Lactation Accommodation, Breastmilk and Formula Feeding

 

 

Breastfeeding Accommodation in a Child Care Setting

Child Care Providers play an important role in nurturing successful feeding for infants in their care. Some mothers will choose to breastfeed. Support parents in how they feed their infant by partnering with them to ensure their child thrives. 

Supporting Moms in a Child Care Setting 

Have a quiet, private, and comfortable place for mothers to breastfeed when they come to pick up or drop off their child. Be sure to create agreements with parents about:

• Their child’s feeding schedule
• Whether or not they take formula or solids yet
• What to do if their child is hungry near arrival time
• What to do if there is no breast milk

Tips for Parents  

• Wash hands before expressing milk 
• Label milk with child’s name and the date/time it was pumped 
• Leave extra milk when possible 
• Store small amounts (2-4 ounces) 
• Freeze or refrigerate milk after pumping 
• ​Visit our Breastfeeding and Mother Friendly Breastfeeding Worksite​ pages for more information   

Child Care Provider Preparation and Handling of Breast Milk 

• Use food preparation areas
• Double check that bottles are appropriately labeled
• Defrost in either:
  • The refrigerator, or 
  • Under warm running water, swirling gently
• Never microwave bottles as a means to thaw
• Don’t leave out any bottles or cups or allow children to carry them around
• Breast milk should be immediately stored in the refrigerator upon the mother’s arrival at the child care program
• Frozen milk should be transported and stored in single-use plastic bags and placed in a freezer, either in a separate drawer or a stand-alone freezer
• Do not re-freeze after thawing
• Fresh bottles should be used for each feeding, parent and caretaker will need to decide who will be cleaning the bottles 
  • Bottles can be cleaned with soap and warm water or washed on the top shelf of the dishwasher

Child Care Provider Feeding of Breast Milk 

• Wash hands before and after feeding
• Use the oldest milk first
• Pay attention to the baby’s early hunger cues; don’t wait until they cry
• Allow time for burping
• Wash bottles after feeding if milk is fully consumed

Child Care Provider Disposal of Breast Milk 

• Fresh bottles with more than 1 ounce remaining may be returned to the mother at the end of the day as long as the child has not fed directly from the bottle
• Do not save milk from a used bottle
• Any milk that appears to be rotten or in an unsanitary bottle should be returned to the mother

Formula Feeding in a Child Care Setting

California Licensing Requirements on Formula Preparation

​Formula preparation regulations differ between Child Care Center-Infant Centers and Family Child Care Homes-

​​Child Care Center-Infant Centers:​

• If an infant's parent/representative provides the formula:
  • it must be prepared (measured and mixed with water) in bottles by the parent/representative before being accepted by the center
  • the Child Care provider may heat the bottle before feeding
  • If the center provides the formula:
    • it must be a commercially prepared formula
    • the brand of formula must be specified in the infant's feeding plan
    • the Child Care provider must store and prepare in accordance with label directions

​Family Child Care Homes:

• • Family Child Care Home providers may choose what type of formula preparation process to adopt:
    • infant's parent/representative can prepare bottles (either with measured formula amounts or already mixed with water)
    • infant's parent/representative can provide the commercial formula and the Family Child Care Home provider may store and prepare in accordance to label directions
    • the Family Child Care Home provider can provide and store the commercial formula and prepare in accordance to label directions

Child Care Provider Preparation and Handling of Infant Formula 

• Label formula containers used at the child care facility with the: 
  • Baby’s name 
  • ​Date it was brought to the facility
• Label bottles with the: 
  • Baby’s name 
  • ​Date and time the formula was prepared
• ​Powdered formula preparation: 
  • Pour heated water into the bottle followed by the appropriate scoops of formula
  • Let formula cool and ensure it is not too hot before feeding
  • If needed, place into an ice bath to cool; be sure water does not get into the bottle or onto the nipple 
  • ​Freshly prepared and unused formula can sit for a maximum of two hours before it needs to be refrigerated, except on warmer days, refrigerate immediately

Child Care Provider Storage, Feeding and Disposal of Formula 

• Anything left in the bottle that the baby does not finish should be discarded
  • If there is frequently leftover formula (more than ½ ounce), try preparing less
  • If hunger cues persist, add an additional ounce to the bottle
• If transporting the formula for any reason, the bottle should be stored in a cold pack or small ice chest

Resources

• Lactation Accommodation for Child Care Providers - lactation accommodation specific to Child Care Providers
• Support Breast Feeding in Child Care Settings - one-page handout on Breast Milk Storage & Handling, Feeding, and Support 
• Infant Formula Preparation and Storage - steps on how to prepare and store infant formula 
• Proper Storage and Preparation of Breast Milk - recommended techniques on the storage/preparation, thawing and feeding of breast milk
• Feeding My Baby - breastfeeding, formula feeding, and starting solid foods
• Be a Champion for New Mothers - more about the benefits of breastfeeding and best practices for family child care or early education centers 
• How to Bottle Feed the Breastfed Baby - tips and resources for bottle feeding of breastmilk
• Tips for Freezing & Refrigerating Breast Milk - Rule of 4's Guideline Table: Countertop, Refrigerator, Freezer, and Deep Freezer

References:

CDPH—website California Department of Public Health

CDC—website Center for Disease Control

WIC— Feeding My baby

AAP—Tips for Freezing & Refrigerating Breast Milk