Journal of Pediatric Health Care January/February 2004 (Volume 18, Number 1) Breastfeeding Knowledge and Practice of Pediatric Nurse Practitioners Hellings P, Howe C Journal of Pediatric Health Care. 2004;18(1):8-14 Given the recognized benefits of breastfeeding, and the unmet goal of the US Department of Health and Human Services that 75% of infants be breastfed at birth, it is important to assess how well NPs are doing in promotion of this practice. The purpose of this study was to examine the attitude, experiences, and knowledge of a group of pediatric nurse practitioners (PNPs) and to compare the results with a sample of pediatricians, other NPs, and nurse-midwives. Results are based on a study tool sent to all 670 licensed family, pediatric, women's health NPs and all nurse-midwives in the state of Oregon; 405 individuals responded, including 77 PNPs, for a response rate of 81%. All of the PNPs were women, and all but one was white. Nearly 75% of the sample had breastfed their own children. More than 80% of the sample had 5 or more years of experience as a PNP; 61% had been practicing for 10 or more years. The respondents were asked about their educational preparation in the area of breastfeeding. Answers were mixed. While a third of the audience had never had the opportunity to observe a breastfeeding woman during their education, another third had had this opportunity 5 or more times. Just over a third had the opportunity to counsel an expectant mother about feeding choices more than 5 times, while just under a third had never had this opportunity. More than half of the sample had never had the opportunity to counsel a woman in the use of a breast pump, and 40% had never counseled women with breastfeeding problems such as cracked nipples or mastitis. Despite some of these gaps in education, more than 80% of the respondents indicated that NP-program faculty were the most common source of information about breastfeeding. However, these NPs also relied on the expertise of lactation consultants and other educational opportunities such as lectures, videos, and rounds. PNPs overwhelmingly agreed that it was their role to recommend and promote breastfeeding, and agreed with statements that nursing decreases the incidence of otitis media and gastroenteritis and increases immune function. A large majority of PNPs answered correctly, stating that breastfeeding should not be discontinued in the case of mastitis or maternal concerns about milk supply. They also agreed that they would not recommend discontinuation of breastfeeding for infant teething, loose stools, or perceived lack of satiety. Only regarding the presence of maternal breast abscess did the PNPs' answers indicate a lack of knowledge, with 35.5% unsure if they would recommend discontinuing nursing, and 9.2% saying they would (incorrectly) recommend discontinuation. Despite this strong support for nursing, 38.2% of PNPs reported that they never counseled women about breastfeeding in their practices and 17.1% never assisted mothers with breastfeeding technique. Just under a third of respondents frequently counseled patients prenatally and assisted mothers with breastfeeding technique and lactation problems. The authors then compared results from this sample with those from a pediatrician survey published in 1995. While a strong majority in both samples were very supportive of breastfeeding, PNPs were more likely than pediatricians to view breastfeeding as beneficial, be more aware of evidence regarding benefits, and be more likely to correctly manage breastfeeding problems. However, PNPs were somewhat less supportive of breastfeeding than nurse-midwives. In addition, PNPs were less likely to offer counseling to nursing mothers, including assisting with technique and lactation problems. It should be noted that this sample was not a nationally representative one. In fact, more than half of the NPs had graduated from the home institution of the coauthors, a program that routinely includes education about breastfeeding in their curriculum. Thus, it cannot be presumed that a national sample of NPs would be as supportive and knowledgeable about breastfeeding. The implications for education are clear. Too many NPs rely on their own personal experience, rather than their NP education, to guide them in breastfeeding management. Editor's Comment: I must admit to being wearied by the continuing chip-on- the-shoulder tendency of NPs to compare our practice to physicians' practice. However, once again, NPs have been shown to be on the right side of the equation, with knowledge and skills that are equivalent or better than that of physicians. Maybe someday we'll be able to dispense with the necessity to keep proving it. *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html