The 2020 Breastfeeding Report Card compiled by the Centers for Disease Control and Prevention (CDC, 2020) was released in August 2020 in time for World Breastfeeding Week and National Breastfeeding Month. This report card is based on data collected from infants born in 2017. Approximately two-thirds of birth hospitals participated. Although many would like to celebrate that the breastfeeding initiation rate has increased to 84.1%, it is important to note that it represents a very minimal increase of the rate of 83.2% in the 2018 Report Card (CDC, 2018).

What is most concerning is that the any breastfeeding rates at 6 months (58.3%) and the exclusive breastfeeding rates at 6 months (25.6%) remain quite low. Breastfeeding initiation rates are inching up slowly, however without evidence-based hospital practices and appropriate early follow-up, infants continue to be at risk for suboptimal health and developmental outcomes. The national average of hospitals reporting rooming-in was only 71%, ranging from 56% in Iowa to 96% in Rhode Island. Formula supplementation rates in the first 2 days increased to 19.2% (CDC, 2020) from 16.9% (CDC, 2018). This is particularly alarming because research demonstrates that there is critical window of opportunity for lactation and milk supply to be effectively established (Spatz, 2020) and if infants are being supplemented with copious amounts of formula during the birth hospital stay, milk supply will be compromised. If a breastfeeding parent is told to supplement the infant, the breast/chest will not receive adequate stimulation and prolactin receptors sites will not be effectively turned on. Without effective breast stimulation and being emptied in the first 3 to 5 days, long-term milk production will be compromised (Spatz). Therefore, in the birth hospital, if supplementation is advised, the parent must be equally advised to initiate pumping with a hospital grade pump (expressing both breasts simultaneously) so a full milk supply can be established. Nurses and other healthcare providers should ensure that full milk production of 500 to 1,000 mL per day (average 750) is achieved by day seven post birth (Spatz). Parents should be instructed about risk factors that may delay onset of copious milk production (Spatz).

Although there is cause to celebrate the progress made in breastfeeding initiation rates, there is still much work to be done. We need to help all families make informed newborn and infant feeding decisions, as tremendous disparities persist across ethnic minority and income groups. All family members need to be included in prenatal and postnatal breastfeeding education and support. The COVID-19 pandemic has had a negative impact on birth and breastfeeding experiences of all mothers (not just those who are COVID-19 positive or Persons Under Investigation). We must effectively provide evidence-based lactation care and intervention in birth hospitals and during the critical first 2 weeks post birth. Unfortunately, many primary care pediatric practices do not have healthcare professionals who are educated in comprehensive breastfeeding care and support. At Children's Hospital of Philadelphia, we have Breastfeeding Resource Nurses who have attended a 2-day course with continuing education credits. These nurses are of paramount importance to ensure that families receive the necessary care during the critical first 2 weeks. All healthcare professionals have a role in improving evidence-based lactation assessment, care, education, and support. However, there are more nurses in the United States and worldwide then any other healthcare professional. Nurses, this is our call to action! We can all do more to promote breastfeeding and help new mothers and their families achieve their breastfeeding goals.

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