Helping breastfed babies to thrive in day care

I have a small, home based day care for infants and toddlers.  Most babies begin coming here when they’re between three and six months old.  Almost all of them are nursing, but I make sure to tell moms to start introducing a bottle well before the time they start day care.  The problem is rarely the babies, it’s the parents. Sometime they don’t leave me enough expressed milk to last the day and they don’t want me to give their babies formula! I think it's good for babies to breast feed (I nursed my own two children) but I also need to be sure that they don't go hungry.  Do you have suggestions for me and the nursing moms?

Breastfeeding moms who can find a supportive child care provider are very lucky.  It takes a good partnership to assure that a nursing baby will get enough nourishment if he's not with his mother all day. If you are both supportive and knowledgeable about the best ways for moms to prepare for working and breastfeeding you may be able to avoid the type of situation that is frustrating you.

If a mom has to return to work when her baby is less than three months old, it can be especially difficult to build up an extra supply of milk.  During the first three months of a baby's life, his demand for milk is constantly increasing. Babies are gaining at least an ounce avery day!  A nursing mother will meet the baby’s needs by breastfeeding every few hours throughout the day and night, typically eight to ten nursing sessions in twenty-four hours.  In these early months, breastfeeding and caring for the newborn are a full-time job even without trying to find time to squeeze in time with a pump.  We are lucky that in the Bay Area resources are available for both general education and to help a mom with an individualized program.  Many women are successful in combining and nursing and working with young babies, but the balance between baby's need and mother's ability to produce milk needs to be carefully worked out. Bananas has an excellent parent handout on Breastfeeding and Working that you can download:  It can also be very helpful for moms of young babies to consult with a lactation specialist a few weeks before they are due to go back to work.

After the first few months, a baby who is well-established in his nursing patterns is likely to stretch his feedings out to every three to four hours. Many moms have an abundant milk supply and find expression of milk easy.  They may have a freezer full of milk long before their first day back at work.  Other moms find that they can be away from their babies for a work day and express enough milk during breaks for the baby to drink the next day.  Most lactation specialists recommend using an electric pump with "double-pumping" capability for maximum success when at work. Although the pumps are expensive, the cost is less than for formula and may be covered by insurance.  Because there are so many moms who are breast feeding it is often possible to purchase used pumps. If a mom begins expressing milk before returning to work she can still freeze a back-up supply of milk for days when the baby is especially hungry.

Some moms prefer to nurse the baby more frequently during the night and on weekends so that the baby actually turns around his schedule.  This plan can work well for a mom who can bring the baby to bed and sleep through the nursing times, but it is pretty tough if a mom has to wake up herself several times during the night. It can also make it harder for day care providers who aren’t always sure if a fussy baby is tired or hungry is he associates sleep with nursing!  There’s no one size fits all approach, but it makes sense to look at baby first rather than the feeding method. Otherwise a mom who is hoping to minimize bottle use can wind up with a baby who refuses to take one at all.

In order for a baby to accept a bottle of breastmilk or formula, he must learn very early to suck on an artificial nipple.  Most babies can start "practicing" on a daily bottle with an ounce of expressed breast milk when they are three to four weeks old.  The baby doesn't need to drink much--one ounce is plenty--but he needs to be comfortable with a different way of sucking.  Older babies are less adaptable and it is sometimes impossible to convince them to take a bottle if they've never had one.

When a nursing baby is left with a child care provider, it will be easier to care for him if the mom has nursed him at least once, preferably twice, that morning.  The mom should provide enough bottles of breast milk to cover each expected feeding time plus one.  For some babies it's a good idea to have the amount of breast milk for each feeding in two bottles so that if the baby falls asleep or isn't especially hungry he can finish the feeding later and the provider won't have to discard as much milk.  However, if a baby is consistently draining the bottle offered, start to gradually increase the amount.  It’s better if baby decides when he’s full rather than the adult deciding he’s had enough!

It's also ideal if mom can nurse her baby again as soon as they are reunited at the end of the day.  For this feeding to be successful, it's helpful if baby hasn't been fed for one to two hours before mom arrives.  However, if a baby is crying with hunger and a mom isn't there yet, a provider shouldn't be expected to withold milk.  Sometimes a hungry baby can be stalled off with a little water, but if this distraction doesn't work, the baby should be fed.  Not only is it unfair to make a hungry baby wait, it's destructive to a good relationship between the baby and his child care provider if his cry for feeding is ignored.

It's a lot of work to produce breast milk, and the fatigue of mothering, work, and lactation can be exhausting.  It’s important to be able to accept that a baby doesn't have to be completely breastfed to be healthy.  Even when a working mom is able to express enough breast milk for all of her baby's needs, she may want to use some formula supplementation. It isn’t a crime to be less than a purist! As a baby gets older, there are options beyond a milk feeding.  The caregiver can feed a four to six month old pureed foods such as fruits, vegetables, and baby cereals to hold him over between nursing times.  Once he’s eating “soupy solids”, a baby will be able to stretch out the periods between nursings even longer, reducing the pressure on mom to provide so much of his nourishment.  

Caregivers who want to be helpful to nursing moms will welcome her to sit down and nurse at the beginning and end of the day.  A comfortable chair and a glass of water will send the message, "I support you."  If a mom feels that you respect and admire her efforts to nurse, she'll also be willing to listen to any suggestions you make about the baby's care.  If you have concerns about baby "getting enough", talk to the mom about it at a time when the two of you can also talk about how she's feeling about combining her roles as mother and worker.  Breastfeeding provides a powerful an important link between mother and baby, and a mother who has to be separated from her baby may feel so sad that it is hard for her to hear any worries that the baby may need more milk than she can offer.  Breastfeeding doesn't have to be "all or nothing" and a mom who can talk through a difficult situation with a provider who cares about her and her baby will usually come up with a solution that works for everyone.