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Breastfeeding, chestfeeding, human milk, and formula

Child care providers play an important role in nurturing successful feeding for infants in their care. There are many ways to feed a baby, whether that is breastfeeding, chest feeding, bottle-feeding, pumping, formula, or some combination of all these methods. Support parents in how they feed their infant by partnering with them to ensure their child thrives.

Benefits of human milk

  • A good source of nutrition for most babies.
  • Can help protect babies against some illnesses and diseases.
  • Promotes immune system and brain development.
  • Reduces the risk for Sudden Infant Death Syndrome (SIDS)
  • Breastfeeding or chest feeding provides warmth and closeness between parent and child helping create a special bond.
  • A birthing parent who breastfeeds or chest feeds recover faster following a delivery than those who do not.
  • Breastfeeding has been shown to reduced the risk of developing breast and ovarian cancer.
    Supporting Breastfeeding / Chestfeeding in a Child Care Setting

    The decision to continue breastfeeding, chest feeding or giving human milk to a child while in daycare is a personal decision for parents. Sometimes a parent cannot breastfeed or chestfeed and putting pressure could make them anxious or depressed. Offer to help find a feeding solution that meets their baby’s nutritional needs and supports the parent’s well-being. Childcare centers and staff should remain supportive and non-judgmental regardless of a parent’s decision.

    Some steps childcare providers can take to support parents:

    • Take trainings that help you better understand the benefits of breastfeeding, chest feeding or offering human milk and how to support parents. In addition, learn the proper handling and storing of human milk and feeding techniques.
    • Have a quiet and comfortable space for a parent to breastfeed, chest feed or pump.
    • Work closely with parents on how best to feed their infant at daycare and offer support, information, and guidance, as necessary.
    • Discuss barriers and challenges with families. Recognize the demands on families and help them find strategies in making the healthiest choices for their children.

    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 more human 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 to 4 ounces)
    • Freeze or refrigerate milk after pumping.
    • Share our Public Health Breastfeeding resource webpage.
    • Learn how to be a friendly breastfeeding or chest feeding worksite through the Family Friendly Workplace Certification (FFWC) Program.
    Child Care Provider Preparation and Handling of Human Milk

    Following recommended storage and preparation techniques can maintain the safety and quality of expressed breast milk for the baby’s health.

    Preparation and handling of breast milk

    • Use food preparation areas.
    • Double check that bottles are appropriately labeled.
    • Do not leave out any bottles or cups or allow children to carry them around.
    • Human milk should be immediately stored in the refrigerator upon the parents arrival at the childcare 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
    • Fresh clean 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.
    • Do not store breast milk in the door of the refrigerator or freezer. This will help protect the breast milk from temperature changes from the door opening and closing.

    Thawing human milk

    • Always thaw the oldest breast milk first. Remember first in, first out. Over time, the quality of breast milk can decrease.
    • There are several ways to thaw your breast milk:
      • In the refrigerator overnight.
      • Set in a container of warm or lukewarm water.
      • Under lukewarm running water.
    • Never thaw or heat breast milk in a microwave. Microwaving can destroy nutrients in breast milk and create hot spots, which can burn a baby’s mouth.
    • If you thaw breast milk in the refrigerator, use it within 24 hours. Start counting the 24 hours when the breast milk is completely thawed, not from the time when you took it out of the freezer.
    • Once breast milk is brought to room temperature or warmed, use it within 2 hours.
    • Never refreeze breast milk after it has thawed.

    Child Care provider feeding of human milk

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

    Child Care provider disposal of human milk

    • Fresh bottles with more than 1 ounce remaining may be returned to the mother at the end of the day if 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.
    Human Milk Storage Guidelines

    Chart displaying human milk storage guidelines

    Learn more about proper storage and preparation of human milk from the CDC.

    Formula Feeding in a Child Care Setting

    California licensing requirements on formula preparation

    ​Formula preparation regulations differ between child care centers, infant centers and family child care homes.

    ​​Child care centers or infant centers:​

    • If an infant's parent or 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 or representative can prepare bottles (either with measured formula amounts or already mixed with water).
      • Infant's parent or 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 childcare 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 half an 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.
    Relevant Evidenced Based Practices and Regulations

    Caring for Our Children (CFOC) - A collection of national standards that represent the best practices, based on evidence, expertise, and experience, for quality health and safety policies and practices for today’s early care and education settings.

    UCSF Child Care Health Program - Trains professionals on health and safety issues related to early care and education settings, supports a statewide childcare health consultation network, and conducts research.

    Child Care Center Regulations, Title 22, Division 12 – Manual of Polices and Procedures from Community Care Licensing Division.

    Family Child Care Home Regulations, Title 22, Division 12, Chapter 3 - Manual of Polices and Procedures from Community Care Licensing Division.

    Resources

     

    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 

     

    Child Care Health Consultant

    East Valley Public Health Department
    1993-B McKee Road
    San Jose, CA 95116

    Child Care Health Consultant: (408) 937-2253
    MCAH Mainline: (408) 937-2250
    Email: [email protected]

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