BREASTFEEDING FRIENDLY CHILD CARE PROVIDER TRAINING

10 Steps Toolkit

Wood County Breastfeeding CoalitionHPWC Chronic Disease Prevention Team

Wood County Health Department

Amber France MS IBCLCAmanda Melinski RDN CLCWood County Health Departmentafrance@co.wood.wi.us(715)421-8937

• Investing Early Grant from Celebrate Children Foundation • Develop Training/Materials• Process• Outcomes

GRANT

BREASTFEEDING IS NORMAL

Education

Support

Awareness

WHAT’S IN BREASTMILK???

• 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

RISKS OF FORMULA

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

BENEFITS TO MOM

“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 THE COMMUNITY

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

• Easier transition• More marketable

BENEFITS TO CHILDCARE PROVIDER

• 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

CACFP MEAL PATTERN

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%

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

HEALTHY PEOPLE 2020 GOALS

• 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!

AAP POLICY STATEMENT

“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.”

SURGEON GENERALS CALL TO ACTION

• 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.

10 STEPS TO BREASTFEEDING FRIENDLY CHILD CARE CENTERS

• 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.

STEPS CONTINUED

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

SELF-APPRAISAL QUESTIONNAIRE

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

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

GAIN SUPPORT FROM MANAGEMENT & STAFF (STEP 1)

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

ASSEMBLE A TEAM & DESIGNATE A COORDINATOR (STEP 1)

• Written guidance• Example in tool-kit

ACTION PLAN (STEP 1)

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

policy.

STEP 2

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

• Sample policies

POLICY (STEP 2)

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

STEP 3

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

SUPPORTIVE ENVIRONMENT (STEP 3)

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

STEP 4

• Store in 1-4 oz. portions• Label milk

– Infants full name– Date– Amount

• Discuss with parents• Use Academy of Breastfeeding Medicine Storage Guidelines

SAFE STORAGE

Example:Sammy Smith

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

Location DurationRoom Temperature 6-8 HoursInsulated Cooler 24 HoursRefrigerator 5 DaysFreezer Compartment in Refrigerator

2 Weeks

Freezer Compartment of Refrigerator with Separate Doors

3-6 Months

Deep Freezer (Freezer Chest) 6-12 Months

STORAGE GUIDELINES (FOR HEALTHY FULL TERM INFANTS)

*The Academy of Breastfeeding Medicine (Protocol #8)

• Separation• Swirl – Don’t shake• Thaw

– Refrigerator– Under warm water

• Do not refreeze

HANDLING 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

WARMING BREASTMILK

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

FEEDING BABY

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

AMOUNT OF BREASTMILK

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

HOW TO FEED BABY

• Reverse Cycle Feeding• Different Containers

WHAT IF BABY REFUSES THE BOTTLE?

• 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

GETTING ENOUGH?

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

BOWEL MOVEMENTS

• Supply and demand• Low supply triggers

– Supplements– Skipping Feedings– Pacifiers– Illness

WHAT HURTS 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

TOOLS TO INCREASE SUPPLY

• 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.

BREAST MILK IS NOT A BODY FLUID*

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

HOW CAN STAFF SUPPORT BREASTFEEDING?

• Staff develop with family• Individualize• Familiarize all staff

INFANT CARE PLANS

• Delay solids until around 6 months– AAP guidelines

• Good starters

INTRODUCTION TO SOLIDS

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 5

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

STEP 6

BREASTFEEDING IS WELCOME HERE SIGN

Stimulate participatory learning experiences with the children related to breastfeeding.

STEP 7

• Books• Pictures

EXPOSING CHILDREN TO BREASTFEEDING (STEP 7)

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 8

PRIVATE SPACE (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”

BREASTFEEDING LAWS (STEP 8)

Establish and maintain connections with your local breastfeeding coalition or other community

resources.

STEP 9

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

accessible area for families.

STEP 10

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

RESOURCES (STEP 10)

RESULTSNAP SACC: Breastfeeding & Infant Feeding Assessment

Area Assessed Baseline (3/2013)

Post (4-5/2013)

BF Environment 19.5 25.2BF Support Practices 21.3 26BF Education & Prof Development 11.6 24.2BF Policy 6.7 24Infant Foods Served 27.8 26Infant Feeding Practices 26.3 26Infant Feeding Education & Prof Development

19 22.8

Infant Feeding Policy 14.7 23.3Average Baseline: 18.2

Average Post: 24.8

RESULTS

NAP SACC: Breastfeeding & Infant Feeding Assessment

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 170

5

10

15

20

25

30

Avg. Score (Pre)Avg. Score (Post)

All Site

s

CCR&R LISTING

EMBLEM

CONTACT INFO

Amber France MS IBCLCWood County Health

Departmentafrance@co.wood.wi.us

(715)421-8937

www.woodcountybreastfeeding.org

WEBSITE

• 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-over-time/

REFERENCES