Breastfeeding Friendly Child Care Johnson County Department of Health 2012
Breastfeeding Friendly Child Care - …kstrain.kdhe.state.ks.us/.../BreastfeedingFCC/Overallhandout.pdf · Breastfeeding Friendly Child Care Johnson County Department of Health 2012
Welcome to the Johnson County Health Department class, Breastfeeding Friendly Child Care. �If you haven’t already, please complete the short pretest now. This anonymous information will be used to help shape future course offerings.
Acknowledgements
Developed by: Michelle Routh, BSN, RN, CBE University of Kansas Graduate Student Special thanks to Eldonna Chesnut, Deborah Nickels, Laura Drake, Melody Engberg Ward, Dr. Elaine Domian, Dr. Victoria Wangia, Vicki Hicks, Dr. Ruth Wetta Hall, Lisette Johnson, Brenda Bandy, Martha Hagen, Vicki Hanley, April Chronister, Susan Merys, Colleen Booker Halverson, the Kansas-TRAIN program, the Kansas Public Health Association and the United Methodist Health Ministry Fund for their contribution to this
work.
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Presentation Notes
This class was developed by Michelle Routh with contributions from Eldonna Chesnut, Deborah Nickels, Laura Drake, Melody Engberg Ward, Dr. Elaine Domian, Dr. Victoria Wangia, Vicki Hicks, Dr. Ruth Wetta Hall, Lisette Johnson, Brenda Bandy, Martha Hagen, Vicki Hanley, April Chronister, Susan Merys, Colleen Booker Halverson, the Kansas-TRAIN program, the Kansas Public Health Association and the United Methodist Health Ministry Fund.
Learning Objectives At the completion of this course, participants will be able to:
1. List 3 benefits of breastfeeding.
2. List 3 common challenges for moms.
3. State how to safely handle human milk.
4. State best ways to feed an infant.
5. List 3 ways to make the facility welcoming.
6. List 3 ways their facility can support breastfeeding.
Presenter
Presentation Notes
The purpose of this course is to inform child care professionals about best ways to care for breastfed clients. At the completion of this course, participants will be able to: 1. List 3 benefits of breastfeeding. 2. List 3 common challenges for moms. 3. State how to safely handle human milk. 4.State best ways to feed an infant. 5.List 3 ways to make the facility welcoming. 6. List 3 ways their facility can support breastfeeding. Essentially, by the end of this course, I hope that you will learn more about how supporting breastfeeding is beneficial for both your facility and for families. We will talk about current care standards for breastfed babies and how to offer high quality breastfeeding support.
Agenda
Module 1 Welcome, introduction, pre test Why Support Breastfeeding?
Module 2 Challenges for Working Mothers Ten Steps to Breastfeeding Friendly Part 1
Module 3 Ten Steps to Breastfeeding Friendly Part 2
Module 4 Care Standards Posttest, evaluation
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Presentation Notes
The class content is broken up into four primary sections. After this introduction we will talk about why it is important to support breastfeeding. Then we will move into the challenges that breastfeeding and working mothers face. After we go over this background information, we will discuss the ten steps for breastfeeding friendly child care. We will take time after each step for you to think about ways that your facility can incorporate the recommendation. Finally, we will talk about current breastfeeding care standards. You will leave this course with an understanding of how to support breastfeeding and why doing so is important.
The Importance of Breastfeeding
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Presentation Notes
We will start by talking about why breastfeeding is important, and we will talk about why child care providers should support breastfeeding.
• “…providers of child care have a critical role to play in
supporting employed mothers who breastfeed”
– U.S. Surgeon General, 2011
Why Support Breastfeeding?
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Presentation Notes
So what is the importance of child care supported breastfeeding? Child care has significant influence over the length of time an infant is breastfed. In the 2011 Call to Action to Support Breastfeeding, the U.S. Surgeon General’s office stated “…providers of child care have a critical role to play in supporting employed mothers who breastfeed” .
• Healthy for Baby • Healthy for Mom • Societal benefits • Environmental benefits
(American Academy of Pediatrics (AAP), 2012).
Why Support Breastfeeding?
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Presentation Notes
Breastfeeding is important for the health of both mom and baby. A point you will hear reiterated throughout this class is that how long a baby is breastfed matters. The longer an infant or child is breastfed, the more both mom and baby reap health benefits.
“Breast milk is uniquely suited to the human infant’s nutritional needs and is a live
substance with unparalleled immunological and anti-inflammatory properties that protect against a host of illnesses and diseases for both mothers and children”.
-U.S. Surgeon General, 2011
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Presentation Notes
The surgeon general’s office also framed the importance of breastfeeding well by stating that “Breast milk is uniquely suited to the human infant’s nutritional needs and is a live substance with unparalleled immunological and anti-inflammatory properties that protect against a host of illnesses and diseases for both mothers and children”. In other words, nothing else exists like human milk. It’s the best fit for our baby’s needs. It also contains ingredients that keep both mom and baby safer from infection and disease.
Health Benefits
for Baby
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Presentation Notes
What are the specific diseases that breastfeeding helps to prevent in babies?
Studies continue to come out that broaden our knowledge of the benefits of breastfeeding. We know that a breastfed infant’s risk for infection of the ears and lungs is lower than a formula fed infant’s. Risk for diarrheal illnesses and SIDs are also lower. Premature infants especially need human milk.
Less risk for chronic illness Health Benefits for Baby
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As a breastfed infant grows into a child and eventually an adult, the benefits of this first nutrition continue. Risk for obesity, diabetes, asthma, allergic skin diseases, like atopic dermatitis and eczema, bowel diseases, like inflammatory bowel disease, or crohn’s disease and ulcerative colitis, celiac disease, high cholesterol, and certain cancers are lower. In sum, breastfeeding protects infants from infectious illnesses. It reduces SIDS risk. Later in life, a formerly breastfed person is at lower risk for many chronic, long term diseases.
• Bleeding after giving birth • Postpartum depression • Obesity • Diabetes, type 2 • Rheumatoid arthritis • High blood pressure • Heart disease • Breast cancer • Ovarian cancer
• Increases patience (AAP, 2012)
Less risk for many illnesses Health Benefits for Mom
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Presentation Notes
Breastfeeding benefits mother’s health as well. Breastfeeding reduces bleeding after birth. A breastfeeding mother may lose weight more easily and is at decreased risk for postpartum depression, diabetes, rheumatoid arthritis, high blood pressure, heart disease, and breast and ovarian cancer. These benefits grow stronger the longer she has breastfed. ��There may be a biological reason that decreases a breastfeeding mother’s chance of committing abuse or neglect. ��Breastfeeding lowers a woman’s lifelong risk for chronic disease.
Cost Savings Breastfeeding could save $13 billion/year by lowering:
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A 2005 study by the American Academy of Pediatrics (or AAP) found that 13 billion dollars per year could be saved if more families breastfeed. Healthcare costs would be lower. There would be less costs from production, transport, purchase, feeding and disposal of infant formula. ��In addition to this $13 billion/year, money would be saved due to parents would take less sick days, and due to less healthcare costs for adult persons who were breastfed earlier in life.
Breastfeeding Recommendations
American Academy of Pediatrics (AAP):
• Exclusively breastfeed for 6 months
• Continue breastfeeding
with solids to at least 12 months
World Health Organization:
• Breastfeed at least 2 years
(AAP, 2012) (World Health Organization, 2003) (CDC, 2011)
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Presentation Notes
Exclusive breastfeeding means the infant is fed only human milk. Medications or vitamin and mineral supplements can be given. No other foods are given. The AAP recommends “exclusive breastfeeding…[for] the first 6 months of life”. The AAP also recommends that breastfeeding continue to at least 12 months. The World Health Organization recommends that breastfeeding continue to at least 2 years. Most United States families, or 74%, attempt to breastfeed. But only 23% breastfeed to at least 12 months of age. This is due to the number of challenges that breastfeeding families must overcome in order to be successful. Child care support can help families breastfeed longer.
Child Care Role
• Know recommendations • Policy support • Resource to mothers
• Mother’s personal decision
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Child care providers should know the recommendations. Child Care policies should support them. Child Care providers should act as a resource to breastfeeding mothers. Ultimately though, if and how long a mother chooses to breastfeed is a personal decision. If a mother chooses to end breastfeeding prior to twelve months of age that is her personal choice. Child care providers and facilities can attempt to help her overcome any challenges that she may be facing. But if she chooses to end breastfeeding, she should not receive judgment from staff.
Child Care Role
“Increased duration of breastfeeding confers significant health and developmental benefits for the child and the mother.”
- American Academy of Pediatrics, 2005
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Presentation Notes
In turn, breastfeeding beyond the age of one year is beneficial to the health of both mother and child. The AAP states “There is no upper limit to the duration of breastfeeding and no evidence of psychologic or developmental harm from breastfeeding into the third year of life or longer”. It also states: “Increased duration of breastfeeding confers significant health and developmental benefits for the child and the mother.” So to summarize, the AAP recommends breastfeeding to at least 12 months of age. Child care facilities should use this recommendation to guide policies, recommendations to parents and infant care decisions. Providers should support each family in meeting their personal breastfeeding goals.
Case Study You provide child care in your home. Monica is the mother of one of your clients, 3 year old Sophia. Monica is pregnant with her second child. One evening when Monica arrives to pick up Sophia, you begin chatting about the new baby to be. Monica shares that she is unsure of how she will feed her baby. “All I’ve heard is ‘breast is best’, she says, “but I’m not sure how much better it is. I tried to breastfeed Sophia but it didn’t work out.”
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Presentation Notes
We will follow the story of Monica and her children throughout this class. Each case study will provide the opportunity to think about what we have just talked about in a practical sense. Then we will discuss possible actions you could take as her child care provider.
Case Study How might you respond to Monica? a) “If it didn’t work for Sophia, then it probably won’t work out for this baby. What kind
of formula do you think you’ll use?” b) “If you don’t breastfeed this baby, it will get very sick. You have to breastfeed!” c) “It is said that ‘Breast is Best’ because breastfeeding is known to lower baby’s risk
for many infections, SIDs, and many chronic diseases later in life. It also lower’s mom’s risk for some cancers other long term diseases. It lowers the risk for obesity for both mom and baby. If you are interested, I can give you some more information than can help prepare you for breastfeeding.”
d) “You don’t want to breastfeed. It’s too hard.”
How would you share breastfeeding information with Monica? a) Verbally. Talk about it in natural conversation. b) Written materials like handouts and books. c) Refer to online resources. d) Refer to local support groups and other skilled resources. e) All of the above.
Case Study - Answers How might you respond to Monica? a) “If it didn’t work for Sophia, then it probably won’t work out for this baby. What kind
of formula do you think you’ll use?” INCORRECT: This response provides false information and is not encouraging.
b) “If you don’t breastfeed this baby, it will get very sick. You have to breastfeed!” INCORRECT: Breastfeeding lowers the risk for many diseases. However, this does not ensure that a baby who is not breastfed with become “very sick”. Monica does not “have to breastfeed”.
c) “It is said that ‘Breast is Best’ because breastfeeding is known to lower baby’s risk for many infections, SIDs, and many chronic diseases later in life. It also lower’s mom’s risk for some cancers other long term diseases. It lowers the risk for obesity for both mom and baby. If you are interested, I can give you some more information than can help prepare you for breastfeeding.” CORRECT: This response provides accurate information about the health importance of breastfeeding.
d) “You don’t want to breastfeed. It’s too hard.” INCORRECT: This response is not encouraging.
How would you share breastfeeding information with Monica? a) Verbally. Talk about it in natural conversation. b) Written materials like handouts and books. c) Refer to online resources. d) Refer to local support groups and other skilled resources. e) All of the above. CORRECT.
Challenges for
Working Mothers
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Presentation Notes
We’ve discussed why breastfeeding is important. Now we will move into why breastfeeding mothers need your support.
Challenges for Working and Breastfeeding Mothers
• Separation from infant • Fears of job insecurity • Lack of Knowledge • Lack of support from:
• Family • Health care providers • Child care providers • Employer
(U.S. Surgeon General, 2011)
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As with many parenting tasks, most breastfeeding mothers encounter hurdles along the way. With support, many mothers can meet their breastfeeding goals. Returning to work can be challenging. Uninformed family members, health and child care providers, and employers can create challenges.
Employer related challenges • Lack of support to pump
• Ø private space
• Ø sink to clean pump parts
• Ø refrigerator
• Insufficient break time
• Coworker disapproval
• Embarrassment
(U.S. Surgeon General, 2011) (National Resource Center for Health and Safety in Child Care and Early Education (NRC), 2011) (Patient Protection and Affordable Care Act, 2010)
•Insufficient Maternity leave
•No lactation support policy
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Challenges related to the workplace can be many. During the early weeks of breastfeeding, feeding on demand is necessary to establish milk supply. Mother and baby often require time to work through any early hurdles as they learn to breastfeed. A short maternity leave can be a problem. Also, worksites may not have what breastfeeding mothers need once they return. Pumping human milk requires time, privacy, running water, and a place to store the milk. Bathrooms are not hygienic spaces in which to express human milk. The Affordable Care Act requires employer support. It states that certain employers must provide time and space to express human milk. The space cannot be a bathroom.
Child care related challenges
• Lack of knowledge related to: • Safe feeding of human milk • Importance of breastfeeding • Breastfeeding recommendations
• Lack of support related to: • Feeding human milk • Breastfeeding on site
(U.S. Surgeon General, 2011) (NRC, 2011)
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Presentation Notes
Many challenges related to child care are due to a lack of knowledge. Lack of knowledge can lead to a lack of support. Education, and policy and practice changes can create breastfeeding friendly child care facilities.
Case Study With your help, Monica, who has a 3 year old in your care and is pregnant with her second child, now understands the compelling reasons why breastfeeding is important. She has decided to breastfeed her new baby. She has read the breastfeeding book you suggested. She has also spent some time reading information from websites that you advised. She now knows how to breastfeed in the early weeks after birth. Now that she understands what she must do to successfully start breastfeeding, she needs to learn how to successfully maintain it. She comes to pick up her 3 year old one evening and mentions that she is nervous. She says “I’m concerned about how to balance it all when I go back to work. I feel like I need to know what the common problems are so I can prepare ahead of time.”
Case Study What are some common challenges that breastfeeding mothers face when going back to work? a. Embarrassment. b. No pumping accommodations. c. Misinformed coworkers, employer, child care provider. d. Short maternity leave. e. All of the above. What could you say to Monica? a. “You are doing exactly what you need to do by preparing for breastfeeding before the
baby comes. Good for you! Here are some sources of good information about preparing to go back to work. You can count on us to support you through this process.”
b. “From what I hear, most employers make it very difficult to pump. You probably won’t be able to breastfeed once you go back to work.”
c. “Breastfeeding and working is SO hard.” d. “Oh, breastfeeding and working is easy. You already know everything you need to
know to breastfeed successfully. You’ve got this!”
Case Study - Answers
What are some common challenges that breastfeeding mothers face when going back to work? e. All of the above. CORRECT.
What could you say to Monica? a. “You are doing exactly what you need to do by preparing for breastfeeding before the
baby comes. Good for you! Here are some sources of good information about preparing to go back to work. You can count on us to support you through this process.” CORRECT: This response is encouraging, realistic and provides breastfeeding information and support.
b. “From what I hear, most employers make it very difficult to pump. You probably won’t be able to breastfeed once you go back to work.” INCORRECT: This response is not encouraging and makes a false assumption.
c. “Breastfeeding and working is SO hard.” INCORRECT: This response is not encouraging and does not provide helpful information.
d. “Oh, breastfeeding and working is easy. You already know everything you need to know to breastfeed successfully. You’ve got this!” INCORRECT: This response is unrealistic and does not provide helpful information.
Ten Steps for Breastfeeding Friendly Child Care
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Presentation Notes
We’ve talked about the reasons why breastfeeding support is important. We’ve also talked about why working and breastfeeding can present challenges for mothers. Fortunately, with the right support, these challenges can be overcome. Child care providers and facility policies can eliminate many of the challenges related to child care. Knowledgeable providers can also aide mothers in working through outside challenges. So now we will move into how child care can help families meet their breastfeeding goals. What are some ways in which your facility supports breastfeeding? What are some ways in which your facility could support breastfeeding more?
Ten Steps for
Breastfeeding-Friendly Child Care
1. Make a commitment to the importance of breastfeeding, especially exclusive breastfeeding, and share this commitment with fellow staff.
2. Train all staff to promote optimal infant and young child feeding.
3. Inform women and families about the importance of breastfeeding.
4. Provide learning and play opportunities for children which normalize breastfeeding.
5. Ensure that all breastfeeding families we serve are able to properly store and label milk for child care center use.
(Carolina Global Breastfeeding Institute, 2011)
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Presentation Notes
These are the Ten Steps for Breastfeeding-Friendly Child Care. These steps were compiled by the Carolina Global Breastfeeding Institute. Child care facilities that complete all ten steps support breastfeeding well. �
Ten Steps for
Breastfeeding-Friendly Child Care
6. Provide a breastfeeding friendly environment.
7. Support breastfeeding employees.
8. Develop a breastfeeding-friendly feeding plan with each family.
9. Contact and coordinate with local skilled breastfeeding support and actively refer.
10. Continue updates and learning about protection, promotion, and support of breastfeeding.
(Carolina Global Breastfeeding Institute, 2011)
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Presentation Notes
After each step, we will discuss how you can apply the step to your own facility.
Step 1
Make a commitment to the importance of breastfeeding, especially exclusive
breastfeeding, and share this commitment
with fellow staff.
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Presentation Notes
Step 1 of the ten steps for Breastfeeding-Friendly Child Care is to “[m]ake a commitment to the importance of breastfeeding, especially exclusive breastfeeding, and share this commitment with fellow staff”. This first step should be completed before the remaining 9. Committing to the importance of breastfeeding, especially facility-wide commitment, begins the process of becoming breastfeeding friendly.��
Step 1
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Presentation Notes
In large child care centers, gaining facility-wide commitment is a process. First one person commits to supporting breastfeeding. Any one child care facility employee taking this course, no matter your position in the child care facility, can suggest facility-wide breastfeeding support. Once one person has committed, then that person talks with facility administrators, coworkers or employees to gain support. Centers and homes officially commit by adopting a breastfeeding support policy. (NRC, 2011). You have a sample breastfeeding support policy in your packet of handouts. Facilities may adapt and adopt this policy if desired.
Planning Worksheet
• Apply to 10 steps. • How is your facility doing? • How can your facility improve breastfeeding support?
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Presentation Notes
You also have a Breastfeeding Friendly Child Care Planning Worksheet. We will use this worksheet after we talk about each step. This worksheet will help you to think about ways that you can apply the steps within your own facility. Think about how your facility is currently performing each step. Each facility is probably going to be in a different stage of breastfeeding support. For example, your facility may already have a breastfeeding support policy. Or, your facility’s policies may include some breastfeeding support activities. Or, your facility may not yet have incorporated any breastfeeding support into policy. As you look at this worksheet, think about what your facility’s current status is concerning making a commitment to breastfeeding. Does your facility need to update a current commitment? Or, does your facility need to create one? ��
Planning Worksheet
• Step to Implement • Activities • People and Things Needed
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Presentation Notes
Under the ‘step to implement’ column, write down what your facility needs to do for step 1. You may find the example listed helpful. � For the activities column, think about how your facility can improve or create a commitment to breastfeeding. Does your facility need an improved policy? Does your facility need to create a policy?��Under ‘people and things needed’, think about who would need to be involved in updating or creating a policy. If you aren’t sure who writes policies in your facility, that’s ok. You can write down who you would talk to in order to get the ball rolling. ��
Planning Worksheet
• Time Frame • Success Criteria
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Presentation Notes
Under ‘time frame’, list an estimated amount of time you think it may take to complete this activity. ��Finally, under ‘success criteria’, write down what the policy should accomplish for your facility or what it should contain.� You now have the beginnings of a plan to complete Step 1 of the Ten Steps for Breastfeeding Friendly Child Care within your facility. We will go through this process for each step. You will walk away from this class with applicable tools to make your facility Breastfeeding Friendly.
Step 2
Train all staff to promote optimal
infant and young child feeding.
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Presentation Notes
Step 2 is to “train all staff to promote optimal infant and young child feeding. Staff should be taught the best ways to feed an infant. Training should occur on an ongoing basis.
Step 2
“Caregivers…have a unique opportunity to support breastfeeding mothers…
…who are often daunted by the prospect of continuing to breastfeed as they return to work…”
– Caring for Our Children, section 4.1
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Presentation Notes
According to the document: Caring for our children: National health and safety performance standards; Guidelines for early care and education programs (which we will refer to as ‘Caring for Our Children’): “Caregivers…have a unique opportunity to support breastfeeding mothers, who are often daunted by the prospect of continuing to breastfeed as they return to work.
Step 2
“…Early care and education programs can reduce a breastfeeding mother’s anxiety…
…by welcoming breastfeeding families…
…and providing a staff that is well-trained in the proper handling of human milk and feeding of breastfed infants.”
– Caring for Our Children, section 4.1
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Presentation Notes
“Early care and education programs can reduce a breastfeeding mother’s anxiety by welcoming breastfeeding families and providing a staff that is well-trained in the proper handling of human milk and feeding of breastfed infants.” After we move through these ten steps, we will talk about the current standards for handling and feeding human milk. This will give you the tools that you need to go back to your facility and take care of breastfed babies AND support their parents in their decision to provide this best first nutrition.
Step 2
Training methods: • Staff may attend this course • In-service • Written materials Breastfeeding
Support
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Presentation Notes
Staff can be trained in a variety of ways. Staff may attend this course (either online or in person). Facility administrators could develop an in-service or written materials. ��Now let’s look back at the planning worksheet. What are the usual ways that staff are trained in your facility? What might it take for staff to receive training on breastfeeding support and handling and feeding of human milk? Take a few minutes to fill out the worksheet for step 2.
Step 3
Inform women and families
about the importance of breastfeeding
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Presentation Notes
The third step towards Breastfeeding Friendly Child Care is to inform women and families about the importance of breastfeeding. This step is encouraged by Caring for Our Children. Parents who are educated about breastfeeding are more likely to meet their goals. Teaching families will help them see the child care center as a caring breastfeeding resource.
Step 3
• Conversation • Handouts • Classes • Facility Newsletter • Social Media
Family Education Methods:
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Presentation Notes
Family education is given in a number of ways. Simply sharing tips and tricks as they come up in natural conversation is a way to show support and educate. More formal methods are providing handouts, classes, and periodically distributing a facility newsletter. Another means of spreading information to clients is through social media such as Facebook or Twitter. Looking back at the planning worksheet, what are the usual ways that families are educated in your facility? What might it take for families to receive education about the importance of breastfeeding? Please take a few minutes to fill out the worksheet for step 3.
Step 4
Provide learning and play opportunities
for children which normalize breastfeeding
Presenter
Presentation Notes
Step 4 is to provide learning and play opportunities for children which normalize breastfeeding. Breastfeeding play helps kids know breastfeeding is normal. It also teaches children about breastfeeding. These early impressions may help the children choose to breastfeed later in life.
Step 4
Breastfeeding play
• ‘Breastfeed’ dolls
• Breastfeeding toys
• Children’s books
• New York State Department of Health: K-12 curriculum
Breastfeeding can be included in play in many ways. Dolls can be ‘breastfed’ by caring little mommies (and daddies!). There are a few toys on the market that feature mother/baby feeding. There are mother cats and dogs with litters of kittens or puppies that attach magnetically. There are human mother dolls and their babies that attach via snap. Children’s books are helpful in explaining and showing breastfeeding. The New York State Department of Health offers a free K-12 curriculum for schools that can be incorporated into child care curriculum.
Step 4 • Planning Worksheet
o How is your facility doing? o How could your facility incorporate more learning and play?
Presenter
Presentation Notes
Looking back at the planning worksheet, what are ways that children are taught about breastfeeding in your facility? What would it take to incorporate breastfeeding into the curriculum? To incorporate breastfeeding related play? Please take a few minutes to fill out the worksheet for step 4.
Step 5
Ensure that all
breastfeeding families served are able to
properly store and label milk for child care center use
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Presentation Notes
Step 5 is to ensure that all breastfeeding families served are able to properly store and label milk for child care center use. We will talk about current standards for human milk storage and labeling in the last section of this class. Both child care providers and families should adhere to these standards.
Step 5
Provide families with:
• Written instructions • Online resources • Feedback
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Presentation Notes
Child Care Facilities should teach parents about these standards. Facilities should provide families with written instructions of how to store and label human milk for use at the facility. Families should receive feedback as needed to reinforce proper labeling and storage. Please complete step 5 of the worksheet now. Think about ways that your facility provides information to families. How does your facility give families feedback?
Step 6
Provide a
breastfeeding friendly environment
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Presentation Notes
Child care facilities work to provide a breastfeeding friendly environment in step 6. What does that mean? It means that breastfeeding mothers are made to feel comfortable and free to do what it takes to meet the needs of their breastfed babies while at the child care facility.
Step 6
• Signs and Fliers • On site breastfeeding • Kansas statute 65-1,248:
• “A mother may breastfeed any place she has the right to be.”
Breastfeeding Friendly Environment
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Presentation Notes
Signs or fliers can be posted as a visual support of breastfeeding. If feasible and a mother wishes to, she should be supported in breastfeeding at the facility. Mothers may wish to breastfeed throughout the day and/or at the beginning or end of the day when dropping off or picking the child up. Some mothers may need to pump in the facility. Providers may support on site breastfeeding by designating a comfortable place to sit. Some mothers may prefer privacy while others may not. Mothers who choose to breastfeed in non-private locations are protected by law in most states. Kansas State law states that “a mother may breastfeed any place she has a right to be”. Public breastfeeding also helps adults and children see breastfeeding as normal.
Step 6
• Comfortable place • Pillow and/or stool • Water
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Presentation Notes
Some mothers may find it helpful to have access to a pillow to support the baby or a stool to put their feet on to relieve back strain. Offering a glass of water helps a mother feel welcome in her choice to breastfeed at the facility. It also alleviates thirst from breastfeeding. �� Look back at the planning worksheet. How is your child care environment currently welcoming to breastfeeding mothers? How could your facility become more welcoming?
Case Study Monica has been back to work for a few weeks now. Breastfeeding is going fairly well and she is learning to balance work and pumping. Through your loving care, three month old Jayden is adjusting well to being in child care. You’ve noticed that Monica has been breastfeeding Jayden in the car before and after care. It has been warm but is starting to get colder outside. What could you say to Monica? a. “You and the kids sure look comfortable out there in your car!” b. “Monica, I’ve been meaning to let you know that we welcome breastfeeding in the
facility. We have a private space for you, but you are also welcome to breastfeed anywhere in the facility.”
c. “Maybe you should let me feed Jayden right when he gets here in the morning and right before he leaves so that you don’t have to feed him in the car.”
Case Study - Answers What could you say to Monica? a. “You and the kids sure look comfortable out there in your car! INCORRECT: They
don’t appear comfortable and could benefit from being welcomed inside.
b. “Monica, I’ve been meaning to let you know that we welcome breastfeeding in the facility. We have a private space for you, but you are also welcome to breastfeed anywhere in the facility.” CORRECT: Welcoming mothers to breastfeed in the facility lets them know that the facility supports breastfeeding. It also allows mothers to meet the needs of their babies while at the facility.
c. “Maybe you should let me feed Jayden right when he gets here in the morning and right before he leaves so that you don’t have to feed him in the car.” INCORRECT: Direct breastfeeding at drop off and pick up helps maintain milk supply. Direct breastfeeding also provides more health benefits than bottle feeding of human milk.
Step 7
Support breastfeeding
employees
Presenter
Presentation Notes
Step 7 emphasizes that facility employees should also be supported in their choice to breastfeed.
Step 7
Employees Need:
• Maternity leave
• On site breastfeeding, or
• Pumping support
(CGBI, 2011) (NRC, 2011) (WHO, 2003)
Presenter
Presentation Notes
Breastfeeding Friendly Child Care also means a Breastfeeding Friendly workplace. Child care providers who are breastfeeding mothers require support to continue breastfeeding. Caring for Our Children recommends that mother and baby remain together until a minimum of 12 weeks of age. Upon return to work, if baby is on site, mother should breastfeed baby on cue. Direct breastfeeding on cue will result in less employee time spent feeding her infant. Mother can relieve her coworker’s time by breastfeeding. This also saves the mother time as pumping is more time consuming than breastfeeding. There are also health advantages to direct breastfeeding over bottle feeding of pumped milk.��
Step 7
• Pumping support:
• Time • Private location • Sink • Milk storage
Presenter
Presentation Notes
If baby is not on site, a breastfeeding employee needs pumping accommodations. Mothers need time and a private location to pump. A bathroom is not a hygienic option. Mothers need access to a sink and a refrigerator to store milk. ��To sum, breastfeeding employees need long enough maternity leaves in order to establish breastfeeding. Once working again, breastfeeding mothers need support. Mothers will need to breastfeed or pump throughout the work day.��Now back to the planning worksheet. How does your facility currently support breastfeeding employees? What could your facility do to provide more support?
Step 7
Business Case for Breastfeeding Kansas: http://www.ksbreastfeeding.org/Employers.aspx National: http://www.womenshealth.gov/breastfeeding/government-in-action/business-case-for-breastfeeding/
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Presentation Notes
The U.S. Department of Health and Human Services administers a program entitled The Business Case for Breastfeeding. For more information and assistance in supporting breastfeeding employees, Kansan employers may contact the Kansas Breastfeeding Coalition’s Business Case for Breastfeeding program director, Brenda Bandy. Nationally, employers can contact the U.S. Department of Health and Human Services for breastfeeding support resources.
Step 8
Develop a
breastfeeding-friendly feeding plan
with each family
Presenter
Presentation Notes
Step 8 is to develop a breastfeeding-friendly feeding plan with each family. Working with parents helps infants receive consistent care between home and child care.
Step 8
• Infant’s patterns
• When infant usually feeds
• Day
• Night
• Both
Feeding plan
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Presentation Notes
Child care providers should find out how the infant normally feeds. Providers should talk with parents to find out the individual infant’s normal eating patterns. Breastfed infant feeding patterns can vary greatly. Some may feed primarily during the day. Others feed primarily at the night and will require less during the day. Some may feed evenly throughout the 24 hour period. The infant should be fed on cue, consistent with the infant’s normal patterns.
Step 8
Feeding plan (continued)
• Complementary solids
• Report to parents
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Presentation Notes
According to Caring for Our Children, facilities should “work closely with parents when complementary solid foods are being introduced. Consistency between home and the early care and education setting is essential during the period of rapid change when infants are learning to eat age-appropriate solid foods”. Parents should be provided with a take home record of feedings while in child care. How closely does your facility currently work with parents regarding infant feeding? Does your facility provide a written report at the end of each day? Please complete Step 8 of the planning worksheet now.
Step 9
Contact and coordinate with local
skilled breastfeeding support and actively refer
Presenter
Presentation Notes
The ninth step to Breastfeeding Friendly Child Care is to contact and coordinate with local skilled breastfeeding support and actively refer. Sometimes mothers experience problems with breastfeeding. When that happens, child care providers should connect mothers with outside help.
Step 9
When problems arise, fix the breastfeeding. Don’t wean to the bottle.
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Presentation Notes
When problems arise, fix the breastfeeding. Don’t wean to the bottle. Skilled breastfeeding support can help solve problems.
• Hospital • Physician office • Private practice • Support groups
• Mother to mother groups • La Leche League
• Women, Infants and Children (WIC) • Breastfeeding Peer Counselors
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Presentation Notes
The outside help available to breastfeeding mothers vary. Urban areas usually offer all of the options listed. Options may be more limited in rural areas. Please see the additional and parent resources listed at the end of this presentation.
Step 9
• What resources can your facility refer to?
• How? o Resource flier o Business cards
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Presentation Notes
Once you have identified locally available resources, you can begin thinking about how your facility can refer. Will your facility compile a list of locally available resources? Will your facility obtain business cards from a local lactation consultant to hand out as needed? Please think about this as you complete Step 9 on the planning worksheet.
Step 10
Continue updates and learning
about protection, promotion and support of breastfeeding
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Presentation Notes
The tenth and final step to Breastfeeding Friendly Child Care is to continue updates and learning about protection, promotion and support of breastfeeding. It is important to keep your ears to the ground about best ways to support breastfeeding.
Step 10
Resources for continued learning: • Caring for Our Children • Amended laws (Fair Labor Standards Act) • Classes • Clients (please see additional resources section)
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Presentation Notes
As new editions of Caring for Our Children are created, watch for additional or amended standards. Amendments in the Fair Labor Standards Act can be incorporated into employee breastfeeding support. It may also help to take a class on breastfeeding support every few years. Always remember to learn from your clients. By completing the ten steps for breastfeeding friendly child care, you will open up lines of communication between parents and child care providers about breastfeeding. Listening to client concerns or ideas provides valuable insight into ways to support breastfeeding. ��Looking back to the planning worksheet one final time, think about ways that you can continue learning about breastfeeding support.
Care Standards
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Presentation Notes
We have talked about the importance of breastfeeding and common challenges that breastfeeding and working mothers face. We have talked about the ways that child care facilities can support breastfeeding. Now we will discuss standards of care that are pertinent to breastfeeding. Knowledgeable child care providers offer safe care to breastfeeding infants. Breastfeeding mothers are reassured that their babies are in reliable and supportive hands.
Standards Source National Resource Center for Health and Safety in Child Care and Early
Education 2011 document:
Caring for Our Children:
National Health and Safety Performance Standards;
Guidelines for Early Care and Education Programs, 3rd edition.
Presenter
Presentation Notes
“The standards we will talk about in this next section are mostly from the document we have referred to as “Caring for Our Children”. This is the American Academy of Pediatrics, American Public Health Association and National Resource Center for Health and Safety in Child Care and Early education third edition of the document: Caring for our children: National health and safety performance standards; Guidelines for early care and education programs.”
Caring for Our Children Preparing, Feeding, and Storing Human Milk
• Transport container:
• Clean • Sealed • Label: infant’s full name, pumping date, contents of container.
• Store immediately
• Refrigerator or freezer
Presenter
Presentation Notes
Recommendations for preparing, feeding and storing human milk ensure that infants are fed safely. Parents should transport human milk to the facility in clean, sealed containers. Containers must be labeled with the infant’s full name and pumping date and time and the contents. Ideally, non-frozen milk is transported in a bottle. Avoid plastic bottles and containers that contain BPA. (#1,2,4,5 are acceptable). Upon arrival to the facility, milk should be stored immediately. Non-frozen milk should be stored in the back of the refrigerator. Frozen milk should be stored in the back of the freezer.
Caring for Our Children Preparing, Feeding, and Storing Human Milk
• Use oldest milk first • Defrost
• Refrigerator, OR • Cool water
• Heat • Warm water • 98.6
• Mix gently, test temperature
Presenter
Presentation Notes
When preparing human milk for feeding, select the oldest milk first. Defrost frozen milk in a refrigerator. If time does not allow slow thawing, milk may be thawed before feeding under cool running water. Heat thawed or non-frozen milk under warm water. Heating the milk above 98.6 may degrade the milk quality. Microwaving the milk may burn the infant due to hot spots. Mix or swirl the milk gently but do not shake. Test the temperature of the milk prior to feeding.
Normal appearance of human milk varies.
Previously frozen, then Refrigerated human milk. Note the layer of cream.
After gently swirling.
Presenter
Presentation Notes
The appearance of human milk varies. Color and texture vary from mother to mother. They will also vary from one bottle to another. Human milk can take on varying flavors. Depending on mother’s diet, medications, or other factors, milk can be tinted many colors including blue, yellow, pink, orange, black, or green! (Mohrbacher, 2010).��The milk in the photo has a large cream layer. After refrigeration, the cream has separated, forming a layer at the top.
Normal, safe appearance of human milk varies. This high lipase, freshly pumped, then refrigerated human milk has a natural green tint.
Presenter
Presentation Notes
This is another example of human milk that is safe to feed. This mother’s milk has a green tint to it. This mother’s milk also has high lipase levels. High lipase levels cause the milk fats to separate quickly. This can mimic the appearance of spoiled milk, however, this milk is not spoiled.
Caring for Our Children Preparing, Feeding, and Storing Human Milk
Previous milk, now spoiled
•In unsanitary bottle •Not stored safely
•Gloves not necessary •Do not use milk if:
•Smells rotten •Curdled
Previously frozen, then Refrigerated human milk
Presenter
Presentation Notes
Using gloves when handling human milk is not necessary. Human milk is considered food and can be stored in the refrigerator and freezer with other food. The only exception is if there is visible blood in the milk. Visible blood tints the milk pink. Milk is unsafe to feed to a baby if it was stored in an unclean bottle, is curdled, smells rotten or was not stored according to milk storage guidelines set by the Academy of Breastfeeding Medicine, American Academy of Pediatrics and the CDC. Return unsafe milk to the parents at the end of the day. Explain the reason it was not used. ��
Academy of Breastfeeding Medicine Human Milk Storage Guidelines
(Academy of Breastfeeding Medicine, 2010) (KDHE, 2012) (National Resource Center for Health and Safety in Child Care and Early Education (NRC), 2011)
Location Temperature Duration
Room Temperature Up to 77ºF 6-8 hours
Insulated Cooler 5 - 39ºF 24 hours
Refrigerator 39ºF 5 days
Freezer compartment within fridge
5ºF 2 weeks
Freezer with separate door
0ºF 3-6 months
Deep freeze -4ºF 6-12 months
Presenter
Presentation Notes
The Academy of Breastfeeding Medicine Guidelines for Storage of Human Milk should be followed to ensure safe infant feeding. Refrigerated milk should be used within 5 days of expression. The length of time that frozen milk can be stored varies greatly depending on the type of freezer used. Milk can be stored for 2 weeks in a freezer compartment of a refrigerator, for 6 months if the compartment has separate doors, and for 12 months in a deep freeze. Thawed milk should be used within 24 hours. The freezing and thawing processes change some properties of the milk. Fresh milk provides more health benefits than previously frozen. The Academy of Breastfeeding Medicine recommends discarding any remaining milk in the bottle 1-2 hours after a finished feeding. Kansas regulations stipulate discarding any remaining milk after the feeding. Kansas regulations state how long refrigerated formula or breast milk can be stored at a facility. Regulations state that formula or breast milk must be used within 24 hours of arrival. Prepared infant formula becomes unsafe to feed an infant after 24 hours. Refrigerated human milk is safe to feed an infant up to 5 days after it is pumped. Caring for Our Children recommends returning unused human milk to the infant’s mother. So, if refrigerated human milk is not used, it should be given back to the parents at the end of the day.��
Align best practice with regulations. Kansas regulation:
o Facility stores refrigerated formula/breast milk < 24 hours. o Does not apply to frozen milk.
Human milk safety: o Refrigerated milk < 5 days.
Caring for Our Children: o Return unused human milk to mother.
Conclusion: Return unused refrigerated milk to parent by the end of the day.
Presenter
Presentation Notes
Kansas regulations state how long refrigerated formula or breast milk can be stored at a facility. Regulations state that formula or breast milk must be used within 24 hours of arrival. Prepared infant formula becomes unsafe to feed an infant after 24 hours. Refrigerated human milk is safe to feed an infant up to 5 days after it is pumped. Caring for Our Children recommends returning unused human milk to the infant’s mother. So, if refrigerated human milk is not used, it should be given back to the parents at the end of the day.��
Case Study One day as you are playing with Jayden, he begins to smack his lips and put his fists in his mouth. You feed him at each feeding every day, so you are very familiar with his hunger cues. You take a bottle of Monica’s milk from the refrigerator and confirm that the bottle is labeled with Jayden’s full name, that the milk was pumped 4 days ago and that it contains Monica’s milk. You notice that the milk looks curdled. It smells rotten. Monica’s milk does not usually have this appearance or odor. It is near the end of the day. This is the last bottle of milk that you have for Jayden.
Case Study What would you do?
a. Do not feed Jayden the milk. Do not feed Jayden formula. Call Monica and ask her to
bring more milk. Help Jayden stay as calm as possible until he is fed. Return milk in question to Monica.
b. Feed Jayden some formula. c. Feed Jayden another mother’s milk. The milk has been stored in a refrigerator for 4 days. Has it been stored safely according to the Academy of Breastfeeding Medicine’s Human Milk Storage Guidelines? a. Yes b. No c. I don’t know
What could be done to prevent running out of milk for Jayden in the future? a. Keep an emergency can of formula on hand. b. Keep at least one bottle or bag of Monica’s milk in the freezer as an emergency stock. c. None of the above.
Case Study - Answers What would you do?
a. Do not feed Jayden the milk. Do not feed Jayden formula. Call Monica and ask her to bring
more milk. Help Jayden stay as calm as possible until he is fed. Return milk in question to Monica. CORRECT: The milk may not be safe to feed. Jayden should only be fed Monica’s milk.
b. Feed Jayden some formula. INCORRECT: Feeding a breastfed infant formula may lead to health problems. It is better to wait for Monica to bring her milk.
c. Feed Jayden another mother’s milk. INCORRECT: Feeding Jayden another mother’s milk may put him at risk for Hepatitis B, C or HIV.
The milk has been stored in a refrigerator for 4 days. Has it been stored safely according to the Academy of Breastfeeding Medicine’s Human Milk Storage Guidelines? a. Yes CORRECT: According to the Academy of Breastfeeding Medicine, refrigerated human
milk is safe to store for 5 days. b. No c. I don’t know
What could be done to prevent running out of milk for Jayden in the future? a. Keep an emergency can of formula on hand. INCORRECT: Feeding a breastfed infant
formula may lead to health problems. b. Keep at least one bottle or bag of Monica’s milk in the freezer as an emergency stock.
CORRECT: An emergency freezer stock of mother’s milk ensures there is a backup supply. c. None of the above.
• Alternate sides • Burp Often • On cue stopping
Caring for Our Children Techniques for Bottle Feeding
• Ensure correct milk • Meet nutritional and emotional needs:
• On cue feeding • Hold infant, never prop • Eye contact, talk
• Do not pacify with bottle
See additional resources
Presenter
Presentation Notes
Prior to feeding an infant, child care providers should check to ensure that the correct milk for the correct infant is in the bottle. Feedings should be in response to infant hunger cues. Infants’ emotional needs for security are satisfied by being held while feeding. Bottle propping can also lead to increased risk for childhood obesity, choking and dental cavities. Infants should be held during all feedings and the provider should talk to the infant and give eye contact. Alternating sides of the lap mimics some of the benefits of breastfeeding. The infant should be burped during and after the feeding as needed. Feeding sessions should end when the infant displays fullness cues. Infants should not be pacified with a bottle. For more information on breastfeeding friendly bottle feeding techniques, please see the additional resources section at the end of this presentation.
Fullness cues • Turning away
• Distracted
• Closing mouth
Caring for Our Children Feeding Infants on Cue by a Consistent Caregiver
Hunger cues
• Opening mouth
• Rooting
• Hands to mouth
• Crying = late sign, avoid
Presenter
Presentation Notes
On cue feeding is best for both breast and formula fed infants. It meets both “nutritional and emotional needs”. Crying is a late hunger sign to be avoided. Earlier signs should be quickly responded to. Early signs are opening mouth, rooting, and infant putting hands to mouth. Optimally, an infant is fed by the same caregiver at each feeding every day. That way, caregivers are able to respond quickly to cues. Fullness cues should signal the end of a feeding. Cues are turning away from the nipple, infant distraction, or closing the mouth. On cue feeding lowers a baby’s risk for childhood obesity. In short, infants should be fed by a consistent caregiver. Feedings should be in response to early hunger cues.
Caring for Our Children Sanitizing Equipment Used for Bottle Feeding
Wash:
• Dishwasher OR
• Hand wash, rinse, and boil for 1 minute
Presenter
Presentation Notes
Bottles and bottle parts should only be reused after they are cleaned safely. Caring for Our Children gives two acceptable methods. Bottles and bottle parts can be washed in a dishwasher. If facilities choose to hand wash, bottles and parts must be washed, rinsed and then boiled for 1 minute.
Caring for Our Children Feeding Human Milk to Another Mother’s Child
1. Ask mother who pumped milk:
• When milk was pumped • How milk was handled/transported • Blood testing for
Hepatitis B, C, and HIV
Presenter
Presentation Notes
If a child is fed another mother’s milk, there is small risk that hepatitis B, C, or HIV could be given to the infant. The facility must follow a procedure in order to protect the infant from disease. In some cases, medical treatments can prevent the infant from contracting a disease. The facility must first contact the mother whose milk was fed. The mother should be asked when the milk was pumped and how it was handled prior to delivery to the facility. The mother’s hepatitis B, C, and HIV status should be asked. If the mother has not been tested, she should be asked if she is willing to be.
Caring for Our Children Feeding Human Milk to Another Mother’s Child 2. Inform exposed infant’s parents:
• Date of error
• Low risk for harm
• Notify primary care provider
• Possible blood testing
• First mother’s information
Presenter
Presentation Notes
After information is gathered from the first mother, the exposed infant’s parents should be notified. The facility should share with the parents when the infant was fed the wrong milk. The parents should be informed that the risk of hepatitis B,C, and HIV transmission is low, but that certain steps may need to be taken to protect the infant. Parents should be encouraged to notify the infant’s primary care provider. All information provided by the first mother should be shared. Inform parents that depending on the first mother’s blood test results, the infant may need to be tested as well.
Caring for Our Children Feeding Human Milk to Another Mother’s Child
3. Determine why, prevent
• Policy change • Staff education
Notify the facility’s Child Care Licensing authority.
Presenter
Presentation Notes
Once parents have been notified, steps should be taken to prevent recurrence. The facility must determine what led to the error. Policy changes or staff education should be considered. While Caring for Our Children does not specifically state this, the facility’s child care licensing authority should be notified as well.
Caring for Our Children Feeding Human Milk to Another Mother’s Child Hepatitis B If: Hep B unknown, child should be vaccinated. If: Hep B positive, child may receive treatment & vaccination.
Presenter
Presentation Notes
If the mother has Hepatitis B, the baby can still be protected against this disease. Quick medication can prevent Hepatitis B after exposure. The Hepatitis B vaccine can also prevent disease if given quickly after exposure. The baby should be vaccinated if the mother doesn’t know if she has Hepatitis B. The baby should also be vaccinated if the mother does have the disease.
Crossword Puzzle
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Presentation Notes
We have completed the lecture portion of the class. Now you can complete a crossword puzzle in your packet of handouts. This is designed to reinforced important points. �http://www.armoredpenguin.com/crossword/Data/2012.03/3018/30183209.444.html�
Now What?
Start with Step 1. Commit to the importance of breastfeeding support in your facility and practice.
Presenter
Presentation Notes
We talked about the reasons breastfeeding is important and about challenges child care providers can alleviate for mothers. We’ve gone through the Ten Steps for Breastfeeding Friendly Child Care and each of you has begun a plan for your facility. We outlined the care standards that apply to human milk. You now have the information needed to create positive change within your facilities. That concludes the class. Please fill out the post test and class evaluation. We appreciate you doing so as it helps us make the class better. Thank you for attending this class. I hope you have found it informative and will now go and do what you do best….take care of those babies. �
Academy of Breastfeeding Medicine, 2010. ABM clinical protocol #8: Human milk storage information for home use for full-term infants. Retrieved from http://www.bfmed.org/Media/Files/Protocols/Protocol%208%20-%20English%20revised%202010.pdf
American Academy of Pediatrics, 2004. Breastfeeding and the risk of postneonatal death in the United States. Retrieved from http://pediatrics.aappublications.org/content/113/5/e435.full.pdf+html
American Academy of Pediatrics, 2012. Breastfeeding and the use of human milk. Retrieved from http://pediatrics.aappublications.org/content/129/3/e827.full.pdf+html
American Academy of Pediatrics, 2005. Breastfeeding and the use of human milk. Retrieved from http://aappolicy.aappublications.org/cgi/content/full/pediatrics;115/2/496
Carolina Global Breastfeeding Institute, 2011. Breastfeeding-friendly child care. Retrieved from http://cgbi.sph.unc.edu/child-care
Centers for Disease Control and Prevention, 2011. 2011 Breastfeeding report card. Retrieved from http://www.cdc.gov/breastfeeding/data/reportcard.htm
Department of Health and Human Services, 2010. Business case for breastfeeding. Retrieved from http://www.womenshealth.gov/breastfeeding/government-in-action/business-case-for-breastfeeding/
Kan. Stat. Ann. § 65-1,248 Retrieved from http://kslegislature.org/li/b2011_12/statute/065_000_0000_chapter/065_001_0000_article/065_001_0248_section/065_001_0248_k/
Kansas Department of Health and Environment, 2012. Kansas laws and regulations for licensing day care homes and group day care homes for children: February 2012. Retrieved from http://www.kdheks.gov/bcclr/regs/daycare_groupdaycare_regs.html
References
Mohrbacher, N., 2010. Breastfeeding answers made simple: A guide for helping mothers. Hale, Amarillo (464).
National Resource Center for Health and Safety in Child Care and Early Education, 2011. Caring for our children: National health and safety performance standards; Guidelines for early care and education programs, 3rd edition. Retrieved from http://nrckids.org/CFOC3/
New York State Department of Health, 2004. A breastfeeding education activity package for grades K-12. Retrieved from http://www.health.ny.gov/community/pregnancy/breastfeeding/main.htm
Patient Protection and Affordable Care Act, Pub. L. No. 111-148, §2702, 124 Stat. 119, 318-319 (2010).
United States Surgeon General, 2011. A call to action to support breastfeeding. Retrieved from http://www.surgeongeneral.gov/topics/breastfeeding/
Wisconsin Department of Health Services, 2008. Ten steps to breastfeeding friendly child care centers. Retrieved from http://www.dhs.wisconsin.gov/publications/P0/P00022.pdf
World Health Organization, 2003. Global strategy for infant and young child feeding. Retrieved from http://whqlibdoc.who.int/publications/2003/9241562218.pdf
References
Additional Resources
Wisconsin Department of Health Services. Ten Steps to Breastfeeding Friendly Child Care Centers Resource Kit. • Self Assessment • List of Children’s Books • Breastfeeding Links
Centers for Disease Control and Prevention (CDC): Human milk storage and handling guidelines. http://www.cdc.gov/breastfeeding/recommendations/handling_breastmilk.htm U.S. Department of Labor. Wage and Hour Division: Break Time for Breastfeeding Mothers. http://www.dol.gov/whd/nursingmothers/ Bottle feeding techniques: • Kellymom: http://www.kellymom.com/bf/pumping/bottle-feeding.html • Dee Kassing Method: http://www.bfar.org/bottlefeeding.pdf
La Leche League www.llli.org Dr. Jack Newman http://www.breastfeedinginc.ca/index.php WomensHealth.gov http://www.womenshealth.gov/breastfeeding
Breastfeeding Friendly Child Care Planning Worksheet Facility______________________________________ Johnson County Health Department
Step to Implement Activities People and things needed
Time frame Success criteria
Example: Step 1 Facility will commit to supporting breastfeeding
Facility will adopt a breastfeeding support policy
Committee of 2-3 facility employees including program director and at least 1 breastfeeding client.
1 month Policy adopted that supports all 10 steps for Breastfeeding Friendly Child Care.
Step 1
Step 2
Step 3
Step 4
Step 5
Adapted from: Department of Health Services, Division of Public Health, Nutrition, Physical Activity and Obesity Program, Wisconsin Partnership for Activity and Nutrition Breastfeeding Committee. Ten Steps to Breastfeeding Friendly Child Care Centers. December 2008.
Goal Activities People and things needed
Time frame Evaluation method
Visual support of breastfeeding
Purchase and display art, posters, fliers and toys related to breastfeeding.
Program director will: Purchase toys, books Find free fliers Purchase art
Purchase within 1 week Display within 1 month
At least 1 poster, flier or piece of breastfeeding art and 1 breastfeeding toy or book in each facility classroom.
Step 6
Step 7
Step 8
Step 9
Step 10
Adapted from: Department of Health Services, Division of Public Health, Nutrition, Physical Activity and Obesity Program, Wisconsin Partnership for Activity and Nutrition Breastfeeding Committee. Ten Steps to Breastfeeding Friendly Child Care Centers. December 2008.
Sample Child Care Center Breastfeeding Support Policy Johnson County Health Department
(facility name) is committed to providing ongoing support to breastfeeding families. Well-defined research has documented a multitude of health benefits to both the mother and infant. (facility name) subscribes to the following policy: Breastfeeding mothers shall be provided a place to breastfeed or express their milk. Breastfeeding mothers, including employees, shall be provided a private and sanitary place to breastfeed their babies or express milk. This area has an electric outlet, comfortable chair, and nearby access to running water. Mothers are also welcome to breastfeed in front of others if they wish. A refrigerator will be made available for storage of expressed breast milk. Breastfeeding mothers and employees may store their expressed breast milk in the center refrigerator. Mothers should provide their own containers, clearly labeled with name and date. Sensitivity will be shown to breastfeeding mothers and their babies. The center is committed to providing ongoing support to breastfeeding mothers, including providing an opportunity to breastfeed their baby in the morning and evening, or throughout the day as desired. The center will hold off giving a bottle, if possible, when mom is due to arrive. Infant formula and solid foods will not be provided unless requested by the parents. Babies will be held closely when feeding. Staff shall be trained in handling breast milk. All center staff will be trained in the proper storage and handling of breast milk, as well as ways to support breastfeeding mothers. The center will follow human milk storage guidelines from the American Academy of Pediatrics and Centers for Disease Control and Prevention to avoid waste and prevent food borne illness. Special precautions are not required in handling breast milk. Breastfeeding employees shall be provided flexible breaks to accommodate breastfeeding or milk expression. Breastfeeding employees shall be provided a flexible schedule for breastfeeding or pumping to provide breast milk for their children. At minimum, accommodations will be made in accordance with the Fair Labor and Standards Act. If needed, additional accommodations will be made per the discretion of center administration. Breastfeeding promotion information will be displayed. The center will provide information on breastfeeding, including the names of area resources should questions or problems arise. In addition, positive promotion of breastfeeding will be on display in the center.
Adapted from: Department of Health Services, Division of Public Health, Nutrition, Physical Activity and Obesity Program, Wisconsin Partnership for Activity and Nutrition Breastfeeding Committee. Ten Steps to Breastfeeding Friendly Child Care Centers. December 2008
