Supporting Breastfeeding
in Child Care Settings
Insert Presenter’s Name
Agenda
Introductions
Pre-test
Presentation
Self-assessments
Action Plans
Post-test/Review
Evaluation
Supporting Breastfeeding in
Child Care Settings
© Addie Imseis and USBC, 2010
Pre-test
Acknowledgments
• Ashley Lucas, MD and Kacie Sims, MD
--Our Lady of the Lake Pediatrics Residency Program
• Marci Brewer, MPH
– Louisiana Breastfeeding Coalition
• Susie Amick, RN, IBCLC, RLC, LCCE
– East Jefferson General Hospital
• Caitrin Alb, MPH
– Tulane Mary Amelia Women’s Center
• Students:
– Stephanie Miles and Chi McKendall-Lewis
Acknowledgments
• Our Lady of the Lake Children’s Hospital
• American Academy of Pediatrics
• Greater New Orleans Breastfeeding Awareness
Coalition (GNOBACC)
• Volunteers of America/Partnerships in Child Care
– Gina Forsman and Janie Starks
• Louisiana Department of Health and Hospitals
Office of Public Health - Maternal and Child
Health Program
• Pilot centers and Reviewers
• Photos: Addie Imseis and the US Breastfeeding
Committee
Acknowledgments
Parts of this educational program were
adapted from:
• The “Breastfeeding-Friendly Child Care
Initiative” of the Carolina Global Breastfeeding
Institute /UNC Gillings School of Public Health
• The Wisconsin Department of Health Services,
Ten Steps to Breastfeeding-Friendly Child Care
Centers Resource Kit
At the end of this presentation,
participants should be able to:
1. Describe changes in infant feedings in
the last three generations.
2. Understand the impact of breastfeeding
on the health of women, infants,
children, and society.
At the end of this presentation,
participants should be able to:
3. Discuss the proper way to label, store
and handle breast milk in the child care
center.
4. Describe ways that a child care
provider can support breastfeeding
and help meet national goals for
promoting health.
Disclaimer
This information is meant for the education
of child care providers. It is not meant to
take the place of any child’s own personal
health care professional. Completing this
training does not guarantee competency in
infant feeding techniques.
Child care
providers are responsible for knowing their
own center’s feeding policy and their own
state regulations.
You can make a difference!
• As a child care
provider you are
an important part
of each mother’s
support system.
©USBC, 2010
Image from Larry Grummer-Strawn, PhD: CDC-USBC Bi-Monthly Teleconferences, Tuesday, February 8, 2011.
ACTIVITY
• Do you think breastfeeding is important?
• Why?
• Why not?
© Addie Imseis and USBC, 2010
Infant feeding history
• Until the mid-1800s almost all US babies
(and babies around the world) were
breastfed.
• Wet nursing was the most common
alternative.
• Other substitutes often led
to infections, malnutrition,
and dehydration.
Walker, M. Still Selling out mothers and babies: marketing of breast milk substitutes in the U.S.A. Weston, MA: NABA REAL, 2007.
When did formula-feeding
become common?
• Mid-1800s – Cow’s milk became the
alternative of choice, but led to infections
and vitamin deficiencies
• 1869 – Leibig’s Soluble Infant Food sold for
$1/bottle
• 1870s – Nestle Infant Food $.50/bottle
• 1897 –The Sears catalogue advertised
formula, but it was still expensive
When did formula-feeding
become common?
• Early 1900s – Some physicians recommended
and sold infant formula
• 1910 – Refrigerators became widely available
• 1920s and 1930s – Evaporated milk used for
feedings
– Often recommended by physicians
– Cheap
– Became widely popular
Artificial feeding became popular.
• 1950s – Artificial Baby Milk available
(Commercial formulas, like Similac, Enfamil)
– Approved by some physicians
– Infant feeding schedules became popular
– Advertisements undermined breastfeeding
– Many more women left home to work
– Women wanted freedom/independence
• 1970s – Only 25% of US babies were breastfed.
Walker, M. Still Selling out mothers and babies: marketing of breast milk substitutes in the U.S.A. Weston, MA: NABA REAL, 2007.
Commonly believed myths
Getting back to “normal”…
• 1980s to present
– Research proves that breastfeeding is
important for optimal health and
development
– Medical and government organizations
recognize and publicize the importance of
breastfeeding.
The National Alliance of Breastfeeding Advocacy
Formula manufacturers often use
false and misleading advertising to
increase sales of their products.
“complete nutrition”
“new and improved”
“closer than ever to breast milk”
Walker, M. Still Selling out mothers and babies: marketing of breast milk substitutes in the U.S.A. Weston, MA: NABA REAL, 2007.
ACTIVITY
Human Milk Components Game
• What are the
ingredients in human
milk that make it the
preferred food for
babies?
© Addie Imseis and USBC, 2010
www.breastmilkcounts.com/educational-activities.html
Which are in
human milk?
Which are in
formula?
www.breastmilkcounts.com/educational-activities.html
How does formula stack up?
Human milk cannot be replicated.
• The enzymes, antibodies, growth and
disease fighting factors, and hormones
found in human milk cannot be added to
formula.
© USBC, 2010
Breastfeeding matters for babies.
• Each animal makes milk that is best for
the development of their young.
• Human milk is the perfect food for
human babies.
• It is the foundation for good health in
early childhood, with benefits that last a
lifetime.
from -- www.ars.usda.gov/is/graphics/photos
Mother’s milk is “The Gold Standard.”
• Mother’s milk is more than food.
• Each mom has custom-made milk for her
baby, which changes as he grows.
• Experts recommend:
– Mother’s milk only for the first six months
– Other foods added slowly after 6 months with
breastfeeding continuing for at least the first year
– Breastfeeding beyond one year, for as long as
desired by mother and baby
A well-built immune system
leads to a healthier life.
• Breastfeeding helps babies develop a
healthy immune system
• These effects on the immune system last
a lifetime.
© Addie Imseis and USBC, 2010
Hanson, L. A. MD, PhD. Immunobiology of Human Milk: How Breastfeeding Protects Babies. Pharmasoft Publishing, 2004.
Breastfeeding lowers infections.
• Lower risk for:
–Ear Infections
–Colds and pneumonia
–Diarrhea
–Urinary Tract Infections
–Bacterial Meningitis
–Wide range of infectious diseases
American Academy of Pediatrics, Work Group on Breastfeeding. (2005).Breastfeeding and the use of human milk. Pediatrics. 115(2), 496-501
United States Breastfeeding Committee. Breastfeeding and child care [issue paper]. Raleigh, NC: United States Breastfeeding Committee; 2002.
Breastfeeding reduces other diseases.
• Lower risk for:
– Sudden Infant Death Syndrome
–Types 1 & 2 diabetes
–Lymphoma and Leukemia
–Inflammatory Bowel Disease
–Asthma and Eczema
–Obesity
–Dental disease
American Academy of Pediatrics, Work Group on Breastfeeding. (2005).Breastfeeding and the use of human milk. Pediatrics. 115(2), 496-501
United States Breastfeeding Committee. Breastfeeding and child care [issue paper]. Raleigh, NC: United States Breastfeeding Committee; 2002.
Breastfeeding promotes bonding.
• Secure attachment in
the early years
influences mental
health and functioning
for a lifetime.
© Addie Imseis and USBC, 2010
Center on the Developing Child at Harvard University (2010). The Foundations of
Lifelong Health Are Built in Early Childhood. http://www.developingchild.harvard.edu
ACTIVITY:
•What do you know about childhood obesity?
•Why did Michelle Obama choose this topic?
www.letsmove.gov
Obesity is a modern epidemic
with serious consequences.
• 18.4% of teenagers are obese
• 18.0% of children age 6-11 years are obese
• 12.1% of children age 2-5 years are obese
Obesity puts children at risk for diabetes, heart
conditions, self-esteem issues and many other
health problems.
www.cdc.gov/nchs/fastats/overwt.htm
Obesity begins in early childhood.
• Help mothers prevent pregnancy-related
risk factors for obesity:
Tobacco exposure
Excess weight gain in pregnancy
Gestational diabetes
High birth weight babies
Low birth weight babies
• Mothers need support to
stay healthy during
pregnancy!
© Addie Imseis and USBC, 2010
Healthy eating must begin
in early childhood.
• Children develop food preferences and eating
habits very early in life.
• Overweight baby
↓
Overweight child
↓
Overweight adult
© USBC, 2010
“I’m so excited about Let’s Move Child Care –
because I know that childcare facilities and
home-based providers can be a real building
block for an entire generation of healthy kids.”
First Lady Michelle Obama, June 2011
www.letsmove.gov
• Goals:
– Increase physical activity
– Reduce screen time
– Serve healthy foods: fruits and vegetables
– Serve healthy drinks: more water, less sugar
– Support infant feeding (breastfeeding)
Obesity Prevention Begins with
Breastfeeding!
• Breastfed infants self-regulate better (learn to
eat when they are hungry and stop eating when
they are full).
• Breast milk contains hormones and other
substances which play a role in weight
regulation.
• Formula feeding and early introduction of solids
can increase the risk of childhood obesity.
Lawrence, R. A. (2010). Does Breastfeeding Protect Against Overweight and Obesity in Children? A Review. Childhood Obesity, 6(4),193-197
A healthy infant leads
to a healthy adult.
• Early childhood is a critical time period
when the brain is growing rapidly and the
baby’s body systems are being
programmed.
• Early childhood health is the foundation
for adult health.
Center on the Developing Child at Harvard University (2010). The Foundations of Lifelong Health Are Built in Early Childhood.
http://www.developingchild.harvard.edu
ACTIVITY
• How do you think
breastfeeding
benefits the
mother?
© Addie Imseis and USBC, 2010
Breastfeeding benefits the mother.
• Decreased postpartum bleeding
• Reduces post-partum depression
• Earlier return to pre-pregnancy
weight
• Reduces fertility and helps to space
babies (no guarantee!)
• Lowers risk for breast and ovarian cancer
• Lowers risk for hip fractures and osteoporosis
• Fewer absent days when she returns to work/school
American Academy of Pediatrics, Work Group on Breastfeeding. (2005).Breastfeeding and the use of human milk. Pediatrics. 115(2), 496-501
United States Breastfeeding Committee. Breastfeeding and child care [issue paper]. Raleigh, NC: United States Breastfeeding Committee; 2002.
Bonding also benefits mothers.
• Both mom and baby benefit from the special
emotional bond that develops between a
mother and her child during the process of
breastfeeding.
© Addie Imseis and USBC, 2010
Strathearn L, Mamun A, Najman, J and O'Callaghan, M. Does Breastfeeding Protect Against Substantiated
Child Abuse and Neglect? A 15-Year Cohort Study. Pediatrics 2009;123;483-493
Breastfeeding benefits employers.
•
•
•
•
•
Higher productivity
Less missed work days
Lower health care costs
Increased loyalty to workplace
Less employee turnover
U.S. Department of Health and Human Services. The Surgeon General’s Call to
Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and
Human Services, Office of the Surgeon General; 2011.
Not breastfeeding costs everyone.
• Formula-feeding families:
– Spend $1,200–$1,500 per year for infant formula
– Have more health insurance claims and more time off
work due to baby being sick
• Society benefits when US mothers breastfeed:
$13 billion dollars could be saved and 911 infant
deaths prevented every year if 90% of babies were
exclusively breastfed for the 1st 6 months
U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department
of Health and Human Services, Office of the Surgeon General; 2011.
Bartick, M. and Reinhold, A The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis. PEDIATRICS (doi:10.1542/peds.2009-1616)
Breastfeeding is “Green.”
•
•
•
•
•
No land needed for production
No energy required (except the mom’s!)
No pollution
Less packaging
Less disposal (cans, bottles, nipples)
www.llli.org
Breastfeeding rates in the U.S.
• 77% of US infants are “ever breastfed”
• Only 47% of US infants are still breastfeeding at 6 months
http://www.cdc.gov/breastfeeding/pdf/2012BreastfeedingReportCard.pdf
Percent %
Louisiana Breastfeeding Rates
48th in the nation
90
80
70
60
50
40
30
20
10
0
81.9
76.9
60.6
53.5
47.2
23.6
Healthy People 2020
34.1
25.5
US rates
Louisiana rates
11.9
Ever
Breastfed
6 months
12 months
Source: Centers for Disease Control and Prevention National Immunization Survey, Provisional Data, 2009 births.
Breastfeeding rates are the lowest among
African American Women in Louisiana
Louisiana Initiation and Duration by Race, 2009
80
71.4
70
Percent %
60
48.1
50
Initiation
40
8 Weeks
30
20
10.9
10.5
10
0
White
Source: Louisiana Risk Assessment Monitoring System (LaPRAMS)
Black
Breastfeeding mothers need
support from everyone!
©USBC, 2010
Louisiana Laws related to
Breastfeeding
• A mother can breastfeed her infant in
any place that a mother and her infant
have a right to be.
• Child care centers cannot discriminate
against breastfed infants.
ACTIVITY:
Barriers to Breastfeeding
•What factors make breastfeeding more
difficult for some women?
© Addie Imseis and USBC, 2010
Top 3 reasons women
stop breastfeeding
• In the United States:
– physical discomfort (example: sore nipples)
– concerns about making enough milk
– going back to work or school
• In Louisiana:
– disliking breastfeeding
– going back to work or school
– taking care of other children
Li, R., Fein, S.B., Chen, J., & Grummer-Strawn, L.M. (2008). Why mothers stop breastfeeding; mother’s self reported reasons for stopping during
the first year. Pediatrics, 122, S69-S76.
Louisiana Pregnancy Risk Assessment Monitoring System (LaPRAMS) data.
Other barriers to breastfeeding:
• Problems with latching
• Issues with breastfeeding attitudes/support
• Concerns about lifestyle (diet, smoking,
personal freedom)
• Medical reasons
• Issues with milk pumping
• Infant self-weaning (infant losing interest, etc)
Ahluwalia, I.B., Morrow, B., & Hsia, J. (2005) Why do women stop breastfeeding? Finding from the pregnancy risk assessment and monitoring
system. Pediatrics, 116,1408-1412
Mothers need workplace support.
• Breastfeeding after returning to work requires
effort and commitment.
• Employers benefit when they support
breastfeeding.
• Federal law requires support for breastfeeding
employees.
The US Department of Health and Human Services: The Business Case for Breastfeeding
ACTIVITY:
Supporting Breastfeeding
in Child Care Settings
•What steps can a child care setting take to
be more breastfeeding-friendly?
“Ten Steps” are adapted from the
“Breastfeeding-Friendly Child Care
Initiative” of the Carolina Global
Breastfeeding Institute /UNC Gillings
School of Public Health
© Addie Imseis and USBC, 2010
Ten Steps to a Breastfeeding-Friendly
Child Care Center
• Step 1: Make a commitment to the importance
of breastfeeding and share with staff.
• Step 2: Train all staff to promote optimal
feeding for infants and young children.
Handouts: Breastfeeding and Child Care: What Child Care Centers Can Do
Our Center Supports Breastfeeding
Sample Center Breastfeeding Policy
Ten Steps to a Breastfeeding-Friendly
Child Care Center
• Step 3: Inform families about the importance
of breastfeeding.
• Step 4: Provide children’s
activities which normalize
breastfeeding.
Ten Steps to a Breastfeeding-Friendly
Child Care Center
• Step 5: Ensure that all breastfeeding families
are able to properly store and label milk for
child care center use.
• Step 6: Provide a breastfeeding-friendly
environment.
Handout: Breastfeeding and Child Care - What Moms Can Do
Preparing and Storing Human Milk
• Use clean bottles specific to each infant
• Warm or defrost under running water or in
bottle warmers.
• Microwaves should never be used!
www.nrckids.org/CFOC3/PREVENTING_OBESITY/index.htm
Preparing and Storing Human Milk
• Each breast milk bottle or bag should have a
label (that does not wash off) including the
child’s name
date/time the milk was expressed
• Washing hands is important.
• Gloves are NOT necessary when preparing
formula or human milk (unless blood is visible
in the milk).
• Accidental breast milk ingestion is low-risk.
Handout: Breast Milk Errors & Mix-ups
www.nrckids.org/CFOC3/PREVENTING_OBESITY/index.htm
Human Milk Storage Guidelines
Location
Temperature
Duration
Comments
6-8 hours Containers should be covered and kept
as cool as possible; covering the
container with a cool towel may keep
milk cooler.
Countertop, table
Room Temperature
(up to 77⁰F or 25⁰C)
Insulated cooler bag
5⁰F—39⁰F or
–15⁰C—4⁰C
24 hours
Refrigerator
39⁰F or
4⁰C
5 days
Freezer compartment of
a refrigerator
5⁰F or
-15⁰C
Freezer compartment of
refrigerator with
separate doors
0⁰F or
-18⁰C
Chest or upright deep
freezer
-4⁰F or
-20⁰C
Handout: Human Milk Storage and Handling
Keep ice packs in contact with milk
containers at all times, limit opening
cooler bag.
Store milk in the back of the main body
of the refrigerator.
Store milk toward the back of the
freezer, where temperature is most
constant. Milk stored for longer
3-6 months durations in the ranges listed is safe,
but some of the lipids in the milk
undergo degradation resulting in lower
quality.
6-12
months
2 weeks
http://nrckids.org/CFOC3/PDFVersion/preventing_obesity.pdf
Human Milk Storage Guidelines
(how long to keep milk for use)
•
•
•
•
After a baby sucks on a bottle:
Room Temperature:
Refrigerator:
Deep Freezer:
1 Hour
6-8 hours
5 days
6-12 months
http://nrckids.org/CFOC3/PDFVersion/preventing_obesity.pdf
Bottle-feeding tips:
• Hold the bottle horizontally
with the infant upright
• Do not let the baby hold
the bottle in the crib
• Never prop a bottle
• Feed one infant at a time
• Maintain eye contact and
vocal communication
www.nrckids.org/CFOC3/PREVENTING_OBESITY/index.htm
Lactation Education Resources www.LERon-line.com 2011
Bottle feeding like breastfeeding
• Begin feedings when the infant provides
EARLY hunger cues (sucking sounds,
opening mouth, rooting, etc.)
• Don’t wait for baby to cry before feedings
–Crying = Late Cue
• Allow breaks for burping
• Allow infant to stop feeding when
satisfied
Handouts: Tips for Day Care Providers
Provide a comfortable
nursing/pumping space.
•
•
•
•
•
•
•
Private, quiet
Comfortable
Electrical outlet
Sink for washing
Footstool
Pillow
Water available
© USBC, 2010
Ten Steps to a Breastfeeding-Friendly
Child Care Center
• Step 7: Support breastfeeding employees.
© USBC, 2010
Ten Steps to a Breastfeeding-Friendly
Child Care Center
• Step 8: Develop a breastfeeding-friendly
feeding plan with each family.
– Allow infants to feed on cue (when they
show early hunger signs: rooting, smacking,
or sucking on hands) and to be breastfed
when possible.
Handout: Sample Center Infant Feeding Plan
Ten Steps to a Breastfeeding-Friendly
Child Care Center
• Step 9:
– Contact and coordinate with local skilled
breastfeeding support.
– Actively refer families who need
breastfeeding support.
Ten Steps to a Breastfeeding-Friendly
Child Care Center
• Step 10: Stay up-to-date
and continue learning
about protection,
promotion, and support
of breastfeeding.
Scenario 1
• A mother asks you if it would be possible for
her to nurse her baby before she leaves him to
go to work.
• What do you say?
• Where would you tell her to nurse the baby?
Scenario 2
• A mother is nursing her infant in a chair in the
corner of the infant room. Another parent
sees this and expresses to you that she does
not think it’s right for the nursing mother to
be doing that in public.
– What is your response?
Scenario 3
• A couple expecting their first baby in 2 months
comes in to your center for a tour. The
mother states that she might breastfeed, but
she isn’t sure she’ll be able to.
– What are some things that you can do as a child
care provider to support her decision?
Scenario 4
• A toddler room teacher is returning to work
after a 3-month maternity leave. She wishes
to continue providing milk to her infant, who
will be enrolling in the infant room.
– What are some ways that your center can
accommodate her?
Support Breastfeeding!
•
•
•
•
•
•
It is natural.
It promotes healthy babies and mothers.
It saves money.
It contributes to a healthier community.
Working mothers need the MOST support!
Child Care Provider Support is Important.
• You can make a difference!
Supporting Breastfeeding in
Child Care Settings
•
•
•
•
Action Plans
Post-Test
Evaluations
Certificates
Thank you for your
attendance and participation!
For more information, visit
www. louisianabreastfeeding.org