This past winter, there was extensive media coverage of the high levels of the flu, respiratory illnesses, and respiratory syncytial virus (RSV) with hospitals being strained and at capacity. Through all the media attention, there has been no mention of an important preventative care measure that does not require any money but instead significant time and support from nurses and other health care providers. People need more help and support to reach their personal lactation goals. In the Centers for Disease Control and Prevention (CDC, 2022) Breastfeeding Report Card representing data from the year 2019, even though 83.2% of people initiate breastfeeding, the exclusive breastfeeding rate at 6 months is only 24.9% (CDC, 2022). This means that three out of four American children are at risk for suboptimal health and developmental outcomes because of a lack of an exclusive human milk diet. There are considerable disparities in the provision of human milk. The American Academy of Pediatrics (AAP) updated position statement states that these disparities represent significant inequity disproportionately affecting the non-Hispanic Black population (Meek et al., 2022). They clearly endorse exclusive breastfeeding for 6 months and its reduction in risk of lower respiratory illness by 19% compared with exclusive breastfeeding for less than 4 months (Meek et al., 2022). Exclusive human milk reduces incidence and severity of RSV (Jang et al., 2020). In one study, infants on exclusive human milk were less likely to require oxygen therapy (4.3%), compared with infants who received mixed human milk and formula diets (8.1%), and infants who received an exclusive formula diet (13.5%) (Jang et al, 2020).

Having observed these statistics and the outcomes in my clinical work, I remain deeply concerned that nurses and other health care professionals are not doing enough to promote and protect human milk, especially in at-risk groups. Per AAP, implicit bias, structural racism, and structural bias must be addressed to eliminate disparities to improve human milk and breastfeeding outcomes (Meek et al., 2022). The first step of my 10-step model is informed decision-making for all families, which is not always happening in clinical practice (Spatz, 2018). We should be educating families about how human milk is an important strategy to reduce respiratory illness and RSV. There should be public health campaigns that address the important role of human milk in keeping infants healthy, especially during flu and virus season.

Informed decision-making is not enough, as nurses we must devote enough time and assistance in supporting families to choose human milk for their child and advise families about how and why breastfeeding is so important for their baby's health and well-being. Step 2 of my model is initiation and maintenance of milk supply (Spatz, 2018). There is a strong body of evidence that the first hours after birth and the first 3 to 5 days are critical in the achievement of a robust milk supply. Therefore, nurses must help families to be able effectively directly breastfeed their infants at the breast, and if there are early challenges, to ensure that the parent starts expressing milk immediately with a high-quality hospital grade pump. To increase exclusive human milk rates at 6 months, we need to have a sense of urgency about milk supply during the first week. As nurses, we must do better to provide evidence-based lactation interventions to improve infant health outcomes and reduce respiratory illnesses long term.

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