Purpose

• To review the relationship between breastfeeding and early childhood health and development;
• To provide effective strategies for increasing breastfeeding initiation and duration rates; and,
• To provide guidelines for how to obtain 50/50 matching funds for breastfeeding efforts through the U.S.D.A.’s California Nutrition Network for Healthy, Active Families (Network).

Intent of Proposition 10

Proposition 10 is intended to establish comprehensive early childhood development and smoking prevention programs. The goal for early childhood development programs are to promote proper parenting, nurturing, and health care during the early years to provide the means for children to enter school: 1) in good health; 2) ready and able to learn; and 3) emotionally well developed.

Breastfeeding Saves Lives, Reduces Illness, and Fosters Optimum Child Development and Parenting

As we enter the new millennium, we must ensure the physical and emotional health of our children for the future. Once thought to be "no longer worth the bother," breastfeeding has been rediscovered by modern science as a means to save lives, reduce illness, foster optimum development and protect the environment. Policy makers are increasingly recognizing that breastfeeding promotion efforts can reduce health care costs that enhance maternal and infant well being. Human milk remains the single most important nutritional and bioactive substance available to the neonate. Breastfeeding also remains the first and best way to form a secure bond between mother and child, nurturing communication and emotional development. While many women in California initiate breastfeeding, too few women continue breastfeeding after the first few weeks.

Breastfeeding Saves Lives and Reduces Illness

Significantly lower rates of diarrhea, ear infections, lower respiratory illness, and childhood lymphomas occur among breastfed infants and children in the United States. Breastfeeding has also been reported to protect against necrotizing enterocolitis, bacteremia, meningitis, botulism, sudden infant death syndrome, urinary tract infection, early childhood caries, juvenile diabetes, and inflammatory bowel disease. Health care costs to federal and state governments, and private healthcare systems because of NOT breastfeeding run into billions of dollars.

Breastfeeding Fosters Optimum Cognitive Development

Research has determined that a child’s first three years are the most critical in brain development. "Nutritional programming" is the concept that nutrition during these critical periods in early growth and development permanently effects the structure and function of organs and tissues.

For a child, optimal nutrition starts in utero and continues with breastfeeding, often called the "fourth trimester." Through thousands of years, human milk has been tailored to meet the challenging needs of the human infant and child; all substitute feeding options differ markedly from it.

The mixture of nutritional factors and growth hormones in human milk has been linked to enhanced cognitive development. In fact, a recent long term study of 1000 children found breastfed children had consistent and statistically significant increases in:

• intelligence quotient (IQ) at age 8 and 9 years of age;
• reading comprehension, mathematical ability, and scholastic ability assessed during the period from 10-13 years of age;
• teacher ratings of reading and mathematics assessed at 8 and 12 years; and,
• higher levels of attainment in "high school leaving examinations."

Oxytocin released during breastfeeding may provide a biological basis for human attachment and bonding. Studies shows that mothers who breastfeed in the first hours of life, choose to keep their infants longer in their hospital rooms than mothers who have later contact. In addition, mothers who breastfeed have less anxiety, more mother-infant harmony, and are more engrossed in the feeding interaction than mothers who bottle feed. In several countries throughout the world, the rate of abandonment was reduced significantly after hospitals implemented "the Baby Friendly Hospital Initiative," which increased the use of rooming in and early breastfeeding.

Strategies to Enhance Childhood Development and Parenting Through Breastfeeding

Given that breastfeeding promotes optimal health, cognitive development, and bonding of infant-mother pairs, it is critical that implementation of Proposition 10 include strategies to increase breastfeeding initiation and duration rates. The California Policy Research Center and the U.C.L.A. Center for Healthier Children, Families and Communities recently released the report, "Building Bridges for California’s Young Children: A 12 Point Agenda to Enhance Proposition 10," which identifies breastfeeding promotion and support as an essential component for child development services, as follows:

"Those who provide prenatal services must also begin to support and encourage important postnatal behaviors such as breastfeeding. National data suggest that women who receive prenatal education about and encouragement of breast-feeding are much more likely to initiate this important health-and-development-promoting behavior."

In addition, their report recommends that mothers have access to breastfeeding support groups, lactation support; family friendly workplaces and communities which support practices that promote optimal development of children (i.e., breastfeeding).

The following strategies will enhance childhood development and parenting by increasing the number of mothers who breastfeed:

1. Increase public awareness of the benefits of breastfeeding for optimal child development.
2. As Rob Reiner’s film, "I Am Your Child," clearly notes, breastmilk has key advantages for brain development. The act of breastfeeding also stimulates the production of "mothering" hormones (prolactin and oxytocin) to assist in bonding and optimal emotional development. This message needs to be expanded and more widely circulated.
3. Provide wellness kit for newborns. Kits can be developed and distributed that include information about breastfeeding benefits, management, and available support services.
4. Increase knowledge and skills of breastfeeding support within the health care community. n years past, breastfeeding was an art passed on from mother to daughter. This art was almost lost, and as a result, allied healthcare professionals (lactation consultants) and some nurses and physicians have filled the gap to support breastfeeding families. However, hospital personnel and other health care providers within the community clearly need to be educated and trained on the benefits of breastfeeding and appropriate management and support.
5. Establish a mechanism to track breastfeeding duration rates. Breastfeeding rates can be used as measurable outcomes and correlated with later neurologic and emotional development. Although breastfeeding initiation rates are tracked at hospital discharge, breastfeeding rates at 2 months, 6 months, one year, two years and beyond are not available. Funding is needed to establish a mechanism for collecting this data, either through standardized statewide reporting, or through the development of local tracking systems.
6. Increase breastfeeding education and training for parents and organizations serving children. Breastfeeding is an essential component of parenting education and such education should be available and provided to all socioeconomic and ethnic groups, using culturally appropriate materials. Other caregivers, child care centers, Head Start, and other perinatal programs need to be educated about the benefits of breastmilk andvbreastfeeding, and the appropriate handling of this important fluid.
7. Increase access to mother-to-mother breastfeeding support. Mother to mother support and role modeling has been shown to be one of the most critical factors for breastfeeding success. Many local WIC agencies lack funds to support peer counselor programs.
8. Promote breastfeeding as part of community efforts to prevent child abuse. Given that breastfeeding promotes maternal-infant bonding and a reduced incidence of child abuse, efforts to promote and support breastfeeding need to be included as part of in home visits to at risk families.
9. Include breastfeeding promotion in community smoking cessation efforts. Pregnant women and parents of infants and young children need encouragement and support to quit smoking. Breastfeeding can mitigate some of the dangers of inhaled smoke, while also providing an incentive to remain cigarette free.
10. Assist public and private businesses with work site breastfeeding support programs. Work site facilities may include lactation rooms, flexible schedules, and classes to assist employees in developing strategies to continue to breastfeed after returning to work.

Increasing the rates of breastfeeding initiation and duration are national health objectives and Health People 2000 and 2010 goals. The California Breastfeeding Promotion Committee and the Department of Health Services have made breastfeeding promotion and support a priority with the publication of "Breastfeeding: Investing in California’s Future." However, despite the importance of breastmilk and breastfeeding for early childhood development, many California infants do not receive these benefits.

Availability of Matching Funds for Nutrition Education

U.S.D.A. provides 50 percent matching funds for nutrition education services targeted to low income members of the community. Although not all breastfeeding promotion strategies meet this requirement, many do and should be pursued as a way of leveraging federal funds with Proposition 10 monies for certain breastfeeding promotion expenditures. Attachment A includes specific guidelines for eligibility and the application process.

Given that breastfeeding promotes early childhood development, it is essential that both the state and local Children and Families First Commissions take steps to ensure that gaps in breastfeeding promotion and support services are identified, solutions are developed, and efforts are evaluated for success.

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