In a recently released article in Pediatrics (10.1542/peds.2017-2076), Dr. Benjamin Neelon and colleagues examine changes in infant feeding regulations for center-based and home-based child care in the US between 2008 and 2016. The authors describe the degree of compliance by state in both years with 10 national standards, described in “Caring for Our Children – National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs (CFOC).” In an approach modeled on their initial 2008 review, they break out the data for home-based and center-based facilities separately, which makes complete sense. Overall there is good news! Viewing the color coded US maps at the end of the article gives one a quick summary, and using either the text or tables gives the detail you will want for each of the 10 recommendations by center type and state.
I was disappointed to find that there was no significant improvement in the standard that outlines support for breastfeeding. Comparing compliance in 2008 to that in 2016, there was a non-significant increase in child care centers (from 11 to 18, p=0.09) and family child care homes (from 5 to 8, p=0.45) that endorsed support for breastfeeding with written regulations. This does not rule out personalized support by individual centers and individual providers for breastfeeding mothers, but does point to a lack of a system-wide safety net that promotes breastfeeding. Over 1/3 of US children ages 0-4 years are in out-of-home childcare while their mothers work (24% in center-based care and 13% in home-based care with a non-relative; Source: ChildStats.gov at https://www.childstats.gov/americaschildren/family3.asp). Thus our collective national ability to meet recommendations for infant breastfeeding depends, for many families, on these childcare providers.
There are states that have stepped up to the plate and created well designed and well thought out state-wide programs for support of breastfeeding in childcare, and these can serve as a model for other states. The two examples I encourage you to examine here are both modeled on the “Ten Steps” approach of the Baby Friendly Hospital Initiative, and while the two are not identical, they incorporate similar themes. The Carolina Global Breastfeeding Institute (http://cgbi.sph.unc.edu/files/2013/11/Ten-Steps-to-Breastfeeding-Friendly-Child-Care.pdf) has posted a “Ten Steps to Breastfeeding-Friendly Childcare”, and the state of Wisconsin (https://www.dhs.wisconsin.gov/publications/p0/p00022.pdf) has its own Ten Steps document and an entire resource kit intended for sharing and broad use. Wisconsin’s work began with a local collaboration between WIC and public health officials, and evolved into a statewide coalition and partnership. The toolkit can be ordered from WIC and has been approved for continuing education hours for childcare providers. Its appendices include planning worksheets, children’s books, and community and other resources and sample policies. All it takes to get started on a statewide program to support breastfeeding in childcare settings is a few dedicated individuals – and thanks to the leadership of those in Wisconsin and the Carolina Global Breastfeeding Institute other states have a running start!