• Overview
• Rationale
• Ten Steps
• Intervention
• Research

Overview:
CGBI has collaborated with the Child Care Health Consultants and SmartStart in Wake County, NC to assess current breastfeeding knowledge and practices, and develop an intervention to improve breastfeeding support in child care centers.


Rationale:
Breastfeeding provides the healthiest start in life for infants, but children who are routinely cared for by someone other than their parents are less likely to be breastfed. When child care centers provide support and encouragement for breastfeeding families, it can make it easier for mothers to continue breastfeeding, thus continuing to provide the optimal nurturing and nutrition for babies.  Although child care standards and best practices emphasize the importance of breastfeeding support, many child care centers and providers find it challenging to provide such support.

back to top


Ten Steps for Breastfeeding-Friendly Child Care:
Ten Step programs have been successfully used to improve breastfeeding support in hospitals.  Using existing guidelines and measurable objectives, we developed “Ten Steps for Breastfeeding-Friendly Child Care Centers.” (detailed handout available)

1. Make a commitment to the importance of breastfeeding, especially exclusive breastfeeding, and share this commitment with fellow staff.
2. Train all staff  to promote optimal infant and young child feeding.
3. Inform women and families about the importance of breastfeeding.
4. Provide learning and play opportunities for children which normalize breastfeeding.
5. Ensure that all breastfeeding families we serve are able to properly store and label milk for child care center use.
6. Provide a breastfeeding friendly environment.
7. Support breastfeeding employees.
8. Develop a breastfeeding-friendly feeding plan with each family.
9. Contact and coordinate with local skilled breastfeeding support and actively refer.
10. Continue updates and learning about protection, promotion, and support of breastfeeding.

back to top


Intervention:
We have piloted an intervention that consists of the following components:

• Initial recruitment and self-assessment of child care centers:

• 96 centers were recruited from centers receiving child care subsidies
• Each center completed a self-assessment using the “Ten Steps” and a survey of infant and toddler teachers on breastfeeding knowledge, attitudes, and practices.

• Breastfeeding training for child care providers

• Training curriculum specifically addresses gaps and areas of concern found in our initial surveys.
• Curriculum uses methods appropriate for adult learning, including active participation and discussion.

• Educational materials for parents and staff

• Respond to gaps found in needs assessment
• Low literacy level
• Short and simple materials
• Easily printable from .pdf files
• Color-coded by purpose

• Follow-up visit by Child Care Health Consultant

• 4-6 weeks after training
• Opportunity for both assessment and additional support

• Follow-up self-assessment/KAP

• Centers participate in 1-2 additional self-assessments

back to top


Research:
In order to determine the impact of the intervention, participating centers were systematically categorized by size, number of low wealth clients, and star rating. Each subgroup was randomly assigned to an intervention group or a later intervention group.  We are currently in the midst of collecting and analyzing our post-intervention data, and will shortly modify the intervention for the later intervention group and initiate activities..  Preliminary results include:

• In pre- and post-tests administered at the training, participants showed improvement in 13 of 15 items.

• In follow-up visits, all centers indicated that they had made some changes due to the training.  For example, 72% reported doing more to inform families about the benefits of breastfeeding, and 50% reported making their environment more breastfeeding-friendly.
• Individual providers showed improvement in multiple areas, including proper handling of human milk, communication of the health benefits of breastfeeding, and improved attitudes toward caring for breastfeeding babies and providing breastfeeding support.

back to top