The United States Department of Agriculture (USDA) Child and Adult Care Food Program (CACFP)¹ reimburses certain care providers—such as licensed daycare providers—for meals given to enrolled individuals. The program has specific guidelines that must be followed in order for meals and snacks to be reimbursed, and is designed to ensure that the individuals under care are given a balanced, nutritious diet.
One enormous flaw of the program has to do with the amount of breastmilk or formula that is required to be offered. Their “infant meal pattern” document outlines the specific number of ounces of breastmilk or formula² that an infant should get through the first 11 months of life (see below).
*See How much expressed milk will my baby need? for a detailed look at milk intake and references.
**Between 6 a.m. and 6 p.m., a baby consumes 64% of its daily intake. See Volume and Frequency of Breastfeedings and Fat Content of Breast Milk Throughout the Day (Kent, et al., 2006) for details.
In the chart and graph, I’ve compared these minimum requirements to the average daily intake of a breastfed baby and how much a baby will consume, on average, between the hours of 6 a.m. and 6 p.m. (64% of the daily volume).
A closer look
If we consider the chart and graph, and compare it to what we know about lactation, we can draw some conclusions.
- The estimated intake when breastfeeding for the 12-hour daytime window is lower than the amount of milk offered when bottlefeeding in the high range for the younger two age groups, and lower than the amount of milk offered in the low and high range for the oldest age group.What does this mean? Most babies are in day care for approximately 10 hours per day, so a baby who is taking in more by bottle than they would during this 12-hour period when breastfeeding may be overfed.
- The number of ounces an infant would receive if getting bottles of the higher amount suggested (“high total”) is almost as much, or higher than, the average intake of a breastfed baby for the entire day.What does this mean? Infants fed on the higher end of the scale could very likely be taking in as much milk as they need for 24 hours in two meals and a snack while they’re at daycare
- When pumping for a missed feeding, assuming everything is working well, a mother might expect to get 3 to 4 ounces per pumping session. Pumping three times per day is common, and this would result in a total of 9 to 12 ounces of pumped milk. This can vary widely, based on many factors. Also consider that babies tend to want to consume 1 to 1.25 ounces of milk per hour they are away from their mothers. It stands to reason that a mother could expect to pump about that much per hour, per baby.What does this mean? If care providers are expecting a minimum of 12 ounces per day for an infant, they may tell a mother that she needs to provide more milk than she’s able to reasonably pump, or that they’ll need to supplement with formula. This may lead mothers to overextend themselves when it comes to pumping or, as is quite common, believe they have a low milk supply.
The guidelines also suggest two meals and one snack per day. Breastfed babies usually like to eat frequent, small meals, even when being fed bottles. They may want to eat more frequently than three times per day, and ignoring a baby’s cues, whether by feeding too infrequently or feeding too much, may cause undue stress for the baby and the caregiver.
What you can do about it
If your care provider is giving you trouble in regard to the amount of milk you’re leaving for your baby, here are some ways to approach the situation. Consider it an opportunity to educate them not only for your baby’s sake, but the sake of other breastfed babies who are in their care, or may be in their care in the future. Of course, with most human interactions, a gentle approach will be best.
- If the care provider is part of the USDA food program, point out the footnote to the meal pattern guidelines. Footnotes are easy to overlook and this might have been missed. And, having just put two kids in daycare for the first time, I can say that not all of the literature includes this footnote; it’s not on the three-part application for enrollment in the program in Minnesota. (“For some breastfed infants who regularly consume less than the minimum amount of breastmilk per feeding, a serving of less than the minimum amount of breastmilk may be offered, with additional breastmilk offered if the infant is still hungry.”)
- Provide information on how to bottlefeed a breastfed baby. Nancy Mohrbacher recently published a handout that is free to print and share.
- Have a discussion about paced bottle feeding, why it’s important, and how to do it. You can share this video or learn from it yourself and pass along the information.
- Discuss breastfeeding and pumping with your care provider. They may not be familiar with how breastfeeding works and what normal milk intake looks like for a breastfed baby.
- Discuss other ways to soothe your baby when he or she may be fussy but not necessarily hungry. Maybe your care provider would be open to babywearing. This might be an appropriate time to introduce a pacifier, as well.
- Have your child’s doctor write a note to be kept on file. A doctor’s note will override any of the meal pattern requirements.
As always, if you ever have questions about pumping or your milk supply, you can talk to a lactation professional for help. We can help you with things like:
- Considering whether or not a provider’s expectations for milk quantities are reasonable.
- Coming up with strategies for how to maximize your pumping output without going to extreme measures.
- Figuring out how much your baby—who is a unique individual with unique needs—wants to eat when away from you.
- Strategies for making the most of what you can pump, such as by timing when you breastfeed (like while at daycare, before leaving for work) and bottlefeeding (like asking care providers to avoid feeding a bottle within an hour or two of when you return).
- Dealing with a baby who won’t take bottles.
- Teaching paced bottlefeeding or how to tell a baby is using a bottle correctly.
A parting thought
Being told by a care provider that you need to send more milk is a very common experience, but it may not be in the best interests of you or your baby. It’s an issue well worth exploring before deciding that your milk supply is low or that you’re not able to pump as much as you should.
¹How’s that for a mouthful? No pun intended. Okay, I admit it. Pun intended.
²The guidelines also suggest offering cereal, fruits, and vegetables starting at four months, or when an infant is developmentally ready. I may write about this in the future, but for now, you can read about the American Academy of Pediatrics’ policy statement that recommends exclusive breastfeeding (i.e., no solid food) for six months, and why we recommend holding off on solids until closer to six months.