In a study conducted in Wake County, NC from 2009-2012, CGBI collaborated with the Child Care Health Consultants and Smart Start in Wake County to assess current breastfeeding knowledge and practices, and develop an intervention to improve breastfeeding support in child care centers.   The intervention consisted of the following components:

Initial recruitment and self-assessment of child care centers:

  • Ninety-six 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 addressed gaps and areas of concern found in our initial surveys.
  • Curriculum used methods appropriate for adult learning, including active participation and discussion.

Educational materials for parents and staff:

  • Responded to gaps found in needs assessment.
  • 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 participated in 1-2 additional self-assessments

In order to determine the impact of the intervention, participating centers were systematically categorized by size, number of low wealth families, and star rating. Each subgroup was randomly assigned to an intervention group or a later intervention group.  Preliminary results include:

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

    This poster describes ways in which the center supports families who are breastfeeding or who are considering breastfeeding.

  • 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.Ten Step programs have been successfully used to improve breastfeeding support in hospitals. In the project described in detail below, we developed the initial “Ten Steps for Breastfeeding-Friendly Child Care Centers” which were then updated and revised based on expert review and stakeholder input in a subsequent project funded by the W.K. Kellogg Foundation.
  • The current Carolina Ten Steps to Breastfeeding-Friendly Child Care include:
    • Make a commitment to the importance of breastfeeding, especially exclusive breastfeeding, and share this commitment with fellow staff.
    • Train all staff to promote optimal infant and young child feeding.
    • Inform women and families about the importance of breastfeeding.
    • Provide learning and play opportunities that normalize breastfeeding for children.
    • Ensure that all breastfeeding families we serve are able to properly store and label milk for child care center use.
    • Provide a breastfeeding-friendly environment.
    • Support breastfeeding employees.
    • Develop a feeding plan that supports best infant feeding practices with each family.
    • Contact and coordinate with local skilled breastfeeding support and actively refer.
    • Continue updates and learning about protection, promotion, and support of breastfeeding.
Phone: (919) 966-3774
Fax: (919) 966-0458
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Carolina Global Breastfeeding Institute
Department of Maternal and Child Health
135 Dauer Drive
422 Rosenau Hall, CB #7445
Chapel Hill, NC 27599-7445