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Infant Feeding in the First 30 Days of Life Families Grow Healthy with WIC.

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Presentation on theme: "Infant Feeding in the First 30 Days of Life Families Grow Healthy with WIC."— Presentation transcript:

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2 Infant Feeding in the First 30 Days of Life Families Grow Healthy with WIC

3 Logistics Lunch Restroom Breaks

4 Families Grow Healthy with WIC Please open your folder Folder Information

5 Families Grow Healthy with WIC  Please pull out the objectives for today and spend a few minutes reviewing.  Throughout today we will revisit these objectives to “chart our route to our final destination ”. Objectives

6 Families Grow Healthy with WIC 1. Welcome and Warm Up Activity 2. Review of Objectives & Agenda 3. Review of Healthy Habits Begins at Birth 4. Breastfeeding Support Policy 5. Review of Counseling Skills 6. Morning Break 7. Baby Behavior Skills 8. Baby Nutrition Questions Form Morning Agenda

7 Families Grow Healthy with WIC 9. Lunch and Physical Activity 10. Infant Feeding Choices 11. Afternoon Break 12. Infant Feeding Choices Continued 13. Next Appointment 14. That reMinds me – Idea 2B Used 15. Questions & Answers 16. Trainers’ Gathering Afternoon Agenda

8 Families Grow Healthy with WIC Think about a positive experience you have had supporting a WIC Mom’s feeding choice… Share with a partner Sharing Successes

9 Families Grow Healthy with WIC Materials & Toolbox

10 Families Grow Healthy with WIC Roadmap to Infant Feeding

11 Families Grow Healthy with WIC Prenatal Education

12 Families Grow Healthy with WIC Keys to Success  From local agencies that have already implemented “no formula in the first 30 days”  Lessons learned  14 years/few months  Many say “it’s not as hard as we thought”  That reMinds Me….

13 Families Grow Healthy with WIC  Provide breastfeeding education to prenatal women at each visit.  Include a reminder that no formula will be issued in first 30 days. Result: Less mothers are asking for formula after delivery. Keys to Success

14 Families Grow Healthy with WIC Earn healthy bucks for correct answers. Healthy Buck = Raffle Ticket Raffle at end of the day. $ Write your name on the back.$ $ Place your healthy bucks in box. Earn Healthy Bucks

15 Families Grow Healthy with WIC

16 Healthy Habits Begin at Birth Focused on pregnant, postpartum and breastfeeding women and infant participants Helped staff become more familiar with food package changes  Promoted and support breastfeeding  Ensured appropriate formula feeding

17 Families Grow Healthy with WIC Work as a table Write answers on Quiz When complete – Raise Hand 1 st TWO tables to get ALL questions CORRECT will get Healthy Bucks! Questions in Envelope Let’s Play Cash Cab

18 Families Grow Healthy with WIC Let’s Play Cash Cab

19 Families Grow Healthy with WIC HHBB Review (H ealthy H abits B egin at B irth ) 1. Beginning in October, fully breastfed babies on WIC will receive twice the amount of baby fruits and vegetables as other babies from age 6 to 12 months. Answer: True 64 (4-ounce jars per month) vs. 32 (4-ounce jars per month)

20 Families Grow Healthy with WIC HHBB Review 2. Beginning in October, a mom who is breastfeeding and receiving more than half of the full formula package for her baby can receive a food package until ____ months postpartum. Answer: 6

21 Families Grow Healthy with WIC 3. Beginning in October, an 8 month old baby on WIC who is fully formula fed will receive more formula than WIC currently provides. Answer: False Baby will receive LESS formula ------ 7 cans powdered formula vs. 9 cans WIC currently provides HHBB Review

22 Families Grow Healthy with WIC 4. To make plenty of breastmilk in the first month, breastfeed often, at least ____ times in 24 hours. Answer: 8 HHBB Review

23 Families Grow Healthy with WIC 5. It’s great for a baby to learn to hold her bottle on her own. Answer: False Babies should be HELD for bottle feeding! HHBB Review

24 Families Grow Healthy with WIC 6. After the first week, a baby should have ____ wet diapers a day. Answer: 6 to 8 HHBB Review

25 Families Grow Healthy with WIC 7. Beginning in October, WIC will not routinely provide formula for breastfed babies in the first month because giving formula interferes with breastmilk production. Answer: True HHBB Review

26 Families Grow Healthy with WIC

27  Invite prenatal and postpartum mothers to attend a breastfeeding support group. Result: Mothers learn about & see other women breastfeeding. They see that a support system is available for them. Keys to Success

28 Families Grow Healthy with WIC Move Taxi to On Roadmap Breastfeeding Support

29 Families Grow Healthy with WIC How can you support your Breastfeeding Moms?  Breastfeeding Support Policy 1. Supporting fully and combination breastfeeding moms 2. Conducting complete assessment 3. The second month appointment Breastfeeding Support

30 Families Grow Healthy with WIC Policy Review Keep In Mind  This is just one step in supporting breastfeeding.  State WIC is requiring 20 hours of breastfeeding training for all WIC staff (by 2011).  This policy meets the new federal regulations. You can still influence the final rule by sending in your comment to USDA by February, 2010.

31 Families Grow Healthy with WIC Breastfeeding Support Policy Supports breastfeeding mothers and babies by not routinely issuing formula during the first 30 days because formula:  interferes in the development of full milk production, and  decreases the chances that a mother will continue breastfeeding.

32 Families Grow Healthy with WIC WIC is committed to:  Providing timely counseling and education  Scheduling of a second month appointment  Additional incentives based on Institute of Medicine recommendations Breastfeeding Support Policy

33 Families Grow Healthy with WIC Conducting Complete Assessment The Components:  Dialogue with Mom Baby Nutrition Questions ISIS Questions Counseling Questions Breastfeeding Support Policy

34 Families Grow Healthy with WIC The Second Month Appointment  A follow up breastfeeding assessment and counseling by a lactation specialist  Local agencies established procedures and protocols for the second month appointment based on the Breastfeeding Policy 600XXX Breastfeeding Support Policy

35 Families Grow Healthy with WIC How comfortable do you feel about implementing the policy in your agency? ON A SCALE OF 1 to 10 Who says 1, 2, or 3? Who says 4, 5, or 6? Who says 7, 8, 9, or 10 ? Breastfeeding Support Policy

36 Families Grow Healthy with WIC Breastfeeding Support Policy Research: More moms are breastfeeding their babies until 1 year of age How can we best support a combination breastfeeding dyad?

37 Families Grow Healthy with WIC Let’s Define:  Who is a Lactation Specialist?  “not routinely issuing formula” Breastfeeding Support Policy

38 Families Grow Healthy with WIC Who is a lactation specialist? Any staff who have >20 hours of breastfeeding education and training CLE, IBCLC, CLC, RDs, PCs Your agency will designate a lactation specialist based on your definition Breastfeeding Support Policy

39 Families Grow Healthy with WIC “…not routinely issuing formula during the first 30 days”  “not routinely” not habitually, not in an expected or customary manner not generally Breastfeeding Support Policy

40 Families Grow Healthy with WIC Reasons for issuing formula:  USDA interim regulation states, “not routinely issuing formula”  There will be moms who will ask for formula  Anticipating gradual change  Value in data collection Breastfeeding Support Policy

41 Families Grow Healthy with WIC  Have your Registered Dietitians see postpartum women for infant enrollment. Results: Participants not asking for formula due to prenatal education. WNAs want to see postpartum mothers. Keys to Success

42 Families Grow Healthy with WIC Roadmap to Infant Feeding Move Taxi Cab to “Tune-Ups”

43 Families Grow Healthy with WIC Breastfeeding Support Policy # 1 Part One:  Supporting Fully and  Combination Breastfeeding Moms How are we going to support our breastfeeding moms?

44 Families Grow Healthy with WIC Table Toolbox Toolkit # 1 Counseling Skills

45 Families Grow Healthy with WIC 3 Step Counseling Overview The Dance of Dialog

46 Families Grow Healthy with WIC The 3-Step Strategy A way to talk with mothers about breastfeeding to help them overcome challenges. 3-Step Strategy: 1. Ask open-ended questions 2. Affirm her feelings 3. Educate

47 Families Grow Healthy with WIC Step 1: Open-Ended Questions Open-Ended Questions:  Many answers  Find out what the mother “thinks”  Start a conversation  Start with “What” or “How” “What do you know about Breastfeeding?”

48 Families Grow Healthy with WIC Avoid Closed-Ended Questions Closed-ended questions: “Yes”, “No” or very short answers Don’t encourage a mother to share her thoughts Many begin with “do” “Do you plan to breastfeed?”

49 Families Grow Healthy with WIC Open or Closed Ended? What does that feel like? Where do you live? What time is it? How do you feel about that? Is he still in the house? What’s a good plan for you? Closed Open Closed Open Closed Open

50 Families Grow Healthy with WIC Open-Ended Questions Review list of open ended questions Circle questions that might be helpful

51 Families Grow Healthy with WIC Need to Know More? Don’t understand what the mother is thinking… There are ways to get more information:  Extending  Clarifying  Reflecting

52 Families Grow Healthy with WIC Getting More Information Extending questions help you get more information. For example:  Could you tell me a little more about that?  What else can you tell me about breastfeeding?  When you say breastfeeding hurts, could you tell me a little more about that?

53 Families Grow Healthy with WIC Clarifying questions find out what she really means. For example:  When you say that it would be uncomfortable, are you saying it would be uncomfortable for you, or for someone else who might see you?  When you say it hurts, are you saying it hurts the entire time you are breastfeeding? Getting More Information

54 Families Grow Healthy with WIC Reflecting shows her you understand what she said; often we use statements. For example:  So you think your mother doesn’t want you to breastfeed  So you feel uncomfortable breastfeeding in front of your family  So you feel your baby is still hungry after you feed her Getting More Information

55 Families Grow Healthy with WIC Helpful hints  Using mother’s name  Repeating her own words  Adding extra words “Why not?” vs. “Margie, can you tell me about why you don’t think that’s a good idea?” Getting More Information

56 Families Grow Healthy with WIC Pull out the “Ways of Getting More Information” activity sheet. In pairs or trios, think of ways you could get more information after a mother says the statement on the sheet. Write extending or clarifying questions or reflective statements for these statements made by mothers. Getting More Information

57 Families Grow Healthy with WIC Step 2: Affirm Her Feelings Figure out what a mother is concerned about… Affirm her feelings Feelings are normal & okay Shows respect Builds confidence Feels “safe” to open up & listen to ideas

58 Families Grow Healthy with WIC Affirming Statements  “I’ve heard a lot of women say that.”  “That’s a pretty common reaction or belief.”  “I felt that way too.”  “My mother told me the same thing.”  “Most women go through a period like that after the baby is born.”  “I can tell you are a concerned mom and want the best for your baby.”

59 Families Grow Healthy with WIC Activity: Affirm Her Feelings Pull out the page titled “Affirming Activity”. In pairs or trios, read the statements & write affirming responses.

60 Families Grow Healthy with WIC Step 3: Educate Only share information related to her concerns or questions Give information in small amounts Have repeated conversations

61 Families Grow Healthy with WIC Explore/Offer/Explore  Explore before giving information: Ask what she already knows or does  Offer information  Explore their reaction after giving information  How can you use this information?  How might this work for you?  What do you think about this?

62 Families Grow Healthy with WIC Activity: Putting it All Together Read the 2 conversations In pairs or trios discuss the following: What did the counselors do well? How could the counselors improve?

63 Families Grow Healthy with WIC

64 Table Toolbox Toolkit # 2 Education Materials

65 Families Grow Healthy with WIC THINK to yourself: Which of these materials do you currently use? Which ones would you like to use in the future? Education Materials

66 Families Grow Healthy with WIC Baby Behavior Study What does my baby need? Why is he always crying? Is it normal for her to wake up 4 times a night? How can I tell if she is hungry? Why can’t I calm him down?

67 Families Grow Healthy with WIC Study Messages on Cues Babies can tell moms what they want by using their bodies and noises – cues. Babies are not always hungry when they cry. Learning your baby’s cues and how to respond will make you both happy.

68 Families Grow Healthy with WIC Results - Baby Behavior Study All Sites Combined : More exclusive Breastfeeding Food Packages selected.  Intervention = 43.6%  Control = 16.5% Less formula given:  3.4% reduction in Formula Feeding  7% reduction in distribution of cans of formula while caseload increased 3.6% This project has been funded at least in part with Federal funds from the USDA, Food & Nutrition Service.

69 Families Grow Healthy with WIC Baby Behavior Misunderstanding their baby’s behavior was the reason many of the mothers we talked to: Stopped breastfeeding Gave too much formula and ran out Gave solid foods too early Gave unhealthy foods to their babies

70 Families Grow Healthy with WIC Inappropriate feeding may lead to overweight. Parents want to know more about their baby! Baby Behavior

71 Families Grow Healthy with WIC Moms believe babies:  cry because of hunger,  wake because of hunger, and  that formula and cereal will prevent this. They think their babies will stay full longer if they are overfed. Mothers are pressured by others to feed. Focus Groups (2003) Baby Behavior

72 Families Grow Healthy with WIC Parents need tools to help them believe they can handle their infants’ crying and waking behavior without overfeeding. Glanz J Occup Med 1992; 34: 1071-8. Baby Behavior

73 Families Grow Healthy with WIC

74 Infant “States” Group of behaviors that occur together: NCAST Keys to Caregiving  Body movement BODY EYES BREATH  Eye movement  Breathing (fast or slow)  How much they respond

75 Families Grow Healthy with WIC Crying Irritable Quiet Alert Drowsy Active Sleep Quiet Sleep Increasing intensity Baby “States”

76 Families Grow Healthy with WIC Crying Tears Jerking motions Responds slowly to comforting measures Color changes Tight muscles Rapid breathing

77 Families Grow Healthy with WIC Common before feeding Irritable Lots of body & facial movement Eyes open but may not want to interact Sometimes fussy Sensitive to what’s going on inside & outside their bodies

78 Families Grow Healthy with WIC Requires effort to control! Quiet Alert Little body movement Eyes open and wide Steady, regular breathing Highly responsive Wants to learn and play Can be tiring for young babies

79 Families Grow Healthy with WIC Easily startled Drowsy Variable movement Irregular breathing Opens and closes eyes Eyes glazed Takes time to react

80 Families Grow Healthy with WIC Active Sleep Moves every now & then Breathing pattern changes Facial twitches Rapid Eye Movement (REM) Easy to wake

81 Families Grow Healthy with WIC Hard to wake Quiet Sleep No body movement Rhythmic breathing Bursts of sucking Startles but does not wake Does not respond

82 Families Grow Healthy with WIC Healthy infants will try to control their own state and give cues to “tell” others what they need. Adapted from: NCAST Keys to Caregiving Help Baby Control State Caregivers can play an important role in helping infants feel comfortable and safe.

83 Families Grow Healthy with WIC To awaken use variety Use different positions, touch, words Will take longer if very drowsy or in deep sleep Can take longer for very young infants Helping Baby Change States To soothe use repetition Addresses the baby’s needs Repeat actions or words over and over May take time if infant is very upset Change in position or situation might help

84 Families Grow Healthy with WIC Infant Cues Two types of cues  Engagement  Disengagement

85 Families Grow Healthy with WIC Interactions will have both types of cues, caregivers need to look for pattern. Kelly et al. Promoting First Relationships, NCAST Pub 2003 Types of Infant Cues Engagement “Near You” cues: Young infants try to tell caregivers when they want to interact  Disengagement “Need a break” cues: Young infants try to tell caregivers when they need to “take a break” or do something different.

86 Families Grow Healthy with WIC Let’s Play WIC Cash Cab

87 Families Grow Healthy with WIC Let’s Play Cash Cab GET READY TO RAISE YOUR HAND!

88 Families Grow Healthy with WIC Disengagement / Crying What Cue? What State?

89 Families Grow Healthy with WIC Engagement --- Quiet Alert What Cue? What State?

90 Families Grow Healthy with WIC Disengagement / Quiet Sleep What Cue? What State?

91 Families Grow Healthy with WIC Disengagement --- Drowsy What Cue? What State?

92 Families Grow Healthy with WIC Disengagement --- Irritable What Cue? What State?

93 Families Grow Healthy with WIC Understanding Baby Cues K ey Messages Babies show their parents what they need with cues. Babies let you know when they want to be with you or need a break.

94 Families Grow Healthy with WIC Infant Sleep Patterns

95 Families Grow Healthy with WIC Babies wake often in the first few months. Babies need to dream and wake up to be healthy. Babies wake less often as they get older. Messages on Infant Sleep

96 Families Grow Healthy with WIC Whole Group: How many times on average do babies wake up at night (10pm – 6am)? At 2 mo? _______ At 4 mo? _______ At 6 mo? _______ Your Turn

97 Families Grow Healthy with WIC Average waking at night is: Peirano et al. J Pediatr 2003; 143: 70-9. Average Night Waking Babies wake when sick, uncomfortable, or because of a change of routine. Too much waking is stressful and should be investigated (before infants are switched from breastfeeding to formula).  2-3 times by 2 months  2 times by 4 months  1 time at 6 months

98 Families Grow Healthy with WIC AS QS Wake Starts in active sleep Infants sleep 13-14 hrs. per day from 2-12 Mo. (but not all at once!) They spend equal time in active & quiet sleep. Babies sometimes wake up because moms put them down in Active Sleep. Newborn Sleep Cycle Quiet Sleep

99 Families Grow Healthy with WIC At 2-3 months, infants begin with shorter Active Sleep cycles then move into Quiet Sleep QS Wake AS QS Sleep Cycle of 2-Month Old Moms might find it’s easier to put baby down to sleep …

100 Families Grow Healthy with WIC QS Fall asleep in Quiet Sleep and sleep more like mom and dad. QS AS QS Much easier to put baby down to sleep… Sleep Cycle of 4+ Month-Old Wake

101 Families Grow Healthy with WIC As they mature, infants can link cycles together. (won’t require caregiver with every cycle) So, infants will sleep longer and will not be as easy to wake as they get older. Peirano et al. J Pediatr 2003; 143: 70-9. Infant Sleep Patterns

102 Families Grow Healthy with WIC Active Sleep (REM) is important for brain development.  Babies dream and blood flows to the brain bringing nutrients to active brain cells  Images stimulate brain function Quiet sleep is deep sleep, no dreaming or movement, important for the brain to rest. Peirano et al. J Pediatr 2003; 143: 70-9. Infant Sleep State

103 Families Grow Healthy with WIC Peirano et al. J Pediatr 2003; 143: 70-9. Waking & Active Sleep Beneficial for Mother & Baby. Waking and Active sleep are important for the brain development of the baby. Waking may be essential to survival—needs must be met for breathing, feeding, warmth. Breastfeeding mothers’ hormonal cycles are interrupted by night feeds, not having periods may lower risk for hormone related cancers.

104 Families Grow Healthy with WIC Breastfed infants wake more than formula-fed infants and:  Spend more time in Active Sleep  Digest breast milk more quickly o best for growth & development Formula-feeding moms can promote Active Sleep by putting babies “back to sleep” and using pacifiers. Horne et al. Ped Resp Rev 2004; 5: 190-8. Infant Feeding & Sleep

105 Families Grow Healthy with WIC Key Messages – Active vs. Quiet Sleep Why Active Sleep is good for babies Sleep cycles How sleep patterns change Tips for sleepy parents Healthy Sleep

106 Families Grow Healthy with WIC Let’s Play WIC Cash Cab

107 Families Grow Healthy with WIC Baby Marcus is 4 weeks old. His mother tries to put him down after falling asleep at the breast but he: Wakes up, Cries loudly Active or Quiet Sleep? Was he in active or quiet sleep?

108 Families Grow Healthy with WIC Baby Anna is 4 months old. Her mother tries to put her down after falling asleep at the breast.  She stays asleep! Active or Quiet Sleep? Is she in active or quiet sleep?

109 Families Grow Healthy with WIC Crying

110 Families Grow Healthy with WIC Crying makes adults want to help. (Important for survival) All babies cry Crying begins in first hours of life, and on average, peaks at 2.6 hours per day at 6 wks. Crying decreases over the next 10 weeks, much better by 3-4 months. “Normal” Crying

111 Families Grow Healthy with WIC Watch for these pre-crying signs: Turning or pushing away Stretching out of fingers Tense muscles in his or her face & body Pre-Crying “I need a break” Cues

112 Families Grow Healthy with WIC Is there a “Hunger Cry”? Hungry babies might cry but they will also:  Bring their hands to their face  Clench their hands  Flex their arms and legs  Root  Make sucking motions and noises All these behaviors together help us know baby is hungry.

113 Families Grow Healthy with WIC Help parents learn to stay calm. Parents can often prevent or control crying. Encourage them to get help from friends & family. Help parents learn their baby’s cues. They won’t stop all crying but they will feel more in control. Ask them to try your ideas. Help Parents Deal with Crying

114 Families Grow Healthy with WIC Let’s Play WIC Cash Cab

115 Families Grow Healthy with WIC Baby Tanya is 3 weeks old. 10-15 min. after nearly all feedings she becomes: Fussy, Arches her back, Stiffens her hands & legs. Why is this Baby Crying?

116 Families Grow Healthy with WIC Baby Luz is 3 weeks old. Every evening between 6 to 8 p.m. she becomes: Quite Fussy, Closes her eyes, Tightens her face, Cries unless she is constantly held & rocked. Why is this Baby Crying?

117 Families Grow Healthy with WIC Baby Elena is 4 weeks old. Despite being fed an hour ago, she begins to cry: Draws her fist toward her chin, Pulls legs into her body, Moves her head from side to side. Why is this Baby Crying?

118 Families Grow Healthy with WIC Key messages Crying is normal Babies cry for many reasons, not just because they are hungry Babies show other cues when they are hungry Why do Babies Cry?

119 Families Grow Healthy with WIC For pregnant women at the end of their pregnancy Getting to Know Your Baby Contains facts and tips to help new moms cope during the first 6 weeks postpartum

120 Families Grow Healthy with WIC That’s All Folks

121 Families Grow Healthy with WIC Let’s Play Simon Says! “Simon Says” Stand up and walk around your table clockwise one time and sit back down

122 Families Grow Healthy with WIC Breastfeeding Support Policy #2 Conducting Complete Assessment DIALOGUE WITH MOMS ISIS QUESTIONS COUNSELING QUESTIONS BABY NUTRITION QUESTIONS

123 Families Grow Healthy with WIC Moms & Babies G loria and G ustavo

124 Families Grow Healthy with WIC Moms & Babies S usie and S ammie

125 Families Grow Healthy with WIC Moms & Babies W ilma and W il

126 Families Grow Healthy with WIC Moms & Babies C yndie and C arrie

127 Families Grow Healthy with WIC Assessment Conducting Complete Assessment BABY NUTRITION QUESTIONS DIALOGUE WITH MOMS ISIS QUESTIONS COUNSELING QUESTIONS

128 Baby Nutrition Questions

129 Families Grow Healthy with WIC Baby Nutrition Questions Questions to ask about Gustavo

130 Families Grow Healthy with WIC In pairs discuss what other questions you would ask about Sammie and Carrie Baby Nutrition Questions

131 Families Grow Healthy with WIC Sammie and Carrie In pairs or trios, review scenarios What are the feeding issues for both scenarios? What are some additional open-ended questions you would ask each of these mothers?

132 Families Grow Healthy with WIC Answers For You

133 Families Grow Healthy with WIC Lunch Time! Be back on time! Simon Says...

134 Families Grow Healthy with WIC

135 Welcome Back! Freeze! Simon Says...

136 Families Grow Healthy with WIC New Breastfeeding Support Policy  Support Fully and Combination Breastfeeding mothers Reviewed Counseling and Baby Behavior skills  Started on Components on Complete Assessment Baby Nutrition Questions Dialogue with Moms = Driving Down that Route Soon Review of Morning

137 Families Grow Healthy with WIC Let’s Play WIC Cash Cab

138 Families Grow Healthy with WIC Open or Closed? Is this question open or closed-ended? “Is your baby sleeping well?”

139 Families Grow Healthy with WIC Is this question open or closed-ended? You are planning to breastfeed, right? Open or Closed?

140 Families Grow Healthy with WIC Question What are the minimum number of hours of training a lactation specialist needs to have?

141 Families Grow Healthy with WIC True or False True or False: A one month old baby falls asleep in quiet sleep.

142 Families Grow Healthy with WIC Question Is this infant engaged or disengaged?

143 Families Grow Healthy with WIC Infant Feeding Crossroads Fully Breastfeeding? Formula Feeding? Combination Feeding?

144 Families Grow Healthy with WIC Breastfeeding Expressway Roadmap to Infant Feeding

145 Families Grow Healthy with WIC Fully Breastfeeding With your partner discuss:  What will be different for fully breastfeeding moms and babies?  How will you discuss your breastfeeding services with mothers ?

146 Families Grow Healthy with WIC What will be different? Moms and babies will receive the largest amount and most variety of foods. At 6 months babies will receive baby fruits, vegetables and meats. Fully breastfed babies receive MORE baby food than other babies. Babies will no longer receive juice. Fully Breastfeeding

147 Families Grow Healthy with WIC What resources might be available?  Lactation specialists (IBCLC, CLE, CLC, Peer Counselor)  Breast Pumps  Education Materials and Classes  Community Resources o La Leche League, Public Health Nurses Fully Breastfeeding

148 Families Grow Healthy with WIC Key to Success  Designate a “Lactation Specialist” for the day to…  Provide pregnant and breastfeeding women with needed support and help  Be accessible to staff for any breastfeeding help and questions Result: Staff feel more confident. Breastfeeding mother’s needs are met!

149 Families Grow Healthy with WIC “Your WIC Foods” Overview of new food packages What do you see that is new? What differences do you notice between the packages? How will you use this tool to encourage as much breastfeeding as possible?

150 Families Grow Healthy with WIC

151 Formula Feeding With your partner discuss: What will be different for  Formula feeding moms and babies?  How will you discuss formula feeding with moms?

152 Families Grow Healthy with WIC What will be different? Babies will receive less formula. The amount of formula will change according to baby’s age. Babies will receive baby food starting at 6 months. Babies won’t receive as much baby foods as breastfed babies. Babies will no longer receive juice. Formula Feeding

153 Families Grow Healthy with WIC What will you discuss? Always holding baby while feeding Proper preparation of formula Formula Feeding

154 Families Grow Healthy with WIC Let’s Play WIC Cash Cab

155 Families Grow Healthy with WIC Cash Cab How do you plan to support your fully breastfeeding Moms starting Oct 1?

156 Families Grow Healthy with WIC Cash Cab How do you plan to support your fully formula feeding Moms starting Oct 1?

157 Families Grow Healthy with WIC Combination Feeding

158 Families Grow Healthy with WIC With your partner discuss: What will be different for…  Combination feeding moms and babies?  How will you discuss combination feeding using “Your WIC Foods” to support breastfeeding? Combination Feeding

159 Families Grow Healthy with WIC What will be different? 2 Categories – mostly and some. Babies will receive less formula. The amount of formula will change according to baby’s age. Babies will receive baby food starting at 6 months. Babies won’t receive as much baby foods as fully breastfed babies. Babies will no longer receive juice. Combination Feeding

160 Families Grow Healthy with WIC What are some of the reasons breastfeeding moms ask for formula? I’m going back to work or school. I want formula just in case… I don’t have enough milk. My family members want to feed my baby too. I (or my baby) have a health issue and can’t fully breastfeed. Combination Feeding

161 Families Grow Healthy with WIC Assessment Conducting Complete Assessment BABY NUTRITION QUESTIONS DIALOGUE WITH MOMS ISIS QUESTIONS COUNSELING QUESTIONS

162 Families Grow Healthy with WIC Let’s watch our WIC actors as they model a challenging breastfeeding scenario. Find your “Observer’s Checklist” Combination Feeding

163 Families Grow Healthy with WIC Work in trios – (Roles) 1. Counselor 2. WIC mom 3. Observer Role play the “Gloria/Gustavo” scenario. How will you counsel the mom? What tools would you use? Combination Feeding

164 Families Grow Healthy with WIC  What went well?  What were some issues?  What tools did you use? Combination Feeding

165 Families Grow Healthy with WIC Switch roles Now role play “Sammie” scenario. How will you counsel the mom? What tools would you use? Combination Feeding

166 Families Grow Healthy with WIC  What went well?  What were some issues?  What tools did you use? Combination Feeding

167 Families Grow Healthy with WIC Key to Success  At anytime when a fully or combination breastfeeding mom asks for formula, have a lactation specialist see her to assess her breastfeeding. Result: Increase in breastfeeding duration Decrease in formula issuance

168 Families Grow Healthy with WIC Table Toolbox Toolkit # 3 Resources

169 Families Grow Healthy with WIC WIC Reference Tools  Guidelines for Referrals  Formula Table  Breastfeeding Resource List  Report: “Amount of formula issued by your agency”

170 Families Grow Healthy with WIC Guidelines for Referrals Health & Nutritional Condition  May need referral to support mother  May affect infant’s growth pattern  May still fully breastfeed

171 Families Grow Healthy with WIC Let’s Play WIC Cash Cab

172 Families Grow Healthy with WIC Guidelines for Referral Breastfeeding Infant is:  Twins  Jaundice  Constipated Yes No Yes

173 Families Grow Healthy with WIC Formula Table Minimum amount of formula needed

174 Families Grow Healthy with WIC Breastfeeding Resource List Online  California Breastfeeding Coalition  La Leche League  United States Breastfeeding Committee  Office of Women’s Health Resources

175 Families Grow Healthy with WIC Data Collection Report: Amount Formula Issued by your agency  Recognize your employees who excel in breastfeeding promotion  Identify the training needs  Monitor your exclusive breastfeeding rates (fully, mostly, and some bf)

176 Families Grow Healthy with WIC BREAK

177 Families Grow Healthy with WIC Honk if you love Breastfeeding Come up with a bumper sticker slogan to support fully breastfeeding in the first 30 days.  Use only 15 words or less  Write on flipchart paper w/markers

178 Families Grow Healthy with WIC What Would You Do? In pairs or trios discuss how you would counsel Carrie’s mother.  What are the feeding issues?  What questions would you ask?  What actions would you take?

179 Families Grow Healthy with WIC Activity Time  What are the feeding issues?  What questions would you ask?  What actions would you take?

180 Families Grow Healthy with WIC What Would You Do? Questions to ask  Tell me about a typical feeding.  Let’s talk more about her diapers.  Tell me more about how your baby sleeps. Things to do  Refer to Lactation Specialist or send to the Emergency Department  Weigh the baby  Issue Combination Package  Schedule appointment for next month

181 Families Grow Healthy with WIC Enroll and Recertify

182 Families Grow Healthy with WIC Enroll and Recertify

183 Families Grow Healthy with WIC Assessment Conducting Complete Assessment BABY NUTRITION QUESTIONS DIALOGUE WITH MOMS ISIS QUESTIONS COUNSELING QUESTIONS

184 Families Grow Healthy with WIC ISIS Documentation Must enter:  Reason for formula issuance  Input into the child INEP ISIS Screen

185 Families Grow Healthy with WIC ISIS defaults to “fully breastfeeding” package when “combination feeding” is entered. You will have to change to “C” ISIS will automatically issue just one month of Food Instruments. Issue Food Instruments

186 Families Grow Healthy with WIC Fully Breastfeeding Package (BE7)  BE7 for fully BF mom; BM8 for Fully Multiples  IB1 = 0-5 mo. fully breastfed, no check for infants  IB2 = 6-11 mo, fully breastfed, infant foods Issue Food Instruments

187 Families Grow Healthy with WIC Mostly Breastfeeding Package  Infant codes: IC1, ICQ, and IC2  Mom certified for 1 year  Mom receives more variety of foods  Codes: BC5 -X,L,S,T,H,P,G Issue Food Instruments

188 Families Grow Healthy with WIC Some Breastfeeding Package (BO6)  Infant codes: IO1, IOQ, IO2, and IO3  Mom receives checks up to 6 months  Mom may choose to attend breastfeeding support up to 1 year.  Mom codes: BO6 and B06N Issue Food Instruments

189 Families Grow Healthy with WIC Combination Feeding Must be in second month Must be with a lactation specialist Fully Breastfeeding Based on needs of mom and baby Schedule Next Appointment

190 Families Grow Healthy with WIC Assessment Completed Assessment BABY NUTRITION QUESTIONS DIALOGUE WITH MOMS ISIS QUESTIONS COUNSELING QUESTIONS

191 Families Grow Healthy with WIC Roadmap to Infant Feeding

192 Families Grow Healthy with WIC The Second Month Appointment Fully breastfeeding mothers may see lactation specialist if needed. All combination feeding mothers see a lactation specialist who will:  Conduct complete assessment  Determine the need for continued formula  Provide appropriate breastfeeding support and counseling

193 Families Grow Healthy with WIC Your Souvenir Complete Assessment Checklist for supporting your breastfeeding moms

194 Families Grow Healthy with WIC 1. Supporting Fully and Combination breastfeeding moms 2. Components of Complete Assessment 3. The Second Month Appointment Breastfeeding Support Policy

195 Families Grow Healthy with WIC Today you heard 5 Keys for Success from agencies who have already implemented the new 30 day policy.  Take the keys out of the toolbox  Pass the keys clockwise until you hear “STOP!”  Share how you might apply the “key” at your agency  Use your “That reMinds Me” form Review Keys to Success

196 Families Grow Healthy with WIC Answers for You

197 Families Grow Healthy with WIC End of the Ride Roadmap to Infant Feeding wic

198 Families Grow Healthy with WIC Roadmap to Infant Feeding

199 Families Grow Healthy with WIC WIC – Healthy and Happy Wil Sammie Gustavo Carrie

200 Families Grow Healthy with WIC Final Destination Evaluation


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