Breastfeeding Friendly Child Care Provider Training

Breastfeeding Friendly Child Care Provider Training 10 Steps Toolkit Amber France MS IBCLC Amanda Melinski RDN CLC Wood County Health Department afrance@co.wood.wi.us (715)421-8937 Wood County Breastfeeding Coalition HPWC Chronic Disease Prevention Team Wood County Health Department

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

Breastfeeding is Normal Support Education 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

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: 12/12/12 Amount: 4 oz.

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

Breastfeeding Friendly Child Care Provider Training