Breastfeeding-friendly designation program enhances child care services

Like many mothers anticipating their return to work just weeks after birth, a South Carolina mother began to transition her baby to formula under the assumption that it would make the transfer to daycare more simple. Upon enrollment into the child care center, a male director shared with the mother their dedication to breastfeeding.

The director referred the mother to their local WIC office and La Leche League group. Now the baby no longer receives artificial milk, only expressed mother’s milk.

This success story is a result of South Carolina Program for Infant/Toddler Care’s (SCPITC) Breastfeeding Friendly Child Care designation program which recognizes child care programs that promote, protect and support breastfeeding and equips child care providers– who aren’t necessarily lactation experts– with the knowledge to help mothers achieve their infant feeding goals.

Lucie Maguire Kramer, MS, RDN, CLC Program Coordinator, Medical Univ. of SC Children’s Health Charleston comments, “[The director] didn’t say, ‘I know exactly how you can pump enough milk for your baby. He said ‘let’s try it.’”

Bringing breastfeeding awareness to the child care setting was part of South Carolina Department of Social Services’ (DSS) goal to enhance services in 2015. Team members looked to Carolina Global Breastfeeding Institute’s (CGBI) The Carolina Breastfeeding-Friendly Child Care (BFCC) Initiative for a framework and translated the material in a way that would work for their state, Maguire Kramer explains.

SCPITC already had an infrastructure of infant toddler specialists implementing programs directly into the child care setting throughout the state; so offering a breastfeeding-friendly designation was another thing to add to “the menu” of ways to improve quality of care, Maguire Kramer puts it.

“We had a lot of buy-in from the beginning,” she says. Child care instructors were on board, and while their partnership with DSS is critical for funding, it also represents a state-level buy-in “that speaks volumes.”

There are currently 13 child care programs designated Breastfeeding-Friendly through the program, two on the horizon and at least ten in backlog which exceeds the team’s initial goal to designate ten programs by 2019.

“It is so meaningful to all of us,” Maguire Kramer says.

From start to finish, becoming designated takes three to five months. Adopted from CGBI’s BFCC, the designation process requires child care providers to journey through the Ten Steps to Breastfeeding Friendly Child Care, modeled after Baby-Friendly Hospital Initiative’s (BFHI) Ten Steps.

Once a program expresses interest in designation, the entire staff must commit to a 2.5 hour training through SCPITC. Training is free to all participants.

Here, they cover things like how to properly warm human milk, how to hold a breastfed baby and how to decipher feeding cues. Participants play an “agree/disagree” game where they discuss controversial topics like breastfeeding in public. Maguire Kramer explains that this format–again adopted from CGBI– allows child care providers to express their reservations and personal attitudes.

From here, instructors lead the group into a “true/false” game where they open the discussion to opinion versus fact. Personal opinions about breastfeeding are inevitable; no matter one’s experience, child care providers are expected to support breastfeeding as part of their job description, just as they are expected to change diapers, Maguire Kramer goes on to say.

Through the training, participants receive a packet of materials including educational materials to pass along to families and breastfeeding-friendly books and toys to be used in their classrooms, which aligns with Step 4: provide learning and play opportunities that normalize breastfeeding for children. Each child care program receives up to three nursing animal toys with magnetic nipples.

“It can be strange for some teachers to talk about breastfeeding,” Maguire Kramer begins. “The animals kind of help break that barrier.”

After reviewing a self-assessment action guide, programs may apply for designation.

The application review committee– comprised of a neonatologist, pediatricians, independent lactation consultant, child care program director, nutrition specialists, and others– conducts quarterly meetings where they discuss their rubric for acceptability, pass around pictures submitted by child care programs, and discuss ways programs can improve their applications. Once programs review comments by the committee and implement suggested updates in their classrooms, they become designated.

Child care programs are awarded a decal, and a letter is sent out statewide announcing their efforts. The Breastfeeding-Friendly Child Care Designation is good for three years with annual renewal requirements.

Creating community networks is important to the sustainability of breastfeeding support. Step 9 encourages child care programs to forge relationships with WIC clinics, La Leche League groups, and other local lactation support people.

The SCPITC Breastfeeding Friendly Child Care designation program itself collaborates with SCale Down and the South Carolina Birth Outcomes Initiative, as well as DSS as mentioned previously. These partnerships have allowed for significant developments; for instance, breastmilk feedings are reimbursable for child care programs through nutrition services, and unfinished breastmilk is to be returned to families to decide how to dispose of or use the milk.

You can visit the SCPITC Breastfeeding Friendly Child Care site here.

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