by Anne Eglash MD, IBCLC, FABM
How well do state regulations support and protect breastfeeding in childcare centers and family in-home daycares? In 2011, the American Academy of Pediatrics and the American Public Health Association published national guidelines on how child care centers and day care providers should support breastfeeding.
The recommendations in this document Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Early Care and Education Programs include:
- 1. Encourage and support breastfeeding
- 2. Have a designated place for mothers to breastfeed
- 3. Solid foods should not be introduced before infants are 4 months of age, but preferably 6 months
- 4. Infant formula should not be fed to breastfed infants without parent permission
- 5. Caregivers should discuss breastfed infant’s feeding patterns with parents because frequency of breastfeeding at home can vary
A 2017 study evaluated how well each state’s licensing regulations include these 5 breastfeeding support recommendations by giving each state a score for each step. The maximum score was a 10, with 2 points for each fully-supported step, 1 point for every step that was partially supported, and a 0 for each step not supported.
What do you think the researchers found, regarding how well state licensing regulations in the USA support these recommended steps to support breastfeeding in child care centers and family in-home day cares? (choose 1 or more)
- All states have at least 1 recommended breastfeeding-support step in their licensing regulations for child care centers and day care providers.
- The states in the Southern USA had the most regulations consistent with these standards
- The states in the Western USA had the least # of regulations consistent with these standards
- On average, state licensing regulations include 3 of the 5 standards.
See the Answer
Answers: B, C (not A or D)
Early feeding in child care in the United States: Are state regulations supporting breastfeeding?
Sarah Gonzalez-Nahm, Elyse R. Grossman, Natasha Frost, Sara E Benjamin-Neelon
Preventive Medicine - Volume 105, December 2017, Pages 232-236
Most women in the US are not meeting the recommendation of exclusively breastfeeding their infants for the first 6 months of life. The child care environment can be especially influential in a mother's ability to continue breastfeeding after returning to employment. For this study, we reviewed child care regulations related to breastfeeding for centers and homes in all 50 states and the District of Colombia in late 2016, and compared them to 5 national standards. We coded regulations as either not meeting, partially meeting, or fully meeting each standard. We assessed correlations between number of regulations consistent with standards and 1) geographic census region and 2) last year of update. This study provides an update to a previous review conducted in 2012. No state met all 5 of the included standards, and only 2 states for centers and 1 state for homes at least partially met 4 of the 5 standards. More states had regulations consistent with standards encouraging general support for breastfeeding and requiring a designated place for mothers to breastfeed onsite. Number of regulations consistent with standards was associated with geographic census region, but not last year of update. States in the South had a greater number of regulations consistent with standards and states in the West had the fewest number of regulations consistent with standards. Overall support for breastfeeding at the state child care regulation level continues to be insufficient. States should improve child care regulations to include greater support for breastfeeding in child care facilities.
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
Ten states had no regulations consistent with any of the standards for childcare centers, and on average, states had regulations that were partially or fully consistent with only 1-2 of the standards listed above. It is interesting that states with the lowest breastfeeding rates (in the South) have more state regulations about breastfeeding in childcare as compared to states with the highest breastfeeding rates (in the West). The 5th step, ‘Caregivers should discuss breastfed infant’s feeding patterns with parents because frequency of breastfeeding at home can vary’ is the step least likely to be regulated in states.
We know that women need a network of support to continue breastfeeding their infants. Childcare centers and in-home daycares play an important role in helping mothers sustain breastfeeding when they are back to work. Many childcare providers need education about breastfeeding, and this is more likely to happen if states enact requirements that include education and standards to support and protect breastfeeding, as recommended in the standards listed above.
The Wisconsin Department of Public Health has a tool kit entitled "10 steps to Breastfeeding Friendly Child Care Centers"