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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
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
Breastfeeding-Friendly Child Care
• 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 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
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 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
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.
Training of Trainers
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
Breastfeeding-Friendly Child Care
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.
Training of Trainers
• 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!
http://cgbi.sph.unc.edu/
(Quick Links – Toolkits)
THANK YOU!