Background: Historically, Holder pasteurization has been used to pasteurize donor human milk available in a hospital setting. There is extensive resea

Breastfeeding provides numerous health benefits for mothers and infants, but worldwide breastfeeding rates fall below recommendations. As part of efforts to increase breastfeeding initiation and duration, the World Health Organization and UNICEF UK recommend educational interventions to increase awareness and positive attitudes towards breastfeeding beginning during the school years. Breastfeeding education in the school setting offers the opportunity to improve the knowledge base, address misconceptions, and positively influence beliefs and attitudes for students from a wide range of socioeconomic and cultural backgrounds. The purpose of this paper is to present a comprehensive narrative review of the literature regarding student and teacher (stakeholder) views of breastfeeding and breastfeeding education programs in schools to inform future research in the area. Articles were located through a systematic search of online databases and journals using the following keywords in various combinations: (1) breastfeeding, lactation, breast-feeding, “bottle feeding”, “infant feeding” (2) student, educator, teacher, “school administrator” and (3) schools, “secondary education”, “primary education”, “K-12”, “high school”, “middle school”, “elementary school”, education, adolescents, curriculum, and a manual search of article references. Studies were screened for inclusion against specific criteria and included papers were assessed using the Mixed Methods Appraisal Tool (MMAT). This review suggests that adolescents have a deficit in breastfeeding knowledge and express negative conceptions about breastfeeding. Breastfeeding is being discussed in some school environments, but the extent of lessons and the specific messages that teachers communicate have not been explored. Students appear to be interested in receiving more information about breastfeeding, especially if delivered by health professionals or breastfeeding mothers. The majority of teachers are supportive of incorporating breastfeeding education in family and consumer sciences, sexual education, and health classes; however, time constraints and limited knowledge of infant feeding recommendations may be barriers to implementation of appropriate lesson plans. Students generally support and are receptive to breastfeeding education; however, research on educator attitudes, knowledge, and experiences are necessary for appropriate implementation of breastfeeding education in varying school settings around the world.

Objective: To determine the impact of storage on bacterial growth and immunological activity of pasteurized human milk and leftover pasteurized human milk that has been exposed to the microflora in an infant's mouth. Materials and Methods: Eighteen mother-infant dyads participated in two separate studies. Mother's milk was pasteurized, and each baby was fed 1 to 2 ounces. Pasteurized and leftover pasteurized milk were stored at room (24°C) and refrigerated temperatures (4°C). After storage, milk was analyzed for bacteria, total protein, lysozyme activity, and secretory immunoglobulin A (SIgA) activity. Results: In pasteurized and leftover pasteurized milk stored in the refrigerator for 7 days, total aerobic bacteria do not increase significantly and total protein and bioactive proteins are stable. At room temperature, there is a significant increase in total aerobic bacteria in leftover pasteurized milk during 12 hours of storage (p < 0.01) and a significant decrease in total protein and SIgA activity in pasteurized milk during 12 hours of storage (p = 0.02 and p = 0.03, respectively). Conclusions: When stored in the refrigerator, pasteurized and leftover pasteurized milk may be stored for at least 7 days when considering the variables studied. Caution should be used when storing pasteurized and leftover pasteurized milk at room temperature to prevent an increase in bacterial growth and a decrease in total protein and SIgA activity.

Objective: The objective was to examine the bacteriological and immunological properties of freshly expressed, previously frozen, and leftover mothers' own milk during storage. Materials and Methods: In the first of two pilot studies, 12 mother-infant dyads participated. The milk studied included freshly expressed unfed and freshly expressed leftover milk. Milk samples were stored at 24°C, 4°C, or −20°C. In the second pilot study, 11 mother-infant dyads participated. The milk studied included milk that had been previously frozen, including previously frozen leftover milk. Milk samples were stored at 24°C and 4°C. After storage in both studies, the milk was analyzed for bacteriological and immunological properties. Results: Bacteriological and immunological characteristics of freshly expressed unfed and freshly expressed leftover milk and previously frozen unfed and previously frozen leftover milk remained stable during storage at 4°C for at least 6 days. The quality of all groups of mothers' milk declined when stored at 24°C for longer than 3 hours. Conclusions: While this study provides evidence that human milk might be safe at longer storage times, storage guidelines should not be revised until more research is performed. This study serves as a call to action for more research on the topic of human milk storage, specifically leftover human milk. The study provides information to inform future study designs on the topic of unpasteurized human milk storage. More research is needed regarding leftover human milk storage with a greater number of participants, determination of the quality of human milk, and the storage of human milk in a real-life setting.