Finding childcare providers that are supportive of breastfeeding

If you would like to continue breastfeeding when you return to work, more information on how you can manage that transition, the benefits and the logistics can be found here and here. This article is about finding the right childcare provider if you are breastfeeding and was inspired by several posts on the Facebook group NWL Breastfeeding - 6 months and beyond.

It is not uncommon for childcare providers to ask mothers to reduce or stop breastfeeding, believing this will help a child settle more easily into their new environment. This can be distressing for both mum and child.

This article will explore why a childcare provider might feel uncomfortable about looking after a child who is breastfed, and will suggest some questions you can ask to ascertain whether the childcare provider you are thinking of using will be supportive of your parenting style and breastfeeding goals.

What mothers have told us:

Here are some quotes from members of NWL Breastfeeding – 6 months and beyond:

• “The nursery manager asked if I had been prepping her and reducing feeds.”

• “The nursery manager told me that she was very clearly attached to me and that breastfeeding her is likely making it even harder for her.”

• To the mother of a 13-month-old: “Nursery have told me twice…she should be put on formula… to “bulk” her up”.

  This last comment is particularly concerning since NHS advice is to stop giving formula at 12 months, and to wean babies off bottles (whether used to give breastmilk or formula) from 12 months.

Research into childcare providers’ attitudes to breastfeeding

Further reading and research shows this issue doesn’t just impact mothers in the U.K. One survey of 28 childcare providers in the U.S. found they simply do not know how to support breastfeeding families or handle breastmilk safely.

Most administrators agreed “breastfeeding is best.” However, they expressed discomfort with mothers breastfeeding at the creche/nursery, and there was a perceived risk with handling and feeding human milk. Nursery workers tended to feel that “formula feeding is normative” and this led to four widespread perceptions/misconceptions: “human milk is potentially harmful”; “people are uncomfortable with breastfeeding in public”; “I'm not the expert” and “‘breastfeeding is best’, in theory.”

Why would anyone insist on mothers not breastfeeding?

It could be to do with how, historically, parenting advice has been given in the Western world. According to Michealeen Ducleff’s Hunt, Gather, Parent, a large study of 650 parenting manuals and books from 1600 onwards found that most parenting advice was not evidence-based, or even passed from mother to daughter. Written advice on everything from feeding to sleep training came from pamphlets written by 17th, 18th and 19th century paediatricians writing advice for nurses in foundling hospitals. These nurses were caring for dozens, if not hundreds of babies and childcare needed to be industrialised. Even something as simple as scheduled feeding dates back to an essay written in 1748 for nurses at the Coram Foundling Hospital where it was impossible to feed responsively, or even hug, the hundreds of babies given up each day. However, maybe because it was ‘experts’ writing these pamphlets, they found their way into the family home, with exhausted mothers dealing with the pressures of the industrial revolution taking advice on parenting, disciplining, feeding and sleeping from these men, instead of following the attachment style that is still practiced in many places outside of the Western world.

Modern day childcare providers may unknowingly be influenced by these old-fashioned ideas and believe that if a baby is breastfed to sleep, or strongly attached to their mother, the mother needs to alter that bond in order for the childcare provider to help the baby settle. This simply isn’t true. No one has the right to decide when you stop breastfeeding except you; it’s your body, your baby, your choice. As Emma Pickett, IBCLC lactation consultant, weaning and natural term breastfeeding specialist and author of Supporting Breastfeeding Past the First Six Months says: “There is no evidence that breastfeeding makes settling into nursery more challenging (in fact, we have research that suggests the opposite - improved ‘school readiness’ in children who continue to breastfeed past infancy.)

Secure attachment

Not all childcare providers will have training in child development or understand the importance of secure attachment; in fact they might not even know what secure attachment is, and how crucial it is to a child’s future psychological and emotional wellbeing.

They may also not appreciate why a mother may wish to continue breastfeeding into toddlerhood, nor have any knowledge of the health protections for both mother and child, and the psychosocial benefits for the child.

Unfortunately, this even applies to some Montessori nurseries where one might have expected staff to be more informed and open-minded.

Breastfeeding tends to help a child to develop a close bond with their mother and become securely attached. When a securely attached child first spends time apart from their mother, it’s normal for them to become upset. In fact, this is a sign of their secure attachment. Breastfeeding doesn’t make a child ‘too attached’ – it's normal and desirable for a child to be attached to their mother. Bottle-fed babies can also be securely attached and will get upset when separated from their mother or main carer. Stopping breastfeeding will not prevent a child from being upset at being away from their mother, but it will deprive them of the comfort and security they derive from breastfeeding when reunited with their mother, not to mention all the health protections. both mother and child receive from breastfeeding.

Alloparents

Another concept that ‘Hunt, Gather, Parent’ introduces is that of the ‘alloparent’ from the Greek ‘allo’ meaning ‘other’. Alloparents can be family, older siblings, close friends, neighbours or paid-for childcare. It’s a network of people that have deep, high quality connections with your child, who make them feel safe, secure and loved. A childcare provider shouldn’t need, or indeed want, to change the bond between parent and child; parents need to find someone willing to create their own strong bond with the child. A network of alloparents has been shown to have a positive impact on a child’s mental wellbeing into adolescence.

The debate about nannies, childminders and nurseries is covered elsewhere online, here , here and here.

Your choice will be influenced by what is available in your area, your budget, working pattern, the age of your child and the times and hours offered by the childcare provider. However, from the posts we see on the NWL groups, it seems some – though definitely not all - nursery workers may be more likely to make negative comments about breastfeeding and put pressure on mothers to reduce or stop breastfeeding, than nannies or childminders, and some believe that nannies or childminders have a better chance of becoming alloparents due to the more intimate nature of the relationship.

Questions to ask a childcare provider

I hope the set of questions below will help you find a childcare provider that is not only supportive of your breastfeeding goals, but willing to treat your child like one of their own.

For babies (under 12 months) who need expressed milk via a bottle or cup:

1. Do you know how to bottle feed responsively?

2. Do you know about paced bottle feeding? (This is crucial because when paced bottle feeding isn’t practiced, babies are more likely to start to reject the breast, and mothers are likely to need to pump more milk.)

3. What are your protocols for safely storing breastmilk?

4. Would you tell me if you run out of breastmilk?

5. Would you ask consent before giving formula?

6. Are you happy for an older baby to drink from a cup instead of a bottle?

For all babies and toddlers:

1. Check out the childcare provider’s attitude to breastfeeding. Mention you are breastfeeding and intend to continue doing so and see what sort of reaction you get. A negative or ambivalent reaction is probably a red flag, not just for attitudes to breastfeeding but also an indication that the childcare provider might not respect parental choice.

2. How flexible will the childcare provider be during the settling in process? Will the childcare provider go at the baby’s pace or theirs? Will they allow a parent to stay with their child during settling in? Can the child gradually increase the number of hours they spend in childcare?

3. If a breastfeed is needed at pick-up is there a comfortable place to do that?

4. What methods does the childcare provider use to get a child to sleep without breastfeeding? Many parents find their partner, or another family member can get a baby settled to sleep without breastfeeding (even if the breastfeeding mother can’t) or that their child will fall asleep in a sling or pram. Is the childcare provider prepared to use methods the child’s parents already know work for other people in the child’s life? If not, which methods will they try?

5. Has the childcare provider asked questions about your home life to get to know you and your child better? For example, when my childminder found out we had a floor bed, she didn’t force my child to use the cot she had, she stuck with the pram until my son had learned to sleep in the cot.

6. How does the childcare provider and/or their employees build trust with a child and make them feel safe and loved?

7. How does the childcare provider respond when a child is upset or crying?

8. How are solids given? What’s the childcare provider’s attitude to Baby Led Weaning? Can children feed themselves or are they spoon fed? Does the childcare provider insist on ‘one more bite’ or cleaning the plate?

9. Do they give dessert? If so, what kind of dessert?

10. Is cow’s milk or formula mixed in with meals?

Follow your gut feelings

No matter how highly recommended they come, if a childcare provider’s answers to your questions aren’t satisfactory or leave you feeling even slightly uncomfortable, go elsewhere. And if your child has started at a nursery, or with a childminder or nanny, and you or your child aren’t happy with the provider you’ve chosen, don’t be afraid to change your mind.

It might take a little time, but there are nurseries, child-minders and nannies who understand, value, support and respect both the breastfeeding relationship and the loving bond between mother and child.

Links:

Emma Pickett’s Makes Milk podcast on childcare and breastfeeding:

https://podcasts.apple.com/gb/podcast/makes-milk-with-emma-pickett/id1697865705

Responsive bottle feeding: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2017/12/Responsive-Feeding-Infosheet-Unicef-UK-Baby-Friendly-Initiative.pdf

Paced bottle feeding: https://youtu.be/OGPm5SpLxXY

Breastmilk storage: https://www.breastfeedingnetwork.org.uk/wp-content/pdfs/BFN%20Expressing%20Leaflet%202019.pdf