Ten Step programs have been successfully used to improve breastfeeding support in hospitals. CGBI 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.

Read more about the project’s beginnings here.

The Steps:

Step 1. Have a written policy that reflects the program’s commitment to promoting and supporting breastfeeding, especially exclusive breastfeeding, and share with employees and families.

Step 2. Train and evaluate all staff in the skills to support and promote optimal infant and young child feeding.

Step 3. Inform women and families about the importance of breastfeeding.

Step 4. Provide learning and play opportunities that normalize breastfeeding for children.

Step 5. Ensure that all breastfeeding families we serve are able to properly store and label their breast milk for child care use.

Step 6. Provide a breastfeeding-friendly environment.

Step 7. Support breastfeeding employees.

Step 8. Ensure that each infant has a feeding plan that supports best feeding practices.

Step 9. Contact and coordinate with community breastfeeding support resources; actively refer mothers and families.

Step 10. Train all staff (teaching and non-teaching) annually on the protection, promotion, and support of breastfeeding.

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Replication & Scale Up

In 2012, with support from the W.K. Kellogg Foundation, CGBI began collaborating with state-level agencies and organizations in NC to replicate the Ten Steps to Breastfeeding-Friendly Child Care for sustainable scale-up throughout NC. Partners include the NC Child Care Health and Safety Resource Center, the NC Infant-Toddler Enhancement Project, Shape NC, the NC Department of Health and Human Services, Wake County Human Services, and Wake County Smart Start.

This project uses a Training of Trainers (TOT) approach and continues the goal of improving support for breastfeeding in Early Care and Education settings that serve low wealth and minority populations to reduce inequities .

Child Care Health Consultants, Infant Toddler Specialists, WIC Regional Coordinators, Shape NC Specialists, and others who conduct trainings in the child care setting participate in the Breastfeeding-Friendly Child Care TOT.  The training consists of:

  • Two hours of pre-training work using an online format of four 30-minute modules that provide information on breastfeeding and using job aids as training tools.
  • Three hours of in-person training to become familiar with the Early Care and Education provider training curriculum.

All TOT participants complete a pretest and post-test of breastfeeding knowledge. This information will facilitate evaluation of the efficacy of the TOT.

Trainers are expected to train 3-5 child care centers each. Trainers assist Early Care and Education providers with self-assessment and action plan development, conduct the two-hour in-person training, and provide follow-up assistance.

Materials have been updated based on a final review of the initial project and continue the color-coding by purpose:

  • Blue for Self-assessment
  • Purple for Child Care Program
  • Orange for All Families
  • Green for Breastfeeding Families

The materials and resources are designed for use by trainers and support people who work with early care providers, as well as by the early care and education providers.

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