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TABLE 1

Baby-Friendly Ten Steps to Successful Breastfeeding (Baby-Friendly Steps) and Questions Consistent with Identified Practices in the USDA's Infant and Toddler Feeding Practices Study-2 (ITPFS-2)

Baby-Friendly StepsIndicator Within ITFPS-2 Consistent with Baby-Friendly StepsTiming of Assessment
1. Have a written breastfeeding policy that is routinely communicated to all health care staff. Not assessed — 
2. Train all health care staff in the skills necessary to implement this policy. Not assessed. — 
3. Inform all pregnant women about the benefits and management of breastfeeding. Not assessed. — 
4. Help mothers initiate breastfeeding within 1 hour of birth. Did you start breastfeeding in the first hour after birth or later? 1 mo interview 
5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants. While you were in the hospital or birthing center, did your doctor, the nurses, or the hospital staff encourage you to breastfeed your baby? 1 mo interview 
and 
Was there someone in the hospital or birthing center whose job it was to help you with breastfeeding, like a lactation consultant or another trained specialist? 
and, selection of at least 1 breastfeeding hospital support service used 
While you were in the hospital or birthing center, did you use any of the following support services, information, or equipment for breastfeeding?a 
6. Give infants no food or drink other than breastmilk, unless medically indicated. What was the very first thing that [CHILD] was fed after birth? 1 mo interview 
and 
When you left the hospital or birthing center, were you feeding your baby only breast milk? 
7. Practice rooming in – allow mothers and infants to remain together 24 h a day. While you were in the hospital or birthing center, did [CHILD] stay in the same room with you, or in a nursery? Do not include time your child was out of your room briefly for things such as medical procedures, bathing, or weighing. 1 mo interview 
8. Encourage breastfeeding on demand. While you were in the hospital or birthing center, did you feed your baby breast milk, either from your breast or from a bottle, on a set schedule or whenever [he or she] cried or seemed hungry? 1 mo interview 
9. Give no pacifiers or artificial nipples to breastfeeding infants. When was [CHILD] given a pacifier for the first time? 3 mo interview 
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center. Not assessed. — 
Baby-Friendly StepsIndicator Within ITFPS-2 Consistent with Baby-Friendly StepsTiming of Assessment
1. Have a written breastfeeding policy that is routinely communicated to all health care staff. Not assessed — 
2. Train all health care staff in the skills necessary to implement this policy. Not assessed. — 
3. Inform all pregnant women about the benefits and management of breastfeeding. Not assessed. — 
4. Help mothers initiate breastfeeding within 1 hour of birth. Did you start breastfeeding in the first hour after birth or later? 1 mo interview 
5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants. While you were in the hospital or birthing center, did your doctor, the nurses, or the hospital staff encourage you to breastfeed your baby? 1 mo interview 
and 
Was there someone in the hospital or birthing center whose job it was to help you with breastfeeding, like a lactation consultant or another trained specialist? 
and, selection of at least 1 breastfeeding hospital support service used 
While you were in the hospital or birthing center, did you use any of the following support services, information, or equipment for breastfeeding?a 
6. Give infants no food or drink other than breastmilk, unless medically indicated. What was the very first thing that [CHILD] was fed after birth? 1 mo interview 
and 
When you left the hospital or birthing center, were you feeding your baby only breast milk? 
7. Practice rooming in – allow mothers and infants to remain together 24 h a day. While you were in the hospital or birthing center, did [CHILD] stay in the same room with you, or in a nursery? Do not include time your child was out of your room briefly for things such as medical procedures, bathing, or weighing. 1 mo interview 
8. Encourage breastfeeding on demand. While you were in the hospital or birthing center, did you feed your baby breast milk, either from your breast or from a bottle, on a set schedule or whenever [he or she] cried or seemed hungry? 1 mo interview 
9. Give no pacifiers or artificial nipples to breastfeeding infants. When was [CHILD] given a pacifier for the first time? 3 mo interview 
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center. Not assessed. — 

Baby-Friendly Ten Steps to Successful Breastfeeding are based on the World Health Organization and UNICEF's Baby-friendly hospital initiative: Revised, updated, and expanded for integrated care. 2009; Available at: http://apps.who.int/iris/bitstream/10665/43593/1/9789241594967_eng.pdf. —, not applicable; USDA, United States Department of Agriculture.

a

Examples of breastfeeding support services, information, or equipment: brochures, pamphlets, TV classes; lactation consultant; other trained specialist who helped with breastfeeding; support groups or classes; breastfeeding equipment (pumps, shields, or other equipment); counseling; hotline; name and number of hospital/birth center staff to call with questions; any other services.

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