Transcript Supporting Breastfeeding in Child Care Settings Insert Presenter’s Name This presentation was created through a collaboration among: • Our Lady of the Lake Children’s Hospital •

Supporting Breastfeeding
in Child Care Settings
Insert Presenter’s Name
This presentation was created through a
collaboration among:
• Our Lady of the Lake Children’s
Hospital
• American Academy of Pediatrics
• Greater New Orleans Breastfeeding
Awareness Coalition
• Louisiana Breastfeeding Coalition
• Tulane’s Mary Amelia Center
• Volunteers of America/Partnerships
in Child Care
• Louisiana Department of Health and
Hospitals Office of Public Health Maternal and Child Health Program
• The “Breastfeeding-Friendly
Child Care Initiative” of the
Carolina Global Breastfeeding
Institute /UNC Gillings School
of Public Health
• The Wisconsin Department of
Health Services, Ten Steps to
Breastfeeding-Friendly Child
Care Centers Resource Kit
• Pilot centers in Baton Rouge
• Photos: Addie Imseis and the US
Breastfeeding Committee
Agenda
Introductions
Pre-test
Presentation
Post-test/Review
Evaluation
Supporting Breastfeeding in
Child Care Settings
© Addie Imseis and USBC, 2010
Pre-test
At the end of this presentation,
participants should be able to:
1. Describe the historical, societal
and social barriers to breastfeeding.
2. Understand the impact of breastfeeding
on the health of women, infants,
children, and society.
At the end of this presentation,
participants should be able to:
3. Discuss the proper way to label, store
and handle breast milk in the child care
center.
4. Describe ways that a child care
provider can support breastfeeding
families.
Disclaimer
This information is meant for the education
of child care providers. It is not meant to
take the place of any child’s own personal
health care professional. Completing this
training does not guarantee competency in
infant feeding techniques. Child care
providers are responsible for knowing their
own center’s feeding policy and their own
state regulations.
You can make a difference!
As a child care
provider you are an
important part of
each mother’s
support system.
©USBC, 2010
Image from Larry Grummer-Strawn, PhD: CDC-USBC Bi-Monthly Teleconferences, Tuesday, February 8, 2011.
ACTIVITY
Do you think breastfeeding is important?
• Why?
• Why not?
© Addie Imseis and USBC, 2010
Infant feeding history
Until the mid-1800s, almost all babies
everywhere were breastfed.
Wet nursing was the most common
alternative. Substitutes often led to
infections, malnutrition, and
dehydration.
Walker, M. Still Selling out mothers and babies: marketing of breast milk substitutes in the U.S.A. Weston, MA: NABA REAL, 2007.
Artificial feedings became more common
about 100 years ago.
• 1870s – Nestle Infant Food $.50/bottle
• 1897 –Formula could be ordered from the
Sears catalogue, but it was still expensive
• 1910 – Refrigerators became widely available
• 1920s and 1930s – Evaporated milk became
available. It was recommended by physicians;
it was cheap and became widely popular
Formula feeding became popular
for modern society.
• 1950s – Commercial formulas, like Similac and
Enfamil, became available.
– Post World War II women wanted freedom
and independence
– Many more women left home to work
– Feeding schedules became popular
– Advertisements undermined breastfeeding
• 1970s – Only 25% of US babies were breastfed.
Walker, M. Still Selling out mothers and babies: marketing of breast milk substitutes in the U.S.A. Weston, MA: NABA REAL, 2007.
Commonly believed myths
Getting back to “normal”…
• 1980s to present
– Research keeps proving that breastfeeding is best for
infant health and development
– The best baby food throughout history is still the best.
Today’s formula is safer than it was
50 years ago, but it will never be….
“complete nutrition”
“premium”
“closer than ever to breast milk”
Walker, M. Still Selling out mothers and babies: marketing of breast milk substitutes in the U.S.A. Weston, MA: NABA REAL, 2007.
ACTIVITY
Human Milk Components Game
What are the
ingredients in human
milk that make it the
preferred food for
babies?
© Addie Imseis and USBC, 2010
www.breastmilkcounts.com/educational-activities.html
Which are in
human milk?
Which are in
formula?
http://www.breastmilkcounts.com/breastfeeding-benefits.php
How does formula stack up?
Human milk cannot be replicated.
The enzymes, antibodies, growth and
disease fighting factors, and hormones
found in human milk cannot be added to
formula.
© USBC, 2010
Each animal makes milk that is best
for the development of their young.
• Human milk is the
perfect food for
human babies.
• It is the foundation
for good health in
early childhood,
with benefits that
last a lifetime.
from -- www.ars.usda.gov/is/graphics/photos
Mother’s milk is “The Gold Standard.”
• Mother’s milk is more than food.
• Each mom has custom-made milk for her
baby, which changes as he grows.
• Experts recommend:
– Mother’s milk only for the first six months
– Other foods added slowly after 6 months with
breastfeeding continuing for at least the first year
– Breastfeeding beyond one year, for as long as
desired by mother and baby
A well-built immune system
leads to a healthier life.
• Breastfeeding helps babies develop a
healthy immune system
• These effects on the immune system last
a lifetime.
© Addie Imseis and USBC, 2010
Hanson, L. A. MD, PhD. Immunobiology of Human Milk: How Breastfeeding Protects Babies. Pharmasoft Publishing, 2004.
Breastfeeding lowers infections.
• Lower risk for:
–Ear Infections
–Colds and pneumonia
–Diarrhea
–Urinary Tract Infections
–Bacterial Meningitis
–Wide range of infectious diseases
American Academy of Pediatrics, Work Group on Breastfeeding. (2005).Breastfeeding and the use of human milk. Pediatrics. 115(2), 496-501
United States Breastfeeding Committee. Breastfeeding and child care [issue paper]. Raleigh, NC: United States Breastfeeding Committee; 2002.
Breastfeeding reduces other diseases.
• Lower risk for:
– Sudden Infant Death Syndrome
–Types 1 & 2 diabetes
–Lymphoma and Leukemia
–Inflammatory Bowel Disease
–Asthma and Eczema
–Obesity
–Dental disease
American Academy of Pediatrics, Work Group on Breastfeeding. (2005).Breastfeeding and the use of human milk. Pediatrics. 115(2), 496-501
United States Breastfeeding Committee. Breastfeeding and child care [issue paper]. Raleigh, NC: United States Breastfeeding Committee; 2002.
Breastfeeding promotes bonding.
Secure attachment in
the early years
influences mental health
and functioning for a
lifetime.
© Addie Imseis and USBC, 2010
Center on the Developing Child at Harvard University (2010). The Foundations of
Lifelong Health Are Built in Early Childhood. http://www.developingchild.harvard.edu
ACTIVITY:
•What do you know about childhood obesity?
•Why did Michelle Obama choose this topic?
www.letsmove.gov
Obesity is a modern epidemic
with serious consequences.
In the US:
• About 69% of adults are overweight or obese.
• About 12% of children age 2-5 are obese.
Obesity puts children at risk for diabetes, heart
conditions, self-esteem issues and many other
health problems.
www.cdc.gov/nchs/fastats/obesity-overweight.htm
Healthy eating must begin
in early childhood.
• Children develop food preferences and eating
habits very early in life.
• Overweight baby
↓
Overweight child
↓
Overweight adult
© USBC, 2010
Obesity Prevention Begins with
Breastfeeding!
• Breastfed infants self-regulate better (learn to
eat when they are hungry and stop eating when
they are full).
• Breast milk contains hormones and other
substances which play a role in weight
regulation.
• Formula feeding and early introduction of solids
can increase the risk of childhood obesity.
Lawrence, R. A. (2010). Does Breastfeeding Protect Against Overweight and Obesity in Children? A Review. Childhood Obesity, 6(4),193-197
ACTIVITY
• How do you
think
breastfeeding
benefits the
mother?
© Addie Imseis and USBC, 2010
Breastfeeding benefits the mother.
• Decreased postpartum bleeding
• Reduces post-partum depression
• Earlier return to pre-pregnancy
weight
• Reduces fertility and helps to space
babies (no guarantee!)
• Lowers risk for breast and ovarian cancer
• Lowers risk for hip fractures and osteoporosis
• Fewer absent days when she returns to work/school
American Academy of Pediatrics, Work Group on Breastfeeding. (2005).Breastfeeding and the use of human milk. Pediatrics. 115(2), 496-501
United States Breastfeeding Committee. Breastfeeding and child care [issue paper]. Raleigh, NC: United States Breastfeeding Committee; 2002.
Bonding also benefits mothers.
• Both mom and baby benefit from the special
emotional bond that develops between a
mother and her child during the process of
breastfeeding.
© Addie Imseis and USBC, 2010
Strathearn L, Mamun A, Najman, J and O'Callaghan, M. Does Breastfeeding Protect Against Substantiated
Child Abuse and Neglect? A 15-Year Cohort Study. Pediatrics 2009;123;483-493
Breastfeeding benefits employers.
•
•
•
•
•
Higher productivity
Less missed work days
Lower health care costs
Increased loyalty to workplace
Less employee turnover
U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support
Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon
General; 2011.
Not breastfeeding costs everyone.
• Formula-feeding families:
– Spend $1,200–$1,500 per year for infant formula
– Have more health insurance claims and more time off
work due to baby being sick
• Society benefits when US mothers breastfeed:
$13 billion dollars could be saved every year if more
babies were exclusively breastfed
• Louisiana benefits:
• A total of $216,103,368 could be saved and 18
infant deaths prevented if 90% of LA infants
were exclusively breastfed for the first 6 months
of life
U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of
Health and Human Services, Office of the Surgeon General; 2011.
Bartick, M. and Reinhold, A The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis. PEDIATRICS (doi:10.1542/peds.2009-1616)
Breastfeeding is “Green.”
•
•
•
•
•
No land needed for production
No energy required (except the mom’s!)
No pollution
Less packaging
Less disposal (cans, bottles, nipples)
www.llli.org
Breastfeeding rates in the U.S.
•
•
•
•
79.2% of US infants are “ever breastfed”
49.4% of US infants are still breastfeeding at 6 months
18.8% are exclusively breastfed at 6 months
There is significant racial and geographic disparities
http://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf
Louisiana Breastfeeding Rates
50th in the nation
70
60
Percent %
50
40
Hispanic
30
White (NH)
20
Black (NH)
10
0
Initiation
6 Months
12 Months
Source: National prevalence of breastfeeding initiation and duration to 6 months and 12 months,* by selected sociodemographic characteristics
--- National Immunization Survey (NIS), United States, 2004—2008. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5911a2.htm
Breastfeeding mothers need
support from everyone!
©USBC, 2010
Louisiana Laws related to
Breastfeeding
• A mother can breastfeed her infant in
any place that a mother and her infant
have a right to be (public or private).
• Child care centers cannot discriminate
against breastfed infants.
ACTIVITY:
Barriers to Breastfeeding
•What factors make breastfeeding more
difficult for some women?
© Addie Imseis and USBC, 2010
Top reasons US women
stop breastfeeding
•
•
•
•
physical discomfort (example: sore nipples)
concerns about making enough milk
going back to work or school
taking care of other children
Most mothers could overcome these
challenges with the right support.
Child care center support is important!
Li, R., Fein, S.B., Chen, J., & Grummer-Strawn, L.M. (2008). Why mothers stop breastfeeding; mother’s self reported reasons for stopping during
the first year. Pediatrics, 122, S69-S76.
Mothers need workplace support.
• Breastfeeding after returning to work requires
effort and commitment.
• Employers benefit when they support
breastfeeding.
• Federal law requires support for breastfeeding
employees.
http://www.womenshealth.gov/breastfeeding/employer-solutions/business-case.php
ACTIVITY:
Supporting Breastfeeding
in Child Care Settings
• What steps can a child care setting take
to be more breastfeeding-friendly?
The “Ten Steps” are adapted from the
“Breastfeeding-Friendly Child Care
Initiative” of the Carolina Global
Breastfeeding Institute /UNC Gillings
School of Public Health
© Addie Imseis and USBC, 2010
Ten Steps to a Breastfeeding-Friendly
Child Care Center
• Step 1: Make a commitment to the importance
of breastfeeding and share with staff.
• Step 2: Train all staff to promote optimal
feeding for infants and young children.
Handouts: Breastfeeding and Child Care: What Child Care Centers Can Do
Our Center Supports Breastfeeding
Sample Center Breastfeeding Policy
Scenario 1
• A couple expecting their first baby in 2 months
comes in to your center for a tour. The
mother states that she might breastfeed, but
she isn’t sure she’ll be able to.
– What are some things that you can do as a child
care provider to support her decision?
Ten Steps to a Breastfeeding-Friendly
Child Care Center
• Step 3: Inform families about the importance
of breastfeeding.
• Step 4: Provide children’s
activities which normalize
breastfeeding.
Scenario 2
• A mother is nursing her infant in a chair in the
corner of the infant room. Another parent
sees this and expresses to you that she does
not think it’s right for the nursing mother to
be doing that in public.
– What is your response?
Ten Steps to a Breastfeeding-Friendly
Child Care Center
• Step 5: Ensure that all breastfeeding families
are able to properly store and label milk for
child care center use.
• Step 6: Provide a breastfeeding-friendly
environment.
Handout: Breastfeeding and Child Care - What Moms Can Do
Preparing and Storing Human Milk
• Use clean bottles specific to each infant
• Warm or defrost under running water or in
bottle warmers.
• Microwaves should never be used!
www.nrckids.org/CFOC3/PREVENTING_OBESITY/index.htm
Preparing and Storing Human Milk
• Each breast milk bottle or bag should have a
label (that does not wash off) including the
child’s name
date/time the milk was expressed
• Washing hands is important.
• Gloves are NOT necessary when preparing
formula or human milk (unless blood is visible
in the milk).
• Accidental breast milk ingestion is low-risk.
www.nrckids.org/CFOC3/PREVENTING_OBESITY/index.htm
Handout: Breast Milk Errors & Mix-ups
Human Milk Storage Guidelines
Location
Temperature
Duration
6-8 hours Containers should be covered and kept
as cool as possible; covering the
container with a cool towel may keep
milk cooler.
Countertop, table
Room Temperature
(up to 77⁰F or 25⁰C)
Insulated cooler bag
5⁰F—39⁰F or
–15⁰C—4⁰C
24 hours
Refrigerator
39⁰F or
4⁰C
5 days
Freezer compartment of
a refrigerator
5⁰F or
-15⁰C
Freezer compartment of
refrigerator with
separate doors
0⁰F or
-18⁰C
Chest or upright deep
freezer
-4⁰F or
-20⁰C
Handout: Human Milk Storage and Handling
Comments
Keep ice packs in contact with milk
containers at all times, limit opening
cooler bag.
Store milk in the back of the main body
of the refrigerator.
Store milk toward the back of the
freezer, where temperature is most
constant. Milk stored for longer
3-6 months durations in the ranges listed is safe,
but some of the lipids in the milk
undergo degradation resulting in lower
quality.
6-12
months
2 weeks
http://cfoc.nrckids.org/StandardView/4.3.1.3
Bottle-feeding tips:
• Hold the bottle
horizontally
with the infant upright
• Do not let the baby hold
the bottle in the crib
• Never prop a bottle
• Feed one infant at a time
• Maintain eye contact and
vocal communication
www.nrckids.org/CFOC3/PREVENTING_OBESITY/index.htm
Lactation Education Resources www.LERon-line.com 2011
Bottle feeding like breastfeeding
• Begin feedings when the infant provides
EARLY hunger cues (sucking sounds,
opening mouth, rooting, etc.)
• Don’t wait for baby to cry before feedings
• Crying = Late Cue
• Allow breaks for burping
• Allow infant to stop feeding when satisfied
Handouts: Bottle-feeding like breastfeeding and
Paced bottle-feeding a breastfed baby
Provide a comfortable
nursing/pumping space.
•
•
•
•
•
•
•
Private, quiet
Comfortable
Electrical outlet
Sink for washing
Footstool
Pillow
Water available
© USBC, 2010
Scenario 3
• A mother asks you if it would be possible
for her to nurse her baby before she
leaves him to go to work.
• What do you say?
• Where would you tell her to nurse the
baby?
Ten Steps to a Breastfeeding-Friendly
Child Care Center
• Step 7: Support breastfeeding employees.
© USBC, 2010
Scenario 4
• A toddler room teacher is returning to
work after a 3-month maternity leave.
She wishes to continue providing milk to
her infant, who will be enrolling in the
infant room.
– What are some ways that your center can
accommodate her?
Ten Steps to a Breastfeeding-Friendly
Child Care Center
• Step 8: Develop a breastfeeding-friendly
feeding plan with each family.
– Allow infants to feed on cue (when they
show early hunger signs: rooting, smacking,
or sucking on hands) and to be breastfed
when possible.
Handout: Sample Center Infant Feeding Plan
Ten Steps to a Breastfeeding-Friendly
Child Care Center
• Step 9:
– Contact and coordinate with local skilled
breastfeeding support.
– Actively refer families who need
breastfeeding support.
Ten Steps to a Breastfeeding-Friendly
Child Care Center
• Step 10: Stay up-to-date
and continue learning
about protection,
promotion, and support
of breastfeeding.
Support Breastfeeding!
•
•
•
•
•
•
It is natural.
It promotes healthy babies and mothers.
It saves money.
It contributes to a healthier community.
Working mothers need the MOST support!
Child Care Provider Support is Important.
• You can make a difference!
Other Opportunities for Centers
• NAPSAAC
• Well Ahead
from Let’s Move Child Care
What is….
Nutrition
And
Physical Activity
Self
Assessment for
Child
Care
Timeline
Self-Assessment
Month 1
Action Planning
Workshop Delivery
Month 2 and 3
Technical Assistance
Months 4-6
Evaluate, Revise,
and Repeat
For more information on NAP SACC
contact Leslie Lewis at [email protected]
• Well-Ahead is a wellness initiative started by the Louisiana
Department of Health and Hospitals aimed at improving the
health and wellness of Louisiana citizens
• DHH is working with worksites, hospitals, schools, child care
centers, colleges/universities, and restaurants to help them
meet wellness benchmarks
• Part of Well-Ahead is the designation of “WellSpots”
What is a WellSpot?
• A place or organization that has implemented
voluntary, smart changes to make healthier living
easier for Louisiana centers
• Places and organizations that meet certain criteria
can be designated as a Level 1, 2, or 3 WellSpot
• Contact DHH for more information on how to
become a WellSpot
For more information on Well Ahead contact
Melissa Martin at [email protected].
Supporting Breastfeeding in
Child Care Settings
•
•
•
•
Action Plans
Post-Test
Evaluations
Certificates
Thank you for your
attendance and participation!
For more information, visit
www. louisianabreastfeeding.org