Breastfeeding Friendly Child Care Provider Training

10 Steps Toolkit

Wood County Breastfeeding CoalitionHPWC Chronic Disease Prevention Team

Wood County Health Department

Amber France MS IBCLCWood County Health Departmentafrance@co.wood.wi.us(715)421-8937

Grant

• Investing Early Grant from Celebrate Children Foundation

• Develop Training/Materials• Process• Outcomes

Breastfeeding is Normal

What’s in Breastmilk???

Risks of Formula

• Lower IQ• Increased risk of SIDS• Increase in infectious illness• Higher risk of inflammatory bowel diseases• Increase NEC in preemies• Higher risk of cancer• Higher risk for cardiovascular disease• Higher risk of diabetes• No protection from asthma & eczema• Higher risk of childhood obesity• More cavities• Problems with oral/jaw structure

Benefits to Mom

• Life is easier• Saves money• Feel great• Health benefits• Miss less work

Benefits to the Community

“If 90 percent of families breastfed exclusively for 6 months, nearly 1,000 deaths among infants could be

prevented.”

• Save $13 billion per year• More productive workforce• Better for environment

Benefits to Childcare Provider

• Babies are sick less• Babies are happier• Diaper odor is less• Baby may spit up less

• Easier transition• More marketable

CACFP Meal Pattern

• Breastmilk is part of the Meal Pattern– Reimbursable component of infant meal pattern– Children >12 months, breastmilk substitute cow’s

milk in the meal pattern for reimbursement

Healthy People 2020 Goals

Duration Healthy People 2020 Goals Wisconsin (2009)

Initiate breastfeeding 81.9% 75.5%

At 6 months 60.6% 48.6%

At 1 year 34.1% 25.9%

Exclusively for 3 months 46.2% 45.2%

Exclusively for 6 months 25.5% 16.8%

Healthy People 2020 Goals

• Increase the proportion of employers that have worksite lactation support programs

AAP Policy Statement

• Exclusive breastfeeding for the 1st 6 months• Continued breastfeeding through at least the

1st year or longer as mutually desired• Medical contraindications are rare

WHO recommends at least 2 years!

Surgeon Generals Call To Action

“One of the most highly effective preventive measures a mother can take to protect the health of her infant and herself is to breastfeed.”“The success rate among mothers who want to breastfeed can be greatly improved through active support from their families, friends, communities, clinicians, health care leaders, employers, and policymakers.”

10 Steps to Breastfeeding Friendly Child Care Centers

• Step 1: Designate an individual or group who is responsible for development and implementation of the 10 steps.

• Step 2: Establish a supportive breastfeeding policy and assure that all staff are aware of and following the policy.

• Step 3: Establish a supportive worksite policy for staff members who are breastfeeding.

Steps Continued

• Step 4: Train all staff so that they are able to carry out breastfeeding promotion and support activities.

• Step 5: Create a culturally appropriate breastfeeding friendly environment.

• Step 6: Inform expectant and new families and visitors about your Center’s breastfeeding friendly policies.

• Step 7: Stimulate participatory learning experiences with the children related to breastfeeding.

Steps Continued

• Step 8: Provide a comfortable place for mothers to breastfeed or pump their milk in privacy, if desired. Educate families and staff that a mother may breastfeed her child wherever they have legal right to be.

• Step 9: Establish and maintain connections with your local breastfeeding coalition or other community resources.

• Step 10: Maintain an updated resource file of community breastfeeding services and resources kept in an accessible area for families.

Self-Appraisal Questionnaire

• Reviews existing practices• Compliance with requirements• Assess key areas for improvement• Tool to prioritize

Step 1

Designate an individual or group who is responsible for development and implementation of the 10 steps.

Step 1

• Designate individual or small group to– Initiate & asses progress– Review policies, procedures, & protocols– Ensure staff receive orientation & training

Step 1

• Support from Management & Staff• Assemble team• Designate a coordinator• Team meetings• Planning• Action Plan• Continuing Education

Gain Support From Management & Staff (Step 1)

• 75% women employed with children <3 years• 51% under 2 cared for by someone other than

parent• Child care vital role in breastfeeding • Benefits to family & center• Child care setting: Natural, logical place for

support

Assemble a Team & Designate a Coordinator (Step 1)

• Depend on size of center• Both management and direct staff• Designate a coordinator• Team meetings

Action Plan (Step 1)

• Written guidance• Example in tool-kit

Step 2

Establish a supportive breastfeeding policy and assure that all staff are aware of and following

the policy.

Policy (Step 2)

• Support & protect mothers/infants• Addresses– Breastfeeding mothers welcome– Accurate information– Trained staff

• Sample policies

Step 3

Establish a supportive worksite policy for staff members who are breastfeeding.

Supportive Environment (Step 3)

• Supportive staff• Comfortable environment• Supporting employees• Example lactation areas

Step 4

Train all staff so that they are able to carry out breastfeeding promotion and support activities.

Safe Storage

• Store in 1-4 oz. portions• Label milk– Infants full name– Date– Amount

• Discuss with parents• Use Academy of Breastfeeding Medicine

Storage Guidelines

Example:Sammy Smith

Date pumped: 12/12/12Amount: 4 oz.

Storage Guidelines (For Healthy Full Term Infants)

Location DurationRoom Temperature 6-8 Hours

Insulated Cooler 24 Hours

Refrigerator 5 Days

Freezer Compartment in Refrigerator 2 Weeks

Freezer Compartment of Refrigerator with Separate Doors

3-6 Months

Deep Freezer (Freezer Chest) 6-12 Months

*The Academy of Breastfeeding Medicine (Protocol #8)

Handling Breastmilk

• Separation• Swirl – Don’t shake• Thaw– Refrigerator– Under warm water

• Do not refreeze

Warming Breastmilk

• Do not use a microwave• Use warm water– Under running water– In container of warm water– Bottle warmer

• Excessive heat destroys properties• Some like cold milk

Feeding Baby

• Easily digested• Typically 1 ½ to 3 hours• Hunger cues• Avoid large feedings

Amount of Breastmilk

• Growth Spurts• Needs as baby grows• Breastmilk vs formula composition

How to Feed Baby

• Mimic breastfeeding• Switch arms• Baby control feeding• Feed slowly• Stop with baby’s cues

What If Baby Refuses The Bottle?

• Reverse Cycle Feeding• Different Containers

Getting Enough?

• Weight gain – Most Important• Wet diapers• Spit up is normal

• Not good indicators– Baby cries after feedings– Mom can only pump ½ ounce– Baby will continue to take more milk after first bottle

Bowel Movements

• Mustard color• Seedy• Runny to pudding consistency• Normal not to stool daily

What Hurts Supply?

• Supply and demand• Low supply triggers– Supplements– Skipping Feedings– Pacifiers– Illness

Tools to Increase Supply

• Referral to Lactation Consultant• To Increase (at center)– Give only what was pumped the previous day– Do not supplement

• To Increase (with mom)– No pacifiers– Nurse more often– Do not skip pumping at work

Breast Milk is NOT a Body Fluid*

• No need for separate refrigerator• No gloves• Not contaminated by touch

*According to OSHA’s and CDC’s definitions, breastmilk is classified as “food” and does not require universal precautions for handling body fluids.

How Can Staff Support Breastfeeding?

• Verbalize and initiate support• Encourage mom to get help • Be accommodating

Infant Care Plans

• Staff develop with family• Individualize• Familiarize all staff

Introduction to Solids

• Delay solids until around 6 months– AAP guidelines

• Good starters

Step 5

Create a culturally appropriate breastfeeding friendly environment.

Step 5

• Written and verbal communication• Eliminate/limit visibility of formula• No baby bottle pictures• Racial/ethnically diverse pictures & materials• Monitor staff

Step 6

Inform expectant and new families and visitors about your Center’s breastfeeding friendly

policies.

Step 6

• Breastfeeding policies and handouts• Information on local laws• Signage

Breastfeeding is Welcome Here Sign

Step 7

Stimulate participatory learning experiences with the children related to breastfeeding.

Exposing Children To Breastfeeding (Step 7)

• Books• Pictures

Step 8

Provide a comfortable place for mothers to breastfeed or pump their milk in privacy, if desired. Educate families and staff that a

mother may breastfeed her child wherever they have legal right to be.

Private Space (Step 8)

Breastfeeding Laws (Step 8)

Wisconsin State Statute 253.16“A mother may breastfeed her child in any public or

private location where the mother and child are otherwise authorized to be. In such a location, no person may prohibit a mother from breastfeeding her child, direct a mother to move to another location to breastfeed her child, direct a mother to cover her child or breast while breastfeeding, or otherwise restrict a mother from breastfeeding”

Step 9

Establish and maintain connections with your local breastfeeding coalition or other

community resources.

Step 10

Maintain an updated resource file of community breastfeeding services and resources kept in an

accessible area for families.

Resources (Step 10)

• Your local breastfeeding coalition will update you on the latest breastfeeding information.

Contact Info

Amber France MS IBCLCWood County Health Department

afrance@co.wood.wi.us(715)421-8937

References• http://

www.cdph.ca.gov/programs/breastfeeding/Documents/MO-HowDoesForWAFBF-Eng.pdf • http://infantnutritioncouncil.com/breastmilk-information/ • http://www.americanpregnancy.org/firstyearoflife/whatsinbreastmilk.html• http://www.womenshealth.gov/breastfeeding/why-breastfeeding-is-important/index.html• http://www.usbreastfeeding.org/Portals/0/Publications/Child-Care-2002-USBC.pdf • http://digitalcommons.unl.edu/cgi/viewcontent.cgi?article=1007&context=sociologydiss&sei-

redir=1&referer=http%3A%2F%2Fwww.google.com%2Furl%3Fsa%3Dt%26rct%3Dj%26q%3Dbenefits%2520of%2520breastfeeding%2520to%2520childcare%2520centers%26source%3Dweb%26cd%3D4%26ved%3D0CFEQFjAD%26url%3Dhttp%253A%252F%252Fdigitalcommons.unl.edu%252Fcgi%252Fviewcontent.cgi%253Farticle%253D1007%2526context%253Dsociologydiss%26ei%3DAKPPULXbHoakyQG5q4HYCQ%26usg%3DAFQjCNGykr2msusoayso3sdiQCL2FosR_A#search=%22benefits%20breastfeeding%20childcare%20centers%22

• http://www.dhs.wisconsin.gov/hw2020/health/nutrition/reportcard09.pdf• http://kellymom.com/bf/normal/growth-spurts/

References• http://www.workandpump.com/reversecycling.htm• http://

www.nbci.ca/index.php?option=com_content&view=article&id=23:is-my-baby-getting-enough-milk&catid=5:information&Itemid=17

• http://www.mayoclinic.com/health/low-milk-supply/AN02187 • http://kellymom.com/bf/got-milk/supply-worries/low-supply/• http://

www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPREATIONS&p_id=20952

• http://kellymom.com/nutrition/starting-solids/solids-how/• http://mchb.hrsa.gov/pregnancyandbeyond/breastfeeding/• http://wdrs.fnal.gov/elr/familybalance/mothersroom.html • http://

uvahealth.com/directions-locations/clinics/images-and-docs/augusta-pediatrics-indoor-shots/nursing%20room.jpg/view

• http://www.meadjohnson.com.ph/news_lactation-suite-room-for-nourishment.html • http://rakhealthmatters.wordpress.com/2012/03/21/breastfeeding-and-the-milk-supply-ov

er-time/