Breastfeeding Friendly Child Care Provider Training

1. Breastfeeding Friendly Child Care Provider Training 10 Steps Toolkit Amber France MS IBCLC 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

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

3. Breastfeeding is Normal

4. What’s in Breastmilk???

5. 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

6. Benefits to Mom • Life is easier • Saves money • Feel great • Health benefits • Miss less work

7. 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

8. Benefits to Childcare Provider • Babies are sick less • Babies are happier • Diaper odor is less • Baby may spit up less • Easier transition • More marketable

9. 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

10. Healthy People 2020 Goals

11. Healthy People 2020 Goals • Increase the proportion of employers that have worksite lactation support programs

12. 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!

13. 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.”

14. 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.

15. 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.

16. 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.

17. Self-Appraisal Questionnaire • Reviews existing practices • Compliance with requirements • Assess key areas for improvement • Tool to prioritize

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

19. Step 1 • Designate individual or small group to • Initiate & asses progress • Review policies, procedures, & protocols • Ensure staff receive orientation & training

20. Step 1 • Support from Management & Staff • Assemble team • Designate a coordinator • Team meetings • Planning • Action Plan • Continuing Education

21. 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

22. Assemble a Team & Designate a Coordinator (Step 1) • Depend on size of center • Both management and direct staff • Designate a coordinator • Team meetings

23. Action Plan (Step 1) • Written guidance • Example in tool-kit

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

25. Policy (Step 2) • Support & protect mothers/infants • Addresses • Breastfeeding mothers welcome • Accurate information • Trained staff • Sample policies

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

27. Supportive Environment (Step 3) • Supportive staff • Comfortable environment • Supporting employees • Example lactation areas

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

29. 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: 12/12/12 Amount: 4 oz.

30. Storage Guidelines (For Healthy Full Term Infants) *The Academy of Breastfeeding Medicine (Protocol #8)

31. Handling Breastmilk • Separation • Swirl – Don’t shake • Thaw • Refrigerator • Under warm water • Do not refreeze

32. 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

33. Feeding Baby • Easily digested • Typically 1 ½ to 3 hours • Hunger cues • Avoid large feedings

34. Amount of Breastmilk • Growth Spurts • Needs as baby grows • Breastmilk vs formula composition

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

36. What If Baby Refuses The Bottle? • Reverse Cycle Feeding • Different Containers

37. 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

38. Bowel Movements • Mustard color • Seedy • Runny to pudding consistency • Normal not to stool daily

39. What Hurts Supply? • Supply and demand • Low supply triggers • Supplements • Skipping Feedings • Pacifiers • Illness

40. 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

41. 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.

42. How Can Staff Support Breastfeeding? • Verbalize and initiate support • Encourage mom to get help • Be accommodating

43. Infant Care Plans • Staff develop with family • Individualize • Familiarize all staff

44. Introduction to Solids • Delay solids until around 6 months • AAP guidelines • Good starters

45. Step 5 Create a culturally appropriate breastfeeding friendly environment.

46. Step 5 • Written and verbal communication • Eliminate/limit visibility of formula • No baby bottle pictures • Racial/ethnically diverse pictures& materials • Monitor staff

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

48. Step 6 • Breastfeeding policies and handouts • Information on local laws • Signage

49. Breastfeeding is Welcome Here Sign

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