It is vital that you choose a care provider that understands how important breastfeeding is to you and who is willing to be supportive of your efforts to continue to breastfeed. Whether you choose the CDC, private daycare, home daycare or a nanny, they may not understand just how much their support can make or break your efforts to be successful, so feel free to explain how much breastfeeding means to you and how they can help. When you are interviewing care providers ask whether they have breastfed their own children or cared for other breastfed babies. If they haven’t, are they comfortable with handling breastmilk and coping with breastfed baby behaviors? Are they encouraging and make you feel normal or do they think it is weird or gross? Do they seem receptive to learning more about breastfeeding and willing to go along with your requests? Once you have chosen your care provider you’ll want to go over the basics of breastfeeding, breastfed baby behavior and handling of breastmilk with them. Give your provider a copy of the handout Childcare Tips which discusses the following concepts:
- Discuss with your caregiver your need to breastfeed your baby at both drop-off and pick-up times in order to help maintain your milk supply. Ask whether they use their own bottles or the ones you provide (and be prepared to request that they use the ones you have chosen). Also find out if your caregiver will allow you to keep a small amount of frozen breastmilk in their freezer for emergencies in addition to the breastmilk that you provide every day. Be sure to go over the storage and handling of breastmilk, in particular the storage times, and how to properly thaw frozen milk. It doesn’t hurt to explain that breastmilk looks very different from formula or cow’s milk and that it separates. You might want to also explain the difference in breastfed versus formula stools so that your caregiver is not concerned at the appearance or odor.
- Caregivers tend to like to feed babies on a schedule, but breastfed babies don’t do schedules. Breastmilk digests quicker than formula so your baby may want smaller and more frequent meals. Do they know what cues to look for that your baby is hungry (rooting, gnawing on fists) and that crying is a late sign of hunger? Make sure that your care provider understands and is willing to feed your baby whenever he is hungry. Just like adults, sometimes your baby will want just a snack; other times he’ll want the whole four-course meal. If your baby is fussy (and has just been fed) will your care provider be willing to hold or carry him, possibly even in a sling, to soothe him? On the flip side, be sure that your caregiver will hold your baby at times other than feedings so he doesn’t associate feeding with the only time he gets held.
- Explain how to properly bottle-feed your baby so that your breastfeeding relationship stays intact. Teach your caregiver how to do ‘paced bottle-feeding’ which begins by holding your baby in an upright position and stroking his upper lip with the bottle. The caregiver needs to wait for him to open his mouth widely and then allow him to ‘accept’ the bottle. Do not force or push the bottle in his mouth. Your caregiver should mimic breastfeeding by encouraging plenty of pauses after each 25-30 sucks, as this mimics your let downs and helps prevent nipple preference. The bottle should be held level throughout the feeding and your baby should be burped after every ounce. It is important that he be switched from one side to other midway through the feeding much like when he is breastfed. Feedings should last about 10-20 minutes which also mimics the usual breastfeeding experience by allowing his stomach to feel full. It also discourages guzzling and overfeeding (see below).
- Overfeeding is a major concern, as too many bottles at daycare can make your baby so full that he doesn’t want to nurse at home with you (leading to a lowered milk supply), it increases colic and fussiness (due to an over-full stomach), and makes it much harder for you to be able to keep up with the demand for expressed milk (which often leads to weaning). Be sure to go over how much to feed your baby with your caregiver. It can be tricky trying to figure out how much to give your baby, but it is determined in part by weight and age. Here is a quick way to estimate how much your baby is likely to take at each feeding: Multiply your baby’s weight by 2.7 and then divide by how many times he eats in 24 hours. That number is about how many ounces he’ll need at each feeding for the first few months. This isn’t foolproof, your baby may take more or less, but it does give you a starting point.
- Remind your caregiver that your baby is in charge of how much he eats. Babies are great at regulating how much food they need. There is no need to make him finish the bottle (you don’t make him finish the breast), when he is done, he is done. By forcing him to finish a bottle your caregiver is ignoring his cues, overfeeding him and contributing to possible obesity in the future. Again, it is all about paying attention to the cues he is giving. If he turns his head away, closes his mouth, or is drowsy and releases the nipple; he is telling the caregiver he is finished. Stress that the caregiver is not to force the nipple into his mouth, massage his throat or reawaken him to finish the bottle. If there is milk left in the bottle you can explain that due to breastmilk properties it is okay to save the milk and re-use it for the next feeding, if it is within a few hours. Repeated bottles that are not finished may signal a need to reevaluate how pumped milk much to send.
- Explain growth spurts and how to manage them by feeding him extra from your frozen stockpile, and how important it is that your caregiver keeps track of how much he eats so you know how much to pump. You should also cover what to do if you’re unable to pump enough for a feeding, or the caregiver runs short of frozen milk to add to the freshly expressed milk your have left. There are two options, your caregiver can add formula to the bottle of expressed milk equal to the amount your baby would eat, however keep in mind that it all must be thrown out if it is not finished (potentially wasting breastmilk). If you would rather that no breastmilk go to waste you can ask that your caregiver give the breastmilk first and then offer a bottle of formula as a top off.
If your baby is being cared for at the base or post Child Development Center (CDC), be aware that once your baby is 12 months old, they may tell you that you can no longer bring in breastmilk. This ‘policy’ varies from base to base and is not enforceable although it happens frequently. This requirement stems from the fact that the CDCs are reimbursed for the food that they provide to the children in their care via the USDA. When you bring in breastmilk the CDC cannot feed your child the provided cow’s milk and hence do not get reimbursed. Some CDCs are also unaware of the benefits of breastmilk past the age of 12 months and will tell you that breastmilk is not nutritionally complete. Some ways to get around this include bringing in a note from your pediatrician stating that your child is to receive breastmilk, and bringing in a copy of the American Academy of Pediatrics Policy Statement on Human Milk that outlines the need for breastmilk “for at least 12 months and thereafter as long as mutually desired.” You can also provide your caregiver with this pamphlet, written from the point of view of a breastfeeding baby, on why breastmilk is important how to properly bottle-fed a breastfed baby (thanks to the NAS Whidbey Island WIC office for permission to use it). In addition, this blog post at Lactation Matters, has many more resources and a great explanation for why daycare centers continue to require breastfeeding infants and toddlers to switch to cows milk at 12 months of age.
Finally, it is very important that you and your caregiver have good communication with one another. Whether verbal or written, be sure that you review your baby’s eating, sleeping, elimination and behavior with your caregiver every day. This will help you determine how to pump and send and your caregiver how much to feed, as well as how your baby is doing.