breastfeeding in the child care setting: breastfeeding basics

Breastfeeding in The Child Care Setting: Breastfeeding Basics

Breastfeeding in The Child Care Setting:Breastfeeding Basics Compiled by: Sarah DeCato, MSN, RN, CLC

6/2/2012114/10/12Collaborators:Maine Roads to Quality & The 2012 State of Maine Breastfeeding Stakeholders Committee

4/10/12224/10/12Breastfeeding.I know its important, but why?

4/10/123Breastfeeding is important because its the best nutrition source we have readily available, world wide for our babies.

As you start this training its a good time to reflect on your own feelings and beliefs surrounding breastfeeding. Were you breastfed? Did you breastfeed your child(ren)? What do you know about breastfeeding already? What has been your experience with breastfeeding at your child care settings? Answering these questions allows us to identify with our own relationship with breastfeeding, perhaps identify any stigmas that may exist on the topic.

34/10/12What does childcare have to do with it?

4/10/124The it is breastfeeding, and childcare has a vital role to play in its success. As childcare providers you can be a huge support to mothers who are breastfeeding; whether it be mothers you employ or mothers whose children are in your care. At the end of this training you are not expected to know everything there is to know about breastfeeding, nor are you expected nor encouraged to give out medical advice unless your credentials allow for such.

Its evident some mothers find breastfeeding easier to manage than others may. Every baby is different, so moms may find it difficult to breastfeed one child when it may have been easier to breastfeed another of their children. Moms who are breastfeeding need support from many different directions to be able to meet their breastfeeding goals. Support can mean: understanding the basics of breastfeeding so you can listen to their concerns they are having, knowing your local resources so that you can connect them with the medical community that can continue to assist them in their breastfeeding efforts, understanding how to properly handle and store breastmilk at your sites, and creating an environment that sees breastfeeding as welcoming and important for the child, not something that is seen as indecent. You have an important role to play as the childcare provider in encouraging these efforts and connecting families to appropriate resources. 4/10/12Our Nations Youth

4/10/125Healthy Kids Healthy Futures reports that approximately 12 million children and babies are in childcare nationwide . According to the Centers for Disease Control, nearly two thirds of infants are regularly cared for by someone other than a parent. Approximately 50% of these infants attend child care centers while the remaining are in home-based settings to include licensed family based child care homes or the homes of family and or friends. With such a large portion of our youth being cared for by additional caregivers, we can see where the child care provider can play a vital role in promoting breastfeeding among mothers whose children are cared for in these facilities. 54/10/12

Source: WIC, California Dept. of Health and Human Services

4/10/126The good stuff found in breastmilk cannot be duplicated by any other milk source. This image comes from the California Dept. of Health and Human Services WIC office and as you can see breastmilk has far more good things that a baby needs. Things like: antibodies, hormones, growth factors, vitamins, anti-allergies. (California Dept. of Health and Human Services)4/10/12Benefits for ChildDecreased risk of obesityDecreased risk of asthmaDecreased incidence of insulin and non-insulin dependent diabetes mellitusDecreased infant mortality rates by 21%Decreased incidence of infectious diseaseDecreased risk of Sudden Infant Death Syndrome (SIDS)

Source: AAP. Breastfeeding and the use of Human Milk, 2005 Policy Statement.

4/10/127The benefits of breastmilk to a child are great. There is a decreased risk of childhood and adolescent obesity and an increased protection against asthma and eczema when breastfed exclusively for at least 4 months. Exclusive breastfeeding a child with a family history of diabetes for at least 4 months, reduces their risk of insulin dependent (juvenile onset) diabetes. According to the United States Breastfeeding Committee, children who are breastfed score higher on cognitive and IQ tests and have a decrease in infant mortality rates by 21%. The incidence of infectious disease is also greatly decreased in children who are breastfed. These diseases include: diarrhea, respiratory tract infections, ear infections, meningitis, necrotizing enterocolitis, urinary tract infections and late-onset sepsis in preterm infants. (AAP, 2005)74/10/12Preventing SIDS

4/10/128We cant talk about breastfeeding without also talking about the preventive benefits related to SIDS rates. The American Academy of Pediatrics in October of 2011 released a policy statement on SIDS to include an expansion on recommendations for safe infant sleeping in general. The recommendations in the policy statement include the following: supine positioning, firm sleeping surface, room-sharing without bed-sharing, routine immunizations, pacifier use considerations, avoidance of the following: soft bedding, overheating, exposure to tobacco smoke, alcohol, and other illicit drugs, and promotion of BREASTFEEDING (AAP, 2011). The AAP policy statement goes on to further state that The protective effect of breastfeeding increases with exclusivity. However, any breastfeeding has been shown to be more protective against SIDS than no breastfeeding( AAP, 2011, p. 1034).

84/10/12Benefits for MomCosts less than non-natural feeding optionsDecreased postpartum bleedingEarly return to pre-pregnancy weightDecreased risk of breast cancerDecreased risk of ovarian cancerPossible decrease risk of osteoporosis in postmenopausal period


4/10/129Beyond the benefits of breastfeeding for the child there are also benefits to be had of the breastfeeding mother. The benefits for the mom include: cost (compared to other feeding options), decreased postpartum bleeding, early return to pre-pregnancy weight, decreased risks of cancer (to include breast and ovarian), and there is also a possible decrease risk of osteoporosis when a woman who has breastfed enters the postmenopausal period of life (AAP, 2005). 94/10/12Benefits to SocietyDecreased annual health care costsDecreased tax dollars spent on health care programsDecreased parental employee absenteeism and associated loss of family incomeIncreased attention to family as a whole due to decreased infant illness


4/10/1210Theres a bumper sticker I have grown fond of over the years and it states Affordable Health Care Begins with Breastfeeding. Take a minute to think about that phrase. Children that are breastfed are on average healthier children than children who are not breastfed. The decrease in medical costs, means an increase in monies back into families pockets. Parents whose children arent sick, have less time they must take off from work; a benefit for you as a child care provider. As a whole, families who are healthier, have more time to bond with one another with less focus and stress placed on illness. Recent research shows that if 90% of families breastfed exclusively for 6 months nearly 1,000 deaths among infants would be prevented. The U.S. would also save $13 billion per year on medical costs; medical care costs are lower for fully breastfed versus never breast fed infants (AAP, 2005).104/10/12Environmental benefits Breastmilk may look white but actually its as green as can be.Dia L. MichelsMother Nature Loves Breastmilk

4/10/1211Breastmilk is one of the few foods produced and delivered to the consumer (i.e. the child) without any unnecessary packaging, pollution, or waste. The complete story on environmental benefits by the author mentioned on this slide can be viewed at www.breastfeeding.com. 4/10/12Breastfeeding recommendationsExclusive breastfeeding first 6monthsContinued breastfeeding to 1year and beyond

4/10/1212The American Academy of Pediatrics (AAP), the United States Breastfeeding Committee (USBC), the Academy of Breastfeeding Medicine, the American Academy of Family Physicians, the World Health Organization, and the United Nations Childrens Fund (UNICEF) all recommend that women should exclusively breastfeed for the first six months of life, and then continuing breastfeeding after adding complementary foods at 6 months of life (CFOC, 3rd edition, p. 151). According to the AAP 2005 policy statement on breastfeeding:Exclusive breastfeeding is sufficient to support optimal growth and development for approximately the first 6 months of life AND provides protection against diarrhea and respiratory tract infections. Breastfeeding should be continued AT LEAST for the first year of life and beyond as long as mutually desired by mother and child.

There is no cut off point where breastfeeding is recommended to cease. The most crucial time frame for a baby to receive breastmilk is in that first 6 months of life where there is rapid growth and development occurring. At 6 months we know we shift towards solid introduction and baby starts to rely more on solid foods, however, milk still plays a vital role in development. A mother and child should be encouraged and supported to continue to breastfeed as long as she so wishes and focus on a baby lead weaning methodology. 124/10/12Healthy People 2020TargetsEver breastfed6 month duration12 month duration3 month exclusive6 month exclusive

Source: U.S. Department of Health and Human Services; Healthy People 2020

4/10/1213Introducing Healthy People 2020Healthy People 2020 continues in this tradition with the launch on December 2, 2010 of its ambitious, yet achievable, 10-year agenda for improving the Nations health. Healthy People 2020 is the result of a multiyear process that reflects input from a diverse group of individuals and organizations. VisionA society in which all people live long, healthy lives.MissionHealthy People 2020 strives to: Identify nationwide health improvement priorities. Increase public awareness and understanding of the determinants of health, disease, and disability and the opportunities for progress. Provide measurable objectives and goals that are applicable at the national, State, and local levels. Engage multiple sectors to take actions to strengthen policies and improve practices that are driven by the best available evidence and knowledge. Identify critical research, evaluation, and data collection needs.Overarching GoalsAttain high-quality, longer lives free of preventable disease, disability, injury, and premature death. Achieve health equity, eliminate disparities, and improve the health of all groups. Create social and physical environments that promote good health for all. Promote quality of life, healthy development, and healthy behaviors across all life stages.

Taken directly from: U.S. Department of Health and Human Services. Healthy People 2020. http://www.healthypeople.gov/2020/default.aspx

4/10/12Healthy People 2020TargetsCurrent Rates10 year National GoalEver breastfed73.9%81.9%6 month duration43.4%60.5%12 month duration22.7%34.1%3 month exclusive33.1%44.3%6 month exclusive13.6%23.7%Source: U.S. Department of Health and Human Services; Healthy People 2020

4/10/1214This table depicts where we currently stand as a nation in regards to breastfeeding rates and where we hope to be by 2020. 4/10/12Births at Baby Friendly Hospitals 2011

Sources: Baby-Friendly facilities : www.babyfriendlyusa.org Live Births: CDC NCHS 2009 Live Births by State

4/10/1215According to the Baby-Friendly Hospital website:The Baby-Friendly Hospital Initiative (BFHI) is a global program sponsored by the World Health Organization (WHO) and the United Nations Childrens Fund (UNICEF) to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding. The BFHI assists hospitals in giving mothers the information, confidence, and skills needed to successfully initiate and continue breastfeeding their babies or feeding formula safely, and gives special recognition to hospitals that have done so.

The intent is that with more Baby Friendly Hospitals nation wide, a positive effect on breastfeeding initiation and duration could result. Maine currently has 5 Baby Friendly Hospitals: York Hospital, Miles Memorial, Central Maine Medical Center , Maine General Medical Center, and Bridgton Hospital. 4/10/12CDC Breastfeeding Report CardPercent of live births occurring at Baby Friendly Facilities Percent of breastfed infants receiving formula before 2 days of age State child care center regulation supports lactation*** Number of state health department FTEs** dedicated to breastfeeding Number of IBCLCs* per 1,000 live births U.S. National4.5324.56125.062.67Maine19.4118.9Not optimal1.005.64Source: Breastfeeding Report Card 2011, United States: Process Indicators* IBCLC - International Board Certified Lactation Consultant. **FTE - Full-Time Equivalent. ***Based on the PCO/CFOC IA1 standard

4/10/1216According to the Centers for Disease Control: Improving the health of mothers and their children is a primary goal of the Centers for Disease Control and Prevention (CDC). Protecting, promoting, and supporting breastfeeding, with its many known benefits for infants, children, and mothers, is a key strategy toward this goal. There are many ways that communities support mothers and babies to breastfeed, and everyone plays a role. The CDC Breastfeeding Report Card brings together state-by-state information to help tell the story of breastfeeding practices in states. It compiles many types of data so states can monitor progress, celebrate state successes, and identify opportunities to work with health professionals, legislators, employers, business owners, community advocates and family members to protect, promote, and support breastfeeding. Mothers need support from the people and organizations they interact with to meet their breastfeeding goals.

Beyond birth facility support mentioned in the last slide, 6 additional indicators are used to measure breastfeeding friendly communities. One of these indicators is support in child care settings. Above are five of the 7 indicators. Those in bold mean they exceed the Healthy People 2020 goals. According to the CDC site: Cut-off points (1- inappropriate; 2- not optimal; 3- less optimal; 4- optimal) were set for the indicator: State childcare center regulation supports lactation. States whose regulations are less than optimal can improve breastfeeding support at child care facilities by meeting best-practice standards as set by the 3rd edition of Caring for Our Children. A complete listing of the report card can be viewed on line at:http://www.cdc.gov/breastfeeding/data/reportcard.htm4/10/12Attachment and bonding

4/10/1217As stated directly from the Caring for Our Children; National Health and Safety Performance Standards (2011) 3rd edition , Breastfeeding sets the stage for an infant to establish healthy attachment(p. 151). Rooming in with a baby versus co-sleeping with a baby sets the stage for parental bonding with their newborn. The action of a baby suckling actually changes how a mothers brain behaves, promoting oxytocin release or the love hormone resulting in enhanced feelings of trust, love, and affection. Oxytocin is produced in the hypothalamus of the brain. According to the journal of Public Library of Science Computational Biology:Normal brain cells, or neurons, release chemicals such as oxytocin in relatively small amounts from their nerve endingsthe research team, led by Warwick University scientists, has shown using computer models that when a baby suckles, the mothers neurons respond by churning out the hormone from their dendrites-the part of the cell that usually receives, rather than transmits information. This extra release of oxytocin creates much stronger links between nerve cells-creating a positive-feedback loop, where the greater the concentration of the chemical, the faster it is produced (Derbyshire, 2008).174/10/12Creating healthier children

4/10/1218When you have a chance to review the 3rd edition of CFOC; National Health and Safety Performance Standards, take a minute to take a look at Chapter 4 on Nutrition. To quote part of this chapter:

Human milk, containing all the nutrients to promote optimal growth, is the most developmentally appropriate food for infants. It changes during the course of each feeding and over time to meet the growing childs changing nutritional needs. All caregivers/teachers should be trained to encourage, support, and advocate for breastfeeding (CFOC, p. 151).

As caregivers and teachers you have an opportunity to positively affect breastfeeding duration and possibly initiation by providing support to breastfeeding mothers; whether they be your staff, or parents of children within your care. 184/10/12

4/10/1219To find out where your facility currently stands in regards to infant feeding, I encourage you to take a look at the Lets Move! Childcare Infant Feeding checklist quiz. This is an initiative of First Lady Michelle Obama.

The Lets Move! Childcare initiative has 5 main goals:Get kids moving Reduce screen time Make nutrition fun Offer healthier beverages Support infant feeding

The Lets Move!Childcare infant feeding checklist is available on line at:http://healthykidshealthyfuture.org/welcome.html

194/10/12Getting started Breastfeeding education Breastfeeding environment Breastfeeding policy

4/10/1220The Lets Move! Childcare infant feeding checklist is a self assessment that covers the following subject areas: breastfeeding education, breastfeeding environment, and breastfeeding policy. Utilizing this checklist is a good starting point for assessing your individual sites on current practices around breastfeeding and can help identify areas of needed improvement.

204/10/12ReferencesAmerican Academy of Pediatrics, American Public Health Association, & National Resource Center for Health and Safety in Child Care (2011). Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care, 3nd Ed. Chicago, IL: American Academy of Pediatrics; American Public Health Association.

American Academy of Pediatrics (2011). SIDS and other sleep-related infant deaths: Expansion of recommendations for a safe infant sleeping environment. Pediatrics, DOI: 10.1542/peds. 2011-2284.

American Academy of Pediatrics (2005). Breastfeeding and the use of human milk; Policy statement. Pediatrics, 115(2), pp 496-506. http://www.aap.org

Baby friendly hospital initative, U.S.A. Retrieved from http://www.babyfriendlyusa.org/eng/index.html

California Dept. of Health and Human Services, WIC. Retrieved from http://www.cdph.ca.gov/programs/wicworks/pages/default.aspx

Centers for Disease Control and Prevention. Breastfeeding Report Card- United States. 2011. Retrieved from http://www.cdc.gov/breastfeeding/data/reportcard.htm

Derbyshire, D. (2008) Breastfeeding does help mothers bond with babies-because it releases the love hormone. Retrieved from http://www.dailymail.co.uk/health/article-1036151/Breast-feeding-DOES-help-mothers-bond-babies--releases-love-hormone.html

Nemours. Lets Move! Childcare. Retrieved from http://healthykidshealthyfuture.org/welcome.html

Maine Center for Disease Control and Prevention; Department of Health and Human Services; Division of Local Public Health. Maine workplaces support nursing moms. Retrieved from http://www.maine.gov/dhhs/mecdc/local-public-health/wic/families/bf-workplace.shtml

4/10/1221214/10/12References cont.Michels, D. (1998). Mother nature loves breastmilk. Retrieved from http://www.breastfeeding.com/reading_room/mother_nature.html

United States Breastfeeding Committee. Breastfeeding and child care. Retrieved from http://www.usbreastfeeding.org/Employment/ChildCareFacilities/tabid/107/Default.aspx

U.S. Department of Health and Human Services. Healthy People 2020. http://www.healthypeople.gov/2020/default.aspx

Wisconsin Nutrition, Physical Activity, and Obesity Program. Ten steps to breastfeeding friendly childcare centers; A resource kit. Retrieved from http://www.dhs.wisconsin.gov/health/physicalactivity/pdf_files/BreastfeedingFriendlyChildCareCenters.pdf

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