Date of Award

Summer 8-23-2025

Document Type

Thesis

Degree Name

Master of Science (MS)

Department

Food Science

First Advisor

Simone Camel

Abstract

The American Academy of Pediatrics recommends exclusive breastfeeding (BF) for the first six months and continued breastfeeding for at least two years with complementary food. Despite this recommendation, only 24.9% of infants in the United States are exclusively breastfed at six months (Breastfeeding Report Card 2022). Breastfeeding support and lactation management are critical to promoting a successful breastfeeding experience. Specifically, qualified support from a Registered Dietitian Nutritionist (RDN) is recommended, yet graduate students in Nutrition and Dietetics do not receive adequate training regarding breastfeeding intervention. This study aimed to evaluate graduate Nutrition and Dietetic programs to determine the amount of exposure students/interns have to breastfeeding education, how it is delivered, and whether it includes an experiential component. A secondary purpose was to assess the program directors' beliefs about the necessity of this advanced breastfeeding education and the potential barriers to inclusion in the programs. The question is whether DI programs with or without graduate courses include Medical Nutrition Therapy for interns to be equipped with the requisite skills necessary for entry-level registered dietitian nutritionists. This research was designed as a cross-sectional survey utilizing a researcher-developed questionnaire of all program directors listed in the public database of all graduate-level nutrition and dietetics programs in the program directory of the Academy of Nutrition and Dietetics (www.eatright.org). The questionnaire was distributed to 402 graduate-level nutrition and dietetic directors across the United States. There were 75 respondents. However, 18 simply opened the questionnaire without responding to any items. They were subsequently removed from the database, leaving 57 responses for this preliminary analysis. The participants included: 33 dietetic internship directors, nine coordinated program directors, 13 Graduate program directors, and two others not identified. Of those programs, 37 are part of a university/college, 10 are freestanding, nine have coordinated graduate courses or master's degrees, and one was unidentified. All programs were located throughout the United States and categorized into regions: 11 in the West, 9 in the Midwest, 22 in the South, and 8 in the Northeast. Responses regarding education delivery methods in the programs indicated that 9.3% of the programs utilized distance education, 26.7% had a hybrid environment, 38.7% delivered education face-to-face, and 1.3% used other methods. When specifically asked about advanced breastfeeding and lactation management education, 57% of directors responded that students receive some breastfeeding education through a planned experience, and 12% do not receive any. When asked about the director’s expectations, 41% stated that students were not expected to deliver breastfeeding counseling, 29% said it was optional, and only 5% were expected to deliver B-Ed counseling to patients Approximately 37% of the program directors believed students gain adequate lactation management skills at the graduate level, and 50% did not believe that students receive advanced content related to lactation management. The most significant proportion agreed that students do not learn enough in this content area during undergraduate courses and need extended training. Many (46%) program directors stated that this content could not be adequately gained by learning through work experience as an RDN once practicing in the field, they also felt that students must focus on current required competencies and do not have time to prioritize specialties such as breastfeeding. Exposure to advanced education in the practice component of the program was significantly different when compared by program size. A chi-square calculation was performed, and no difference was found for didactic delivery, but a significant difference was found for practicum exposure. The smaller programs, with 1-10 students, required exposure to breastfeeding education. The larger programs, with greater than 10 students, did not require exposure to breastfeeding education, but it was optional for the student. Awareness of the breastfeeding landscape included breastfeeding rates throughout the geographical regions. Of the participants (N=57), 6.7% were not familiar with the breastfeeding rates in the U.S., 44% were slightly/moderately familiar, and 16% were very/extremely familiar. The participants were similarly asked about being familiar with BF rates in their state: 16% were unfamiliar, 37.3% were slightly/moderately familiar, and 13.3% were very/extremely familiar. Perhaps impacting decisions regarding the provision of content in the program. The results also indicated that 34.7% of participants agreed that graduate programs should develop specific lactation/BF competencies, to ensure the breadth and depth of requisite skills needed for entry-level practice as an RDN are obtained; 21.3% disagreed, and 9.3% stated it did not matter. In summary, this study indicated that vague accreditation guidance, limited program time, access to expertise, and a lack of prioritization of breastfeeding and lactation management by programs have resulted in inconsistent, minimal breastfeeding curriculum implemented throughout the programs. Future research should explore whether accreditation competencies and the programs corresponding to planned experiences involving breastfeeding/lactation should be developed with greater specificity. The programs may accomplish this development, allowing them to incorporate learning experiences tailored to their available resources. Many programs reported not implementing breastfeeding education because accreditation did not require it. Advanced breastfeeding education/lactation management should be viewed as foundational knowledge, as it is important in health promotion and disease prevention in mothers and their infants. It is not necessarily a specialty topic. Particularly in reducing overweight and obesity and other related chronic diseases, which will affect the mother and infant throughout the lifespan. Research supports successful breastfeeding experiences and increased rates following breastfeeding education. Healthcare professionals with access to mothers during this critical period should have the knowledge to support this patient/client education.

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