supporting breastfeeding in child care - scpitc · child care standards for breastfeeding “the...

Supporting Breastfeeding

in Child Care

Kathleen L. Anderson, MEd, CLC

March 3-4, 2014

2014 Annual SCPITC Advanced Training

Conflict of Interest

No Conflict of interest to report.

Learning Objectives

By the end of the session, participants will

be able to:

• Describe benefits of breastfeeding for

infants, their mothers, and the child care

program;

• Describe the Breastfeeding-Friendly

Child Care program to support

breastfeeding in child care;

• Identify features of a breastfeeding-

friendly child care environment.

Why Support Breastfeeding?

Which Side is Human Milk?

Left? Right?

Courtesy of Azoreg, Retrieved 02-12-2013 from http://commons.wikimedia.org/wiki/File:Human_Breastmilk_-_Foremilk_and_Hindmilk.png#filehistory

http://commons.wikimedia.org/wiki/File:Human_Breastmilk_-_Foremilk_and_Hindmilk.png#filehistory



Which Side is Human Milk?

Human milk.

Breastfed Babies are Healthier

Not breastfeeding is associated with

an increased risk of:

– acute otitis media (ear

infections)

– gastroenteritis (diarrhea,

vomiting)

– severe lower respiratory tract

infections

Ip et al., 2007

Breastfed Babies are Healthier

Not breastfeeding also is associated with

increased risk of:

– diabetes

– sudden infant death syndrome

(SIDS)

– obesity

Ip et al., 2007

Breastfeeding Mothers are

Healthier

Mothers who do not breastfeed have

increased risk for:

• Type II diabetes

• Breast and ovarian cancer

• Rheumatoid arthritis

• Cardiovascular Disease (CVD)

The longer and more exclusively a

woman breastfeeds, the lower her risks. Ip et al, 2007

Pikwer, 2009

Schwarz et al., 2009

National Initiative

Healthy People 2020

1. Ever Breastfeeding

2. Breastfeeding at six months

3. Breastfeeding at one year

4. Exclusive breastfeeding at three

months

5. Exclusive breastfeeding at six months

Are we meeting those goals?

2020 SC NC

Any breastfeeding 81.9% 67.5% 74.9%

At 6 months 60.6% 32.0% 48.5%

At 12 months 34.1% 18.7% 31.9%

EBF 3 months 46.2% 32.7% 32.7%

EBF 6 months 25.5% 16.0% 14.8%

*CDC Breastfeeding Report Card –– United States, 2013

Why Support Breastfeeding in

Child Care?

Focus on Child Care

• Infants who are routinely cared for by someone other than their mothers are significantly less likely to be breastfed.

• More than half of

mothers with infants

under a year of age

enter the workforce.

Kim & Peterson, 2008

US Bureau of Labor Statistics, 2013

We are CALLED

Action 16: Ensure

that all child care

providers

accommodate the

needs of

breastfeeding

mothers and

infants.

Benefits for the Child Care Program

• Less Illness

• Less absences

• Economical

• Easier to care for breastfed babies

• Community recognition as

Breastfeeding-Friendly Child Care

Ip et al, 2007

US Department of Agriculture, 2000

Supporting Early Care and

Education Providers

Wake County, NC


• Supported by the John Rex Endowment

with additional funds from CGBI

• Partnership with:

− Wake County Smart Start

− Wake County agencies

Implementation Plan

• Drafted Ten Steps for Breastfeeding-

Friendly Childcare Centers

• Collected KAP data and finalized Ten Step

Self-Assessment for child care programs

• Developed and Piloted training and materials

• Implemented intervention

• Completed follow-up

• Provided further intervention

Training • Two-hour curriculum

− addressed gaps from baseline assessments

− used active participation and discussion

• The training included:

− one hour of self-awareness

− breastfeeding discussion

− job-aid-driven instruction

• Single centers on-site, or multiple sites join

together off-site

• Director and staff attend together

Guiding principles for materials

development

• Responds to expressed

needs of the ECE

providers.

• Diverse, population-

appropriate photographs.

• Addresses gaps found in

needs assessment.

Guiding principles for materials development Attention to literacy level, Brief and to the point, Diverse, population-appropriate photographs, Easily printable from .pdf files, to be made available on the web as part of a “Breastfeeding-Friendly Child Care” toolkit, and, Color-coded by purpose. Materials for All Materials for Breastfeeding Mothers/Families Materials for Centers


Guiding principles for materials

development

• Easily printable from .pdf

files.

• Color-coded by purpose.

• Materials for all.

• Available in a toolkit:

http://cgbi.sph.unc.edu/

Quick Links - Toolkits





Material borders are color-coded according to their use: For breastfeeding families For all families For center use

TEN STEPS SELF-ASSESSMENT RESULTS

It Works!

REPLICATION and SCALE-UP • W K Kellogg Foundation support

− Scale-up to reach entire state

• Includes:

– Regular stakeholder engagement

– Online basic breastfeeding training

– In-person training of trainers

– Development of color-coded materials – ECE provider training and follow-up

UPDATES to the TEN STEPS

• Consolidated some steps

• Replaced steps in two areas:

- Step 4

- Step 7

• Modified Step 8

Training of Trainers

Online Pre-Training Work

Four 30-minute modules

1. What is So Special about Human Milk?

2. Understanding the Risks of Not

Breastfeeding and Benefits of Breastfeeding.

3. Supporting Breastfeeding: Families,

Communities, and Society.

4. Adult Learning and Using Job Aids.


In-Person Training

• Review of modules

• Breastfeeding Self-Awareness

• Breastfeeding and Job Aids discussion

• Wrap up and Next Steps – child care

center recruitment

Early Care Provider Training

• Self-Assessment and Action Plan

• Supporting Breastfeeding Families Training

− Self-Awareness

− Breastfeeding discussion

− Job-aid driven activities

• Follow-up with Trainer

− Monitor action plan

− Assess need for additional materials

AGREE OR DISAGREE?

Agree or Disagree

Breastfeeding is something

that should be done in private.

Agree or Disagree

I feel comfortable

handling human milk.

What is Breastfeeding-Friendly Child Care?

Caring for Our Children 3rd Edition 2011

Child Care Standards for Breastfeeding

“The facility should encourage, provide arrangements for, and

support breastfeeding. The facility staff, with appropriate training, should

be the mother’s cheerleader and enthusiastic supporter for the

mother’s plan to provide her milk.”

Ten Steps to


Step 1

Make a commitment to

the importance of

breastfeeding, especially

exclusive breastfeeding,

and share this

commitment with fellow

staff.

Step 2

Train all staff to

support and

promote optimal

infant and young

child feeding.

Optimal infant

and young child feeding

• Recognize infant hunger

cues.

• Feed infants in response to

their hunger cues.

• Practice safe bottle feeding

techniques.

Teaching satiety to reduce the risk

of obesity:

Step 3

Inform women and families

about the importance of

breastfeeding.

Provide learning

and play

opportunities that

normalize

breastfeeding for

children.

Step 4

Ensure that all

breastfeeding

families we serve are

able to properly store

and label milk for

child care center

use.

Step 5

Provide a breastfeeding-friendly environment.

Step 6

Support breastfeeding employees.

Step 7

Ensure that each

infant has a

feeding plan that

supports best

feeding

practices.

Step 8

Contact and

coordinate with

local skilled

breastfeeding

support and

actively refer.

Step 9

Continue

updates and

learning about

protection,

promotion, and

support of

breastfeeding.

Step 10

Feeding Plan: Activity

Using the Feeding Plan

• Conversation with

the mom and family.

• Learn about the

mother’s wants and

needs.

• Educational tool.


• Infant-Toddler Specialists

• Child Care Health Consultants

• WIC Regional Breastfeeding Coordinators

• Shape NC Hub Specialists

• Partners in Health and Wholeness Liaisons

• Others…?

Challenges

• Motivating ECE Providers to

complete training.

• Finding time to add new/another

training.

• Integrating the training into the

child care training schedule.

STEPS to SUSTAINABILITY

• Ongoing assessment and

evaluation.

• NC DPH Breastfeeding-Friendly

Child Care Designation.

• NC DHHS links to the materials

and training.

STEPS to SUSTAINABILITY

• Online Training of Trainer

curriculum.

• Online ECE Provider

training.

• National collaboration on

breastfeeding in child care.

Acknowledgements

• The John Rex Endowment

• W. K. Kellogg Foundation

• With Appreciation to Our Collaborators:

NC Infant Toddler Enhancement Project

NC Child Care Health and Safety Resource Center

Shape NC: Healthy Starts for Young Children

NC Department of Health and Human Services

Wake County Human Services

and Wake County Smart Start

• Carolina Global Breastfeeding Institute

Breastfeeding

Welcome Here!


(Quick Links – Toolkits)

THANK YOU!


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