Transcript Supporting the Breastfeeding Mother A Guide for the Childcare Center 1/2015 American Academy of Pediatrics Breastfeeding Policy Statement • Breastfeeding is best • Breastfeed exclusively for the.

Supporting the
Breastfeeding
Mother
A Guide for the Childcare Center
1/2015
American Academy of Pediatrics Breastfeeding
Policy Statement
• Breastfeeding is best
• Breastfeed exclusively for the first 6 months
• Breastfeed at least through the first 12
months of age and thereafter as long as
“mutually desired” by mother and infant
*World Health Organization (WHO)
recommends at least 2 years.
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AAP Recommendations
• Provide breast milk even when mom and
child are separated
• Encourage family & community support
• Media should portray breastfeeding as the
norm
• Employers provide space and time to
accommodate milk expression
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Healthy People 2020 Goals
• 82% breastfeeding
initiation
• 61% continuing to 6
months
• 34% at 1 year
• 46.2% exclusively
through 3 months
• 25.5% Exclusively
through 6 months
©DSHS PHOTO
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Breastfeeding Report Card 2014,
United States
90
80
79
82
78
70
61
60
50
40
30
20
Ever BF
49
41
43
46
39
BF 12 mo
34
27
19
21
26
0
Texas
Excl BF 3 mo
Excl BF 6 mo
17
10
U.S. National
BF 6 mo
2020 Goals
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Women in the Workforce
• Mothers are the fastest-growing segment of the
U.S. labor force
• Approximately 60% of employed mothers with
children younger than 3 years work full time
• One-third of these mothers return to work within 3
months after birth and two-thirds return within 6
months
• Working outside the home is related to a shorter
duration of breastfeeding
• Intentions to work full time are associated with
lower rates of breastfeeding initiation and shorter
duration
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Women in the Work Force
70
60
58.4
55.3
50.7
50
41.8
38.9
40
Total
employed
36.1
30
20
Employed full
time
16.7
16.4
14.6
10
0
With own children
under 6 years
With own children
under 3 years
With own children
under 1 year
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Employed part
time
©DSHS PHOTO
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• The US Surgeon General issued a “Call to
Action to Support Breastfeeding” in 2010,
stating, “Everyone can help make
breastfeeding easier!’ Four of the 20 action
steps are directed at how employers play a
critical role in supporting a mother’s decision
to breastfeed. Many employers want to
support employed mothers in their choice to
breastfeed, but are often unsure of what is
required.
1/2015
http://www.cdc.gov/breastfeeding/promotion/calltoaction.htm
Childcare Settings: The natural and logical place
for supporting breastfeeding (1 of 2)
• Design child care facilities with equipment and furnishings to
support breast feeding
• Provide a welcoming atmosphere that encourages mothers
to initiate and continue breastfeeding after returning to
work or school
• Provide accurate basic breastfeeding information
• Refer for skilled breastfeeding support
• Designate a space for the safe expression and storage of
human milk
United States Breastfeeding Committee. Breastfeeding
and child care [issue paper]. Raleigh, NC: United States Breastfeeding Committee; 2002.
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Childcare Settings: The natural and logical
place for supporting breastfeeding (2 of 2)
• Feed infant/toddler human milk in alternative devices (e.g.,
cups or spoons) when parents request it
• Provide space for mothers to breastfeed their children onsite
• Create an environment that fosters the formation of parent
support groups and the ability to share information
• Empower families to advocate at their workplaces for
policies that support breastfeeding
United States Breastfeeding Committee. Breastfeeding
and child care [issue paper]. Raleigh, NC: United States Breastfeeding Committee; 2002.
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Human milk changes to meet
the needs of the infant
©DSHS PHOTO
©DSHS PHOTO
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Healthier Babies in the
Childcare Setting
Reduces babies’ risk of:
• Ear Infections
• Allergic reactions and asthma
• Respiratory infections
• Stomach problems
• Obesity and diabetes
• Childhood leukemia
• SIDS
The Agency for Healthcare Research and Quality (AHRQ)
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Breastfeeding Saves Money
In the U.S., the health care
system would save at
least 2-4 billion dollars
annually if mothers were
enabled to choose and to
succeed in breastfeeding
for as little as twelve
weeks. (Miriam Labbok,
M.D., Medical
Researcher, Georgetown
University)
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Economic Advantages
If 90% of US families could comply with medical
recommendations to breastfeed exclusively for 6
months, the United States would save $13 billion
per year and prevent an excess 911 deaths, nearly
all of which would be in infants.
A Pediatric Cost Analysis: The Burden of Suboptimal Breastfeeding in the United
States: Pediatrics published online Apr 5, 2010; Melissa Bartick and Arnold Reinhold DOI:
10.1542/peds.2009-1616
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Benefits to Society
• Breastfed children are healthier, which makes for a
more productive workplace in the future
• Decreased tax dollars spent to subsidize dairy
farming, free formula, and health care programs
• Potential for reduced health insurance premiums
• Decreased social costs of morbidity and mortality
• Reduced waste of natural resources and water, and
decreased garbage and pollution
http://www.breastfeedingworks.org/econ.htm
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Benefits for Mom
• Reduces risk of:
o breast and ovarian cancers
o diabetes
o postpartum depression
• Provides a special bond between mom and
baby
• Burns up to 600 calories a day
• Releases hormones that relax mom
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Breastfeeding Benefits Employers
•
•
•
•
Reduced staff turnover
Reduced sick time/personal leave
Reduced health care costs
Higher job productivity, employee satisfaction and
morale
• Added recruitment incentive for women
• Enhanced reputation as a company concerned for
the welfare of its employees and their families
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Breastfeeding Benefits
Childcare Centers
• Infants are more
resistant to illness
• Less diaper rash
• Diapers have less odor
• Breastfed baby spits up
less
• Baby is happier
©DSHS PHOTO
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Increased Risks for Babies
of Employed Mothers
• Infants in child care centers are at 69% increased
risk of hospitalization for respiratory infection (Kamper
2006)
• Being in a child care setting doubles odds of
needing antibiotics by age 1.5-5 years (Dubois 2005)
• Exclusive breastfeeding at least 4 months had
protective effect for 2.5 years
• Among infants of employed mothers who were
never sick during the first year, 86% were breastfed
(Cohen 1994)
Business Case for Breastfeeding
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Support of the Breastfeeding
Childcare Employee
www.texasmotherfriendly.org
An employer may be designated as a Texas MotherFriendly Worksite if they have a written employee
worksite lactation support policy
If your childcare center is interested in becoming a Texas MotherFriendly Worksite, contact:
Julie Stagg, MSN, RN, IBCLC, RLC
State Breastfeeding Coordinator
[email protected]
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Simple. Easy. Affordable.
Flexible programs can be designed to meet the needs
of both the employer and employee. Basic low-cost
requirements include:
• Scheduling for lactation breaks
• Private, clean space, other than a bathroom, to
express milk or breastfeed (a dedicated lactation room
is NOT required)
• Arrangements for cleaning hands and equipment,
and for hygienic storage of expressed milk
A Private Location to Pump or
Breastfeed
Tarrant County WIC Photo©
Tarrant County WIC Photo©
1/2015
Why should companies become
Mother Friendly Worksites?
• It reduces health care
costs
• It lowers absenteeism
• It reduces turnover
• It increases morale and
productivity
• It earns the business a
positive image in the
community
• Customers like it!
©DSHS PHOTO
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Legal Basis
Fair Labor Standards Act
Section 7 of the Fair Labor Standards Act was amended effective
March 2010:
• Employers are required to provide “reasonable break time for an
employee to express breast milk for her nursing child for 1 year
after the child’s birth each time such employee has need to
express the milk.”
• Employers are also required to provide “a place, other than a
bathroom, that is shielded from view and free from intrusion from
coworkers and the public, that may be used by an employee to
express breastmilk.”
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Other Relevant Legal Standards
• Family Medical Leave Act: Job protection can help
women take maternity leave to establish
breastfeeding.
• Texas Health &Safety Code 165:
• Affirms a woman’s entitlement to breastfeed in
any location in which she “is authorized to be.”
• Provides the basis for Texas Department of State
Health Services (DSHS) Mother-Friendly Worksite
Designation.
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http://www.dol.gov/whd/nursingmothers/
Texas Health and Safety Code
165-Breastfeeding (est. 1995)
• Affirms a woman’s right to breastfeed in any
location in which she “is authorized to be”
Childcare Licensing Rules, Minimum
Standards print date June 2014
• Minimum Requirement: Provide a comfortable
place with a seat in your center or within a
classroom that enables a mother to breastfeed her
child. In addition, your policies must inform parents
that they have the right to breastfeed or provide
breast milk for their child while in care
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Childcare Licensing Rules,
Breastfeeding Statement (1 of 2)
• Human milk is the best source of milk for
infants. Additionally, breastfeeding supports
optimal health and development.
• Providing a mother with a place to sit and
breastfeed her child helps to support this
practice. Use of an adult-size chair in the
classroom meets the intent of this
requirement.
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Childcare Licensing Rules,
Breastfeeding Statement (2 of 2)
• Other things your operation may do to
provide additional support include providing:
o a pillow to support her infant in her lap
o a stepstool for her to prop her feet and prevent back strain,
o water or other liquid to help her stay hydrated.
• Childcare Standards and Regulations
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Texas WIC Breastfeeding Friendly Establishment
Working &
Breastfeeding?
Yes!
With a little loving support!
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“I never considered weaning because I was returning to work.
It’s so easy to pump at work and it’s good to know that I’m
taking care of my baby even while I’m away from her.” Kirsy
Traweek
©DSHS PHOTO
1/2015
For information on Working and
Breastfeeding:
www.breastmilkcounts.com/working-moms.php
1/2015
Handling of Human Milk
Storage and Feeding
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Breast milk is classified as “food” and
does not require universal precautions
for handling body fluids.
(CDC/OSHA)
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Human Milk
Is NOT Classified as A Body Fluid*
• You do not need to store human milk in a
separate refrigerator.
• You do not need to wear gloves to give a
bottle of human milk to a baby.
• You do not contaminate human milk by
touch. Touching human milk is not
hazardous exposure nor a potential
contaminant.
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What To Do If An Infant Or
Child Is Mistakenly Fed
Another Woman’s
Expressed Breast Milk
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The Childcare Provider Should:
• Inform the mother who expressed the breast milk
of the bottle switch, and ask
o When the breast milk was expressed and how it was
handled.
o Whether she has ever had an HIV test.
o If she does not know whether she has ever been tested for
HIV, would she be willing to contact her physician and find
out if she has been tested.
o If she has never been tested for HIV, would she be willing to
have one and share the results with the parents of the
other child.
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Discuss the Situation
with the Parents
• Inform them that their child was given another child’s bottle
of expressed breast milk.
• Inform them that the risk of transmission of HIV is very
small.
• Encourage the parents to notify the child’s physician of the
exposure.
• Provide the family with information on when the milk was
expressed and how the milk was handled.
• Inform the parents that their child should soon undergo a
baseline test for HIV.
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Refrigerators and Freezers
• At home
o Normal food storage
temperatures
o Freezer that keeps ice
cream solid
• In the hospital and
childcare settings
o Refrigerators: 35° to
40° F (1° to 4° C)
o Freezers: -4° ± 4° F (20° ± 2° C)
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Storage Guidelines for Term Healthy Infant
Location
Best used within
Still safe to use within*
Temperature
Room temperature must
not be warmer than 85°F or
29°C. Containers should be
covered and kept as cool as
possible.
Keep ice packs in contact
with milk containers and
limit opening the cooler
bag.
Countertop
3 hours
3 hours
Insulated cooler bag
24 hours
24 hours
3 days
5 days
At or below 39°F or 4°C
2 weeks
2 weeks
At or below 5°F or -15°C
6 months
12 months
Refrigerator
Freezer section inside of a
refrigerator
Freezer section of
refrigerator with a separate
door or chest or upright
deep freezer
Below 0°F or -17°C
Amount of Breastmilk to Store for Age
• 2 to 4 ounces for 6
week old
• 4 to 6 ounces for 3
month old
• 5 to 8 ounces for 6
month old
©DSHS PHOTO
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Handling Human Milk
• Clearly label each child’s bottle.
• Use the oldest milk first.
• Feed infants expressed human milk on
demand.
• Staff should use proper hygiene.
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Thawing Breastmilk
• Place in warm water.
 Babies can drink cold breast milk.
• Place in refrigerator.
• Do not boil.
• Do not microwave.
o Hot spots can develop, which could burn the
baby.
• After human milk is thawed discard unused
portion after 24 hours.
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Thawing Breastmilk
•
•
•
•
•
Place in warm water
Place in refrigerator
Do not boil
Do not microwave
Discard unused milk after
24 hours
• Swirl gently to remix
©DSHS PHOTO
Refrigerated Breastmilk
• Place in bowl of
warm water
• Shake gently to
mix
©DSHS PHOTO
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Facts About Storing
Human Milk
• Cream rises and forms a separate layer
• Foods may color the milk
• Milk can pick up certain scents - onions,
garlic, mint
• Milk may smell “soapy” but is still good
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Odor and Taste of Stored
Breastmilk
• Typically human milk has a slightly
sweet odor and taste
o May be altered by:
• Mother’s diet (may also change color)
• Storage containers
• Storage conditions
• Milk can get freezer burn
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Feeding Suggestions for
Childcare Worker
• Use paced (baby-led) bottle feeding
technique
• Burp well
• Avoid pacifiers for babies under 2 - 3 weeks
old
• Avoid solids before six months
• Try not to feed baby during the last 2 hrs
before mom is due to pick up baby—or if you
do, just give baby a “snack”
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Paced Bottle-feeding
• Gives babies control over the amount of milk
consumed, just like breastfeeding does
• Supports the breastfeeding relationship,
particularly for mothers who are separated from
their babies on a regular basis
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What is the best way to feed a
baby a bottle?
• Holding the baby in an upright position keeps him
close to you and helps give him more control and
comfort during the feeding. Other helpful feeding
tips include:
o Touch the baby’s bottom lip with the bottle nipple, this will help the baby to open his
mouth.
o Place the nipple inside his mouth slowly and gently. Never force the baby’s mouth
open.
o Try offering only 1/2 to 1 ounce in the bottle to help baby learn to drink without
feeling too full.
o Increase feeding amount only if your baby seems hungry and gives a cue for more.
o About half way through the bottle-feeding, switch your baby’s position by moving him
from one arm to the other. This helps prevent your baby from preferring one side
when breastfeeding and also keeps good eye contact with him, helping you to better
read his cues..
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Incorrect Bottle Feeding
If baby is laid back too
much:
• Baby cannot control
the flow
• Prevents the baby from
learning to selfregulate his food
©DSHS PHOTO
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Correct Bottle Feeding Position
• Baby is upright
• Bottle is parallel to
your lap
• Use a round nipple
• Deep latch to bottle
nipple
©DSHS PHOTO
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How do I know baby is hungry?
•
•
•
•
•
•
•
Whimpering or lip-smacking
Making sucking motions
Pulling up arms or legs toward her middle
Waking and looking alert
Moving hands or fists to her mouth
Becoming more active
Nuzzling against your breast
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Other Ways to Be Supportive
©DSHS PHOTO
• Praise mom for providing
the very best nutrition to
her baby
• Keep one bottle of frozen
milk for emergencies
• Keep track of wet, soiled
diapers for mom
• Keep track of amount baby
consumes and report to
mom
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Caregiver Tip:
• If there’s breastmilk
left over, don’t
throw it out! It will
keep just fine in the
refrigerator until the
next feeding.
©DSHS PHOTO
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Caregiver Tip:
• Watch the baby and
not the clock during
the feeding.
• Learn to watch the
baby’s feeding and
ending cues.
• This is a great way to
better understand a
baby’s special
language!
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Things to Remember
• The risks of artificial infant feeding are numerous
and can have lifelong implications
• If breastfeeding is not going well, the solution is to
fix the breastfeeding--NOT to “wean to a bottle”
• Most potential problems are easily managed
without interrupting breastfeeding
• A little human milk is better than none
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Need Help?
Texas Lactation Support Hotline: 855-550-6667
Mom’s Place - Austin
www.momsplace.org
800-514-6667
Lactation Care Center- Dallas
www.lactationcarecenterdallas.com
Lactation Foundation - Houston
www.lactationfoundation.org
Lactation Care Center – RGV
http://www.co.hidalgo.tx.us/index.aspx?NID=1648
La Leche League International:
www.llli.org
1-800-525-3243
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