Supporting Breastfeeding in Child Care Programs During Epidemics

During epidemics, child care programs work hard to ensure the health and safety of the children and families they serve while also continuing to provide high-quality care. This resource can serve as a guide to modify existing policies and procedures to ensure ongoing, safe breastfeeding practices in childcare programs during epidemics and other infectious disease occurrences.

Rationale for Breastfeeding

Research has shown that there are many benefits of breastfeeding, both for mothers and infants. According to the Centers for Disease Control and Prevention (CDC) Breastfeeding Recommendations and Benefits web page, “Breast milk is the best source of nutrition for most babies. Breastfeeding can also help protect mother and baby against some short- and long-term illnesses and diseases” (para. 3).

The CDC web page also lists the following benefits for babies: 

Babies who are breastfed have a lower risk of: 

•  Asthma.
•  Obesity.
•  Type 1 diabetes.
• Severe lower respiratory disease.
• Acute otitis media (ear infections). 
• Sudden infant death syndrome (SIDS). 
• Gastrointestinal infections (diarrhea/vomiting). (para. 4)

 The CDC web page also lists the following benefits for mothers:
 Mothers who breastfeed their babies have a lower risk of:

•   Breast cancer.
•   Ovarian cancer.
•   Type 2 diabetes. 
•   High blood pressure. (para. 5)

Breastfeeding in Centers and Family Child Care Programs During Epidemics.

During epidemics, it is important that child care centers and home-based child care providers continue to support breastfeeding of infants when families prefer this method of feeding their children. There is health and safety guidance in “Standard 4.3.1.1: General Plan for Feeding Infants,” (p.174) which is in the fourth edition of Caring for Our Children: National Health and Safety Performance Standards Guidelines for Early Care and Education Programs. In addition, programs should follow CDC and local guidance regarding allowing visitors, including family members, into the facility, and may consider strategies that support continuation of breastfeeding. The American Academy of Pediatrics (AAP) suggests these strategies on its Guidance Related to Childcare During COVID-19 web page:

• Create lactation rooms or private spaces with a comfortable chair and pillow (with disposable or washable covers), flat surface for a breast pump, easy access to electrical outlets and a sink with soap and disposable towels to wash hands and rinse pump parts. 
•  Ask the mother to properly label and leave her pumped milk in the private space. A staff member should transport the milk for proper refrigeration and storage. The milk should still be stored according to recommendations in Caring for Our Children.
• If a program decides to allow a mother to breastfeed her baby during program hours (in place of pumping and storing milk), a staff member from the classroom environment should bring the infant to the mother in this separate space to feed her child and carry the infant back to the classroom.
• The private lactation space should have adequate ventilation bringing fresh air in and indoor air outside. 
• All furniture, equipment, surfaces, doorknobs, light switches, faucets (and other high touch areas) in these rooms should be cleaned and disinfected after each use. Chair and pillow covers should be removed, replaced, and washed. Soft, porous items are not easily cleaned and should be limited to a chair and pillow. (AAP Supporting Breastfeeding Mothers section)

Creating a Plan

When developing a plan to support breastfeeding and help mothers feel welcome, consider these questions:

• What will be the process for mothers to schedule times? 
•  What will be the process for safe entry into the program? 
  •    Will you have a health questionnaire/attestation? 
  •    Will you take a temperature?
  •    Is there a handwashing sink near the entry, or will hand sanitizer be supplied? 
  •    Are there masks available if needed?
•  Where will mom and baby be during feeding?
  • Is there a private place for mothers to use? 
  • Is there a handwashing sink available for mom and baby before and after feeding? 
  • Who will ensure the space has been thoroughly cleaned before and after use? 
  •  Who will bring the child to the mother?
• What will be the process for departure?
  •  How will mom let you know she is ready to leave?
  •  Who will bring the baby back to classroom/escort mom out of facility? 
  •  Will mom or staff ensure baby’s hands are washed?

Additional Resources about Breastfeeding

• The Colorado Department of Public Health and Environment offers the Breastfeeding and Child Care web page, which includes general guidance on supporting breastfeeding in both center and family child care programs. Note that this resource is not specific to COVID-19.
•  CDC offers information on COVID-19 and breastfeeding on the Pregnancy, Breastfeeding, and Caring for Newborns web page. Note that this information is not specific to child care
• The Kansas Breastfeeding Coalition, Inc. offers the Information and Resources for COVID-19 and Breastfeeding web page, which includes information about breastfeeding hotlines in Michigan, Ohio, and Oklahoma as well as resources for help with breastfeeding in Kansas. 
• The Michigan Breastfeeding Network offers Guidance for Child Care Centers on Safe Storage and Handling of Breast Milk during the COVID-19 Pandemic. 
• The United Nations Children’s Fund (UNICEF) offers Breastfeeding during COVID-19 Pandemic: Tips on Keeping Your Baby Healthy and Safe web page.
• United States Breastfeeding Committee offers the web page Infant and Young Child Feeding in Emergencies, Including COVID-19. This resource includes several links to websites about breastfeeding. Note that this resource is not specific to child care.