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
Awareness
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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
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Life is easier
Saves money
Feel great
Health benefits
Miss less work
“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
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Babies are sick less
Babies are happier
Diaper odor is less
Baby may spit up less
• Easier transition
• More marketable
• 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
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
• 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!
“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.”
• 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.
• 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.
• 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.
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Reviews existing practices
Compliance with requirements
Assess key areas for improvement
Tool to prioritize
Designate an individual or group who is responsible for
development and implementation of the 10 steps.
• Designate individual or small group to
– Initiate & asses progress
– Review policies, procedures, & protocols
– Ensure staff receive orientation & training
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Support from Management & Staff
Assemble team
Designate a coordinator
Team meetings
Planning
Action Plan
Continuing Education
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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
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Depend on size of center
Both management and direct staff
Designate a coordinator
Team meetings
• Written guidance
• Example in tool-kit
Establish a supportive breastfeeding policy and assure that all
staff are aware of and following the policy.
• Support & protect mothers/infants
• Addresses
– Breastfeeding mothers welcome
– Accurate information
– Trained staff
• Sample policies
Establish a supportive worksite policy for staff members who
are breastfeeding.
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Supportive staff
Comfortable environment
Supporting employees
Example lactation areas
Train all staff so that they are able to carry out breastfeeding promotion and support
activities.
• 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.
Location
Duration
Room Temperature
6-8 Hours
Insulated Cooler
24 Hours
Refrigerator
5 Days
Freezer Compartment in Refrigerator
2 Weeks
Freezer Compartment of Refrigerator
with Separate Doors
3-6 Months
Deep Freezer (Freezer Chest)
6-12 Months
*The Academy of Breastfeeding Medicine (Protocol #8)
• Separation
• Swirl – Don’t shake
• Thaw
– Refrigerator
– Under warm water
• Do not refreeze
• 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
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Easily digested
Typically 1 ½ to 3 hours
Hunger cues
Avoid large feedings
• Growth Spurts
• Needs as baby grows
• Breastmilk vs formula composition
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Mimic breastfeeding
Switch arms
Baby control feeding
Feed slowly
Stop with baby’s cues
• Reverse Cycle Feeding
• Different Containers
• 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
• Mustard color
• Seedy
• Runny to pudding
consistency
• Normal not to stool
daily
• Supply and demand
• Low supply triggers
– Supplements
– Skipping Feedings
– Pacifiers
– Illness
• 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
• 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.
• Verbalize and initiate support
• Encourage mom to get help
• Be accommodating
• Staff develop with family
• Individualize
• Familiarize all staff
• Delay solids until around 6 months
– AAP guidelines
• Good starters
Create a culturally appropriate breastfeeding friendly environment.
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Written and verbal communication
Eliminate/limit visibility of formula
No baby bottle pictures
Racial/ethnically diverse pictures & materials
Monitor staff
Inform expectant and new families and visitors about your Center’s breastfeeding
friendly policies.
• Breastfeeding policies and handouts
• Information on local laws
• Signage
Stimulate participatory learning experiences with the children related to
breastfeeding.
• Books
• Pictures
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.
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”
Establish and maintain connections with your local
breastfeeding coalition or other community resources.
Maintain an updated resource file of community breastfeeding
services and resources kept in an accessible area for families.
• Your local breastfeeding coalition will update you on the latest
breastfeeding information.
RESULTS
Area Assessed
Baseline (3/2013)
Post (4-5/2013)
BF Environment
19.5
25.2
BF Support Practices
21.3
26
BF Education & Prof Development
11.6
24.2
BF Policy
6.7
24
Infant Foods Served
27.8
26
Infant Feeding Practices
26.3
26
Infant Feeding Education & Prof
Development
19
22.8
Infant Feeding Policy
14.7
23.3
Average Baseline: 18.2
Average Post: 24.8
RESULTS
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25
20
Avg. Score (Pre)
15
Avg. Score (Post)
10
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All
Sites
CCR&R LISTING
EMBLEM
Amber France MS IBCLC
Wood County Health Department
afrance@co.wood.wi.us
(715)421-8937
WEBSITE
www.woodcountybreastfeeding.org
REFERENCES
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http://www.cdph.ca.gov/programs/breastfeeding/Documents/MO
-HowDoesForWAFBF-Eng.pdf
http://infantnutritioncouncil.com/breastmilk-information/
http://www.americanpregnancy.org/firstyearoflife/whatsinbreast
milk.html
http://www.womenshealth.gov/breastfeeding/whybreastfeeding-is-important/index.html
http://www.usbreastfeeding.org/Portals/0/Publications/ChildCare-2002-USBC.pdf
http://digitalcommons.unl.edu/cgi/viewcontent.cgi?article=1007&
context=sociologydiss&seiredir=1&referer=http%3A%2F%2Fwww.google.com%2Furl%3Fsa%3Dt
%26rct%3Dj%26q%3Dbenefits%2520of%2520breastfeeding%2520to%2
520childcare%2520centers%26source%3Dweb%26cd%3D4%26ved%3D
0CFEQFjAD%26url%3Dhttp%253A%252F%252Fdigitalcommons.unl.ed
u%252Fcgi%252Fviewcontent.cgi%253Farticle%253D1007%2526conte
xt%253Dsociologydiss%26ei%3DAKPPULXbHoakyQG5q4HYCQ%26us
g%3DAFQjCNGykr2msusoayso3sdiQCL2FosR_A#search=%22benefit
s%20breastfeeding%20childcare%20centers%22
http://www.dhs.wisconsin.gov/hw2020/health/nutrition/reportca
rd09.pdf
http://kellymom.com/bf/normal/growth-spurts/
REFERENCES
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http://www.workandpump.com/reversecycling.htm
http://www.nbci.ca/index.php?option=com_content&view=articl
e&id=23:is-my-baby-getting-enoughmilk&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_t
able=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-anddocs/augusta-pediatrics-indoor-shots/nursing%20room.jpg/view
http://www.meadjohnson.com.ph/news_lactation-suite-room-fornourishment.html
http://rakhealthmatters.wordpress.com/2012/03/21/breastfeeding
-and-the-milk-supply-over-time/