Wednesday WebinarBecoming a Breastfeeding-Friendly Office Practice

November 29th, 201712:00pm- 1:00pm (central time)

Lori Feldman-Winter, MD, MPHProfessor of Pediatrics

CMSRUDivision Head, Adolescent Medicine

Children’s Regional Hospital at Cooper University Hospital

Remember to mute your line by pressing *6. Please do not press hold. Unmute is #6.

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CHAMPS 4-hour Clinical Skills Trainings

Training Updates:• To date, CHAMPS has hosted 49 trainings in 21 hospitals and has trained

over 900 MS-based clinicians!

Upcoming Trainings: • (4-hour) Wayne General Hospital – November 30th

• (4-hour) Northwest Mississippi Regional Medical Center – December 6th

• (4-hour) Merit Health Natchez – December 7th

• (4-hour) Merit Health Central – December 8th• (4-hour) Magnolia – January 15th (afternoon) & January 16th (morning)

Check our website for updates and to register: cheerequity.org/trainings.html

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SAVE THE DATE

Mississippi CHAMPS ConferenceDate: Wednesday, April 11th, 2018

Location: Courtyard by Marriott Gulfport Beachfront1600 E Beach Blvd

Gulfport, MS

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Upcoming Wednesday Webinar

Webinars are held in collaboration with the Mississippi State Department of Health and are scheduled on Wednesdays from 12p-1p (CST)

Fall 2017 Schedule• December 6th: Understanding the Baby-Friendly USA Fair Market

Price Requirements- Lora L. Elston, BSN, RNC-NIC, IBCLC

Clinical Director, Baby-Friendly USA, Inc.

ALL ARE WELCOME TO ATTEND! For log-in information, visit:http://www.cheerequity.org/webinars.html

Slides and recordings are posted the CHEERequity.org website.

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Becoming a Breastfeeding-Friendly Office Practice

Lori Feldman-Winter, MD, MPHProfessor of Pediatrics

CMSRUDivision Head, Adolescent Medicine

Children’s Regional Hospital at Cooper University Hospital

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Learning Objectives

1. Understand why physicians matter in breastfeeding

2. Describe the challenges physicians have in supporting breastfeeding

3. Delineate the AAP and ABM guidelines to develop a Breastfeeding-Friendly Office Practice

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Why Physicians matter?• Encouragement from health care providers is associated

with breastfeeding initiation• Lu MC, Lange L, Slusser W, Hamilton J, Halfon N. Provider

encouragement of breast-feeding: evidence from a national survey. Obstet Gynecol.2001; 97 :290 –295

• …and continuation• Taveras EM, Capra AM, Braveman PA, Jensvold NG,

Escobar GJ, Lieu TA. Clinician support and psychosocial risk factors associated with breastfeeding discontinuation. Pediatrics.2003; 112 :108 –115

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Why Pediatricians Matter?• Specific practices and opinions of pediatricians were associated

with continuation of exclusive breastfeeding

• Clinicians who recommended formula supplementation or who think their advice is NOT very important may be sending signals that exclusive breastfeeding is NOT something that mothers should value highly

• Many clinicians do not feel confident in their skills to support breastfeeding and may have limited time to address the issue during preventive visits.

Taveras E. et al. 2004. Pediatrics. 113(4):e283-e290

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Physicians’ Knowledge and Attitudes: Historical Perspective

Hollen BK Freed GL

Schanler RJ

Graph data modified from the Mother’s Survey, Ross Products Division of Abbott, and CDC NIS

03 05 07 09

Feldman-Winter

These guys taught

These guys who taught

These guys/gals

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Knowledge and Attitudes

• Sometimes it is what physicians don’t say or are “too vague” in saying• Physicians need to show that they care

• Sometimes it’s not what docs say… but what docs do • Docs give out formula company literature and portray bottle feeding as the

norm in the office setting

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Pediatricians’ Recommendations from 1995-2014

46

71

87

93

92

33

67

71

89

67

24

62

49

80

44

0 10 20 30 40 50 60 70 80 90 100

NO PACIFIERS IN HOSPITAL

UNRESTRICTED BREASTFEEDING

ROOMING-IN 24 HOURS/DAY

GIVE NOTHING BUT BREASTMILK UNLESS MEDICALLY INDICATED

BREASTFEED WITHIN 1 HOUR OF DELIVERY

Multivariable Results Using Predicted Values*

1995 2004 2014

*% Pediatricians adjusted for personal experience, age, gender, practice experience and hours per week of work

Results from AAP Periodic Surveys #30, #57, and #89. Source: Feldman-Winter L , et a. Pediatrics. 2017;140(4):e20171229.

ФФ

Ф

Ф

Ф Ф

ФФ

Ф= statistically different from2014, p

Pediatricians’ Attitudes from 1995 to 2014

81

24

41

50

57

83

25

45

58

62

83

33

44

70

70

0 20 40 60 80 100

Confidence in ability to competentlymanage breastfeeding problems

Formula fed infants are just as healthy asbreastfed infants

Breastfeeding and formula feeding areequally acceptable

Benefits of breastfeeding outweigh thedifficulties

Almost any mother can be successful ifshe keeps trying

Multivariable Results Using Predicted Values*

1995 2004 2014

*%Pediatricians adjusted for personal experience, age, gender, practice experience and hours per week of work

Ф

Ф

Ф

Ф= statistically different from 2014, p

Pediatricians’ Confidence and Practice Patterns- Related to Experience

Feldman-Winter L. et al. Arch Pediatr Adol Med. 2008;162:1142-1150.

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Confidence in Breastfeeding Care by Age

P

Pediatric Workforce and Breastfeeding

Feldman-Winter L. et al. Pediatrics. 2017

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Pediatricians’ Personal Experience with Breastfeeding During Residency

Dixit et al. JHL 2015"Frustrated," "depressed," and "devastated" pediatric trainees: US academic medical centers fail to provide adequate workplace breastfeeding support. COPYRIGHTED

Pediatricians’ Personal Experience with Breastfeeding During Residency

Dixit et al. JHL 2015COPYRIGHTED

Risks of Not Having a Breastfeeding-Friendly Office Practice

•More Baby-Friendly hospitals means more babies will leave the hospital exclusively breastfeeding

•Problems happen•Poorly managed breastfeeding leads to devastating results (as we have learned from the FIB group)

•Most problems may be overcome, but not all•Breastfeeding management is in the physicians’ scope of practice

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Does Physician Education Help?

Labarere J. et al. Pediatrics. Feb 2005;115(2):e139-e146

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AAP Residency Curriculum

•Trained residents (PEDS, OB/GYN, FM) - significant improvement•Intervention vs Control groups

•Knowledge •OR 2.8 (95% CI 1.5 – 5.0)

•Confidence•OR 2.4 (95% CI 1.4 – 4.1)

•Practice patterns related to BF•OR 2.2 (95% CI 1.3 – 3.7)

Feldman-Winter et al, Pediatrics 2010; 126:289-297

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AAP Residency Curriculum

Feldman-Winter et al, Pediatrics 2010; 126:289-297

Increased Exclusive Breastfeeding

0

5

10

15

20

25

30

Intervention Intervention

BeforeAfter

Control Control

Exclusive BF at 6 mo Before and After Study

Exclusive BF at hospital discharge Before and After Study

*

*

**

**

%

* p < 0.01

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Traditional vs. Competency-based Education

Frenk J. et. al. Lancet 2010.

What are the most pressinghealth system needs regardingbreastfeeding in 2017?

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Competency-based Education• Health System needs

• Need to improve physician knowledge, skills and attitudes to support exclusive breastfeeding

• Competencies• Skills in taking history, doing assessments and

counseling• Outcomes

• Increased Exclusive Breastfeeding; Eliminate Disparities• Assessment of Outcomes

• Measure rates• Assessment of Competencies

• Tools• Direct observation, OSCE

• Develop curriculum You determine what your docs need to learn

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AAP Clinical Report 2017

Meek et al. Pediatrics 2017COPYRIGHTED

ABM Clinical Protocol

• Evidence-based guidelines for Breastfeeding-Friendly Office Practices• Levels of evidence: I, II-1, II-2, II-3, and III

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ABM Protocol in Office Setting

Corriveau et al. Pediatrics 2013

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Office Based Protocol

ABM protocol1. Establish a written

office policy (III)2. Encourage exclusive

breastfeeding (I, III)3. Culturally competent

care (III)4. Offer a prenatal visit

(I, II-1, II-2, II-3, III)

Operationalized1. Team formed-(docs nurses and

LC’s), policy manual with ABM clinical protocols

2. Staff training to encourage/support exclusive breastfeeding, physicians had to complete AAP approved training

3. Spanish interpreters trained in breastfeeding support and mother’s cultural beliefs supported

4. Prenatal class offered by practice and monthly meet and greet offered to new patients

ABM Protocol BFMed 2013

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Advocate for Exclusive Breastfeeding…And Be Able to Solve Problems

•Risk/Benefit Assessment•Understand the consequences of not breastfeeding exclusively

•Know where there are gaps in research•Practice Evidence Based Medicine (EBM)

•Become educated in the benefits and management of breastfeeding

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Culturally Competent/Sensitive Care

•Define Disparities•Address common barriers: breastfeeding in public, acculturation, language and literacy

•Understand spheres of support•Increase cultural knowledge•Develop an approach to counseling•Use peer counselors

Hedberg. MCN Am J Matern Child Nurs. 2013 Jul-Aug;38(4):244-9

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Breastfeeding Disparities- National

Data source CDC National immunization Survey COPYRIGHTED

Chart1

White/NHWhite/NHWhite/NHWhite/NHWhite/NH

HispanicHispanicHispanicHispanicHispanic

BlackBlackBlackBlackBlack

AsianAsianAsianAsianAsian

AI/ANAI/ANAI/ANAI/ANAI/AN

2 or more2 or more2 or more2 or more2 or more

overall

6 months

12 months

3 mo exclusive

6 mo exclusive

2014 Breastfeeding in the US

85.7

60

37.8

51.5

27.9

84.8

52.5

31.7

45.5

24.5

68

41.5

21.5

32.7

15

80.7

61.9

37.5

44.3

27.6

79.5

52.8

29.7

51.2

26.5

79.9

53.4

32.8

42.5

21.2

Sheet1

overall6 months12 months3 mo exclusive6 mo exclusive

White/NH85.76037.851.527.9

Hispanic84.852.531.745.524.5

Black6841.521.532.715

Asian80.761.937.544.327.6

AI/AN79.552.829.751.226.5

2 or more79.953.432.842.521.2

Geographic Disparities 2014Exclusive Breastfeeding Through 6 months

Data source CDC National immunization Survey

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Understand Support System-Don’t Stereotype

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Provide Culturally and Linguistically Competent Care

•Use interpreters or phones for translation

•Understand common cultural practices

•Use open ended questions to identify specific and individual beliefs and practices

•Use MI to encourage optimal feeding

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http://www.google.com/url?sa=i&rct=j&q=spanish+mom+breastfeeding&source=images&cd=&cad=rja&docid=hL1DLG2U2GZzYM&tbnid=ibhUvP5W0kXwFM:&ved=0CAUQjRw&url=http://www.michigan.gov/mdch/0,1607,7-132-2942_4911_34593---,00.html&ei=4A7eUeihJIv-4AOGsYHAAw&psig=AFQjCNHdWZC5qZ-MexQN0OxXGFqZRkQtXg&ust=1373593670828768http://www.google.com/url?sa=i&rct=j&q=spanish+mom+breastfeeding&source=images&cd=&cad=rja&docid=hL1DLG2U2GZzYM&tbnid=ibhUvP5W0kXwFM:&ved=0CAUQjRw&url=http://www.michigan.gov/mdch/0,1607,7-132-2942_4911_34593---,00.html&ei=4A7eUeihJIv-4AOGsYHAAw&psig=AFQjCNHdWZC5qZ-MexQN0OxXGFqZRkQtXg&ust=1373593670828768

Physicians should make referrals to WIC Peer Counselors

•WIC peers•Hospital doulas•Community health workers

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http://www.google.com/url?sa=i&rct=j&q=peer%20counselors%20breastfeeding&source=images&cd=&cad=rja&docid=50mcABOFTVsklM&tbnid=5Qy3XEGno42xeM:&ved=0CAUQjRw&url=http://www.houstontx.gov/health/WIC/breastfeeding.html&ei=s2sLUp_uGqPkyQG6pYCICg&bvm=bv.50723672,d.aWc&psig=AFQjCNHtMhKOmLPsd-h2mzaSe4ZVbdmG_Q&ust=1376566570394240http://www.google.com/url?sa=i&rct=j&q=peer%20counselors%20breastfeeding&source=images&cd=&cad=rja&docid=50mcABOFTVsklM&tbnid=5Qy3XEGno42xeM:&ved=0CAUQjRw&url=http://www.houstontx.gov/health/WIC/breastfeeding.html&ei=s2sLUp_uGqPkyQG6pYCICg&bvm=bv.50723672,d.aWc&psig=AFQjCNHtMhKOmLPsd-h2mzaSe4ZVbdmG_Q&ust=1376566570394240http://www.google.com/url?sa=i&rct=j&q=peer%20counselors%20breastfeeding&source=images&cd=&cad=rja&docid=r2UneRAWmOIB6M&tbnid=Cen-WL6UBP9M2M:&ved=0CAUQjRw&url=http://www.nal.usda.gov/nal_web/wicworks/resources/images-download.html&ei=6WsLUvXTM4bmyQGTuYDwBw&bvm=bv.50723672,d.aWc&psig=AFQjCNHtMhKOmLPsd-h2mzaSe4ZVbdmG_Q&ust=1376566570394240http://www.google.com/url?sa=i&rct=j&q=peer%20counselors%20breastfeeding&source=images&cd=&cad=rja&docid=r2UneRAWmOIB6M&tbnid=Cen-WL6UBP9M2M:&ved=0CAUQjRw&url=http://www.nal.usda.gov/nal_web/wicworks/resources/images-download.html&ei=6WsLUvXTM4bmyQGTuYDwBw&bvm=bv.50723672,d.aWc&psig=AFQjCNHtMhKOmLPsd-h2mzaSe4ZVbdmG_Q&ust=1376566570394240

Pediatric Providers Can Offer a Prenatal Visit

•Meet and greet session with physician and team•Discuss the Ten Steps•First visit with baby•Answer questions

about breastfeeding

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http://www.google.com/url?sa=i&rct=j&q=AAP+prematal+visit&source=images&cd=&cad=rja&docid=WP5qCapOvPIlSM&tbnid=QhhAWMVdBePD_M:&ved=0CAUQjRw&url=http://brightfutures.aap.org/3rd_Edition_Guidelines_and_Pocket_Guide.html&ei=sBDeUfeRAdK64APV54CgDw&psig=AFQjCNGvarW3ZdSMPSGUZg5PkGChaUEvDA&ust=1373593911531885http://www.google.com/url?sa=i&rct=j&q=AAP+prematal+visit&source=images&cd=&cad=rja&docid=WP5qCapOvPIlSM&tbnid=QhhAWMVdBePD_M:&ved=0CAUQjRw&url=http://brightfutures.aap.org/3rd_Edition_Guidelines_and_Pocket_Guide.html&ei=sBDeUfeRAdK64APV54CgDw&psig=AFQjCNGvarW3ZdSMPSGUZg5PkGChaUEvDA&ust=1373593911531885

Office Based ProtocolABM Protocol5. Collaborate with local

hospital and community6. First visit within 48 hours

from hospital discharge and provide access to a lactation consultant

7. Provide educational resources (I)

8. Encourage breastfeeding in the office (II-2, II-3)

9. Discourage formula marketing (II-2, II-3)

Operationalized5. Raise awareness about what is

offered to local hospitals and Obstetricians

6. Mothers scheduled for up to 1 hr of direct LC support with an RN/IBCLC during first visit and F/U visits as requested by mom

7. Handouts from AAP and ILCA8. Breastfeeding in waiting room

supported and space available if privacy desired

9. Formula only provided if there is a medical need. Formula and ads for formula not displayed

ABM Protocol BFMed 2013

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Newborn Hospital Follow Up within 48 hours of D/C

•Periodic Survey data (AAP survey of Fellows) indicate nationally only 38% of pediatricians follow AAP recommendation for F/U within 5 days of life (

Newborn Follow-up

Source: NJ PRAMS 2010COPYRIGHTED

Office Environment/Support

• Pictures of breastfeeding• “Breastfeeding Welcome

Here” decals• Knowledgeable and

supportive reception and office staff

• Acceptance of public breastfeeding

• Private space for breastfeeding

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• Most medications compatible with breastfeeding

• Evidence-based resources– Lact MED– AAP Policy Statements– Medications and Mother’s

Milk, by T. Hale, PhD

Check It Out Before Saying No!Medications and Breastfeeding

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Family Centered Care

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Everyone Has A Role In Supporting Breastfeeding

•Front Desk•Office Staff•Nursing Staff•PCP

•Clinical Management•Identify appropriate referrals

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Discourage Formula Marketing

•AAP ALF resolution: Divesting from Formula Marketing in Pediatric Care-passed 2012

…that the AAP advise pediatricians not to provide formula company gift bags, coupons, and industry-authored handouts to the parents of newborns and infants in office and clinic settings.

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Office Based Protocol

ABM Protocol10.Telephone Support (I)11.Commend breastfeeding

(I, II-1, II-2, II-3)12.Recommend exclusive

breastfeeding to 6 months (III)

13.Develop worksite lactation policy (II-2, III)

14.Establish community resources (I, II-3, III)

Operationalized10.A Warm line available for mothers to call

and questions answered by IBCLC (trained provider) within 24 hours

11.Staff trained to offer praise and acknowledgement for continued breastfeeding

12.The ABM guideline for exclusive breastfeeding for 6 months is provided to all parents

13.Worksite policy developed and described as part of the Breastfeeding Policy Manual Space and break time provided for all employees to pump and store milk

14.Weekly support group offered and families provided with list of other local community resources

ABM Protocol BFMed 2013

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Telephone Support

•Warm line•Train staff•Provide evidence-based information

•Ensure follow-up

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http://www.google.com/url?sa=i&rct=j&q=Bunik+telephone+triage+breastfeeding&source=images&cd=&cad=rja&docid=SLoflP_NEl-7vM&tbnid=heplZdRZ2GbtsM:&ved=0CAUQjRw&url=http://www.betterworldbooks.com/breastfeeding-telephone-triage-triage-and-advice-id-9781581107449.aspx&ei=qBfeUdy2IpG24AOwk4BY&bvm=bv.48705608,d.aWc&psig=AFQjCNG4_juITSbmvB2pVBCdhNgiBtm0sA&ust=1373595942422334http://www.google.com/url?sa=i&rct=j&q=Bunik+telephone+triage+breastfeeding&source=images&cd=&cad=rja&docid=SLoflP_NEl-7vM&tbnid=heplZdRZ2GbtsM:&ved=0CAUQjRw&url=http://www.betterworldbooks.com/breastfeeding-telephone-triage-triage-and-advice-id-9781581107449.aspx&ei=qBfeUdy2IpG24AOwk4BY&bvm=bv.48705608,d.aWc&psig=AFQjCNG4_juITSbmvB2pVBCdhNgiBtm0sA&ust=1373595942422334

Worksite Policy on Breastfeeding

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Refer to Support Groups

• On site support group

• La Leche League Leaders– Provide basic

information and encouragement through: Support groups Telephone warm

lines

• WIC peer counselors• Baby Cafés

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Office Based ProtocolABM Protocol15. Insurance and Billing 16. Assist with workplace

support (II-2, III)17. Formal staff training and

on-site IBCLC services (I, II-2, II-3)

18. Mentor health care providers including residents (II-2, II-3)

19. Data tracking

Operationalized15.Lactation consultant visits are billed

to insurance using AAP Breastfeeding CPT and ICD-10 codes

16.“Going back to work” class offered to mothers and taught by the IBCLC

17.Support staff trained in the breastfeeding-friendly office environment specific to their roles, physicians all completed Wellstart on line program

18.Physicians act as preceptors to residents, NP students, PA’s and medical students.

19.Breastfeeding rates are tracked for surveillance and entered into a database by a team member

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AAP ICD-10 Coding booklet

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Support Moms Returning to Work or School

Influencing factors• Type of work• Worksite accommodations:

Support, Time, Education, Private space

• Baby’s age upon return• Family, health provider

and/or community support • Child care arrangements

that support continued breastfeeding

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Breastfeeding and Health Care Reform

•2010 Patient Protection and Affordable Care Act

•Section 7(r) of the Fair Labor Standards Act – Break Time for Nursing Mothers Provision •reasonable break time to express breast milk after the birth of her child.

•The amendment also requires that employers provide a place for an employee to express breast milk.

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USBC Model Policy to Guide Implementation of the ACA

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Alternative Workplace

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Train HCP’s:USBC Core Competencies for all Health Care Professionals

•Endorsed by the AAP and other health care organizations

•Multidisciplinary competencies•Consistent care models

Feldman-Winter L Evidenced-based Interventions PCNA 2013

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Providing Anticipatory Guidance

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http://www.google.com/url?sa=i&rct=j&q=AAP%20breastfeeding%20billing%20coding%20booklet&source=images&cd=&docid=ux7mvyTmP6JH5M&tbnid=Ai9ymumyhSgdLM:&ved=0CAUQjRw&url=https://www.facebook.com/AAPSectionOnBreastfeeding&ei=VxneUcS3CpLj4AP454GoBA&psig=AFQjCNHe6An9rdU64y-gnkca1k7UmAKvVA&ust=1373596372494423http://www.google.com/url?sa=i&rct=j&q=AAP%20breastfeeding%20billing%20coding%20booklet&source=images&cd=&docid=ux7mvyTmP6JH5M&tbnid=Ai9ymumyhSgdLM:&ved=0CAUQjRw&url=https://www.facebook.com/AAPSectionOnBreastfeeding&ei=VxneUcS3CpLj4AP454GoBA&psig=AFQjCNHe6An9rdU64y-gnkca1k7UmAKvVA&ust=1373596372494423

First Pediatric Visit

• Ask open-ended questions• How is breastfeeding going? • Tell me about your baby’s latch.• What are your expectations?• Who is your support system?

• Reinforce that frequent feeding is not an indicator of insufficient milk supply.

• Remember Vitamin D!

Give Encouragement, Support and Praise!

Chart feeding method

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2-Week Pediatric Visit

1. Assess current feeding regimen and plans2. Explain normal “cluster feedings” which occur in

early evening3. Reassess weight and concerns for low milk supply4. Inquire about mother’s medications , birth control

plans , and plans to return to work5. Ask about other caregivers and whether they help to

feed the baby6. Discuss bottle use and expressing breast milk7. Reinforce use of Vitamin D.

Give Encouragement, Support and Praise!

Chart feeding method

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One Month Pediatric Visit

• Continue to ask open-ended questions• Review safe breastfeeding/sleeping

environment• Assess back-to-work or school issues

• Assess current feeding regimen and plans• Discuss change in stooling pattern• Provide positive messages!!

Give Encouragement, Support and Praise!

Chart feeding method

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6 Week Maternal Care Visit- Consider Doing Visit at 2 weeks, or 2 Days-4th trimester

•Assess the breast•Contraceptive Visit•Look out for

•Mastitis•Nipple infections•Milk production

Continue to Give Encouragement, Support and Praise!

Chart feeding method

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Don't Miss Opportunity to Support Breastfeeding at Sick Visits

Continue breastfeeding through:• Gastroenteritis• Viral infections – mother’s milk

helps decrease severity and duration

• Ear infection - less frequent• Urinary Tract Infection (UTI)• Vaginitis

“Use every patient encounter to promote and support continued breastfeeding.”

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Track Your Progress

• Record feeding at every visit (any breastfeeding, supplemented breastfeeding, no breastfeeding, and +/- solid food)

• Monitor rates by demographics (race/ethnicity, insurance status, office location)

• Keep track of changes and how they may have affected rates• Don’t change everything at once

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Summary

•Physicians need to be educated to provide breastfeeding care•Poor support can lead to bad consequences

•Understand why physicians may have low confidence and lack of ability to support breastfeeding

•Physician office practices provide many opportunities for improvement

•Start with one change at a time•Don’t forget teamwork

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• Thanks for joining today!• Upcoming webinars

• December 6th : Lora L. Elston, Baby-Friend USA, will talk about Understanding Baby-Friendly USA Fair Market Price Requirements

• These slides have been uploaded to our website and a recording of the webinar will be uploaded there this afternoon.

CHEERequity.org/webinars

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Wednesday Webinar�Becoming a Breastfeeding-Friendly Office Practice�CHAMPS 4-hour Clinical Skills TrainingsSlide Number 3�Upcoming Wednesday WebinarBecoming a Breastfeeding-Friendly Office PracticeLearning Objectives�Why Physicians matter?Why Pediatricians Matter?Physicians’ Knowledge and Attitudes: Historical PerspectiveKnowledge and AttitudesPediatricians’ Recommendations from 1995-2014Pediatricians’ Attitudes from 1995 to 2014Pediatricians’ Confidence and Practice Patterns- Related to ExperienceConfidence in Breastfeeding Care by AgePediatric Workforce and BreastfeedingPediatricians’ Personal Experience with Breastfeeding During ResidencyPediatricians’ Personal Experience with Breastfeeding During ResidencyRisks of Not Having a Breastfeeding-Friendly Office PracticeDoes Physician Education Help?AAP Residency CurriculumSlide Number 21Traditional vs. Competency-based EducationCompetency-based EducationAAP Clinical Report 2017ABM Clinical ProtocolABM Protocol in Office Setting Office Based ProtocolAdvocate for Exclusive Breastfeeding�…And Be Able to Solve ProblemsCulturally Competent/Sensitive CareBreastfeeding Disparities- National�Geographic Disparities 2014�Exclusive Breastfeeding Through 6 monthsUnderstand Support System-Don’t StereotypeProvide Culturally and Linguistically Competent CarePhysicians should make referrals to WIC Peer CounselorsPediatric Providers Can Offer a Prenatal VisitOffice Based ProtocolNewborn Hospital Follow Up within 48 hours of D/CNewborn Follow-upSlide Number 39Slide Number 40Family Centered CareEveryone Has A Role In �Supporting BreastfeedingDiscourage Formula MarketingOffice Based ProtocolTelephone SupportWorksite Policy on BreastfeedingSlide Number 47Office Based ProtocolAAP ICD-10 Coding bookletSlide Number 50Breastfeeding and Health Care ReformUSBC Model Policy to Guide Implementation of the ACAAlternative Workplace�Train HCP’s:�USBC Core Competencies for all Health Care ProfessionalsSlide Number 55Slide Number 56Slide Number 57Slide Number 586 Week Maternal Care Visit- Consider Doing Visit at 2 weeks, or 2 Days-4th trimester Slide Number 60Track Your ProgressSummarySlide Number 63Slide Number 64