’s taboo to practice extended breastfeed (i.e., to breastfeed full-on kids). Calling it “extended” makes it an oddity—past what is expected, normal, or reasonable. Beyond its purpose to supply a product that can be extracted in private, fed to your kid by anyone. A pediatrician and an obstetrician separately told me that breastfeeding beyond six months is “just for the mom.” It’s almost certainly not. But so what if it is? It’s curious that when the act tips from benefiting babies to benefiting mothers, the censure flares.

The bulk of research devoted to understanding breastfeeding is on the nutritive benefits during the first six months to the first year of an infant’s life.While bodies like the WHO recommend breastfeeding babies for up to two years or beyond , we know practically nothing about breastfeeding beyond year one because we don’t study it. Still, we do know that breastfeeding’s rewards for mom–at least for the period that’s been the focus of research–are manifold and significant. It has been linked to a reduction in breast and ovarian cancer, and thanks to the oxytocin hit you get when you do it, you may experience a reduction in postpartum depression, stress, and anxiety. It can feel good in your head, in your body. It can create a closeness with your kid. Yet, by the time breastfeeding moves beyond necessity, beyond engorgement, spraying milk everywhere and soaking clothes, you’re urged to quit. Because doing it “for the mom” is wrong.

No one should feel shame about their feeding choices—everyone should make decisions that suit their body and family. I really appreciate that my kid comes to nurse for comfort, to regroup, as a pick-me-up or expression of love, rather than for a meal. Most women won’t experience this. The majority of people giving birth want to breastfeed, but only a quarter of moms exclusively breastfeed for their infant’s first six months as the CDC recommends .

We’re told infant feeding is individual choice. But the hurdles are institutional. “Women not meeting breastfeeding goals is presented as individual failure. That is such a lie. It’s such a fiction,” says Katie Hinde, a lactation researcher and professor of evolutionary biology at Arizona State University. We should receive far more support—from caregivers, health providers, work, family, the government, society. We all deserve the possibility of breastfeeding our kids for as long as we want, if we want to at all, but it’s a choice far too few people get to make.

Read More: Allyson Felix on How Motherhood Made Her an Activist

Even for those who manage to overcome the societal stigma and dearth of support to breastfeed babies in the early months, extended breastfeeding remains largely elusive, because stopping is what’s expected, or demanded. What feels like a natural conclusion to breastfeeding is actually a confluence of forces masquerading as care. As concern for mom, even—her body, space, money, and time. Breastfeeding your kid takes away your productivity and time with other people, so the pump and the bottle are presented as paths to freedom. Instead, they are the beginning of the end.

I think about this now, as I look forward to returning home at the end of the day to nurse my kid who is almost 4. It’s when my shoulders lower, I exhale deeply, snuggle him close, look in his eyes, and get a shot of oxytocin. To nurse is to be flooded with love. Sometimes I wonder why we must find verbal substitutes for what our bodies know and can communicate.

We are a universe away from the existential chaos of infant feeding—stressing that he isn’t getting enough ounces, trying to soothe cracked nipples, and being milked by my partner to unclog my ducts. Breastfeeding now feels gratifying, pleasurable, and anxiety reducing. The longer I do it and enjoy it, the more radical it feels. I’m saying I can do with my body what I want.

This article has been adapted from Birth Control: The Insidious Power of Men Over Motherhood, by Allison Yarrow. Copyright © 2023. Available from Seal Press, an imprint of Perseus Books, LLC, a subsidiary of Hachette Book Group, Inc.

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What are the benefits of breastfeeding?

Research shows that breastfeeding offers many health benefits for infants and mothers, as well as potential economic and environmental benefits for communities.

Breastfeeding provides essential nutrition. Among its other known health benefits are some protection against common childhood infections and better survival during a baby's first year, including a lower risk of  Sudden Infant Death Syndrome . 1

Research also shows that very early skin-to-skin contact and suckling may have physical and emotional benefits. 2

Other studies suggest that breastfeeding may reduce the risk for certain allergic diseases, asthma, obesity, and type 2 diabetes. It also may help improve an infant's cognitive development. However, more research is needed to confirm these findings.

For more specific information about the health benefits of breastfeeding, visit one of the following resources:

• Policy Statement: Breastfeeding and the Use of Human Milk  
• Clinical Report: Safe Sleep and Skin-to-Skin Care in the Neonatal Period for Healthy Term Newborns  
• Breastfeeding Benefits Your Baby's Immune System  
• Psychological Benefits of Breastfeeding  
• Info for Health Care Providers: Clinical Guidelines  
• FAQ: Breastfeeding Your Baby  
• HHS Office of Women's Health: Why Breastfeeding Is Important
• UNICEF: Breastfeeding and Complementary Feeding  
• Call to Action to Support Breastfeeding
• Fact Sheet on Call to Action to Support Breastfeeding
• World Health Organization: Breastfeeding  
• American Academy of Pediatrics. (2012). Breastfeeding and the use of human milk. Pediatrics, 129(3) , e827–e841. Retrieved April 27, 2012, from https://pediatrics.aappublications.org/content/129/3/e827  
• Feldman-Winter, L., & Goldsmith, J. P.; Committee on Fetus and Newborn, Task Force on Sudden Infant Death Syndrome. (2016). Safe sleep and skin-to-skin care in the neonatal period for healthy term newborns. Pediatrics, 138 (3), e20161889. Retrieved December 20, 2016, from http://pediatrics.aappublications.org/content/early/2016/08/18/peds.2016-1889  

Benefits of breastfeeding

Home > About the Baby Friendly Initiative > The benefits of breastfeeding

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Our work to support breastfeeding is based on extensive and resounding evidence that breastfeeding saves lives, improves health and cuts costs in every country worldwide..

• Infant health : Breastfeeding protects children from a vast range of illnesses, including infection, diabetes, asthma, heart disease and obesity, as well as cot death (Sudden Infant Death Syndrome)
• Maternal health : Breastfeeding also protects mothers from breast and ovarian cancers and heart disease
• Relationship-building : Breastfeeding supports the mother-baby relationship and the mental health of both baby and mother
• Worldwide benefits : The benefits are seen in both high- and low-income countries, with a study published in The Lancet in 2016 finding that increasing breastfeeding rates around the world to near universal levels could prevent 823,000 annual deaths in children younger than five years and 20,000 annual maternal deaths from breast cancer
• Cost savings: Breastfeeding contributes to significant savings to the NHS, with initial investments paying off within just a few years. A NICE costing report estimates that Baby Friendly accreditation will start to save a facility money after three years, owing to a reduction in the incidence of certain childhood illnesses. Baby Friendly’s report  Preventing disease and saving resources  found that moderate increases in breastfeeding would translate into cost savings for the NHS of many millions of pounds, and tens of thousands of fewer hospital admissions and GP consultations. In addition, Baby Friendly’s staged approach to assessment and accreditation allows facilities to spread costs and enables better financial planning.

Key sources of breastfeeding research

• Lancet breastfeeding series : Confirms the benefits of breastfeeding for children and mothers, regardless of whether they live in high- or low-income nations, and that countries are not doing enough to support breastfeeding
• Acta Paediatrica special issue on breastfeeding : Finds that the health benefits of breastfeeding are substantial, lasting well beyond the period of breastfeeding and affecting high- and low-income populations alike, whilst also demonstrating that the Baby Friendly Initiative is highly effective in improving breastfeeding rates
• Evidence and rationale for the Baby Friendly standards
• Preventing disease and saving resources : Looks at the potential health and cost contributions of increasing breastfeeding rates in the UK.

Find our more in our research section .

Breastfeeding is a natural 'safety net' against the worst effects of poverty ... Exclusive breastfeeding goes a long way toward cancelling out the health difference between being born into poverty and being born into affluence ... It is almost as if breastfeeding takes the infant out of poverty for those first few months in order to give the child a fairer start in life and compensate for the injustice of the world into which it was born.

About the Baby Friendly Initiative

Breastfeeding in the uk, call to action on infant feeding in the uk, baby friendly standards.

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Institute of Medicine (US) Committee on Nutritional Status During Pregnancy and Lactation. Nutrition During Lactation. Washington (DC): National Academies Press (US); 1991.

Nutrition During Lactation.

• Hardcopy Version at National Academies Press

1 Summary, Conclusions, and Recommendations

During the past decade, the benefits of breastfeeding have been emphasized by many authorities and organizations in the United States. Federal agencies have set specific objectives to increase the incidence and duration of breastfeeding (DHHS, 1980, 1990), and the Surgeon General has held workshops on breastfeeding and human lactation (DHHS, 1984, 1985). At the federal and state levels, the Special Supplemental Food Program for Women, Infants, and Children (WIC) has produced materials designed to promote breastfeeding (e.g., Malone, 1980; USDA, 1988). Furthermore, the Office of Maternal and Child Health has sponsored breastfeeding projects (e.g., The Steering Committee to Promote Breastfeeding in New York City, 1986), as have state health departments and others. However, less attention has been given to two general topics: (1) the effects of breastfeeding on the nutritional status and long-term health of the mother and (2) the effects of the mother's nutritional status on the volume and composition of her milk and on the potential subsequent effects of those changes on infant health. The present report was designed to address these topics.

This summary briefly describes the origin of this effort and the process; provides key definitions; reviews what was learned about who is breastfeeding in the United States and if those women are well nourished; discusses nutritional influences on milk volume or composition; and describes how breastfeeding may affect infant growth, nutrition, and health, as well as maternal health. It then presents major conclusions, clinical recommendations, and the research recommendations most directly related to the nutrition of lactating women in the United States.

• Origin Of This Study

This study was undertaken at the request of the Maternal and Child Health Program (Title V, Social Security Act) of the Health Resources and Services Administration, U.S. Department of Health and Human Services. In response to that request, the Food and Nutrition Board's Committee on Nutritional Status During Pregnancy and Lactation and its Subcommittee on Nutrition During Lactation were asked to evaluate current scientific evidence and formulate recommendations pertaining to the nutritional needs of lactating women, giving special attention to the needs of lactating adolescents; women over age 35; and women of black, Hispanic, or Southeast Asian origin. Part of this task included consideration of the effects of maternal dietary intake and nutritional status on the volume and composition of human milk, the appropriateness of various anthropometric methods for assessing nutritional status during lactation, and the effects of lactation both on maternal and infant health and on the nutritional status of both the mother and the infant.

• Approach To The Study

The study was limited to consideration of healthy U.S. women and their healthy, full-term infants. The Subcommittee on Nutrition During Lactation conducted an extensive literature review, consulted with a variety of experts, and met as a group seven times to discuss the data and draw conclusions from them. The Committee on Nutritional Status During Pregnancy and Lactation (the advisory committee) reviewed and commented on the work of the subcommittee and helped establish appropriate linkages between this report and the reports on weight gain and nutrient supplements during pregnancy contained in Nutrition During Pregnancy —a report prepared by two other subcommittees of this advisory committee (IOM, 1990). Compared with earlier reports from the National Research Council, Nutrition During Pregnancy recommended a higher range of weight gain (11.5 to 16 kg, or 25 to 35 lb, for women of normal prepregnancy weight for height). In addition, it advised routine low-dose iron supplementation during pregnancy, but supplements of other vitamins or minerals were recommended only under special circumstances.

In examining the nutritional needs of lactating women, priority was given to energy and to those nutrients believed to be consumed in amounts lower than Recommended Dietary Allowances (RDAs) by many women in the United States. These nutrients include calcium, magnesium, iron, zinc, folate, and vitamin B 6 . Careful attention was given to the effects of lactation on various indicators of nutritional status, such as measurements of levels of biochemical compounds; functions related to specific nutrients; nutrient levels in specific body compartments; and height, weight, or other indicators of body size or adiposity. The subcommittee took into consideration that weight gain recommendations for pregnant women have been raised (see Nutrition During Pregnancy [IOM, 1990]) and that average weight gains of U.S. women during pregnancy have risen over the past two decades.

When possible, a distinction was made between exclusive breastfeeding, defined as the consumption of human milk as the sole source of energy, and partial breastfeeding, defined as the consumption of human milk in combination with formula or other foods, or both.

The nutritional demands imposed by lactation were estimated from data on volume and composition of milk produced by healthy, successfully lactating women, as done in Recommended Dietary Allowances (NRC, 1989). When it was feasible, evidence relating to possible depletion of maternal stores or to a decrease in the specific nutrient content of milk resulting from low maternal intake of the nutrient was also addressed. Because of the complex relationships between the nutrition of the mother and infant, the subcommittee examined the nutrition and growth of the breastfed infant.

The terms maternal health and infant health were interpreted in a broad sense. Consideration was given to both beneficial and adverse consequences for the health of the mother and her offspring, both during lactation and long after breastfeeding has been discontinued. For the mother, there was a search for evidence of differences in outcome related to whether or not she had breastfed. For the infant, evidence was sought for differences in outcome related to the method of feeding (breast compared with bottle). The possible influences of breastfeeding on prevention or promotion of chronic disease were addressed.

To the extent possible, this report includes detailed coverage of published evidence linking maternal nutrition, breastfeeding, and maternal and infant health. Because breastfeeding is encouraged primarily as a method for promoting the health of infants, considerable attention is also directed toward infant health even when there is no established relationship to maternal nutritional status. Recognizing the serious gaps in knowledge of nutrition during lactation, the subcommittee gave much thought to establishing directions for research.

The members of the subcommittee realized that nutrition is not the sole determinant of successful breastfeeding. A network of overlapping social factors including access to maternal leave, instructions concerning breastfeeding, availability of prenatal care, the length of hospital stay following delivery, infant care in the workplace, and the public attitudes toward breastfeeding are important. Given the goals of this report, the subcommittee did not specifically address those factors, but it recognizes that they should be considered in depth by public health groups that are attempting to improve rates of breastfeeding in this and other countries.

• What Was Learned

Who Is Breastfeeding

The incidence and duration of breastfeeding changed markedly during the twentieth century—first declining, then rising, and, from the early 1980s, declining once again. Currently, women who choose to breastfeed tend to be well educated, older, and white. Data on the incidence and duration of breastfeeding in the United States are especially limited for mothers who are economically disadvantaged and for those who are members of ethnic minority groups. The best data for any minority groups are for black women. Their rates of breastfeeding are substantially lower than those for white women, but factors that distinguish breastfeeding from nonbreastfeeding women tend to be similar among black and white women. Social, cultural, economic, and psychological factors that influence infant feeding choices by adolescent mothers are not well understood. In the United States, where few employers provide paid maternity leave, return to work outside the home is associated with a shorter duration of breastfeeding, but little else is known about when mothers discontinue either exclusive or partial breastfeeding. Such data are needed to estimate the total nutrient demands of lactation.

How Can It Be Determined Whether Lactating Women Are Well Nourished

The few lactating women who have been studied in the United States have been characterized as well nourished, but this observation cannot be generalized since these subjects were principally white women with some college education. Women from less advantaged, less well studied populations may be at higher risk of nutritional problems but tend not to breastfeed.

To determine whether women are adequately nourished, investigators use biochemical or anthropometric methods, or both. For lactating women, however, there are serious gaps and limitations in the data collected with these methods. Consequently, there is no scientific basis for determining whether poor nutritional status is a problem among certain groups of these women. To identify the nutrients likely to be consumed in inadequate amounts by lactating women, the subcommittee used an approach involving nutrient densities (nutrient intakes per 1,000 kcal) calculated from typical diets of nonlactating U.S. women. That is, they made the assumption that the average nutrient densities of the diets of lactating women would be the same as those of nonlactating women but that lactating women would have higher total energy intake (and therefore higher nutrient intake). Using this approach, the nutrients most likely to be consumed in amounts lower than the RDAs for lactating women are calcium, zinc, magnesium, vitamin B 6 , and folate.

Data for U.S. women indicate that successful lactation occurs regardless of whether a woman is thin, of normal weight, or obese. Anthropometric measurements (such as weight, weight for height, and skinfold thickness) have not been useful for predicting the success of lactation among the few U.S. women who have been studied. The predictive ability is not known for anthropometric measurements that fall outside the ranges observed in these limited samples.

Lactating women eating self-selected diets typically lose weight at the rate of 0.5 to 1.0 kg (˜1 to 2 lb) per month in the first 4 to 6 months of lactation. Such weight loss is probably physiologic. During the same period, values for subscapular and suprailiac skinfold thickness also decrease; triceps skinfold thickness does not. Not all women lose weight during lactation; studies suggest that approximately 20% may maintain or gain weight.

Biochemical data for lactating women have been obtained only from small, select samples. Such data are of limited use in the clinical situation because there are no norms for lactating women, and the norms for nonpregnant, nonlactating women may not be applicable to breastfeeding women. For example, there appear to be changes in plasma volume post partum, and there are changes in blood nutrient values over the course of lactation that are unrelated to changes in plasma volume.

Does Maternal Nutritional Status or Dietary Intake Influence Milk Volume

The mean volume of milk secreted by healthy U.S. women whose infants are exclusively breastfed during the first 4 to 6 months is approximately 750 to 800 ml/day, but there is considerable variability from woman to woman and in the same woman at different times. The standard deviation of daily milk intake by infants is about 165 ml; thus, 5% of women secrete less than 550 ml or more than 1,200 ml on a given day. The major determinant of milk production is the infant's demand for milk, which in turn may be influenced by the size, age, health, and other characteristics of the infant as well as by his or her intake of supplemental foods. The potential for milk production may be considerably higher than that actually produced, as evidenced by findings that the milk volumes produced by women nursing twins or triplets are much higher than those produced by women nursing a single infant.

Studies of healthy women in industrialized countries demonstrate that milk volume is not related to maternal weight or height or indices of fatness. In developing countries, there is conflicting evidence about whether thin women produce less milk than do women with higher weight for height.

Increased maternal energy intake has not been linked with increased milk production, at least among well-nourished women in industrialized countries. Nutritional supplementation of lactating women in developing countries where undernutrition may be a problem has generally been reported to have little or no impact on milk volume, but most studies have been too small to test the hypothesis adequately and lacked the design needed for causal inference. Studies of animals indicate that there may be a threshold below which energy intake is insufficient to support normal milk production, but it is likely that most studies in humans have been conducted on women with intakes well above this postulated threshold.

The weight loss ordinarily experienced by lactating women has no apparent deleterious effects on milk production. Although lactating women typically lose 0.5 to 1 kg (˜1 to 2 lb) per month, some women lose as much as 2 kg (˜4 lb) per month and successfully maintain milk volume. Regular exercise appears to be compatible with production of an adequate volume of milk.

The influence of maternal intake of specific nutrients on milk volume has not been investigated satisfactorily. Early studies in developing countries suggest a positive association of protein intake with milk volume, but those studies remain inconclusive. Fluids consumed in excess of thirst do not increase milk volume.

Does Maternal Nutritional Status Influence Milk Composition

The composition of human milk is distinct from the milk of other mammals and from infant formulas ordinarily derived from them. Human milk is unique in its physical structure, types and concentrations of macronutrients (protein, fat, and carbohydrate), micronutrients (vitamins and minerals), enzymes, hormones, growth factors, host resistance factors, inducers/modulators of the immune system, and anti-inflammatory agents.

A number of generalizations can be made about the effects of maternal nutrition on the composition of milk (see also Table 1-1 ):

Possible Influences of Maternal Intake on the Nutrient Composition of Human Milk and Nutrients for Which Clinical Deficiency Is Recognizable in Infants.

• Even if the usual dietary intake of a macronutrient is less than that recommended in Recommended Dietary Allowances (NRC, 1989), there will be little or no effect on the total amount of that nutrient in the milk. However, the proportions of the different fatty acids in human milk vary with maternal dietary intake.
• The concentrations of major minerals (calcium, phosphorus, magnesium, sodium, and potassium) in human milk are not affected by the diet. Maternal intakes of selenium and iodine are positively related to their concentrations in human milk, but there is no convincing evidence that the concentrations of other trace elements in human milk are affected by maternal diet.
• The vitamin content of human milk is dependent upon the mother's current vitamin intake and her vitamin stores, but the strength of the relationships varies with the vitamin. Chronically low maternal intake of vitamins may result in milk that contains low amounts of these essential nutrients.
• The content of at least some nutrients in human milk may be maintained at a satisfactory level at the expense of maternal stores. This applies particularly to folate and calcium.
• Increasing the mother's intake of a nutrient to levels above the RDA ordinarily does not result in unusually high levels of the nutrient in her milk; vitamins B 6 and D, iodine, and selenium are exceptions. Studies have not been conducted to evaluate the possibility that high levels of nutrients in milk are toxic to the infant.
• Some studies suggest that poor maternal nutrition is associated with decreased concentrations of certain host resistance factors in human milk, whereas other studies do not suggest this association.

In What Ways May Breastfeeding Affect Infant Growth and Health

Infant nutrition.

Several factors influence the nutritional status of the breastfed infant: the infant's nutrient stores (which are largely determined by the length of gestation and maternal nutrition during pregnancy), the total amount of nutrients supplied by human milk (which is influenced by the extent and duration of breastfeeding), and certain genetic and environmental factors that affect the way nutrients are absorbed and used.

Human milk is ordinarily a complete source of nutrients for the exclusively breastfed infant. However, if the infant or mother is not exposed regularly to sunlight or if the mother's intake of vitamin D is low, breastfed infants may be at risk of vitamin D deficiency. Breastfed infants are susceptible to deficiency of vitamin B 12 if the mother is a complete vegetarian—even when the mother has no symptoms of that vitamin deficiency.

The risk of hemorrhagic disease of the newborn is relatively low. Nonetheless, all infants (regardless of feeding mode or of maternal nutritional status) are at some risk for this serious disease unless they are supplemented with a single dose of vitamin K at birth.

Full-term, exclusively breastfed infants ordinarily maintain a normal iron status for their first 6 months of life, regardless of maternal iron intake. Providing solid foods may reduce the percentage of iron absorbed by the partially breastfed infant, making it important in such cases to ensure that adequate iron is provided in the diet.

Growth and Development

Breastfed infants gain weight at about the same rate as formula-fed infants during the first 2 to 3 months post partum, although breastfed infants usually ingest less milk and thus have a lower energy intake. After the first few months post partum, healthy breastfed infants gain weight more slowly than those who are formula fed. In general, this pattern is not altered by the introduction of solid foods. Differences in linear growth between breastfed and formula-fed infants are small if statistical techniques are used to control differences in size at birth.

Infant Morbidity and Mortality

Several types of health problems occur less often or appear to have less serious consequences in breastfed than in formula-fed infants. These include certain infectious diseases (especially ones involving the intestinal and respiratory tracts), food allergies, and, perhaps, certain chronic diseases. There is suggestive evidence that severe maternal malnutrition might reduce the degree of immune protection afforded by human milk, but further studies will be required to address that issue.

Few infectious agents are commonly transmitted to the infant via human milk. The most prominent ones are cytomegalovirus in all populations that have been studied and human T lymphocytotropic virus type 1 (HTLV-1) in certain Asian populations. The transmission of cytomegalovirus by breastfeeding does not result in disease; the consequences of the transmission of HTLV-1 by breastfeeding are unknown. There are some case reports that indicate that human immunodeficiency virus (HIV) can be transmitted by breastfeeding as a result of the transfusion of HIV-contaminated blood during the immediate postpartum period. The likelihood of transmitting HIV via breastfeeding by women who tested seropositive for the agent during pregnancy has not been determined. Public policy on this issue has ranged from the Centers for Disease Control's recommendation not to breastfeed under these circumstances to the World Health Organization's encouragement to breastfeed, especially among women in developing countries.

In developing countries, mortality rates are lower among breastfed infants than among those who are formula fed. It is not known whether this advantage also holds in industrialized countries, in which death rates are lower in general. It is reasonable to believe that breastfeeding will lead to lower mortality among disadvantaged groups in industrialized countries if they have higher than usual infant and child mortality rates, but this issue has not been studied.

Medications, Drugs, and Environmental Contaminants

The few prescription drugs that are contraindicated during lactation because of potential harm to the infant can usually be avoided and replaced with safer acceptable ones. For example, there are a number of safe and effective substitutes for the antibiotic chloramphenicol, which is contraindicated for lactating women. If treatment with antimetabolites or radiotherapeutics is required by the mother, breastfeeding is contraindicated.

Cigarette smoking and alcohol consumption by lactating women in excess of 0.5 g/kg of maternal weight may be harmful to the infant, partly because of potential reduction in milk volume. Furthermore, a single report (Little et al., 1989) associates heavy alcohol use by the mother with retarded psychomotor development of the infant at 1 year of age. Infrequent cigarette smoking, occasional consumption of small amounts of alcohol, and moderate ingestion of caffeine-containing products are not considered to be contraindicated during breastfeeding. Use of illicit drugs is contraindicated because of the potential for drug transfer through the milk as well as hazards to the mother. Since the limited information on the impact of these habits upon the nutrition of women in the childbearing years is reviewed in Nutrition During Pregnancy (IOM, 1990), they were not considered further by this subcommittee.

In the uncommon situation of a high risk of exposure to such environmental contaminants as organochlorinated compounds (such as dichlorodiphenyl-trichloroethane [DDT] or polychlorinated biphenyls [PCBs]) or toxic metals (such as mercury), risks must be weighed against the benefits of breastfeeding for both mother and infant on a case-by-case basis. In areas of unusually high exposure, levels of the contaminant should be measured in the mother's blood and milk.

How Does Breastfeeding Affect Maternal Nutrition and Health

Breastfeeding substantially increases the mother's requirements for most nutrients. The magnitude of the total increase is most strongly affected by the extent and duration of lactation. Adequacy of intakes of calcium, magnesium, zinc, folate, and vitamin B 6 merits special attention since average intakes may be below those recommended. The net long-term effect of lactation on bone mass is uncertain. Some data associate lactation with short-term bone loss, whereas most recent studies suggest a protective long-term effect. Those data are provocative but of such preliminary nature that no definitive conclusions may be drawn from them.

Although most lactating women lose weight gradually during lactation, some do not. The influence of lactation on long-term postpartum weight retention and maternal risk of adult-onset obesity has not been determined.

A well-documented effect of lactation is delayed return to ovulation. In addition, some recent epidemiologic evidence indicates that breastfeeding may lessen the risk that the mother will develop breast cancer, but the data are not consistent across all studies.

• Conclusions And Recommendations

The major conclusions of the report are as follows.

Women living under a wide variety of circumstances in the United States and elsewhere are capable of fully nourishing their infants by breastfeeding them. Throughout its deliberations, the subcommittee was impressed by evidence that mothers are able to produce milk of sufficient quantity and quality to support growth and promote the health of infants—even when the mother's supply of nutrients and energy is limited. With few exceptions (identified later in the summary under "Infant Growth and Nutrition"), the full-term exclusively breastfed infant will be well nourished during the first 4 to 6 months after birth.

In contrast, the lactating woman is vulnerable to depletion of nutrient stores through her milk. Measures should be taken to promote food intake during lactation that will prevent net maternal losses of nutrients, especially of calcium, magnesium, zinc, folate, and vitamin B 6 .

Breastfeeding is recommended for all infants in the United States under ordinary circumstances. Exclusive breastfeeding is the preferred method of feeding for normal full-term infants from birth to age 4 to 6 months. Breastfeeding complemented by the appropriate introduction of other foods is recommended for the remainder of the first year, or longer if desired. The subcommittee and advisory committee recognize that it is difficult for some women to follow these recommendations for social or occupational reasons. In these situations, appropriate formula feeding is an acceptable alternative.

Data are lacking for use in developing strategies to identify lactating women who are at risk of depleting their own nutrient stores. Although nutrient intake appears adequate for the small number of lactating women who have been studied in the United States, evidence from U.S. surveys of nonpregnant, nonlactating women suggests that usual dietary intake of certain nutrients by disadvantaged women is likely to be somewhat lower than that by women of higher socioeconomic status. Thus, if breastfeeding rates increase among less advantaged women as a result of efforts to promote breastfeeding, it will be important to examine more completely the nutrient intake of these women during lactation.

If lactating women follow eating patterns similar to those of the average U.S. woman in sufficient quantity to meet their energy requirements, they are likely to meet the recommended intakes of all nutrients except perhaps calcium and zinc. However, if they curb their energy intakes, their intakes of several nutrients are likely to be less than the RDA.

Recommendations for Women Who Wish To Breastfeed and for Their Care Providers

Because of serious gaps in information about nutrition assessment and nutrient requirements during lactation and about effects of maternal nutrition on the wide array of components in the milk, the following recommendations should be considered preliminary. Although they reflect the best judgment of the subcommittee and advisory committee, these recommendations are open to reconsideration as the knowledge base grows.

Diet and Vitamin-Mineral Supplementation

Lactating women should be encouraged to obtain their nutrients from a well-balanced, varied diet rather than from vitamin-mineral supplements.

• Provide women who plan to breastfeed or who are already doing so with nutrition information that is culturally appropriate (that is, information that is sensitive to the foodways, eating practices, and health beliefs and attitudes of the cultural group). To facilitate the acquisition of this information, health care providers are encouraged to make effective use of teaching opportunities during prenatal visits, hospitalization following delivery, and routine postpartum visits for maternal or pediatric care.
• Encourage lactating women to follow dietary guidelines that promote a generous intake of nutrients from fruits and vegetables, whole-grain breads and cereals, calcium-rich dairy products, and protein-rich foods such as meats, fish, and legumes. Such a diet would ordinarily supply a sufficient quantity of essential nutrients. The individual recommendations should be compatible with the woman's economic situation and food preferences. The evidence does not warrant routine vitamin-mineral supplementation of lactating women.
• If dietary evaluation suggests that the diet does not provide the recommended amounts of one or more nutrients, encourage the woman to select and consume foods that are rich in those nutrients.
• For women whose eating patterns lead to a very low intake of one or more nutrients, provide individualized diet counseling (preferred) or recommend nutrient supplementation (as described in Table 1-2 ).
• Encourage sufficient intake of fluids—especially water, juice, and milk—to alleviate natural thirst. It is not necessary to encourage fluid intakes above this level.
• The elimination of major nutrient sources (e.g., all dairy products) from the maternal diet to treat allergy or colic in the breastfed infant is not recommended unless there is evidence from oral elimination-challenge studies to determine whether the mother is sensitive or intolerant to the food or that the breastfed infant reacts to the foods ingested by the mother. If a key nutrient source is eliminated from the maternal diet, the mother should be counseled on how to achieve adequate nutrient intake by substituting other foods.

Suggested Measures for Improving Nutrient Intake of Women with Restrictive Eating Patterns.

A Defined Health Care Plan for Lactating Women

There should be a well-defined plan for the health care of the lactating woman that includes screening for nutritional problems and providing dietary guidance. Since preparation for lactation should begin during the prenatal period, the physician, midwife, nutritionist, or other member of the obstetric team should introduce general information about nutrition during lactation and should screen for possible problems related to nutrition. Ideally, more extensive evaluation and counseling should take place during hospitalization for childbirth. If that is precluded by the brevity of the hospital stay, an early visit to an appropriate health care professional by the mother or a visit to the mother's home is advisable.

To implement routine screening economically and practically, the subcommittee considers it sufficient to continue the practice of weighing women (using standard procedures as described in Nutrition During Pregnancy [IOM, 1990]) at scheduled visits and to ask a few simple questions to determine the following:

• Are calcium-rich foods eaten regularly?
• Does the diet include vitamin D-fortified milk or cereal or is there adequate exposure to ultraviolet light?
• Are fruits and vegetables eaten regularly?
• Is the mother a complete vegetarian?
• Is the mother restricting her food intake severely in an attempt to lose weight or to treat certain medical conditions?
• Are there life circumstances (e.g., poverty, or abuse of drugs or alcohol) that might interfere with an adequate diet?

It is not necessary to obtain measurements of skinfold thickness or to conduct laboratory tests as a part of the routine assessment of the nutritional status of lactating women.

The subcommittee recognizes that establishing standard health care procedures for lactating women requires expanded training of health care providers. Activities to achieve this expanded training are being initiated by the Surgeon General's workshop committee comprising representatives from the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, and other professional organizations.

Breastfeeding Practices

Efforts to support lactation must consider breastfeeding practices.

• Because the early management of lactation has a strong influence on the establishment of an adequate milk supply, breastfeeding guidance should be provided prenatally and continued in the hospital after delivery and during the early postpartum period.
• All hospitals providing obstetric care should provide knowledgeable staff in the immediate postpartum period who have responsibility for providing support and guidance in initiating breastfeeding and measures to promote establishment of an ample supply of milk.
• Breastfeeding practices that are responsive to the infant's natural appetite should be promoted. In the first few weeks, infants should nurse at least 8 times per day, and some may nurse as often as 15 or more times per day. After the first month, infants fed on demand usually nurse 5 to 12 times per day.

Maternal Weight

Women who plan to breastfeed or who are breastfeeding should be given realistic, health-promoting advice about weight change during lactation.

• Advise women that it is normal to lose weight during the first 6 months of lactation. The average rate of weight loss is 0.5 to 1.0 kg (˜ 1 to 2 lb)/month after the first month post partum. However, not all women who breastfeed lose weight; some women gain weight post partum, whether or not they breastfeed. If a lactating woman is overweight, a weight loss of up to 2 kg (˜4.5 lb) per month is unlikely to adversely affect milk volume, but such women should be alert for any indications that the infant's appetite is not being satisfied. Rapid weight loss (>2 kg/month after the first month post partum) is not advisable for breastfeeding women.
• Advise women who choose to curb their energy intake to pay special attention to eating a balanced, varied diet and to including foods rich in calcium, zinc, magnesium, vitamin B 6 , and folate. Encourage energy intake of at least 1,800 kcal/day. Calcium, multivitamin-mineral supplements, or both may be advised when dietary sources are marginal and it is unlikely that appropriate dietary practices will or can be followed. Intakes below 1,500 kcal/day are not recommended at any time during lactation, although fasts lasting less than 1 day have not been shown to decrease milk volume. Liquid diets and weight loss medications are not recommended. Since the impact of curtailing maternal energy intake during the first 2 to 3 weeks post partum is unknown, dieting during this period is not recommended.

Maternal Substance Use and Abuse

The use of illicit drugs should be actively discouraged, and affected women (regardless of their mode of feeding) should be assisted to enter a rehabilitative program that makes provision for the infant. The use of certain legal substances by lactating women is also of concern, including the potential for alcohol abuse.

• There is no scientific evidence that consumption of alcoholic beverages has a beneficial impact on any aspect of lactation performance. If alcohol is used, advise the lactating woman to limit her intake to no more than 0.5 g of alcohol per kg of maternal body weight per day. Intake over this level may impair the milk ejection reflex. For a 60-kg (132-lb) woman, 0.5 g of alcohol per kg of body weight corresponds to approximately 2 to 2.5 oz of liquor, 8 oz of table wine, or 2 cans of beer.
• Actively discourage smoking among lactating women, not only because it may reduce milk volume but because of its other harmful effects on the mother and her infant.
• Discourage intake of large quantities of coffee, other caffeine-containing beverages and medications, and decaffeinated coffee. The equivalent of 1 to 2 cups of regular coffee daily is unlikely to have a deleterious effect on the nursling, although preliminary evidence suggests that maternal coffee intake may adversely influence the iron content of milk and the iron status of the infant.

Infant Growth and Nutrition

The subcommittee recommends that health care providers be informed about the differences in growth between healthy breastfed and formula-fed infants. On average, breastfed infants gain weight more slowly than those fed formula after the first 2 to 3 months. Slower weight gain, by itself, does not justify the use of supplemental formula. When in doubt, clinicians should evaluate adequacy of growth according to the guidelines described by Lawrence (1989).

Regardless of what the mother eats, the following steps should be taken to ensure adequate nutrition of breastfed infants.

• All newborns should receive a 0.5- to 1.0-mg injection or a 1.0-to 2.0-mg oral dose of vitamin K immediately after birth regardless of the type of feeding that will be offered the infant.
• If the infant's exposure to sunlight appears to be inadequate, the infant should be given a 5- to 7.5-µg supplement of vitamin D per day.
• Fluoride supplements should be provided to breastfed infants if the fluoride content of the household drinking-water supply is low (<0.3 ppm)
• When breastfeeding is complemented by other foods, and by 6 months of age in any case, the infant should be given food rich in bioavailable iron or a daily low-dose oral iron supplement.

Infant Health

Health care providers should recognize that breastfeeding is recommended to reduce the incidence and severity of certain infectious gastrointestinal and respiratory diseases and other disorders in infancy. Breastfeeding ordinarily confers health benefits to the infant, but in certain rare cases it may pose some health risks, as indicated below.

• For mothers requiring medication and desiring to breastfeed, the clinician should select the medication least likely to pass into the milk and to the infant.
• Although medications rarely pose a problem during lactation, breastfeeding is contraindicated in the case of a few. Such drugs include antineoplastic agents, therapeutic radiopharmaceuticals, some but not all antithyroid agents, and antiprotozoan agents.
• In those rare cases when there is heavy exposure to pesticides, heavy metals, or other contaminants that may pass into the milk, breastfeeding is not recommended if maternal levels are high.

Recommendations for Nutrition Monitoring

The committee recommends that the U.S. government provide a mechanism for periodically monitoring trends in lactation and developing normative indicators of nutritional status during lactation.

• Monitoring of trends . Data are needed on the incidence and duration of breastfeeding among the population as a whole, and among some particularly vulnerable subpopulations. Exclusive, partial, and minimal breastfeeding should be distinguished; and data should be collected at several ages during infancy. Current or planned surveys by such agencies as the National Center for Health Statistics or the Nutrition Monitoring Division of the U.S. Department of Agriculture could be modified to serve these goals.
• Developing normative indicators of nutritional status . There is a need for data on dietary intakes by, and nutritional status among, lactating women and their relationship to lactation performance. Identification of groups of lactating women who are at nutritional risk is a problem of public health importance.

Research Recommendations

In its deliberations, the subcommittee was well aware that many factors (such as hospital practices, social attitudes, governmental policies, and exposure to infectious agents) may have a great influence on breastfeeding rates and lactation performance and that there is a need for studies to examine approaches that hold the most promise for improving both of these. Similarly, the subcommittee recognized the great need for studies to examine the short- and long-term benefits of breastfeeding in the United States among mothers and infants in all segments of the population, but especially among disadvantaged groups, which currently have the lowest rates of breastfeeding. Research recommendations concerning several of these issues (infant mortality, growth charts for breastfed infants, possible transmission of HIV, indicators of infant nutritional status) are contained in Chapter 10 . They have been excluded from this summary, not because they are unimportant, but rather because they relate only indirectly to the nutrition of healthy U.S. women during lactation.

• Research is needed to develop indicators of nutritional status for lactating women. First, the identification of normative values for nutritional status should be based on observations of representative, healthy, lactating women in the United States. In addition, indicators are needed of both (1) risks of adverse outcomes related to the mother's dietary intake and (2) the potential of the mother or her nursing infant to benefit from interventions designed to improve their nutritional status or health.
• Research is needed to identify groups of lactating women in the United States who are at nutritional risk or who could benefit from nutrition intervention programs. In general, it has been difficult to identify groups of mothers and infants in the United States with nutritional deficits that are severe enough to have measurable functional consequences. Priority should be given to the study of lactating women in subpopulations believed to be at risk of inadequate intake of certain nutrients, such as calcium by blacks and vitamin A by low-income women. The potential influence of culture-specific food beliefs on nutrient intake of lactating women should be included in any such investigations.
• Intervention studies of improved design and technical sophistication are needed to investigate the effects of maternal diet and nutritional status on milk volume; milk composition; infant nutritional status, growth, and health; and maternal health. The nursing dyad (the mother and her infant) has seldom been the focus of studies. Thus, a key aspect of this recommendation is concurrent examination of the mother, the volume and composition of the milk, and the infant. The design of such research needs to be adequate for causal inference; thus, if possible, it should include random assignment of lactating subjects to treatment groups. Appropriate sampling and handling of milk for the valid assessment of energy density, nutrient concentration, and total milk volume are essential, as is accurate measurement of nutrient concentrations.

With regard to the energy balance of lactating women, the threshold below which energy intake is insufficient to support adequate milk production has not yet been identified. Resolution of this question will probably require supplementation studies of women in developing countries whose diets are chronically energy deficient. Although such deficient diets are not common in the United States, identification of the level of energy intake that is too low to support lactation will be useful in establishing guidelines for women who want to breastfeed but who also want to restrict their energy intake to lose weight. Although chronically low energy intakes by women in disadvantaged populations may not be completely analogous to acute energy restriction among otherwise well-nourished women, ethical considerations limit the kinds of investigations that could directly address the influence of energy restriction. In supplementation studies, measurements should be made of lactation performance and of any impact on the mother's nutritional status and health, including the period of lactation amenorrhea.

With regard to specific nutrients, the impact of relatively low intakes of folate, vitamin B 6 , calcium, zinc, and magnesium during lactation on the mother's nutritional status and health needs to be assessed in more detail. As a part of this assessment, studies of the absorption of calcium, zinc, and magnesium during lactation will be useful. There is also a need to identify a reliable indicator of vitamin B 6 status of infants and to document the relationships between this indicator, maternal vitamin B 6 intake, and vitamin B 6 content in milk. Finally, resolution of the conflicting findings concerning the impact of maternal protein intake on milk volume would be desirable.

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• DHHS (Department of Health and Human Services). 1985. Followup Report: The Surgeon General's Workshop on Breastfeeding & Human Lactation . DHHS Publ. No. HRS-D-MC 85-2. Health Resources and Services Administration, Public Health Service, U.S. Department of Health and Human Services, Rockville, Md. 46 pp.
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• IOM (Institute of Medicine). 1990. Nutrition During Pregnancy: Weight Gain and Nutrient Supplements . Report of the Subcommittee on Nutritional Status and Weight Gain During Pregnancy, Subcommittee on Dietary Intake and Nutrient Supplements During Pregnancy, Committee on Nutritional Status During Pregnancy and Lactation, Food and Nutrition Board. National Academy Press, Washington, D.C. 468 pp.
• Lawrence, R.A. 1989. Breastfeeding: A Guide for the Medical Profession , 3rd ed. C.V. Mosby, St. Louis. 652 pp.
• Little, R.E., K.W. Anderson, C.H. Ervin, B. Worthington-Roberts, and S.K. Clarren. 1989. Maternal alcohol use during breastfeeding and infant mental and motor development at one year . N. Engl. J. Med. 321:425-430. [ PubMed : 2761576 ]
• Malone, C. 1980. Breast-Feeding. Cumberland County WIC Program, People's Regional Opportunity Program, Portland, Maine . 13 pp.
• NRC (National Research Council). 1989. Recommended Dietary Allowances , 10 th ed. Report of the Subcommittee on the Tenth Edition of the RDAs, Food and Nutrition Board, Commission on Life Sciences. National Academy Press, Washington, D.C. 284 pp.
• The Steering Committee to Promote Breastfeeding in New York City. 1986. The Art and Science of Breastfeeding . Division of Maternal and Child Health, Bureau of Health Care Delivery and Assistance, Health Resources and Services Administration, U.S. Department of Health and Human Services, Washington, D.C. 74 pp.
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• Cite this Page Institute of Medicine (US) Committee on Nutritional Status During Pregnancy and Lactation. Nutrition During Lactation. Washington (DC): National Academies Press (US); 1991. 1, Summary, Conclusions, and Recommendations.
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