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This document contains the same information as your online course and is provided for your convenience. We do not require that you read both this document and the online course.

Supporting Breastfeeding in Child Care

Interactive Edition

a Distance-Learning Care Course for Early Childhood Professionals

The Care Courses School, Inc.

P. O. Box 10526 McLean, VA 22102-8526

1-800-685-7610 www.CareCourses.com

This document contains the same information as your online course and is provided for your convenience. We do not require that you read both this document and the online course.

About the curriculum developer Clairece Feagin holds an Ed.M. from Harvard University. She is author of Contemporary Books’ Stories for Par- ents and Let’s Read Together series as well as various social studies texts and teaching materials including more than 70 distance-learning courses offered by Care Courses.

Credit available for this course Supporting Breastfeeding in Child Care offers 2 clock hours (0.2 CEUs) of training. Credit for this course is available only through Care Courses.

To obtain credit, read and study the course material and submit your coursework online Upon success- ful completion of this course you will receive a certificate documenting the hours/CEUs you have earned.

Proprietary interest statement Neither Care Courses nor our cur- riculum developers/trainers have any proprietary interest in any product, instrument, device, service, or mate- rial mentioned in this course. Students who participate in Care Courses have the right to know of any proprietary interests a trainer or curriculum devel- oper may have in a product or service mentioned. Care Courses is required to disclose all proprietary interests in any product, instrument, device, service, or material discussed in a course.

Contact information: Care Courses P. O. Box 10526 McLean, Virginia 22102-8526

1-800-685-7610

[email protected]

www.CareCourses.com

Getting the most out of this course We want you to be successful with this course: to receive your certificate as well as be able to apply what you learn. Follow these steps toward a successful learning experience and they will help you successfully pass this course:

• Read the course material at least two times. You may be surprised by what you notice on the second reading.

• Take notes with pen and paper, or underline and highlight as you work through your course. Writing out ideas by hand will help you focus on key concepts and remember them for your assessments. Research shows that taking handwritten notes greatly enhances learning.

• Discuss the course with others: coworkers, spouse, friends, etc. Talking about it out loud with other adults will help with comprehension.

• Take a proactive approach and implement in your facility what you’ve learned. This will reinforce what you’re learning and make the courses come alive.

• Contact a Care Courses trainer for assistance when you need it.

The Care Courses School, Inc. Honor Code and Study

Strategies Policy

Care Courses requires that you, the student, complete all course- work and that all coursework, including quizzes and assess- ments, is done solely by you. Fur- thermore, Care Courses requires that you study and comprehend all the material in this course before completing the assess- ments. This includes reading the material twice, taking notes, com- pleting no more than eight hours of coursework each day, and con- tacting a Care Courses trainer for assistance when needed. Care Courses requires that you show respect in all communication with our staff and other students.

Care Courses cannot grade coursework or issue a certificate of completion unless you have agreed to and acknowledged agreement certifying that you have adhered to this Honor Code and Study Policy.

In the event Care Courses in its sole discretion determines that the coursework is not your own work, or that you did not adequately study and comprehend the course material, no certificate of comple- tion will be issued, and other remedial action may be taken.

iv Supporting Breastfeeding in Child Care – Introduction

This document contains the same information as your online course and is provided for your convenience. We do not require that you read both this document and the online course.

Introduction

Welcome to Supporting Breastfeed-ing in Child Care. This distance learning course is designed for adults who teach or care for young children. Breastfeeding has many benefits to both the child and the mother. It is important that infant care providers make certain that they provide an envi- ronment in which families feel com- fortable and supported in their decision to breastfeed. This course also presents information to assist you in implementing breast- feeding policies and help you create a welcoming, breastfeeding-friendly environment in your infant care facility. As you read and study this course, think about your current program. Note what improvements need to be made in order to fully support families who have cho- sen breastfeeding for their child. The District of Columbia, US Virgin Islands, and all US States (with the exception of Idaho) have laws that spe- cifically allow women to breastfeed in any public or private location, and sev- eral states have unique laws related to breastfeeding. This course satisfies the Maryland requirement for training in breastfeed- ing support as required by COMAR Regulations, and may be taken by any- one in any state. The Code of Maryland Regulations (COMAR) states that a licensed infant/ toddler child care facility must pro- vide a designated space for mothers to breastfeed or express breast milk. Ensure that this location is not located in a bathroom, has access to an electri- cal outlet, has appropriate seating, has access to running water, and accommo- dates a mother’s need for privacy.

Additionally, Maryland Code § 20-801 states: 1. A mother may breastfeed her

child in any public or private location in which the mother and child are authorized to be.

2. A person may not restrict or limit the right of a mother to breastfeed her child.

Review your state laws to ensure com- pliance with the regulations. A sum- mary of state laws related to breastfeed- ing can be found at the National Con- ference of State Legislators website.

http://www.ncsl.org/research/health/ breastfeeding-state-laws.aspx#State

Course Features Learning Outcomes This course begins with Learning Out- comes. Read these before you read the course. They will help you focus on the important points of the course.

Course Preview This course includes a Course Preview with questions or statements relating to the material covered in the course. Think about the ideas in the Course Preview as you study. The Course Pre- view items are analyzed for you at the end of the course.

Notebook Assignments This course includes required Note- book Assignments. You will need a notebook or journal (loose-leaf is rec- ommended) for these assignments. Information you record will be helpful in your work. Keep your notebook for your own reference.

Self-Checks This course has True/False Self-Check statements with answers provided. Read each course section at least two times before you attempt the Self- Check. When you feel that you have understood the material in the sections, read each Self-Check statement and decide if it is true or false. Re-read any sections that gave you trouble.

Course Quiz Read this course two times before attempting its quiz. When you have fin- ished reading the course, return to My Courses within your account online and open your course to access the Online Quiz.

End of Course Reflection This course includes a section where you will enter your reflection on what you’ve learned.

Using What You’ve Learned This course includes a section where you will enter how you have imple- mented (or plan to apply) what you’ve learned in this course.

End of Course Reflection This course includes a section where you will enter your reflection on what you’ve learned.

Using What You’ve Learned This course includes a section where you will enter how you have imple- mented (or plan to apply) what you’ve learned in this course.

Speak with Trainer All coursework is reviewed by Care Courses. You may receive a request to speak with a Care Courses trainer to discuss your work on this course.

Documents This course includes printable hand- outs including our Cultural Compe- tency in Child Care and Special Needs in Child Care statements, instructions on how to do an observation, and a Breastfeeding Policies: Self-Appraisal Questionnaire.

Vocabulary The online Vocabulary section gives a definition of terms used in the course. Each term is defined in relation to its use in the course.

Course Discussion Area You will find an online discussion area where you will share your ideas from your Notebook Assignments with our trainers and other students.

Supporting Breastfeeding in Child Care – Introduction v

This document contains the same information as your online course and is provided for your convenience. We do not require that you read both this document and the online course.

Regulations This course has been written to comply with most U.S. states’ child care regu- lations. Review our online Regulations section for excerpts of regulations from a few select states that specifically per- tain to content in this course.

References A list of references used to create this course is included in the online Refer- ences section.

Additional Resources Want to learn more? Online you will find Additional Resources where you can learn more about what you’ve stud- ied in this course.

Contact My Trainer On the left-hand side of the online area for this course is a Contact My Trainer button. Use this button to ask your trainer questions and to respond to the discussion question included in this section.

Submission and Certificate When you have completed your Les- son Quizzes and are comfortable with your answers, you may submit them for grading. Follow the directions in your online course.

You must earn a score of at least 70% on each Lesson Quiz to receive credit for this course. If your score on a Les- son Quiz is less than 70%, you will be given a second chance to pass. If you fail to get a 70% on your second attempt, Care Courses cannot issue a certificate for this course.

This course is not designed to be hard. The quiz questions are not designed to be tricky. Read all of the course (at least twice!) and think about what it says. If you have trouble, please con- tact us. We’re happy to help!

Happy Studying!

Supporting Breastfeeding in Child Care 1

This document contains the same information as your online course and is provided for your convenience. We do not require that you read both this document and the online course.

Supporting Breastfeeding in Child Care Course Preview

What do you think? Consider the following statements before you do this course. Do you feel they are correct or incorrect? Think through the reasons for your position on each item. Keep these ideas in mind as you do this course. 1. A breastfed infant’s desire for

frequent feedings indicates that the child isn’t getting enough milk.

2. Infants should be trained to a four-hour feeding schedule before they are placed in child care.

3. Breast milk provides benefits that formula cannot match.

4. If mothers wish to breastfeed, you should direct them to a private bathroom.

5. All mothers should breastfeed their babies.

(These Course Preview items will be analyzed at the end of this course.)

Learning Outcomes After completing this course, you will be able to

• list and explain the benefits of breastfeeding for both the child and the mother;

• describe and apply the four goals that breastfeeding support policies should address to create a welcoming environment for breastfeeding families;

• identify and summarize strategies that can be used to create a breastfeeding-friendly program.

* * *

The American Academy of Pediatrics (AAP) recommends that infants be exclusively fed breast milk for the first six months of life. The AAP also recom- mends that mothers continue to breast- feed their child for a year or longer if mutually desired by the mother and child. Mothers’ milk provides important nutritional benefits for infants. However, the benefits of breastfeeding extend well

beyond nutrition. Breast milk can help prevent the negative effects of infec- tious disease, lower harmful cholesterol, increase resistance to illness, and pro- vide infants with important antibodies. Breastfeeding can enhance a trusting and secure relationship between mother and child. Breastfeeding has also been linked to lower risks of some cancers for the mother. Every year scientists are learning more about the valuable sub- stances present in breast milk, and have only begun to scratch the surface of how all the components work together to pro- mote a baby’s growth and development.

Nutrition

Breast milk provides almost all the pro- tein, sugar, fat, vitamins, and minerals that an infant needs to stay healthy in the first six months of life, and con- tinues to provide nutritional benefit for as long as the mother continues to nurse her child. In addition, breast milk includes important growth fac- tors that stimulate organ development in the child, and is easier to digest than formula. Breast milk is especially ben- eficial for babies with heart problems or cystic fibrosis who may have trouble gaining weight. Breast milk is also less irritating to a baby’s nasal passages than formula which may be beneficial to a baby with a cleft palate.

While formula is designed to include many of the same vitamins and minerals present in breast milk, the way in which an infant is able to process and utilize these elements is much different. This is due to a concept known as bioavailabil- ity, meaning how efficiently the body can absorb the ingested nutrient into the bloodstream. Take iron, for exam- ple. About 50 to 75 percent of the iron present in breast milk will be absorbed into the bloodstream, meaning the iron present in breast milk has a high bio- availability. Conversely, as little as four percent of the iron present in formula will be absorbed into the bloodstream, indicating a much lower bioavailabil- ity. To account for this, manufacturers increase the concentration of iron in for- mula to ensure that a sufficient amount is absorbed by the infant.

Increasing the concentration of nutri- ents does come with consequences. Because such a low percentage of a nutrient can be utilized by the grow- ing child, the rest is processed as waste in the baby’s bowels. The unabsorbed minerals (especially iron) can interfere with the growth of healthy bacteria in the child’s digestive system and pro- mote the growth of harmful bacteria. The difference in composition between breast milk and formula may surprise you. For a complete comparison, view the handout “Did You Ever Wonder What’s In…? Breast Milk vs. For- mula,” found in the online Additional Resources section. Immune System Feeding a child breast milk allows the mother’s body to transfer important antibodies, enzymes, and white blood cells to the child to protect him or her against illness and infection, protection that formula cannot provide. Breast milk also promotes the growth of healthy bacteria and inhibits the growth of harmful bacteria in the child’s digestive system. This decreases the chance that the child will suffer from ear infections, vomiting, diarrhea, pneumonia, and uri- nary tract infections. Research has also shown that children who are exclusively fed breast milk for at least four months are less likely to suffer from lower respi- ratory infections. Breastfed children are also less likely to catch germs from other children while in group care. Breastfeeding has also been shown to reduce the risk of:

• Asthma • Childhood leukemia and lymphoma • Childhood obesity • Eczema • Sudden Infant Death Syndrome

(SIDS) • Type 1 and type 2 diabetes

Unless otherwise advised by her doctor or pediatrician, a mother should con- tinue to breastfeed even when she is suffering from a contagious illness such as a cold, flu, or stomach bug. Breast- feeding will not transmit these illnesses

2 Supporting Breastfeeding in Child Care

This document contains the same information as your online course and is provided for your convenience. We do not require that you read both this document and the online course.

to the child. Instead, breastfeeding will transmit antibodies produced by the mother that are specific to that illness, further fortifying the child’s immune system. In fact, withholding breast milk during times of illness increases the pos- sibility that the child will get sick, as the child will have already been exposed to the mother’s illness well before symp- toms begin to show.

For mothers, breastfeeding has also been linked to a reduced risk of ovarian cancer and breast cancer. Some stud- ies have also shown a reduced risk of developing type 2 diabetes, rheumatoid arthritis, and cardiovascular disease.

Cognitive and Emotional Benefits The benefits of breastfeeding also extend to the emotional wellbeing of a child. The physical closeness to his or her mother during nursing creates a sense of reassurance and security as a newborn adapts to life outside the womb. Children benefit from the act of nursing, developing an emotional closeness to their mothers through being held and provided sustenance.

Infants learn best in an environment where they experience emotional closeness with an adult, improving cognitive development. Breastfeeding has been linked to higher intelligence, greater reading comprehension, and improved mathematical abilities.

Mothers also benefit from this exchange, as breastfeeding stimulates the release of the hormones prolactin and oxytocin, which help foster nurturing sensations as well as a strong sense of love and attach- ment between the mother and child. Studies have also shown a correlation between abuse and neglect perpetrated by mothers, indicating that the rate of abuse and neglect was significantly higher for mothers who did not breast- feed compared with those who did.

Breastfeeding can greatly benefit chil- dren with autism spectrum disorder, giv- ing the mother and child the opportunity to bond even when the child’s condition may impede his or her ability to express emotions. Studies have indicated that children with autism who are breastfed appear more responsive, better socially adjusted, and more affectionate than those who have been formula fed.

The following section by Sandra L. Morris emphasizes the benefits of breastfeeding and discusses ways that you as a caregiver can support moth- ers who wish to continue breastfeeding infants when they are in child care. Sandra L. Morris, B.A., has been a child care provider, foster parent for newborns, and certified group leader for La Leche League International.

Supporting the Breastfeeding Relationship During Child Care: Why

Is It Important? By Sandra L. Morris

Young children do not enroll in our child care programs alone; they bring their families with them, espe- cially their mothers. The breastfeeding child, however, literally comes with his mother attached. Many of us are so accustomed to feeding an infant or toddler with a bottle of formula that we have a difficult time thinking of doing it any other way. Breastfeeding mothers may ask us to feed their babies “another way”—to give only breast milk in a bottle or cup (see the section, “Help- ing a Breastfed Baby Take a Bottle of Breast Milk” at the end of this article) or to modify our routine to accommo- date the mother’s coming to feed the baby herself throughout the day. The breastfeeding relationship is unique to each mother and child. It evolves over time, changing and devel- oping different patterns—the frequency increasing during illness or anxiety and decreasing with the introduction of other foods and the young child’s grow- ing independence. That is why we must communicate often with a breastfeed- ing infant’s mother (a sound practice with any infant’s mother, actually) and respond to this evolution as it occurs. While it is true that breastfeeding infants are as different from one another as are young children of any group, some general characteristics are com- mon to these infants as a whole. Fur- thermore, it is also true that mother– child relationships vary, and it is to our advantage to become aware of the many aspects that apply to most breast- feeding relationships.

Perhaps the most critical piece of infor- mation about breastfeeding for us to keep in mind is that many of the advantages of breastfeeding rely on the infant’s con- sumption of breast milk only, without formula or other supplements.

It may be valuable for us to look at some of the advantages of breastfeed- ing as well as some of the characteris- tics of breastfeeding infants and moth- ers that may have an impact in group care. Keeping the demands of child care in mind, the following list has been selected from recent breastfeed- ing fact sheets. While reviewing these breastfeeding facts, let’s consider not only how they benefit babies and their mothers but how they are beneficial to us as caregivers in group programs.

Breastfeeding Can Make a Difference

■ Breast milk provides all the nutri- tion a baby needs for at least the first six months of life.

As long as nourishment is offered in ade- quate amount, meeting the infant’s needs in child care is simple. If the mother can- not come to feed her child throughout the day, we give breast milk in a bottle, cup, spoon, or eye dropper, expecting feeding frequency to mirror the infant’s current breastfeeding patterns.

■ Human milk has advantages artifi- cial foods cannot duplicate.

Human milk is free, is readily available at the right temperature (whenever mother and baby are together), and its nutrient makeup changes over the course of a single feeding (a good reason to allow unhurried feedings) as well as over the course of the child’s development.

■ Mothers “immunize” their babies through breastfeeding.

Colostrum—the pre milk fluid pres- ent in the mother’s breasts during late pregnancy and the first postpartum days—passes the mother’s antibod- ies on to the baby, which protects the child from disease. Moreover, recent research indicates that this immunolog- ical protection does not diminish with time, and, in fact, high levels of anti- bodies are present throughout the first year of lactation and are maintained through the second year as well.

Supporting Breastfeeding in Child Care 3

This document contains the same information as your online course and is provided for your convenience. We do not require that you read both this document and the online course.

■ Breastfeeding protects babies against illness.

The protective effects of breastfeeding are many. Studies indicate that breast- feeding is protective against SIDS (Sudden Infant Death Syndrome), that breastfed infants have milder forms of acute gastroenteritis than formula- fed infants, and that antibody levels of immunized breastfed infants are signifi- cantly higher. Similarly, being breastfed decreases ear infections and protects against upper respiratory illnesses in the first four months of life, particularly when other risk factors are present.

■ Allergy occurrence is less frequent among breastfed infants.

Breastfeeding, even for a short period, has been clearly associated with a lower incidence of wheezing, pro- longed colds, diarrhea, vomiting, and eczema. In addition, totally breastfed babies’ diapers have a mild odor, and the babies seldom get diaper rash.

■ Breastfeeding enhances development.

One study found a small but significant positive relationship between duration of breastfeeding and cognitive devel- opment. Especially low-birthweight infants appear to benefit cognitively from being breastfed.

The stimulation provided naturally in the breastfeeding position—tucked close to the mother, hands free for pet- ting, near enough for frequent touching and eye contact—as well as switch- ing baby from arm to arm while feed- ing may be factors in healthy child development.

■ Growth patterns of breastfed infants differ from those of formula-fed infants.

Except for rare cases, it is nearly impossible to overfeed or underfeed a baby at the breast; the milk changes in consistency during the feeding and the baby himself regulates the flow and amount by his suckling.

■ Breastfeeding provides a safety net for babies in disadvantaged environments.

Poverty and mismanagement of formula can put children’s health at risk. Breast milk at the breast cannot be watered down as can bottle-fed formula; breast- feeding necessitates holding the child

physically close, which, in and of itself, provides stimulation and nurturing; breastfeeding costs little, if anything, for a great deal of nutrition, regardless of the mother’s knowledge of nutri- tion. If nothing else, breastfeeding may enhance a mother’s consistent contribu- tion to her relationship with her child.

How does this safety net help care-giv- ers? When we support this relationship in our words and our actions, we are saying we are partners—we are inter- dependent; the mother gives the baby wonderful nurturing that we cannot, and we give the baby experiences that the mother may be unable to give.

■ Breastfeeding benefits children with special needs.

While specialists evaluate and prescribe interventions and therapies, sometimes breast milk seems to be the only contri- bution a mother of a child born with a disability can offer, and, in most cases, she and her baby can develop a suc- cessful breastfeeding relationship with the appropriate support.

Furthermore, for young children with particular conditions, such as PKU (phenylketonuria), asthma, allergies, or Crohn’s disease, breastfeeding decreases associated and/or future risks to development.

■ Breastfeeding enhances a woman’s mothering role.

It appears that women adjust to their new role as mothers and experience less “postpartum depression” when they breastfeed. Most breastfeeding women have observed that, no mat- ter how harried and hassled they may feel, once they settle down and begin to breastfeed, a wonderful, relaxing sen- sation comes over them. Moreover, the hormones produced during breastfeed- ing cause powerful maternal feelings that make mothers feel close to their babies and uneasy when they are away from them.

Providing a private, quiet space with a rocking chair or soft chair will encour- age this all-important contact. Because the mother is doing a natural thing, it seems unnatural to send her to a bath- room or to her car on the street.

■ Breastfeeding delays the return of fertility.

The lack of fertility is determined by the frequency of breastfeeding, the duration of each feeding, and minimal supplemental feeding. While breast- feeding does not provide 100% protec- tion, mothers who do not want to get pregnant again quickly may be ada- mant about our fulfilling their requests to support and sustain the breastfeed- ing relationship.

■ Breastfeeding has health benefits for the mother and provides maternal pro- tection against breast cancer.

A marked reduction in the risk of devel- oping ovarian, uterine, and cervical cancer as well as osteoporosis is asso- ciated with having breastfed. Breast- feeding appears to have a preventive effect on urinary tract infection in both mother and baby. In addition, lactation plays a modest part in reducing the risk of breast cancer.

■ Human milk contains protection against bacterial growth.

At room temperature, mature milk from term mothers can be stored for six hours without a significant increase in bacterial counts.

As we begin to realize how precious mother’s milk is and how much effort may go into pumping it, carefully stor- ing (or freezing) it, and bringing it to us, it is important and respectful to treat it appropriately.

Considering the many benefits to moth- ers, babies, and caregivers (and more are being discovered every day), main- taining the breastfeeding relationship is an important aspect of quality child care. Perhaps it is clearer now why some mothers are insistent that their infants be fed breast milk only and why frequent communication with parents of infants in our care is so essential.

When child care providers fully realize the positive difference breastfeeding can make to mothers and their babies, it increases the likelihood that we will support and encourage parents’ choice to breastfeed and find solutions to any challenges that arise.

4 Supporting Breastfeeding in Child Care

This document contains the same information as your online course and is provided for your convenience. We do not require that you read both this document and the online course.

Helping a Breastfed Baby Take a Bottle of Breast Milk

Suckling at the breast is a different suckling pattern than is done with an artificial nipple; both are learned behaviors, and establishing one pattern at a time is less confusing to an infant. Six to eight weeks of breastfeeding is ideal, in most cases, before introducing an artificial nipple, and patience must be displayed as the infant learns the new skill of suckling a rubber nipple.

■ Of all the different kinds of nipples available, none is more like the breast than another; whichever the baby prefers is the one to use, although many mothers find that the baby can switch back and forth from bottle to breast with less confusion if an orthodontic nipple is used.

■ Babies are more likely to accept a bottle (of juice, water, formula, or breast milk) when it is offered by someone besides their mother; or they may refuse to take the bottle of breast milk but accept juice or water readily.

■ Be gentle and patient; take a little time. Rub the nipple on the baby’s mouth and let her mouth the nipple. Some babies like to chew on an icy cold nipple; others may be receptive when everything is at body temperature, just like at home. Rocking or walking while feeding may calm some babies.

■ Duplicating the nursing position when offering the bottle works with some babies. Others may need to be distracted and cajoled by different positions—perhaps held in your lap with their back against your chest.

■ Try offering the bottle before the baby is overly hungry, possibly even while the baby is still sleeping.

■ [U]se a preemie nipple, as they are soft and flexible. The cup, eyedropper, spoon, or even periodontal syringe are options when an infant will not accept an artificial nipple.

■ Call a La Leche League leader, public health nurse, or experienced infant caregiver to commiserate—they may be able to offer fresh ideas.

How to Get Through a Mom-Is- Not-Here-Yet-Baby-Is-Hungry! Moment and Avoid Having to

Say “I’m Sorry, I Just Fed Your Baby” to a Returning Mother

This should happen only occasionally; make some different arrangements with Mom if it occurs too often. Con- sider this a temporary state; as breast- fed babies get older, they frequently learn to quiet themselves and willingly wait for Mom unless she is late. Some of the following suggestions are one- on-one efforts; but in most cases this dilemma seems to occur at the end of the day when most of the other children are gone anyway.

■ Distract with motion (rocking, walking, bouncing, jiggling); with sound (rattles, singing, talking, whistling, vacuuming); or with toys (swings, shakers, bouncers, teething rings).

■ Comfort by rubbing or patting back or bottom.

■ Use a front or back pack to keep baby close as you move around.

■ With Mom’s permission, try a pacifier or a clean knuckle (yours or baby’s).

■ Combine all of the above! ■ Discuss with Mom frequently what

amount—how many minutes—of fussing (if any) is OK before you just go ahead and start feeding in spite of your knowing she may come any minute.

■ Give a small amount of water or breast milk using a slow nipple (with small holes).

■ Call Mom to apprise her of the situation and problem-solve together.

Copyright © 1995 by Sandra L. Morris. Reprinted with permission from author. This article first appeared in Young Children volume 50, no. 2, January 1995, pp. 59–62. References for this article can be found in this course’s online References section.

Hints for Bottle Feeding the Breastfed Baby

Breast milk is digested quickly and easily. Thus breastfed babies usually eat more frequently than for- mula-fed babies. Timing of feedings may range between 11/2 to 3 hours. Feed breastfed babies when their cues indicate hunger, not on a time sched- ule. Early hunger cues include mouth movements, rooting, sucking on hands, and restlessness. Do not wait for the baby to begin crying, as crying is a late hunger cue (meaning the baby has been hungry for quite some time).

Feed the baby in a way that mimics breastfeeding. Hold the baby in an upright position, and never put a baby to bed with a bottle. Switch holding the baby from your right arm to your left arm midway through each feeding. This provides equal eye stimulation and facial muscle development, helps pace feedings, and keeps the baby from developing a preference for one side.

Let the baby control the start of the feeding. Stroke the baby’s lips with the nipple to elicit a rooting response and a wide-open mouth. Allow the infant to gape widely for the bottle nipple (rather than pushing it in). Allow the baby to “accept” or draw in the nipple.

Feed slowly. Liquid flows faster out of the nipple on a bottle than from a breast. Sucking on a bottle nipple may need to be paced. Pause frequently during feed- ings to burp, switch sides, or talk to the baby, and hold the bottle at an angle (avoid holding the bottle in a vertical upright position). Rapid feedings can lead to overfeeding, which puts the mother’s milk supply at risk and can cause discomfort for the baby. Infants need time to recognize that they are full.

Do not force a baby to finish “just the last bit” of a bottle. If the baby is drowsing off and releasing the bottle nipple before the bottle is empty, the baby is finished. Don’t reawaken the baby to take more. If bottles are often left unfinished, ask the mother to send milk in smaller amounts.

Breastfed babies sometimes eat smaller amounts at each feeding than babies who are formula fed. The amount of

Supporting Breastfeeding in Child Care 5

This document contains the same information as your online course and is provided for your convenience. We do not require that you read both this document and the online course.

breast milk consumed may or may not increase with the age of the baby. A breastfed baby often consumes higher quantities when breastfeeding than when being bottle fed.

Self-Check 1 – True or False? The Self-Checks in this course are designed as a review of the sections you have just studied. For each state- ment write “T” for true or “F” for false, then check your answers. For each false statement, an explanation is provided for why the statement is not true. Re- read the material that relates to any Self-Check items you missed. Self- Checks are not graded by Care Courses. ___ 1. The American Academy

of Pediatrics recommends that infants be breastfed exclusively for the first six months of life.

___ 2. Breastfeeding provides more than just nutritional benefits.

___ 3. Trusting and secure attachments between adult and infant can be developed during breastfeeding.

___ 4. Breastfed babies usually eat more frequently than formula- fed babies.

___ 5. Feed babies who are breastfed based on their hunger cues, not on a time schedule.

___ 6. Crying is an early hunger cue.

___ 7. Switching the arm in which you hold a baby during feeding keeps the baby from developing a preference for one side.

___ 8. Liquid flows faster during breastfeeding compared with bottle feeding.

___ 9. Encourage the baby to finish all of the milk in a bottle to prevent wasted milk.

___ 10. Breastfed babies often eat smaller amounts at each feeding than babies who are formula-fed.

___ 11. Breast milk and formula both provide equal protection against infections.

___ 12. Colostrum passes antibodies to the baby.

___ 13. Breastfeeding has been shown to increase the risk of Sudden Infant Death Syndrome (SIDS).

___ 14. Children who are breastfed tend to have fewer allergies.

___ 15. Hormones produced during breastfeeding can create a calming sensation for the mother.

___ 16. Women who breastfeed have a lower risk of developing breast cancer and ovarian cancer.

___ 17. Breast milk promotes healthy weight gain in children with heart conditions or cystic fibrosis.

Answers Statements 6, 8, 9, 11, and 13 in Self- Check 1 are false. All other statements are true. Please review the following explanations. 6. Crying is a late hunger cue. Mouth movements, rooting, sucking on hands, and restlessness are all early hunger cues, indicating the child is ready to be fed. 8. Liquid flows faster out of the nipple on a bottle. Sucking on a bottle nipple may need to be paced. 9. Children should never be forced to eat. Stop feeding when the baby is fin- ished. If the baby is drowsing off and releasing the bottle nipple before the bottle is empty, the baby is finished. 11. While formula provides nutrients babies need, it does not have the pro- tective properties of breast milk that fight against illness and death from infectious diseases. 13. Breastfeeding has been shown to decrease the risk of SIDS.

Creating a Welcoming Environment

Inez and Robert are visiting the center with baby Lucia. Inez will be returning to work full-time soon, and she has been trying to decide whether or not to continue breast- feeding her baby. As she and Robert talk to Ms. A, she notices pamphlets about breastfeeding set out in the front office. Ms. A offers one with a

smile, and Inez puts the pamphlet in her purse for later reading. The tour of the center begins after Ms. A finishes talking with the new family. She leads them down a hall to the infant room. They peek in the window to see Ms. S lovingly look- ing into a baby’s eyes as she feeds him a bottle. Another caregiver changes a diaper nearby, talking to the happily babbling baby. Inez smiles as she watches the interac- tions and the tour group moves on. Ms. A walks the family through the center before leading them back to her office. Along the way they come to a room with several posters of mothers nursing their infants. “This is our breastfeeding room,” she says, pausing in front of the open door. “Several of the mothers of our infants choose to continue breastfeeding while their children are in our care. This room is always open to them if they want to come by to express milk or nurse their babies.” As Ms. A lets Inez step inside to look around, she points out the comfortable chairs, and an electrical outlet and a sink. Ms. A explains the storage and feeding policy for breast milk and for for- mula. As she is speaking, a mother approaches the room with her baby. Ms. A greets mother and daughter with a warm smile before leading Inez and Robert back to her office. Inez and Robert leave the center with the assurance that, whether or not they choose to continue breast- feeding Lucia, their family will be welcome at this center.

Supporting Families Who Are Breastfeeding One of the barriers to breastfeeding that is most often cited by mothers is embarrassment and the perceived lack of a supportive environment. Placing their child in a welcoming breastfeed- ing environment is often a critical factor of a family’s decision when choosing a group childcare setting. It is extremely important that your early childhood facility clearly communicate that breastfeeding is considered a normal and accepted way to feed babies. Assure

6 Supporting Breastfeeding in Child Care

This document contains the same information as your online course and is provided for your convenience. We do not require that you read both this document and the online course.

families, children, staff, and visitors that every effort is being made to provide a comfortable and welcoming environ- ment for breastfeeding. Providing a welcoming and supportive environment increases the likelihood that parents will continue to breastfeed their child.

Ways to create a welcoming environ- ment for breastfeeding families:

• Provide information for families regarding your facility’s supportive breastfeeding policies and individualized plans.

• Call attention to support for breastfeeding (such as a comfortable chair for nursing, refrigerator space for milk storage, and a list of local breastfeeding resources) when giving tours.

• Provide information regarding city, county, and state laws that protect mothers’ rights to breastfeed in public.

• Train staff in ways to answer questions or concerns raised by visitors or others who may object to seeing a mother breastfeed.

• Post breastfeeding-friendly messages or posters.

Supporting Families Who Are Not Breastfeeding A family’s decision regarding breast- feeding their child is a very personal decision. Although families should be educated about the benefits of breast- feeding, each individual family’s deci- sion regarding breastfeeding must always be respected.

Some mothers are unable to breastfeed for medical reasons. Or, they may try breastfeeding but be unable to sus- tain the practice for as long as they had desired. Some families’ decisions about breastfeeding are influenced by cultural practices. Some families make a conscious choice not to breastfeed. Regardless of a family’s choice regard- ing the feeding of their child, it is your responsibility as a caregiver to support each family in their choices.

You can provide support for mothers who are not breastfeeding by assuring them that you will follow all of their expectations as you formula feed their

child. Assure families of formula-fed infants that you will follow safe and caring infant feeding practices, such as holding each child close in order to help develop trust.

Video Segment Return to your course online to view a video that explains key ways in which you can support breastfeeding mothers and their children as well as facts about the benefits of breastfeeding.

Creating Breastfeeding Policies

Your program’s breastfeeding poli-cies should specify ways that staff members can support breastfeeding mothers and infants as well as protect the health of breastfed infants. A breastfeeding-friendly policy should address the following goals: 1. Staff will be trained to provide

accurate breastfeeding information to families;

2. Staff will be trained to provide support to help mothers continue to breastfeed when they return to work or school;

3. Staff will be trained on the proper handling and storage of breast milk; and

4. Mothers will be welcome and feel welcome to breastfeed in the center.

Begin your facility’s breastfeeding policies with a supportive statement of your ongoing support to breastfeeding families. Briefly note the research that shows the many benefits associated with breastfeeding for the mother and child. Then outline your own specific policies. Share your breastfeeding pol- icies with staff, families, and visitors. When creating your policies, keep in mind the following:

• Train staff in the proper storage and handling of breast milk.

• Provide a comfortable, private and sanitary location for breastfeeding.

• Show sensitivity to the needs and wishes of the family.

• Educate children about breastfeeding through learning activities.

• Display breastfeeding information for parents, staff and visitors.

Safe Handling of Breast Milk Both the Center for Disease Control and Prevention (CDC) and the Ameri- can Academy of Pediatrics (AAP) offer guidelines for the proper handling and storage of breast milk to avoid waste and food borne illnesses. Ensure that all staff are trained on your local and state licensing regulations regarding the handling and storage of breast milk. Breast milk is classified as a food. This means that it does not require the use of universal precautions for handling bodily fluids. You cannot become con- taminated from direct contact with breast milk, you do not need to wear gloves when handling breast milk, and breast milk does not need to be stored in a separate refrigerator or freezer from other foods. Wash your hands before handling expressed milk just as you would when preparing other foods.

Refrigerating and Freezing Breast Milk According to the CDC, expressed milk can remain at room temperature (no higher than 77° F) for up to six hours. Refrigerated breast milk (at 39° F) can last for three to five days. Frozen breast milk can last upwards of three to six months; longer if stored below 0° F. Ensure that containers of expressed breast milk are stored in the back of your freezer or refrigerator compart- ment where the temperature remains the most consistent. Never store breast milk in the refrigerator door, as the door is more prone to temperature fluctua- tions that can cause the milk to spoil. Breast milk is not homogenized, mean- ing that it may separate into layers with fats rising to the top. You can expect frozen milk to have color or density variations as a result of this separation.

Warming Breast Milk Several options are available for pre- paring frozen or refrigerated breast milk for consumption. You can store

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This document contains the same information as your online course and is provided for your convenience. We do not require that you read both this document and the online course.

frozen milk in the refrigerator over- night to allow it to thaw. Thawed milk that remains in the refrigerator will last for up to 24 hours. You can also run or submerge the milk’s container under warm water, gently shaking or swirling it to mix separated layers. Do not vig- orously shake the container, as this can damage important components that are valuable to the infant’s health. Never refreeze breast milk once it has been thawed. Once breast milk has been brought to room temperature, it is best consumed within 1–2 hours.

To warm a bottle, hold it under warm running water, place it in a container of warm water, or use a bottle warmer. The temperature should not exceed 98.6° F, so do not leave the bottle under warm water for more than a few minutes. Overheating milk can cause proteins and enzymes to begin to break down, reducing the milk’s health benefits. Use of a crockpot is not recommended. Never use a microwave to warm milk, as microwaving milk causes hotspots that can burn the child’s mouth. Test the temperature of the milk by dripping a small amount on your wrist to ensure it is comfortably warm. Never hold an infant while you are removing a bottle from where it is warming.

Discard unconsumed milk after feed- ing; do not mix it with fresh breast milk.

Additional Guidelines Ensure that parents label their con- tainers with the full name of the child as well as the date and time the milk was expressed. The quality of breast milk degrades over time, so use a first- in, first-out approach when selecting which container of milk to give a child, using the oldest stored milk first.

Breast milk should be placed in the refrigerator immediately when brought to the childcare facility and warmed to the desired temperature right before feeding.

Create policies that ensure the correct milk is given to the right baby in your care. Many childcare providers attach a color-coded label to each container of breast milk, using different colors for each child. Doing so will help you to quickly identify which bottle belongs to each child in your care.

Keep track of the frequency of feed- ings and the amount consumed by each child. Share this information with the family. This will allow the mother to adjust the amount of milk she supplies, as well as the quantities in each con- tainer, thus reducing waste.

Provide a comfortable location Breastfeeding mothers, including employees, need a private and sani- tary place to breastfeed their babies or express milk.

• Include an electrical outlet, comfortable chair, and nearby access to running water.

• Give mothers a private, clean, and quiet space, or allow mothers to breastfeed in front of others if they wish. This location should not be in a bathroom.

Show sensitivity Part of creating a welcoming atmo- sphere is showing your sensitivity to the needs and wishes of the families and children in your care. You should:

• commit to providing ongoing support to breastfeeding mothers and families;

• provide an opportunity to mothers to breastfeed their babies in the morning and evening;

• refrain from giving a bottle when the mother is due to arrive soon (unless asked by the mother to do otherwise);

• do not provide infant formula or solid foods unless requested by the baby’s parents; and

• hold babies closely when giving them breast milk from a bottle.

Notebook Assignment: Utilizing Resources What is a Care Courses Notebook Assignment? Care Courses notebook assignments are exercises designed to help you inte- grate and apply what you have learned in this course into your child care setting. These assignments will enhance your learning experience and make the concepts you learn in this course come alive. Think carefully about your entries. Ask the children’s parents for ideas, and enter their input in your note- book as well.

Notebook assignments are for your use during and after your work on this course. Keep your notebook for your own reference.

Your Assignment A vast array of information is available to help you to learn more about breastfeeding. You can enhance children’s learning activities by accessing children’s books with breastfeeding content. You can access websites with information directed at teaching the benefits of breastfeeding, how to best support working mothers, and how to help parents who are struggling with breastfeeding issues.

In your notebook create a section to list breastfeeding resources to share with parents.

Review the websites listed in the online Additional Resources section. Visit at least two websites and include in your notebook:

• information you will share with parents • sections that you can print out and provide to parents

In your notebook, create a plan to share these resources with parents of the children in your care. Review other caregivers’ responses and share the descriptions you have written in your notebook with other caregivers in the student discussion area online under Notebook Assignment: Resources.

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This document contains the same information as your online course and is provided for your convenience. We do not require that you read both this document and the online course.

Cultural Considerations As noted earlier in this course, a family’s decision whether or not to breastfeed may be influenced by their own cultural practices. Families also differ in how they view and approach breastfeeding based on their culture and background. For example, in many non-industrial- ized cultures, mothers tend to breastfeed their babies on cue, in short intervals, and throughout the day and night, while in other cultures (particularly Western cultures) feeding on a set schedule or supplementing breast milk with formula may be considered the norm. Families seek to nurture their children to the best of their ability based on their own experiences and worldview. What works well for one family in one soci- ety may not work well for other fami- lies under different circumstances. By assessing cultural differences, you can provide information and support that respects a family’s worldview while at the same time encouraging healthy breastfeeding practices that keep the child’s best interests in mind.

Educate children Exposing children to breastfeeding helps children understand this natural way to feed infants.

Valeria, an inquisitive and very per- ceptive child, recently welcomed a younger cousin, Fernanda, to her family. Having observed her aunt breastfeeding Fernanda on many occasions, Valeria quickly learned the process and began modeling the behavior. She lifted her shirt and “breastfed” her baby doll. Noticing that her aunt used a Boppy® pillow to support baby Fernanda when she was breast- feeding, Valeria placed her dad’s traveling neck pillow around her waist to support her baby doll in the same manner. Throughout the entire process, Valeria remained confident in her actions, modeling the process without any hesitation or concern for others around her.

Learning Activities for Children Children should consider pretending to breastfeed baby dolls as natural an

activity as any other aspect of their play with dolls.

You can help children learn about breastfeeding through a variety of con- versations and activities. Here are a few examples:

Books (A variety of children’s book titles are listed in the online Additional Resources section.)

• Make children’s books that contain pictures of breastfeeding available to your group.

• Read children’s books during circle time and highlight the pictures that show breastfeeding.

• As you read, ask children questions periodically and encourage children’s own questions.

Toys • Provide Boppy® pillows, travel

neck rests, scarves, and baby dolls so that children can nurse babies in their pretend play.

• Provide stuffed animal babies and their mothers.

Conversations • Encourage children who have a

younger sibling who is nursed at home to share information with others in your group—just as they share information and stories about other aspects of having an infant in their family.

• Explain how mammals provide species-specific milk for their young. Baby cats, dogs, giraffes, and whales all drink milk from their mothers.

• When children ask questions about mothers who are breastfeeding at your program, explain how the baby is getting important food from his or her mother.

• Define and explain words that children might hear about breastfeeding.

• Encourage children to create pictures of families eating together. Explain how breastfeeding can be part of that picture.

• Provide children with images of mammals that nurse their babies. Have them match the babies and mamas.

Display information Display information for staff, visitors and parents to review. Ensure that your staff is fully trained in your policies and that you:

• provide information on breastfeeding, using tools such as posters, information packets, handouts, and pamphlets.

• provide a copy of your facility’s breastfeeding support policies.

• keep a list of contact information for local resources, including public health departments, lactation consultants, breastfeeding coalitions, and breastfeeding support groups, such as La Leche League International llli.org) and the Office of Women’s Health (womenshealth.gov/breastfeeding)

Self-Check 2 – True or False? ___ 1. Parents who are well

supported are more likely to continue to breastfeed.

___ 2. All families should be educated about the benefits of breastfeeding.

___ 3. A family’s decision whether or not to breastfeed should always be respected and supported.

___ 4. Parents who are not breastfeeding have no need of support with the feeding of their child.

___ 5. A common barrier to breastfeeding is the mother’s feeling of embarrassment or lack of support.

___ 6. Pointing out supports for breastfeeding to prospective families helps create a welcoming environment.

___ 7. Mothers should be given access to a private place to breastfeed their babies or express milk.

___ 8. When a mother asks to pump milk, she can be directed to the bathroom if you have no other location.

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___ 9. Mothers should feel welcome to breastfeed in front of others if they wish.

___ 10. Breast milk shouldn’t be stored in a refrigerator with other food.

___ 11. Staff must wear gloves when handling breast milk.

___ 12. Breast milk should never be warmed in the microwave.

___ 13. Leftover breast milk from a feeding should be mixed with new milk.

___ 14. Color and density variations in frozen milk are an indication that the milk has spoiled.

___ 15. Exposing children to breastfeeding results in embarrassment and confusion.

___ 16. Children’s books depicting breastfeeding should be available to all children in your care.

___ 17. Culture and worldview shape a family’s approach to breastfeeding.

Answers Statements 4, 8, 10, 11, 13, 14, and 15 in Self-Check 2 are false. All other statements are true. Please review the following explanations. 4. All parents need assurance that their child’s caregivers are sensitive to and supportive of their child’s needs. You can provide support for mothers who are not breastfeeding by assuring them that you will follow all of their expectations as you feed their child formula. This includes assuring them that you will fol- low safe and caring infant feeding prac- tices, such as holding their child close in order to help develop trust. 8. For expressing milk, provide moth- ers a sanitary place with an electrical outlet, comfortable chair, and access to running water. This location cannot be in a bathroom. 10. Expressed breast milk should be stored in the facility’s refrigerator. Families should provide their own con- tainers, clearly labeled with the child’s name and the date. 11. Breast milk is not a biohazard and does not require gloves to be worn when handling.

13. Unconsumed breast milk should never be mixed with fresh breast milk or refrozen. Any breast milk that is leftover from a feeding should be discarded.

14. Breast milk is not homogenized and the fats within will naturally begin to separate, resulting in natural color and density variations when frozen. This does not mean the milk has spoiled. Mix the separated components together by gently shaking or swirling the breast milk after warming it for consumption.

15. Educating children is an important part of creating a welcoming breast- feeding environment. Openly speaking about breastfeeding and providing sup- portive activities helps children under- stand that breastfeeding is a natural way to feed infants.

Individualized Plans In addition to creating breastfeeding policies that are designed to support the families of all children in your care, it is important to take into consideration the individual needs and wishes of each family. An individualized breast- feeding plan is recommended in order for infant care facilities to provide the most helpful support for breastfeeding families. Such a plan should clarify the role as well as the goals of each mem- ber of the family-caregiver partnership, and everyone involved should contrib- ute to the preparation of this plan. Part of an individualized plan should include a plan to transition an infant from his or her home to your care. When a mother is preparing to return to work or school, suggest that both she and another adult expose the infant to bottle feeding. The transition to group care will be much smoother and less stressful for everyone if the baby has begun adapting to a bottle and to being fed by another adult. Also suggest that the mother bring the infant to your facil- ity for trial days before the infant starts care and while the mother’s schedule is still flexible. After the child is in your care, encourage the mother to come to the center to feed her infant during her lunch hour if she is able to do so. Decide how much frozen breast milk should be kept in reserve. Be mindful of growth spurts during which infants will

require additional milk to stay sated and continue healthy development. You can expect children to experience growth spurts at approximately 7–10 days, 2–3 weeks, 4–6 weeks, 3 months, 4 months, 6 months and 9 months of age. Communication is paramount; be sure to incorporate a communication plan that ensures the mother is aware of how much milk is being consumed by the child and how much is being discarded or returned at the end of the day. This will help the mother adjust to changes in the infants feeding patterns, as well as ensure she is able to keep a sufficient supply of milk.

A breastfeeding support plan should also address details such as:

• What should be done if the child displays hunger cues close to pickup time?

• What should be done if the mother is running late?

• What should be done if the child displays hunger cues but all of the expressed milk supply has been consumed?

• What strategies should be used when an infant refuses the bottle?

• Does the family have preferred feeding strategies such as how the infant is held, or the temperature to which expressed milk should be warmed before it is given to the child?

The individual support plan should be updated regularly as the needs of the family and child change. Just as every- one involved contributes to the prepa- ration of this plan, alterations should be discussed by all parties involved.

Children with Special Needs Infants born with Down syndrome, cleft lip or palate, cardiac problems, cystic fibrosis, autism spectrum dis- order, or a neurological impairment benefit greatly from being breastfed. Breast milk is especially important in promoting healthy weight gain and helps strengthen the bodies of children with special needs, preparing them for surgeries or treatments they may need.

It is not uncommon for a child with spe- cial needs to be reluctant or unable to take milk from a mother’s breast and/

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or bottle. As a result, children with special needs may require special feed- ing arrangements. For example, some infants may require the use of a nursing supplementer, which is a small bottle or bag filled with milk that is attached to a thin tube. This tube can be taped to your finger, which more closely simulates the nipple of a breast than a rubber bot- tle nipple. Additionally, children with neurological impairments may have too much or too little muscle tone, and may require special support when feeding.

Developing a Breastfeeding- Friendly Program

Mia was a new staff member in the Happy Days Child Care Center’s infant room. She looked forward to her daily interactions with both the infants and their parents. Holding the infants close at feeding time, rocking them to sleep at nap time, and see- ing each one grow and develop new skills brought her a special joy. And in general, she agreed with the poli- cies at Happy Days. However, Mia had found one aspect of the procedures at Happy Days disappointing—the center was not very supportive of breastfeeding. From her own experience as a breastfeeding mom some years ear- lier, Mia was well aware of the mul- tiple benefits of breastfeeding. And she very much wanted to be part of

an organization that actively sup- ported this choice. Although she was new at the center, Mia felt very strongly about this mat- ter. So she arranged to have a chat with Mrs. Todd, the center’s director, hoping that Mrs. Todd wouldn’t be offended by her suggestions. To Mia’s great delight, Mrs. Todd was extremely receptive to every- thing Mia had to say. In fact, Mrs. Todd confessed that for some time she had been thinking that the cen- ter’s policies regarding breastfeed- ing should be examined. “I would love for Happy Days to develop and implement a program that makes us truly breastfeeding friendly. Perhaps we were just wait- ing for someone to help us do just that. And I think you might just be that person,” she told Mia. Mia was, of course, relieved that she had found Mrs. Todd to be so recep- tive to her ideas. She was more than a bit surprised at Mrs. Todd’s sug- gestion that she help develop and implement a breastfeeding-friendly program at Happy Days. However, the more she thought about it, the more she liked the idea.

Mia realized that all the families whose infants were cared for at Happy Days would benefit from a breastfeeding- friendly program and supportive staff who were willing to evaluate their pro- gram and work to constantly improve

it. She knew that developing and imple- menting the components of any program requires planning. And she understood that in order for this new program to succeed, all members of the Happy Days team would need to be on board. So she

• Provided information, both verbally and in written form, to all members of the center’s staff—both managers and direct care staff. This information described how a breastfeeding- friendly program would impact both families served by the center as well as the wider community. Information regarding the proposal was shared first with key managers in individual meetings and then with staff members as a group.

• Enlisted the support and commitment of all levels of management as well as staff.

• Created a workgroup to carry the proposal forward.

Implementing the Program

As you work to create a program that is supportive of families who breastfeed, keep Mia’s story in mind. While implementing a breastfeeding friendly program may seem daunting at first, proper planning and support will help make the process go smoothly.

Assess your situation The first step to planning a success- ful program is to assess your facility’s current support for breastfeeding. The Breastfeeding Policies: Self-Appraisal Questionnaire on p. 14 is a helpful tool to identify components of your facil- ity’s program that need work. You can customize the list of questions, omit- ting those that do not apply to your situation and adding questions to guide additional goals of your program that aren’t addressed by the questionnaire.

Gather support and commitment from colleagues Whether you work in a large child care center or in a small family setting, get- ting the support and commitment from everyone in your organization is the key to a successful breastfeeding-friendly program. Provide information to your

Notebook Assignment: Self-Appraisal Questionnaire Label a section of your notebook, “Self-Appraisal Questionnaire.” Review the sample Breastfeeding Policies: Self-Appraisal Questionnaire printed at the end of this course. Do all of the questions apply to your child care setting? If not, change or remove questions to match your setting. Next, complete your updated questionnaire to assess your child care facility’s level of support for breastfeeding families. Reflect on the results of the questionnaire and write answers to the following questions in your notebook:

• In what ways does your child care program support breastfeeding families? • What improvements need to be made to your program to create a

supportive breastfeeding environment? • What supplies do you need to create a more supportive breastfeeding

environment? Keep notes in your notebook as you make adjustments to your program.

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management team on the benefits and goals of a breastfeeding-friendly pro- gram. Once you have the support of management, you will need the com- mitment of other staff members to make the program a reality. Maintain your own commitment to developing the program by regularly reminding your- self of all the benefits a breastfeeding- friendly program can provide.

Plan your program Once you have the support and com- mitment from your organization, the next stage is to create an implemen- tation plan. Depending on the size of your organization and the scope of your goals, you may need to assemble a team to assist in putting together and executing the plan. Include both management and direct care staff in this process. Select a goal-oriented and enthusiastic person to manage the team’s efforts to increase the likelihood of successfully implementing the plan.

If you work alone or in a small group, reach out to your community for assis- tance when developing your program. Speak with friends and colleagues, reach out to community resources, and consult the parents of the children in your care. Just because someone is not part of your organization does not mean that they cannot be part of your team.

Your plan should address any item on the questionnaire that you marked “no.” Prioritize items to help guide your implementation plan. Outline the steps you will need to take to make each unaddressed item a reality in your pro- gram. Clarify which team member(s) will be responsible for taking care of each item on your list of tasks.

Remember that ideas proposed for any new program must be sustainable. Make sure all plans are geared to meet the needs of the families you serve as well as needs of your facility’s employees.

Execute your plan Once you have finished planning your breastfeeding program, it’s time to imple- ment it. Be sure to create realistic dead- lines for each team member. Work with management to ensure team members are allotted enough time to complete their tasks and meet the goals of the program.

Regularly check in with team members to address problems or bottlenecks dur- ing implementation. Be ready to adapt to changing circumstances and needs.

Follow-up No matter how carefully you plan or how smoothly you implement your program, there are going to be areas in need of ongoing improvement. Cir- cumstances may change over the life of your program, so be sure to regularly reassess its effectiveness. Document program successes and shortcomings so that you can readily identify what is working and what is not. Every breast- feeding family you work with is an opportunity for new insights on how to improve your program.

Self-Check 3 – True or False? ___ 1. Support from a facility’s

managers and direct care staff is the key to the success of a breastfeeding program.

___ 2. Your team coordinator should be a goal-oriented person who is enthusiastic about the program.

___ 3. A successful breastfeeding-friendly program supports both the needs of the families served and the needs of the staff involved.

___ 4. Team members should be expected to plan and implement a breastfeeding-friendly program as quickly as possible.

___ 5. An individualized plan should include a communication plan for relaying information to the mother about how much milk her child is consuming each day.

___ 6. Individualized plans should address specific accommodations required for a child with special needs.

___ 7. Individualized breastfeeding support plans should be created exclusively by the caregiver.

___ 8. The first step to developing a breastfeeding-friendly program is to assess how well your facility currently meets the needs of breastfeeding mothers.

___ 9. Implementing a breastfeeding-friendly program will be more successful and manageable if you plan ahead.

___ 10. The policies you put in place when implementing your program must be effective through the lifetime of your program.

Answers Statements 4, 7, and 10 in Self-Check 3 are false. All other statements are true. Please review the following explanations.

4. Set realistic deadlines when deter- mining a timeline for your implementa- tion plan, and adapt as challenges arise. Ensure team members are allotted enough time to complete their assigned tasks to meet the program’s goals.

7. Individualized breastfeeding plans should be created through a partnership between the family and program staff. Both the families and caregivers are important collaborators to ensure the success of a breastfeeding support plan.

10. Creating a successful breastfeed- ing-friendly environment requires regular reevaluation. Circumstances may change or certain policies may not work as well as you had anticipated. The policies you put into place initially may need to be adapted over time.

Course Preview Analysis At the beginning of this course we asked you to consider the following statements. Now that you have read the course, think about the statements again and then read our analysis of the statements below. Course Preview Statement 1. A breastfed infant’s desire for frequent feedings indicates that the child isn’t getting enough milk. Analysis: This is incorrect. Because breast milk is easier to digest, breast- fed babies tend to eat more frequently than formula fed babies. You can expect most breastfed babies (older than 6 weeks) to want to eat every two to three hours.

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Course Preview Statement 2. Infants should be trained to a four- hour feeding schedule before they are placed in child care. Analysis: This is incorrect. Infants need to be fed when they are hungry, not according to the clock. Child care schedules should be determined by infants’ needs. Course Preview Statement 3. Breast milk provides health benefits that formula cannot match. Analysis: Yes! There are benefits that only breast milk can provide. Studies indicate that breastfeeding protects against SIDS, breastfed infants have milder forms of acute gastroenteritis, and immunized breastfed infants have significantly higher antibody levels. Being breastfed decreases the inci- dence of ear infections and protects against upper respiratory illnesses in the first four months of life, particu- larly when other risk factors are pres- ent. Breastfeeding, even for a short period, has been clearly associated with a lower incidence of wheezing, prolonged colds, diarrhea, vomiting, and eczema. Course Preview Statement 4. If mothers wish to breastfeed, you should direct them to a private bathroom. Analysis: This is incorrect. Breast- feeding mothers, including employees, should be provided a private, sanitary, quiet place to breastfeed their babies or to express milk. This area should have an electrical outlet, a comfortable chair, and nearby access to running water. This location cannot be in a bathroom. Course Preview Statement 5. All mothers should breastfeed their babies. Analysis: This is incorrect. Some mothers are unable to breastfeed for medical reasons. Or, they may try breastfeeding but are unable to sustain the practice. Some families’ decisions about breastfeeding are influenced by cultural practices. Some families make a conscious choice not to breastfeed. Always respect each family’s decision regarding breastfeeding.

Course Quiz Please read this course two times before attempting its quiz. When you have fin- ished reading this course, return to My Courses within your Account and open your course to access the Online Quiz for this course.

Using What You’ve Learned Take a moment to consider how you have applied (or might in the future apply) the material you have studied in this course in your own early child- hood setting.

Respond to one or both of the following sets of questions in the Using What You’ve Learned section online.

1. What suggestions/strategies from this course have you applied in your own early childhood facility? For each strategy you list, include a statement telling us what effect it has had.

2. What suggestions/strategies from this course do you plan to apply in your own early childhood facility in the future?

[Suggestion for your own use: Keep a journal in which you record the steps you are taking to make your plan a reality.]

End of Course Reflection Your role as an early childhood professional is extremely important in the lives of the children in your care. Care Courses’ mission is to provide you with the knowledge and skills to help you succeed in this role.

Take a few moments to reflect on the ideas and concepts presented in this course. Answer the following in the End of Course Reflection section online:

How does providing a welcoming environment enhance the breastfeeding experience for breastfeeding families? How does learning about breastfeeding benefit young children?