1. “How To Support A Breastfeeding Mother”
A Guide for
Childcare Providers
Welcome to the How to Support a Breastfeeding Mother workshop! This is the sixth and final workshop in the TOP Star online training series about preventing childhood overweight. This workshop was developed by the Mississippi State Department of Health WIC program also revised by the Wisconsin State Health Department. This workshop was revised by the Utah Department of Health in which national data was updated and Utah-specific data included for the purpose of the Top Star program. The set of revised workshops is referred to as the TOP Star training and is approved for professional development credit, 10 hours of Career Ladder Credit in levels 1 health and safety or levels 5-8.
While you listen to this presentation, you may want to boost your metabolism while learning by getting up out of your chair and stretching or doing some strength training exercises such as crunches, calf raises, bicep curls, or some basic stretches.
The goal of this workshop is to give childcare center employees and owners accurate information and consistent lactation support to support breastfeeding mothers whose babies are in their care.
Revised by Utah Physical Activity Nutrition and Obesity Program
Developed by the Mississippi State Department of Health WIC Program, revised by Wisconsin

2. Objectives
Describe importance of breastfeeding for infants and mothers and risks of not breastfeeding
Describe safe handling of human milk
Describe elements of a breastfeeding-friendly child care environment
Describe the role of the child care environment and staff in helping mothers and infants to achieve their breastfeeding goals
By the end of the training today, you will be able to:
Describe importance of breastfeeding for infants and mothers and risks of not breastfeeding
Describe safe handling of human milk
Describe elements of a breastfeeding-friendly child care environment
Describe the role of the child care environment and staff in helping mothers and children to achieve their breastfeeding goals

3. *The World Health Organization (WHO) recommends 2 years.
AAP Policy Statement
Breastfeeding is the normal way to feed a baby
Breastfeed exclusively for the first 6 months
Continue for at least 1 year*
And as long thereafter “as is mutually desired”
The American Academy of Pediatrics (AAP) policy statement contains a list of the many benefits of breastfeeding for both mother and infant. It also lists the recommended breastfeeding practices such as when to start, how often, no supplements, follow-up schedule, etc. Some of the key points from the policy statement are
Breastmilk is the natural first food for babies, it provides all the energy and nutrients that the infant needs for the first months of life, and it continues to provide up to half or more of a child’s nutritional needs during the second half of the first year, and up to one-third during the second year of life. Most infants are not physically ready for other foods (including cereal or juice) before 6 months of age.
Infants will take in less breast milk when solids are introduced earlier than 4 months of age (Auerbach, Riordan, Breastfeeding and Human Lactation 2nd edition). Solids should complement the diet of a baby under a year of age, not replace breast milk.
Former Surgeon General of the United States, Antonia Novello, stated that it “was the lucky baby who breastfed well into the second year of life”.
Provide breast milk even when mom and child are separated.
The media should portray breastfeeding as the norm.
The AAP and the World Health Organization breastfeeding policy statements can be accessed at the website links listed on this slide.
*The World Health Organization (WHO) recommends 2 years.

4. Healthy People 2020 Goals At least 82% ever breastfed
At least 60% at 6 months
At least 34% at 1 year
At least 44% exclusively breastfed at 3 months
At least 24% exclusively breastfed at 6 months
The US Department of Health and Human Services sets goals for the population every 10 years. The current objectives are called Healthy People The Healthy People 2020 goals for breastfeeding are at least 82% of mothers start breastfeeding, at least 60% continue for 6 months, and at least 34% continue through 1 year and beyond. Exclusive breastfeeding is defined by CDC as ONLY breast milk — NO solids, no water, and no other liquids.
For babies born in 2007, the national rates for all infants for any breastfeeding were :
75.0% Ever Breastfed
43.0% Breastfed at 6 months
22.4% Breastfed at 12 months
Breastfeeding Report Card – United State, 2010
U.S. National Immunization Survey, 2007 Births, CDC

5. Utah Breastfeeding Data
89.8% ever breastfed
58.3% at 6 months
35.4% at 12 months
41.3% exclusively at 3 months
16.3% exclusively at 6 months
Most Utah mothers breastfeed their babies. Utah has one of the highest rates in the US. Utah met the Healthy People 2020 Goals for ever breastfed, and breastfeeding at 12 months, but falls short for 6 month breastfeeding and exclusive breastfeeding at 3 and 6 months. Of infants born in 2007, nearly 90% were ever breastfed. By 6 months, however, slightly more than half (58%) are still breastfeeding and only 16% are exclusively breastfeeding. Many mothers discontinue breastfeeding when they return to work or school. Child care providers are in a unique position to help moms continue breastfeeding by providing support and establishing breastfeeding-friendly policies and environments.
U.S. National Immunization Survey, 2007 Births, CDC

6. is the Normal Way to Feed a Child
Breastfeeding
is the Normal Way to Feed a Child
Breastfeeding has been the normal way to feed children since the beginning of time.
Professionals continually try to make breastfeeding the normal way to feed children through education, awareness and support of breastfeeding and breastfeeding families.

7. Benefits to Baby Reduced risks for: otitis media (ear infections)
upper and lower respiratory infections
urinary tract infections
gastroenteritis
NEC in preemies
allergies
overweight/obesity
Formula-fed infants are at a greater risk of developing ear infections, respiratory infections, urinary tract infections, allergies, and being overweight. Breastmilk contains antibodies that fight infections and illness. The mother produces antibodies to illnesses she and the baby are exposed to.
Otitis media ohtahytis (middle ear infection) is the most common illness diagnosed in children under age two in the United States. Breastfeeding greatly reduces the risk of both acute and recurrent otitis media in the first year of life.
Breastfeeding is protective against respiratory illnesses in the first year of life including protection from RSV (respiratory syncytial virus).
Breastfeeding and breast milk protects infants from diarrhea and reduces the risk for gastroenteritis.
NEC is necrotizing enterocolitis a condition that damages the intestinal lining of the baby’s gut and sometimes results in the death of parts of the gut. Many premature babies die from NEC. Breastmilk helps protect babies from this illness.
Exclusive breastfeeding helps protect many infants against the symptoms of food allergy. Breastfeeding results in delayed exposure to the things in food that may cause allergic symptoms.
Breastfeeding is also being found to help prevent overweight in children which in turn may offer some protection against overweight and obesity as an adult.
Resource: The Wisconsin Breastfeeding Coalition Position Statement,

8. More Benefits to Baby Reduced risks of: Diabetes Crohn’s disease
Childhood leukemia
Cardiovascular disease
Sudden Infant Death
Syndrome (SIDS)
Not only does breastfeeding reduce a baby’s risk for diabetes, but breastfeeding is good for a diabetic mother as well. Some women have lower insulin requirements while they are breastfeeding.
Ulcerative colitis is an ulceration of mucosa of the colon. Crohn’s disease is a very painful condition which develops later in life. It is a serious chronic disease of the gastrointestinal tract and causes inflammation of the mucous membrane of the small intestine and colon. It can cause irreversible damage.
Adolescents who had shorter durations of breastfeeding, or early introduction of infant formula, had higher total serum cholesterol levels than those breastfed longer than six months, putting them at higher risk of cardiovascular disease later in life.
Putting a baby to sleep on his/her back and breastfeeding are two preventive measures against Sudden Infant Death Syndrome.

9. More Benefits for baby Breastfeeding...
Enhances brain and IQ development
Optimizes mother-infant bonding
Enhances strong jaw and facial development
reduces need for orthodontic treatment later in childhood.
Breastfed infants score higher in tests of IQ and visual function. Breastmilk contains fatty acids that play a role in infant brain development. Two of these fatty acids, DHA (docosahexanenoic acid) and ARA (arachadonic acid), are highly concentrated in the brain and retinal tissues. The brain triples in size during infancy, achieving more than 90% of its final adult size by two years of age. Fatty acids are especially important during this time.
Breastfeeding enhances the development of a close and warm bond between mom and baby. Babies learn to associate their mother’s breast with a sense of comfort and security as well as a place of nourishment.
Breastfeeding also promotes strong jaw and facial development with reduces the need for braces and other orthodontic treatments later in life.

10. Breastfeeding Saves Money
The cost of formula feeding for one year is ~$1,500 (just for the formula)
The cost of breastfeeding is PRICELESS
The cost of feeding a standard infant formula for 1 year is ~$1,500 just for the formula. Special formulas are much more expensive. Other costs include bottles, liners, nipples, nursery water, time lost from work caring for a sick child, cost of formula to the WIC federal program and over the counter medications.
The cost of breastfeeding is priceless! Breastfeeding is quite inexpensive. About the only costs with breastfeeding might be extra food for mom and maybe a good quality breast pump for moms who are separated from their baby.

11. Breastfeeding Saves Money
A minimum of $3.6 billion would be saved if breastfeeding were increased from current levels to those recommended in Healthy People 2010!
At least 75% initiate breastfeeding
At least 50% continue breastfeeding at least 6 months
At least 25% continue breastfeeding at least 12 months
These cost savings are calculated from just 3 illnesses: otitis media, gastroenteritis and necrotizing entercolitis
Healthy babies result in reduced health care costs and reduced employee absenteeism. Billions of dollars are saved when mothers breastfeed their infants.
The cost of not breastfeeding has been calculated at:
a minimum of $3.6 billion would be saved if breastfeeding increased from current levels to those levels in Healthy People This figure represents the cost savings from the treatment on only three childhood illnesses: otitis media, gastroenteritis, and necrotizing enterocolitis. It does not include the costs of over the counter medications, time lost from work caring for a sick child and other associated costs. Source: The Economic Benefits of Breastfeeding: A Review and Analysis. March (
One study looked at infants who were exclusively breastfed for 3 months and those that were formula fed and the number and cost of three common illness (lower respiratory tract illnesses, otitis media and gastrointestinal illnesses). In the first year of life there were 2033 excess office visits, 212 excess days of hospitalization and 609 excess prescriptions per 1000 never breastfed infants as compared to 1000 infants exclusively breastfed for at least 3 months. The cost to the health care system was between $331 - $475 per never breastfed infant. (Pediatrics Vol. 103 No. 4 April 1999)
The nation would save $13 billion per year in health care and other costs if 90% of US babies were exclusively breastfed for six months.

12. Benefits for Mom Promotes rapid recovery after having a baby
Decreases risk of anemia
Helps in weight reduction
Reduces risk of breast cancer, especially premenopausal
Reduces risk of ovarian cancer
May reduce risk of endometrial cancer (of the uterus lining)
Reduces risk for osteoporosis
Breastfeeding is normal for mothers as well as babies. The hormones produced during breastfeeding help the mother recover from childbirth. This includes stimulating uterine contractions which decreases risk of postpartum hemorrhage.
Mothers who exclusively breastfeed usually have a delay in return of the menstrual cycle, which decreases the risk of anemia.
A woman burns 500 – 800 calories a day just by making milk! This helps mom return to her pre-pregnancy weight quicker.
Women who breastfeed reduce their risk of breast (especially premenopausal), ovarian, and uterine cancer, as well as osteoporosis, heart disease and diabetes.

13. Breastfeeding Benefits Employers
Less employee turnover
Faster return from maternity leave
Less employee absenteeism
Happier employee
Employers also benefit from breastfeeding.
Satisfied employees stay with the company longer. When a woman feels the support for her decision to breastfeed from her employer she is less likely to look for employment elsewhere.
Breastfeeding women, as a general rule, recover from labor and delivery faster than the formula feeding woman and may choose to return to the workplace sooner.
Breastfed babies are sick less often therefore mother (or dad) won’t have to take off from work as often. Employers also save money on health care premiums because mothers and children are sick less often.
Women feel confident that they are leaving the very best nutrition and health benefits for the babies when they leave breast milk with the childcare provider. Because of this they worry less about their baby and are happier employees.
In 2010, the Affordable Care Act included a provision requiring employers to provide workplace accommodations that enable employees who are breastfeeding to express their milk. Employers are required to provide reasonable, though unpaid, break time for a mother to express her milk and a place, other than a restroom, that is private and clean where she can express her milk.

14. Breastfeeding Benefits Childcare Providers
Baby is sick less often
Diapers have less odor
Baby spits up less
Baby is happier
Breastfeeding benefits the childcare provider as well.
Breastfed babies and children are easier to take care of …
They are generally healthier
They have less colic
Less diaper rash
when exclusively breastfed, the bowel movements are softer and don’t smell foul. Breastfed babies rarely have problems with constipation.
The baby’s “separation anxiety” stage is less severe.
When they begin solids, they eat a variety of solids and table foods more readily.
In general, they are more sociable, and reach developmental milestones sooner.
They spit up less(and if they do spit up, it doesn’t smell bad or stain clothes and carpet)
Childcare providers and staff will be empowered to breastfeed their won children.

15. AAP Recommendations Breastfeed for at least 12 months
Provide breast milk even when mom and child are separated
Encourages family & community support
Media should portray breastfeeding as the norm
Employers provide facilities and time
A summary of the recommendations from the American Academy of Pediatrics is
That breastfeeding continue for at least 12 months, and thereafter as long as mutually desired.
That arrangements be made to provide expressed breast milk if mother and child must be separated during the first year.
That breastfeeding be promoted as a normal part of daily life, and that the AAP encourages family and community support for breastfeeding.
That the media be encouraged to portray breastfeeding as a positive norm.
That employers be encouraged to provide appropriate facilities and adequate time in the workplace for breast-pumping.

16. Breastfeeding Best Practices for Child Care Providers
Facility has a written policy on breastfeeding
Each breastfeeding infant will have a feeding plan on file, which is completed by the parent(s) and facility as a team to address their unique feeding patterns
To achieve best practices, the child care facility should have a written breastfeeding policy. The policy should include several elements, including
Staff will be sensitive to breastfeeding mothers and infants, and their feeding patterns.
Each breastfeeding infant will have a feeding plan on file, which is completed by the parent(s) and facility as a team. The feeding plan will address the baby’s usual feeding schedule, how breast milk is to be stored and served, what the provider should do if baby is hungry and mom is late, or her supply of expressed breast milk is gone.
All child care staff will be trained in the proper storage and handling of human milk, as well as ways to support breastfeeding mothers.

17. Elements of Breastfeeding Policy
Breastfeeding mothers shall be provided a place to breastfeed or express their milk
A refrigerator will be made available for storage of expressed breast milk
Sensitivity will be shown to breastfeeding mothers and their babies
Staff shall be trained in handling human milk
A breastfeeding policy should include, but is not limited to, these components.
Breastfeeding mothers, including employees, shall be provided a private and sanitary place to breastfeeding their babies or express milk. This area will have an electrical outlet, comfortable chair, and nearby access to running water.
Breastfeeding mothers and employees may store their expressed breast milk in the center refrigerator. Mothers should provide their own containers, clearly labeled with name and date.
The child care facility is committed to providing ongoing support to breastfeeding mothers, including providing an opportunity to breastfeed their baby in the morning and evening, and holding off giving a bottle, if possible, when mom is due to arrive. Artificial baby milk (formula) and solid foods will not be provided unless the mother has requested. Babies will be held closely when feeding and bottles will never be propped.
All child care facility staff will be trained in the proper storage and handling of human milk, as well as ways to support breastfeeding mothers. The facility will follow guidelines from the American Academy of Pediatrics and Centers for Disease Control and Prevention in ensuring that breast milk is properly handled to avoid waste.

18. Policy Elements, continued
Breastfeeding employees shall be provided flexible breaks to accommodate breastfeeding or milk expression
Breastfeeding promotional information will be displayed
Breastfeeding employees shall be provided a flexible schedule for breastfeeding or pumping to provide breast milk for their children. The time allowed would not exceed the normal time allowed to other employees for lunch and breaks. For time above and beyond normal lunch and breaks, sick/annual leave may be used, or the employee can come in a little earlier or leave a little late to make up the time.
The facility will provide information on breastfeeding, including the names of area resources should questions or problems arise. In addition, positive promotion of breastfeeding will be on display in the center.

19. Elements of Feeding Plan
Baby’s usual schedule
How breast milk is to be stored and served
What the provider should do if baby is hungry and mom is unavailable, or her supply of expressed breast milk is gone
A feeding plan should include, but is not limited to, these elements.

20. Sample Infant Feeding Plan

21. Model Breastfeeding Best Practices
Breastfeeding employees shall be provided flexible breaks to accommodate breastfeeding or milk expression
Breastfeeding promotion information will be displayed
Be sure to model best practices in your facility. Your policy should also address your breastfeeding employees. Breastfeeding employees shall be provided a flexible schedule for breastfeeding or expressing milk to provide breast milk for their children. The time allowed would not exceed the normal time allowed for lunch and breaks. For time above and beyond normal lunch and breaks, sick/annual leave must be used, or the employee can come in a little earlier or leave a little late to make up the time. Provide a private, clean location for employees to express their milk.
Display breastfeeding promotion information, including the names of area resources should questions or problems arise. Your local WIC clinic should have a list of breastfeeding resources in your area. Contact La Leche League for a list of leaders and groups in your area.

22. Post the International Breastfeeding Symbol in Your Facility
Post the International Symbol of Breastfeeding in your facility indicating breastfeeding mothers and children are welcome here.

23. Activity Please take a few minutes to complete this activity.
Review the childcare provider information handout and the sample breastfeeding policy handout. After reviewing these handouts, fill out the worksheet on the next slide.

24. Activity
To complete this worksheet, list 3 best practices you currently follow. List 2 additional practices you will implement in your facility to support breastfeeding mothers.

25. Breastfeeding is the Gold Standard
Breastfeeding is the gold standard. All forms of infant nutrition attempt to imitate breast milk. It cannot be done. Breastmilk changes to the needs of the infant, time of year, time of day, beginning, during and end of the feeding, and contains antibodies to protect the infant from illness and disease, the infant or the mother have been exposed to.
Sometimes you will hear breast milk called “liquid gold” because it is such a precious thing that a mother can provide to her child.

26. Breastmilk as part of the Meal Pattern
If your center participates in the Child and Adult Care Feeding Program…
Breastmilk is a reimbursable component of the infant meal pattern
For children over 12 months - breast milk is a substitute for cow’s milk in the meal pattern for children and the meal is reimbursable
Some parents may request that the caregiver continue feeding their babies breast milk after 12 months of age. Continue to serve babies their mother’s milk as long as the mother wishes to provide it. Mothers who wish to continue providing breast milk for their babies older than 12 months of age can do so without having to submit a medical statement. Breastmilk is a substitute for cow’s milk in the meal pattern for children.
Resource: Feeding Infants: A Guide for Use in the Child and Nutrition Programs.

27. Storing that Liquid Gold
There are different sets of recommendations from different organizations.
As a childcare center you should be using guidelines from AAP and CDC
Mom may be following a different set of guidelines
Working with mom regarding storage of breast milk will avoid problems
There are several organizations that have published guidelines for storing breast milk, but they are all a little different. Some of the guidelines are the same as for infant formula, but breast milk is not the same as infant formula. Breastmilk has special properties that protect it from bacterial contamination. Studies have suggested that because of these properties refrigerated human milk can stay fresh longer than previously thought. Day Care facilities should follow guidelines from the American Academy of Pediatrics (AAP) and Centers for Disease Control and Prevention (CDC.)
In general, all guidelines for storing breast milk are for:
Healthy, full-term babies
Storing milk for home use
Moms are washing their hands before expressing
the containers that the milk is being put into are clean
and the refrigerator temperature is 40 degrees or lower and the freezer temperature is 0 degrees or lower.
It is important to work with mom and communicate the guidelines for milk storage that your facility follows as it may be different from the guidelines mom is following.
Provide clear written guidelines for parents and staff about collecting, storing and feeding expressed breast milk. Mothers should provide milk in a container clearly labeled with the child’s full name and the date the breast milk was collected.
Breastmilk may be stored in glass or plastic bottles, or plastic liners. If using the plastic liners designed for formula, they should be double bagged to prevent breakage.

28. Storing that Liquid Gold
At room temperature (66-72OF)….…6-8 hours
In an insulated cooler (on ice)…..24 hours
In a refrigerator (32-39OF)……...….….5 days
In a freezer inside a refrigerator……. 2 weeks
In a freezer with a separate door months
In a separate deep freeze (0)OF months
*From CDC; reference: Academy of Breastfeeding Medicine. (2004).
This slide shows the milk storage guidelines from CDC and are for milk for healthy, full-term infants.
Reference: Academy of Breastfeeding Medicine. (2004) Clinical Protocol Number #8: Human Milk Storage Information for Home Use for Healthy Full Term Infants.

29. Handling of Breastmilk
Label the bottles with baby’s name, the date the breast milk was collected and the date thawed
Breastmilk separates into layers
Swirl gently to mix layers back together
Thawed breast milk can be kept in the refrigerator for 24 hrs. Do not refreeze
Heat breast milk in warm water
never microwave breast milk
After a feeding, throw out any unused breast milk left in the bottle
Most people think of breast milk as being very fragile … that it requires a lot of special handling …. Not true!
As mentioned earlier, there are properties in breast milk that actually destroy bacteria.
It is important that all bottles be labeled with the child’s name, the date the milk was expressed and the date thawed (if frozen). When you have each infant’s bottle clearly labeled there is less risk of giving the wrong bottle to an infant, whether it is breast milk or infant formula.
Use the oldest milk first - it is a shame to discard the “liquid gold” and the mother may get quite upset.
Breastmilk will separate … the cream rises to the top and there is a bluish watery layer at the bottom .. THIS IS NORMAL!
Gently “rock” the bottle back and forth to mix - don’t shake hard as this can destroy some of the components of breast milk.
Do Not Microwave! This destroys nutritional properties in the milk and heats unevenly - could burn baby’s mouth. Infant formula shouldn’t be heated in the microwave either.
Don’t cook on the stove … cooking will destroy essential protective properties in breast milk.
If the breast milk has been previously frozen you may thaw it by placing the bottle of breast milk in a container of warm water. It may be kept in the refrigerator for 24 hrs. after thawing. Do not refreeze.
After a feeding, throw out any unused breast milk left in the bottle. Only put the amount that you think baby is going to eat in the bottle, you can always add more breast milk to the bottle. Let mom know if she needs to adjust the amount in the bottle or the number of bottles she brings.
By following the simple guidelines above, the babies in your care will be less likely to get sick!

30. This is a poster containing the guidelines discussed that you may choose to hang at your facility.

31. Breastmilk Is NOT Classified as a Body Fluid*
You do not need to store breast milk in a separate refrigerator
You do not need to wear gloves to give a bottle of breast milk
You do not contaminate breast milk by touch. Touching breast milk is not a hazardous exposure nor a potential contaminant
*According to OSHA’s and CDC’s definitions,breastmilk is classified as “food” and does not require universal precautions for handling body fluids.
The Center for Disease Control and OSHA both consider breast milk to be “Food”, not a “body fluid”, so universal precautions are not necessary. You do not need to wear gloves when handling it. Also, breast milk may be stored in the same fridge as other “foods”.
Resources:
Caring for Our Children: National Health and Safety Standards: Guidelines for Out-of-Home Child Care, Chapters 3 and 4
OSHA, Search for breast milk

32. Feeding Suggestions for Childcare Workers
Hold baby close
Discuss with mom ahead of time how to handle times when baby is hungry at the end of the day
Mom may be ready or want to feed her baby as soon as she arrives at the center
Provide a “nursing nook” in the childcare center where mom can breastfeed her baby
Babies are held close while breastfeeding. Most babies nurse from both breasts at a feeding. This helps in eye development. Breastfed babies are used to being held close. When bottlefeeding, at some point in the feeding transfer the baby from one position to another, so that they too benefit from this eye stimulation. NEVER prop the bottle! It may take time for the baby to get used to bottlefeeding. Don’t put baby down for a nap with a bottle. Also, be sure that you place the baby on his back to sleep.
Mom may want to sit and quietly nurse her baby before she leaves the day care. By postponing a feeding until she gets there the baby will be interested and hungry. Discuss with mom ahead of time how to handle times when baby is hungry at the end of the day.
A nursing nook can be as simple or as elaborate as you like. What changes could you make in your daycare for providing a quiet, private place for nursing? Mom should feel comfortable nursing before she leaves, to come on her breaks and before leaving at the end of the day.
If you are caring for very young infants (2-3 weeks) pacifiers can cause nipple preference or nipple confusion. Avoid the use of pacifiers until breastfeeding is well established. (Infants under 6 weeks can’t be in licensed daycare)
Starting solids too soon increases chances of allergies, and replaces a superior food with an inferior food. Most babies start solids around 6 months of age.

33. Other Ways to be Supportive
Some babies prefer to wait for their mother’s return and not eat much at the childcare center
Keep 1 bottle of frozen milk in the freezer for emergencies
Keep track of the number of ounces of breast milk baby ate
Praise mom for providing the very best nutrition to her baby
Breastfed babies may prefer to wait to eat for their mother’s return, and may spend more time sleeping at daycare. They nurse more frequently at night. This “reversal” is not an uncommon pattern.
It helps to have a little extra breast milk on hand in times of growth spurts, accidents, and when the infant just seems to need a little more today.
In the first couple of days or weeks, the exclusively breastfed infant may seem to consume a lot of milk. This settles down pretty soon. Remember they have been able to suck for food and comfort at the breast. Bottlefeeding may not give them the amount of comfort sucking they are use to.
Keeping track of the number of ounces that baby drank helps mom know how much breast milk to bring and know that baby is getting enough.
A few tips for helping a breastfed baby take a bottle or cup.
Tickle the baby’s lips with the bottle nipple (the hole should be on the top) … when the mouth opens WIDE, place bottle nipple in the infant’s mouth FULLY … the infant’s lips should be flanged around the largest part of the nipple.
Babies often take the bottle better from someone other than mom.
Use lots of cuddling when feeding the baby
Some babies prefer to be fed in the same position as when breastfeeding, others prefer a totally different position.
Try different kinds of nipple
Other choices for feeding baby may be an eyedropper, spoon, or cup
Praise mom for providing the very best nutrition to her baby.
Resource: See the website at

34. Critical Times for Support...
The transition back to work can be a difficult time for moms and babies and she may feel that she is unable to pump enough or continue pumping. Praise her efforts and encourage her to talk to a breastfeeding professional
When baby is teething
When mom needs to take medications
When baby is having a “growth spurt”
When pumping isn’t going well
When mom thinks her supply is declining
There are certain times when it is really important that the breastfeeding mother gets support from those around her, especially her daycare provider. These are times when a mom may think about stopping breastfeeding.
-The transition of going back to work can be a difficult time for moms and babies and she may feel that she is unable to pump enough or continue pumping. Praise her efforts and encourage her to talk to a breastfeeding professional.
-Teething doesn’t have to be a reason to wean. Babies can’t bite if they are actively nursing. If a baby is teething and bites during breastfeeding, the mom should remove the baby from the breast. The baby quickly learns that biting removes them from something they enjoy - the breast.
-Babies who are in a “growth spurt” may be eating more frequently and mom may feel she doesn’t have enough milk. Growth spurts are normal and eating more frequently gives the energy babies need to grow and signals mom to make more breast milk. Encourage mom to continue to breastfeed through the growth spurt and talk to a breastfeeding professional.
-There are many breast pumps, some are good, some are not so good. Pumping and pumps are very individual - if a mom is having problems with pumping encourage her to talk to a breastfeeding professional. Her pump may not be the best for her situation or may not be working properly.

35. Baby’s Hunger Cues
Turning his or her head side to side in search of the breast
Making sucking noises
Sucking on hand or fist
Crying is a late cue. Try to feed baby before he or she start crying
Babies should be fed on request, at the first signs of hunger.
Learn to recognize early signs of hunger. When babies begin rooting, turning his or her head side to side in search of the breast and/or sucking on their hands or fists, it is a sign that they may be getting hungry. If a baby starts crying, feeding will be more difficult as the baby will need to be calmed first. Try to feed the baby before he or she starts to cry.

36. Things to Remember
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 breastfeeding is better than none
For help call: WIC, La Leche League, Baby Your Baby, The Utah Breastfeeding Coalition or your health care provider
Remember to praise and support the mother in her decisions.
If you and/or the mother have a concern or question about breastfeeding call a breastfeeding professional from WIC at the local health department, La Leche League, baby your baby or the Utah Breastfeeding Coaltion at the Utah Dept. of health.
The mother may also consult one of the websites listed on the following slide.

37. Helpful Websites

38. Breastfeeding... Baby’s Best Start
Breastfeeding is Baby’s Best Start and can work … (next slide)

39. With a little Loving Support!