Childcare and the Breastfed Baby

Cute kid @Childcare Centre, Tokyo - Image credit: e_chaya on flickr

Image credit: e_chaya on flickr

Resources on childcare and breastfeeding for both moms and childcare providers.


Caregiver’s Guide to the Breastfed Baby by Anne Smith, IBCLC. There may be times when, for a variety of reasons, nursing mothers need or want to leave their nursing baby with a caregiver. This information is intended as a guide for the caregiver of a breastfed baby, so she/he can better understand how to care for the baby and the expressed breastmilk left for the baby’s use.

Supporting Breastfeeding in Child Care (PDF) from the Canadian Child Care Federation

Ten Steps to Breastfeeding Friendly Child Care Centers Resource Kit (PDF) – A resource kit from the state of Wisconsin to assist child care providers and community groups to implement strategies to promote, protect and support breastfeeding women.  The kit includes a self-appraisal tool and information and resources for planning and implementing action plan based on the ten steps.  Child care center staff can earn continuing education units.

Occasionally, a child care provider will tell mom that baby must switch to whole cow’s milk at a year old. This is due to a misinterpretation of USDA program rules. The USDA’s Child and Adult Care Food Program underwrites the cost of food and labor (for preparing and serving food) at day care centers for both children and the elderly, afterschool care programs, emergency shelters, etc. To keep their funding, businesses that participate in this program must follow certain guidelines when it comes to the foods that are served. After the age of 12 months, the USDA specifies that the child be fed whole milk (which the USDA assumes will be whole cow’s milk), but the FDA notes that “Breastmilk meets the requirement of a milk substitute and can be served to children over the age of 12 months.” Mom may need to have a note on file saying that she is providing expressed breastmilk for her child (a medical statement is not required), and the facility will need to document that the parent provided breastmilk (or any other foods) so they will get credit for having provided the proper foods even if they did not purchase all of them.

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CACFP Handbook: Independent Child Care Centers (May 2014)

For some breastfed infants who regularly consume less than the minimum amount of breastmilk per feeding, a serving of less than the minimum amount of breastmilk may be offered, with additional breastmilk offered if the infant is still hungry.

If a parent requires their toddler to receive breastmilk, is the meal reimbursable? Breastmilk meets the requirement of a milk substitute and can be served to children over the age of 12 months. The center must provide the other required meal components for the meal to be reimbursable.

DOH-CACFP: Policy Memo Number 162 – Fluid Milk and Milk Substitutes, Questions and Answers (02/12)

Can a parent request that their infant over 12 months of age continue to be fed breastmilk? Yes. Mothers who wish to continue providing breastmilk for their babies over 12 months of age can do so without having to submit a medical statement. Breastmilk is a substitute for cow’s milk in the meal pattern for children.

Feeding Infants: A Guide for Use in the Child Nutrition Programs

[from Chapter 3] Some parents may request that the caregiver continue feeding their babies breastmilk after 12 months of age. Continue to serve babies their mother’s milk as long as the mother is able and wishes to provide it. Mothers who wish to continue providing breastmilk for their babies older than 12 months of age can do so without having to submit a medical statement. Breastmilk is a substitute for cow’s milk in the meal pattern for children.

Milk Requirement-Child Nutrition Programs (1-24-95)

In addition to the types of milk mentioned above, breastmilk may be served in place of fluid milk in the Child Nutrition Meal Programs. Breastmilk may be served at meals, snacks, or other appropriate times throughout the day. Breastmilk should be properly identified and labeled with the child’s name and the date that the milk was collected. Breastmilk identified for a particular child should only be served to that child. Breastmilk should be stored and handled according to applicable federal and State guidance.


What can happen if a mother’s milk is given to the wrong child?

HIV and other serious infectious diseases can be transmitted through breastmilk. However, the risk of infection from a single bottle of breastmilk, even if the mother is HIV positive, is extremely small. For women who do not have HIV or other serious infectious diseases, there is little risk to the child who receives her breastmilk.”

– source: US Centers for Disease Control Breastfeeding FAQs

Misappropriated Human Milk: Fantasy, Fear, and Fact Regarding Infectious Risk by Barbara B. Warner, MD, FABFM and Amy Sapsford, RD, CSP, LD. (You may need to sign up for a free account at Medscape to view this.)

Are special precautions needed for handling breast milk?

“CDC does not list human breast milk as a body fluid for which most healthcare personnel should use special handling precautions. Occupational exposure to human breast milk has not been shown to lead to transmission of HIV or HBV infection. However, because human breast milk has been implicated in transmitting HIV from mother to infant, gloves may be worn as a precaution by health care workers who are frequently exposed to breast milk (e.g., persons working in human milk banks)…”

– source: US Centers for Disease Control Breastfeeding FAQs

“No special precautions exist for handling expressed human milk, nor does the milk require special labeling. It is not considered a biohazard. The Universal Precautions to prevent the transmission of human immunodeficiency virus (HIV), Hepatitis B virus, and other bloodborne pathogens do not apply to human milk.”

– source: US Centers for Disease Control

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