"Breast Is Best, But…" According to Childcare Administrators, Not Best for the Childcare Environment.

Abstract

Background: Nearly 74% of U.S. mothers work full-time and employment is a cited reason for stopping breastfeeding. In the effort to increase breastfeeding duration, childcare providers could facilitate continuation of human milk feeding when mothers return to work. Yet, mothers report receiving little support when transitioning infants into childcare. Objective: Explore the themes of comfort with human milk and formula feeding among childcare administrators near Tampa, Florida. Material and Methods: Twenty-eight childcare administrators participated in semistructured interviews regarding policies and perceptions about infant feeding practices at their center. Using Applied Thematic Analysis, interview themes were identified. Results: Most administrators agreed "breastfeeding is best." However, they expressed discomfort with mothers breastfeeding at the center and perceived risk with handling and feeding human milk. These perceptions are illustrated through the theme "Formula feeding is normative" and four emergent subthemes: "Human milk is potentially harmful," "People are uncomfortable with breastfeeding in public," "I'm not the expert," and "'Breastfeeding is best', in theory." Conclusion: While breastfeeding may be best for health, from the childcare administrators' perspectives, it may not be best for the childcare environment. A cultural shift may be needed to change norms and perceptions in the childcare environment to support mothers in their effort to provide human milk. Perhaps it is time for a new message, such as "We can help you."