Supporting the Breastfeeding

MotherA Guide for the Childcare Center

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American Academy of Pediatrics Breastfeeding Policy Statement

• Breastfeeding is best• Breastfeed exclusively for the first 6 months• Breastfeed at least through the first 12

months of age and thereafter as long as “mutually desired” by mother and infant

*World Health Organization (WHO) recommends at least 2 years.

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AAP Recommendations

• Provide breast milk even when mom and child are separated

• Encourage family & community support• Media should portray breastfeeding as the

norm• Employers provide space and time to

accommodate milk expression

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Healthy People 2020 Goals• 82% breastfeeding

initiation• 61% continuing to 6

months• 34% at 1 year• 46.2% exclusively

through 3 months• 25.5% Exclusively

through 6 months

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Breastfeeding Report Card 2014, United States

U.S. Na-

tional

Texas 2020 Goals0

10

20

30

40

50

60

70

80

9079 78

82

4943

61

2721

3441 39

46

19 17

26

Ever BFBF 6 moBF 12 moExcl BF 3 moExcl BF 6 mo

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Women in the Workforce• Mothers are the fastest-growing segment of the U.S.

labor force• Approximately 60% of employed mothers with

children younger than 3 years work full time• One-third of these mothers return to work within 3

months after birth and two-thirds return within 6 months

• Working outside the home is related to a shorter duration of breastfeeding

• Intentions to work full time are associated with lower rates of breastfeeding initiation and shorter duration

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Women in the Work Force

58.455.3

50.7

41.838.9

36.1

16.7 16.4 14.6

0

10

20

30

40

50

60

70

With own childrenunder 6 years

With own childrenunder 3 years

With own childrenunder 1 year

Totalemployed

Employed fulltime

Employed parttime

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• The US Surgeon General issued a “Call to Action to Support Breastfeeding” in 2010, stating, “Everyone can help make breastfeeding easier!’ Four of the 20 action steps are directed at how employers play a critical role in supporting a mother’s decision to breastfeed. Many employers want to support employed mothers in their choice to breastfeed, but are often unsure of what is required.

http://www.cdc.gov/breastfeeding/promotion/calltoaction.htm

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Childcare Settings: The natural and logical place for supporting breastfeeding (1 of 2)

• Design child care facilities with equipment and furnishings to support breast feeding

• Provide a welcoming atmosphere that encourages mothers to initiate and continue breastfeeding after returning to work or school

• Provide accurate basic breastfeeding information• Refer for skilled breastfeeding support • Designate a space for the safe expression and storage of

human milk

United States Breastfeeding Committee. Breastfeedingand child care [issue paper]. Raleigh, NC: United States Breastfeeding Committee; 2002.

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Childcare Settings: The natural and logical place for supporting breastfeeding (2 of 2)

• Feed infant/toddler human milk in alternative devices (e.g., cups or spoons) when parents request it

• Provide space for mothers to breastfeed their children on-site

• Create an environment that fosters the formation of parent support groups and the ability to share information

• Empower families to advocate at their workplaces for policies that support breastfeeding

United States Breastfeeding Committee. Breastfeedingand child care [issue paper]. Raleigh, NC: United States Breastfeeding Committee; 2002.

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Human milk changes to meet the needs of the infant

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Healthier Babies in the Childcare Setting

Reduces babies’ risk of:• Ear Infections• Allergic reactions and asthma• Respiratory infections • Stomach problems • Obesity and diabetes• Childhood leukemia • SIDS

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The Agency for Healthcare Research and Quality (AHRQ)

Breastfeeding Saves Money

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In the U.S., the health care system would save at least 2-4 billion dollars annually if mothers were enabled to choose and to succeed in breastfeeding for as little as twelve weeks. (Miriam Labbok, M.D., Medical Researcher, Georgetown University)

Economic Advantages

If 90% of US families could comply with medical recommendations to breastfeed exclusively for 6 months, the United States would save $13 billion per year and prevent an excess 911 deaths, nearly all of which would be in infants.

A Pediatric Cost Analysis: The Burden of Suboptimal Breastfeeding in the United States: Pediatrics published online Apr 5, 2010; Melissa Bartick and Arnold Reinhold DOI: 10.1542/peds.2009-1616

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Benefits to Society• Breastfed children are healthier, which makes for a

more productive workplace in the future • Decreased tax dollars spent to subsidize dairy

farming, free formula, and health care programs • Potential for reduced health insurance premiums • Decreased social costs of morbidity and mortality • Reduced waste of natural resources and water, and

decreased garbage and pollution

http://www.breastfeedingworks.org/econ.htm 1/2015

Benefits for Mom• Reduces risk of:

o breast and ovarian cancerso diabeteso postpartum depression

• Provides a special bond between mom and baby

• Burns up to 600 calories a day • Releases hormones that relax mom

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Breastfeeding Benefits Employers

• Reduced staff turnover • Reduced sick time/personal leave • Reduced health care costs• Higher job productivity, employee satisfaction and

morale • Added recruitment incentive for women • Enhanced reputation as a company concerned for

the welfare of its employees and their families

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Breastfeeding Benefits Childcare Centers

• Infants are more resistant to illness

• Less diaper rash• Diapers have less odor• Breastfed baby spits up

less• Baby is happier

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Increased Risks for Babies of Employed Mothers

• Infants in child care centers are at 69% increased risk of hospitalization for respiratory infection (Kamper 2006)

• Being in a child care setting doubles odds of needing antibiotics by age 1.5-5 years (Dubois 2005)

• Exclusive breastfeeding at least 4 months had protective effect for 2.5 years

• Among infants of employed mothers who were never sick during the first year, 86% were breastfed (Cohen 1994)

Business Case for Breastfeeding1/2015

Support of the Breastfeeding Childcare Employee

www.texasmotherfriendly.org

An employer may be designated as a Texas Mother-Friendly Worksite if they have a written employee

worksite lactation support policy

If your childcare center is interested in becoming a Texas Mother-Friendly Worksite, contact:

Julie Stagg, MSN, RN, IBCLC, RLCState Breastfeeding Coordinator

Julie.stagg@dshs.state.tx.us

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Simple. Easy. Affordable.Flexible programs can be designed to meet the needs of both the employer and employee. Basic low-cost requirements include:

• Scheduling for lactation breaks• Private, clean space, other than a bathroom, to

express milk or breastfeed (a dedicated lactation room is NOT required)

• Arrangements for cleaning hands and equipment, and for hygienic storage of expressed milk

A Private Location to Pump or Breastfeed

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Tarrant County WIC Photo© Tarrant County WIC Photo©

Why should companies become Mother Friendly Worksites?

• It reduces health care costs

• It lowers absenteeism• It reduces turnover• It increases morale and

productivity• It earns the business a

positive image in the community

• Customers like it!1/2015

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Legal BasisFair Labor Standards ActSection 7 of the Fair Labor Standards Act was amended effective March 2010:

• Employers are required to provide “reasonable break time for an employee to express breast milk for her nursing child for 1 year after the child’s birth each time such employee has need to express the milk.”

• Employers are also required to provide “a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public, that may be used by an employee to express breastmilk.”

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Other Relevant Legal Standards

• Family Medical Leave Act: Job protection can help women take maternity leave to establish breastfeeding.

• Texas Health &Safety Code 165: • Affirms a woman’s entitlement to breastfeed in any

location in which she “is authorized to be.”• Provides the basis for Texas Department of State

Health Services (DSHS) Mother-Friendly Worksite Designation.

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http://www.dol.gov/whd/nursingmothers/

Texas Health and Safety Code 165-Breastfeeding (est. 1995)

• Affirms a woman’s right to breastfeed in any location in which she “is authorized to be”

Childcare Licensing Rules, Minimum Standards print date June 2014

• Minimum Requirement: Provide a comfortable place with a seat in your center or within a classroom that enables a mother to breastfeed her child. In addition, your policies must inform parents that they have the right to breastfeed or provide breast milk for their child while in care

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Childcare Licensing Rules, Breastfeeding Statement (1 of 2)

• Human milk is the best source of milk for infants. Additionally, breastfeeding supports optimal health and development.

• Providing a mother with a place to sit and breastfeed her child helps to support this practice. Use of an adult-size chair in the classroom meets the intent of this requirement.

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Childcare Licensing Rules, Breastfeeding Statement (2 of 2)

• Other things your operation may do to provide additional support include providing: o a pillow to support her infant in her lapo a stepstool for her to prop her feet and prevent back strain, o water or other liquid to help her stay hydrated.

• Childcare Standards and Regulations

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Texas WIC Breastfeeding Friendly Establishment

Working & Breastfeeding?

Yes!With a little loving support!

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“I never considered weaning because I was returning to work. It’s so easy to pump at work and it’s good to know that I’m taking care of my baby even while I’m away from her.” Kirsy

Traweek

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For information on Working and Breastfeeding:

www.breastmilkcounts.com/working-moms.php

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Handling of Human MilkStorage and Feeding

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Breast milk is classified as “food” and does not require universal precautions for handling body fluids. (CDC/OSHA)

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Human Milk Is NOT Classified as A Body Fluid*

• You do not need to store human milk in a separate refrigerator.

• You do not need to wear gloves to give a bottle of human milk to a baby.

• You do not contaminate human milk by touch. Touching human milk is not hazardous exposure nor a potential contaminant.

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What To Do If An Infant Or Child Is Mistakenly Fed

Another Woman’s Expressed Breast Milk

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The Childcare Provider Should:

• Inform the mother who expressed the breast milk of the bottle switch, and ask o When the breast milk was expressed and how it was handled.o Whether she has ever had an HIV test.o If she does not know whether she has ever been tested for

HIV, would she be willing to contact her physician and find out if she has been tested.

o If she has never been tested for HIV, would she be willing to have one and share the results with the parents of the other child.

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Discuss the Situation with the Parents

• Inform them that their child was given another child’s bottle of expressed breast milk.

• Inform them that the risk of transmission of HIV is very small.

• Encourage the parents to notify the child’s physician of the exposure.

• Provide the family with information on when the milk was expressed and how the milk was handled.

• Inform the parents that their child should soon undergo a baseline test for HIV.

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Refrigerators and Freezers• At home

o Normal food storage temperatures

o Freezer that keeps ice cream solid

• In the hospital and childcare settingso Refrigerators: 35° to

40° F (1° to 4° C)o Freezers: -4° ± 4° F (-20°

± 2° C)

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Storage Guidelines for Term Healthy InfantLocation Best used within Still safe to use within* Temperature

Countertop 3 hours 3 hours

Room temperature must not be warmer than 85°F or 29°C. Containers should be covered and kept as cool as possible.

Insulated cooler bag 24 hours 24 hours

Keep ice packs in contact with milk containers and limit opening the cooler bag.

Refrigerator 3 days 5 days At or below 39°F or 4°C

Freezer section inside of a refrigerator 2 weeks 2 weeks At or below 5°F or -15°C

Freezer section of refrigerator with a separate door or chest or upright deep freezer

6 months 12 months Below 0°F or -17°C

Amount of Breastmilk to Store for Age• 2 to 4 ounces for 6

week old

• 4 to 6 ounces for 3 month old

• 5 to 8 ounces for 6 month old

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Handling Human Milk

• Clearly label each child’s bottle. • Use the oldest milk first.• Feed infants expressed human milk on

demand.• Staff should use proper hygiene.

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Thawing Breastmilk

• Place in warm water. Babies can drink cold breast milk.

• Place in refrigerator.• Do not boil.• Do not microwave.

oHot spots can develop, which could burn the baby.

• After human milk is thawed discard unused portion after 24 hours.

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Thawing Breastmilk• Place in warm water• Place in refrigerator• Do not boil• Do not microwave• Discard unused milk after

24 hours• Swirl gently to remix

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Refrigerated Breastmilk• Place in bowl of

warm water• Shake gently to

mix

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Facts About Storing Human Milk

• Cream rises and forms a separate layer• Foods may color the milk• Milk can pick up certain scents - onions,

garlic, mint • Milk may smell “soapy” but is still good

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Odor and Taste of Stored Breastmilk

• Typically human milk has a slightly sweet odor and tasteoMay be altered by:

• Mother’s diet (may also change color)• Storage containers• Storage conditions• Milk can get freezer burn

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Feeding Suggestions for Childcare Worker

• Use paced (baby-led) bottle feeding technique• Burp well• Avoid pacifiers for babies under 2 - 3 weeks old• Avoid solids before six months• Try not to feed baby during the last 2 hrs

before mom is due to pick up baby—or if you do, just give baby a “snack”

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Paced Bottle-feeding

• Gives babies control over the amount of milk consumed, just like breastfeeding does

• Supports the breastfeeding relationship, particularly for mothers who are separated from their babies on a regular basis

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What is the best way to feed a baby a bottle?

• Holding the baby in an upright position keeps him close to you and helps give him more control and comfort during the feeding. Other helpful feeding tips include:o Touch the baby’s bottom lip with the bottle nipple, this will help the baby to open his

mouth.o Place the nipple inside his mouth slowly and gently. Never force the baby’s mouth

open. o Try offering only 1/2 to 1 ounce in the bottle to help baby learn to drink without

feeling too full.o Increase feeding amount only if your baby seems hungry and gives a cue for more. o About half way through the bottle-feeding, switch your baby’s position by moving him

from one arm to the other. This helps prevent your baby from preferring one side when breastfeeding and also keeps good eye contact with him, helping you to better read his cues..

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Incorrect Bottle FeedingIf baby is laid back too

much:• Baby cannot control

the flow• Prevents the baby from

learning to self-regulate his food

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Correct Bottle Feeding Position• Baby is upright• Bottle is parallel to

your lap• Use a round nipple• Deep latch to bottle

nipple

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How do I know baby is hungry?

• Whimpering or lip-smacking• Making sucking motions• Pulling up arms or legs toward her middle• Waking and looking alert• Moving hands or fists to her mouth• Becoming more active• Nuzzling against your breast

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Other Ways to Be Supportive• Praise mom for providing

the very best nutrition to her baby

• Keep one bottle of frozen milk for emergencies

• Keep track of wet, soiled diapers for mom

• Keep track of amount baby consumes and report to mom

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Caregiver Tip:

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• If there’s breastmilk left over, don’t throw it out! It will keep just fine in the refrigerator until the next feeding.

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Caregiver Tip:

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• Watch the baby and not the clock during the feeding.

• Learn to watch the baby’s feeding and ending cues.

• This is a great way to better understand a baby’s special language!

Things to Remember

• The risks of artificial infant feeding are numerous and can have lifelong implications

• If breastfeeding is not going well, the solution is to fix the breastfeeding--NOT to “wean to a bottle”

• Most potential problems are easily managed without interrupting breastfeeding

• A little human milk is better than none

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Need Help?Texas Lactation Support Hotline: 855-550-6667

Mom’s Place - Austinwww.momsplace.org

800-514-6667Lactation Care Center- Dallas

www.lactationcarecenterdallas.com Lactation Foundation - Houston

www.lactationfoundation.orgLactation Care Center – RGV

http://www.co.hidalgo.tx.us/index.aspx?NID=1648

La Leche League International: www.llli.org

1-800-525-32431/2015

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