Families turn to their pediatrician for breastfeeding information and support. Yet a survey of pediatricians in the U.S. revealed gaps in breastfeeding training and education for physicians. The Kansas Breastfeeding Friendly Practice Designation (KBFPD) includes scholarships for one eligible office staff member to become an IBCLC, earning their practice a “5-star” designation. KBFPD is designed to close the gaps in knowledge and significantly increase physician confidence in addressing breastfeeding problems. It also builds a seamless referral system for community support where it exists. This project provides training and tools for physician practices in all specialties. Physicians and their staff will learn how to identify problems and will learn about local lactation support providers to whom they can refer mothers for help.

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Coordinator Information

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Criteria 1 - Office Environment
Create a breastfeeding friendly office environment by displaying posters and other visual images that support breastfeeding. Show your practice's support for breastfeeding by displaying the Kansas "Breastfeeding Welcome Here" window cling. Order online at https://ksbreastfeeding.org/take-the-pledge/.

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Offer to meet with expectant parents and discuss your practice’s values in relation to breastfeeding. During this visit promote the importance of breastfeeding and describe how you support breastfeeding families.

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Do not distribute infant formula samples unless medically necessary and remove all formula marketing materials from your office. All formula and supplies must be stored out of patient view.

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Provide noncommercial breastfeeding educational materials for families. All breastfeeding materials have been reviewed within the previous five years.

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Have a plan that identifies private place(s) for breastfeeding families to use if they prefer to breastfeed in private. All staff understands the plan and can accommodate this request.

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Office practices promote breastfeeding and do not interrupt or discourage breastfeeding when the infant is in the office.

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Have a plan to accommodate breastfeeding employees by providing a private space to pump and adequate time to do so, in compliance with the federal PUMP Act https://www.dol.gov/agencies/whd/pump-at-work.

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Keep breastfeeding supplies, such as supplemental nursing systems and nipple shields, on hand for families that are not for sale in our community.

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Criteria 2 - Community Connections
Identify local breastfeeding resources. Become knowledgeable about their credentials for the purpose of client referral for extra assistance with breastfeeding. Be knowledgeable about and post contact information for local community organizations and resources for parents and refer appropriately. Make sure all staff has this information available. Refer expectant and new parents to counselors for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) when applicable and to other breastfeeding support resources. These can be found at the Kansas Breastfeeding Coalition Local Resource Directory https://ksbreastfeeding.org/local-resource-directory/.

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Develop and nurture reciprocal working relationships with local lactation consultants. They can be found here https://ksbreastfeeding.org/local-resource-directory/.

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Encourage local maternity care professionals to ensure promotion and support of breastfeeding during the prenatal and intrapartum period, including the adoption of hospital practices that support exclusive breastfeeding.

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Encourage local maternity care professionals to identify patients with potential lactation risk factors (i.e. inverted or flat nipples, previous breast surgery, no change in breast size during pregnancy, hypoplastic breasts), recommend prenatal consultation with a lactation consultant, and encourage early follow-up after delivery.

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Encourage local hospitals to implement effective breastfeeding support practices and policies, such as the “High 5 for Mom & Baby” program or the Baby-Friendly Hospital Initiative. More information can be found at https://www.high5kansas.org/ or https://www.babyfriendlyusa.org/.

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Encourage hospitals to cease the distribution of commercial infant formula discharge packs and eliminate the practice of accepting free infant formula and supplies.

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Criteria 3 - Education for Staff and Parents
Develop knowledge and skills in managing common breastfeeding problems.

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Identify a breastfeeding coordinator in the practice who will facilitate an annual policy update and review for the entire staff.

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Ensure that the office staff is educated on all aspects of providing breastfeeding support.

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Develop skill and comfort in assessing breastfeeding through culturally relevant history and physical assessment.

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Know the medical contraindications to breastfeeding.

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Utilize current and accurate reference materials when considering the impact of maternal medications on the breastfed baby. (See Resource Sheet for several credible sources of information)

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Participate in annual continuing education activities on breastfeeding to acquire and maintain knowledge, skills, and practices following the American Academy of Pediatrics (AAP) policies on breastfeeding.

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Learn interventions for stimulating the production of breast milk.

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Learn normal variation in the growth patterns of breastfed infants and use World Health Organization growth charts as recommended by the Centers for Disease Control and Prevention and the American Academy of Pediatrics. https://www.cdc.gov/growthcharts/who-growth-charts.htm

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Educate parents and expectant parents on the importance of exclusive breastfeeding for about 6 months, followed by continued breastfeeding as complementary foods are introduced, and continuation of breastfeeding for 2 years or longer as mutually desired by mother and infant. Educate parents on the normal stool and urine patterns of a breastfed newborn.

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Teach infant feeding cues, and discuss the importance of feeding a newborn who exhibits feeding cues to breastfeeding parents, as outlined in “Baby Behavior” program, which can be found at https://lactation.ucdavis.edu/projects-services/baby-behavior-tools-for-medical-professionals/.

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Explain the importance of frequent feedings (including nighttime feedings) to help establish and maintain an adequate milk supply.

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Provide current (within the past five years), culturally appropriate breastfeeding educational resources to breastfeeding families.

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Provide instruction about expression and storage of breast milk for families when they will be separated from their breastfeeding child(ren).

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Explain to parents the occurrence of growth spurts and the need to increase breastfeeding or pumping frequency during those periods.

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Counsel families about the normal sleep patterns and behaviors of a breastfed baby.

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Discuss the importance of delaying the introduction of solid foods until the infant is approximately 6 months of age and shows signs of readiness.

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Educate parents about the normal nursing behaviors of the breastfeeding toddler.

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Provide appropriate instruction about oral hygiene for infants. (See AAP webpage)

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Criteria 4 - Policies and Procedures
Have a breastfeeding friendly office policy containing 80% of the points below that the entire staff is knowledgeable about and understands.

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Acknowledge that professional education and skills that encourage, protect, and sustain breastfeeding are an integral aspect of maternal child health care.

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Have a telephone triage protocol compatible with breastfeeding and consistent with current breastfeeding practices and evidence.

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Identify at least one breastfeeding resource person on staff and facilitate the acquisition of advanced breastfeeding management skills by enabling attendance at education programs and clinical preceptorships.

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Encourage mother and newborn to remain together with minimal interruption until mother’s milk production and breastfeeding are well established. Perform all hospital exams in the patient room.

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Encourage skin-to-skin contact for the newborn even after the family goes home from the hospital.

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Schedule early follow-up visits for all newborns within 48-72 hours after discharge or at 3 to 5 days of life.

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Collect historical information about feeding activity since birth, and keep data on breastfeeding initiation and duration in the practice. Ex: https://ksbreastfeeding.org/wp-content/uploads/2024/11/LACT-Score-Sheet-2024.pdf

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Evaluate for successful breastfeeding including adequacy of milk production and evaluate newborn’s state of hydration during the first visit after discharge.

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Evaluate newborns for jaundice and know the current Academy of Breastfeeding Medicine protocol for treatment. https://www.bfmed.org/assets/DOCUMENTS/PROTOCOLS/22-jaundice-protocol-english.pdf

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Educate families on the use of bottles and pacifiers and their potential impact on exclusive breastfeeding.

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Provide anticipatory guidance and age-appropriate breastfeeding intervention as part of every routine, periodic, maternal, and infant health screening visit.

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Commend breastfeeding families at every office visit for continuing to breastfeed their babies.

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Have a system in place to automatically prescribe vitamin D to infants per the AAP protocol.

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Criteria 5 - On Site Breastfeeding Support
Employ an International Board Certified Lactation Consultant (IBCLC) in the office.

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