Welcome Baby Handouts

— Contents —

Educational Resource List .....................................................................................2

Materials and Supplies to be Purchased or Ordered ..................................4

Breastfeeding .............................................................................................................8

Infant Feeding .......................................................................................................109

Infant Development .............................................................................................122

Lead Poisoning Prevention ...............................................................................134

Pest Management .................................................................................................155

Car Safety ................................................................................................................164

Safe Sleeping ..........................................................................................................169

Handouts for Home Visitation/Engagement Points

Topic Source Title Required Optional PN1 PN3 Hosp RN PP2-4 PP3-4 PP9 Comments

211 LA County County of Los Angeles211 LA County

Information Card

Baby BehaviorUC Davis Human

Lactation Center

7 Secrets of Baby

Behavior

Brain Development March of DimesLate Preterm Brain

Development

Breastfeeding CA WIC, CDPHHow Does Formula

Compare to Breast Milk

Breastfeeding

DHHS Office of Women's

Health

www.Womenshealth.gov

Your Guide to

Breastfeeding

Breastfeeding Choose Health LA and

Breastfeed LAInfant Feeding Cues

Breastfeeding Breastfeed LA Extreme Fullness

Breastfeeding Breastfeed LA Sore Nipples

Breastfeeding CA WIC, CDPHBreastfeeding and Return

to Work or School

Breastfeeding CA WIC, CDPHPumping and Storing

Breastmilk

BreastfeedingLA Best Babies Network

(LABBN)

Breastfeeding Friendly

Workplace Policies

Development Zero to Three

Healthy Minds: Nurturing

your Child's Healthy

Development: Birth to 3

Months; 2 to 6 Months; etc

Multiple time periods

available

Feeding CA WIC, CDPHWhen You Feed Me

Formula

To be given if/when

formula is introduced.

Feeding CA WIC, CDPHFeed Me! Birth to 6

Months

Kick CountsComprehensive Perinatal

Services ProgramCount Your Baby's Kicks

Labor Positions Childbirth GraphicsPositions for Laboring Out

of Bed

Welcome Baby Educational Resource List

Prepared by LA Best Babies Network. Download resources here: LABestBabies.org/resources

Topic Source Title Required Optional PN1 PN3 Hosp RN PP2-4 PP3-4 PP9 Comments

Skin-to-SkinCalifornia Hospital

Medical Center (CHMC)The Golden Hour

Lead Poisoning

Prevention

County of Los Angeles

Public HealthLead and Your Newborn

Lead Poisoning

Prevention

County of Los Angeles

Public HealthDanger! Azarcon, Greta

Lead Poisoning

Prevention

County of Los Angeles

Public Health

Don’t Take Lead Home

From Your Job

Lead Poisoning

Prevention

County of Los Angeles

Public Health

Make Your Home Lead-

Safe and Healthy for

Children

Lead Poisoning

Prevention

County of Los Angeles

Public HealthRemodeling or Repainting?

Lead Poisoning

Prevention

County of Los Angeles

Public Health

Traditional Pottery May

Contain Lead

Lead Poisoning

Prevention

County of Los Angeles

Public Health

Warning! These Candies

Have Been Found to

Contain Lead

Pest Control Safer Pest Control Project Bed Bugs

Pest Control Our Water Our WorldKeeping Cockroaches Out

of Your House

Oral Health Health EDCO® Baby Bottle Tooth Decay To be given if/when

formula is introduced.

Car Seat Safety

California Highway Patrol

U.S. Consumer Product

Safety

Child Safety Seats Save

Lives

Safe Sleep/SIDS First 5 LA Safe Sleep

Prepared by LA Best Babies Network. Download resources here: LABestBabies.org/resources

Prepared by LA Best Babies Network. Download resources here: LABestBabies.org/resources

Materials and Supplies to be Purchased or Ordered

The Welcome Baby program requires the use and distribution of a variety of materials and supplies across the various engagement points. Some of these items will be provided by the Family Strengthening Oversight Entity via LA Best Babies Network (e.g., Welcome Baby Books and engagement point materials). Other education materials and supplies may be helpful, many are available online and others will need to be purchased or ordered separately. These items are listed in the following table and are grouped alphabetically by source organization.

Source Name of Material/Supply Languages Amount To Order 211 LA County (Attn. Jennifer Leach)

211 Card English, Spanish, Chinese

Free By Email: PRMaterials@211LA.org By Phone: 626-350-1841 x2110 By Fax: 626-442-6940 By Mail: 211 LA County, 526 W. Las Tunas Dr., San Gabriel, CA 91776

(Order form: www.211la.org/PRMaterials.pdf)

Breastfeed LA Extreme Fullness English, Spanish Free PDF versions can be downloaded at http://www.breastfeedla.org/for-parents/91-flyers-and-brochures

Sore Nipples

Brookes Publishing Co.

ASQ-3 Starter Kit Plus materials below

English, Spanish $275.00 each

Online: www.brookespublishing.com/asq By Phone: 1-800-638-3775 By Fax: 410-337-8539 By Mail: Brookes Publishing Co., PO Box 10624, Baltimore, MD 21285

(Order form: agesandstages.com/pdfs/order_form.pdf)

ASQ-3: Learning Activities Book English, Spanish $49.95 each

ASQ-3: Materials Kit Contains all materials needed for assessments for age 2 mos through 60 mos OR

Purchase materials separately:

4 mos: baby bottle, mirror, toy(small, easy to grasp)

9 mos: baby bottle, toy (small,easy to grasp), clothing (coat,jacket, or shirt), cheerios orother small food, cookies orcrackers, crib rail or supportive furniture, cup, paper, string orshoelace

N/A $295.00 per kit

These materials may be purchased locally, or may be present in the home

California Highway Patrol

Child Safety Seats Save Lives English, Spanish, Chinese, Russian

Free PDF version can be downloaded at www.chp.ca.gov/community/safeseat.html

Source Name of Material/Supply Languages Amount To Order California Hospital Medical Center

The Golden Hour English, Spanish Free Brochures may be ordered through LA Best Babies Network

Childbirth Graphics

Positions for Laboring Out of Bed tear pad

English/Spanish $17.14/pack of 100

By Phone: 1-855-510-6730 By Fax: 1-888-977-7653

(Order form: www.childbirthgraphics.com/media/wysiwyg/2013CGorderform.jpg)

Online: www.childbirthgraphics.com/index.php/positions-for-laboring-out-of-bed-tear-pad-english-spanish.html

Healthy Newborns flipchart English with Spanish subtitles

$108.80 Online: www.childbirthgraphics.com/index.php/shop-by-subject/newborns/healthy-newborns-flip-chart.html

The Process of Giving Birth flipchart

English/Spanish $114.10 Online: www.childbirthgraphics.com/index.php/shop-by-subject/labor-and-birth/the-process-of-giving-birth-flip-chart-english-spanish.html

Guide to Breastfeeding charts N/A $28.75 Online: http://www.childbirthgraphics.com/index.php/guide-to-breastfeeding-spiral-bound-charts.html

Comprehensive Perinatal Services Program

Count Your Baby’s Kicks English Free Welcome Baby Training Binder: Prenatal and Postpartum Care section OR CPSP Steps to Take Handbook: page HE 27 (http://www.cdph.ca.gov/programs/CPSP/Documents/MO-CPSP-SteptoTakeHandbook.pdf)

County of Los Angeles Public Health

Lead and your newborn English/Spanish Free By Phone: 800-542-5323 By Fax: 323-890-8736 By Mail: Childhood Lead Poisoning Prevention Program, Health Education Unit, 5555 Ferguson Dr., Ste. 210-02, City of Commerce, CA 90022

(Order form: publichealth.lacounty.gov/lead/reports/HEU%20Flyers/General%20%20Order%20Form.pdf)

Some PDF versions can be downloaded at publichealth.lacounty.gov/lead/admin/ed_material_list.htm

Danger! Azarcon, Greta

Don’t Take Lead Home from Your Job

Make Your Home Lead-Safe and Healthy for Children

Remodeling or Repainting?

Traditional Pottery May Contain Lead

Warning! These Candies Have Been Found to Contain Lead

Free CHDP Health Check-ups English, Spanish By Phone: 800-993-2437 By Fax: 626-569-9350 By Mail: Child Health and Disability Prevention Program, 9320 Telstar Ave., Ste. 226, El Monte, CA 91731

(Order form: publichealth.lacounty.gov/cms/docs/CHDPMaterialsOrderForm.pdf)

Prepared by LA Best Babies Network. Download resources here: LABestBabies.org/resources

Source Name of Material/Supply Languages Amount To Order Health Edco Baby Bottle Tooth Decay English/Spanish $17.14/pack

of 100 Online: www.healthedco.com/index.php/baby-bottle-tooth-decay-tear-pad-english-spanish.html By Phone: 1-855-510-6720 By Fax: 1-888-977-7653

(Order form: www.healthedco.com/media/wysiwyg/2013HEorderform.jpg)

LA Best Babies Network

Breastfeeding Friendly Workplace Policies

English Free PDF version can be downloaded at labestbabies.org/publications/breastfeeding-friendly-workplace-policies LA Best Babies Network can provide hard copies if requested

LA County Infant Safe Sleeping Campaign

Safe Sleep English, Spanish Free PDF version available at http://www.ican4kids.org/safesleep/pdf/training-toolkit-all-files-english-only.pdf

March of Dimes

Late Preterm Brain Development

English, Spanish $6.50/pack of 50

Online: www.marchofdimes.com/catalog/product.aspx?productid=5248&categoryid=&productcode=37-2525-10

National Center on Shaken Baby Syndrome

Enjoy Your Baby English, Spanish, Arabic

$.20 per brochure

Online: secure.dontshake.org/buymaterials/detail.php?id=166&cid=9 By Email: mail@dontshake.org By Phone: 801-447-9360 By Fax: 801-447-9364 By Mail: National Center on Shaken Baby Syndrome, 1433 N. Hwy. 89, Ste. 110, Farmington, UT, 84025

(Order form: secure.dontshake.org/buymaterials/img/bm/6-20-11_NCSBS_order_form.pdf)

Safer Pest Control Project

Bed Bugs English, Spanish, Chinese, French, Polish

Free if you register

PDF version can be downloaded at spcpweb.org/resources/

SAMHSA National Suicide Prevention Lifeline wallet card

English Free (shipping charges may apply)

Online (and PDF version can be downloaded at): store.samhsa.gov/product/National-Suicide-Prevention-Lifeline-Wallet-Card-Having-Trouble-Coping-With-Help-Comes-Hope-/SVP13-0155R

Having Trouble Coping After a Disaster wallet card

Free PDF version can be downloaded at store.samhsa.gov/product/Disaster-Distress-Helpline-Wallet-Card/PEP12-DDHCARD

Prepared by LA Best Babies Network. Download resources here: LABestBabies.org/resources

Source Name of Material/Supply Languages Amount To Order State of California Health and Human Services Agency

L.A. County Appointment of Representative form

English N/A PDF version can be downloaded at www.dhcs.ca.gov/formsandpubs/forms/Forms/mc306.pdf)

Our Water Our World

Keeping Cockroaches Out of Your House

English, Spanish Free PDF version can be downloaded at www.ourwaterourworld.org/FactSheets.aspx

UC Davis Human Lactation Center

7 Secrets of Baby Behavior English, Spanish $15.00/pack of 25

By Email: lactation@ucdavis.edu By Phone: 530-754-5364 By Fax: 530-752-7582 By Mail: UC Davis Human Lactation Center, Department of Nutrition, One Shields Ave., Davis CA 95616

(Order form: lactation.ucdavis.edu/products/7%20secrets%20order%20form.pdf)

U.S. DHHS Office of Women’s Health

Your Guide to Breastfeeding English, Spanish, Chinese (Also have versions for African American and American Indian/Alaskan Native women)

Free PDF Versions can be downloaded at http://www.womenshealth.gov/publications/our-publications/breastfeeding-guide/index.html

WIC How Does Formula Compare to Breast Milk

English, Spanish Free PDF versions can be downloaded at www.cdph.ca.gov/programs/wicworks/Pages/WICEducationMaterialsWomen.aspx OR http://www.breastfeedla.org/for-parents/91-flyers-and-brochures

Breastfeeding While Working or Going to School

Pumping and Storing Breast Milk for Your Baby

When You Feed Me Formula PDF versions can be downloaded at www.cdph.ca.gov/programs/wicworks/Pages/WICEducationMaterialsInfants.aspx

Feed Me! Birth to 6 months

Feed Me! 6 to 12 Months

Your WIC Foods English, Spanish, Chinese, Russian, Armenian, Hmong, Vietnamese

PDF versions can be downloaded at www.cdph.ca.gov/programs/wicworks/Pages/WICEducationMaterialsGeneralInformationaboutWIC.aspx

For your local area

Farmer’s Market flyer

Prepared by LA Best Babies Network. Download resources here: LABestBabies.org/resources

Breastfeeding Handouts

How does formula compare to breastmilk?Compared to mother’s breastmilk, formula is missing many things babies need to be strong, healthy and smart. Did you know…

Formula-fed babies have a greater risk of:• Ear infections

• Diarrhea/constipation

• Pneumonia

• SIDS (Sudden InfantDeath Syndrome)

Children who were formula-fed have a greater risk of:• Obesity (becoming overweight)

• Diabetes

• Asthma and allergies

• Cancer

What is the cost of formula feeding?Formula feeding costs money. The dollars add up because you must buy extra formula as your baby grows, since WIC does not give you all the formula your baby will need. But the real cost of formula is the cost to your baby’s health… and the time you spend away from work or

at the doctor when your baby is sick.

Babies are born to breastfeed!

Breastmilk has MOREof the Good Things Babies Need

See for Yourself!

*Not all formulas have prebiotics and probiotics.

This institution is an equal opportunity provider. California WIC Program,

California Department of Public Health. 1-800-852-5770

Formula vs. Breastmilk —English (06/12) IC# 920095

Formula

Breastmilk

MineralsPrebiotics*Probiotics*

Vitamins

Fat

DHA/ARA

Carbohydrates

Protein

Water

EnzymesGrowth Factors

PrebioticsProbiotics

Anti-Cancer (HAMLET)

Disease Fighting

Stem Cells

¿Cómo se compara la fórmula con la leche materna?Comparada con la leche materna, a la fórmula le hacen falta muchas cosas que necesitan los bebés para ser fuertes, sanos e inteligentes. ¿Sabía usted que…

Los bebés alimentados con fórmula están en mayor riesgo de tener:• Infecciones de los oídos

• Diarrea y estreñimiento

• Neumonía

• SIDS (el Síndrome de Muerte Súbita del Bebé)

Los niños que fueron alimentados con fórmula tienen un mayor riesgo de tener:• Obesidad (exceso de peso)

• Diabetes

• Asma y alergias

• Cáncer

¿Qué es el costo de alimentar con fórmula?La alimentación con fórmula cuesta dinero. Los dólares se suman, porque tiene que comprar cada vez más fórmula a medida que crece el bebé, dado que WIC no le da toda la fórmula que su bebé necesitará. Pero el verdadero costo de la fórmula es el costo para la salud de su bebé… y el tiempo que usted pasa sin ir a trabajar o en el consultorio del médico cuando el bebé está enfermo.

¡Para madre e hijo dar pecho es lo más natural!

La leche materna tiene más de las cosas buenas que necesitan los bebés

¡Compare usted misma!

Esta institución es un proveedor que ofrece igualdad de oportunidades. Programa de WIC de California,

Departamento de Salud Pública de California. 1-800-852-5770

Formula vs. Breastmilk — Spanish (06/12) IC# 920096

Fórmula

Anticáncer (HAMLET)

Prebióticos*Probióticos*

Enzimas

Factores de

crecimiento

PrebióticosProbióticos

Células madre que

combaten las enfermedades

La leche materna

*No todas las fórmulas tienen los prebióticos y probióticos.

Your Guide toBreastfeeding

Common Questions

tear-outFeedingChart!

Why Breastfeedingis imPortantWhy Breastfeedingis imPortantLearn about the health benefits for both mom and baby! Pages 4-5

Learning to BreastFeedWhat you can do even before your baby is born. Page 11

Common QuestionsCan I breastfeed even if I am sick? Find out the answer to this question and others. Page 26

tear-outFeedingChart! Page 45

Breastfeeding in PuBlic

Tips for making it work. Page 33

commonchallenges

Learn tips for saying farewell to sore

nipples! Page 18

U.S. Department of Health and Human Services, Office on Women’s Health

2

Your guide to Breastfeeding

January 2011

Introduction

The experience of breastfeeding is special for so many rea-sons, including:

The joyful bonding with your baby•The perfect nutrition only you can provide•The cost savings•Thehealthbenefitsforbothmotherandbaby•

In fact, breast milk has disease-fighting antibodies that can helpprotectinfantsfromseveraltypesof illnesses.Andmoth-erswhobreastfeedhavealowerriskof somehealthproblems,includingbreastcancerandtype2diabetes.

Keep in mind that breastfeeding is a learned skill. It requires patienceandpractice.Forsomewomen,thelearningstagescanbefrustratinganduncomfortable.Andsomesituationsmakebreast-feedingevenharder,suchasbabiesbornearlyorhealthproblemsinthemother.Thegoodnewsisthatitwillgeteasier,andsupportforbreastfeedingmothersisgrowing.

You are special because you can make the food that is unique-ly perfect for your baby.Investthetimeinyourself andyourbaby–foryourhealthandforthebondthatwilllastalifetime.

The U.S. Department of Health and Human Services’ Office on Women’s Health (OWH) is raising awareness of the importance of breastfeeding to help mothers give their babies the best start possible in life. In addition to this guide, OWH offers online content at http://www.womenshealth.gov/breastfeeding and provides the National Breastfeeding Helpline at 800-994-9662. The Surgeon General’s Call to Action to Support Breastfeeding puts forth steps that family members, communities, clinicians, health care systems, and employers can take to make breastfeeding an easy choice for mothers. Learn more at http://www.surgeongeneral.gov. OWH also partners with the Health Resources and Services Administration’s Maternal and Child Health Bureau to educate employers about the needs of breastfeeding mothers via The Business Case for Breastfeeding.

The Affordable Care Act (health care reform) helps pregnant women and breastfeeding mothers get the medical care and support they and their children need. Learn more at http://www.healthcare.gov.

U.S.Departmentof HealthandHumanServices,OfficeonWomen’sHealth

Contents4 Why Breastfeeding is important

Health benefits for babies and mothers

6 finding support and informationTypes of health professionals who can help with breast-feeding, and how to find support by phone

8 how Breast milk is madeHow your body meets your baby’s nutrition needs

10 Before you give BirthSteps you can take before the baby arrives, and what your family members can do

11 Learning to BreastfeedHow to hold your baby and know if your baby is getting enough breast milk

18 Common ChallengesTips for troubleshooting common problems

25 Common QuestionsFind out if your baby needs cereal, if you can take medicine, and more

28 Breastfeeding a Baby with health Problems

Dealing with jaundice, reflux, and cleft palate and lip

30 Breastfeeding and special situationsInformation for mothers of multiples, mothers who are adopting, and more

33 Breastfeeding in PublicWays to feel comfortable feeding your baby while out and about

34 Pumping and milk storageDifferent ways to express breast milk and how to store it

37 going Back to WorkYour rights and how to talk to your employer about your breastfeeding needs

39 nutrition and fitnessHow to take care of yourself while breastfeeding

42 handling stressCoping tips to keep stress at bay

43 tear-out tools Write down questions to ask your doctor and your baby’s doctor, and keep track of diapers and feedings

3

Tools you can useBreast milk storage guide, page 36

Jot it down: questions to ask your baby’s doctor (page 43) and questions to ask your health care provider (page 44)

tear-out feeding chart, page 45

4

Why Breastfeeding is importantBreastfeeding Protects Babies

Early breast milk is liquid gold.1. Knownasliquidgold,colostrum(coh-LOSS-trum)isthethickyellowfirstbreastmilkthatyoumakeduringpregnancyandjustafterbirth.Thismilkisveryrichinnutrients and anti-bodiestoprotectyourbaby.Althoughyourbabyonlygetsasmallamountof colostrumateachfeeding,itmatchestheamounthisorhertinystomachcanhold.(Seepage 17 to see just howsmallyournewborn’stummyis!)

Your breast milk changes as your baby grows.2. Colostrumchangesintowhatiscalledmaturemilk.Bythethirdtofifthdayafterbirth,thismaturebreastmilkhasjusttherightamountof fat,sugar,water,andpro-teintohelpyourbabycontinuetogrow.Itisathinnertypeof milkthancolostrum,butitprovides all of the nutrients and antibodies yourbabyneeds.

Breast milk is easier to digest.3. Formostbabies–especiallyprematurebabies–breastmilkiseasiertodigestthanformula.Theproteinsinformulaaremadefromcow’smilk,andittakestimeforbabies’stomachstoadjusttodigestingthem.

Breast milk fights disease.4. Thecells,hormones,andantibodiesinbreast

milkprotectbabiesfromillness.Thispro-tectionisunique;formulacannotmatchthechemicalmakeupof humanbreastmilk.Infact,amongformula-fedbabies,earinfectionsanddiarrheaaremorecommon.Formula-fedbabies also have higher risks of:

Necrotizing(nek-roh-TEYE-zing)entero-•colitis(en-TUR-oh-coh-lyt-iss),adiseasethat affects the gastrointestinal tract in pre-terminfants.

Lowerrespiratoryinfections•

Atopicdermatitis,atypeof skinrash•

Asthma•

Obesity•

Type 1 and type 2 diabetes•

Childhoodleukemia•

Breastfeedinghasalsobeenshowntolowertheriskof SIDS(suddeninfantdeathsyndrome).

Formula-feeding can raise health risks in babies, but there are rare cases in which formula may be a necessary alternative. Very rarely, babies are born unable to tolerate milk of any kind. These babies must have soy formula. Formula may also be needed if the mother has certain health conditions and she does not have access to donor breast milk. To learn more about rare breastfeeding restrictions in the mother, see page 26. To learn more about donor milk banks, see page 32.

Breastfeeding Glossarynutrients are any food substance that provides energy or helps build tissue.

antibodies (AN-teye-bah-deez) are blood proteins made in response to germs or other foreign substances that enter the body. Antibodies help the body fight illness and disease by attaching to germs and marking them for destruction.

The gastrointestinal system is made up of the stomach, and the small and large intestines. It breaks down and absorbs food.

The respiratory system includes the nose, throat, voice box, windpipe, and lungs. Air is breathed in, delivering oxy-gen. Waste gas is removed from the lungs when you breathe out.

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Mothers Benefit from BreastfeedingWays that breastfeeding can make your 1. life easier. Breastfeedingmaytakealittlemoreeffortthanformulafeedingatfirst.Butitcanmakelife easier once you and your baby settle into a goodroutine.Whenyoubreastfeed,therearenobottlesandnipplestosterilize.Youdonothavetobuy,measure,andmixformula.Andtherearenobottlestowarminthemiddleof thenight.

Breastfeeding can save money.2. Formulaandfeedingsuppliescancostwellover$1,500eachyear,dependingonhowmuchyourbabyeats.Breastfedbabiesarealsosicklessoften,whichcanlowerhealthcarecosts.

Breastfeeding can feel great. 3. Physicalcontactisimportanttonewborns.Itcanhelpthemfeelmoresecure,warm,andcomforted.Motherscanbenefitfromthiscloseness,aswell.Breastfeedingrequiresamothertotakesomequietrelaxedtimetobond.Theskin-to-skincontactcanboostthemother’soxytocin(OKS-ee-TOH-suhn)levels.Oxytocinisahormonethathelpsmilkflowandcancalmthemother.

Breastfeeding can be good for the mother’s 4. health, too. Breastfeedingislinkedtoalowerriskof thesehealthproblemsinwomen:

Type 2 diabetes•

Breastcancer•

Ovarian cancer•

Postpartumdepression•

Expertsarestilllookingattheeffectsof breastfeeding on osteoporosis and weight loss afterbirth.Manystudieshavereportedgreaterweightlossforbreastfeedingmothersthanforthosewhodon’t.Butmoreresearchisneededtounderstandif astronglinkexists.

Breastfeeding During an EmergencyWhen an emergency occurs, breastfeeding can save lives:

Breastfeeding protects babies from the risks •of a contaminated water supply.

Breastfeeding can help protect against respi-•ratory illnesses and diarrhea. These diseases can be fatal in populations displaced by disaster.

Breast milk is the right temperature for babies •and helps to prevent hypothermia when the body temperature drops too low.

Breast milk is readily available without need-•ing other supplies.

Nursing mothers miss less work.5. Breastfeedingmothersmissfewerdaysfromworkbecausetheirinfantsaresicklessoften.

Breastfeeding Benefits SocietyThenationbenefitsoverallwhenmothersbreast-feed.Recentresearchshowsthatif 90percentof familiesbreastfedexclusivelyfor6months,nearly1,000deathsamonginfantscouldbeprevented.TheUnitedStateswouldalsosave$13billionperyear–medicalcarecostsarelowerforfullybreast-fedinfantsthanfornever-breastfedinfants.Breast-fedinfantstypicallyneedfewersickcarevisits,prescriptions,andhospitalizations.

Breastfeedingalsocontributestoamoreproduc-tiveworkforcebecausemothersmisslessworktocareforsickinfants.Employermedicalcostsarealsolower.

Breastfeedingisalsobetterfortheenvironment.Thereislesstrashandplasticwastecomparedtothatproducedbyformulacansandbottlesupplies.

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Finding support and informationWhilebreastfeedingisnatural,youstillmayneedsomeadvice.Therearemanysourcesof supportavailableforbreastfeedingmothers.Youcanseekhelpfromdifferenttypesof healthprofessionals,organizations,andmembersof yourownfamily.UndertheAffordableCareAct(healthcarere-form),moreandmorewomenwillhaveaccesstobreastfeeding support without any out-of-pocket costs.Anddon’tforget,friendswhohavesuccess-fullybreastfedcanbeagreatsourceof informa-tionandencouragement!

health Professionals Who help with BreastfeedingPediatricians,obstetricians,andcertifiednurse-midwivescanhelpyouwithbreastfeeding.Otherspecial breastfeeding professionals include:

International Board Certified Lactation • Consultant (IBCLC).Lactationconsultantsare credentialed breastfeeding professionals with the highest level of knowledge and skill in breastfeedingsupport.IBCLCsareexperiencedinhelpingmotherstobreastfeedcomfortablybyhelpingwithpositioning,latch,andawiderangeof breastfeedingconcerns.ManyIBCLCsarealsonurses,doctors,speechtherapists,dietitians,orotherkindsof healthprofessionals.Askyourhospitalorbirthingcenterforthenameof alactationconsultantwhocanhelpyou.Or,youcangotohttp://www.ilca.orgtofindanIBCLCinyourarea.

Breastfeeding Peer Counselor or Educator.• Abreastfeeding counselor can teach others about thebenefitsof breastfeedingandhelpwomenwithbasicbreastfeedingchallengesandquestions.A“peer”meansapersonhasbreastfedherownbabyandisavailabletohelpothermothers.Somebreastfeeding educators have letters after their nameslikeCLC(CertifiedLactationCounselor)orCBE(CertifiedBreastfeedingEducator).

EducatorshavespecialbreastfeedingtrainingbutnotasmuchasIBCLCs.Theseprofessionalsstillcanbequitehelpful.

Doula (DOO-la)• .Adoulaisprofessionallytrainedandexperiencedingivingsocialsupporttobirthingfamiliesduringpregnancy,labor,andbirthandathomeduringthefirstfewdaysorweeksafterbirth.Doulaswhoaretrainedinbreastfeedingcanhelpyoubemoresuccessfulwithbreastfeedingafterbirth.

mother-to-mother supportOtherbreastfeedingmotherscanbeagreatsourceof support.Motherscansharetipsandofferoneanotherencouragement.Therearemanywaysyoucanconnectwithotherbreastfeedingmothers:

Askyourhealthcareproviderorhospitalstaff •torecommendasupportgroup.

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SearchyourphonebookortheInternetfora•breastfeedingcenternearyou.Thesecentersmayoffersupportgroups.

FindalocalLaLecheLeaguesupportgroup•byvisitingtheorganization’swebsiteathttp://www.llli.org/.

SearchtheInternetforbreastfeedingmessage•boardsandchats.(Theseresourcescanbegreatforsharingtips,butdonotrelyonwebsitesformedicaladvice–talktoyourhealthcareprovider.)

WiC ProgramFood,nutritioncounseling,andaccesstohealthservicesareprovidedtolow-incomewomen,in-fants,andchildrenundertheSpecialSupplementalNutritionProgramforWomen,Infants,andChil-dren.ThisprogramispopularlyknownasWIC(Women,Infants,andChildren).BreastfeedingmotherssupportedbyWICmayreceiveeducation-almaterials,peercounselorsupport,anenhancedfoodpackage,breastpumps,andothersupplies.

Breastfeedingmothersarealsoeligibletopartici-pateinWIClongerthannon-breastfeedingmoth-ers.TofindcontactinformationforyourlocalWICprogram,visithttp://www.fns.usda.gov/wic/Breastfeeding/breastfeedingmainpage.htmorcallthenationalofficeat703-305-2746.

Learn more about breastfeeding basics and find other online resources at http://www.womenshealth.gov/breastfeeding.

The National Breastfeeding HelplineThe National Breastfeeding Helpline from the Office on Women’s Health has trained breastfeeding peer counselors to provide support by phone. The counselors can help answer common breastfeeding questions. They can also help you decide if you need to see a doctor or lactation consultant. The Helpline is available for all breastfeeding mothers, partners, prospective parents, family members, and health professionals seeking to learn more about breastfeeding. The Helpline is open from Monday through Friday, from 9 a.m. to 6 p.m., EST. If you call after hours, you will be able to leave a message, and a breastfeeding peer counselor will return your call on the next business day. Help is available in English or Spanish.

Call 800-994-9662 for support!

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how Breast milk is madeKnowinghowthebreastworkstoproducemilkcanhelpyouunderstandthebreastfeedingprocess.Thebreastitself isaglandthatismadeupof sev-eralparts,including:

Glandular tissue• –bodytissuethatmakesandreleasesoneormoresubstancesforuseinthebody.Someglandsmakefluidsthataffecttis-suesororgans.Othersmakehormonesorassistwithbloodproduction.Inthebreast,thistissueisinvolvedinmilkproduction.

Connective tissue• – a type of body tissue thatsupportsothertissuesandbindsthemtogether.Thistissueprovidessupportinthebreast.

Blood• –fluidinthebodymadeupof plasma,redandwhitebloodcells,andplatelets.Bloodcarriesoxygenandnutrientstoandwastema-terialsawayfromallbodytissues.Inthebreast,blood nourishes the breast tissue and providesnutrientsneededformilkproduction.

Lymph• –thealmostcolorlessfluidthattravelsthroughthelymphaticsystemandcarriescellsthathelpfightinfectionanddisease.Lymphtis-sueinthebreasthelpsremovewaste.

Nerves• – cells that are the building blocks ofthenervoussystem(thesystemthatrecordsandtransmitsinformationchemicallyandelectri-callywithinaperson).Nervetissueinthebreastmakesbreastssensitivetotouch,allowingthebaby’ssuckingtostimulatethelet-downormilk-ejectionreflexandmilkproduction.(Seepage 9tolearnhowlet-downworks!)Fatty tissue• – connective tissue that containsstoredfat.Itisalsoknownasadiposetissue.Fattytissueinthebreastprotectsthebreastfrominjury.Fattytissueiswhatmostlyaffectsthesizeof awoman’sbreast.Breastsizedoesnothaveaneffectontheamountof milkorthequalityof milkawomanmakes.

Lobe (Each mammary gland forms a lobe of the breast, which consists of a single major branch of alveoli and milk ducts that end at the nipple pore)

Areola (The dark area around the nipple)

Nipple

Milk duct (Tube through which milk travels)

Alveoli cells (Grape-like clusters of tissue that secrete milk)

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What is a let-down reflex?A let-down reflex or milk ejection reflex is a conditioned reflex ejecting milk from the alveoli through the ducts to the sinuses of the breast and the nipple. (See the anatomy of the breast on page 8.) This reflex makes it easier to breastfeed your baby. Let-down happens a few seconds to several minutes after you start breastfeeding your baby. It can happen a few times during a feeding, too. You may feel a tingle in your breast or you may feel a little uncomfortable. Keep in mind that some women don’t feel anything.

Let-down can happen at other times, too, such as when you hear your baby cry or when you may just be thinking about your baby. If your milk lets down as more of a gush and it bothers your baby, try expressing some milk by hand before you start breastfeeding.

Specialcellsinsideyourbreastsmakemilk.Thesecellsarecalledalveoli(al-VEE-uh-leye).Whenyourbreastsbecomefullerandtenderduringpregnancy,this is a sign that the alveoli are getting ready to work.Somewomendonotfeelthesechangesintheirbreasts.Othersmaysensethesechangesaftertheirbabyisborn.

Thealveolimakemilkinresponsetothehormoneprolactin(proh-LAK-tin).Prolactinriseswhenthebabysuckles.Anotherhormone,oxytocin(oks-ee-TOH-suhn),causessmallmusclesaroundthecellstocontractandmovethemilkthroughaseriesof

smalltubescalledmilkducts.Thismovingof themilkiscalledlet-downreflex.

Oxytocinalsocausesthemusclesof theuterustocontractduringandafterbirth.Thishelpstheuterustogetbacktoitsoriginalsize.Italsolessensanybleedingawomanmayhaveaftergivingbirth.Thereleaseof bothprolactinandoxytocinmayberesponsibleinpartforamother’sintensefeelingof needingtobewithherbaby.

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Before You give BirthToprepareforbreastfeeding,themostimportantthingyoucandoishaveconfidenceinyourself.Committingtobreastfeedingstartswiththebelief thatyoucandoit!

Other steps you can take to prepare for breastfeeding:

Getgoodprenatalcare,whichcanhelpyou1.avoidearlydelivery.Babiesborntooearlyof-tenneedspecialcare,whichcanmakebreast-feedingharder.

Takeabreastfeedingclass.2.

Askyourhealthcareprovidertorecommend3.alactationconsultant.Youcanestablishare-

lationshipbeforethebabycomes,orbereadyif youneedhelpafterthebabyisborn.

Talk to your health care provider about your 4.health.Discussanybreastsurgeryorinjuryyoumayhavehad.If youhavedepressionoraretakingmedications,discusstreatmentoptionsthatcanworkwithbreastfeeding.

Tell your health care provider that you would 5.like to breastfeed your newborn baby as soon aspossibleafterdelivery.Thesuckinginstinctisverystrongwithinthefirsthourof life.

Talk to friends who have breastfed or consider 6.joiningabreastfeedingsupportgroup.

Talk to Fathers, Partners, and Other Family Members About How They Can HelpBreastfeeding is more than a way to feed a baby – it becomes a lifestyle. And fathers, partners, and other spe-cial support persons can be involved in the breastfeeding experience, too. Partners and family members can:

Support the breastfeeding relationship by being •kind and encouraging.

Show their love and appreciation for all of the •work that is put into breastfeeding.

Be good listeners when a mother needs to talk •through breastfeeding concerns.

Make sure the mother has enough to drink and gets •enough rest, help around the house, and take care of other children at home.

Give emotional nourishment to the child through •playing and cuddling.

Fathers, partners, and other people in the mother’s sup-port system can benefit from breastfeeding, too. Not only are there no bottles to prepare, but many people feel warmth, love, and relaxation just from sitting next to a mother and baby during breastfeeding.

What Dad Can DoThe bond between mother and baby is important, but so is the bond between father and baby. Babies need cuddles and hugs from their dads, too! In fact, skin-to-skin contact helps baby and father bond much like it does for mother and baby.

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Learning to BreastfeedBreastfeedingisaprocessthattakestimetomaster.Babiesandmothersneedtopractice.Keepinmindthatyoumakemilkinresponsetoyourbabysuck-ingatthebreast.Themoremilkyourbabyremovesfromthebreasts,themoremilkyouwillmake.

Afteryouhavethebaby,thesestepscanhelpyouget off to a great start:

Breastfeedassoonaspossibleafterbirth.•

Askforanon-sitelactationconsultanttocome•helpyou.

Askthestaff nottogiveyourbabyotherfood•orformula,unlessitismedicallynecessary.

Allowyourbabytostayinyourhospitalroomallday•andnightsothatyoucanbreastfeedoften.Or,askthenursestobringyourbabytoyouforfeedings.

Trytoavoidgivingyourbabyanypacifiersor•artificialnipplessothatheorshegetsusedtolatchingontojustyourbreast.(Seepage 12 tolearnaboutlatching.)

How often should I breastfeed?Early and often! Breastfeed as soon as possible after birth, then breastfeed at least 8 to 12 times every 24 hours to make plenty of milk for your baby. This means that in the first few days after birth, your baby will likely need to breastfeed about every hour or two in the daytime and a couple of times at night. Healthy babies develop their own feeding schedules. Follow your baby’s cues for when he or she is ready to eat.

How long should feedings be?Feedings may be 15 to 20 minutes or longer per breast. But there is no set time. Your baby will let you know when he or she is finished. If you are worried that your baby is not eating enough, talk to your baby’s doctor. See page 45 for a feeding tracker if you would like to write down when your baby wants to eat.

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Bringing Your Baby to the BreastWhenawake,yourbabywillmovehisorherheadbackandforth,lookingandfeelingforthebreastwithhisorhermouthandlips.Thestepsbelowcanhelpyougetyourbabyto“latch”ontothebreasttostarteating.Keepinmindthatthereisnoonewaytostartbreastfeeding.Aslongasthebabyislatchedonwell,howyougetthereisuptoyou.

Holdyourbaby,wearingonlyadiaper,against•yourbarechest.Holdthebabyuprightwithhisorherheadunderyourchin.Yourbabywillbecomfortableinthatcozyvalleybetweenyourbreasts.Youcanaskyourpartneroranursetoplaceablanketacrossyourbaby’sbackandbringyourbedcoversoveryouboth.Yourskintemperaturewillrisetowarmyourbaby.

Supporthisorherneckandshoulderswithone•handandhipswiththeother.Heorshemaymoveinanefforttofindyourbreast.

Yourbaby’sheadshouldbetiltedbackslightly•tomakeiteasytosuckandswallow.Withhisorherheadbackandmouthopen,thetongueisnaturally down and ready for the breast to go on topof it.

Allowyourbreasttohangnaturally.Whenyour•babyfeelsitwithhisorhercheek,heorshemayopenhisorhermouthwideandreachitupandoverthenipple.Youcanalsoguidethebabytolatchonasyouseeintheseillustrations.

Atfirst,yourbaby’snosewillbelinedupoppo-•siteyournipple.Ashisorherchinpressesintoyourbreast,hisorherwideopenmouthwillgetalargemouthfulof breastforadeeplatch.Keepinmindthatyourbabycanbreatheatthebreast.Thenostrilsflaretoallowairin.

Tiltyourbabyback,supportingyourbaby’s•head,upperback,andshoulderswiththepalmof yourhandandpullyourbabyinclose.

Getting your baby to latch:

Ticklethebaby’slipstoencouragehimorhertoopenwide.

Pull your baby close so that the chin and lower jawmovesintoyourbreastfirst.

Watchthelowerlipandaimitasfarfromthebase of the nipple as possible,sothebabytakesalargemouthfulof breast.

When my son was born 4 years ago, we had a very difficult time breastfeeding because he wasn’t latch-ing correctly. He seemed almost lazy and disinter-ested in eating. In the first 2 weeks, he lost quite a bit of weight and appeared gaunt and fussy. Naturally, I was nearly frantic with worry. Luckily, I connected with an amazing lactation consultant. She put me on a rigorous, week-long regimen which consisted of nursing, then bottle feeding breast milk, then pump-ing every 3 hours. I was completely dedicated to the regimen, and when I met with her a week later, she was stunned by the results. My son had gained an entire pound, and she said he had developed a per-fect latch. She called us the miracle mom and miracle baby! I was so proud of us. My determination paid off and I enjoyed breastfeeding for 7 months. – JillBridgewater, MA

Some babies latch on right away, and for some it takes more time.

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Signs of a good latchThelatchfeelscomfortabletoyou,without•hurtingorpinching.Howitfeelsismoreimpor-tantthanhowitlooks.

Yourbaby’schestisagainstyourbodyandheor•she does not have to turn his or her head while drinking.

Youseelittleornoareola,dependingonthe•sizeof yourareolaandthesizeof yourbaby’smouth.If areolaisshowing,youwillseemoreaboveyourbaby’slipandlessbelow.

Whenyourbabyispositionedwell,hisorher•mouthwillbefilledwithbreast.

Thetongueiscuppedunderthebreast,al-•thoughyoumightnotseeit.

Youhearorseeyourbabyswallow.Somebabies•swallowsoquietly,apauseintheirbreathingmaybetheonlysignof swallowing.

Youseethebaby’sears“wiggle”slightly.•

Yourbaby’slipsturnoutlikefishlips,notin.•Youmaynotevenbeabletoseethebottomlip.

Yourbaby’schintouchesyourbreast.•

Help with latch problemsAre you in pain? Manymomsreportthattheirbreastscanbetenderatfirstuntilboththeyandtheirbabyfindcomfortablebreastfeedingposi-tionsandagoodlatch.Onceyouhavedonethis,breastfeedingshouldbecomfortable.If ithurts,yourbabymaybesuckingononlythenipple.Gentlybreakyourbaby’ssuctiontoyourbreastbyplacingacleanfingerinthecornerof yourbaby’smouthandtryagain.Also,yournippleshouldnotlookflatorcompressedwhenitcomesoutof yourbaby’smouth.Itshouldlookroundandlong,orthesameshapeasitwasbeforethefeeding.

Are you or your baby frustrated? Take a short breakandholdyourbabyinanuprightposition.Tryholdinghimorherbetweenyourbreastsskintoyourskin.Talk,sing,orprovideyourfingerforsuckingforcomfort.Trytobreastfeedagaininalittlewhile.Or,thebabymaystartmovingtothebreastonhisorherownfromthisposition.

Does your baby have a weak suck or make only tiny suckling movements?Breakyourbaby’ssuc-tionandtryagain.Heorshemaynothaveadeepenoughlatchtoremovethemilkfromyourbreast.Talk with a lactation consultant or pediatrician if yourbaby’ssuckfeelsweakorif youarenotsureheorsheisgettingenoughmilk.Rarely,ahealthproblemcausestheweaksuck.

A Good LatchA good latch is important for your baby to breast-feed effectively and for your comfort. During the early days of breastfeeding, it can take time and patience for your baby to latch on well.

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Breastfeeding holdsSomemomsfindthatthefollowingpositionsarehelpfulwaystogetcomfortableandsupporttheirbabiesinfindingagoodlatch.Youalsocanusepillowsunderyourarms,elbows,neck,orbacktogiveyouaddedcomfortandsupport.Keepinmindthatwhatworkswellforonefeedingmaynotworkwellforthenext.Keeptryingdifferentpositionsuntilyouarecomfortable.

Cradle hold1. –aneasy,commonholdthatiscomfortableformostmothersandbabies.Holdyourbabywithhisorherheadonyourfore-armandhisorherwholebodyfacingyours.

Cross cradle or transitional hold2. –usefulforprematurebabiesorbabieswithaweaksuckbecauseitgivesextraheadsupportandmayhelpbabiesstaylatched.Holdyourbabyalongtheoppositearmfromthebreastyouareusing.Supportyourbaby’sheadwiththepalmof yourhandatthebaseof hisorherneck.

Clutch or “football” hold3. –usefulformotherswhohadac-sectionandmotherswithlargebreasts,flatorinvertednipples,orastronglet-downreflex(seepage 9).Itisalsohelpfulforbabieswhoprefertobemoreupright.Thisholdallowsyoutobetterseeandcontrolyourbaby’sheadandtokeepthebabyawayfromac-sectionincision.Holdyourbabyatyourside,lyingonhisorherback,withhisorherheadatthelevelof yournipple.Supportbaby’sheadwiththepalmof yourhandatthebaseof thehead.(Thebabyisplacedalmostunderthearm.)

Side-lying position4. –usefulformotherswhohadac-sectionortohelpanymothergetextrarestwhilethebabybreastfeeds.Lieonyoursidewithyourbabyfacingyou.Pullyourbabyclosesoyourbabyfacesyourbody.

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tips for making it WorkLearn your baby’s hunger signs.1. Whenbabiesarehungry,theybecomemorealertandactive.Theymayputtheirhandsorfiststotheirmouths,makesuckingmotionswiththeirmouth,orturntheirheadslookingforthebreast.If anythingtouchesthebaby’scheek–suchasahand–thebabymayturntowardthehand,readytoeat.Thissignof hungeriscalledrooting.Offeryourbreastwhenyourbabyshowsrootingsigns.Cryingcanbealatesignof hunger,anditmaybehardertolatchoncethebabyisupset.Overtime,youwillbeabletolearnyourbaby’scuesforwhentostartfeeding.

Follow your baby’s lead. 2. Makesureyouarebothcomfortableandfollowyourbaby’sleadafterheorsheislatchedonwell.Somebabiestakebothbreastsateachfeeding.Otherbabiesonlytakeonebreastatafeeding.Helpyourbabyfinishthefirstbreast,aslongasheorsheisstillsuckingandswallowing.Thiswillensurethebabygetsthe“hind”milk–thefattiermilkattheendof afeeding.Yourbabywillletgoof thebreastwhenheorsheisfinishedandoftenfallsasleep.Offertheotherbreastif heorsheseemstowantmore.

Keep your baby close to you. 3. Rememberthatyour baby is not used to this new world and needstobeheldveryclosetohisorhermother.Beingskintoskinhelpsbabiescrylessandsta-bilizesthebaby’sheartandbreathingrates.

Avoid nipple confusion.4. Avoidusingpacifi-ers,bottles,andsupplementsof infantformulainthefirstfewweeksunlessthereisamedicalreasontodoso.If supplementationisneeded,trytogiveexpressedbreastmilkfirst.Butit’sbestjusttofeedatthebreast.Thiswillhelpyoumakemilkandkeepyourbabyfromget-tingconfusedwhilelearningtobreastfeed.

Sleep safely and close by. 5. Haveyourbabysleepinacriborbassinetinyourroom,sothatyoucanbreastfeedmoreeasilyatnight.Sharingaroomwithparentsislinkedtoalowerriskof SIDS(suddeninfantdeathsyndrome).

Know when to wake the baby. 6. In the early weeksafterbirth,youshouldwakeyourbabytofeedif 4hourshavepassedsincethebegin-ningof thelastfeeding.Sometipsforwakingthe baby include:

Changingyourbaby’sdiaper•

Placing your baby skin to skin•

Massagingyourbaby’sback,abdomen,andlegs•

If your baby is falling asleep at the breast during mostfeedings,talktothebaby’sdoctoraboutaweightcheck.Also,seealactationconsultanttomakesurethebabyislatchingonwell.

Vitamin DBabies need 400 IU of vitamin D each day. Ask your baby’s doctor about supplements in drop form.

How long should I breastfeed?Many leading health organizations recommend that most infants breastfeed for at least 12 months, with exclusive breastfeeding for the first 6 months. This means that babies are not given any foods or liquids other than breast milk for the first 6 months. These recommendations are supported by organizations in-cluding the American Academy of Pediatrics, Ameri-can Academy of Family Physicians, American College of Obstetricians and Gynecologists, American College of Nurse-Midwives, American Dietetic Association, and American Public Health Association.

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making Plenty of milkYourbreastswilleasilymakeandsupplymilkdirectlyinresponsetoyourbaby’sneeds.Themoreoftenandeffectivelyababybreastfeeds,themoremilkwillbemade.Babiesaretryingtodoubletheirweightinafewshortmonths,andtheirtummies

aresmall,sotheyneedmanyfeedingstogrowandtobehealthy.

Mostmotherscanmakeplentyof milkfortheirbaby.If youthinkyouhavealowmilksupply,talktoalactationconsultant.Seepage 6 for other typesof healthprofessionalswhocanhelpyou.

What will happen with you, your baby, and your milk in the first few weeks

Time Milk The Baby You (Mom)Birth Your body makes

colostrum (a rich, thick, yellowish milk) in small amounts. It gives your baby a healthy dose of early protection against diseases.

Will probably be awake in the first hour after birth. This is a good time to breastfeed your baby.

You will be tired and excited.

First 12-24 hours

Your baby will drink about 1 teaspoon of colostrum at each feeding. You may or may not see the colostrum, but it has what the baby needs and in the right amount.

It is normal for the baby to sleep heavily. Labor and deliv-ery are hard work! Some babies like to nuzzle and may be too sleepy to latch well at first. Feedings may be short and disorganized. As your baby wakes up, take advantage of your baby’s strong instinct to suck and feed every 1-2 hours. Many babies like to eat or lick, pause, savor, doze, then eat again.

You will be tired, too. Be sure to rest.

Next 3-5 days

Your white milk comes in. It is nor-mal for it to have a yellow or golden tint first. Talk to a doctor and lactation con-sultant if your milk is not yet in.

Your baby will feed a lot (this helps your breasts make plenty of milk), at least 8-12 times or more in 24 hours. Very young breastfed babies don’t eat on a schedule. Because breast milk is more easily digested than formula, breastfed babies eat more often than formula-fed babies. It is okay if your baby eats every 2-3 hours for several hours, then sleeps for 3-4 hours. Feedings may take about 15-20 minutes on each side. The baby’s sucking rhythm will be slow and long. You might hear gulping.

Your breasts may feel full and leak. (You can use disposable or cloth pads in your bra to help with leaking.)

The first 4-6

weeks

White breast milk continues.

Your baby will likely be better at breastfeeding and have a larger stomach to hold more milk. Feedings may take less time and will be farther apart.

Your body gets used to breast-feeding so your breasts will be softer and the leaking may slow down.

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how to Know Your Baby is getting enough milkManybabies,butnotall,loseasmallamountof weightinthefirstdaysafterbirth.Yourbaby’sdoctorwillcheckhisorherweightatyourfirstvisitafteryouleavethehospital.Makesuretovisityourbaby’sdoctorwithinthreetofivedaysafterbirthandthenagainattwotothreeweeksof ageforcheckups.

Youcantellif yourbabyisgettingplentyof milkif heorsheismostlycontentandgainingweightsteadilyafterthefirstweekof age.Frombirthtothreemonths,typicalweightgainis2/3to1ounceeachday.

Other signs that your baby is getting plenty of milk:

Heorsheispassingenoughclearorpaleyellow•urine,andit’snotdeepyellowororange(seethechartbelow).

Heorshehasenoughbowelmovements(see•thechartbelow).

Heorsheswitchesbetweenshortsleepingperi-•odsandwakeful,alertperiods.

Heorsheissatisfiedandcontentafterfeedings.•

Yourbreastsfeelsofterafteryoufeedyourbaby.•

Talktoyourbaby’sdoctorif youareworriedthatyourbabyisnoteatingenough.

How much do babies typically eat?A newborn’s tummy is very small, especially in the early days. Once breastfeeding is established, exclusively breastfed babies from 1 to 6 months of age take in between 19 and 30 ounces per day. If you breastfeed 8 times per day, the baby would eat around 3 ounces per feeding. Older babies will take less breastmilk as other food is introduced. Every baby is different, though.

Hazelnut Walnut

The Newborn Tummy

At birth, the baby’s stomach can comfortably digest what would fit in a hazelnut (about 1-2 teaspoons). In the first week, the baby’s stomach grows to hold about 2 ounces or what would fit in a walnut.

See our diaper tracker on page 46!

Minimum number of wet diapers and bowel movements in a baby’s first week(it is fine if your baby has more) 1 day = 24 hours

Baby’s gea umber of Wet n umber of Bowel n Color and exture of Bowel tdiapers movements movements

Day 1 (first 24 1 The first one usually occurs Thick, tarry, and black hours after birth) within 8 hours after birth

Day 2 2 3 Thick, tarry, and black Day 3 5-6 3 Looser greenish to yellow (color may vary)Day 4 6 3 Yellow, soft, and watery Day 5 6 3 Loose and seedy, yellow color Day 6 6 3 Loose and seedy, yellow color Day 7 6 3 Larger amounts of loose and seedy, yellow color

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Common ChallengesBreastfeedingcanbechallengingattimes,especiallyintheearlydays.Butitisimportanttorememberthatyouarenotalone.Lactationconsultantsaretrainedtohelpyoufindwaystomakebreastfeed-ingworkforyou.Andwhilemanywomenarefacedwithoneormoreof thechallengeslistedhere,manywomendonotstruggleatall!Also,manywomenmayhavecertainproblemswithonebabythattheydon’thavewiththeirsecondorthirdbabies.Readonforwaystotroubleshootproblems.

Challenge: sore nipplesManymomsreportthatnipplescanbetenderatfirst.Breastfeedingshouldbecomfortableonceyouhavefoundsomepositionsthatworkandagoodlatchisestablished.Yetitispossibletostillhavepainfromanabrasionyoualreadyhave.Youmayalsohavepainif yourbabyissuckingononlythenipple.

What you can doAgoodlatchiskey,sosee1. page 13 for detailedinstructions.If yourbabyissuckingonlyonthenipple,gentlybreakyourbaby’ssuctiontoyourbreastbyplacingacleanfingerinthecor-nerof yourbaby’smouthandtryagain.(Yournippleshouldnotlookflatorcompressedwhenitcomesoutof yourbaby’smouth.Itshouldlookroundandlong,orthesameshapeasitwasbeforethefeeding.)

If youfindyourself wantingtodelayfeedings2.becauseof pain,gethelpfromalactationcon-sultant.Delayingfeedingscancausemorepainandharmyoursupply.

Trychangingpositionseachtimeyoubreast-3.feed.Thisputsthepressureonadifferentpartof thebreast.

Afterbreastfeeding,expressafewdropsof4.milkandgentlyrubitonyournippleswithcleanhands.Humanmilkhasnaturalhealing

propertiesandemollientsthatsoothe.Alsotrylettingyournipplesair-dryafterfeeding,orwearasoftcottonshirt.

If youarethinkingaboutusingcreams,hydrogel5.pads,oranippleshield,gethelpfromahealthcareproviderfirst.

Avoidwearingbrasorclothesthataretootight6.andputpressureonyournipples.

Change nursing pads often to avoid trapping in7.moisture.

Avoidusingsoaporointmentsthatcontain8.astringentsorotherchemicalsonyournipples.Makesuretoavoidproductsthatmustberemovedbeforebreastfeeding.Washingwithclean water is all that is needed to keep yournipplesandbreastsclean.

If youhaveverysorenipples,youcanaskyour9.doctoraboutusingnon-aspirinpainrelievers.

Ask a lactation consultant for help to improve your baby’s latch. Talk to your doctor if your pain does not go away or if you suddenly get sore nipples after several weeks of pain-free breastfeeding. Sore nipples may lead to a breast infection, which needs to be treated by a doctor.

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Challenge: Low milk supplyMostmotherscanmakeplentyof milkfortheirbabies.Butmanymothersareconcernedabouthavingenough.

Checkingyourbaby’sweightandgrowthisthebestwaytomakesureheorsheisgettingenoughmilk.Letthedoctorknowif youareconcerned.Formorewaystotellif yourbabyisgettingenoughmilk,seepage 17.

There may be times when you think your sup-ply is low, but it is actually just fine:

Whenyourbabyisaroundsixweekstotwo•monthsold,yourbreastsmaynolongerfeelfull.Thisisnormal.Atthesametime,yourbabymaynurseforonlyfiveminutesatatime.Thiscanmeanthatyouandbabyarejustadjusting to the breastfeeding process – and gettinggoodatit!

Growth spurts can cause your baby to want to•nurselongerandmoreoften.Thesegrowthspurtscanhappenaroundtwotothreeweeks,sixweeks,andthreemonthsof age.Theycanalsohappenatanytime.Don’tbealarmedthatyoursupplyistoolowtosatisfyyourbaby.Fol-lowyourbaby’slead–nursingmoreandmoreoftenwillhelpbuildupyourmilksupply.Onceyoursupplyincreases,youwilllikelybebacktoyourusualroutine.

What you can doMakesureyourbabyislatchedonandposi-1.tionedwell.

Breastfeedoftenandletyourbabydecidewhen2.toendthefeeding.

Offerbothbreastsateachfeeding.Haveyour3.babystayatthefirstbreastaslongasheorsheisstillsuckingandswallowing.Offerthesec-ondbreastwhenthebabyslowsdownorstops.

Trytoavoidgivingyourbabyformulaorcereal4.asitmayleadtolessinterestinbreastmilk.Thiswilldecreaseyourmilksupply.Yourbabydoesn’tneedsolidfoodsuntilheorsheisat

leastsixmonthsold.If youneedtosupple-mentthebaby’sfeedings,tryusingaspoon,cup,oradropper.

Limitorstoppacifierusewhiletryingthe5.abovetipsatthesametime.

Challenge: oversupply of milkSomemothersareconcernedabouthavinganover-supplyof milk.Havinganoverfullbreastcanmakefeedingsstressfulanduncomfortableforbothmotherandbaby.

What you can doBreastfeedononesideforeachfeeding.1.Continuetoofferthatsamesideforatleasttwohoursuntilthenextfullfeeding,graduallyincreasingthelengthof timeperfeeding.

If the other breast feels unbearably full be-2.foreyouarereadytobreastfeedonit,handexpressforafewmomentstorelievesomeof thepressure.Youcanalsouseacoldcompressorwashclothtoreducediscomfortandswelling.

Feedyourbabybeforeheorshebecomes3.overlyhungrytopreventaggressivesucking.(Learnabouthungersignsonpage 15.)Trypositionsthatdon’tallowtheforceof4.gravitytohelpasmuchwithmilkejection,such as the side-lying position or the footballhold.(seepage 14 for illustrations of thesepositions.)

Burpyourbabyfrequentlyif heorsheisgassy.5.

Somewomenhaveastrongmilkejectionreflexorlet-down(seepage 9).Thiscanhappenalongwithanoversupplyof milk.If youhavearushof milk,try the following:

Holdyournipplebetweenyourforefingerand1.middlefingerorwiththesideof yourhandto

Let your baby’s doctor know if you think the baby is not getting enough milk.

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lightlycompressmilkductstoreducetheforceof themilkejection.

If babychokesorsputters,unlatchhimorher2.andlettheexcessmilksprayintoatowelorcloth.

Allowyourbabytocomeonandoff thebreast3.atwill.

Challenge: engorgementItisnormalforyourbreaststobecomelarger,heavier,andalittletenderwhentheybeginmakingmoremilk.Sometimesthisfullnessmayturnintoengorgement,whenyourbreastsfeelveryhardandpainful.Youalsomayhavebreastswelling,tender-ness,warmth,redness,throbbing,andflatteningof thenipple.Engorgementsometimesalsocausesalow-grade fever and can be confused with a breast infection.Engorgementistheresultof themilkbuildingup.Itusuallyhappensduringthethirdtofifthdayafterbirth,butitcanhappenatanytime.

Engorgementcanleadtopluggedductsorabreastinfection(seepage 21),soitisimportanttotrytopreventitbeforethishappens.If treatedproperly,engorgementshouldresolve.

What you can doBreastfeedoftenafterbirth,allowingthebaby1.tofeedaslongasheorshelikes,aslongasheorsheislatchedonwellandsuckingeffectively.Intheearlyweeksafterbirth,youshouldwakeyour baby to feed if four hours have passedsincethebeginningof thelastfeeding.

Workwithalactationconsultanttoimprovethe2.baby’slatch.

Breastfeedoftenontheaffectedsidetore-3.movethemilk,keepitmovingfreely,andpre-ventthebreastfrombecomingoverlyfull.

Avoidoverusingpacifiersandusingbottlesto4.supplementfeedings.

Handexpressorpumpalittlemilktofirst5.softenthebreast,areola,andnipplebeforebreastfeeding.

Massagethebreast.6.

Usecoldcompressesinbetweenfeedingsto7.helpeasepain.

If youarereturningtowork,trytopump8.yourmilkonthesameschedulethatthebabybreastfedathome.Or,youcanpumpatleasteveryfourhours.

Getenoughrest,propernutrition,andfluids.9.

Wearawell-fitting,supportivebrathatisnot10.tootight.

Ask your lactation consultant or doctor for help if the engorgement lasts for two days or more.

Ask a lactation consultant for help if you are unable to manage an oversupply of milk on your own.

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Challenge: Plugged ductItiscommonformanywomentohaveapluggedductatsomepointwhenbreastfeeding.Apluggedmilkductfeelslikeatenderandsorelumpinthebreast.Itisnotaccompaniedbyafeverorothersymptoms.Ithappenswhenamilkductdoesnotproperlydrainandbecomesinflamed.Then,pres-surebuildsupbehindtheplug,andsurroundingtissuebecomesinflamed.Apluggedductusuallyonlyoccursinonebreastatatime.

What you can doBreastfeedoftenontheaffectedside,asoften1.aseverytwohours.Thishelpsloosentheplug,andkeepsthemilkmovingfreely.

Massagethearea,startingbehindthesorespot.2.Useyourfingersinacircularmotionandmas-sagetowardthenipple.

Useawarmcompressonthesorearea.3.

Getextrasleeporrelaxwithyourfeetupto4.helpspeedhealing.Oftenapluggedductisthefirstsignthatamotherisdoingtoomuch.

Wearawell-fittingsupportivebrathatisnot5.tootight,becausethiscanconstrictmilkducts.Considertryingabrawithoutunderwire.

Challenge: Breast infection (mastitis)Mastitis(mast-EYE-tiss)issorenessoralumpinthebreastthatcanbeaccompaniedbyafeverand/orflu-likesymptoms,suchasfeelingrundownorveryachy.Somewomenwithabreastinfectionalsohavenauseaandvomiting.Youalsomayhaveyellowishdischargefromthenipplethatlookslikecolostrum.Or,thebreastsmayfeelwarmorhottothetouchandappearpinkorred.Abreastinfectioncanoccurwhenotherfamilymembershaveacoldortheflu.It

usuallyonlyoccursinonebreast.Itisnotal-ways easy to tell the difference between a breast infection and a plugged duct because both have similarsymptomsandcanimprovewithin24to48hours.Mostbreastinfectionsthatdonotim-proveontheirownwithinthistimeperiodneedtobetreatedwithmedicinegivenbyadoctor.(Learnmoreaboutmedicinesandbreastfeedingon page 26.)

What you can doBreastfeedoftenontheaffectedside,asoften1.aseverytwohours.Thiskeepsthemilkmov-ingfreelyandkeepsthebreastfrombecomingoverlyfull.

Massagethearea,startingbehindthesorespot.2.Useyourfingersinacircularmotionandmas-sagetowardthenipple.

Applyheattothesoreareawithawarmcom-3.press.

Getextrasleeporrelaxwithyourfeetupto4.helpspeedhealing.Oftenabreastinfectionisthefirstsignthatamotherisdoingtoomuchandbecomingoverlytired.

Wearawell-fittingsupportivebrathatisnot5.tootight,becausethiscanconstrictmilkducts.

If your plugged duct doesn’t loosen up, ask for help from a lactation consultant. Plugged ducts can lead to a breast infection.

Ask your doctor for help if you do not feel better within 24 hours of trying these tips, if you have a fever, or if your symptoms worsen. You might need medicine. see your doctor right away if:

You have a breast infection in which both •breasts look affected. There is pus or blood in the milk. •You have red streaks near the area.•Your symptoms came on severely and suddenly.•

Even if you are taking medicine, continue to breastfeed during treatment. This is best for both you and your baby. Ask a lactation consultant for help if need be.

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Challenge: Fungal infections Afungalinfection,alsocalledayeastinfectionorthrush,canformonyournipplesorinyourbreastbecauseitthrivesonmilk.Theinfectionformsfromanovergrowthof theCandidaorganism.Candidaexistsinourbodiesandiskeptathealthylevelsbythenaturalbacteriainourbodies.Whenthenaturalbalanceof bacteriaisupset,Candida can overgrow,causinganinfection.

Akeysignof afungalinfectionisif youdevelopsorenipplesthatlastmorethanafewdays,evenafteryoumakesureyourbabyhasagoodlatch.Or,youmaysuddenlygetsorenipplesaftersev-eralweeksof pain-freebreastfeeding.Someothersignsof afungalinfectionincludepink,flaky,shiny,itchy,orcrackednipplesordeeppinkandblisterednipples.Youalsocouldhaveachybreastsor shooting pains deep in the breast during or after feedings.

Causes of thrush include:

Thrushinyourbaby’smouth,whichcanpass•to you

Anoverlymoistenvironmentonyourskinor•nipples that are sore or cracked

Antibioticsorsteroids•

AchronicillnesslikeHIV,diabetes,oranemia•

Thrushinababy’smouthappearsaslittlewhitespotsontheinsideof thecheeks,gums,ortongue.Manybabieswiththrushrefusetonurseoraregas-syorcranky.Ababy’sfungalinfectioncanalsoap-pearasadiaperrashthatlookslikesmallreddotsaroundamainrash.Thisrashwillnotgoawaybyusingregulardiaperrashcreams.

What you can doFungalinfectionsmaytakeseveralweekstocure,soitisimportanttofollowthesetipstoavoidspreading the infection:

Changedisposablenursingpadsoften.1.

Washanytowelsorclothingthatcomesincontact2.withtheyeastinveryhotwater(above122°F).

Wearacleanbraeveryday.3.

Washyourhandsoften,andwashyourbaby’s4.hands often – especially if he or she sucks onhisorherfingers.

Putpacifiers,bottlenipples,ortoysyourbaby5.putsinhisorhermouthinapotof waterandbringittoaroaringboildaily.Afteroneweekof treatment,discardpacifiersandnipplesandbuynewones.

Boildailyallbreastpumppartsthattouchthe6.milk.

Makesureotherfamilymembersarefreeof7.thrushorotherfungalinfections.If theyhavesymptoms,makesuretheygettreated.

If you or your baby has symptoms of a fungal in-fection, call both your doctor and your baby’s doc-tor so you can be correctly diagnosed and treated at the same time. This will help prevent passing the infection to each other.

I had a terrible time learning to nurse my son. My nipples were terribly sore and it felt like it wasn’t getting any better. After visiting my doctor, the lactation consultant, and the pediatrician, it be-came clear that a horrible case of thrush had been the source of my pain. I honestly did not think I would make it, but I was too stubborn to quit and I am grateful I stuck with it. I am proud to say that I breastfed my son until he was 16 months old! – JessicaEdmonton, AB, Canada

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Challenge: nursing strikeAnursing“strike”iswhenyourbabyhasbeenbreastfeedingwellformonthsandthensuddenlybeginstorefusethebreast.Anursingstrikecanmeanthatyourbabyistryingtoletyouknowthatsomethingiswrong.Thisdoesnotusuallymeanthatthebabyisreadytowean.Notallbabieswillreactthesametothedifferentsituationsthatcancauseanursingstrike.Somebabieswillcontinuetobreastfeedwithoutaproblem.Othersmayjustbecomefussyatthebreast,andotherswillrefusethebreastentirely.Someof themajorcausesof anursing strike include:

Mouthpainfromteething,afungalinfection•likethrush,oracoldsore

Anearinfection,whichcausespainwhile•sucking

Painfromacertainbreastfeedingposition,•eitherfromaninjuryonthebaby’sbodyorfromsorenessfromanimmunization

Beingupsetaboutalongseparationfromthe•motheroramajorchangeinroutine

Beingdistractedwhilebreastfeeding–becoming•interestedinotherthingsaroundhimorher

Acoldorstuffynosethatmakesbreathing•whilebreastfeedingdifficult

Reducedmilksupplyfromsupplementingwith•bottlesoroveruseof apacifier

Respondingtothemother’sstrongreactionif•the baby has bitten her

Beingupsetafterhearingpeopleargue•

Reactingtostress,overstimulation,orhaving•been repeatedly put off when wanting tobreastfeed

If yourbabyisonanursingstrike,itisnormaltofeelfrustratedandupset,especiallyif yourbabyisunhappy.Itisimportantnottofeelguiltyorthinkthatyouhavedonesomethingwrong.Keepinmindthatyourbreastsmaybecomeuncomfortableasthemilkbuildsup.

What you can doTrytoexpressyourmilkonthesameschedule1.as the baby used to breastfeed to avoid en-gorgementandpluggedducts.

Tryanotherfeedingmethodtemporarilyto2.giveyourbabyyourmilk,suchasacup,drop-per,orspoon.

Keeptrackof yourbaby’swetdiapersand3.dirtydiaperstomakesureheorsheisgettingenoughmilk.

Keepofferingyourbreasttothebaby.If thebaby4.isfrustrated,stopandtryagainlater.Youcanalsotrywhenthebabyissleepingorverysleepy.

Tryvariousbreastfeedingpositions,withyour5.bareskinnexttoyourbaby’sbareskin.

Focusonthebabywithallof yourattention6.andcomforthimorherwithextratouchingandcuddling.

Try breastfeeding while rocking and in a quiet7.roomfreeof distractions.

Ask for help if your baby is having a nursing strike to ensure that your baby gets enough milk. The doctor can check your baby’s weight gain.

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Challenge: inverted, Flat, or Very Large nipplesSomewomenhavenipplesthatturninwardinstead of protruding or that are flat and do notprotrude.Nipplescanalsosometimesbeflattenedtemporarilyduetoengorgementorswellingwhilebreastfeeding.Invertedorflatnipplescansometimesmakeithardertobreastfeed.Butrememberthatforbreastfeed-ingtowork,yourbabyhastolatchontoboththenippleandthebreast,soeveninvertednipplescanworkjustfine.Often,flatandin-vertednippleswillprotrudemoreovertime,asthebabysucksmore.

Verylargenipplescanmakeithardforthebaby to get enough of the areola into his or hermouthtocompressthemilkductsandgetenoughmilk.

What you can doTalk to your doctor or a lactation consultant if1.youareconcernedaboutyournipples.

Youcanuseyourfingerstotryandpullyour2.nipplesout.Therearealsospecialdevicesdesignedtopulloutinvertedortemporarilyflattenednipples.

Thelatchforbabiesof motherswithverylarge3.nippleswillimprovewithtimeasthebabygrows.Insomecases,itmighttakeseveralweekstogetthebabytolatchwell.Butif amotherhasagoodmilksupply,herbabywillgetenoughmilkevenwithapoorlatch.

Ask for help if you have questions about your nipple shape or type, especially if your baby is having trouble latching well.

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Common Questionsshould i supplement with formula?Givingyourbabyformulamaycausehimorhertonotwantasmuchbreastmilk.Thiswilldecreaseyourmilksupply.If youareworriedthatyourbabyisnoteatingenough,talktoyourbaby’sdoctor.

does my baby need cereal or water?Yourbabyonlyneedsbreastmilkforthefirstsixmonthsof life.Breastmilkalonewillprovideallthenutritionyourbabyneeds.Givingthebabycerealmaycauseyourbabytonotwantasmuchbreastmilk.Thiswilldecreaseyourmilksupply.Eveninhotclimates,breastfedinfantsdonotneedwaterorjuice.Whenyourbabyisreadyforotherfoods,thefoodshouldbeironrich.

is it okay for my baby to use a pacifier? If youwanttotryit,itisbesttowaituntilthebabyisonemontholdtointroduceapacifier.Thisallows the baby to learn how to latch well on the breastandgetenoughtoeat.

is my baby getting enough vitamin d?VitaminDisneededtobuildstrongbones.Allinfantsandchildrenshouldgetatleast400Inter-nationalUnits(IU)of vitaminDeachday.Tomeet

thisneed,allbreastfedinfants(includingthosesup-plementedwithformula)shouldbegivenavitaminDsupplementof 400IUeachday.Thisshouldstartinthefirstfewdaysof life.Youcanbuyvita-minDsupplementsforinfantsatadrugstoreorgrocerystore.Sunlightisamajorsourceof vitaminD,butitishardtomeasurehowmuchsunlightyourbabygets,andtoomuchsuncanbeharmful.Onceyourbabyisweanedfrombreastmilk,talktoyourbaby’sdoctoraboutwhetheryourbabystillneedsvitaminDsupplements.SomechildrendonotgetenoughvitaminDthroughdietalone.

When should i wean my baby?TheAmericanAcademyof Pediatricsrecommendsbreastfeedingbeyondthebaby’sfirstbirthday,andforaslongasboththemotherandbabywouldlike.Theeasiestandmostnaturaltimetoweaniswhenyourchildleadstheprocess.Buthowthemotherfeelsisveryimportantindecidingwhentowean.

is it safe to smoke, drink, or use drugs? If yousmoke,itisbestforyouandyourbabytoquitassoonaspossible.If youcan’tquit,itisstillbetterto breastfeed because it can help protect your baby fromrespiratoryproblemsandsuddeninfantdeathsyndrome.Besuretosmokeawayfromyourbabyand change your clothes to keep your baby away fromthechemicalssmokingleavesbehind.Askahealthcareproviderforhelpquittingsmoking!

Youshouldavoidalcohol,especiallyinlargeamounts.Anoccasionalsmalldrinkisokay,butavoidbreastfeedingfortwohoursafterthedrink.

It is not safe for you to use or be dependent on an illicitdrug.Drugssuchascocaine,marijuana,hero-ine,andPCPharmyourbaby.Somereportedsideeffectsinbabiesincludeseizures,vomiting,poorfeeding,andtremors.

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Can i take medicines if i am breast-feeding?Althoughalmostallmedicinespassintoyourmilkinsmallamounts,mosthavenoeffectonthebabyandcanbeusedwhilebreastfeeding.Veryfewmedi-cinescan’tbeusedwhilebreastfeeding.Discussanymedicinesyouareusingwithyourdoctorandaskbeforeyoustartusingnewmedicines.Thisincludesprescriptionandover-the-counterdrugs,vitamins,anddietaryorherbalsupplements.Forsomewomenwithchronichealthproblems,stoppingamedicinecanbemoredangerousthantheeffectsitwillhaveonthebreastfedbaby.

Youcanlearnmorefrom Medications and Mothers’ Milk, abookbyThomasHale,foundinbook-storesandlibraries.TheNationalLibraryof Medi-cine also offers an online tool for learning about theeffectsof medicinesonbreastfedbabies.Thewebsiteaddressishttp://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT.

Can i breastfeed if i am sick?Somewomenthinkthatwhentheyaresick,theyshouldnotbreastfeed.But,mostcommonill-nesses,suchascolds,flu,ordiarrhea,can’tbepassedthroughbreastmilk.Infact,if youaresick,yourbreastmilkwillhaveantibodiesinit.Theseantibod-ieswillhelpprotectyourbabyfromgettingthesamesickness.(Seepage 4tolearnaboutantibodies.)

Breastfeeding is not advised if the mother:

HasbeeninfectedwithHIVorhasAIDS.If•youhaveHIVandwanttogiveyourbabybreastmilk,youcancontactahumanmilkbank(see

page 32formoreinformation).Istakingantiretroviralmedications.•

Hasuntreated,activetuberculosis.•

IsinfectedwithhumanT-celllymphotropic•virustypeIortypeII.

Istakingprescribedcancerchemotherapy•agents,suchasantimetabolites,thatinterferewithDNAreplicationandcelldivision.

Isundergoingradiationtherapies,butsuch•nuclearmedicinetherapiesrequireonlyatem-porarybreakfrombreastfeeding.

What should i do if i have postpar-tum depression?First,postpartumdepressionisdifferentthanpost-partum“blues.”Theblues–whichcanincludelotsof tears,andfeelingdownandoverwhelmed–arecommonandgoawayontheirown.Postpartumdepressionislesscommon,moreserious,andcanlastmorethantwoweeks.Symptomscanincludefeelingirritableandsad,havingnoenergyandnotbeingabletosleep,beingoverlyworriedaboutthebabyornothavinginterestinthebaby,andfeelingworthlessandguilty.

If youhavepostpartumdepression,workwithyourdoctortofindtherighttreatmentforyou.Treatmentmayincludemedicationsuchasanti-depressantsandtalktherapy.Researchhasshownthatwhileantidepressantspassintobreastmilk,fewproblemshavebeenreportedininfants.Evenso,itisimportanttoletyourbaby’sdoctorknowif youneedtotakeanymedications.

Letyourdoctorknowif yourbluesdonotgoawaysothatyoucanfeelbetter.If youarehavinganythoughtsaboutharmingyourself oryourbaby,call911rightaway.

Will my partner be jealous if i breastfeed?If youprepareyourpartnerinadvance,thereshouldbenojealousy.Explainthatyouneedsup-port.Discusstheimportantandlastinghealth

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benefitsof breastfeeding.Explainthatnotmak-ingformulameansmorerest.Besuretoempha-sizethatbreastfeedingcansaveyoumoney.Yourpartnercanhelpbychangingandburpingthebaby,sharingchores,andsimplysittingwithyouandthebabytoenjoythespecialmoodthatbreastfeed-ingcreates.Yourpartnercanalsofeedthebabypumpedbreastmilk.

do i have to restrict my sex life while breastfeeding?No.But,if youarehavingvaginaldryness,youcantrymoreforeplayandwater-basedlubricants.Youcanfeedyourbabyorexpresssomemilkbeforelovemakingsoyourbreastswillbemorecomfort-ableandlesslikelytoleak.Duringsex,youalsocanput pressure on the nipple when it lets down or haveatowelhandytocatchthemilk.

do i still need birth control if i am breastfeeding?Likeotherformsof birthcontrol,breastfeedingisnotasurewaytopreventpregnancy.Breastfeed-ingcandelaythereturnof normalovulationandmenstrualcycles.Youshouldstilltalkwithahealthcare provider about birth control choices that are okaytousewhilebreastfeeding.

i heard that breast milk can have toxins in it from my environment. is it still safe for my baby? Whilecertainchemicalshaveappearedinbreastmilk,breastfeedingremainsthebestwaytofeedandnurtureyounginfantsandchildren.Thead-vantages of breastfeeding far outweigh any pos-siblerisksfromenvironmentalpollutants.Todate,theeffectsof suchchemicalshaveonlybeenseenrarely–inbabieswhosemothersthemselveswereillbecauseof them.Infantformula,thewateritismixedwith,and/orthebottlesornipplesusedtogiveittothebabycanbecontaminatedwithbacte-riaorchemicals.

does my breastfed baby need vac-cines? is it safe for me to get a vac-cine when i’m breastfeeding? Yes.Vaccinesareveryimportanttoyourbaby’shealth.Breastfeedingmayalsoenhanceyourbaby’sresponsetocertainimmunizations,providingmoreprotection.Followthescheduleyourdoctorgivesyou,and,if youmissany,checkwithhimorheraboutgettingyourbabybackontrack.Breastfeed-ing while the vaccine is given to your baby – or immediatelyafterward–canhelprelievepainandsootheanupsetbaby.Mostnursingmothersmayalsoreceivevaccines.Breastfeedingdoesnotaf-fectthevaccine.Vaccinesarenotharmfultoyourbreastmilk.

What should i do if my baby bites me?If yourbabystartstoclampdown,youcanputyourfingerinthebaby’smouthandtakehimorheroff of yourbreastwithafirm,“No.”Trynottoyellbecauseitmayscarethebaby.If yourbabycontinuestobiteyou,youcan:

Stopthefeedingrightawaysothebabyisnot•temptedtogetanotherreactionfromyou.Don’tlaugh.Thisispartof yourbabylearninglimits.

Offerateethingtoy,orasnack(if olderbaby),•ordrinkfromacupinstead.

Putyourbabydownforamomenttoshowthat•bitingbringsanegativeconsequence.Youcanthenpickyourbabyupagaintogivecomfort.

What do i do if my baby keeps cry-ing?If yourbabydoesnotseemcomfortedbybreast-feedingorothersoothingmeasures,talktoyourbaby’sdoctor.Yourbabymayhavecolicormaybeuncomfortableorinpain.Youcanalsochecktoseeif yourbabyisteething.Thedoctorandalacta-tionconsultantcanhelpyoufindwaystohelpyourbabyeatwell.

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Breastfeeding a Baby with health ProblemsTherearesomehealthproblemsinbabiesthatcanmakeithardertobreastfeed.Yetbreastmilkandearlybreastfeeding are still best for the health of both you andyourbaby–evenmoresoif yourbabyispre-matureorsick.Evenif yourbabycannotbreastfeeddirectlyfromyou,it’sbesttoexpressorpumpyourmilkandgiveittoyourbabywithacupordropper.

Somecommonhealthproblemsinbabiesarelistedbelow.

JaundiceJaundice(JAWN-diss)iscausedbyanexcessof bilirubin,asubstancethatisinthebloodusuallyinverysmallamounts.Inthenewbornperiod,bilirubincanbuildupfasterthanitcanberemovedfromtheintestinaltrack.Jaundicecanappearasayellowingof theskinandeyes.Itaffectsmostnewbornstosomedegree,appearingbetweenthesecondandthirddayof life.Thejaundiceusuallyclearsupbytwoweeksof ageandisnotharmful.

Two types of jaundice can affect breastfed infants – breastfeedingjaundiceandbreastmilkjaundice.

Breastfeedingjaundicecanoccurwhenabreast-•feedingbabyisnotgettingenoughbreastmilk.This can happen either because of breastfeedingchallengesorbecausethemother’smilkhasn’tyetcomein.Thisisnotcausedbyaproblemwiththebreastmilkitself.

Breastmilkjaundicemaybecausedbysubstanc-•esinthemother’smilkthatpreventsbilirubinfrombeingexcretedfromthebody.Suchjaun-diceappearsinsomehealthy,breastfedbabiesafteraboutoneweekof age.Itmaylastforamonthormoreanditisusuallynotharmful.

Yourbaby’sdoctormaymonitoryourbaby’sbiliru-binlevelwithbloodtests.Jaundiceisbesttreatedbybreastfeedingmorefrequentlyorforlongerperiodsof time.Itiscrucialtohaveahealthcare

providerhelpyoumakesurethebabyislatch-ingonandremovingmilkwell.Thisisusuallyallthatisneededfortheinfant’sbodytoriditself of excessbilirubin.

Somebabieswillalsoneedphototherapy–treat-mentwithaspeciallight.Thislighthelpsbreakdownbilirubinintoaformthatcanberemovedfromthebodyeasily.If youarehavingtroublelatchingyourbabytothebreast,itisimportantthatyoupumporhandexpresstoensureagoodmilksupply.Thesameistrueif thebabyneedsformulaforashorttime–pumpingorhandexpressingwillmakesurethebabyhasenoughmilkwhenyoureturntobreastfeeding.

Itisimportanttokeepinmindthatbreastfeedingisbestforyourbaby.Evenif yourbabyexperienc-esjaundice,thisisnotsomethingthatyoucaused.Yourhealthcareproviderscanhelpyoumakesurethat your baby is eating well and that the jaundice goesaway.

If your baby develops jaundice once at home, let your baby’s doctor know. Discuss treatment options and let the doctor know that you do not want to inter-rupt breastfeeding if at all possible.

Reflux DiseaseSomebabieshaveaconditioncalledgastroe-sophageal(GASS-troh-uh-SOF-uh-JEE-uhl)refluxdisease(GERD),whichoccurswhenthemuscleattheopeningof thestomachopensatthewrongtimes.Thisallowsmilkandfoodtocomebackupintotheesophagus,thetubeinthethroat.Somesymptomsof GERDcaninclude:

Severespittingup,orspittingupafterevery•feeding or hours after eating

Projectilevomiting,wherethemilkshootsout•of themouth

Inconsolablecryingasif indiscomfort•

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Archingof thebackasif inseverepain•

Refusaltoeatorpullingawayfromthebreast•during feeding

Wakingupoftenatnight•

Slowweightgain•

Gaggingorchoking,orproblemsswallowing•

Manyhealthybabiesmighthavesomeof thesesymp-tomsandnothaveGERD.Buttherearebabieswhomightonlyhaveafewof thesesymptomsandhaveaseverecaseof GERD.NotallbabieswithGERDspituporvomit.Moreseverecasesof GERDmayneedtobetreatedwithmedicationif thebabyrefusestonurse,gainsweightpoorlyorislosingweight,orhasperiodsof gaggingorchoking.

Cleft Palate and Cleft LipCleftpalateandcleftliparesomeof themostcom-monbirthdefectsthathappenasababyisdevelop-inginthewomb.Acleft,oropening,ineitherthepalateorlipcanhappentogetherorseparately,andbothcanbecorrectedthroughsurgery.Bothcondi-tionscanpreventbabiesfromformingagoodsealaroundthenippleandareolawithhisorhermouthoreffectivelyremovingmilkfromthebreast.Amothercantrydifferentbreastfeedingpositionsanduseherthumborbreasttohelpfillintheopeningleftbytheliptoformasealaroundthebreast.

Rightafterbirth,amotherwhosebabyhasacleftpal-atecantrytobreastfeedherbaby.Shecanalsostartexpressinghermilkrightawaytokeepuphersupply.Evenif herbabycan’tlatchonwelltoherbreast,thebabycanbefedbreastmilkbycup.Insomehospi-tals,babieswithcleftpalatearefittedwithamouth-piececalledanobturatorthatfitsintothecleftandsealsitforeasierfeeding.Thebabyshouldbeabletoexclusivelybreastfeedafterhisorhersurgery.

Premature and/or Low Birth WeightPrematurebirthiswhenababyisbornbefore37weeks’gestation.Prematurityoftenwillmeanthatthebabyisbornatalowbirthweight,definedaslessthan5½pounds.Lowbirthweightcanalsobecausedbymalnourishmentinthemother.Arrivingearlyorbeingsmallcanmakeforatoughadjust-ment,especiallyif thebabyhastostayinthehos-pitalforextracare.Butkeepinmindthatbreastmilkhasbeenshowntohelpprematurebabiesgrowandwardoff illness.

Mostbabieswhoarelowbirthweightbutbornafter37weeks(fullterm)canbeginbreastfeedingrightaway.Theywillneedmoreskin-to-skincontactwithmomanddadtohelpkeepthemwarm.Thesesmallerbabiesmayalsoneedmorefrequentfeedings,andtheymaygetsleepierduringthosefeedings.

Manybabiesbornprematurelyareoftennotabletobreastfeedatfirst,buttheydobenefitfromexpressedmilk.Youcanexpresscolostrumbyhandorpumpassoonasyoucaninthehospital.Youcantalktothehospitalstaff aboutrentingahospital-gradeelectricpump.CallyourinsurancecompanyorlocalWICOfficetofindoutif youcangetreimbursedforthistypeof pump.Youwillneedtoexpressmilkasoftenasyouwouldhavebreastfed,soabout8timesina24-hourperiod.

Onceyourbabyisreadytobreastfeeddirectly,skin-to-skincontactcanbeverycalmingandagreatstarttoyourfirstfeeding.Besuretoworkwith a lactation consultant on proper latch and po-sitioning.Manymothersof prematurebabiesfindthecrosscradleholdhelpful.(Seepage 14 for an illustration.)Itmaytakesometimeforyouandthebabytogetintoagoodroutine.

See your baby’s doctor if he or she spits up after every feeding and has any of the other symptoms mentioned here. If your baby has GERD, it is impor-tant to continue breastfeeding. Breast milk is more easily digested than infant formula.

If you leave the hospital before your baby, you can express milk for the hospital staff to give the baby by feeding tube.

If your baby is born with a cleft palate or cleft lip, talk with a lactation consultant in the hospital. Breast milk is still best for your baby’s health.

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Breastfeeding and special situations

twins or multiplesThebenefitsof humanmilktomothersof multi-plesandtheirbabiesarethesameasforallmothersandbabies–possiblygreater,becausemanymul-tiplesarebornearly.Buttheideamayseemover-whelming!Yetmanyof thesemomsfindbreastfeed-ingeasierthanotherfeedingmethodsbecausethereisnothingtoprepare.Manymothershaveovercomechallengestosuccessfullybreastfeedtwinsandmoreevenaftergoingbacktowork.

Being preparedItwillhelptolearnasmuchasyoucanaboutbreastfeedingduringyourpregnancy.Youcan:

Takeabreastfeedingclass.•

FindInternetandprintresourceforparentsof•multiples.

Joinasupportgroupforparentsof multiples•

Many twin and multiple babies are smaller or born premature. Please see the information on page 29 for other tips for caring for these babies. Also, talk with a lactation consultant about more ways you can successfully breastfeed.

throughyourhealthcareprovider,hospital,localbreastfeedingcenter,orLaLecheLeagueInternational.

Letyourhealthcareproviderandfamilymem-•bersknowthatyouplantobreastfeed.

Keepinmindthatevenif yourbabiesneedto•spendtimeintheNICU(neonatalintensivecareunit),breastfeedingisstillpossible,withsomeadjustments.

Findalactationconsultantwithmultiplesexperi-•ence before the babies are born so that you knowwheretoturnforhelp.Askherwhereyoucanrentabreastpumpif thebabiesarebornearly.

Making enough milkMostmothersareabletomakeplentyof milkfortwins.Manymothersfullybreastfeedorprovidemilkfortripletsorquadruplets.Keepthesetipsinmind:

Breastfeedingsoonafterbirthandoftenishelp-•fulformultiplesthesamewayitisforonebaby.Themoremilkthatiseffectivelyremoved,themoremilkamother’sbodywillmake.

If thebabiesarebornearly,doublepumping•oftenwillhelpthemothermakemoremilk.

Thedoctor’sweightcheckscantellyouif your•babiesaregettingenoughbreastmilk.Youcanalsotrackwetdiapersandbowelmovementstotellif yourbabiesaregettingenough.(Seeourdiapertracker on page 46.)Forothersignsthatyourbabiesaregettingenoughbreastmilk,seepage 17.Ithelpstohaveeachbabyfeedfromboth•breasts.Youcan“assign”abreasttoeachbabyforafeedingandswitchatthenextfeeding.Or,you can assign a breast to each baby for a dayandswitchthenextday.Switchingbreastshelpskeepmilkproductionupif onebabyisn’teatingaswellforabit.Italsogivesbabiesadifferentviewtostimulatetheireyes.

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Breastfeeding positionsBreastfeedingtwinsandmoremaytakepractice,butyouandyourbabiescanfindyouridealposi-tionsandroutine.Keeptryingdifferentpositionsuntilyoufindonesthatworkforyou.Forsomemothersandbabies,breastfeedingtwinsatthesametimeworkswell.Othersfindindividualfeed-ingstoworkbetter.Stillothersfindthatitdependsonthetime–youmayfeedonebabyatatimeatnightandfeedtwobabiesatthesametimeduringtheday.Finally,asyourbabiesgrow,youmayfindthatyouneedtochangeyourfeedingroutine.

Belowaresomepositionsthatmayworkforyou:

Double clutch• (“football”)–Placebothbabiesintheclutchhold.Youwillneedpillowsatyourside(andmaybeoneonyourlap)andyouwillplace the babies on the pillows with their legsgoingtowardthebackof thechairorcouch.Ifyouareplacingthebabiesinfrontof you,trytokeeptheirwholebodiesturnedtowardyou,theirchestsagainstyourchest.Theirbodiesmustnotbefacingup.Thisisveryimportanttohelppreventnipplepainandtomakesurethatthebabiesaregettingenoughmilk.

Cradle-clutch combination• – Place one baby(usuallytheeasiesttolatchorstaylatched)in

the cradle position and then position the second babyintheclutchposition.

Double cradle• – Place the babies in front ofyouwiththeirlegsoverlapping,makinganXacrossyourlap.

Partial breastfeeding Eventhoughfull,directbreastfeedingisideal,manymothersof multiplesfeedtheirbabiesbreastmilkorsomeformulabybottlesattimes.Itisimportanttoworkwithyourdoctor,yourbaby’sdoctor,andalactationconsultanttofigureoutwhatworksbestforyourfamily.

Breastfeeding during PregnancyBreastfeedingduringyournextpregnancyisnota risk to either the breastfeeding toddler or to thenewdevelopingbaby.If youarehavingsomeproblemsinyourpregnancysuchasuterinepainorbleeding,ahistoryof pretermlabor,orproblemsgainingweightduringpregnancy,yourdoctormayadviseyoutowean.Somewomenalsochoosetoweanatthistimebecausetheyhavenipplesore-nesscausedbypregnancyhormones,arenauseous,orfindthattheirgrowingbelliesmakebreastfeed-inguncomfortable.Yourtoddleralsomaydecideto wean on his or her own because of changes in theamountandflavorof yourmilk.Heorshewillneed additional food and drink because you will likelymakelessmilkduringpregnancy.

If you keep nursing your toddler after your baby is born,youcanfeedyournewbornfirsttoensureheorshegetsthecolostrum.Onceyourmilkproduction

Many breastfeeding basics are the same for twins or multiples as they are for one baby. Learn more about these important topics:

How to know your babies are getting enough•milk (page 17)

How to troubleshoot common challenges • (page 18)

Ways to keep milk supply up • (page 19)

When they were first born, it was too overwhelming for me to care for them at the same time. I fed them one at a time, which was nice, because I was able to bond with each individually. But then I realized that I was pretty much feeding one of them every 1 ½ to 2 hours and in order to get more sleep, I started feeding them at the same time. Once I got the hang of feeding both at once, I was able to free up so much more time! They started to get on the same eating/sleeping schedule and while both were sleeping, I would find myself having a solid two to three hours to catch up on some sleep, relax, and clean up around the house. It was so liberating and much needed! I’m so glad I figured out something that worked for all of us.– JenCharleston, SC

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increasesafewdaysafterbirth,youcandecidehowtobestmeeteveryone’sneeds,especiallythenewbaby’sneedsforyouandyourmilk.Youmaywanttoaskyour partner to help you by taking care of one child whileyouarebreastfeeding.Also,youwillhaveaneedformorefluids,healthyfoods,andrestbecauseyouaretakingcareof yourself andtwosmallchildren.

Breastfeeding after Breast surgeryHowmuchmilkyoucanproducedependsonhow your surgery was done and where your inci-sionsare,andthereasonsforyoursurgery.Wom-en who have had incisions in the fold under the breastsarelesslikelytohaveproblemsmakingmilkthanwomenwhohavehadincisionsaroundoracrosstheareola,whichcancutintomilkductsandnerves.Womenwhohavehadbreastimplantsusuallybreastfeedsuccessfully.If youeverhadsurgeryonyourbreastsforanyreason,talkwithalactationconsultant.If youareplanningbreastsurgery,talkwithyoursurgeonaboutwaysheorshecanpreserveasmuchof thebreasttissueandmilkductsaspossible.

adoption and inducing LactationManymotherswhoadoptwanttobreastfeedtheirbabiesandcandoitsuccessfullywithsomehelp.Manywillneedtosupplementtheirbreastmilkwithdonatedbreastmilkfromamilkbankorinfantformula,butsomeadoptivemotherscanbreastfeedexclusively,especiallyif theyhavebeenpregnantbe-fore.Lactationisahormonalresponsetoaphysicalaction,andsothestimulationof thebabynursingcausesthebodytoseeaneedforandproducemilk.Themorethebabynurses,themoreawoman’sbodywillproducemilk.

If youareadoptingandwanttobreastfeed,talkwithbothyourdoctorandalactationconsultant.Theycanhelpyoudecidethebestwaytotrytoestablishamilksupplyforyournewbaby.Youmightbeabletopre-parebypumpingeverythreehoursaroundtheclockfortwotothreeweeksbeforeyourbabyarrives,oryou can wait until the baby arrives and start to breast-feedthen.Devicessuchasasupplementalnursingsystem(SNS)oralactationaidcanhelpensurethatyour baby gets enough nutrition and that your breasts arestimulatedtoproducemilkatthesametime.

Using Milk from Donor BanksIf you can’t breastfeed and still want to give your baby human milk, the best and only safe place to go is to a hu-man milk bank. You should never feed your baby breast milk that you get directly from another woman or through the Internet. A human milk bank can dispense donor human milk to you if you have a prescription from your doctor. Many steps are taken to ensure the milk is safe. Donor human milk provides the same precious nutrition and disease-fighting properties as your own breast milk.

If your baby was born premature or has other health problems, he or she may need donated milk not only for health but also for survival. Your baby may also need donated milk if she or he:

Can’t tolerate formula •Has severe allergies •Isn’t thriving on formula•

You can find a human milk bank through the Human Milk Banking Association of North America (HMBA-NA). HMBANA is a multidisciplinary group of health care providers that promotes, protects, and supports donor milk banking. HMBANA is the only professional membership association for milk banks in Canada, Mexico, and the United States and as such sets the stan-dards and guidelines for donor milk banking for those areas. You can also contact HMBANA if you would like to donate breast milk.

To find out if your insurance will cover the cost of the milk, call your insurance company or ask your doctor. If your insurance company does not cover the cost of the milk, talk with the milk bank to find out how pay-ment can be made later on, or how to get help with the payments. A milk bank will never deny donor milk to a baby in need if it has the supply.

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Breastfeeding in PublicManywomenhavereportedfeelinguncomfort-ablebreastfeedinginpublic,evendoingsodis-creetly.Butitisimportanttorememberthatyouarefeedingyourbaby.Youarenotdoinganythinginappropriate.Andeventhoughitmayseemtabooinsomeplaces,awarenessof theneedtosupportnewbreastfeedingmothersisbuilding.

Thefederalgovernmentandmanystateshavelawsthatprotectnursingwomen.Theselawsarebasedon the recognition of organizations such as the AmericanAcademyof Pediatrics,theAmericanCollegeof ObstetriciansandGynecologists,Amer-icanPublicHealthAssociation,UnitedNationsInternationalChildren’sEmergencyFund(UNI-CEF),andtheWorldHealthOrganization(WHO)that breastfeeding is the best choice for the health of amotherandherbaby.

Evenwiththegrowingawarenessof thebenefitsof breastfeeding,youmayfinditdifficulttodosoinpublic.Yetitisimportanttobelieveinyourself andyourchoice.Remindyourself thatyoucansucceedandwearyourconfidence!Sometipsforbreastfeeding in public include:

Wearclothesthatalloweasyaccesstoyour•breasts,suchastopsthatpullupfromthewaistorbuttondown.

Use a special breastfeeding blanket around your•shoulders.Somebabiesdonotlikethis,though,soyou’llhavetoseewhatworksforyourbaby.

Breastfeedyourbabyinasling.Slingsorother•soft infant carriers are especially helpful fortraveling–itmakesiteasiertokeepyourbabycomfortedandclosetoyou.

Slipintoawomen’sloungeordressingroomto•breastfeed.

If you are worried about being too revealing in pub-•lic,practiceathomeuntilyouarecomfortable.

It helps to breastfeed your baby before he or she be-comesfussysothatyouhavetimetogetintoacom-fortableplaceorpositiontofeed.(Overtime,youwilllearnyourbaby’searlyhungercues.)Whenyougettoyourdestination,scoutoutaplaceyoucanbreastfeed,if thatmakesyoufeelmorecomfortable.

If someonecriticizesyouforbreastfeedinginpublic,checkouttheLaLecheLeague’swebsiteathttp://www.llli.orgforpossiblewaystorespond.

Mostof all,itisimportanttorememberthatyouaremeetingyourbaby’sneeds.Itisn’tpossibletostayhomeallthetime,andyoucanfeelfreetofeedyourbabywhileoutandabout.Youshouldbeproudof yourcommitment!Plus,nobottlesandformulameansfewersuppliestopack!

Follow the instructions for infant slings very carefully. Check in with the Consumer Product Safety Commis-sion for warnings before buying a sling.

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Pumping and milk storageIf youareunabletobreastfeedyourbabydirectly,itisimportanttoremovemilkduringthetimesyourbabynormallywouldfeed.Thiswillhelpyoucontinuetomakemilk.Beforeyouexpressbreastmilk,besuretowashyourhands.Also,makesuretheareawhereyouareexpressingisclean.

If youneedhelptogetyourmilktostartflow-ing,haveoneof thefollowingitemsnearby–apictureof yourbaby,ababyblanket,oranitemof yourbaby’sclothingthathashisorherscentonit.Youcanalsoapplyawarmmoistcompresstothebreast,gentlymassagethebreasts,orsitquietlyandthinkof arelaxingsetting.

Ways to Express Your Milk

Type How It Works What’s Involved Average CostHand Expression

You use your hand to massage and com-press your breast to remove milk.

Requires practice, skill, and coordination.•Gets easier with practice; can be as fast as•pumping.Good if you are seldom away from baby or•need an option that is always with you. But allmoms should learn how to hand express.

Free, unless you need help from a breastfeeding professional who charges for her services.

Manual Pump You use your hand and wrist to operate a hand-held device to pump the milk.

Requires practice, skill, and coordination.•Useful for occasional pumping if you are•away from baby once in a while.

$30 to $50

Automatic, Electric Breast Pump

Runs on battery or plugs into an electrical outlet.

Can be easier for some moms.•Can pump one breast at a time or both•breasts at the same time.Double pumping may collect more milk in less•time, so it is helpful if you are going back towork or school full time.Need places to clean and store the equipment•between uses.

$150 to over $250

Hospital-grade electric pumps can be rented from a lactation consultant at a local hospital or from a breastfeeding organization. These pumps work well for establishing milk supply when new babies can’t feed at the breast. Moth-ers who have struggled with other expression methods may find that these pumps work well for them.

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Electric Pumps

Milk Storage Bags and Bottles Manual Pump

You can keep germs from getting into the milk by washing your pumping equipment with soap and water and letting it air dry.

storage of Breast milk BreastmilkcanbestoredincleanglassorhardBPA-freeplasticbottleswithtight-fittinglids.Youcanalsousemilkstoragebags,whicharemadeforfreezinghumanmilk.Donotusedisposablebottlelinersorotherplasticbagstostorebreastmilk.

After each pumpingLabelthedateonthestoragecontainer.Include•yourchild’snameif youaregivingthemilktoachildcareprovider.

Gentlyswirlthecontainertomixthecreampart•of thebreastmilkthatmayrisetothetopbackintotherestof themilk.Shakingthemilkisnotrecommended–thiscancauseabreakdownof someof themilk’svaluablecomponents.

Refrigerateorchillmilkrightafteritis•expressed.Youcanputitintherefrigerator,placeitinacoolerorinsulatedcoolerpack,orfreezeitinsmall(2to4ounce)batchesforlaterfeedings.

Tips for freezing milkWaittotightenbottlecapsorlidsuntilthemilk•iscompletelyfrozen.

Trytoleaveaninchorsofromthemilktothe•topof thecontainerbecauseitwillexpandwhenfreezing.

Storemilkinthebackof thefreezer–notin•thefreezerdoor.

Tips for thawing and warming up milkClearlylabelmilkcontainerswiththedateitwas•expressed.Usetheoldeststoredmilkfirst.

Breastmilkdoesnotnecessarilyneedtobe•warmed.Somemomsprefertotakethechilloff andserveatroomtemperature.Somemomsserveitcold.

Thawfrozenmilkintherefrigeratorovernight,•byholdingthebottleorfrozenbagof milkunderwarmrunningwater,orsettingitinacontainerof warmwater.

Neverputabottleorbagof breastmilkin•themicrowave.Microwavingcreateshotspotsthatcouldburnyourbabyanddamagethecomponentsof themilk.

Swirlthemilkandtestthetemperatureby•droppingsomeonyourwrist.Itshouldbecomfortablywarm.

Usethawedbreastmilkwithin24hours.Donot•re-freezethawedbreastmilk.

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Guide to Storing Fresh Breast Milk for Use with Healthy Full-Term Infants

Place Temperature How Long Things to KnowCountertop, table

Room temp (60°F-85°F)

Up to 3-4 hours is best.

Up to 6-8 hours is okay for very clean expressed milk.

Containers should be covered and kept as cool as possible; covering the container with a clean cool towel may keep milk cooler. Throw out any leftover milk within 1 to 2 hours after the baby is finished feeding.

small cooler with a blue-ice pack.

59°F 24 hours. Keep ice packs in contact with milk containers at all times; limit opening cooler bag.

refrigerator 39°F or colder Up to 72 hours is best.

Up to 5-8 days is okay for very clean expressed milk.

Store milk in the back of the main body of the refrig-erator.

Freezer 24°F or colder Up to 6 months is best.

Up to 12 months is okay if milk is stored at 0°F or colder.

Store milk toward the back of the freezer where tem-perature is most constant. Milk stored at 0°F or colder is safe for longer durations, but the quality of the milk might not be as high.

Guide to Storing Thawed Breast Milk

Room Temperature(60°F to 85°F)

Refrigerator(39°F or colder)

Any Freezers thawed Breast milk Up to 1-2 hours is best.

Up to 3-4 hours is okay.24 hours Do not re-freeze.

I was committed to breastfeeding, but learning to nurse while learning to take care of a newborn was tough. My baby hated taking the entire nipple, and slipping off as she nursed was painful. And when it’s 3 a.m. and your baby is fussing and you are sore, those bottles are incredibly tempting.

At the same time, most of the health professionals I came in contact with – as well as many of my family members and friends – seemed to be undermining my breastfeeding relationship. My daycare providers seemed afraid of my breast milk, my workplace didn’t offer me a place to pump, and other mothers would act as though my breast-feeding was condemning their choice not to.

But I remembered that my nurse, Charlene, asked me to give it at least 8 weeks. I remembered that advice and decided to wait a little longer. I went back to Charlene for help and she showed me how to combat my daughter’s slipping latch. She also put me in touch with a local support group and helped me find professionals who really knew how to help. They got me through the most critical period, but it was only my willingness to seek out their guidance that allowed me to keep nursing. Don’t be afraid to ask for help whenever you need it!

– LinLock Haven, PA

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going Back to WorkPlanning ahead for your return to work can help ease thetransition.Learnasmuchasyoucanaheadof timeandtalkwithyouremployeraboutyouroptions.This can help you continue to enjoy breastfeeding yourbabylongafteryourmaternityleaveisover.

during PregnancyJoin a breastfeeding support group to talk with •othermothersaboutbreastfeedingwhileworking.

Talk with your supervisor about your plans to•breastfeed.Discussdifferenttypesof schedules,suchasstartingbackparttimeatfirstortakingsplitshifts.

Findoutif yourcompanyprovidesalactation•supportprogramforemployees.If not,askaboutprivateareaswhereyoucancomfortablyandsafelyexpressmilk.TheAffordableCareAct(healthcarereform)supportswork-basedeffortstoassistnursingmothers.

Askthelactationprogramdirector,yoursuper-•visor,wellnessprogramdirector,employeehu-manresourcesoffice,orothercoworkersif theyknowof otherwomenatyourcompanywhohavebreastfedafterreturningtowork.

after the Baby is BornFollowthestepson• page 15 to set up a breast-feedingroutinethatworksforyouandyourbaby.

Askforhelpfromalactationconsultantoryour•doctor,if youneedit.

during Your maternity LeaveTakeasmanyweeksoff asyoucan.Atleast•sixweeksof leavecanhelpyourecoverfromchildbirth and settle into a good breastfeedingroutine.Twelveweeksisevenbetter.

Practiceexpressingyourmilkbyhandorwith•aqualitybreastpump.Freeze2to4ouncesatatimetosaveforyourbabyafteryoureturnto

work.Seepages 34-36formoreinformationaboutpumpingandstorage.

Helpyourbabyadjusttotakingbreastmilk•fromabottle(orcupforinfants3to4monthsold)shortlybeforeyoureturntowork.Babiesareusedtonursingwithmom,sotheyusuallydrinkfromabottleorcupwhenit’sgivenbysomebodyelse.

Seeif thereisachildcareoptionclosetowork,•sothatyoucanvisitandbreastfeedyourbaby,if possible.Askif thefacilitywilluseyourpumpedbreastmilk.

Talkwithyourfamilyandyourchildcarepro-•videraboutyourdesiretobreastfeed.Letthemknowthatyouwillneedtheirsupport.

Back at WorkKeep talking with your supervisor about your•scheduleandwhatisorisn’tworkingforyou.Keepinmindthatreturningtoworkgraduallygivesyoumoretimetoadjust.

If yourchildcareiscloseby,findoutif youcan•visittobreastfeedoverlunch.

Whenyouarrivetopickupyourbabyfromchild-•care,taketimetobreastfeedfirst.Thiswillgiveyoubothtimetoreconnectbeforetravelinghomeandreturningtootherfamilyresponsibilities.

If youarehavingahardtimegettingsupport,•talktoyourhumanresourcesdepartment.Youcanalsoaskalactationconsultantfortips.

get a Quality Breast PumpAgood-qualityelectricbreastpumpmaybeyourbeststrategyforefficientlyremovingmilkdur-ingtheworkday.Contactalactationconsultantoryourlocalhospital,WICprogram,orpublichealthdepartmenttolearnwheretobuyorrentagoodpump.Electricpumpsthatallowyoutoexpressmilkfrombothbreastsatthesametimereducepumpingtime.

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Find a Private Place to express milk Workwithyoursupervisortofindaprivateplacetoexpressyourmilk.TheAffordableCareAct(healthcarereform)supportswork-basedeffortstoassistnursingmothers.TheDepartmentof Laborisproposinganewregulationtoallownurs-ingwomenreasonablebreaktimeinaprivateplace(otherthanabathroom)toexpressmilkwhileatwork.(Employerswithfewerthan50employeesarenotrequiredtocomplyif itwouldcausethecompanyfinancialstrain.)

If yourcompanydoesnotprovideaprivatelactationroom,findanotherprivateareayoucanuse.Youmaybeabletouse:

Anofficewithadoor•

Aconferenceroom•

Alittle-usedclosetorstoragearea•

Theroomshouldbeprivateandsecurefromintruderswheninuse.Theroomshouldalsohave an electrical outlet if you are using an electricbreastpump.Explaintoyoursupervisorthatitisbestnottoexpressmilkinarestroom.Restroomsareunsanitary,andthereareusuallynoelectricaloutlets.Itcanalsobedifficulttomanageapumpinatoiletstall.

Pumping tips Itmaytaketimetoadjusttopumpingbreastmilkinaworkenvironment.Foreasierpumping,trythesetipsforgettingyourmilktolet-downfromthemilkducts:

Relaxasmuchasyoucan•

Massageyourbreasts•

Gently rub your nipples•

Visualizethemilkflowingdown•

Think about your baby – bring a photo of •yourbaby,orablanketoritemof clothingthatsmellslikeyourbaby

When to express milkAtwork,youwillneedtoexpressandstoremilkduringthetimesyouwouldnormallyfeedyourbaby.(Inthefirstfewmonthsof life,babiesneedtobreastfeed8to12timesin24hours.)Thisturnsouttobeabout2to3timesduringatypical8-hourworkperiod.Expressingmilkcantakeabout10to15minutes.Sometimesitmaytakelonger.Thiswillhelpyoumakeenoughmilkforyourchildcarepro-vidertofeedyourbabywhileyouareatwork.Thenumberof timesyouneedtoexpressmilkatworkshouldbeequaltothenumberof feedingsyourbabywillneedwhileyouareaway.Asthebabygetsolder,thenumberof feedingtimesmaygodown.Manywomentaketheirregularbreaksandlunchbreakstopump.Somewomencometoworkearlyorstaylatetomakeupthetimeneededtoexpressmilk.

storing Your milkBreastmilkisfood,soitissafetokeepitinanem-ployeerefrigeratororacoolerwithicepacks.Talkto your supervisor about the best place to store yourmilk.If youworkinamedicaldepartment,donotstoremilkinthesamerefrigeratorswheremedicalspecimensarekept.Besuretolabelthemilkcontainerwithyournameandthedateyouexpressedthemilk.

Call to Action to Support Breastfeeding The Surgeon General’s Call to Action to Support Breastfeeding explains why breastfeeding is a national public health priority and sets forth actionable steps that businesses, communities, health systems, and others can take to support nursing mothers. Learn more at http://www.surgeongeneral.gov.

The Business Case for Breastfeeding is a resource kit that can help your company support you and other breastfeeding mothers in the workplace. Share this website with your supervisor: http://www.womenshealth.gov/breastfeeding/government-programs/business-case-for-breastfeeding.

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nutrition and Fitnesshealthy eatingManynewmotherswonderif theyshouldbeonaspecialdietwhilebreastfeeding,buttheanswerisno.Youcantakeinthesamenumberof caloriesthatyoudidbeforebecomingpregnant,whichhelpswithweightlossafterbirth.Therearenofoodsyouhavetoavoid.Infact,youcancontinuetoenjoythefoodsthatareimportanttoyourfam-ily–thespecialmealsyouknowandlove.

Asforhowyourdietaffectsyourbaby,therearenospecialfoodsthatwillhelpyoumakemoremilk.Youmayfindthatsomefoodscausestom-achupsetinyourbaby.Youcantryavoidingthosefoods to see if your baby feels better and ask your baby’sdoctorforhelp.

Keeptheseimportantnutritiontipsinmind:

Drinkplentyof fluidstostayhydrated(butfluid•

intakedoesnotaffecttheamountof breastmilkyoumake).Drinkwhenyouarethirsty,anddrinkmorefluidsif yoururineisdarkyellow.Acommonsuggestionistodrinkaglassof waterorotherbeverageeverytimeyoubreastfeed.Limitbeveragesthatcontainaddedsugars,suchassoftdrinksandfruitdrinks.

Drinkingamoderateamount(upto2to3cups•aday)of coffeeorothercaffeinatedbeveragesdoesnotcauseaproblemformostbreastfeed-ingbabies.Toomuchcaffeinecancausethebabytobefussyornotsleepwell.

Vitaminandmineralsupplementscannotreplace•ahealthydiet.Inadditiontohealthyfoodchoic-es,somebreastfeedingwomenmayneedamulti-vitaminandmineralsupplement.Talkwithyourdoctortofindoutif youneedasupplement.

See• page 25forinformationondrinkingalco-holandbreastfeeding.

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Can a baby be allergic to breast milk?Researchshowsthatamother’smilkisaffectedonlyslightlybythefoodssheeats.Breastfeedingmotherscaneatwhatevertheyhaveeatenduringtheirlifetimesanddonotneedtoavoidcertainfoods.Babieslovetheflavorsof foodsthatcomethroughinyourmilk.Sometimesababymaybesensitivetosomethingyoueat,suchasdairyprod-uctslikemilkandcheese.Symptomsinyourbabyof anallergyorsensitivitytosomethingyoueatincludesomeorallof these:

Greenstoolswithmucusand/orblood,diar-•rhea,vomiting

Rash,eczema(EG-zuh-muh),dermatitis,hives,•dry skin

Fussinessduringand/orafterfeedings•

Crying for long periods without being able to•feel consoled

Suddenwakingwithdiscomfort•

Wheezingorcoughing•

Babieswhoarehighlysensitiveusuallyreacttothefoodthemothereatswithinminutesorwithin4to24hoursafterward.Thesesignsdonotmeanthebabyisallergictoyourmilkitself,onlytosome-thingyouareeating.If youstopeatingwhateverisbotheringyourbabyoreatlessof it,theproblemusuallygoesawayonitsown.Youalsocantalkwithyourbaby’sdoctoraboutanysymptoms.If yourbabyeverhasproblemsbreathing,call911orgotoyournearestemergencyroom.

FitnessAnactivelifestylehelpsyoustayhealthy,feelbetter,andhavemoreenergy.Itdoesnotaffectthequal-ityorquantityof yourbreastmilkoryourbaby’sgrowth.If yourbreastsarelargeorheavy,itmayhelptowearacomfortablesupportbraorsportsbraandpadsincaseyouleakduringexercise.Itisalsoimportanttodrinkplentyof fluids.Besuretotalk to your doctor about how and when to slowly beginexercisingafteryourbaby’sbirth.

MyPyramid Plans for MomsThe USDA’s online, interactive tool can help you choose foods based on your baby’s nursing habits and your energy needs. Visit http://www.mypyramid.gov/mypyramidmoms/pyramidmoms_plan.aspx to:

Figure out how much you need to eat•Choose healthy foods•Get the vitamins and minerals you need•

For a sample of nutrition needs for breastfeeding mothers, see page 41.

Vegan dietsIf you follow a vegan diet or one that does not include any forms of animal protein, you or your baby might not get enough vitamin B12 in your bodies. This can also happen if you eat meat, but not enough. In a baby, this can cause symptoms such as loss of appetite, slow motor development, being very tired, weak muscles, vomiting, and blood problems. You can protect your and your baby’s health by tak-ing vitamin B12 supplements while breastfeeding. Talk to your doctor about your vitamin B12 needs.

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handling stressBothshort-andlong-termstresscanaffectyourbody.Infact,stresscanmakeyoumorelikelytogetsick.Itcanalsomakeproblemsyoualreadyhaveworse.Itcanplayapartinarangeof issues,includingtroublesleeping,stomachproblems,headaches,andmentalhealthconditions.

Havinganewbabyandlearninghowtobreastfeedcanbeverystressfulevents.Butitisimportantformotherstotakecareof themselves.Trytolistentoyour body so that you can tell when stress is affect-ingyourhealth,andtakethesestepstofeelbetter!

Get help from a professional if you need it.•Atherapistcanhelpyouworkthroughstressandfindbetterwaystodealwithproblems.Formoreseriousstress-relateddisorders,likepost-traumaticstressdisorder,therapycanbehelpful.Therealsoaremedicationsthatcanhelpeasesymptomsofdepressionandanxietyandhelppromotesleep.

Relax.• It’simportanttounwindinawaythatworksforyou.Tryabubblebath,deepbreath-ing,yoga,meditation,andmassagetherapy.Ifyoucan’tdothesethings,takeafewminutestosit,listentosoothingmusic,orreadabook.

Sleep.• Yourstresscouldgetworseif youdon’tgetenoughsleep.Itishardtofightoff illnesswhenyousleeppoorly.Withenoughsleep,itiseasiertocopewithchallengesandstayhealthy.Trytogetseventoninehoursof sleepeverynight.If youcan’t,trytosleepwhenthebabysleeps.

Eat right.• Trytofuelupwithfruits,vegetables,proteins,andwholegrains.Seepages 39-41 formorenutritioninformation.

Get moving. • Physical activity not only helpsrelieveyourtensemusclesbuthelpsyourmoodtoo!Yourbodymakescertainchemicals,calledendorphins,beforeandafteryouexercise.Theserelievestressandimproveyourmood.If youareanewmother,askyourdoctorwhenitisokaytostartexercising.

Talk to friends.• Friendscanbegoodlisteners.Findingsomeonewhowillletyoutalkfreelyaboutyourproblemsandfeelingswithoutjudgingyoudoesaworldof good.Italsohelpstohearadifferentpointof view.Friendswillremindyouthatyou’renotalone.

Compromise.• Sometimes,it’snotalwaysworththestresstoargue.Giveinonceinawhile.

Keep a journal. • Writedownyourthoughts.Haveyouevertypedane-mailtoafriendaboutyourlousydayandfeltbetterafterward?Whynotgrabapenandpaperandwritedownwhat’sgoingoninyourlife!Keepingajournalcanbeagreat way to get things off your chest and workthroughissues.

Help others.• Helpingsomeoneelsecanhelpyou.Helpyourneighbor,orvolunteerinyourcommunity.

Get a hobby.• Findsomethingyouenjoy.Makesuretogiveyourself timetoexploreyourinterests.

Set limits.• Figureoutwhatyoucanreallydo.Thereareonlysomanyhoursintheday.Setlimitswithyourself andothers.Don’tbeafraidtosaynotorequestsforyourtimeandenergy.

Plan your time.• Thinkaheadabouthowyou’regoingtospendyourtime.Writeato-dolist.Fig-ureoutwhichtasksarethemostimportanttodo.

Don’t deal with stress in unhealthy ways.•Thisincludesdrinkingtoomuchalcohol,usingdrugs,orsmoking,allof whichcanharmthebaby.Itisalsounhealthytoover-eatinresponsetostress.

42

Did You Know?Breastfeeding can help mothers relax and handle stress better. Skin-to-skin contact with your baby has a soothing effect.

43

Questions to ask Your Baby’s doctorUsethistear-outformtowritedownquestionsyouhaveforyourbaby’sdoctorandbringittoyournextvisit.

If yourbabyisnoteatingwellorif youareconcernedaboutyourbaby’shealth,callthepediatricianrightaway.

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44

Questions to ask Your health Care ProviderUsethistear-outformtowritedownquestionsyouhaveforyourhealthcareproviderandbringittoyournextvisit.

If youhavesymptomsof aninfection(seepage 21)orurgenthealthconcerns,callyourhealthcareproviderrightaway.

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45

Mon Tue Wed Thurs Fri Sat Sun6 a.m.

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Feeding ChartMark your baby’s feedings in the chart below. The times should be when the feeding begins. You can note how long the baby fed at each breast. But keep in mind that feeding times will vary. Your baby will let you know when he or she is finished eating. If you are feeding pumped breast milk, include the amount your baby eats.

46

Baby’s Age Number of Wet Diapers

Number of Bowel Movements

Color and Texture of Bowel Movements

Day 1 (first 24 hours after birth)

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Day 8

Day 9

Day 10

Day 11

Day 12

Day 13

Day 14

Day 15

Day 16

Day 17

Day 18

Day 19

Day 20

Day 21

Day 22

Day 23

Day 24

Day 25

Day 26

Day 27

Day 28

Day 29

Day 30

diaper trackerYou do not have to track diapers for a month to know your baby is eating well, but some women find it helpful to write it down. Weight gain is the best way to know if your baby is eating well. Talk to your baby’s doctor if you are concerned.

47

Health Information from the Office on Women’s healthTheOfficeonWomen’sHealth(OWH)offersfreewomen’shealthinformationonmorethan800topicsthroughourtoll-freecallcenterandwebsite,http://www.womenshealth.gov.Otherinformationresourcesinclude:

Could I have Lupus?

http://www.girlshealth.govHelping girls learn about health and growing up

http://www.bestbonesforever.govHelping girls build strong bones

http://www.couldihavelupus.govProviding an online community for women with lupus

http://www.womenshealth.govEmpowering women to live healthier lives

U.S.Departmentof HealthandHumanServicesOfficeonWomen’sHealth

200IndependenceAve,S.W.Room712EWashington,DC20201

www.womenshealth.gov800-994-9662•TDD888-220-5446

Scanthiscodeusingyoursmartphonetogodirectlytowomenshealth.gov.

January 2011

Stirring Mouth opening Turning headSeeking/rooting

1. EARLY CUES: “I’m hungry”

Stretching Increasing movement Hand to mouth

2. MID CUES: “I’m really hungry”

Crying Lots of movement Color turning red

CALM CRYING BABY BEFORE FEEDING

Cuddling, Skin-to-skin on chestTalking, Stroking

3. LATE CUES: “Calm me, then feed me”

Feeding Cues

LOOk FOR EARLY FEEDING CuEs

County of Los Angeles Public Health working for you. Made possible with funding from the Centers for Disease Control and Prevention through the Los Angeles County Department of Public Health. Used with permission from Women’s and Newborn Services, Royal Brisbane and Women’s Hospital, July 2013.

Stirring Mouth opening Turning headSeeking/rooting

1. EARLY CUES: “I’m hungry”

Stretching Increasing movement Hand to mouth

2. MID CUES: “I’m really hungry”

Crying Agitated movements Color turning red

CALM CRYING BABY BEFORE FEEDING

Cuddling, Skin-to-skin on chestTalking, Stroking

3. LATE CUES: “Calm me, then feed me”

Feeding Cues

LOOk FOR EARLYFEEDING CuEs

County of Los Angeles Public Health working for you. Made possible with funding from the Centers for Disease Control and Prevention through the Los Angeles County Department of Public Health. Used with permission from Women’s and Newborn Services, Royal Brisbane and Women’s Hospital, July 2013.

Inquieto Abre la boca Mueve la cabeza busca el pecho

1. SEÑALES TEMPRANAS: “Tengo hambre”

Se estira Incrementa su movimiento Se lleva la mano a la boca

2. SEÑALES INTERMEDIAS: “Tengo mucha hambre”

Llora Movimientos Agitados Se pone rojo

CALME AL BEBE QUE LLORA ANTES DE ALIMENTARLO

Arrullándolo, Poniéndolo sobre el pecho con con-

tacto de piel con piel, Hablándole, Acariciándolo.

3. SEÑALES TARDIAS: “Cálmame y después aliméntame”

SEÑALES DE HAMBRE

ESTE AL PENDIENTE DE LAS SEÑALES TEMPRANAS

DE HAMBRE.

El Departamento de Salud Pública del Condado de Los Ángeles trabaja para usted: Hecho posible con fondos de los Centros para el Control y la Prevención de Enfermedades a través del Departamento de Salud Pública del Condado de Los Ángeles.Usado con permiso del Women’s and Newborn Services, Royal Brisbane and Women’s Hospital, Julio 2013.

El Departamento de Salud Pública del Condado de Los Ángeles trabaja para usted: Hecho posible con fondos de los Centros para el Control y la Prevención de Enfermedades a través del Departamento de Salud Pública del Condado de Los Ángeles.Usado con permiso del Women’s and Newborn Services, Royal Brisbane and Women’s Hospital, Julio 2013.

Inquieto Abre la boca Voltea la cabeza/ buscando

1. PRIMERAS SEÑALES: “Tengo hambre”

Se estira Incrementasu movimiento Se lleva la mano a la boca

2. SEÑALES INTERMEDIAS: “Tengo mucha hambre”

Llora Movimientos Agitados Se pone rojo

CALME AL BEBE QUE LLORA ANTES DE ALIMENTARLO

Arrullándolo, Poniéndolo en el pecho piel a piel, Hablándole, Acariciándolo

3. SEÑALES TARDIAS: “Cálmame y después aliméntame”

ESTE AL PENDIENTE DE LAS SEÑALES TEMPRANAS

DE HAMBRE.

SEÑALES DE HAMBRE

Extreme Fullness It is normal to experience increasing breast fuLLness during the first few days after birth. Some mothers experience extreme fullness, which may be uncomfortable and make it difficult to breastfeed.

To prevent extreme fullness in your breasts: • Breastfeed on cue - whenever your baby is interested, or 8 - 12 times per 24 hours.

• Wake your newborn to breastfeed if he sleeps longer than 2 hours during the day or 3 hours during the night.

• Latch your baby on to your breast so that he takes most of the dark area around your nipple, taking slightly more of the dark area below the nipple t1lan above.

• Use bOtil breasts at each feeding, if you can.

• Let your baby decide when to stop breastfeeding. A breastfeeding may take between 1(2 to one hour.

To relieve discomfort

If extreme fullness occurs, lean over a basin of warm water and stroke your breasts. This will help the milk flow into rhe water and soften your breasts, and will help your baby latch all.

For comfort between feedings YOli can lise a cold compress or frozen pack.

*If mese steps don't resolve the problem, call a breastfeeding counselor to help you find a way to breastfeed your baby comfortably.

The wrc Program is an equal op(XlrulIliry provider and employer

Hinchazon Extrema Es normal eI experimentar un aumento de tamano en los pechos durante los primeros dfas despues del parro. Algunas mamas tienen pechos extremadamente hinchados, 10 cual puede ser incomodo y hacer diffcil eI dar pecho.

Para prevenir hinchazon extrema en sus pechos: • De pecho frecuentemente---<:ada vez que su be be este interesado, 0 de 8 a 12 veces

en 24 horas.

• Despierte a su recien nacido para dade pecho si el duerme mas de 2 horas seguidas durante el dfa 0 3 horas seguidas durante la noche.

• Ponga al bebe a su pccho de tal manera que t'I agarre la mayorfa del arca oscura alrededor de su pezon, tomando un poquito mas de la parte de abajo que de arriba.

• Use los dos pechos cada vez que de pccho, si puede.

• Deje que su bebe decida cuando parar de tomar eI pecho. EI dar pecho puede tomar de 1/2 a una hora.

Para quitar fa incomodidad

Si hinchaw n extrema ocurrc, . I hacia dclante sabre de un lavabo con agua tibia, y masajc SliS pcchos. Esro ayudara a que su Icchc fluya y suavisc SliS pcchos, y ayudad. rambien a que Sll bebe sc pcgue 31 pecho mas faci lmentc.

Usc comprcsas de agua fria 0 un pagucte de hielo cuanda d bebe no cste en eI pecha , para reducir la hinchazon y scntirsc mas camada.

*Si estos pasos no resuelven eI problema, Bame a una consejera de dar pecho para que Ie ayude a encontrar Wla manera de darle pecho a su be be comodamente.

El Program:! \.vIC cs un cmplcador y proveedor de igualdad de oportunidad J)c"eiul'cJ hy Soulh Los Angeles Hcahh I'rojcn s EFs 4{04

Sore Nipples To avoid soreness, make sure that your baby is attached and positioned correctly on

your breast. If it hurts, take the baby off and try again.

Tickle your baby's bps with your nipple until she opens her mouth VERY WID E, like a yawn.

Bring your baby in close to you- her chest to your chest. Her nose and chin should be touching your breast. Her mouth should cover much of the dark area arOlUld your nipple - slightly morc of the area below the nipple than above.

When removing your baby from your breast, place your ti ttle finger in ti,e corner of the baby's mouth, between the gUJ11S to break the slIction; then gently move the baby away from the breast.

If your nipples are sore, try nursing in different positions.

f 1

Cross-cradle hold Clutch position

.. Begin breastfeeding on ti,e side that is less sore.

>( . /

LYing down

.. If both breasts are sore, massage your breasts before breastfeeding until the milk begins to flow.

.. Afte r feeding, wash your hands and express a few drops of your milk and rub it into the sore skin; warm water may also be helpful.

.. If soreness doesn't improve within 1 to 2 days, consult a breastfeeding counselor.

The WIC Program is an eqllal oppormniry provider and employer

Breastfeeding and Returning to Work or School

You Can Continue Breastfeeding!

The American Academy of Pediatrics recommends women breastfeed their

infants for at least one year.

Congratulations!You have given your baby the best possible start in life — by breastfeeding. In fact, nine out of ten women in California start out breastfeeding their infants and many of them continue after returning to work or school. You can too! This booklet is designed to help you do just that.

The longer you breastfeed, the fewer illnesses your child will have and the less work or school you will miss. Did you know that as soon as you pick up a toy at your child’s day care, your body begins to make breastmilk with antibodies to protect your baby from the germs living on that toy? That’s how great your milk is. Your child’s risk of developing obesity, diabetes, and other conditions is reduced with every additional month you breastfeed.

There are benefits for you too. You may burn up to 600 calories a day which can help you lose your pregnancy weight easier. Nursing your baby decreases your risk for type 2 diabetes. Likewise, your risk of breast cancer decreases more with each additional month you breastfeed. You will be giving something to your infant that no one else can provide. Your milk is not just food, it is protection. You can’t buy that in a can at the grocery store.

ContentsWill working and breastfeeding work for me? 1

Will I need a breast pump? 2

Where can I get a breast pump? 2

Do I also need to know how to hand express my milk? 3

What steps should I take before I return to work? 4

What law protects a mother’s right to express milk at work? 5

What is the best way to talk to my employer? 6

What questions should I ask my employer? 7

What about child care? 8

What tips can I share with my child-care provider? 8

How do I store my milk? 9

How do I keep up a good milk supply? 10

What do I do once I return to work or school? 11

i

“I’m glad I continued

breastfeeding after

returning to work. I love

the closeness I have

with my baby when I’m

breastfeeding. I love

having one thing that

I can do for my baby

that no one else can, especially

considering I’m back at work and other

people are helping take care of him.”

—Elizabeth, WIC Mom

ii

Will working and breastfeeding work for me?Moms in almost every line of work are continuing to breastfeed, including:

³ College and high school students

³ Teachers

³ Waitresses

³ Retail workers

³ Administrative staff

³ Members of the Armed Forces

³ Construction workers

³ Sales and manufacturing workers

³ Well-known celebrities

With a little planning, you too can successfully return to work or school and continue breastfeeding.

1

Will I need a breast pump?If you will be away from your baby long enough that you regularly miss one feeding or more, then you may need an electric breast pump.

Where can I get a breast pump?Breastfeeding moms who are returning to work or school and currently enrolled in WIC are eligible for free breast pumps from the WIC office. Talk to the WIC staff for more information.

“I never considered weaning because

I was returning to work. It’s so easy to

pump at work and it’s good to know

that I’m taking care of my baby even

while I’m away from her.”

—Kirsy, WIC Mom

2

1. Wash your hands.

2. Use a clean container with a wideopening to collect your milk.

3. Place a warm washcloth on your breaststo help your milk flow.

4. Massage your breast to help increasethe amount of milk you express.

• Place one handunder your breastfor support.

• Apply gentlepressure, usinga circular motion with your other hand.

• Massage from several starting points,always working from the chest towardthe nipple.

• Repeat on your other breast.

• Gently shaking your breasts whileleaning forward may also help to getyour milk flowing.

5. Hold the cleancontainer nearyour breast. Withyour other hand,place your fingersand thumb aboutone to two inches awayfrom the base of your nipple.

PRESS IN toward your ribs, SQUEEZEgently into the center of your breast,then RELAX your hand, and REPEAT.The milk will not flow quickly at first butkeep going and your milk should beginto drip.

Every breastfeeding mom needs to learn to hand express their milk. Even if you have a pump, you never know when it might stop working or you may forget a part of the pump at home. Using hand expression along with pumping can also increase the amount of milk you are able to store for your baby.

To hand express:

Expressing your milk gets easier with practice. Don’t be discouraged if you can only express a small amount in the first few days.

If hand expression is not working for you, talk to the WIC staff. You may need a breast pump.

View a hand-expression animation at www.breastmilkcounts.com or talk to your WIC counselor.

3

Do I also need to know how to hand express my milk?

• Take as much time as you can for maternityleave. Talk to your boss or human resourcesdepartment about your options.

• Breastfeed often to build up a good milk supply.

• Begin pumping and storing your milk about twoweeks before your start date. If you are goingback to work full time, two weeks of pumpingone time a day should give you plenty of milkstored in the freezer.

• Talk to your boss and work out a scheduleso you can pump or nurse your baby duringbreaks at work. It is best to find a place and talkabout your pumping needs before you haveyour baby.

• Have at least one practice run where you leaveyour baby with a caregiver who will feed yourbaby a bottle of breastmilk. Take this time to dosomething special for yourself; a nap, a movie,time with a friend or your spouse. Your babymay not easily take the bottle if you are in thesame room.

• Ask your employer if you can start back towork part time at first, job-share with anotheremployee, or have a more flexible schedule. Ifyour employer is open to it, ask if you can bringyour baby to work.

• Start back to work in the middle of your workweek. Having a short first week will help youand your baby adjust.

What steps should I take before I return to work?

Start expressing and storing your milk about

two weeks before you go back to work.

4

Breastfeeding is

good for business!

Your employer can

experience up to a

$3 return for every $1

invested in creating a

supportive environment

for breastfeeding

employees. Studies

show that employers

that support

breastfeeding have:

³ Less absenteeism (moms AND dads miss work less often).

³ Lower employee turnover.

³ Increased productivity.

³ Increased employee loyalty.

³ Lower healthcare costs.

What law protects a mother’s right to express milk at work?California Labor Code Section 1030-1033 is a law that offers protections for all working moms so that they can continue to breastfeed even after they return to work.

❧ Employers must provide:

• A clean, private place, other than a bathroom to express breastmilk. • Reasonable break time

for you to express breastmilk at work. Most mothers will need to pump 2-3 times during the work day for 20-30 minutes. If pumping takes longer than your normal break time, your employer does not need to pay you for the extra time.

❧ For more information about your rights under the law, or to file a complaint, contact the California Department of Industrial Relations, Division of Labor Standards Enforcement. Visit www.dir.ca.gov/dlse/HowToFileBOFEClaim.htm. Or, call the Legal Aid Society at 1-800-880-8047.

5

Breastfeeding is a natural step in becoming a mother and very important for your baby. Some employers may not know much about it or may not be aware of the state law that protects all breastfeeding employees. Have confidence in your decision as you speak to your boss. Here are some simple steps successful moms suggest:

1. Before talking to your employer orschool, talk to your friends and family.Find out if they have any experience withbreastfeeding and working and ask fortheir support.

2. Talk to your coworkers. You may findother mothers who have pumpedat work before. Is anyone elsepregnant or breastfeeding? If so,consider meeting with your boss tomake arrangements together.

3. Talk to your human resources (HR)department if your employer has one.HR will know any policies or programsthat may help you combine working andbreastfeeding. They may also be able tohelp you to talk with your manager aboutscheduling breastfeeding breaks.

4. Schedule a meeting or write a letter ore-mail to your employer to discussyour return.

5. Before your meeting, practice what youplan to say with your friends or family.This will help you ease your nerves andbe prepared.

6. At your meeting:

• Explain why breastfeeding is importantto you, your baby, and how it benefitscompanies as well.

• Offer to come in early and stay lateto make up for the time you needto pump if you need more time thanyour regular break times.

• Discuss your ideas about where youwould pump and store your milk.Include how often you think you willneed to pump. This will help youremployer to plan for business needs.

• Discuss any questions or concernsyour employer has.

7. Encourage your employer to developa policy supporting breastfeedingemployees. For more informationgo to www.cdph.ca.gov/HealthInfo/healthyliving/childfamily/Pages/GoingBacktoWorkorSchool.aspx andclick on “For Employers”.

What is the best way to talk to my employer?

6

1. Is there a private space to pump?If a private space is not available, look for aspace that you are willing to use. It doesn’t haveto be used only for pumping but it should beavailable anytime that you need to use it.

• Use an office.

If the door doesn’t lock, hang a signoutside the door when you are pumping,or ask if your employer could have a lockinstalled for privacy.

• Use a cubicle.

Use a shower curtain rod or woodendowel from a hardware store to hang alarge curtain outside the cubicle when youneed to pump.

• Make a space.

Room dividers, partitions, or even apop-up tent can be used to make a quickpump room. Tip — use a radio or fan inthis portable space if you are concernedabout people hearing your pump.

2. How should I arrange my schedule to pumpat work?

• You will need to pump the samenumber of times that you arecurrently breastfeeding.

• Most moms will need to use their morningand afternoon break times and part oftheir lunch hour to express their milk.

• With a double electric pump, eachpumping session will take about 15-20minutes. You will also need time to get toand from the milk expression space andto wash your hands and equipment.

What questions should I ask my employer?• If you need to use unpaid break time, talk

to your employer to see if you can comeearly or stay late to make up the time.

• Ask if your baby can come have lunch withyou. Because you can nurse and eat at thesame time it will give you a chance to relaxand not feel rushed on your break.

3. Where should I store my milk?• It is safe to store breastmilk in a shared

staff refrigerator.• If you will be using a shared staff

refrigerator, store your milk containersin a brown paper bag or lunch boxwith your name on it.

• An insulated bag with ice packs can beused to store freshly expressedmilk for up to 24 hours.

Visit www.breastmilkcounts.com for more ideas.

7

What tips can I share with my child-care provider?• It is normal for your milk to separate into a cream layer on top and a thin and watery-looking layer

on the bottom. Simply swirl the milk to mix it up.

• Breastmilk is considered a food and does not need special handling.

• Take a blanket, pillow case, or item of clothing with your scent on it to your baby’s child-care center. They can place it between them and your baby for feedings. If your baby is having a hard time, your scent may help to calm him.

• The milk can be warmed by placing the bag or bottle in a cup of warm water for a few minutes.

• Breastfed babies usually eat smaller more frequent meals. Your baby will probably eat every 2-3 hours.

• Leftover milk in the bottle should be thrown out.

• Ask your child-care provider to learn more about supporting breastfeeding babies. For more information go to www.cdph.ca.gov/HealthInfo/healthyliving/childfamily/Pages/

GoingBacktoWorkorSchool.aspx and click on “For Child Care Workers”.

What about child care?³ Find a child-care provider that is close to your work and supports breastfeeding.

³ Visit your child-care center a few times. Touch toys and items in the center. Your milk will build up immunities to germs in the child-care center and pass that protection on to your baby.

³ Take your baby to the child-care center to get your baby used to it.

8

• Put your breastmilk inclean bottles or breastmilkstorage bags that are labeled“BPA Free”.

• Store about 2-4 ounces perbottle or bag for the first6 months.

• Once your baby starts solidfoods the amount that you willneed to store for your babymay decrease.

• Label containers with the datepumped and the baby’s name.

• Use the oldestmilk first.

• At work or school,store breastmilkin a cooler withice packs or in arefrigerator.

• If your storedbreastmilk smellssour, throw it out.

• Thaw breastmilk in therefrigerator overnight orin a bowl of warm water.

Location Fresh BreastmilkThawed

BreastmilkTemperature

Countertop 3-4 hours 1-2 hoursRoom temperature must not be higher than 85°F or 29°C. Containers should

be covered and kept as cool as possible.

Insulated cooler bag 24 hoursFor transport

onlyKeep ice packs in contact with milk

containers and limit opening the cooler bag.

Refrigerator 3 days 24 hours At or below 39°F or 4°C

Freezer section inside a refrigerator

2 weeksDo not

refreeze

At or below 5°F or minus 15°C

Freezer with separate door or deep freezer

6 monthsBelow 0°F or minus 7°C

How do I store my milk?

Never microwave breastmilk.

Breastmilk storage guidelines*

*For healthy full-term babies.

9

How do I keep up a good milk supply?• Breastfeeding your baby is the best way to make more milk. The

more often you breastfeed, the more milk you will make. Nurseoften when you and your baby are together.

• Be sure to pump your milk at work as often as you would nurseyour baby at home.

• Take good care of your breast pump. Read the pump instructionsor watch the video so you know when to replace the valve or ifyou need to use a larger breast flange. Both of these things canaffect your milk supply.

• Some moms will take breastmilk vacations. This means taking aday or two off work so you can be together with your baby andbreastfeed often for a few days in a row. This is a great way toincrease milk supply.

“Pumping isn’t fun, but I do it

because it’s best for my baby.

It makes me feel like we’re still

connected even though we’re not

together.”

—Lauren, WIC Mom

Nurse often when you and

your baby are together.

10

What do I do once I return to work or school?• Nurse your baby just before leaving for work or school and tell your child-care provider to

feed your baby about 2 hours before you will be there so that you can nurse as soon as you pick him up.

• Don’t wait till your breasts get full to pump. Pump every 2-3 hours if your baby is 0-6 months and every 3-4 hours if your baby is 6 months or older. (Sample schedule below)

• Wash your hands before and after pumping.

• Relax — before pumping take a few deep breaths, think about your baby, and gently massage your breasts to start the milk flowing. Some women will bring a photo or a recording of their baby’s coos.

• Your baby may want to nurse more often in the evening or whenever you are together. That is normal and will help you keep up your milk supply.

• As your baby gets older and starts solids he will need less breastmilk so you don’t have to pump as often. By 10 – 12 months you may only need to pump once at work.

• Speak to your WIC counselor or lactation consultant right away if you have any problems or questions.

• Take one day at a time and be willing to try new ways to make breastfeeding a success. Be proud of all your efforts.

0 – 6 Months Sample Pumping Schedule

Before work

7 a.m.

Lunch

11 a.m.

Break

3 p.m.

After work

5:30 p.m.

Breastfeed Pump Pump Breastfeed

6 - 12 Months Sample Pumping Schedule

Before work

7 a.m.

Break

10 a.m.

Lunch

12:30 p.m.

Break

3 p.m.

After work

5:30 p.m.

Breastfeed Pump Pump Pump Breastfeed

11

The California WIC Program asks businesses to help working mothers breastfeed for as long as they want.

If you have any questions about breastfeeding, please call:

California WIC Program, California Department of Public HealthThis institution is an equal opportunity provider.

1-800-852-5770 #900030 Rev 8/12

Photos and some content compliments of the Texas Department of State Health Services WIC Program

Dar pecho y volver al trabajo o a la escuela

¡Puede seguir dando pecho!

La Academia Americana de Pediatría recomienda que las mujeres den pecho

a sus bebés mínimo por un año.

¡Felicidades! Al dar pecho a su bebé, le ha dado el mejor comienzo en la vida. De hecho, nueve de cada diez mujeres en California empiezan dando pecho a sus bebés y muchas de ellas siguen haciéndolo después de regresar al trabajo o a la escuela. Usted también puede hacerlo, y este folleto está diseñado para ayudarle a lograr esta meta.

Entre más dé pecho, menos enfermedades sufrirá el niño y menos días faltará usted al trabajo. ¿Sabía usted que tan pronto agarre un juguete de la guardería de su hijo, su cuerpo empieza a producir leche materna con anticuerpos para proteger al bebé de los microbios que se encuentran en ese juguete? Así de buena es su leche materna. Cada mes adicional que usted dé pecho, disminuye el riesgo de que su hijo padezca de diabetes, obesidad y otras condiciones.

También para usted hay beneficios. Es posible que usted queme hasta 600 calorías al día, lo cual podría ayudarle a bajar de peso después del embarazo. Dar pecho al bebé reduce el riesgo de que usted padezca diabetes tipo 2. Asimismo, cada mes adicional que dé pecho, disminuye más el riesgo de padecer cáncer de seno. Le dará al bebé algo que ninguna otra persona le puede ofrecer. La leche materna no es solo un alimento, es una protección. Eso no lo puede comprar en una lata en la tienda.

Contenido¿Podré seguir dando pecho a mi bebé después de regresar a trabajar? 1

¿Tendré que usar un sacaleches? 2

¿Dónde obtengo un sacaleches? 2

¿También debo saber cómo extraerme la leche con las manos? 3

¿Qué medidas debo tomar antes de regresar al trabajo? 4

¿Qué ley protege el derecho de una mamá de extraerse la leche en el trabajo? 5

¿Cuál es la mejor manera de hablar con mi empleador? 6

¿Qué debo preguntarle a mi empleador? 7

¿Y el cuidado de niños? 8

¿Cuáles consejos puedo darle a la persona que cuida de mi hijo? 8

¿Cómo debo guardar la leche materna? 9

¿Cómo mantengo un buen suministro de leche? 10

¿Qué debo hacer cuando regrese al trabajo o a la escuela? 11

i

“Me alegra haber seguido

dando pecho después de

regresar al trabajo. Me

encanta sentir el cariño

de mi bebé cuando le

estoy dando pecho. Me

encanta poder hacer

algo por mi bebé que

nadie más puede hacer,

especialmente como ya volví a

trabajar, y otras personas están

ayudando a cuidarlo”.

—Elizabeth, una mamá de WIC

ii

¿Podré seguir dando pecho a mi bebé después de regresar a trabajar?Muchas mamás en casi todos los tipos de trabajo siguen dando pecho, por ejemplo:

³ Estudiantes universitarias y de la preparatoria

³ Maestras

³ Meseras

³ Trabajadoras de las tiendas

³ Empleadas administrativas

³ Mujeres miembras de las fuerzas armadas

³ Trabajadoras de la construcción

³ Vendedoras y trabajadoras de fábricas

³ Mujeres famosas

Con un poco de planeación, usted también puede regresar al trabajo o a la escuela y seguir dando pecho exitosamente.

1

¿Tendré que usar un sacaleches?Si va a estar alejada de su bebé por ratos largos y no lo va a poder alimentar una o más veces, probablemente va a necesitar un sacaleches eléctrico.

¿Dónde obtengo un sacaleches?Las mamás que dan pecho y que van a regresar al trabajo o a la escuela y actualmenteestán inscritas en WIC llenan los requisitos para recibir sacaleches gratis de la oficina de WIC. Hable con el personal de WIC para más información.

“Nunca pensé dejar de dar pecho

porque iba a regresar a trabajar.

Es tan fácil usar el sacaleches en el

trabajo, y es bueno saber que estoy

cuidando a mi bebé, aun cuando

estoy alejada de ella”.

—Kirsy, una mamá de WIC

2

1. Lávese las manos.2. Use un recipiente limpio con una

apertura ancha para recoger la leche.

3. Coloque una toallita tibia en

los senos para facilitar la salida de

la leche.

4. Masajéese los senos para aumentar la

cantidad de leche que extrae.

• Coloque una mano debajo del seno para

darle apoyo.

• Presione suavemente, haciendo

un movimiento circular

con la otra mano.

• Empiece el masaje

desde varios puntos,

siempre desde el

pecho hasta el pezón.

• Repita con el otro seno.

• Mover suavemente el seno mientras se

inclina hacia adelante también puede

ayudar a empezar el flujo de leche.

5. Sostenga el recipiente

limpio cerca del seno.

Con la otra mano,

coloque los dedos y el

pulgar entre una y dos

pulgadas de la base

del pezón.

EMPUJE en dirección a las costillas,

APRIETE suavemente hacia el centro

del seno, luego RELAJE la mano y REPITA.

El flujo de leche será lento al principio pero

siga haciéndolo y la leche debe empezar

a salir.

Todas las mamás que dan pecho deben aprender a extraerse la leche con las manos. Aunque tenga un sacaleches, nunca se sabe si va a dejar de funcionar o si va a olvidarse de una parte del sacaleches en casa. Sacarse la leche a mano además de usar el sacaleches también puede aumentar la cantidad de leche que puede guardar para su bebé.

Con la práctica, se hace más fácil extraer la leche. No se desaliente si solo puede extraer una pequeña cantidad durante los primeros días.

Si está teniendo dificultad para extraer la leche, hable con el personal de WIC. Es posible que necesite un sacaleches.

Vea un dibujo animado de cómo extraerse la leche a mano en www.breastmilkcounts.com/spanish/

o hable con su consejera de WIC.

Para extraerse la leche con las manos:

3

¿También debo saber cómo extraerme la leche con las manos?

• Tome todo el tiempo que pueda para la licencia de maternidad. Hable con su jefe o el departamento de recursos humanos sobre sus opciones.

• Dé pecho con frecuencia para tener una buena cantidad de leche materna.

• Empiece a extraer y guardar la leche materna unas 2 semanas antes de volver a trabajar. Si va a volver a trabajar a tiempo completo, con extraerse leche 1 vez al día durante 2 semanas tendrá suficiente para guardar en el congelador.

• Hable con su jefe y planeen un horario para que usted pueda usar el sacaleches o dar pecho a su bebé cuando tenga descansos en el trabajo. Lo mejor es encontrar un lugar y hablar sobre sus necesidades de extraer leche antes de que nazca el bebé.

• Al menos una vez, practique dejar a su bebé con un cuidador que lo alimentará con un biberón de leche materna. Use este tiempo para hacer algo que sea especial para usted: tomar una siesta, ver una película, pasar tiempo con una amiga o con su pareja. Es posible que el bebé no acepte fácilmente el biberón si usted está en el mismo cuarto.

• Pregúntele a su empleador si es posible regresar a trabajar a tiempo parcial al principio, compartir el trabajo con otro empleado, o tener más flexibilidad en su horario. Si el empleador parece estar dispuesto a aceptarlo, pregúntele si puede llevar al bebé al trabajo.

• Vuelva al trabajo un día en la mitad de la semana. Tener una primera semana corta les ayudará a usted y a su bebé a adaptarse.

¿Qué medidas debo tomar antes de regresar al trabajo?

Empiece a extraerse la leche materna unas 2 semanas

antes de que vuelva a trabajar.

4

¡La lactancia

materna es buena

para los negocios!

Su empleador puede

tener una ganancia de

$3 por cada $1 invertido

en crear un entorno de

apoyo para las empleadas

que dan pecho. Los

estudios muestran que

los empleadores que

apoyan la lactancia

materna tienen:

³ Menos ausentismo. (las mamás Y los papás faltan menos al trabajo).

³ Menos rotación de personal.

³ Más productividad.

³ Más lealtad de los empleados.

³ Menos costos de atención médica.

¿Qué ley protege el derecho de una mamá de extraerse la leche en el trabajo?Secciones 1030-1033 del Código Laboral de California es una ley que ofrece protecciones a todas madres que trabajan para que puedan seguir dando pecho aun después de regresar al trabajo.

❧ Los empleadores tienen que ofrecer:

• Un lugar limpio y privado para extraerse la leche materna, perono un baño.

• Descansos razonables para extraerse la leche materna en eltrabajo. La mayoría de las mamás tendrá que extraerse la lechede 2 a 3 veces durante el día laboral, de 20 a 30 minutos cadavez. Si toma más tiempo para extraerse la leche de su tiempo dedescanso, su empleador no necesita pagarle por el tiempo extra.

❧ Para más información sobre sus derechos bajo la ley, o para presentar una queja, comuníquese con el Departamento de Relaciones Industriales de California, División de Enforzamiento de Normas Laborales. Visite la página www.dir.ca.gov/dlse/HowToFileBOFEClaim.htm. O llame a la Sociedad de Asistencia Legal al 1-800-880-8047.

5

Dar pecho es un paso natural al llegar a ser madre y es muy importante para su bebé. Algunos empleadores quizás no sepan mucho al respecto ni estén conscientes de la ley del estado que protege a todas las empleadas que dan pecho. Tenga confianza en su decisión cuando hable con su jefe. A continuación hay algunos pasos simples que sugieren las mamás que han tenido éxito:

1. Antes de hablar con su empleador o

escuela, hable con sus amigos y familiares.

Pregunte si han tenido alguna experiencia

con dar pecho y trabajar y pídales su apoyo.

2. Hable con sus compañeros de trabajo.

Quizás encuentre a otras mamás que han

usado el sacaleches en el trabajo. ¿Hay otras

mujeres embarazadas o que dan pecho? Si

es así, piensen en reunirse juntas con su jefe

para hacer planes.

3. Hable con el Departamento de Recursos

Humanos (HR) si su empleador tiene uno.

El Departamento de Recursos Humanos

sabe si hay normas o programas que puedan

ayudarle a combinar el trabajo y dar pecho.

Y quizás pueda ayudarle a hablar con el

supervisor sobre coordinar los descansos

para dar pecho.

4. Programe una reunión o escriba una carta o

un correo electrónico a su empleador para

platicar sobre su regreso.

5. Antes de la reunión, practique con sus

amigos o familia lo que piensa decirle a su

empleador. Esto le ayudará a calmarse los

nervios y a estar preparada.

6. En la reunión:

• Explique por qué dar pecho es

importante para usted y el bebé, y

cómo también beneficia a las compañías.

• Si necesita usar más tiempo de su tiempo

de descanso regular, ofrezca venir

temprano o quedarse tarde para

reponer el tiempo.

• Platique de sus ideas sobre dónde usaría

el sacaleches y guardaría la leche

materna. También platique de la

frecuencia con que cree que tendrá que

extraerse la leche. Esto le ayudará

a su empleador a planear para

las necesidades de la compañía.

• Hable de cualquier pregunta o inquietud

que tenga su empleador.

7. Anime a su empleador a que implemente

una pólitica de apoyo a las empleadas

que dan pecho. Para más información,

visite la página www.cdph.ca.gov/

HealthInfo/healthyliving/childfamily/Pages/

GoingBacktoWorkorSchool.aspx y haga clic

en “For Employers”.

¿Cuál es la mejor manera de hablar con mi empleador?

6

1. ¿Hay algún lugar privado donde pueda usar el sacaleches? Si no hay un lugar privado, busque un espacio que esté dispuesta a usar. No tiene que estar diseñado solo para usar el sacaleches, pero debe estar disponible en cualquier momento que usted lo necesite.

• Use una oficina.

Si la puerta no cierra con seguro, cuelgue un aviso afuera de la puerta cuando esté usando el sacaleches, o pregunte si su empleador puede poner una cerradura para que tenga privacidad.

• Use un cubículo.

Use una varilla para colgar cortinas de baño o una barra de madera que se consigue en una ferretería para colgar una cortina grande en la entrada del cubículo cuando necesite usar el sacaleches.

• Haga un espacio.

Puede usar separadores de cuartos, particiones o hasta una carpa pequeña para crear rápidamente un cuarto donde puede extraer la leche. Consejo: Prenda un radio o ventilador en ese espacio si le preocupa que puedan oír el sacaleches.

2. ¿Cómo debo organizar mi horario para extraerme la leche en el trabajo?

• Necesitará extraerse la leche el mismo número de veces que está dando pecho ahora.

• La mayoría de las mamás tendrán que usar el descanso de la mañana y de la tarde y parte de su hora de almuerzo para extraerse la leche.

¿Qué debo preguntarle a mi empleador? • Con un sacaleches eléctrico doble, cada

sesión de extracción durará de 15 a 20 minutos. También necesitará tiempo para ir al lugar de extracción y regresar, y para lavarse las manos y lavar el equipo.

• Si necesita usar tiempo de descanso no pagado, hable con su empleador para ver si puede entrar temprano o salir tarde para reponer el tiempo. • Pregunte si el bebé puede estar con usted a la hora de almorzar. Como usted puede dar pecho y comer al mismo tiempo, podrá relajarse y no sentirse apresurada durante el descanso.

3. ¿Dónde debo guardar la leche materna? • Es seguro guardar la leche en un refrigerador compartido por el personal. • Si usa un refrigerador compartido, guarde los envases de la leche en una bolsa o en otro envase con su nombre. • Se puede usar una hielera portátil con hielo para guardar la leche recientemente extraída, hasta por 24 horas.

Visite www.breastmilkcounts.com/Spanish/ para más ideas.

7

¿Cuáles consejos puedo darle a la persona que cuida de mi hijo?

• Es normal que su leche se separe y forme una capa de crema en la parte superior y una capa finay de aspecto acuoso en la parte inferior. Simplemente agite la leche suavemente para quese mezcle.

• La leche materna se considera un alimento y no requiere un manejo especial.

• Lleve una manta, funda, o alguna ropa con el olor suyo a la guardería de su bebé. El personalpuede colocarla al lado del bebé durante las tomas. Si el bebé tiene problemas para alimentarse,el olor suyo quizás lo tranquilice.

• Se puede calentar la leche poniendo la bolsa o el biberón en una taza de agua templadadurante unos minutos.

• Los bebés amamantados normalmente comen menos a la vez, pero con más frecuencia. Su bebéprobablemente se alimentará cada 2 a 3 horas.

• La leche que quede en el biberón debe ser deshechada.

• Pídale a su proveedor de cuidado de niños que aprenda más sobre cómo apoyar a los bebésamamantados. Para más información visite la página www.cdph.ca.gov/HealthInfo/healthyliving/

childfamily/Pages/GoingBacktoWorkorSchool.aspx y haga clic en “For Child Care Workers”.

¿Y el cuidado de niños?³ Encuentre a un proveedor de cuidado de niños

que quede cerca de su trabajo y que apoye la lactancia materna.

³ Visite el centro de cuidado de niños varias veces. Toque los juguetes y los objetos del centro. De esta manera, su leche aumentará la resistencia a los microbios del centro de cuidado de niños y esa protección será transferida al bebé.

³ Lleve a su bebé al centro de cuidado de niños

para acostumbrarlo al lugar.

8

• Ponga su leche materna enbotellas limpias o bolsas paraalmacenar leche materna queestán etiquetadas “BPA Free”.

• Guarde entre 2 a 4 onzas porbotella o bolsa durante losprimeros 6 meses.

• Una vez que el bebé empiece losalimentos sólidos, posiblementebaje la cantidad que necesitaráguardar para su bebé.

• Anote la fecha de extraccióny el nombre del bebé en elrecipiente.

• Use la leche más vieja primero.

• En el trabajo o en la escuela,guarde la lechematerna en unahielera portátil conpaquetes de hieloo en el refrigerador.

• Si la leche maternaguardada hueleagria, tírela a labasura.

• Descongele la leche maternaen el refrigerador durante lanoche, o en un tazón conagua templada.

LugarLeche materna

frescaLeche materna descongelada

Temperatura

Cubiertas de la cocina 3-4 horas 1-2 horasLa temperatura del cuarto no debe sobrepasar

los 85°F o los 29°C. Los recipientes se deben tapar y mantener lo más frescos posibles.

Hielera portátil con hielo

24 horasSolo para

transporte

Mantenga las paquetes de hielo en contacto con los recipientes de leche y

limite las veces que abre la hielera.

Refrigerador 3 días 24 horas 39°F o 4°C o menos

Congelador dentro del refrigerador

2 semanasNo vuelva a congelar

5°F o -15°C o menos

Congelador con puerta separada o para almacenar a largo plazo

6 mesesMenos de 0°F o -7°C

¿Cómo debo guardar la leche materna?

Nunca caliente la leche materna

en un horno de microondas.

Consejos para guardar la leche materna*

*Para bebés sanos que nacieron a término.

9

¿Cómo mantengo un buen suministro de leche?• Para hacer más leche lo mejor es dar pecho a su bebé. Entre más dé pecho, más leche

va a producir. Dé pecho a su bebé con frecuencia cuando estén juntos.

• Asegúrese de sacarse la leche en el trabajo con la misma frecuencia con que daría pecho a su bebé si estuviera en casa.

• Cuide bien el sacaleches. Lea las instrucciones de cómo usar el sacaleches o vea el vídeo para saber cuándo reemplazar la válvula o si necesita usar copas de succión más grandes. Ambas cosas pueden afectar su suministro de leche.

• Algunas mamás toman uno o dos días de licencia para estar con el bebé y darle pecho con regularidad durante unos días seguidos. Esta es una forma excelente de aumentar el suministro de leche.

“Usar el sacaleches no es divertido,

pero lo hago porque es lo mejor para

mi bebé. Me hace sentir que todavía

tenemos una conexión, aunque no

estemos juntos”.

—Lauren, una mamá de WIC

Dé pecho con frecuencia cuando usted y su bebé estén juntos.

10

¿Qué debo hacer cuando regrese al trabajo o a la escuela?• Dé pecho a su bebé justo antes de salir para el trabajo o a la escuela. Dígale al proveedor

de cuidado de niños que alimente al bebé unas 2 horas antes de que usted llegue para quepueda darle pecho tan pronto lo recoja.

• No espere hasta que los senos estén llenos para extraerse la leche. Extraiga la leche cada2 a 3 horas si el bebé tiene entre 0 y 6 meses, y cada 3 a 4 horas si tiene 6 meses o más. (Acontinuación hay un ejemplo de un plan)

• Lávese las manos antes y después de extraer la leche.

• Relájese: antes de usar el sacaleches, respire profundo 2 o 3 veces, piense en su bebé, ydése un masaje suave en los senos para empezar el flujo de la leche. Algunas mujeres llevanuna foto o una grabación de los sonidos que hace el bebé.

• Puede ser que su bebé quiera amamantar con más frecuencia de noche o cuando esténjuntos. Eso es normal y la ayudará a mantener un buen suministro de leche materna.

• A medida que su bebé crece y empieza a comer alimentos sólidos, él no necesitará tantaleche materna y usted no tendrá que extraerse leche con tanta frecuencia. Para los 10 a 12meses puede ser que solo tenga que extraerse leche una vez durante el trabajo.

• Hable inmediatamente con su consejera de WIC o con una consejera de lactancia si tienealgún problema o pregunta.

• Tome las cosas con calma y esté dispuesta a intentar nuevas formas de dar pecho con éxito.Siéntase orgullosa de todos sus esfuerzos.

0 a 6 meses: ejemplo de un horario para extraerse la leche

Antes del trabajo

7 a.m.

Almuerzo

11 a.m.

Descanso

3 p.m.

Después del

trabajo 5:30 p.m.

Dar pecho Extraer Extraer Dar pecho

6 a 12 meses: ejemplo de un horario para extraerse la leche

Antes del trabajo

7 a.m.

Descanso

10 a.m.

Almuerzo

12:30 p.m.

Descanso

3 p.m.

Después del

trabajo 5:30 p.m.

Dar pecho Extraer Extraer Extraer Dar pecho

11

El Programa de WIC de California pide a las empresas que ayuden a las madres que trabajan para que puedan dar pecho el tiempo que deseen.

Si tiene alguna pregunta sobre dar pecho, por favor llame:

Programa de WIC de California, Departamento de Salud Pública de CaliforniaEsta institución es un proveedor que ofrece igualdad de oportunidades.

1-800-852-5770 #900031 Rev 8/12

Las fotografías y parte del contenido son cortesía del Departamento Estatal de Servicios de Salud de Texas, Programa de WIC

How to Pump Your Breast Milk Mothers who are pumping milk for premature or sick babies should consult their

pediatrician or a lactation consultant. These guidelines apply to healthy term babies.

YOU WILL NEED:

or

To Pump Your Milk: • Learn how to use your breast pump correctly

• Set up a pumping schedule - Pump at the same times each day.

• Wash your hands with soap and water before you begin.

• Pour small amounts of collected milk (2 to 30z) into a clean bottle or milk storage bag.

• Date and label the milk storage bag, leaving an inch of empty space.

Helpful Hints: • Before pumping, place a warm towel on your

breasts; massage your breasts to improve the flow of your milk.

• You may not get a lot of milk the first few days. Continued pumping will increase your milk supply.

The WIC Program is an eqllal oppormniry provider and employer

or

and

Sacar A Mano La Leche Materna

• Lave sus manos con agua y jab6n .

• Tenga un tawn limpio listo para poner su leche.

Suavcmenrc masajc cada pecho para haccr que Ia Icchc salga mas fac ilmcnrc. Pascsc la mano suavcmcnrc hacia cI pcz6n.

Coloquc la mallO alrcdcdor del pecho , can d pulgar arriba}' atras del ~rca obsclIra, y cl rcsto de Ja m:mo dcbajo del pecho. Presionc ]a mallO hacia ademro comra SliS costillas; aJ rnismo [iempo, aprictc los dC<.los cuidadosa­mente hacia cllfrclltc. No cxprima ni jalc eI pewn.

Saquc stJ leche hasta que no Ie salga mas. Lucgo cam bic SliS

dcdos de posicion atras del area obscura y rcpita. Cambic al mro pecho cuando dcjc de saJir lcchc.

Mirando una foro 0 rocando y o liendo una ropita de su bebe Ie ayudara a que su leche salga mas ficihnente.

Si t rabaja fuera de casa, L1eve esros objecros con usted.

EI Progra m:! \-VIC cs un cm plcador y proveedor de iguald<ld de oportunidad 1k"~i<>!',,,11>y Somh Los AJ1g~ks H~~hh I'rojoxis F..\\$ 4/0"

How to Store Breast Milk If you are returning to work or school,

you can pump your milk while you are away from home.

Store your freshly pumped or expressed breast milk in a clean, sealed container.

j.1 j: 4 hours •

~ 24 hours

Outside the refrigerator: • Pl1l11pcd or expressed milk wi ll keep for

4 hours, if it is cooler than 1000 F.

• When possible, put the pumped or expressed milk in a cooler with an ice pack until it can be refrigerated.

• Pumped or expressed milk may be kept in a cooler with an ice pack for up to 24 hours.

In the refrigerator: • Store d,e breast milk

in the center of the refrigerator, not in the door.

• Use the fresh pumped or expressed breast milk within 5-8 days.

• Freeze your pumped or expressed breast milk if it wiH nor be used within d,e 5 days .

2 weeks

6 months

In the freezer: • Frozen breast milk stored in a freezer

comparmlcnt inside the refrigerator will keep up to 2 weeks.

• Frozen breast milk stored in the freezer comparOllcnt with a separate door wi ll keep up to 3 - 4 mond1s.

• Frozen breast milk stored in a separate deep freeze at a constant temperature of 0 0 F wi ll keep for 6 mond,s or longer.

Oefrosting frozen milk: • Defrost the frozen milk in the refrigerator

o r under warm nmning water.

• Do not defrost it in dle microwave or boil it on the stove.

• Defrosted milk stored in the refrigerator must be used widlin 24 hours.

• Defrosted milk kept at room temperature should be used widlin I hour.

• Do not refreeze defrosted milk.

Tips on Using Expressed Breast Milk: • Breast milk will separate naturally - the milk is still good. Just shake it to mix it.

• Throwaway leftover breast milk after a feeding.

The Wle Program is an equal oppornmity provider and employer

Almacenqje tie Leche Materna Si usted va a regresar al trabqjo 0 a la escuela,

usted puede extraerse su leche cuando este fuera de casa.

Almacene su leche extraida recienternente, en un recipiente cerrado.

A .L \ ~ I) 11 11111 \ '1' 1 [";) ~ ~~ J;

f ;; : 4 horas ( l --..cO

~ 24 horas

A temperatura ambiental: .. La lcchc extra Ida sc mlntcndd por 4 hora5, si la tcmpcranlra es menos de 1000 F. .. Si cs posiblc, ponga Ia lcchc materna extra{da en un cnfriador porrari l con un paqucte de hiclo hasta que sc pllcda rcfrigcrar.

" La lcchc materna sc pucdc guardar en lin cnfr iador porraril con lin cmpaquc de hic10 por 24 horas.

Oentro del refrigerador:

" Guarde la leche en el centro del refrigerado r, no en la puerta.

" Use la Ieche materna extraida recientcmcntc durante los primeros 5-8 dias.

" Congele la leche extrafda si no se va a usaf durante los primeros 5 dias.

) 3-4meses

6 meses

En el congelador: " La lcchc materna congdada guardada en un

compartimiento congelador dentro del refrigerador se mantiene hasta por 2 semanas.

• La leche materna congclada guardada en un

compartimiento congclador con puerta separada del refrigerador se mantiene de 3 - 4 mcse.';;.

• La leche materna congelada guardada en un congelador separado con Ulla temperatura constante de 0 ° F se manticne por 6 meses 0

Imls.

Oescongelando la leche: .. Descongele la leche en el refrigerado r 0 bajo

lin cho rro de agua.

• No la descongele en un ho m o de microo ndas a la hierba en la estufa.

• Leche previamente congelada g uardada en el refrigerador debera usarse durante las primeras 24 horas.

.. La !eche materna que es descongelada debe ser usada denu·o de una ho ra.

• No vue1va a congelar leche que ha sido descongelad a.

Sugerencias del uso de la leche materna: • La leche materna se separa naturalmellte- todavia esd buena. Solo agftcla para mezclarl a.

• Tire las sobras de la leche materna dcspuCs de una alimentaci6n

El Programa \VIC es un empleador y proveedor de igualdad de opormnidad Ikldop",J 1>)' Soo."h Los Angeles Heal,h l'roj«ts PS, 4/04

,

FEDERAL LAW EFFECTIVE MARCH 2010: REASONABLE BREAK TIME FOR NURSING MOTHERSSection 7 of the Fair Labor Standards Act of 1938 3(29 U.S.C. 207) is amended by adding at the end the following: (r)(1) An employer shall provide (A) a reasonable break time for an employee to express breast milk for her nursing child for 1 year after the child’s birth, each time such employee has need to express the milk; and (B) a place, other than a bathroom, that is shielded from view and free from intrusion from co-workers and the public, which may be used by an employee to express breast milk.(2) An employer shall not be required to compensate an employee receiving reasonable break time under paragraph (1) for any work time spent for such purpose.(3) An employer that employs less than 50 employees shall not be subject to the requirements of this subsection, if such requirements would impose an undue hardship considered in relation to the size, financial resources, nature, or structure of the employer’s business.(4) Nothing in this subsection shall preempt a State law that provides greater protections to employees than the protections provided for under this subsection.

CALIFORNIA LACTATION ACCOMMODATION LAW (Chapter 3.8, Section 1030, Part 3 of Division 2 of the Labor Code)This law requires all California employers to provide a reasonable amount of break time and to make a reasonable effort to provide space other than a toilet stall, close to the employee’s work area, to accommodate an employee desiring to express breast milk for her baby. The break time shall be unpaid if the break time does not run concurrently with the rest time authorized for the employee. An employer is not required to provide break time for pumping if taking break time beyond the usual time allotted for breaks would seriously disrupt the operations of the employer. Violation of this chapter is subject to a civil penalty of $100.

Additional Breastfeeding Laws in California:

California Civil Code § 210.5 (2000) allows a breastfeeding mother to postpone jury duty for one year and specifically eliminates the need for the mother to appear in court to request the postponement. The law also provides that the one-year period may be extended upon written request of the mother. [Chap. 266 (AB 1814)]

California Civil Code § 43.3 (1997) allows a mother to breastfeed her child in any location, public or private, except the private home or residence of another, where the mother and the child are otherwise authorized to be present. (AB 157)

Academy of Breastfeeding Medicine, The (ABM) - www.bfmed.orgAmerican Academy of Family Physicians (AAFP) - www.aafp.orgAmerican Academy of Pediatrics (AAP) - www.aap.orgAmerican College of Nurse-Midwives (ACNM) - www.midwife.orgAmerican College of Obstetricians and Gynecologists, The (ACOG) - www.acog.orgAmerican Dietetic Association (ADA) - www.eatright.orgAssociation of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) - www.awhonn.orgBreastfeeding Task Force of Greater Los Angeles, The - www.breastfeedingtaskforla.orgCalifornia Department of Public Health (CDPH) - www.cdph.ca.govCalifornia Women, Infants & Children (WIC) - www.wicworks.ca.govCenters for Disease Control and Prevention (CDC) - www.cdc.govLA Best Babies Network - www.labestbabies.org La Leche League International (LLLI) - www.llli.orgNational Association of Neonatal Nurses (NANN) - www.nann.orgNational Association of Nurse Practitioners in Women’s Health (NPWH) - www.npwh.orgNational Association of Pediatric Nurse Practitioners (NAPNAP) - www.napnap.orgNational Institutes of Health (NIH) - www.nih.govNational Medical Association (NMA) - www.nmanet.orgOffice on Women’s Health, The (OWH) - www.4women.gov/owhUnited Nations Children’s Fund (UNICEF) - www.unicef.orgUS Department of Agriculture (USDA) - www.usda.govUS Department of Health and Human Services (HHS) - http://www.womenshealth.gov/breastfeeding/programs/business-case/

World Health Organization (WHO) - www.who.int

Federal and California Law Support Breastfeeding Notes and References

End Notes1. Cohen, R. et al. Comparison of maternal absenteeismand infant illness rates among breastfeeding and formula-feeding women in two corporations. Am J Health Promo 1995; 10(2):148-53.

2. Cohen, R. and Mrtek, M. The impact of two corporatelactation programs on the incidence and duration of breastfeeding by employed mothers. Am J Health Promo 1994; 8(6):436-41.

3. Bartick, M. and Reinhold, A. The Burden ofSuboptimal Breastfeeding in the United States: A Pediatric Cost Analysis. Pediatrics 2010 0: peds.2009-1616.

4. Montgomery, D. and Splett P. Economic Benefit ofBreast-feeding Infants Enrolled in WIC. J AM Diet Assoc. 1997; 97: 379-385.

References American Academy of Family Physicians; AAFP Policy on Breastfeeding. www.aafp.org.

American Academy of Pediatrics. Breastfeeding and the Use of Human Milk PEDIATRICS Vol. 115 No. 2 February 2005, pp. 496-506.

American College of Obstetricians and Gynecologists. Breastfeeding: Maternal and Infant Aspects. ACOG Educ Bull. 2000; 258: 1-16.

American Dietetic Association; Position of the American Dietetic Association: Breaking the Barriers to Breastfeeding. J AM Diet Assoc. 2001; 101: 1213-1220.

Centers for Disease Control and Prevention. The CDCGuide to Breastfeeding Interventions. Shealy KR, Li R,Benton-Davis S, Grummer-Strawn LM, Atlanta; U.S.Department of Health and Human Services, Centers forDisease Control and Prevention, 2005.

Fein SB, Roe B, The Effect of Work Status on Initiation and Duration of Breastfeeding. American Journal of Public Health, 1998 Vol 88 pp. 1042-46.

U.S. Department of Health and Human Services. HHS Blueprint for Action on Breastfeeding. Washington, D.C.; U.S. Department of Health and Human Services, Office on Women’s Health; 2000.

U.S. Department of Health and Human Services. Healthy People 2010: Conference Edition. Vol 1 & 2. Washington, D.C.; U.S. Department of Health andHuman Services, Public Health Service, Office of the Assistant Secretary for Health, 2000-2, 47-48.

World Health Organization. Protecting, Promoting and Supporting Breastfeeding: The Special Role of Maternity Services. Geneva, Switzerland: World Health Organization; 1989: 13-18.

Acknowledgments

Useful Web Sites

We gratefully acknowledge First 5 LA for funding this project.

We thank the following individuals and agencies for their contributions to the development of this project:

Demitra Adams, MPH, CHESHealth Educator, L.A. County Department of Public Health

Janice French, CNM, MSDirector of Programs, LA Best Babies Network

Rebeca Pastrana-Sheng, BS, IBCLCDirector, WIC Breastfeeding Services, Northeast Valley Health Corporation—WIC Program

Karen Peters, MBA, RD, IBCLC, LCCEExecutive Director, Breastfeeding Task Force of Greater Los Angeles

Ellen Steinberg, RN, IBCLCPresident, Breastfeeding Task Force of Greater Los Angeles

Olga A. Vigdorchik, MPH, CHESHealth Educator, L.A. County Department of Public Health.

Service Planning Area 2Healthy Births Learning Collaborative Breastfeeding- Friendly

Workplace Policies350 South Bixel Street, Suite 100Los Angeles, California 90017(213) 250-7273

www.LABestBabies.orgApril 2010

Human milk is acknowledged to be the best nutrition for infants. Leading health organizations strongly advise mothers to exclusively breastfeed their babies for the first 6 months, and continue for at least one to two years, as long as it is mutually desired by mother and baby.

Many women stop breastfeeding, however, when they return to work. More than half of mothers in the US with children under age 3 work. Approximately one-third of mothers return to work within 3 months of giving birth, and half return before the baby is 6 months old.

Mothers who want to keep breastfeeding after returning to work have only a few simple needs. Employers who create a breastfeeding-support program in the workplace that helps mothers breastfeed babies longer will find that they have made a sound business decision. They will also help to bolster babies’ health.

Benefits of Providing a Breastfeeding-Friendly Work Environment

For Employers and Employees• Cost savings • Lower healthcare costs• Increased job productivity • Improved employee satisfaction and morale• Improved corporate image • Greater employee loyalty and retention• Decreased absenteeism • Additional recruitment incentive

For every $1 spent to support breastfeeding in the workplace, companies save $3.1,2 Because breastfed babies are healthier, breastfeeding mothers will take fewer days off to care for a sick child. The company will spend fewer healthcare dollars on both mother and infant. In addition, employers report less staff turnover because employees are more satisfied with their jobs. An added benefit is that a family-friendly work environment makes an excellent recruitment tool.

For the Working Mother Who Breastfeeds• Better health • A healthier baby• Easier transition back to work • Less conflict between career and motherhood• Increased self-confidence and self-reliance • Greater work satisfaction• Cost savings • Increased child spacing (time between births)

Women who breastfeed their babies for longer accrue significant health benefits. Breastfeeding is linked to a reduction in risk for many diseases, such as breast and ovarian cancers, osteoporosis and Type 2 diabetes. Breastfeeding has a calming effect on the mother and helps her better manage stress. It also has a contraceptive effect, which can lengthen the time between pregnancies and help make the next child healthier. Financially, breastfeeding means families will save on formula costs, healthcare expenses, and alternative care when a baby is sick.

For the Baby• Recommended method of feeding by • Protection against chronic diseases all health authorities • Decreased risk of Sudden Infant Death Syndrome (SIDS)• Healthier immune system • Stronger mother-baby attachment• Fewer doctor visits and hospitalizations

Health experts worldwide recognize that breastfeeding is the best way to feed an infant (see “Useful Web Sites” for a list of professional health organizations). Breastfed babies have fewer ear, respiratory and intestinal infections; are less likely to have allergies and asthma; and less risk of developing chronic diseases and conditions, such as SIDS, diabetes, childhood cancers, obesity and high cholesterol. All of these factors aid in reducing medical visits, prescriptions and hospitalizations. The benefits of breastfeeding last a lifetime.

For the Community• Reduced healthcare costs • Enhanced long-term health• Environmental friendliness

A 2010 study published in Pediatrics found that the U.S. would save $13 billion per year and prevent over 900 infant deaths if 90% of mothers were to breastfeed exclusively for 6 months.3 US taxpayers would save $478 in Women, Infants, and Children (WIC) costs and Medicaid expenditures for each infant breastfed during the first 6 months of life.4 Breastfeeding in the workplace requires no environmental costs in terms of production, packaging or waste disposal.

Supporting Breastfeeding in the Workplace

Additional recommendations for providing breastfeeding promotion and support include:

Highly recommended:

• The breastfeeding employee may be offered a flexible schedule toaccommodate pumping or breastfeeding.

• The breastfeeding employee may be offered flexible assignments toaccommodate pumping or breastfeeding.

• The employer may provide appropriate labeling for the “Lactation Area.”(Images of bottles or pacifiers are not suitable symbols.)

• The employer may provide a refrigerator labeled exclusively for breast milkstorage.

• Appropriate signage and/or other security measures may be used to identifythe occupied status of the “Lactation Area.”

• [Agency]’s visitors, clients and customers who breastfeed will be welcomed andappropriately accommodated.

Also suggested:

• The employer may provide the option of part-time work, telecommuting/working from home, or job sharing to the breastfeeding employee.

• The employer may extend maternity leave beyond the period stipulated by theFamily Medical Leave Act (FMLA) and California Family Rights Act (CFRA).

• The employer may provide on-site or nearby day care.

• The employer may provide referrals to breastfeeding resources and services inthe community.

• The employer may incorporate breastfeeding information into the employeewellness program.

• The employer may provide on-site or agency-wide lactation services thatinclude some or all of the following:

○ Professional lactation personnel.

○ Purchase of electrical pump(s) for the “Lactation Area.”

○ Discounted breast pump purchasing/rental program for employees.

○ A breastfeeding support group for working mothers.

○ Healthcare benefits with a lactation services coverage rider.

Recommendations

Breastfeeding-Friendly Workplace Policy TemplateThis template can be customized by employers to individual workplaces. It can be downloaded as a Word document at: www.LABestBabies.org/templates/bfwp.doc.

PurposeTo establish guidelines for promoting a breastfeeding-friendly work environment at [Agency].

Policy[Agency] recognizes that breast milk is the optimal food for the growth and development of infants, and encourages employees and management to have a positive, accepting attitude to working women who are breastfeeding. [Agency] promotes and supports breastfeeding and the expression of breast milk by employees who are breastfeeding when they return to work.

Discrimination and harassment of breastfeeding mothers in any form is unacceptable and will not be tolerated by [Agency].

It shall be the policy of [Agency] to provide:

Training [Agency]’s Breastfeeding-Friendly Workplace policy shall be disseminated to every incoming and current employee.

Information about breastfeeding support after returning to work shall be provided to employees prior to their maternity leave.

Time to Express Milk or Breastfeed (Lactation Time)Lactation times shall be established for each employee, based on her work schedule. If possible, the lactation time is to run concurrently with any break time already allotted.

Lactation time beyond the regular break is unpaid and will be negotiated between the employee and [Agency].

Space and Equipment for Expressing Milk or BreastfeedingEmployees shall be provided the use of a clean, comfortable space or “Lactation Area.” A toilet stall shall not serve as the lactation area. For ideas on the use of office space as a lactation area, visit http://www.cdph.ca.gov/programs/wicworks/Pages/WICBFEmployerResources.aspx.

The Lactation Area shall:• Be equipped with an electrical outlet• Be in close proximity to the employee’s work area• Contain comfortable seating

Ideally, the Lactation Area will be near:• A sink, with hot water and soap, for hand washing and cleaning of equipment.• A refrigerator, for storage of expressed breast milk.

Atmosphere of ToleranceBreastfeeding shall not be the cause of discrimination in the workplace nor in access to employment. It is prohibited under this policy to harass a breastfeeding employee. Such conduct unreasonably interferes with an employee’s work performance and creates an intimidating, hostile and offensive working environment.

Any incident of harassment of a breastfeeding employee will be addressed in accordance with [Agency]’s policies and procedures for discrimination and harassment.

,

LEY DE CALIFORNIA SOBRE ALOJAMIENTO PARA LA LACTANCIA (Chapter 3.8, Section 1030, Part 3 of Division 2 of the Labor Code)Esta ley requiere que todos los empleadores de California provean una cantidad de tiempo de descanso razonable y hagan un esfuerzo razonable para proveer espacio que no sea una cabina de baño, cerca del área de trabajo de los empleados, para alojar a una empleada que desea extraerse su leche para su bebé. El tiempo de descanso deberá ser sin pago si el tiempo de descanso no va concurrentemente con el resto del tiempo autorizado para el empleado. No es requisito que un empleador provea tiempo de descanso para extraerse la leche si el tomarse tiempo de descanso aparte del tiempo usual asignado para descansos afecta gravemente las operaciones del empleador. La violación de este capítulo está sujeta a una multa civil de $100.

Leyes adicionales sobre la lactancia en California:

Código Civil de California § 210.5 (2000) permite a la madre de un niño alimentado al pecho posponer su deber de jurado por un año y específicamente elimina la necesidad de que la madre se presente en el tribunal para solicitar la postergación. La ley también provee que el periodo de un año pueda extenderse bajo la solicitud por escrito de la madre. [Chap. 266 (AB 1814)]

Código Civil de California § 43.3 (1997) permite a la madre amamantar a su hijo en cualquier lugar, ya sea público o privado, excepto el hogar o residencia de otra persona, donde la madre y el niño están de otra manera autoirzados a estarpresentes. (AB 157)

Academy of Breastfeeding Medicine, The (ABM) - www.bfmed.org

American Academy of Family Physicians (AAFP) - www.aafp.org

American Academy of Pediatrics (AAP) - www.aap.org

American College of Nurse-Midwives (ACNM) - www.midwife.org

American College of Obstetricians and Gynecologists, The (ACOG) - www.acog.org

American Dietetic Association (ADA) - www.eatright.org

Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) - www.awhonn.org

Breastfeeding Task Force of Greater Los Angeles, The - www.breastfeedla.org

California Department of Public Health (CDPH) - www.cdph.ca.gov

California Women, Infants & Children (WIC) - www.wicworks.ca.gov

Centers for Disease Control and Prevention (CDC) - www.cdc.gov

LA Best Babies Network - www.labestbabies.org

La Leche League International (LLLI) - www.llli.org

National Association of Neonatal Nurses (NANN) - www.nann.org

National Association of Nurse Practitioners in Women’s Health (NPWH) - www.npwh.org

National Association of Pediatric Nurse Practitioners (NAPNAP) - www.napnap.org

National Institutes of Health (NIH) - www.nih.gov

National Medical Association (NMA) - www.nmanet.org

Office on Women’s Health, The (OWH) - www.4women.gov/owh

United Nations Children’s Fund (UNICEF) - www.unicef.org

U.S. Department of Agriculture (USDA) - www.usda.gov

U.S. Department of Health and Human Services (HHS) - www.hhs.gov

World Health Organization (WHO) - www.who.int

Las leyes de California apoyan la lactancia materna Notas y Referencias Notas finales1 Cohen, R. et al. Comparación del índice de absentismo materno y enfermedad infantil entre mujeres que amamantan y mujeres que alimentan con fórmula artificial en dos corporaciones. Am J Health Promo 1995; 10(2):148-53.2 Cohen, R. and Mrtek, M. El impacto de dos programas corporativos de lactancia sobre la incidencia y duración de la lactancia materna por madres empleadas. Am J Health Promo 1994; 8(6):436-41.3 Departamento de Agricultura de los Estados Unidos. Los beneficios económicos de la lactancia materna. Una revisión y análisis. Jon Weimer. División de Alimentos y Economía Rural. Servicio de Investigación Económica. Departamento de Agricultura de los Estados Unidos. Reporte de Investigación sobre la Asistencia con Alimentos y Nutrición No. 13, 2001.4 Montgomery, D. and Splett P. Beneficios económicos de los bebés amamantados inscritos en WIC. Revista de la Asociación Americana de Dietistas 1997; 97: 379-385.

Referencias Academia Americana de Médicos Familiares; AAFP Política sobre la lactancia materna. Academia Americana de Pediatría. La lactancia materna y el uso de leche humana. PEDIATRA Vol. 115 No. 2 Febrero 2005, pp. 496-506.

Colegio Americano de Obstetras y Ginecólogos. Lactancia materna: los aspectos materno e infantil. ACOG Educ Bull. 2000; 258: 1-16.

Asociación Dietética Americana; La posición de la Asociación Dietética Americana: Rompiendo las barreras de la lactancia materna. J AM Diet Assoc. 2001; 101: 1213-1220.

Centros para el Control y Prevención de Enfermedades. Guía para Intervenciones sobre Lactancia Materna de los Centros para el Control y Prevención de Enfermedades. Shealy KR, Li R, Benton-Davis S, Grummer-Strawn LM, Atlanta; Departamento de Salud y Servicios Humanos de los Estados Unidos. Centros para Control y Prevención de Enfermedades, 2005.

Fein SB, Roe B, El efecto del status en el trabajo para la iniciación y duración de la lactancia. Revista americana de salud pública, 1998 Vol 88 pp. 1042-46.

Departamento de Salud y Servicios Humanos de los Estados Unidos. Programa de acción del Departamento de Salud y Servicios Humanos sobre la lactancia materna. Departamento de Salud y Servicios Humanos de los Estados Unidos; Oficina de Salud de la Mujer; 2000.

Departamento de Salud y Servicios Humanos de los Estados Unidos. Gente Sana 2010. Edición de la Conferencia. Vol 1 & 2. Washington, D.C.; Departamento de Salud y Servicios Humanos de los Estados Unidos. Servicio de Salud Pública. Oficina de la Secretaría de Asistencia para la Salud, 2000-2, 47-48.

Organización Mundial de la Salud. La protección, promoción y apoyo de la lactancia materna. El papel especial de los servicios de maternidad. Ginebra, Suiza; Organización Mundial de la Salud; 1989: 13-18.

Sitios útiles de la red

ReconocimientosAgradecemos a las siguientes personas y agencias porsus contribuciones al desarrollo de este proyecto:

Demitra Adams, MPH, CHESEducadora de la salud, Departamento de Salud Pública del Condado de Los Angeles

Janice French, CNM, MSDirectora de Programas, LA Best Babies Network

Rebeca Pastrana-Sheng, BS, IBCLCDirectora, Servicios de Lactancia Materna de WIC, Valle del noreste Corporación de Salud—Programa WIC

Karen Peters, MBA, RD, IBCLC, LCCEDirectora Ejecutiva, Equipo Operativo de Lactancia del Gran Los Angeles

Ellen Steinberg, RN, IBCLCPresidenta, Equipo Operativo de Lactancia del Gran Los Angeles

Olga A. Vigdorchik, MPH, CHESEducadora de la salud, Departamento de Salud Pública del Condado de Los Angeles

Área 2 de planeación de serviciosHealthy Births Learning Collaborative

350 South Bixel Street, Suite 100Los Angeles, California 90017(213) 250-7273

www.LABestBabies.orgFunded by First 5 LA

Enero 2008

Políticas a favor de la lactancia materna en el lugar de trabajo

La leche humana se considera que es la mejor nutrición para los bebés. Las principales organizaciones de salud aconsejan enfáticamente que las madres deberían exclusivamente amamantar a sus bebés durante los primeros seis meses y que la lactancia materna debería continuar por lo menos durante uno o dos años mientras que se desee mutuamente.

Sin embargo, las mujeres frecuentemente dejan de amamantar a sus bebés cuando regresan a trabajar. El setenta por ciento de las madres trabajadoras en los Estados Unidos con niños menores de 3 años trabajan tiempo completo. Aproximadamente un tercio de estas madres regresan a trabajar dentro de los tres meses de haber dado a luz y dos tercios regresan antes de que el bebé tenga 6 meses de edad.

Las madres que quieren seguir amamantando después de regresar a trabajar tienen relativamente pocas y simples necesidades. Los empleadores que establecen un lugar de trabajo con programas de apoyo a la lactancia que ayudan a la madre a amamantar a su bebé más tiempo encontrarán que han hecho una buena decisión profesional. También ayudarán a reforzar la salud del bebé.

Para los empleadores y compañeros de trabajo Beneficios de proveer a los empleadores y compañeros de trabajo un ambiente de trabajo que apoya la lactancia materna

• Ahorro en los costos • Disminución de los costos de atención médica• Aumento de la productividad en el trabajo • Mejor satisfacción y ánimo del empleado• Mejor imagen de la corporación • Aumento de la lealtad y retención de los empleados• Disminución de absentismo • Incentivo adicional de reclutamiento

Los empleadores ahorran $3 por cada dólar que gastan dando apoyo a la lactancia materna en el lugar de trabajo.1,2 Los bebés amamantados son mucho más sanos. Como resultado, las madres que trabajan en una compañía que apoya la lactancia materna se ausentarán menos días para atender a su niño enfermo. La compañía gastará menos dólares en atención médica tanto para la madre como para el niño. Además, los empleadores reportan menos renovación del personal porque el personal está más satisfecho con sus trabajos. Como un beneficio adicional, un ambiente de trabajo a favor de la familia es una excelente herramienta de contratación.

Para la madre trabajadora que amamanta• Madres más sanas • Bebés más sanos• Transición de regreso al trabajo con • Menos conflicto entre la carrera y la maternidad

menos complicaciones • Mayor satisfacción en el trabajo• Mayor auto-confianza y auto-dependencia • Mayor espacio entre los hijos (el tiempo entre cada nacimiento)• Ahorro en costos

Las mujeres que amamantan a sus hijos por tiempo más prolongado acumulan beneficios de salud importantes. La lactancia materna está ligada a una reducción en el riesgo para muchas enfermedades, como cáncer de mama y de ovario, osteoporosis y diabetes tipo 2. Su práctica tiene un efecto calmante en la madre y ayuda a controlar mejor el estrés. También tiene un efecto anticonceptivo, el cual puede prolongar el tiempo entre los embarazos y ayudar a que el próximo hijo sea más sano. Económicamente, la lactancia significa que las familias ahorrarán en los costos de la fórmula artificial, los gastos de cuidados médicos y el cuidado alternativo cuando un bebé está enfermo.

Para el bebé• El método recomendado por todas las • Protección contra enfermedades crónicas

autoridades en salud para alimentar a los bebés • Disminución del riesgo del síndrome de muerte infantil súbita• Sistemas inmunológicos más fuertes (SIDS en inglés)• Menos visitas al doctor y hospitalizaciones • Apego madre-hijo más fuerte

Los expertos en salud en los Estados Unidos y en todo el mundo reconocen que la lactancia es la mejor forma de alimentar a un bebé (vea “Sitios en la red útiles” para una lista de organizaciones de salud profesionales). Los bebés amamantados tienen menos infecciones de oído, respiratorias e intestinales; alergias y asma menos frecuentes; y menos riesgo de desarrollar enfermedades y padecimientos crónicos, como el síndrome de muerte infantil súbita, diabetes, cánceres de la niñez, obesidad y colesterol alto. Todos estos factores ayudan a reducir el número de visitas médicas, prescripciones y hospitalizaciones. Los beneficios de la lactancia duran toda la vida.

Para la comunidad• Costos de cuidados de salud reducidos • Mejor salud a largo plazo• Inocuos para el medio ambiente

El Departamento de Agricultura calcula que anualmente se ahorrarían un mínimo de $3.6 billones en gastos médicos si el número de niños amamantados durante 6 meses se incrementara en un 50 por ciento.3 Los contribuyentes de los Estados Unidos ahorrarían $478 por bebé en los costos del programa para Mujeres, bebés y niños (WIC, en inglés) y en los gastos de Medicaid si los bebés fueran amamantados durante los primeros seis meses de vida.4 El permitir la lactancia en el lugar de trabajo no requiere de costos para el medio ambiente desde el punto de vista de la producción, empaque o desecho de desperdicios.

Apoyo de la lactancia materna en el lugar de trabajo

Las recomendaciones adicionales para proveer la promoción y apoyo de la lactancia materna incluyen:

Muy recomendable:

• A la empleada que está amamantando se le podría ofrecer un horario de trabajoflexible para facilitar la extracción de leche o la lactancia.

• A la empleada se le podrían ofrecer tareas flexibles para facilitarla extracción de leche o la lactancia.

• El empleador podría proveer un etiquetado adecuado para la “zona paralactancia” (las imágenes de biberones o chupones no son símbolos adecuados.)

• El empleador podría proveer un refrigerador etiquetado exclusivamente para elalmacenamiento de la leche materna.

• Podría utilizarse un señalamiento adecuado u otras medidas de seguridad paraidentificar que está ocupada la “Zona para lactancia.”

• Los visitantes, clientes y consumidores de [Agencia] que amamantan seránbienvenidos y alojados adecuadamente.

También se sugiere:

• El empleador podría proveer opciones de trabajo de medio tiempo, trabajo adistancia o trabajo desde casa o trabajo compartido para la empleada queamamanta.

• El empleador podría proveer una extensión de la incapacidad por maternidadsegún la Ley de ausencia médica por motivos familiares [Family Medical Leave Act(FMLA)] y la Ley de California sobre los Derechos de la Familia [California FamilyRights Act (CFRA)].

• El empleador podría proveer una guardería en sus instalaciones o un lugarcercano.

• El empleador podría proveer referencias sobre lactancia para recursos y serviciosen la comunidad

• El empleador podría incorporar información sobre lactancia en el programa debienestar de la empleada.

• El empleador podría proveer servicios de lactancia locales o por medio de unaagencia que incluyan algo o todo lo siguiente:

• Personal profesional en lactancia

• Compra de bomba(s) eléctrica(s) para la “zona para lactancia”

• Programa de descuento para compra o renta de bombas para lactancia paraempleados

• Un grupo de apoyo para madres trabajadoras

• El empleador podría proveer beneficios de atención médica con unacobertura para el usuario de servicios para lactancia.

Recomendaciones

Plantilla sobre la Política del lugar de trabajo que apoya la lactancia maternaEsta plantilla, que los empleadores pueden adaptar individualmente para sus lugares de trabajo está disponible en línea www.LABestBabies.org/templates/bfwp.doc.

PropósitoEstablecer normas para promover un ambiente de trabajo que apoya la lactancia materna en [Agencia].

Política[Agencia] reconoce que la leche materna es el alimento óptimo para el crecimiento y desarrollo de los bebés y [Agencia] estimula a los empleados y la administración a tener una actitud de aceptación positiva hacia las mujeres trabajadoras y [Agencia] promueve y apoya la lactancia materna y la extracción de leche materna por las empleadas que están lactando al regresar a trabajar.

La discriminación y el acoso de las madres que están lactando de cualquier forma es inaceptable y no serán tolerados en [Agencia].

La política de [Agencia] será la de proveer:

Capacitación La política de [Agencia] de un lugar de trabajo a favor de la lactancia materna deberá ser difundida a todos los nuevos empleados en [Agencia].

La información sobre el apoyo de la lactancia materna después del regreso al trabajo deberá ser provista a las empleadas antes de su ausencia por maternidad.

Tiempo para extraerse la leche o amamantar (Tiempo para lactancia)Las horas de lactancia deberán establecerse para cada empleada sobre la base de su horario de trabajo. Si es posible, el tiempo para lactancia debe ser en forma concurrente con cualquier tiempo de descanso ya provisto.

El tiempo de lactancia que rebase el tiempo de descanso regular no se paga y será negociado entre la empleada y [Agencia].

Espacio y equipo para extraer la leche materna o para la lactanciaA las empleadas se les deberá proveer el uso de un espacio limpio, cómodo o “zona para lactancia”

Para ideas sobre el uso de espacio de oficina como zona para lactancia, visite el sitio www.wicworks.ca.gov.

Un baño no debe servir como zona para lactancia.La zona para lactancia:

• está equipada con una toma de corriente eléctrica• está cerca del área de trabajo de la empleada• contiene asientos cómodos.

Idealmente, el área para lactancia estará cerca de:• un lavamanos con agua caliente y jabón para lavarse las manos y limpiar el equipo• un refrigerador para guardar la leche extraída.

Atmósfera de toleranciaLa lactancia materna no debería constituir una fuente de discriminación en el empleo o en el acceso a un empleo. Está prohibido bajo esta política el acosar a una empleada que está amamantando; dicha conducta injustificadamente interfiere con el desempeño de una empleada y crea un ambiente de trabajo intimidante, hostil u ofensivo.

Cualquier incidente de acoso hacia una empleada que está lactando será tratado de acuerdo con las políticas y procedimientos de [Agencia] para casos de discriminación y acoso.

Infant Feeding Handouts

When You Feed Me Formula

Getting ready Keep my bottles and nipples clean

• Washmybottles,nipples,andringswithabottlebrushinhotsoapywater.Rinse well.

Until I am 3 months old:• Afteryouwashmybottles,nipples,and

rings,puttheminboilingwaterfor5minutesorwashthemonthetoprackofthedishwasher.Letthemcool.

Use safe water for mixing my formula• Usecoldtapwaterorbottledwater.Hottap

watercouldhaveleadinit.Until I am 3 months old:• Boilthewateronthestoveforonly 1 minute.

Letitcooltoroomtemperature.

A helpful

guide to

feeding your

baby formula.

This institution is an equal opportunity provider. Developed by the California WIC Program,California Department of Public Health.1-800-852-5770

Arnold Schwarzenegger, Governor, State of CaliforniaKimberly Belshé, Secretary, California Health and Human Services AgencyMark B Horton, MD, MSPH, Director, California Department of Public Health

When You Feed Me Formula, Pub 910182, (12/08)

I will drink about this much formula each time:Birth to 2 months: 2 to 3 ounces2 to 4 months: 3 to 4 ounces4 to 6 months: 4 to 6 ounces6 to 8 months: 6 to 8 ounces8 to 12 months: 4 to 6 ounces

Iwillnotalwaysdrinkthesameamountofformulaateachfeeding.

How much to feed me

Mystomachisverysmall(aboutthesizeofmyfist).Ineedyoutofeedmeoftenbutonlyinsmallamounts.• Neverforcemetofinishmybottle.Icouldgeta

stomachache,vomit,orgaintoomuchweight.• WhenIamfull,Iwillstopsucking,turnmy

headawayfromthebottle,orfallasleep.• Itisnormalformetospitupalittleformula.If

Ispitupalotaftereveryfeeding,talkwiththedoctorortheWICcounselor.

WICmaynotprovidealltheformulathatyourbabyneeds,especiallyafteryourbabyis6monthsold.Thishandoutappliesonlytohealthy,full-termbabieswhodrinkregularformulas,notspecialortherapeuticformulas.

Avoidclear,hardplasticbottlesmarkedwitha7or“PC”(polycarbonate)onthebottom.Throwoutmybottleswhentheygetoldandscratched.

Which type of baby bottle is the best?Thebestbottlesareeither:• Glassor• Flexible,milky-colored

plastic(polyethyleneorpolypropylene).

Warning:Add the right amount of water! Too much water or not enough water is dangerous for me! I could get very sick or not grow well

Keep my formula safe• Keepthecanofpowderedformulainacool,dryplace.

Keepconcentratedformulaintherefrigeratoraftermixing.• Aftermixingmyformula,feedmerightawayorkeepitin

therefrigerator.After24hours,throwitaway.• Donotkeepformulaatroomtemperatureformorethan

1hour.Throwoutformulaleftinmybottleafteryoufeedme.• Only put formula or breastmilk in my bottle.Donotput

cereal,babyfoods,honey,juice,orotherliquidsinmybottle.

How to mix my formulaWash your hands first.Makesurethecanopenerisclean.

Powder1 Beforeyouopentheformulacan,rinseand

drythecanandtheplasticlid.2 Measurethewaterandputitinmybottle

first.Forevery2ouncesofwaterinthebottle,add 1levelscoop(notpacked)ofpowderedformula.

3 Shakethebottlegentlyorstir.4 It’sbettertomixeachbottleofpowderedformularightbeforefeedingme.

Concentrate1 Beforeyouopentheformulacan,shakeit,

rinseit,anddryit.2 Pourthecanofformulaintoacleancontainer.

3 Fillthecanwithwaterandaddittotheformulainthecontainer.

4 Mixandpourintobottles.5 Oryoucanmixequalamountsof

concentratedformulaandwaterinmybottle.

Do NOT prop my bottle!

How to feed me

Hold me close• Alwaysholdmeclosetoyouwhen

youfeedme.Ineedlove,closeness,andattention.

• HoldmewhileIdrink,evenifIcanholdmybottlebymyself.

• Neverputmetobedwithmybottle,propmybottle,orleavemealonewithit!Icouldchoke,spitup,getearinfections,orgettoothdecay.

Keep me comfortable• Youcanwarmmybottleinasmallbowlof

hotwater,thenshake it.Do not heat my bottle in the microwave!Hotspotscanburnmymouth.

• Makesurethenippleholeistherightsize.Whenyouholdmybottleupside-down,theformulashoulddripoutataboutonedroppersecond.

• Youmightneedtotryadifferenttypeofbottleornippletoseewhatworksbestforme.

• Keepmyheadhigherthanmychest.Tiltmybottleupsothenipplestaysfullofformula.Letmestopsuckingoftentotakeabreak.

• Burpmeduringeveryfeeding.ThisbringsuptheairthatIhaveswallowed.

Esta institución es un proveedor que ofrece igualdad de oportunidades.Desarrollado por el Programa de WIC de CaliforniaDepartamento de Salud Pública de California1-800-852-5770

Arnold Schwarzenegger, Gobernador del Estado de CaliforniaKimberly Belshé, Secretaria de la Dirección de Salud y Servicios Humanos de CaliforniaMark B Horton, MD, MSPH, Director del Departamento de Salud Pública de California

When You Feed Me Formula–Spanish, Pub 910183, (12/08)

Cuando me das fórmula

Cada vez voy a tomar más o menos esta cantidad de fórmula:Del nacimiento a los 2 meses: 2 a 3 onzasDe 2 a 4 meses: 3 a 4 onzasDe 4 a 6 meses: 4 a 6 onzasDe 6 a 8 meses: 6 a 8 onzasDe 8 a 12 meses: 4 a 6 onzas No siempre voy a tomar la misma cantidad de fórmula cada vez que me des de comer.

Preparándote

Mantén limpios mis biberones y chupones• Lava mis biberones, chupones y anillos con

un cepillo para biberones en agua caliente con jabón. Enjuágalos bien.

Durante mis primeros 3 meses:• Después de lavar mis biberones, chupones y

anillos, ponlos a hervir durante 5 minutos o si no lávalos en la parte superior de la máquina lavaplatos. Déjalos enfriar.

Para mezclar mi fórmula, usa agua que sea segura• Usa agua fría de la llave o agua embotellada. El agua

caliente de la llave podría tener plomo.Durante mis primeros 3 meses:• Hierve el agua en la estufa sólo por 1 minuto.

Déjala enfriar a temperatura ambiente.

Una guía

útil para

darle fórmula

a su bebé.

Cuánto me debes darMi estómago es muy pequeño (más o menos el tamaño de mi puño). Necesito que me des de comer con frecuencia, pero sólo en pequeñas cantidades.• Nunca me obligues a terminar mi biberón. Podría

tener dolor de estómago, vomitar o aumentar demasiado de peso.

• Cuando me llene, dejaré de tomar, voltearé la cabeza lejos del biberón o me quedaré dormido.

• Es normal que se me devuelva un poco de la fórmula. Si devuelvo mucho después de tomar cada biberón, habla con el médico o con la consejera de WIC.

Es posible que WIC no proporcione toda la fórmula que su bebé necesita, especialmente después de que su bebé cumpla 6 meses. Este folleto aplica sólo a los bebés sanos que nacieron en su término y que toman las fórmulas regulares, no las fórmulas especiales o terapéuticas.

¿Qué tipo de biberón es el mejor?Los mejores biberones son los de:

• Vidrio, o bien• Plástico flexible de color lechoso

(polietileno o polipropileno).

Evita los biberones de plástico duro y transparente marcados con un 7 ó “PC” (policarbonato) al fondo del biberón. Tira mis biberones cuando estén muy gastados y rayados.

Mantenme cómodo• Puedes calentar

mi biberón en un pequeño envase con agua caliente, y luego agítalo. ¡No calientes mi biberón en el microondas! Puede haber areas muy calientes que me pueden quemar la boca.

• Asegúrate de que el agujero del chupón tenga el tamaño correcto. Cuando sostengas mi biberón boca abajo, la fórmula debe escurrir más o menos a una gota por segundo.

• Tal vez necesites darme de un biberón o chupón diferente, para ver cuál es mejor para mí.

• Mantén mi cabeza más alta que mi pecho. Inclina mi biberón hacia arriba para que el chupón siempre esté lleno de fórmula. Permíteme dejar de tomar del biberón con frecuencia para descansar.

• Hazme eructar durante cada alimentación. Esto hace salir el aire que me pueda haber tragado.

Advertencia:¡Agrega la cantidad correcta de agua! ¡Si pones demasiada agua o si no pones la suficiente es peligroso para mí! Me podría enfermar mucho o no crecer bien

Mantén segura mi fórmula•Guarda la lata de fórmula en polvo en un lugar fresco y seco.

Guarda la fórmula concentrada en el refrigerador después de mezclarla.

•Tan pronto mezclas mi fórmula, dame de comer o guárdala en el refrigerador. Tírala después de 24 horas.

•No guardes la fórmula a temperatura ambiente por más de 1 hora. Tira la fórmula que quede en mi biberón después de darme de comer.

• Sólo pon en mi biberón fórmula o leche materna. No pongas en mi biberón cereal, comida de bebé, miel, jugo ni ningún otro líquido.

Cómo preparar mi fórmulaPrimero, lávate las manos. Asegúrate de que el abrelatas esté limpio.

Cómo darme de comer

¡NO me dejes apoyado el biberón!

En polvo1 Antes de abrir la lata de la fórmula, enjuaga y

seca la lata y la tapa de plástico.2 Mide el agua y ponla primero en mi biberón.

Por cada 2 onzas de agua en el biberón, agrega 1 medida nivelada de fórmula en polvo.

3 Agita suavemente o revuelve el biberón.4 Es mejor mezclar cada biberón de fórmula en

polvo justo antes de darme de comer.

Concentrada1 Antes de abrir la lata de la fórmula, agítala,

enjuágala y sécala.2 Vacía la lata de fórmula en un envase limpio.3 Llena la lata con agua y agrégala a la fórmula

en el envase.4 Mezcla y vacía en biberones.5 O si no, puedes mezclar en mi biberón partes

iguales de fórmula concentrada y de agua.

Cárgame cerca de ti• Siempre cárgame cerca de ti cuando

me des de comer. Necesito amor, cercanía y atención.

• Cárgame mientras tomo, aunque pueda sostener mi biberón yo solo.

• ¡Nunca me acuestes con mi biberón, no me dejes apoyado mi biberón ni me dejes solo con él! Me puedo ahogar, vomitar, se me puede infectar el oído o se me pueden formar caries en los dientes.

Keep me safe and healthy!

This institution is an equal opportunity provider.Developed by the California WIC Program,California Department of Public Health1-800-852-5770

Arnold Schwarzenegger, Governor, State of CaliforniaKimberly Belshé, Secretary, California Health and Human Services AgencyMark B. Horton, MD MSPH, Director, California Department of Public Health

Adapted in part from Help Me Be Healthy, Birth to 6 Months, developed by the Maryland State WIC Program. Some photos courtesy of the Texas Department of Health.Feed Me! Birth to 6 Months–English, Pub 910158, (01/08)

Take good

care of

yourself, and

give your baby

a healthy

start!

Feed Me! Birth to 6 Months

• Wash your hands before you feed me. Germs could make me sick.

• If you feed me with a bottle, only put breastmilk or formula in it. If you feed me formula, mix it the way the can says.

• You can store bottles of breastmilk or formula in the refrigerator. Formula is safe for 24 hours, and breastmilk is safe for 5 days. You can also freeze breastmilk—ask WIC how.

• Please heat my bottle or jar of food in hot water, shake or stir it well, and test it before feeding me. If you heat my bottle or my food in the microwave oven, it can get too hot and burn my mouth.

• Throw away what is left in the bottle when I am done. It could make me sick if I drink it later.

• Wipe my gums after I eat. Use a soft wet cloth.

• Don’t feed me honey or foods made with honey. I could get serious food poisoning.

• I don’t need to drink water or juice. I get all the liquid I need from breastmilk or formula. Please don’t give me any sweet drinks or soda.

• Take me to the doctor for my check ups and shots.

• Put me on my back to sleep.

• Keep me away from tobacco smoke.

• Never leave me alone at bath time or while you are changing my diaper.

• Always put me in my car seat when we ride in a car. Put my seat in the back seat, facing backwards. Never leave me alone in the car.

• Crying is my way to say I need you. When you come to me, I calm down. I learn that you care. Holding me will not spoil me.

A helpful

guide to

feeding your

baby from

birth to 6

months old.

I need to sit up to eat. Hold the spoon near my mouth and wait for me to look at it. Then, put a little bit on my lips so I can taste it.

Wait until I open my mouth before you try to put food in.

Wait until I am ready for each bite. When I turn my

head away, that means I am

done. Don’t try to get me to eat more!

Be patient while I am learning to eat.

If I won’t eat baby cereal, wait a week and try again. I will do better when I am ready. Start feeding me baby cereal by about 7 months, unless my doctor says to wait.

Around 6 months continued

Breastfeed me, or feed me baby formula with iron. If you’re breastfeeding me, please continue until my fi rst birthday or longer.

Please don’t feed me any other foods until I am about 6 months old. I’m not ready for them yet!

I know when I need to eat.

Feed me when I show you I am hungry. I will move my arms and legs, turn my head and open my mouth. I might suck on my hand or fuss a little. Please feed me before I cry.

I know how much to eat.

Let me eat until I show you I am full. I will stop sucking and let go. If I close my mouth and turn away, that means I am done. If you feed me with a bottle, please don’t try to make me fi nish it!

How do you know if I’m eating enough?

After the fi rst week, I will have 6 or more wet diapers every day. The doctor will say that I am gaining weight and growing well.

I need to eat about 8 to 12 times or more in 24 hours.

I might want to eat more often when I’m growing faster. My tummy can hold about 2 to 3 ounces at a time.

It might take me 3 months or more to be able to sleep through the night, 6 hours or more. Please be patient with me. Please don’t put cereal in my bottle to try to help me sleep. I’m not ready for cereal yet!

4 to 6 months

I need to eat about 6 to 8 times or more in 24 hours.

My tummy can hold about 4 to 6 ounces at a time.

I need your touch. Smile and talk to me. I love to look at your face. If you feed me with a bottle, don’t prop up my bottle or put me in bed with it. Please hold me close when you feed me.

Dad—please hold me and talk to me

You can bathe me, change my diaper, burp me, read to me, and play with me! I love to spend time with you.

When I am about 6 months old, I will probably be ready to try some solid foods. I need to be able to do all these things:

• sit up with support

• hold my head steady

• put my fi ngers or toys in my mouth

• show I want food by opening my mouth

• close my lips over the spoon

• show I don’t want food by turning my head away

• keep food in my mouth and swallow it

If our family has food allergies or I was

born early, talk to the doctor and WIC

before you try feeding me other foods.

When I’m ready, try feeding me a little bit of solid food.

You can start with baby cereal with iron—try rice, oatmeal,

or barley. Mix the cereal with breastmilk or formula—make it thin at fi rst. When I get better at eating it, you can make it thicker.

Feed me my food with a

baby spoon. Cereal in my bottle can make me gain too much weight—and I need to learn to use a spoon!

From birth Birth to 4 months Around 6 months

Take good

care of

yourself, and

give your baby

a healthy

start!

Necesito estar sentado para comer.

Sostén la cuchara cerca de mi boca y espera a que yo la vea. Luego pon un poquito en mis labios para que la pueda probar.

Espera hasta que abra la boca antes deque trates de meter la comida.

Espera hasta que esté listo para cada bocado. Cuando

voltee la cabeza, eso significa

que ya terminé. ¡No trates de que coma más!

Ten paciencia mientras aprendo a comer.

Si no me como el cereal para bebé, espera una semana e intenta otra vez. Lo haré mejor cuando esté listo. Empieza a darme cereal para bebé antes de los 7 meses, a menos que el doctor diga que debes esperar.

Alrededor de los 6 meses continuación

¡Dame de comer! Del nacimiento a los 6 meses

Una guía útil

para dar de

comer a su

bebé, desde

el nacimiento

hasta los 6

meses de edad.

Esta institución es un proveedor que ofrece igualdad de oportunidades.Desarrollado por el Programa WIC de California, Departamento de Salud Pública de California.1-800-852-5770Arnold Schwarzenegger, Gobernador del Estado de CaliforniaKimberly Belshé, Secretaria de la Dirección de Salud y de Servicios Humanos de CaliforniaMark B Horton, MD, MSPH, Director del Departamento de Salud Pública de California

Adaptado en parte de Help Me Be Healthy, Birth to 6 Months (Ayúdame a estar sano, del nacimiento a los 6 meses), desarrollado por el Programa WIC del Estado de Maryland.Algunas fotos compartidas por el Departamento de Salud de Texas.Feed Me! Birth to 6 Months–Spanish, Pub 910159, (05/09)

¡Mantenme seguro y sano!

Lávate las manos antes de darme de comer. Los microbios me pueden enfermar.

Si me das de comer con un biberón, ponle solamente leche materna o fórmula. Si me das fórmula, mézclala como dice en la lata.

Puedes guardar los biberones de leche materna en el refrigerador por 5 dias. La fórmula se conserva bien por 24 horas. También puedes congelar la leche materna. Pregúntale a WIC cómo hacerlo.

Si calientas mi biberón o frasco de comida, por favor agítalo o revuélvelo bien, y pruébalo antes de darme de comer.

Cuando yo termine de comer, tira lo que sobre en el biberón. Si me la tomo después me puedo enfermar.

Límpiame las encías después de que coma. Usa una tela húmeda suave.

No me des de comer miel ni alimentos que contengan miel. Me puedo intoxicar gravemente.

No necesito tomar agua ni jugo. Todo el líquido que necesito me lo da la leche materna o la fórmula. No me des bebidas dulces ni refrescos.

Llévame al doctor para que me examine y me ponga mis vacunas.

Acuéstame boca arriba para dormir.

Mantenme lejos del humo del tabaco.

Nunca me dejes solo a la hora del baño ni cuando estés cambiando mi pañal.

Siempre siéntame en mi asiento de seguridad cuando vayamos en carro. Pon mi asiento sobre el asiento trasero, mirando hacia atrás. Nunca me dejes solo en el carro.

Llorar es mi manera de decir que te necesito. Cuando llegues, me voy a calmar. Yo me doy cuenta que te preocupas. No me vas a malcriar por tenerme cargado.

Dame pecho, o dame de comer fórmula para bebé con hierro. Si me das pecho, por favor continúa hasta mi primer cumpleaños o más.

No me des de comer ninguna otra comida hasta que tenga unos 6 meses de edad. ¡Todavía no estoy listo!

Yo sé cuándo necesito comer.

Dame de comer cuando te demuestre que tengo hambre. Moveré mis brazos y mis piernas, voltearé la cabeza y abriré la boca. Tal vez me chupe la mano o esté un poco inquieto. Dame de comer antes de que llore.

Yo sé cuánto comer.

Déjame comer hasta que te muestre que estoy lleno. Dejaré de chupar y soltaré. Si cierro la boca y doy vuelta la cara, significa que ya terminé. Si me das de comer con

un biberón, ¡no intentes que me lo acabe!

¿Cómo sabes que estoy comiendo lo suficiente?

Después de la primera semana, mojaré 6 ó más pañales todos los días. El doctor dirá que estoy ganando peso y que estoy creciendo bien.

Necesito comer 8 a 12 veces o más en 24 horas.

Tal vez quiera comer más a menudo cuando estoy creciendo más rápidamente. Mi pancita puede contener unas 2 a 3 onzas a la vez.

Tal vez me tarde 3 meses o más en poder dormir toda la noche, 6 horas o más. Sé paciente conmigo. Por favor no pongas cereal en mi biberón para tratar de ayudarme a dormir. ¡Todavía no estoy listo para comer cereal!

De los 4 a los 6 meses

Necesito comer 6 a 8 veces o más en 24 horas.

Mi pancita puede contener unas 4 a 6 onzas a la vez.

Necesito tu contacto. Sonríe y háblame. Me encanta verte a la cara. Si me das de comer con un biberón, no uses ningún objeto para sostener el biberón ni me pongas en la cama con él. Por favor, sostenme cerca cuando me des de comer.

Papá—por favor, tenme cargado y háblame

¡Tú puedes bañarme, cambiar mi pañal, leerme un cuento, y jugar conmigo! Me encanta pasar tiempo contigo.

Cuando tenga unos 6 meses de edad, probablemente estaré listo para probar algunos alimentos sólidos. Necesito poder hacer todas estas cosas:

sentarme con respaldo

sostener firme la cabeza

poner mis dedos o mis juguetes en la boca

mostrar que quiero comer abriendo la boca

cerrar mis labios sobre la cuchara

mostrar que no quiero comida volteando la cabeza

mantener la comida en la boca y tragarla

Si nuestra familia tiene alergias a algunos alimentos o si yo nací

prematuro, habla con el médico y con WIC antes de que trates de

darme de comer otros alimentos.

Cuando esté listo, trata de darme un poquito de comida sólida.

Puedes comenzar con cereal con hierro para bebé. Prueba el arroz,

la avena o la cebada. Mezcla el cereal con leche materna o fórmula, y al principio que esté aguado. Cuando empiece a comer mejor, puedes hacerlo más espeso.

Dame de comer con una

cuchara para bebé. Poner el cereal en mi biberón puede hacerme ganar demasiado peso, ¡y necesito aprender a usar una cuchara!

Desde el nacimiento Del nacimiento a los 4 meses Alrededor de los 6 meses

This institution is an equal opportunity provider.Developed by the WIC Supplemental Nutrition Program,California Department of Public Health.1-800-852-5770

Arnold Schwarzenegger, Governor, State of CaliforniaKimberly Belshé, Secretary, California Health and Human Services AgencyMark B. Horton, MD MSPH, Director, California Department of Public Health

Adapted in part from Help Me Be Healthy, 6 to 12 Months, developed by the Maryland State WIC Program.Feed Me! 6 to 12 Months–English, Pub 910160, (03/08)

Feed Me! 6 to 12 Months

Keep me safe and healthy!

• Wash your hands and my hands before you give me food. Germs could make me sick.

• If you use a bottle to feed me, only put breastmilk or formula in it. If you feed me formula, mix it the way the can says.

• You can store bottles of breastmilk or formula in the refrigerator. Formula is safe for 24 hours, and breastmilk is safe for 5 days. You can also freeze breastmilk—ask WIC how.

• Throw away what is left in the bottle when I am done. It could make me sick if I drink it later.

• Feed me from a small dish, not from the baby food jar. Feed me with a small spoon. Use a clean spoon to take food out of the jar. Germs from my mouth can spoil the food and I could get diarrhea.

• Throw away any food left over in my dish when I am done. You can keep the jar in the refrigerator for 2 days after you open it.

• Don’t feed me honey or foods made with honey. I could get serious food poisoning.

• Don’t feed me any foods I could choke on. I might choke on hot dogs, nuts, seeds, popcorn, chips, grapes, raisins, raw vegetables, peanut butter, and candy.

• Please heat my bottle or jar of food in hot water, shake or stir it well,and test it before feeding me. If you heat my bottle or my food in the microwave oven, it can get too hot and burn my mouth.

• When my teeth start to come in, brush them with a small soft toothbrush twice a day. Put a tiny dot of fl uoride toothpaste on the brush. Wipe off excess toothpaste until I learn how to spit it out. Ask my doctor if I need fl uoride drops.

Let me sit at the table with my family.

Start giving me food you are eating that is safe for me. Be patient with me — I will be messy. I need practice to learn to eat. Please sit with me while I eat, and talk to me.

Start teaching me to drink from a small cup.

Be patient while I learn. As I start to eat more food, I will drink less breastmilk or formula. I will get better at using a cup. By around one year, I should be drinking just from a cup or the breast, not from a bottle. Please give me my cup just with meals and snacks.

Give me water, breastmilk or formula in my cup. I don’t need to drink juice. If you do give me juice, only give me apple or grape–and no more than 2 ounces a day, mixed with water! Please don’t give me any sweet drinks or soda. These drinks are bad for my teeth and they fi ll me up.

9 to 12 months

When I am ready, let me start feeding myself with a spoon or my hands.

Here are some good fi nger foods:

• small pieces of peeled soft fruits and soft cooked vegetables

• small pieces of cooked ground meat

• small pieces of dry cereal

• toasted bread squares, unsalted crackers, teething biscuits, small pieces of soft tortilla

• small slices of cheese

• cut-up noodles

A helpful

guide to

feeding your

6 to 12 month

old baby.

Around 6 months

Keep feeding me breastmilk or baby formula with iron.

It is still my main food. I need to breastfeed 6 times a day or more. If I am drinking formula, I need you to feed me 4 times a day or more. My tummy can hold about 6 to 8 ounces at a time. If you’re breastfeeding me, please continue until my fi rst birthday or longer. Let’s cuddle while I eat. Even if I can hold my own bottle, I want to see your face. Don’t prop up my bottle or put me in bed with it. I could choke or get tooth decay.

When I am about 6 months old, I am probably ready to try some solid foods. I need to be able to do all these things:

• sit up with support• hold my head steady• put my fi ngers or toys in my mouth• show I want food by opening my mouth• close my lips over the spoon• show I don’t want food by turning my head away• keep food in my mouth and swallow it If our family has food allergies or I was born early, talk to the doctor and WIC before you try feeding me other foods.

When I’m ready, try feeding me a little bit of solid food. You can start with baby cereal with iron — try rice, oatmeal, or barley. Mix the cereal with breastmilk or formula — make it thin at fi rst. When I get better at eating it, you can make it thicker. Feed me my food with a baby spoon. Cereal in my bottle can make me gain too much weight — and I need to learn to use a spoon!

I need to sit up to eat. Hold the spoon near my mouth and wait for me to look at it. Then, put a little bit on my lips so I can taste it.

Be patient while I am learning to eat. If I won’t eat baby cereal, wait a week and try again. I will do better when I am ready. Start feeding me baby cereal by about 7 months, unless my doctor says to wait.

6 to 9 months

I need to move through 4 stages of food:

Smooth (strained or pureed)

Mashed (smooth with a few tiny lumps)

Chopped (more lumps)

Tiny pieces of food

Be sure I can chew and swallow foods from one stage before I move to the next one.

I don’t need teeth to eat soft foods. I use my gums and my tongue.

You can make my food.

You can use a strainer, blender, or baby food grinder. When I’m a little older, you can use a fork to mash my food. You can also buy baby food in jars, but that is more expensive.

Choose healthy foods. I need them to grow right. Help me learn to eat a variety of foods. Here are some good ones to start with:

• Baby cereal: rice, oatmeal, barley

• Meats: beef, chicken, turkey

• Vegetables: squash, peas, carrots, sweet potato

• Fruit: applesauce, bananas, pears

• Other foods: beans, egg yolk, tofu, cottage cheese, plain yogurt, rice, noodles

Wait until I am one year old to give me cow’s milk or honey.

Keep my foods plain.

I don’t need sugar, salt, spices, butter, fat, or gravy. If you buy baby food in a jar, choose plainvegetables, fruits, and meats. These are better for me than baby dinners or desserts.

Watch me for allergies. If I’m allergic to something, I might get a skin rash, gas, or diarrhea, or I might have trouble breathing. Stop feeding me that food. Tell the doctor.

Give me only one new food at a time. Wait a few days before you try another new food. Take your time. That way you can see if I am allergic to anything.

Foods that babies are more likely to be allergic to are: • cow’s milk • soy milk or tofu • egg whites • fi sh or other seafood • wheat • nuts

• corn

Most babies will outgrow these allergies.

I know when I am hungry. I let you know by the way I act. Please feed me when I act hungry. I will open my mouth and be interested in food.

Wait until I open my mouth before you try to put food in. Wait until I am ready for each bite.

I know when I am full. Let me eat until I show you I am full. When I turn my head away, that means I am done. Don’t force me to fi nish my food or a bottle!

Give me a variety of foods.

Keep giving me new foods to try, so I will like lots of different foods. Keep trying — I might need to try a new food about 10 times or more before I decide I like it! I like to touch the food and smell it before I am ready to taste it.

Be patient with me. I will be messy. Let me touch my food. Please wait until I am done to clean me up.

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Deja que me siente en la mesa con mi familia. Comienza a darme la comida que tú comes y que sea segura para mí. Ten paciencia conmigo. Voy a estar sucio. Necesito práctica para aprender a comer. Siéntate conmigo mientras como, y háblame.

Comienza a enseñarme a tomar de una taza pequeña.Ten paciencia mientras aprendo. Al comenzar a comer más comida, tomaré menos leche materna o fórmula. Voy a tener más práctica al usar una taza. Más o menos al cumplir un año debo tomar solamente de la taza o del pecho, no del biberón. Dame mi taza solamente con mis

comidas y bocadillos.

Dame agua, leche materna o fórmula en mi taza. No necesito tomar jugo. Si me das jugo, dame solamente de manzana o de uva, y no más de 2 onzas al día, mezclado con agua. No me des bebidas dulces ni refrescos. Son malas para mis dientes y me llenan.

Esta institución es un proveedor que ofrece igualdad de oportunidades.Desarrollado por el Programa de Nutrición Suplementaria de WIC, Departamento de Servicios de Salud de California.1-800-852-5770

Arnold Schwarzenegger, Gobernador del Estado de CaliforniaKimberly Belshé, Secretaria de la Dirección de Salud y de Servicios Humanos de CaliforniaSandra Shewry, Directora del Departamento de Servicios de Salud de California

Adaptado en parte de Help Me Be Healthy, 6 to 12 Months (Ayúdame a estar sano, de los 6 a los 12 meses), desarrollado por el Programa WIC del Estado de Maryland.Feed Me! 6 to 12 Months–Spanish, Pub 910161, (02/07)

¡Dame de comer! De los 6 a los 12 meses

¡Mantenme seguro y sano!

• Lávate las manos y lávame las mías antes de darme de comer. Los microbios me pueden enfermar.

• Si me das de comer con un biberón, ponle solamente leche materna o fórmula. Si me das fórmula, mézclala como dice en la lata.

• Puedes guardar los biberones de leche materna o fórmula en el refrigerador. La fórmula se conserva bien por 2 días y la leche materna se conserva bien por 5 días. También puedes congelar la leche materna. Pregúntale a WIC cómo hacerlo.

• Cuando yo termine de comer, tira lo que sobre en el biberón. Si me la tomo después me puedo enfermar.

• Dame de comer en un platito, no del frasco de comida para bebé. Dame de comer con una cucharita. Usa una cuchara limpia para sacar la comida del frasco. Los microbios de mi boca pueden echar a perder la comida y me puede dar diarrea.

• Tira la comida que sobre en mi plato cuando termine. Puedes guardar el frasco en el refrigerador durante 2 días después de abrirlo.

• No me des de comer miel ni alimentos que contengan miel. Me puedo intoxicar gravemente.

• No me des de comer alimentos con los que me pueda ahogar, como salchichas, nueces, semillas, palomitas de maíz, tostaditas, uvas, pasas, verduras crudas, crema de cacahuate y dulces.

• Calienta mi biberón o frasco de comida en agua caliente, agítalo o revuélvelo bien, y pruébalo antes de darme de comer. Si calientes mi biberón o mi comida en el horno de microondas, puede calentarse demasiado y quemarme la boca.

• Cuando me empiecen a salir los dientes, cepíllalos con un cepillo de dientes suave y pequeño dos veces al día. Ponle a mi cepillo una cantidad muy pequeña de pasta de dientes con fl uoruro. Quítale el exceso de pasta de dientes hasta que yo aprenda cómo escupirla. Pregúntale a mi doctor si necesito gotas de fl uoruro.

Una guía útil

para dar de

comer a su

bebé, desde los

6 hasta los 12

meses de edad.

9 a 12 mesesCuando esté listo, déjame comer yo mismo con una cucharita o con mis manos.

Algunos alimentos que son buenos para comerse con la mano son:

• pedacitos de frutas blandas sin cáscara y de verduras blandas cocidas

• pedacitos de carne molida cocida

• pedacitos de cereal seco

• cuadritos de pan tostado, galletas sin sal, galletas para la dentición, pedacitos de tortilla suave

• pequeñas rebanadas de queso

• fi deos cortados en pedacitos

Sigue dándome de comer leche materna o fórmula con hierro para bebé. Todavía es mi principal alimento. Necesito tomar pecho 6 veces o más al día. Si tomo fórmula, la necesito 4 veces o más al día. Mi pancita puede contener de 6 a 8 onzas a la vez. Si me das pecho, por favor continúa hasta mi primer cumpleaños o más.

Vamos a acurrucarnos mientras como. Aunque pueda sostener solo mi biberón, quiero ver tu cara. No uses ningún objeto para sostener el biberón ni me pongas en la cama con él. Me podría ahogar o se me podrían picar los dientes.

Cuando tenga unos 6 meses de edad, probablemente esté listo para probar algunos alimentos sólidos. Necesito poder hacer todas estas cosas:

6 a 9 mesesNecesito pasar por las 4 etapas de la comida: Obsérvame para reacciones alérgicas.

Si soy alérgico a algo, podrían salirme ronchas en la piel, darme gases o diarrea, o podría tener problemas para respirar. No me des ya ese alimento. Platícaselo al médico.

Dame solamente un alimento nuevo a la vez. Espera unos días antes de que pruebes con otro alimento nuevo. Tómate tu tiempo. De esa manera puedes ver si soy alérgico a algo.

Los alimentos que más a menudo dan alergias a los bebés son:

• sentarme con respaldo

• sostener fi rme la cabeza

• poner mis dedos o mis juguetes en la boca

• mostrar que quiero comer abriendo la boca

• cerrar mis labios sobre la cuchara

• mostrar que no quiero comida volteando la cabeza

• mantener la comida en la boca y tragarla

Si nuestra familia tiene alergias a algunos alimentos o si yo nací prematuro, habla con el médico y con WIC antes de que trates de darme de comer otros alimentos.

Cuando esté listo, trata de darme un poquito de comida sólida. Puedes comenzar con cereal con hierro para bebé. Prueba el arroz, la avena o la cebada. Mezcla el cereal con leche materna o fórmula, y al principio que esté aguado. Cuando yo tenga práctica, puedes hacerlo más espeso.

Dame de comer con una cuchara para bebé. Poner el cereal en mi biberón puede hacerme ganar demasiado peso, ¡y necesito aprender a usar una cuchara!

Necesito estar sentado para comer. Sostén la cuchara cerca de mi boca y espera a que yo la vea. Luego pon un poquito en mis labios para que lo pueda probar.

Ten paciencia mientras aprendo a comer. Si no me como el cereal para bebé, espera una semana e intenta otra vez. Lo haré mejor cuando esté listo. Empieza a darme cereal para bebé antes de los 7 meses, a menos que el doctor diga que debes esperar.

• leche de vaca

• clara de huevo

• trigo

• maíz

• leche de soya o tofu

• pescado u otros mariscos

• nueces

La mayoría de los bebés superan estas alergias cuando crecen.

Yo sé cuando tengo hambre. Te lo voy a decir por cómo actúe. Dame de comer cuando te demuestre que tengo hambre. Abriré la boca y me interesará la comida.

Espera hasta que abra la boca antes de que trates de meter la comida. Espera hasta que esté listo para cada bocado.

Colado o hecho puré

Machacado (puré con unos cuantos grumos pequeños)

Picado (más grumos)

Pequeños pedacitos de comida

Asegúrate de que pueda masticar y tragar la comida de una etapa antes de pasar a la que sigue.

No necesito dientes para comer alimentos suaves. Uso mis encías y mi lengua.

Tú puedes hacer mi comida. Puedes usar un coladero, una licuadora, o un molino para comida de bebé. Cuando crezca un poco, puedes usar un tenedor para machacar mi comida. También puedes comprar comida para bebé en frasco, pero es más cara.

Elige alimentos saludables. Los necesito para crecer bien. Ayúdame a aprender a comer diversos alimentos. Los siguientes son buenos para comenzar:

• Cereal para bebé: arroz, avena, cebada

• Carnes: de res, de pollo, de pavo

• Verduras: calabaza, chícharos, zanahoria, camote

• Frutas: puré de manzana, plátano, pera

• Otros alimentos: frijoles, yema de huevo, tofu, requesón, yogurt simple, arroz, fi deos

Espera hasta que tenga un año de edad para darme leche de vaca o miel.

Dame comida simple. No necesito azúcar, sal, especias, mantequilla, grasa o salsa. Si compras comida para bebé en frasco, elige verduras, frutas y carnes simples. Son mejores para mí que las cenas o postres preparados para bebé.

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3

4

Alrededor de los 6 meses

Yo sé cuando estoy lleno. Déjame comer hasta que te muestre que estoy lleno. Cuando voltee la cabeza, eso signifi ca que ya terminé. ¡No me obligues a terminar mi comida o un biberón!

Dame comida variada. Sigue dándome a probar nuevos alimentos, para que me gusten muchas comidas diferentes. Sigue intentando. Tal vez tengas que intentar con un alimento nuevo unas 10 veces o más hasta que decida que me gusta. Me gusta tocar y oler la comida antes de que esté listo para probarla.

Ten paciencia conmigo. Voy a estar sucio. Déjame tocar mi comida. Espera a que termine antes de limpiarme.

Infant Development

Handouts

Healthy Minds:Nurturing Your Child’s Development from 0 to 2 Months

These handouts arebrought to you by ZEROTO THREE, the nation’sleading resource on thefirst 3 years of life, andthe American Academyof Pediatrics, dedicated tothe health of all children.

Key findingsfrom the report include:

What do we really know about how a young child develops? Whatcan parents do to best support their child’s healthy development andgrowing brain? Some of the answers are in this series of HealthyMinds handouts. Each handout is based on findings from a report*from the National Academy of Sciences that examined the research onchild and brain development to establish what is known about theearly years. The information we offer is age-specific, summarizes keyfindings from the report and suggests how you might be able to usethese key findings to nurture your own child’s healthy development.

● Your relationship with your child is the foundation of his orher healthy development.● Your child’s development depends on both the traits he orshe was born with (nature), and what he or she experiences(nurture). ● All areas of development (social/emotional/intellectual/lan-guage/motor) are linked. Each depends on, and influences,the others.● What children experience, including how their parentsrespond to them, shapes their development as they adapt tothe world.

When 2-month-old Benjamin cries and crieseach evening and kicks his arms and legs wild-ly, his parents try everything they can think ofto comfort him. They rock, walk and swaddlehim, massage his tummy in case he has gasand sing lullabies, all to calm him down.Sometimes it takes 20 minutes; sometimes ittakes 2 hours.

Benjamin’s crying, and his parents’ responseto it, shows how all areas of his developmentare linked, and how his parents help toencourage his development. Benjamin criesbecause he has come to expect that his par-ents will respond. When mom and dad don’tgive up trying to comfort Benjamin no matter

how frustrating it can be, they are nurturinghis social and emotional developmentbecause it makes him feel important and helearns to trust that his parents will care forhim. This gives him the confidence to trustothers, which will help him form healthy rela-tionships as he grows. In addition, beingsoothed by his parents in these early monthswill help him learn to soothe himself as hegets older, a very important skill throughoutlife. Using his voice and body to communicateis part of Benjamin’s early language andmotor development. When his parentsanswer his cries, he learns that his efforts atcommunicating are successful, which encour-ages him to communicate more, first throughgestures and sounds, and later through words.

Relationships are the foundation of a child’shealthy development.

How it looks in everyday family life:

10539 ZT 0-02mo eng 3/2/05 1:29 PM Page 1

For more information go to:www.zerotothree.orgwww.aap.org

The following chart describes many of the things your baby is learning between 0 and 2 months and whatyou can do to support your child in all areas of his development. As you read, remember that childrendevelop at their own pace and in their own way. Understanding who your child is, what his strengths areand where he needs more support, is essential for promoting his healthy development. If you have ques-tions regarding your child’s development, ask your pediatrician

What’s going on:

One of the most important tasks ofthe first 2 months is to help new-borns feel comfortable in theirnew world. They are learning toregulate their eating and sleepingpatterns and their emotions,which help them feel content, safeand secure.

Even as newborns, babies canplay in many ways. They canconnect sounds with theirsources, and love when you talkand sing to them. Play helpsbabies learn about the worldaround them. It is also an impor-tant way they connect with you,helping them to develop a strongattachment and promotinghealthy social development.

Newborns use their gestures(body movements), sounds andfacial expressions to communi-cate their feelings and needsfrom day 1. They use differentcries to let you know they arehungry, tired or bored. They askfor a break by looking away,arching their backs, frowning orcrying. They socialize with youby watching your face andexchanging looks.

● Offer your baby lots of differentobjects for him to look at, touchand even grip in his palms. Hecan focus best on things that are 8to 12 inches away.● Play “tracking” games by movingyourself and interesting objectsback and forth. First he will use hiseyes to follow. Eventually he willmove his head from side to side.This helps strengthen his neckmuscles as well as exercise hisvisual abilities.

● Figure out what your baby is try-ing to tell you. Responding makeshim feel important and tells himhe is a good communicator. Thisbuilds a positive sense of self anda desire to communicate more. ● Talk and sing to your baby. Tellhim about everything that’s goingon around him. Pay attention tothe sights and sounds he likes.Find toys and everyday objectswith different colors and texturesand see which he likes best.

What you can do:

● Observe carefully. This willhelp you figure out what yourbaby’s cries are telling you. ● Soothe your baby. When yourespond to your baby’s cries andmeet his needs, you let him knowhe is loved. You can’t spoil ababy. In fact, by responding lov-ingly to his needs, you are help-ing him learn skills now thatallow him eventually to soothehimself. You are also promoting astrong bond and healthy braindevelopment.

*The report, From Neurons to Neighborhoods: The Science of Early Childhood Development, was a 21/2-year effort by a groupof 17 leading professionals with backgrounds in neuroscience, psychology, child development, economics, education, pedi-atrics, psychiatry and public policy. They reviewed what was known about the nature of early child development and theinfluence of early experiences on children’s health and well-being. The study was sponsored by a number of federal agen-cies and private foundations.

● What experiences does yourbaby seem to like best? (Forexample, talking with him; look-ing at toys or other objects; hear-ing the cat “meow.”) ● What kind of toys grab yourbaby’s attention? How does he letyou know what he’s interested in?● What kind of play do you enjoymost with your baby?

● How does your baby communi-cate with you? ● What kinds of interactions doeshe like best? How do you know?● How does he let you knowwhen he has had enough?

Questions to ask yourself:

● What soothes your baby? Howdo you know?● What most distresses him?

Charting Your Child’s Healthy Development: 0 to 2 months

With thanks to © 2003 ZERO TO THREE. This may befreely reproduced without permission for nonprofit, educational purposes.Reproduction for other uses requiresexpress permission of ZERO TO THREE.

10539 ZT 0-02mo eng 3/2/05 1:29 PM Page 2

Healthy Minds:Nurturing Your Child’s Development from 2 to 6 Months

These handouts are brought toyou by ZERO TO THREE, thenation’s leading resource onthe first 3 years of life, and theAmerican Academy ofPediatrics, dedicated to thehealth of all children.

Key findingsfrom the report include:

What do we really know about how a young child develops?What can parents do to best support their child’s healthy devel-opment and growing brain? Some of the answers are in thisseries of Healthy Minds handouts. Each handout is based onfindings from a report* from the National Academy of Sciencesthat examined the research on child and brain development toestablish what is known about the early years. The informationwe offer is age-specific, summarizes key findings from the reportand suggests how you might be able to use these key findings tonurture your own child’s healthy development.

● Your relationship with your child is the foundation ofhis or her healthy development.● Your child’s development depends on both the traitshe or she was born with (nature), and what he or sheexperiences (nurture). ● All areas of development (social/emotional/intellec-tual/language/motor) are linked. Each depends on, andinfluences, the others.● What children experience, including how their par-ents respond to them, shapes their development asthey adapt to the world.

Five-month-old Tara loves playing peek-a-boowith her mom and dad. When they stop, shesqueals and reaches out her arms to let themknow she wants more. So they continue. Soonher parents add another twist to the game asthey start to hide behind the pillow for a fewseconds before they “reappear” to give hertime to anticipate what will happen next.

This simple game is more than just fun. Itshows how all areas of Tara’s developmentare linked and how her parents help toencourage her healthy development. Tara’sinterest in playing with her parents is a signof her social and emotional developmentbecause she has fun with her parents and cansee how much they enjoy being with her. Thismakes her feel loved and secure, and will

help her develop other positive relationshipsas she grows. Her desire to play this gamewith mom and dad leads to the developmentof new intellectual abilities as she learnsto anticipate what comes next, an importantskill for helping her feel more in control of herworld. Knowing what to expect will also helpher to more easily deal with being separatedfrom you as she learns that people exist evenwhen she can’t see them.

Tara’s early language and motor abilitiesemerge as she squeals, makes sounds andmoves her arms to let her parents know thatshe does not want them to stop.When theycontinue, her parents let her know that she isa good communicator, and each time theyreappear, she learns that she can trust them toalways come back

Relationships are the foundation of a child’shealthy development.

How it looks in everyday family life:

10539 ZT 02-06mo eng 3/2/05 1:40 PM Page 1

The following chart describes many of the things your baby is learning between 2 and 6 months and whatyou can do to support your child in all areas of her development. As you read, remember that childrendevelop at their own pace and in their own way. Understanding who your child is, what her strengths areand where she needs more support, is essential for promoting her healthy development. If you have ques-tions regarding your child’s development, ask your pediatrician.

What’s going on:

Babies are very interactive at thisage. They use their new languageand communication skills as theysmile and coo back and forth, andenjoy babbling, starting with“ohs” and “ahs” and progressingto P’s, M’s, B’s and D’s. Your babymay babble and then pause, wait-ing for you to respond. They alsolove to imitate, which helps themlearn new skills. For example,mom sticks out her tongue, babyimitates and mom does it again.This also teaches them about theback and forth of conversation.

Babies have greater control overtheir bodies. By 4 to 6 months,they may be able to roll bothways, become better at reachingand grasping and will begin to sitwith assistance. They also beginwanting to explore their food andhelp feed themselves. Touchingand tasting different foods is goodfor learning and for building self-confidence.

Babies this age love to explore.They learn from looking at, hold-ing and putting their mouths ondifferent objects. At about 3months, babies begin to reach forthings and try to hold them. Makesure all objects are safe. A toy oranything else you give hershouldn’t fit entirely in hermouth.

● Place your baby in differentpositions—on her back, stomach,and sitting with support. Eachgives her a different view and achance to move and explore indifferent ways. ● Let your baby play with your fin-gers and explore the bottle orbreast during feedings. As shegrows, let her handle finger foodsand help hold the spoon.

● Introduce one toy at a time soyour baby can focus on, andexplore, each one. Good choicesinclude a small rattle with a han-dle, a rubber ring, a soft doll anda board book with pictures. ● Lay your baby on her back andhold brightly colored toys overher chest within her reach. She’lllove reaching up and pullingthem close. You will start to seewhat most interests her.

What you can do:

● When your baby babbles, bothtalk and babble back, as if youboth understand every word.These early conversations willteach her hundreds of wordsbefore she can actually speakany of them. ● Engage in back-and-forthinteractions with gestures. Forexample, hold out an interestingobject, encourage your baby toreach for it and then signal herto give it back. Keep this goingas long as your baby seems toenjoy it.

*The report, From Neurons to Neighborhoods: The Science of Early Childhood Development, was a 21/2-year effort by a groupof 17 leading professionals with backgrounds in neuroscience, psychology, child development, economics, education, pedi-atrics, psychiatry and public policy. They reviewed what was known about the nature of early child development and theinfluence of early experiences on children’s health and well-being. The study was sponsored by a number of federal agenciesand private foundations.

● How does your baby use herbody to explore? Which positionsdoes she like the best and least?● How would you describe yourbaby’s activity level? Does shelike/need to move around a lot oris she more laid-back?

● What kind of toys or objectsdoes your baby seem most inter-ested in? How do you know?● How do you and your baby mostenjoy playing together? Why?

Questions to ask yourself:

● How does your baby let youknow what she wants and howshe’s feeling?● How do you and your baby enjoycommunicating with each other?What do you say or do that getsthe biggest reaction from her?

Charting Your Child’s Healthy Development: 2 to 6 months

© 2003 ZERO TO THREE. This may befreely reproduced without permission for nonprofit, educational purposes.Reproduction for other uses requiresexpress permission of ZERO TO THREE.

For more information go to:www.zerotothree.orgwww.aap.org

With thanks to

10539 ZT 02-06mo eng 3/2/05 1:40 PM Page 2

HE | 25STEPS TO TAKE

HEALTH EDUCATION

Goal Help your client:

n Be aware of the baby’s movements each day

n Understand how to do kick counts

n Understand when to call the clinic or hospital

Background

If a woman is pregnant for the first time, she will usually feel the baby moving (quickening) between 18 and 22 weeks. Women who have been pregnant before may notice movement earlier. This fetal movement helps show the wellbeing of the fetus.

By 22 weeks of pregnancy, the fetus should be felt moving often.

After 28 weeks of pregnancy, no fetal movement over a 24-hour period is a sign of possible trouble. She should be checked by a health care provider.

Steps to TakeFor all clients:

n Discuss the importance of fetal movement

n There are several methods for doing kick counts. Discuss the method used in your practice.

n Discuss the Count Your Baby’s Kicks handout with the client. Show her the method for doing kick counts.

u The method discussed in the handout is “Count to 10”. In the handout, the woman is advised to feel for kick counts. After eating, she should sit or lie down on her left side. She should count up to 10 movements. For normal pregnancies, this usually occurs within 1 hour and at most will take place within 2 hours.

n Practice kick counts with the client

n Tell her she can start counting kicks at her 7th month or at 28 weeks

n Review when and how to call during business hours, and during evenings and weekends

Follow Up

At each prenatal visit, ask the client whether she is doing kick counts each day. Remind her to talk to her provider if the pattern of movement changes.

Kick Counts

After 28 weeks of pregnancy, if there is no fetal movement over a 24-hour period, notify the health care provider immediately.

Lead Poisoning Handouts

Sources of Lead PoisoningSources of Lead PoisoningSources of Lead Poisoning

Dust with LeadDust with LeadDust with Lead In homes built before 1978, lead dust is created

when paint deteriorates or is sanded. Brooms,

dusters, and regular vacuums will spread lead

dust. Use a HEPA vacuum, wet mop, and wet

paper towels for cleaning.

Imported PotteryImported PotteryImported Pottery Many imported ceramic dishes or pots are decorated

with lead paint or glaze. Do not use these dishes/pots

for cooking, serving, or storing food.

Childhood Lead Poisoning Prevention Program (CLPPP)Childhood Lead Poisoning Prevention Program (CLPPP)Childhood Lead Poisoning Prevention Program (CLPPP) www.publichealth.lacounty.gov/leadwww.publichealth.lacounty.gov/leadwww.publichealth.lacounty.gov/lead

For more information on sources of lead poisoning & how to protect your childFor more information on sources of lead poisoning & how to protect your childFor more information on sources of lead poisoning & how to protect your child

call 1call 1call 1---800800800---LALALA---444---LEAD (800LEAD (800LEAD (800---524524524---5323)5323)5323)

LeadLeadLead---Based Paint (PreBased Paint (PreBased Paint (Pre---1978)1978)1978) Homes or apartments built before 1978 may

have lead-based paint. Chipping or peeling

paint is a hazard. All remodeling should follow

lead safe work practices.

Imported Jewelry**Imported Jewelry**Imported Jewelry** Children’s jewelry can be made with lead metal

or decorated with lead paint. Keep children

from placing jewelry in their mouth.

TakeTakeTake---Home LeadHome LeadHome Lead If you work in jobs such as battery manufacturing,

remodeling, plumbing, or radiator repair you might

get lead dust on your clothes and bring it into your

home. Change out of your work clothes before

returning home.

Soil with LeadSoil with LeadSoil with Lead Lead paint chips/dust or gasoline could have

fallen and become part of the bare soil around

your home. Do not let children play with or eat

bare soil.

Imported Toys**Imported Toys**Imported Toys** Some toys made in other countries are made

with lead or lead-based paint. Keep children

from chewing on toys with painted surfaces.

Check toys for peeling paint and wash often.

Imported Candy*Imported Candy*Imported Candy* Some candies made in other countries may have

lead. Eating these candies can increase your

child’s risk for lead poisoning. Limit the

amount of candy your child eats. Call CLPPP

for a list of candies tested to contain lead.

* Candies Shown were recalled as of 03/28/11

** For more information on current recalls, please visit Consumer Product Safety Commission (CPSC) website at www.cpsc.gov or call 1-800-638-2772

GretaGreta AzarconAzarcon

4/11

PayPay--looloo--ahah

Traditional RemediesTraditional RemediesTraditional Remedies Some imported folk/traditional remedies may

have high levels of lead. Stop using these

remedies. Call CLPPP for a list of remedies

with lead.

Lead is a poison that can cause permanent harm.

It is especially a concern for children and

pregnant women.

How do you know if your child is lead poisoned?

Only a Blood Lead Test Can Tell You.

For information on Free & Low-Cost Health

Services and blood lead screening call:

Medi-Cal (888) 747-1222

LA County Info Line 211

C A L I F O R N I A D E P A R T M E N T O F H E A L T H S E R V I C E S

Don̓t take leadhome from your job!

Can Lead at work harm my child?Yes. Your child can get lead poisoning if you or someone who lives in your homeworks with lead.

Some kinds of work make lead dust or fumes. You cannot see lead dust, but itcan get on your hands, face, and clothes. You take lead dust from your job to yourfamily when you wear your work clothes and shoes home. Lead dust can get inyour car. It can get on furniture, floors, and carpets. Your child can swallow thislead dust and be poisoned.

What can lead poisoning do to my child?

Children who swallow lead dust may haveproblems learning and paying attention. Leadcan harm the brain, nerves and kidneys. Leadis even more dangerous for children under theage of six.

Most children with lead poisoning do notlook or act sick.

Ask your doctor to test your child’s blood forlead. This is the only way to know if your childis being lead poisoned.

How do I know if I work with lead?You may work with lead if you:

make or fix batteriesmelt, cast, or grind lead, brass, or bronzemake or fix radiatorsmake or paint ceramicsremove old painttear down or remodel houses, buildings, tanks, or bridgessolderwork with scrap metalwork at a shooting range

There are many other jobs where lead can be dangerous.

Ask your employer if you work with lead. The law says your employer musttell you about anything at work which is dangerous. This includes lead.

Get the Material Safety Data Sheet (MSDS) for each product you use onthe job. An MSDS is a form which lists the ingredients in a product. Youremployer must give you the MSDS if you ask for it. Look at "Section II" of theMSDS to see if the product contains lead.

Ask to see the results of any tests that are done for lead in your work area.You are exposed to lead when you scrape, blast, sand, burn, weld, or cut onsurfaces where there is lead paint. Your employer should test these surfacesbefore you work on them to see if they contain lead. You have a right to see theresults of the tests.

Ask your doctor for a blood lead test. Adults who are lead poisoned may feeltired, irritable, or get aches and pains. They may also have serious healthproblems without knowing it.

How can I protect my family from lead poisoning?

Change into clean clothes andshoes at work before you getinto your car or go home. Putdirty work clothes and shoes ina plastic bag.

Wash your face and hands withsoap and warm water beforeleaving work.

Take a shower and wash yourhair as soon as you get home.(It is better to shower at work ifyou can.)

Wash work clothes separately fromall other clothes. Empty your workclothes from the plastic bag directlyinto the washing machine andwash them. Run the empty washingmachine again to rinse out thelead. (It is better if your employerwashes the work clothes.)

The law says your employer must provide a place to wash your hands. In jobswhere workers are exposed to high levels of lead, employers must also providework clothes and a shower.

3/06

OccupationalLead Poisoning

PreventionProgram C H I L D H O O D

LEAD POISONINGP R E V E N T I O NB R A N C H

California Relay Service (800) 735-2929 or 711To obtain a copy of this document in an alternate format, please call (866) 627-1587. Please allow at least10 working days to coordinate alternate format services.

Does my employer have to protect my health?Yes. Your employer must follow special laws toprotect you from lead poisoning. To find outmore about these laws, talk to your employeror your union representative, or call theOccupational Lead Poisoning PreventionProgram (see below).

Where can I get help?Information on lead at work

Occupational Lead Poisoning Prevention ProgramCalifornia Department of Health Services

This program provides information about lead in the workplace, worker rights,and how to protect yourself from lead on the job. Call (866) 627-1587 toll-free inCalifornia. On the Web: www.dhs.ca.gov/ohb

Complaints about lead at workCal/OSHA(California Division of Occupational Safety and Health)

Talk to your employer if you think you have a lead problem at your job. If youremployer does not fix the problem, you can call Cal/OSHA and ask for aninspection. Cal/OSHA will not tell your employer who made the call.

Call the Cal/OSHA office in your area, or call Cal/OSHA headquarters at(510) 286-7000.

Free blood lead testingYour child may be able to get free health care, including tests for lead. To find out,call (800) 524-5323.

Lead dust in your homeLocal lead poisoning prevention program

If you think you have a problem with lead dust in your home, contact your localhealth department.

Los Angeles CountyDepartment of Public HealthChildhood Lead Poisoning Prevention Program(800) LA-4-LEAD

¡No lleve el plomoa su casa!

¿Puede dañar a mi hijo el plomo que se encuentra enmi trabajo?Sí. Su hijo puede ser envenenado con plomo si usted o alguien que vive en su casatrabaja con plomo.

Los niños que se han envenenado con plomopueden tener problemas de aprendizaje odificultad en concentrarse. El plomo daña elcerebro, los nervios y los riñones. El plomo esaún más peligroso para los niños menores de 6años de edad.

La mayoría de los niños envenenados conplomo no se portan o aparentan estarenfermos.

Pídale a su médico que le haga a su hijo unanálisis de sangre para el plomo. Esta es la únicamanera de saber si su hijo está envenenado.

Algunos métodos de trabajo producen humo o polvo de plomo. No se ve este polvo, perose pega en las manos, la cara y la ropa de trabajo. Usted lleva el polvo de plomo a sufamilia cuando trae puestos los zapatos y la ropa de trabajo a su casa. Así, el polvo deplomo cae en los muebles, el piso, y la alfombra. Su hijo puede comerlo y ser envenenado.

¿Cómo afecta el envenenamiento con plomo a mi hijo?

D E P A R T A M E N T O D E S E R V I C I O S D E S A L U D D E C A L I F O R N I A

¿Cómo sé si trabajo con plomo?Es posible que trabaje con plomo si usted:

fabrica o repara baterías

funde, fresa o esmerila plomo, latón o bronce

fabrica o repara radiadores de autos

fabrica o pinta la cerámica

remueve pintura vieja

demuele o remodela casas, edificios, tanques o puentes

trabaja con soldadura

trabaja con chatarra (desechos de metal)

trabaja en una galería de tiro

Hay muchos otros trabajos donde se encuentra el peligro del plomo. Haga lo siguientesi no sabe si su trabajo lo expone al plomo:

Pregunte a su patrón si usted trabaja con plomo. Bajo la ley, su patrón tiene queinformarle de los peligros en su trabajo. Esto incluye el plomo.

Obtenga la Hoja de Datos sobre la Salud y Seguridad (en inglés “Material SafetyData Sheet” o “MSDS”) para cada producto que se usa en su trabajo. La Hoja deDatos es un formulario que incluye una lista de todos los ingredientes de un producto.Bajo la ley, su patrón está obligado a darle la Hoja de Datos si se la pide. Lea la“Sección II” de la Hoja de Datos para saber si el producto contiene plomo.

Pida una copia de los resultados de cualquier prueba para detectar el plomoque se haga en su lugar de trabajo. Usted está expuesto al plomo cuando lija,raspa, quema, suelda, o corta en superficies cubiertas con pintura a base de plomo.Antes de trabajar en estas superficies, su patrón debe tomar unas muestras paraaveriguar si contienen plomo. Usted tiene el derecho de ver los resultados de lasmuestras.

Pídale a su doctor que le haga a usted un análisis de sangre para el plomo. Losadultos envenenados con plomo pueden sentirse agotados, de malhumor, o con doloresmusculares. También es posible tener problemas graves de salud sin darse cuenta.

¿Qué debo hacer para proteger a mi familia contra elenvenenamiento con plomo?

La ley requiere que su patrón le provea un lugar donde se pueda lavar las manos. Cuandolos trabajadores están expuestos a niveles altos de plomo, el patrón también tiene queproveerles ropa de trabajo y una ducha (regadera).

Cámbiese la ropa y los zapatos detrabajo antes de subirse a su carroor regresar a casa. Póngase ropa yzapatos limpios. Guarde la ropa ylos zapatos sucios de trabajo enuna bolsa de plástico.

Lávese las manos y la cara conagua tibia y jabón antes de salirdel trabajo.

Tome un baño de ducha y lávese elpelo en cuanto llegue a casa. (Esmejor ducharse en el trabajo si esposible.)

Lave la ropa de trabajo separada detoda la otra ropa. Eche la ropa deltrabajo de la bolsa de plástico a lalavadora sin tocarla. (Es mejor si supatrón lave la ropa de trabajo.)

3/06

¿Tiene que proteger mi salud el patrón?Sí. Su patrón tiene que cumplir con leyes específicaspara protegerle contra el envenenamiento conplomo. Para más información sobre estas leyes,hable con su patrón o su sindicato (unión); o llameal Programa de Prevención del Envenenamiento conPlomo en el Trabajo (vea abajo).

¿Dónde puedo conseguir ayuda?Información sobre el plomo en el lugar de trabajo

Programa de Prevención del Envenenamiento con Plomo en el TrabajoDepartamento de Servicios de Salud de California

Este programa ofrece información sobre el plomo en el trabajo, los derechos de lostrabajadores, y cómo protegerse contra el plomo en el trabajo. Llame al (866) 627-1587(llamada gratis en California). En el Internet: www.dhs.ca.gov/ohb.

Problemas con el plomo en el trabajoCal/OSHA (División de Salud y Seguridad Ocupacional de California)

Hable con su patrón si cree que hay un problema con plomo en su trabajo. Si supatrón no lo soluciona, usted puede pedir una inspección por Cal/OSHA. Cal/OSHAno le informará a su patrón quién pidió la inspección.

Llame a la oficina de Cal/OSHA en su área, o llame a la oficina central de Cal/OSHAal (510) 286-7000.

Análisis de sangre para el plomo gratisMuchos niños pueden recibir análisis de sangre y otros servicios médicos gratis.Llame a (888) 747-1222 para preguntar si su hijo puede recibir estos servicios.

Polvo de plomo en su casaPrograma local de prevención del plomo

Si cree que tiene polvo de plomo en su casa, llame al departamento de salud ensu área.

Teletexto en español (800) 855-3000 o 711Para pedir una copia de este documento en un formato diferente, llame al (866) 627-1587. El procesopara coordinar estos servicios toma por lo menos dos semanas.

OccupationalLead Poisoning

PreventionProgram C H I L D H O O D

LEAD POISONING

P R E V E N T I O N

B R A N C H

If you have answered yes to any of these questions, have your home tested by a certified professional by contacting 1-800-424-LEAD (5323) or visiting www.epa.gov/lead. If you rent, find out if your landlord has checked your home for lead. Have your children tested for lead poisoning by asking your doctor or your health specialist at a Head Start center to do a simple blood test. Medicaid should pay for the cost of the lead poisoning test.

Home ChecklistLead Poisoning

1. Was your home built before 1978? A majority of homes built before 1978 (especially homes built throughout the 1940s to 1960s), contain lead-based paint, which can have a dangerous effect on the health of young children (under the age of six) and pregnant women.

2. Do you see walls, furniture, or window sills in your home with chipping or peeling paint? Lead-based paint is unsafe if it peels, chips, or cracks. Harmful lead dust is created when windows, doors, edges of stairs, rails, or other lead-based painted surfaces wear away over time. You or your landlord can get your home checked for lead by hiring a trained, certified professional. Many young children put their hands or other objects covered with lead dust in their mouths, which can cause serious damage to their health. Wash children’s hands, bottles, pacifiers, and toys often.

3. Do your children play in lead-contaminated soil near your home? Soil around homes with lead-based paint may have lead chips, dust, or flakes in it. Children can acciden-tally swallow this soil while playing outdoors, or the soil may be tracked indoors from shoes onto carpet and floors where children can eventually come into contact with it. Teach children to wipe and remove their shoes, as well as to wash their hands, after playing outdoors.

4. Do you store food in imported pottery that contains lead? Imported pottery and dishware usually contain lead. To protect your family from lead poisoning, use imported pottery only for decoration, and keep food and drinks in other safe, storage containers.

5. Do you work with lead in your job? You may be exposed to lead on the job if you work as a painter, ironworker, construction worker, cable splicer, automobile radiator repair mechanic, firearms instructor, metal shop worker, stained glass artist, or battery maker. If you work in a lead-related industry, change your work clothes before entering the home, wash your work clothes separately from the clothes you wear around your family, and remove your shoes before entering your home, as lead can be tracked indoors onto carpets, floors, and furniture.

If yes,

The following questions will help you determine if your family is at risk for lead poisoning.

ü

ü

To find simple ways to prevent lead poisoning in your home look for the “Chance of a Lifetime” brochure at your Head Start center.

Preventing Lead Poisoning

is in Your Hands

Funded by California Department of Public Health (Rev. 03/11)

Make Your Home

Lead-Safe And

Healthy For Children

LEAD IS A POISON YOU CAN PREVENT

LEAD POISONING

RESOURCES

HOW DOES

LEAD POISONING OCCUR?

Lead is a poison that can damage the

brain, kidneys, liver, and other organs.

Even small amounts of lead can cause

learning problems and changes in

behavior.

Children under 6 years of age and

pregnant women are at a higher risk.

Children and adults with retained

bullets are also at risk.

LOOK INSIDE

Lead poisoning is caused by eating lead

or breathing lead dust.

Since young children often put things

in their mouths, they can also pick up

lead-dust that can be dangerous.

Most of the time, lead poisoning has

no symptoms. The only way to know

is with a blood lead test.

Inside this brochure is information on

how lead can get into our bodies.

Free & Low-Cost Health Services:

Children in low-income families may be

eligible for free or low-cost medical

check-ups, including a blood lead test. Call

the numbers below for more information.

Medi-Cal (888) 747-1222

Healthy Families (800) 880-5305

Healthy Kids (First 5 LA) (888) 347-7855

CHDP (800) 993-2437

Access for Infants & (800) 433-2611

Mothers (AIM)

Public/Private Partnership (800) 427-8700

Program (PPP)

LA County Info Line 211

* If you do not have a HEPA vacuum, use an allergen filter bag.

Get Tested for Lead:

If your child is between

6 months to 6 years old,

ask your doctor

whether to test for lead.

Children on public

insurance programs

should be tested at age

1 and 2.

Eat Healthy Foods:

Good nutrition helps protect children

from lead.

Iron-rich foods: beans, raisins, cereals

fortified with iron, lean meat, or fish

Calcium-rich foods: milk, yogurt,

cheese, dark-green vegetables, canned

salmon, or tofu

Vitamin C: fruits

Keep a Healthy House:

Keep surfaces as clear as possible for

easy cleaning.

Use a wet mop for cleaning instead of

dry sweeping to minimize the spread of

dust.

Use a vacuum

that has a

HEPA filter*.

Wipe down

window sills

with mild

detergent

weekly.

Call (800) LA-4-LEAD:

To get more information on lead, lead

screenings, or lead test kits

To get more information on other

sources of lead, such as, imported

spices, make-up, or jewelry

To locate a licensed lead inspector

To learn about lead safe work practices

1-800-LA-4-LEAD

(1-800-524-5323)

http://publichealth.lacounty.gov/lead

Make Your HomeMake Your Home

Some imported home remedies, such as

Greta, Azarcon, or Ayurvedics, may contain

lead.

Avoid using traditional remedies or

spices that may contain lead.

Call (800) LA-4-LEAD to receive a list

of traditional remedies containing lead.

1. Traditional Remedies

3. Toys

7. Chipping &

Peeling Paint

2. Ceramics 5. Activities that use lead

6. Work Clothes

Adapted with permission of Consumer Action’s Lead Poisoning Prevention Project

1. TRADITIONAL REMEDIES

4. Soil

2. CERAMICS

Many imported ceramic dishes or pottery are

decorated with lead paint or glaze. Lead

may get into the food or drink if you use

these ceramic dishes/pots for cooking,

serving, or storing.

Test imported dishware or pottery for

lead before use.

Call (800) LA-4-LEAD for more

information on testing dishes & pottery.

4. SOIL

3. TOYS & JEWELRY

5. ACTIVITIES

THAT USE LEAD

7. CHIPPING & PEELING

Paint (Pre-1978 Homes)

6. WORK CLOTHES

Toys made in other countries may have lead

paint.

Discourage children from chewing on

toys with painted surfaces.

Wash children’s toys often.

Hobbies such as stain glass making, jewelry

making, or fishing may use products

containing lead.

Keep these items away from small

children.

LeadLead--Safe and Healthy For ChildrenSafe and Healthy For Children

You may also consider testing

your home for lead. Call (800)

LA-4-LEAD to receive a sample

lead test kit or to obtain a referral

for Certified Lead Inspectors.

Homes or apartments built before 1978 may

have lead-based paint. Chipping or peeling

paint may create dangerous dust that can

affect your health.

Protect Children Before Repairs:

Move beds, cribs, and play-pens

away from peeling paint.

Cover damaged paint with cloth

tape or plastic sheets until repairs

can be made.

Repair Flaking Paint:

Wipe off small areas of loose

paint with a damp sponge and

paint over.

Never dry scrape, dry sand, or

burn off old paint

Fix moisture problem to prevent

peeling paint.

Consider hiring professionals to

deal with large areas of flaking

paint.

Repair old windows or doors.

Never do renovation or painting

while children are in the house.

Use Lead Safe Work Practices or

Consider Checking Your Home for

Lead:

When doing renovations, assume

your home contains lead paint and

follow lead safe work practices.

Call (800) LA-4-LEAD for more

information on lead safe work

practices.

Lead from paint chips/dust, gasoline

(smog) could have fallen into the dirt

around your home.

Do not let children play

with or eat bare soil.

Cover bare soil with

grass, wood chips, or

cement.

Use a doormat and

clean often.

Call (800) LA-4-LEAD on how to

protect your family from lead.

Lead can be taken home if you work in jobs

such as construction, painting, plumbing, or

radiator repair.

If you can’t shower at work, wash

your hands, arms, face and neck

thoroughly before leaving.

La prevención del envenenamiento por plomo

está en sus manos

Financiado por el Departamento de Salud Pública de California (Rev. 07/10)

EspañolEspañolEspañol

Hága de su hogar un

lugar seguro contra el

Plomo y Saludable

para los Niños

EL PLOMO ES UN VENENEL PLOMO ES UN VENENOO USTED PUEDE PREVENIR USTED PUEDE PREVENIR

EL ENVENENAMIENTO EL ENVENENAMIENTO

POR PLOMO POR PLOMO

RECURSOSRECURSOS

¿C¿CÓÓMO OCURRE ELMO OCURRE EL

ENVENENAMIENTO POR ENVENENAMIENTO POR

PLOMO?PLOMO?

El plomo es un veneno que puede dañar

el cerebro, riñones, hígado y otros

órganos.

Incluso pequeñas cantidades de plomo

pueden causar problemas de aprendizaje

y cambios en el comportamiento.

Los niños menores de 6 años de edad y

mujeres embarazadas están en más alto

riesgo.

Niños y adultos con balas retenidas

también están en riesgo.

REVISE ADENTROREVISE ADENTROREVISE ADENTRO

El envenenamiento por plomo ocurre al

ingerir plomo o inhalar polvo de plomo.

Los niños pequeños suelen llevarse obje-

tos a la boca que pudieran tener polvo

de plomo, que pudiera ser peligroso.

La mayoría de las veces la

intoxicación por plomo no tiene

síntomas. La única manera de saber es

con una prueba de plomo en la sangre.

Dentro de este folleto está la información

sobre cómo el plomo puede entrar en

nuestros cuerpos.

Servicios de Salud Gratis o a Bajo Costo:

Los niños de familias de bajos ingresos pueden

ser elegibles de forma gratuita o a bajo costo

para exámenes médicos, incluyendo una prueba

de plomo en la sangre. Llame a los siguientes

números para más información.

Medi-Cal (888) 747-1222

Healthy Families (800) 880-5305

Healthy Kids (First 5 LA) (888) 347-7855

CHDP (800) 993-2437

Access for Infants & (800) 433-2611

Mothers (AIM)

Public/Private Partnership (800) 427-8700

Program (PPP)

Condado de L.A., información 211

* Si no tiene aspiradora con filtro HEPA, use una bolsa

contra los alérgenos.

Hágale la prueba del plomo:

Si su hijo tiene entre 6

meses a 6 años de edad,

pregúntele a su médico

si debe hacerle una

prueba para el plomo.

Los niños en los planes

gubernamentales de

seguro médico deben

ser examinados a la

edad de 1 y 2 años.

Deles alimentos saludables:

Una buena nutrición ayuda a proteger a

los niños del plomo.

Alimentos ricos en hierro: frijoles, pa-

sas, cereales fortificados con hierro,

carne baja en grasa o pescado

Alimentos ricos en calcio: leche,

yogur, queso, verduras de color verde

oscuro, salmón enlatado o tofu

Vitamina C: frutas

Mantenga una casa saludable:

Mantenga las superficies libre de

obstáculos para facilitar la limpieza.

Use un trapeador húmedo para la

limpieza en lugar de barrer en seco,

para no levantar el polvo.

Use una aspiradora

que tenga un filtro

HEPA*.

Limpie las repisas

de ventana cada

semana con un

detergente suave.

Llame al (800) 524-5323:

Para más información sobre el plomo,

exámenes de plomo o equipos de análisis

para el plomo

Para más información sobre otras fuentes de

plomo, tales como, las especias importadas,

maquillaje o joyería

Para encontrar un inspector de plomo con

licencia

Para obtener información acerca de

prácticas seguras de trabajar con plomo

1-800-LA-4-LEAD

(1-800-524-5323)

http://publichealth.lacounty.gov/lead

Haga de su hogar un Haga de su hogar un

Algunos remedios caseros importados como

Greta, Azarcón o medicina Ayurveda pueden

tener plomo.

Evite el uso de remedios tradicionales o

especias que pueden tener plomo.

Llame al (800) 524-5323 para recibir una

lista de remedios tradicionales que tienen

plomo.

1. Remedios Tradicionales

3. Juguetes

7. Pintura

Descascarada

2. Cerámica 5. Actividades que usan el plomo

6. Ropa de Trabajo

Adaptado con el permiso del Proyecto Consumidor en Acción por la

Prevención de Envenenamiento por Plomo

1. 1. REMEDIOS TRADICIONALREMEDIOS TRADICIONALESES

4. Tierra

2. CERÁMICA2. CERÁMICA

Mucha de la cerámica y alfarería importada

está decorada con pintura o barniz de plomo.

El plomo puede pasar a la comida o bebida

si utiliza estos platos/ollas de cerámica para

cocinar, servir o almacenar alimentos.

Examine la cerámica y alfarería impor-

tada para el plomo antes de usarla.

Llame al (800) 524-5323 para obtener

más información de pruebas en cerámica.

4. TIERRA4. TIERRA

3. JUGUETES Y JOYER3. JUGUETES Y JOYERÍÍAA

5. 5. ACTIVIDADES DONDEACTIVIDADES DONDE

SE USA EL PLOMOSE USA EL PLOMO

7. PINTURA (Casas Pre7. PINTURA (Casas Pre--1978)1978)

DESCASCARADA DESCASCARADA 6. ROPA DE TRABAJO6. ROPA DE TRABAJO

Juguetes fabricados en otros paises pueden

tener pintura con plomo.

Desalentar a los niños de morder los

juguetes con superficies pintadas.

Lave los juguetes de los niños a menudo.

Las aficiones tales como hacer vitrales,

fabricación de joyas o la pesca, podrían

utilizar productos que tengan plomo.

Mantenga estos productos lejos de los

niños pequeños.

Saludable para los NiñosSaludable para los Niños

Las casas o apartamentos construidos antes de

1978 pueden tener pintura con base de plomo.

Pintura descascarada puede producir polvo

peligroso que puede afectar su salud.

Proteja a los niños antes de hacer

reparaciones:

Aleje las camas, cunas y corrales

lejos de la pintura descascarada.

Cubra la pintura dañada con cinta de

tela o láminas de plástico hasta que

las reparaciones se hagan.

Reparación de pintura descarapelada:

Limpie las áreas pequeñas de pintura

suelta con una esponja húmeda y

pinte encima.

Nunca raspe o lije en seco. No queme

la pintura vieja.

Arregle el problema de humedad para

prevenir que la pintura se desprenda.

Considere la posibilidad de contratar

a profesionales para reparar grandes

áreas de pintura pelada.

Repare ventanas y puertas viejas.

Nunca haga renovaciones o pinte

mientras que los niños estén en casa.

Siempre trabaje usando prácticas seguras

contra el plomo, o considere hacerle un

examen para plomo a su casa:

Al hacer renovaciones, asuma que su

casa tiene pintura con plomo y debe

seguir las prácticas seguras en el

trabajo. Llame al (800) 524-5323

para obtener más información sobre

prácticas seguras de trabajo

contra el plomo.

Considere hacerle una prueba de

plomo a su hogar. Llame al (800)

524-5323 para recibir un equipo de

prueba para el plomo o para obtener

referencias para inspectores

certificados en plomo.

El plomo de la pintura descarapelada y

el que fue usado en la gasolina podría

haber caido en la tierra y estar

alrededor de su casa.

No deje que los niños

jueguen con/o coman

tierra.

Cubra la tierra con

césped, virutas de

madera o cemento.

Utilice los felpudos y

límpielos con frecuencia.

Llame al (800) 524-5323

sobre cómo proteger a su

familia contra el plomo.

El plomo puede llevarse a casa si usted

trabaja en trabajos como la construcción,

pintura, fontanería o reparación de

radiadores.

lugar seguro contra el Plomo y lugar seguro contra el Plomo y

Si no puede bañarse en el trabajo,

lávese las manos, brazos, cara y

cuello cuidadosamente antes de salir.

Do You Cook with Traditional Pottery?It May Contain Lead!

Lead is dangerous for everyone, especially for children under 6 years of age.

• Lead is in some traditional pottery.

• Lead can cause serious health problems.

• Lead can get into food and drinks that are made, served or stored in pottery.

• If you don’t know if your pottery has lead, do not use it for cooking, serving or storing food or drinks. You can still use it for decoration.

• A child with lead poisoning may not look or act sick. Ask your doctor to test your child for lead.

To find out more about how to keep your family safe from lead, contact:

El plomo es peligroso para todos, sobre todo para niños menores de 6 años.

• El plomo se encuentra en algunas vajillas de barro.

• El plomo puede causar serios problemas de salud.

• El plomo puede contaminar comidas o bebidas que se preparen, se sirvan o se guarden en vajillas de barro.

• Si usted no sabe si sus vajillas de barro contienen plomo, no las use para cocinar, servir, o guardar alimentos y bebidas. Las puede seguir usando como decoración.

• Un niño envenenado con plomo puede no parecer enfermo. Pídale a su médico que le haga la prueba del plomo.

Para más información sobre cómo proteger a su familia del plomo, favor de llamar a:

¿Está Cocinando Con Vajillas de Barro?¡Estas Pueden Contener Plomo!

Warning!These snacks and candies have been found to contain lead1

2 THE INFORMATION CONTAINED IN THIS DOCUMENT IS SUBJECT TO FREQUENT CHANGE WITHOUT PRIOR NOTICE. This information is e�ective and accurate only as of the “Last Updated” date at the top of the page, and is only valid until next updated. Some manufacturers may have made changes to their production process and/or ingredients so the results reported above may not accurately re�ect the lead levels, if any, in these products currently on the market. Data presented in this document

is for information purposes only, does not include all candies, and represents lead levels only in the candy samples tested by the CA FDB since January 2011.

Last Updated: January 07, 20132

For complaints or questions about recalled candies, please contact the California Department of Public Health: Food and Drug Branch (FDB): 1-800-495-3232 (Complaint Hotline) or 1-916-650-6500 (Questions/Complaints on Lead in Candy)For the most up to date information visit the FDB Website: http://www.cdph.ca.gov/data/Documents/fdbLiCLiC07.pdf

For questions or more information, please contact the Los Angeles County Department of Public Health:

Childhood Lead Poisoning Prevention Program: 1-800-LA-4-LEAD (1-800-524-5323)

1 The California Department of Public Health, Food and Drug Branch has issued a Health Alert for the candies shown on this �yer. These candies have been found to have lead levels in excess of the allowable level (0.10ppm).

Flash Pop Candy by Kidsmania3

“Toxic Waste” brand “Nuclear Sludge Bar” (various �avors)

from PakistanRecalled: 1/14/11

Santra Goli Recalled: 1/28/11

Khati Mithi GoliRecalled: 1/28/11

Sugar Rewari Recalled: 6/30/11

BAVAN Brand from IndiaSantra Candy

Recalled: 3/24/11

Roopal Swad Candyfrom India

Recalled: 11/18/11

Jyoti Indian Sweets Bonbons Indiens

Sugar RewdiRecalled: 11/17/11

Sugar RewariRecalled: 11/17/11

Punjab Bazaar from IndiaRewari Gur JaggeryRecalled: 11/17/11

Mix GoliRecalled: 12/1/11

Hans Brand from India

Sweet RewdiRecalled: 11/17/11

Bee Brand Sunny Day Gummies

Recalled: 12/1/11

3 E�ective 12/28/2011 - This candy bearing lot code of ‘110201’ or greater (for example 110330, 120409, etc.) is allowed for sale in California.

OKAY TOEAT

DO NOTEAT

Laxmi Brand Rewadi (Jaggery) from India

Recalled: 2/16/12

Rewari Gur-Flat(Jaggery Candy)

Recalled: 2/16/12

HB Brand from IndiaRewari Gur-Coin(Jaggery Candy)

Recalled: 2/23/12

Rewari Sugar-Coin Candy

Recalled: 2/23/12

Rewari Sugar-Flat Candy

Recalled: 2/23/12

Rewari Sugar-Round Candy

Recalled: 2/23/12

Chef’s Pride Rewadi Candyfrom Pakistan

Recalled: 3/5/12

Revdi (Gud) (Sesame Candy)Recalled: 3/5/12

Revdi (Gud) (Sesame Candy)Recalled: 3/5/12

Shah’s Deer Brand from IndiaVagabundo Paletas

from MexicoRecalled: 3/30/12

Gold Plum Candyfrom Taiwan

Recalled: 7/20/12

Aussie-Style Lucky CountrySoft Licorice

‘Traditional Black’ 98% Fat Free4

World’s Sour Dudes Sour Strawberry Strawz

Recalled: 8/27/12

Sanh Yuan Preserved Plum

from TaiwanRecalled:10/16/12

Red Lantern Plum Candyfrom China

Recalled:10/16/12

Chan Pui Mui Preserved Plum

from Hong KongRecalled:10/16/12

Dried Plumfrom Hong KongRecalled:11/5/12

Sweet & Soure Prunefrom Taiwan

Recalled:11/5/12

Ching Ling Dried Prunefrom Taiwan

Recalled:11/5/12

Preserved Plumfrom China

Recalled:11/5/12

Dried Red Prunefrom Taiwan

Recalled:11/5/12

2.5oz Black Licorice Bar

Recalled: 9/7/12

Red Vines 5oz Black

Licorice TrayRecalled: 9/7/12

4lb Black Licorice Jar

Recalled: 9/7/12

8oz Jumbo Black Licorice Hanging Bag

Recalled: 9/7/12

7oz Black Licorice Laydown Bag

Recalled: 9/7/12

16oz Black Licorice Laydown Bag

Recalled: 9/7/12

24oz Family Mix Laydown Bag

Recalled: 9/7/12

32oz Family Mix Laydown Bag

Recalled: 9/7/12

8oz Mixed Bites Hanging Bag

Recalled: 9/7/12

16oz Mixed Bites Bag

Recalled: 9/7/12

4.5oz Snaps Theater Box

Recalled: 9/7/12

5.5oz Snaps Hanging Bag

Recalled: 9/7/12

12oz Snaps Tin

Recalled: 9/7/12

1lb Black Licorice Twists

Recalled: 08/22/12

OKAY TOEAT

DO NOTEAT

4 E�ective 10/17/2011 - This candy in a new ‘Gray’ package is allowed for sale in California.

Red Vines

¡Aviso!En estos bocadillos y dulces se ha encontrado plomo1

2 LA INFORMACIÓN CONTENIDA EN ESTE DOCUMENTO ESTÁ SUJETA A CAMBIOS FRECUENTES SIN PREVIO AVISO. Esta información es correcta y efectiva hasta la “Fecha de Actualización” indicada al comienzo de la página, y sólo es válida hasta la siguiente actualización. Algunos fabricantes de dulces pueden haber cambiado sus métodos de producción y/o los ingredientes usados. Por lo tanto, los resultados indicados arriba puede que no re�ejen con precisión los niveles de plomo, si es que lo tienen, en los productos de ese fabricante que estén actualmente a la venta en el mercado desde 2009. Los datos presentados en este documento son sólo con el propósito de informar al público. No se incluyen todos los dulces en el mercado y sólo representan los niveles de plomo de las muestras examinadas por CA FDB desde enero de 2011.

Ultima Fecha de Actualización: 7 de enero 20132

Para quejas o preguntas sobre los dulces retirados, favor de contactarse con el Departamento de Salud Pública de California: Food and Drug Branch (FDB)/Sucursal de Drogas y Alimentos: 1-800-495-3232 (Teléfono para quejas) or 1-916-650-6500 (Preguntas / Quejas sobre Plomo en los Dulces)Para la información más actualizada visite la página de Internet del FDB: http://www.cdph.ca.gov/data/Documents/fdbLiCLiC07.pdf

Programa de Prevención del Envenenamiento por Plomo en la Niñez: 1-800-LA-4-LEAD (1-800-524-5323)

1 El Departamento de Salud Pública de California, Sucursal de Drogas y Alimentos han emitido una Alerta de Salud sobre los dulces mostrados en este folleto. En estos dulces se ha encontrado plomo arriba de el nivel aceptable (0.10 ppm)

Para preguntas o más información favor de ponerse en contacto con el Departamento de Salud Pública del Condado de Los Angeles:

3 Efectivo 12/28/2011 - Este dulce que tiene el código del lote de ‘110201’ or mayor (por ejemplo 110330, 120409, etc.) se permite la venta en California.

“Toxic Waste” brand “Nuclear Sludge Bar” (Sabores diferentes)

de PakistanRetirado: 1/14/11

Santra Goli Retirado: 1/28/11

Khati Mithi GoliRetirado: 1/28/11

Sugar Rewari Retirado: 6/30/11

BAVAN una marca de IndiaSantra Candy

Retirado: 3/24/11

Roopal Swad Candyde India

Retirado: 11/18/11

Jyoti Indian Sweets Bonbons Indiens

Sugar RewdiRetirado: 11/17/11

Sugar RewariRetirado: 11/17/11

Punjab Bazaar de IndiaRewari Gur JaggeryRetirado: 11/17/11

Mix GoliRetirado: 12/1/11

Hans una marca de India

Sweet RewdiRetirado: 11/17/11

Bee Brand Sunny Day Gummies

Retirado: 12/1/11

Laxmi Brand Rewadi (Jaggery) de IndiaRetirado: 2/16/12

Rewari Gur-Flat(Jaggery Candy)

Retirado: 2/16/12

HB una marca de IndiaRewari Gur-Coin(Jaggery Candy)

Retirado: 2/23/12

Rewari Sugar-Coin Candy

Retirado: 2/23/12

Rewari Sugar-Flat Candy

Retirado: 2/23/12

Rewari Sugar-Round Candy

Retirado: 2/23/12

Chef’s Pride Rewadi Candyde Pakistan

Retirado: 3/5/12

Revdi (Gud) (Sesame Candy)Retirado: 3/5/12

Revdi (Sesame Candy)Retirado: 3/5/12

Shah’s Deer una marca de India

Flash Pop Candy by Kidsmania3

Vagabundo Paletasde Mexico

Retirado: 3/30/12

PUEDECOMERLO

NO LOCOMA

Gold Plum Candyde Taiwan

Retirado: 7/20/12

Aussie-Style Lucky CountrySoft Licorice

‘Traditional Black’ 98% Fat Free4

World’s Sour Dudes Sour Strawberry Strawz

Retirado: 8/27/12

Sanh Yuan Preserved Plum

de TaiwanRetirado:10/16/12

Red Lantern Plum Candyde China

Retirado:10/16/12

Chan Pui Mui Preserved Plumde Hong Kong

Retirado:10/16/12

Dried Plumde Hong Kong

Retirado:11/5/12

Sweet & Soure Prunede Taiwan

Retirado:11/5/12

Ching Ling Dried Prunede Taiwan

Retirado:11/5/12

Preserved Plumde China

Retirado:11/5/12

Dried Red Prunede Taiwan

Retirado:11/5/12

2.5oz Black Licorice Barra

Retirado: 9/7/12

Red Vines 5oz Black

Licorice en BandejaRetirado: 9/7/12

4lb Black Licorice en JarraRetirado: 9/7/12

8oz Jumbo Black Licorice en

Bolsa ColganteRetirado: 9/7/12

7oz Black Licorice en Bolsa Asentada

en RepisaRetirado: 9/7/12

16oz Black Licorice en Bolsa Asentada

en RepisaRetirado: 9/7/12

24oz Family Mix en Bolsa Asentada

en RepisaRetirado: 9/7/12

32oz Family Mix en Bolsa Asentada

en RepisaRetirado: 9/7/12

8oz Mixed Bites en Bolsa ColganteRetirado: 9/7/12

16oz Mixed Bites en Bolsa

Retirado: 9/7/12

4.5oz Snaps en Caja para CineRetirado: 9/7/12

5.5oz Snaps en Bolsa ColganteRetirado: 9/7/12

12oz Snaps en Lata

Retirado: 9/7/12

1lb Black Licorice Twists

Retirado: 08/22/12

4 Efectivo 10/17/2011 - Este dulce en el nuevo paquete ‘Gris’ se permite vender en California.

Red Vines

PUEDECOMERLO

NO LOCOMA

General Order Form

Mail or FAX to: Childhood Lead Poisoning Prevention Program Phone: 800.524.5323 Health Education Unit Fax: 323.890.8736 5555 Ferguson Dr., Suite 210-02 Contact: Health Education Unit City of Commerce, CA 90022

Educational Materials

General Information: Lead Poisoning Prevention Language Quantity

Booklet: “A Guide to a Healthy and Lead Safe Home for Children” English

Spanish

Card: “Getting Your Child Tested for Lead”

English

Spanish

Chinese

Brochure: “Keep Your Newborn Safe from LEAD” Bilingual: Eng/Sp

Brochure: “Lead in House Paint and Dirt Can Hurt Your Child”

Chinese

Vietnamese

Hmong

Lao

Brochure: “Learn About Lead Poisoning: Protect Your Children”

Bilingual: Eng/Sp

Bilingual: Eng/Vietnamese

Bilingual: Eng/Chinese

Bilingual: Eng/Hmong

Bilingual: Eng/Lao

Brochure: “Make Your Home Lead-Safe and Healthy for Children”

English

Spanish

Vietnamese

Korean

Chinese

Armenian

Russian

Brochure: “Pregnant?” Bilingual: Eng/Sp

Brochure: “Simple Steps to Protect Your Child from LEAD”

Bilingual: Eng/Sp

Bilingual: Eng/Vietnamese

Bilingual: Eng/Chinese

Bilingual: Eng/Hmong

Bilingual: Eng/Lao

Nutrition and Lead Language Quantity Brochure: “Lead is a Poison” Thai

Card: “Well Fed=Less Lead”

English

Spanish

Chinese

Sources of Lead Poisoning Language Quantity

Card: “Danger! Azarcon, Greta” English

Spanish

Brochure: “Lead in Traditional Ceramic Dishware-Warning!” English

Spanish

Card: “Protect Your Child From Lead in Dirt” English

Spanish

Please Turn Over

Sources of Lead Poisoning (Continued) Language Quantity

Card: “Protect Your Child From Lead in Paint” English

Spanish

Flyer: “Sources of Lead Poisoning” English

Spanish

Flyer: “Traditional Pottery May Contain Lead” Bilingual: Eng/Sp

Flyer: “Traditional Remedies, Cosmetics, and other Products Reported to Contain Lead”

English

Flyer/Poster: “Warning! These Candies Have Been Found to Contain Lead” Bilingual: Eng/Sp

Lead-Safe Work Practices Language Quantity Brochure: “Lead-Safe Work Practices” Spanish

Brochure: “Remodeling or Repainting? Protect Your Family from the Dangers of Lead Poisoning”

Bilingual: Eng/Sp

Booklet: “Renovate Right” English

Spanish

Occupational Information Language Quantity

Brochure: “Don’t Take Lead Home From Your Job” English

Spanish

Posters Language Quantity Poster: “ Lead Is a Poison” Bilingual: Eng/Sp

Poster: “Sources of Lead Poisoning” English

Spanish

Poster: “Traditional Pottery May Contain Lead” Bilingual: Eng/Sp

Other Resources Language Quantity Book: “Citizens Guide to County Services” LIMITED TO 1 PER ORDER

English

Spanish

Flyer: “Free and Low cost Dental and Vision Services for Children and Teenagers”

English

Spanish

Flyer: “Free and Low Cost Health Services” Bilingual: Eng/Sp

Flyer: “Free or Low-cost Health Coverage for Children (List of Agencies) Bilingual: Eng/Sp

Brochure: “LA County Helps” English

Spanish

Flyer: “Parent Resources at a Glance for Their Children at Ages 0-5” English

Spanish

Flyer: “Understanding Your Rights as a Tenant” Bilingual: Eng/Sp

Promotional Materials Language Quantity

Bookmarkers English

Spanish

Growth Chart: “Bee Lead-Free: Keep Your Child Safe” Bilingual: Eng/Sp

Date: ____________

Agency Name: ___________________________________________________________________

Contact Person: __________________________________________________________________

Mailing Address: _________________________________________________________________

City, Zip Code: ___________________________________________________________________

Phone: _________________________________ Fax: ___________________________________

Email: __________________________________________________________________________

7/13 cs

Pest Management Handouts

BIOLOGYUnderstanding how bed bugs eat and live can help you get rid of them.

Adult bed bugs are flat, small (less than ¼ inch long), oval-shaped, wingless, and reddish brown. Immature bugs are smaller and amber colored. Eggs are tiny and white.

They feed on blood and attach themselves to their favorite meal: humans and animals. Bed bugs need blood to grow and can live up to one year on a single feeding.

Bed bugs usually bite at night, while we are sleeping.

Bed bugs move around by hitching rides on clothing, furniture, bedding, and baggage. Bed bugs will live in any crack or crevice in or around your sleeping areas.

HEALTH ISSUESNot known disease carriers.

Bites can cause an allergic reaction with swelling, redness, and itching.

Skin infection and scarring can result from scratching.

The majority of people do not react to bed bug bites.

Lack of sleep is a serious side-effect causing reduced allertness, loss of productivity, and mood problems.

PREVENTIONBed bugs are hard to prevent because of their small size, night habits, and ability to hitchhike. Here are some tips to get you started:

Be on the look out for signs of infestations such as: waking up with bites; seeing live bugs; or dark red or black spots on bedding, carpets, walls and furniture. Finding bed bugs early is the key to preventing their spread.

Paint and caulk around sleeping areas – such as along baseboards, windows and bed frames – to seal hiding spots.

Inspect used furniture closely before bringing into your home. Look for signs of infestations in cushions, zippers, seams, and underneath including springs and frames. Use a magnifying glass if possible. Beware of items in alleys and dumpsters.

Take a look around mattresses and funiture when staying in an unfamiliar place. Bed bugs can hitch a ride home on your clothing or luggage.

BED BUGSA FACTSHEET FROM SAFER PEST CONTROL PROJECT

Bed bugs are making a comeback, big-time, and can be found just about anywhere–from warming shelters to four-star hotel rooms. No one really knows why they have returned, but these little bugs are determined to stick around. Although bed bugs are tiny, they can cause major headaches because they’re so difficult to find. Use the tips below to help control this stubborn pest.

Safer Pest Control Project is dedicated to reducing the health risks and environmentalimpacts of pesticides and promoting safer alternatives in Illinois.

4611 N. Ravenswood Ave., Suite 107, Chicago, Illinois 60640 Tel: 773/878-PEST (7378) Fax: 773/878-8250 Web: www.spcpweb.org

CONTROLBe persistent!! Getting rid of bed bugs will require many different steps over several weeks. Be patient and persistent, and you will succeed.

Find out where they are hiding. Bed bugs don’t just stay in mattresses (though that is a favorite hiding spot). Look along baseboards, under and behind dressers, and any other dark hidden areas nearby. Monitoring devices, like glue boards or special bed bug detectors, may be helpful with locating bed bugs.

Vacuum infested areas carefully. This will quickly knock down numbers of live bugs. Remove vacuum bag or contents, place into a plastic bag, seal tightly, and dispose right away. Vacuuming alone will not eliminate an infestation.

Steam clean furniture and other surfaces to kill remaining bugs and hidden eggs. Handheld steamers are widely available in stores and online. The steaming time depends on the steam temperature, i.e., the higher the temperature the faster the kill. Pass the steamer slowly over infested surfaces. Always use caution to avoid burns.

Put mattress and box spring into a bed bug proof cover. These covers are tear resistant and have a tight locking zipper that keeps bed bugs from escaping. Leave cover on for at least one year and pull bed away from the wall. Keep bedding from touching the floor and change sheets often until the problem is eliminated.

Wash all linen, laundry, and other infested clothing articles in hot water. Dry on the highest possible setting. Unwashed, unwashable, and “dry clean only” items can be put in the drier for at least 20 minutes to kill bed bugs.

You do not have to throw away furniture, including mattresses. Most items can be treated. Talk to your pest control professional before throwing anything out.

Infested items left in common areas such as alleys, basements and curbs may spread the problem to others in your community. Mark or label any items that you are throwing out to prevent others from accidentally bringing bed bugs home.

Do not use chemicals around sleeping areas and furniture unless they are properly labeled to treat these surfaces for bed bugs.

If you are renting, notify your landlord about any sign of bed bug immediately. You have the right to live in safe and decent housing. Work with your landlord to get problems corrected quickly and prevent the spread of bed bugs.

Remember, there is no magic formula that will guarantee bed bug elimination. These tips are not intended to replace a select treatment program by knowledgeable professionals. The use of pesticides may be necessary. If possible, seek professional advice before applying pesticides for bed bugs especially around people with health conditions.

BED BUGS (cont.)

REFERENCES1.) L.J. Pinto, R. Cooper and S.K. Kraft. 2007. Bed Bug Handbook: The Complete Guide to Bed Bugs

and Their Control. Pinto & Associates, Inc. Mechanicsville, MD.

2.) Dr. Jody Gangloff-Kaufmann and Jill Shultz. 2003. “Bed Bugs Are Back: an IPM answer”. New York State Integrated Pest Management Program, Cornell Cooperative Extension, Cornell University. http://www.nysipm.cornell.edu/publications/bed_bugs/files/bed_bug.pdf

3.) Dr. Stephen A. Kells and Jeff Hahn. 2006. “Traveler Q & A: Preventing bed bugs from hitchhiking to your home”. Communication and Educational Technology Services, University of Minnesota Extension. http://www.extension.umn.edu/distribution/housingandclothing/M1196.html

4.) UC IPM Online. 2002. “Bed Bugs”. Statewide IPM Program, Agriculture and Natural Resources, University of California. http://www.ipm.ucdavis.edu/PMG/PESTNOTES/pn7454.html

LA BIOLOGÍAPuede deshacerse de los chinches entendiendo cómo ellos viven y comen.

Los chinches adultos son chatos y pequeños (menos de ¼ de pulgada de longitud), no tienen alas, son de forma oval y color marrón rojizo. Los chinches jóvenes son más pequeños y de color ámbar. Los huevos son minúsculos y blancos.

Se alimentan de sangre y se pegan a sus huéspedes preferidos: los humanos. Los chinches necesitan sangre para crecer y pueden vivir hasta un año después de una sola ingestión.

En general, los chinches pican por la noche mientras dormimos.

Los chinches se transportan pegándose en la ropa, en los muebles y en el equipaje. Durante el día, se esconden en las grietas del piso, dentro de los colchones, en el marco de las camas así como en la cabecera y en las costuras de los sofás.

PROBLEMAS DE SALUDNo se les conocen como portadores de enfermedades.

Las picaduras pueden producir una reacción alérgica con hinchazón, rojez y comezón.

Rascarse puede provocar infecciones y cicatrices en la piel.

La mayoría de las personas no reaccionan a las picaduras de los chinches.

La falta de sueño es un efecto secundario grave que provoca menos vigilancia, pérdida de productividad y cambios de humor.

LA PREVENCIÓNEs difícil evitar la presencia de los chinches debido a su pequeño tamaño y laforma de transportarse. Para comenzar, se indican a continuación algunos consejos prácticos:

Esté pendiente de detectar señales de infestación tales como despertar con picaduras, ver chinches vivos o puntos de color rojo oscuro o negro en la ropa de cama, las alfombras, las paredes y los muebles. La detección temprana de los chinches es la clave para evitar que se propaguen.

Pinte o enmasille la zona cerca de las áreas para dormir – como por ejemplo a lo largo de la cabecera, las ventanas y el marco de las camas – para sellar los escondites.

Examine a fondo los muebles usados antes de llevarlos a casa. Revise los cojines, las cremalleras, las costuras y debajo de los muebles incluso los resortes y marcos para buscar alguna evidencia de infestación. Si es posible utilice una lupa. Tenga cuidado con los artículos desechados en los callejones y los basureros.

Inspeccione los colchones y los muebles cuando esté de visita en lugares desconocidos. Los chinches pueden transportarse sobre su ropa maletas y corren el riesgo de de traerlos a casa con ustedes.

LOS CHINCHESHOJA DE INFORMACIÓN DELSAFER PEST CONTROL PROJECT

Los chinches están de vuelta de manera significativa y se les pueden encontrar casi en cualquier lugar – desde los refugios contra el frío hasta las habitaciones de hoteles de cuatro estrellas. En realidad, nadie sabe por qué han vuelto pero estos pequeños chínches están decididos a quedarse. Aunque los chinches son minúsculos, pueden ocasionar grandes preocupaciones porque es difícil descubrirlos. Siga los siguientes consejos prácticos para áyudar a eliminar estas plagas.

Safer Pest Control Project se dedica a la reducción de los riesgos de la salud y del impacto en el medioambiente que los pesticidas pueden tener y a la promoción de alternativas saludables para el estado de Illinois.

4611 N. Ravenswood Ave., Suite 107, Chicago, Illinois 60640 Tel: 773/878-PEST (7378) Fax: 773/878-8250 Web: www.spcpweb.org

EL CONTROL¡Insista! Una vez que los chinches hayan entrado en su casa, lo mejor que puede hacer es ser persistente. Este problema requerirá numerosas medidas distintas durante varias semanas pero con paciencia usted puede lograrlo.

Averigüe donde se esconden. Los chinches no se encuentran sólo en los colchones (aunque ésos son sus escondites preferidos). Revise a lo largo de los zócalos, debajo y detrás de la cómoda y en otras partes cercanas que estén escondidas y a oscuras.

Pase cuidadosamente la aspiradora en las zonas infestadas. Esto eliminará rápidamente gran cantidad de chinches vivos. Saque el contenido o la bolsa de la aspiradora, colóquela en una bolsa de plástico, séllela bien y deséchela enseguida.

Limpie los muebles con un limpiador de vapor para matar los chinches y los huevos que queden. Ahora los limpiadores de vapor portátiles son fácil de conseguir y limpiarán muy bien tanto los muebles como los colchones. Los chinches son vulnerables cuando expuestos a temperaturas de más de 97°F. Las temperaturas de vapor deben ser más de 120°F para crear el mayor impacto. Lentamente pase el limpiador a vapor sobre las superficies infestadas. Siempre debe de tener cuidado con estas altas temperaturas.

Cubra el colchón y la base con un forro que proteja contra los chinches. Estos forros son resistentes a roturas y tienen una cremallera ajustada que sella bien, lo cual evita que se escapen los chinches. Deje los forros puestos por lo menos durante un año y retire la cama de la pared. Impida que la ropa de cama toque el piso y cambie las sabanas con frecuencia hasta que el problema se elimine.

Lave en agua caliente toda la ropa blanca, la ropa sucia y cualquier otro artículo infestado. Luego seque la ropa en la secadora a la temperature máxima. Si no pueden lavar todo, el secarlo durante, por lo menos, 15 minutos matará los bichos. También pueden meter los artículos de “limpieza en seco solamente” en la secadora siempre y cuando no estén mojados.

No tiene que desechar los muebles ni los colchones. La mayoría de artículos se pueden tratar. Hable con su agente profesional de control de plagas antes de desechar algo.

Los artículos infestados dejados en áreas comunes tales como callejones, sótanos y bordillos pueden propagar el problema a otros en la comunidad. Marque o ponga etiquetas en cualquier artículo que deseche para evitar que otras personas sin querer se lleven a casa los chinches.

Si usted está en alquiler, informe enseguida al dueño de la casa de cualquier evidencia de chinches. Usted tiene el derecho de vivir en un entorno adecuado y seguro. Colabore con el dueño de su casa para resolver rápidamente los problemas y evitar la propagación de los chinches.

Estos consejos prácticos deben de usarse en adición al uso limitado de los pesticidas, y no se debe de pretender remplazar un programa tratamiento de profesionales especialistas. No use químicos alrededor de los muebles y lugares donde se duerme al menos que estén adecuadamente etiquetados para tratar los chinches en el hogar. Siempre pida consejo profesional antes de aplicar pesticidas alrededor de personas con condiciones de salud.

LOS CHINCHES (SIGUE)

REFERENCIAS1.) Dr. Jody Gangloff-Kaufmann and Jill Shultz. 2003. Bed Bugs Are Back: an IPM

answer. New York State Integrated Pest Management Program, Cornell Cooperative Extension, Cornell University. http://www.nysipm.cornell.edu/publications/bed_bugs/files/bed_bug.pdf

2.) Dr. Stephen A. Kells and Jeff Hahn. 2006. Traveler Q & A: Preventing bed bugs from hitchhiking to your home. Communication and Educational Technology Services, University of Minnesota Extension. http://www.extension.umn.edu/distribution/housingandclothing/M1196.html

3.) UC IPM Online. 2002. Bed Bugs. Statewide IPM Program, Agriculture and Natural Resources, University of California. http://www.ipm.ucdavis.edu/PMG/PESTNOTES/pn7454.html

4.) L.J. Pinto, R. Cooper and S.K. Kraft. 2007. Bed Bug Handbook: The Complete Guide to Bed Bugs and Their Control. Pinto & Associates, Inc.: Mechanicsville, MD.

COCKROACHESCOCKROACHESKEEPING

OUT OF YOUR HOUSE

A lthough cockroaches are useful outdoors, where they help re-

cycle plant and animal wastes, they are not welcome indoors. Research clearly indicates that roaches can carry disease-causing organisms from sewers, garbage cans, or bathrooms to kitchen counters and human food. Cockroaches can also trigger allergic reactions in some people.

DETECTIONExcept for size and markings, all cockroaches have a similar appear-ance. These insects are dark in color, oval-shaped, and have long antennae. Roaches are mainly active at night and generally remain hidden during the day in cracks and crevices near their source of food.• Use nontoxic sticky traps to locate

roach habitat. Roaches like to travel by touching the edges of objects.

Place traps along the edges of walls, appliances, cupboards, etc., and not in the middle of the room. Sticky traps with a nontoxic “pheromone” attractant will catch more roaches. Whenyoufindoutwhere roachesare hiding, you’ll know where to concentrate your efforts.

LESS-TOXIC CONTROLS• Use sticky traps for small infesta-

tions. If you only have a few roaches, you may be able to control the prob-lem with sticky traps.

• Use a strong vacuum with a creviceattachment to pull roaches fromtheir hiding places.

• Use insecticidal dusts such as dia-tomaceous earth (DE) or boric acidin wall voids or cracks and crevicesbefore you seal them, under large ap-pliances, or in other prime habitats.One way to gain access to a wall void is to remove the cover plates on elec-trical outlets and switches. Alwaysturn off the power before applyingproducts near electrical outlets.When properly used, DE has littletoxicity to humans and pets, but kills insects by absorbing their outer waxy coating, causing dehydration anddeath. Use DE sold for pest controland notforpoolfilters.Although boric acid has a low acute(immediate) toxicity for humans and

pets, it should be handled carefully and kept out of the reach of children and pets. For roaches, boric acid is a slow-acting but effective stomach poison. When applying these dusts, use a hand duster and wear a dust mask, gloves, and safety goggles. Apply a very light coating because roaches will avoid piles of dust.

• Use cockroach baits because theyuse minimal amounts of insecticideand confine the poison to a verysmall area (see Tips for Using Cock-roach Baits on back).

PREVENTIONPrevent cockroach infestations by de-nying them access to your home and to the food, water, and shelter they need to survive.• Store food in the refrigerator or in

containers that seal tightly.• Keep things clean and tidy. Thor-

oughly clean counters and vacuum or sweepfloorsdailyineatingandfoodpreparation areas. Don’t leave dirtydishes out overnight, even in thedishwasher. Any garbage containingfood scraps should be removed fromthe house nightly. Thoroughly cleanrecyclables before storing them. Atnight, place pet food and water bowls in a moat of soapy water. Reduceclutter in all rooms (it provideshabitat for roaches).

Choose less toxic products for your home and garden. Look for this symbol before you buy.

LESS-TOXIC PEST MANAGEMENT

•Keep things dry. Fix leaky plumb-ing. Keep kitchen surfaces dry when-ever they are not in use, especially overnight.

• Seal cracks and crevices. Before sealing, vacuum and wash the area to eliminate all roach egg cases, fecal matter, or other debris. Caulk and paint cracks around baseboards, cup-boards, pipes, sinks, etc. Use mildew-resistant caulk in moist areas.

•Weatherstrip around doors and win-dows and repair holes in screens.

• Inspect materials you bring into your house for roaches or their egg cases (small, dark, kidney bean shaped). Pay special attention to used furniture and appliances and cardboard cartons from food stores.

•Monitor with sticky traps. Once you have eliminated roaches or signifi-cantly reduced their numbers, con-tinue to use sticky traps to alert you to a new infestation or a rise in the popu-lation. This is especially important in apartment buildings, condominiums, or other connected dwellings where roaches can easily move from one household to another.

TIPS FOR USING COCKROACH BAITS• Usebaitsindoors.• Usebaitswithboricacid,fipronil,or

hydramethylnon.• Reduceoreliminatefoodsourcesso

roaches will feed on baits.• Ifyouareusingagelbait,putsmall

dabs in a number of locations rather than large blobs in a few locations.

• Placebaitsnearareaswhereroachesare hiding and between their hiding places and food sources.

• Placebaitswhereroachesaremostlikely to travel or congregate, such as along the edges of walls, appliances, cupboards, etc. — not in the middle of the room.

• Keepbaitsoutofthereachofchil-dren and pets.

• Check bait stations frequently,especially if you have a large infesta-tion. Empty bait stations should be removed because they make great roach hiding spots.

PRODUCTSExamples of trade names for the products listed in this fact sheet:Desiccating Dust: Concern® Diatomaceous Earth Crawling Insect Killer,

Grow More®DiatomaceousEarth,Surefire® Crawling Insect KillerBoric Acid Powder: Roach Prufe®, Victor® Boric Acid PowderHand-Duster: Pest Pistol® (if unavailable locally, call (888) 784-1722 or

visit www.groworganic.com)Sticky Traps: Black Flag® Roach MotelSticky Traps with pheromone attractant: Victor® Roach MagnetBaits containing boric acid: Niban® Granular Bait, Niban® FG,

Seabright® Roach Free System BaitBait containing fipronil: Combat® Quick Kill Roach Bait Stations,

Combat® Source Kill Max Roach Killing Gel, Combat Source Kill for Small Roaches Bait Stations

Bait containing hydramethylnon: Combat® Roach Control System, Combat® Source Kill Max Roach Killing Gel

PESTICIDES AND WATER POLLUTIONCommon household pesticides show up in treated wastewater and in local waterways, sometimes at levels that can harm sensitive aquaticlife.So,waterpollutionpreventionagencies have teamed up with participat-ing retail stores, pesticide distributors, and manufacturers to reduce the risks associated with pesticide use. This fact sheet is part of a series of fact sheets and store displays aimed at educating residents about less-toxic pest management. For the rest of the series of fact sheets, visit www.ourwaterourworld.org. Also, look for the “Our Water Our World” logo next to products in participating stores and nurseries. See the Pesticides and Water Pollution fact sheet for information on active ingredients in common pesticides that may causewaterqualityproblems.

Pest control strategies and methods described in this publication are consistent with inte-grated pest management (IPM) concepts, and arebasedonscientificstudiesandtestsinac-tual home and garden settings. Use suggested products according to label directions and dispose of unwanted or leftover pesticides at a household hazardous waste collection facility or event. For more information on pesticide disposal, call 1-800-CLEANUP or visit: www.1800CLEANUP.org. No en-dorsement of specific brandnameproductsis intended, nor is criticism implied of similar products that are not mentioned.

ACKNOWLEDGMENT

The Central Contra Costa Sanitary District orig-inally developed this IPM outreach program.

FOR MORE INFORMATION

For more information, contact:Bio-Integral Resource Center (BIRC) (510) 524-2567; www.birc.orgUniversity of California Cooperative Extension Master Gardeners in your area (in the phone book)University of California IPM website: www.ipm.ucdavis.edu

www.OurWaterOurWorld.org

March 2013Paper content: 25% post-consumer waste, 50% recycled content. Printed with soy-based ink.

CONTROL MENOS TÓXICO DE PLAGAS

CUCARACHAS

Si bien las cucarachas son útiles afuera de nuestra casa, en donde ayudan a

reciclar los desechos de plantas y animales, no son bienvenidas adentro del hogar. Pueden ser portadoras de organismos cau­santes de enfermedades y también pueden desencadenar reac ciones alérgicas en mucha gente.

DETECCIÓNLas cucarachas realizan sus actividades principalmente de noche y por lo gen eral se ocultan durante el día en grietas y rajaduras cercanas a su fuente de alimentos.•Utilice trampas pegajosas no tóxicas

para detectar el lugar donde se encuentran las cucarachas. A las cuca rachas les gusta caminar por los bordes de los objetos. Coloque trampas a lo largo de los bordes de paredes, electrodomésticos, armarios, etc.; no las coloque en medio de la habitación. Si utiliza trampas pegajosas con un atra yente no tóxico de “feromona” podrá atrapar más cucarachas. Cuando descubra en dónde se esconden las cucarachas, sabrá dónde debe con­centrar su esfuerzo.

CONTROLES MENOS TÓXICOS•Utilice trampas pegajosas para

infestaciones pequeñas. Si tiene sólo unas pocas cucarachas, podrá controlar el problema con trampas pegajosas.

•Utilice una aspiradora potente con un accesorio para introducir en grietasafindesacaralascucarachasde sus escondites.

•Utilice polvos insecticidas tales como diatomita [diatomaceous earth] (DE) o ácido bórico dentro de los huecos, grietas y rendijas de las paredes antes de sellarlos; también debajo de electrodomésticos grandes o en otro lugar donde posiblemente habiten. Una forma de obtener acceso a un hueco en la pared es quitando las tapas de los tomacorrientes e inter­ruptores. Siempre corte la energía antes de aplicar productos en lugares próximos a los tomacorrientes. Utilice el tipo de diatomita que se vende para control de plagas, no el que se vende parafiltrosdepiscinas.

Si bien el ácido bórico es de toxicidad mínima para los seres humanos y los animales domésticos, utilícelo con cuidado y manténgalo fuera del alcance de los niños y los animales domésticos.

Cuando aplique estos polvos, haga uso de un sacudidor de mano y trabaje con una máscara contra el polvo, guantes y gafas protectoras. Aplique una capa muyfina,yaquelascucarachasevitanlas acumulaciones de polvo.

•Utilice cebos para cucarachas ya que contienen una cantidad mínima de insecticida y mantienen el veneno en un área muy pequeña (vea “Consejos para la Utilización de Cebos para Cucarachas” en la parte de atrás).

PREVENCIÓNPrevenga infestaciones de cucarachas bloqueándoles el acceso a su casa, a la comida, el agua y el refugio que necesitan para sobrevivir.• Guarde la comida en recipientes muy

bien cerrados o dentro del refrigerador.•Mantenga todo limpio y ordenado.

Limpie cuidadosamente los estantes y pase la aspiradora o la escoba diariamente en áreas en donde se come o se preparan alimentos. No deje platos sucios durante la noche, ni siquiera dentro del lavaplatos. Todas las noches saque de la casa la basura que contenga restos de comida. Limpie cuidadosamente los envases reciclables antes de guardarlos. Por la noche, coloque los platos de comida y agua de los animales domésticos en un recipiente poco profundo con agua jabonosa. Disminuya el desorden de todas las habitaciones (el desorden es ideal para las cucarachas).

•Mantenga todo seco. Repare las fugas de agua.Mantengasecaslassuperficiesdesu cocina mientras no las esté utilizando, especialmente durante la noche.

• Selle grietas y rajaduras. Antes de sellar, aspire y lave el área para eliminar todos lo huevecillos, materia fecal

MANTENGA A LAS

FUERA DE SU HOGAR

Elija productos menos tóxicos para su hogar y jardín. Busque este símbolo antes de hacer su compra.

PRODUCTOSEjemplos de las marcas de productos mencionadas en esta hoja informativa:Polvo Desecador: Concern Diatomaceous Earth Crawling Insect Killer,

Grow More Diatomaceous Earth, Safer Ant y Crawling Insect KillerPolvos que contienen ácido Bórico: Roach Prufe, Victor Boric Acid PowderSacudidor de Mano: Pest Pistol (si no está disponible en su área, llame al

(888) 784­1722 o consulte el sitio Web www.groworganic.com)Trampas Pegajosas: Black Flag Roach MotelTrampas Pegajosas con atrayente de Feromona: Victor Roach MagnetCebos que contienen ácido Bórico: Niban Granular Bait, Niban FG, Seabright

Roach Free System BaitCebos que contienen Fipronil: Combat Quick Kill Roach Bait Stations,

Combat® Source Kill Max Roach Killing Gel, Combat Source Kill for Small Roaches Bait Stations

Cebos que contienen Hidrametilón (hydramethylnon): Combat Roach Control System, Combat® Source Kill Max Roach Killing Gel

Esta lista de productos no se ha elaborado con el propósito de respaldar los productos aquí nombrados ni de excluir implícitamente a productos similares que no se mencionan.

LOS PESTICIDAS Y LA CONTAMINACIÓN DEL AGUALos pesticidas pueden aparecer en aguas residuales tratadas y en arroyos de la zona, a veces a niveles que dañan la delicada vida acuática. Por eso, las entidades de preven­ción de la contaminación del agua se han unido con los establecimientos comerciales locales para disminuir los riesgos asociados con la utilización de pesticidas. Esta hoja informativa forma parte de una serie de materiales informativos proporcionados por negocios comerciales que tienen como obje­tivo orientar a los residentes locales acerca del control menos tóxico de plagas. Busque el logotipo “Our Water, Our World” junto a los productos de los establecimientos que participan en el programa.

PARA OBTENER MÁS INFORMACIÓN

Para obtener más información, comu­níquese con:Bio-Integral Resource Center (BIRC) (510) 524­2567University of California Cooperative Extension Master Gardeners de su área (en la guía de teléfonos)University of California — Notas Breves en español www.ipm.ucdavis.edu/QT/qtindexsp.html

RECONOCIMIENTOS

Esta hoja informativa es proporcionada para el programa “Our Water, Our World” que promueve el control menos tóxico de plagas y fue desarrollada inicialmente por el Distrito Sanitario de Central Contra Costa.Redacción Tanya Drlik, Bio­Integral Resource CenterDiseño: Lauren Wohl DesignTraducción: International Contact, Inc., Oakland CA.Fondos para la Traducción: National Foundation for IPM EducationEnvironmental Protection Agency

u otros desechos de las cucarachas. Calafatee y pinte las grietas que se encuentran alrededor de zócalos, armarios, tuberías, fregaderos, etc. Utilice masilla resistente al moho en todas las áreas.

• Aísle térmicamente las puertas y ventanas y repare los agujeros de las puertas de tela metálica.

• Revise los materiales que ingresana su hogar para comprobar que no poseen cucarachas ni sus huevecillos.Preste especial atención a los mueblesy electrodomésticos de segunda manoy a los envases de cartón de las tiendas de alimentos.

• Controle las cucarachas con trampaspegajosas. Una vez que haya elimi­nadoodisminuidosignificativamentela cantidad de cucarachas, continúeutilizando las trampas pegajosascomo medio de alerta ante unanueva infes tación o un aumento en lacantidad de cucarachas. Este control es importanteespecialmenteenedificiosde apartamentos, condominios u otras viviendas conectadas entre sí en quelas cucarachas pueden desplazarsefácilmente de una casa a la otra.

CONSEJOS PARA LA UTILIZACIÓN DE CEBOS PARA CUCARACHAS• Utilicecebosdentrodesuhogar.• Utilicecebosconácidobórico,fipronil,

o hidrametilón (hydrame thylnon).• Retireotrasfuentesdealimentospara

que las cucarachas coman los cebos.• Siutilizaceboengel,coloquepequeñas

cantidades en muchos lugares en vezde mucha cantidad en pocos lugares.

• Coloquelosceboscercadeaquellasáreas en que las cucarachas se esconden y entre sus escondites y lasfuentes de alimentos.

• Coloque los cebos en los lugaresposibles de paso o reunión de lascucarachas, como por ejemploalrededor de los bordes de las paredes, electrodomésticos, armarios, etc.—no en el centro de la habitación.

• Mantengaloscebosfueradelalcancedelos niños y los animales domésticos.

• Verifique con frecuencia los reci­pien tes de cebo, especialmente sila infestación es significativa. Losrecipien tes vacíos de cebo debenser retirados, ya que son escondites perfectos para las cucarachas.

Marzo de 2013

Contenido de papel: 25% desecho post­consumidor, 50% reciclado. Impreso con tinta a base de soya.

www.OurWaterOurWorld.org

Car Safety Handouts

Step 1-Rear-Facing Seats

• Infant only or rear-facing convertible seat.• Newborn to at least 1 year of age and at least 20 pounds.• May stay rear-facing longer to maximum rear-facing

weight limit of infant or convertible seat.

Step 2-Forward-Facing Seats (with a harness)• Convertible or combination seat.• Children must be at least one year of age and 20 pounds.• Children should remain in 5-point harness until they

reach the top weight or height limit allowed.

Step 3-Booster Seats (high-back or backless)• Children under 8 years of age OR under 4’9” in height.• High-back or boosters must be used when the vehicle

does not have a head-rest or if vehicle’s seat back islower than child’s ears.

• Must be used with lap and shoulder belts.• Never use with lap belt only.• Recommended to use until child fits seat belt correctly as

described below.

Step 4-Seat Belt• Children 8 years of age OR 4’9” in height are permitted

to use a seat belt, however, the seat belt should bechecked for proper fit.

• To confirm if a child over 8 years old can safely ride ina seat belt alone, all of the following should occur:◆ Child can sit with back against vehicle seat back.◆ Knees bend naturally over the edge of vehicle seat.◆ Lap belt fits low and snug across top of thighs.◆ Shoulder belt crosses the collar-bone and center

of chest.

Funding for this program was provided by a grant from the California Office of Traffic Safety, through the National Highway Traffic Safety Administration.

• Child Safety Seat Check-Up Events. • Traffic Safety Presentations, Classes, and Seminars.• Educational Brochures.• A Spotter Program where the public can report unrestrained children by calling 1-800-TELL-CHP.• Disposal of Child Safety Seats at CHP offices.

old OR at least 4’9” in height.

4 PASOS PARA LOS NIÑOSPaso 1- Asientos orientados hacia atrás• Asiento solo para infantes o asiento convertible orientado hacia atrás.• Recién nacidos hasta por lo menos 1 año de edad de al menos 20 libras.• Puede viajar orientado hacia atrás más tiempo hasta el límite de peso máximo del asiento orientado hacia atrás o asiento convertible.

Paso 2-Asientos orientados hacia adelante (con arnés)• Asiento convertible o combinado.• Los niños deben tener por lo menos un año de edad y pesar 20 libras.• Los niños deben seguir usando el arnés de 5 puntos hasta que alcancen el límite permitido de peso o altura máxima.

Paso 3-Asientos elevadores (con respaldo alto o sin respaldo)• Para niños menores de 8 años O que midan menos de 4'9" de altura.• Los respaldos altos o elevadores deben usarse cuando el vehículo no tiene un apoya-cabezas o si el respaldo del vehículo es inferior a las orejas del niño.• Debe usarse con un cinturón de seguridad de cadera y de hombros.• Nunca usar solo con cinturón de cadera.• Se recomienda su uso hasta que el niño se ajuste correctamente al cinturón de seguridad tal como se describe ahora.

Paso 4-Cinturón de seguridad• Los niños de 8 años de edad O 4’9” tiene permitido usar el cinturón de seguridad pero siempre debería comprobarse que cinturón se ajusta correctamente.• Para confirmar si un niño de más de 8 años puede ir de forma segura solo con cinturón de seguridad, debería ocurrir algo de lo siguiente:• El niño puede sentarse con la espalda contra el respaldo del asiento del vehículo.• Las rodillas se doblan naturalmente en el borde del asiento del vehículo.• El cinturón de cadera se encaja a nivel bajo y se ajusta por la parte superior de las caderas.• El cinturón de los hombros cruza la clavícula y el centro del pecho.

4 PASOS PARA LOS NIÑOSPaso 1- Asientos orientados hacia atrás•Asiento solo para infantes o asiento convertible orientado hacia atrás.•Recién nacidos hasta por lo menos 1 año de edad de al menos 20 libras.•Puede viajar orientado hacia atrás más tiempo hasta el límite de peso máximo del asiento orientado hacia atrás o asiento convertible.

Paso 2-Asientos orientados hacia adelante (con arnés)•Asiento convertible o combinado.•Los niños deben tener por lo menos un año de edad y pesar 20 libras.•Los niños deben seguir usando el arnés de 5 puntos hasta que alcancen el límite permitido de peso o altura máxima.

Paso 3-Asientos elevadores (con respaldo alto o sin respaldo)•Para niños menores de 8 años O que midan menos de 4'9" de altura.•Los respaldos altos o elevadores deben usarse cuando el vehículo no tiene un apoya-cabezas o si el respaldo del vehículo es inferior a las orejas del niño.•Debe usarse con un cinturón de seguridad de cadera y de

hombros.• Nunca usar solo con cinturón de cadera.• Se recomienda su uso hasta que el niño se ajuste correctamente al cinturón de seguridad tal como se describe ahora.

Paso 4-Cinturón de seguridad• Los niños de 8 años de edad O 4’9” tiene permitido usar el cinturón de seguridad pero siempre debería compro-barse que cinturón se ajusta correctamente. • Para confirmar si un niño de más de 8 años puede ir de forma segura solo con cinturón de seguridad, debería ocurrir algo de lo siguiente:• El niño puede sentarse con la espalda contra el respaldo del asiento del vehículo.• Las rodillas se doblan naturalmente en el borde del asiento del vehículo.• El cinturón de cadera se encaja a nivel bajo y se ajusta por la parte superior de las caderas.• El cinturón de los hombros cruza la clavícula y el centro del pecho.

La financiación para este programa fue entregada por una subvención de la oficina de California para la seguridad del tráfico California Office of Traffic Safety, a través de la administración nacional para la seguridad del tráfico en carretera National Highway Traffic Safety Administration.

OFICINA DE SEGURIDAD DEL TRÁFICO DE CALIFORNIA (CALIFORNIA OFFICE OF TRAFFIC SAFETY)

4 PASOS PARA LOS NIÑOSPaso 1- Asientos orientados hacia atrás•Asiento solo para infantes o asiento convertible orientado hacia atrás.•Recién nacidos hasta por lo menos 1 año de edad de al menos 20 libras.•Puede viajar orientado hacia atrás más tiempo hasta el límite de peso máximo del asiento orientado hacia atrás o asiento convertible.

Paso 2-Asientos orientados hacia adelante (con arnés)•Asiento convertible o combinado.•Los niños deben tener por lo menos un año de edad y pesar 20 libras.•Los niños deben seguir usando el arnés de 5 puntos hasta que alcancen el límite permitido de peso o altura máxima.

Paso 3-Asientos elevadores (con respaldo alto o sin respaldo)•Para niños menores de 8 años O que midan menos de 4'9" de altura.•Los respaldos altos o elevadores deben usarse cuando el vehículo no tiene un apoya-cabezas o si el respaldo del vehículo es inferior a las orejas del niño.•Debe usarse con un cinturón de seguridad de cadera y de

hombros.• Nunca usar solo con cinturón de cadera.• Se recomienda su uso hasta que el niño se ajuste correctamente al cinturón de seguridad tal como se describe ahora.

Paso 4-Cinturón de seguridad• Los niños de 8 años de edad O 4’9” tiene permitido usar el cinturón de seguridad pero siempre debería compro-barse que cinturón se ajusta correctamente. • Para confirmar si un niño de más de 8 años puede ir de forma segura solo con cinturón de seguridad, debería ocurrir algo de lo siguiente:• El niño puede sentarse con la espalda contra el respaldo del asiento del vehículo.• Las rodillas se doblan naturalmente en el borde del asiento del vehículo.• El cinturón de cadera se encaja a nivel bajo y se ajusta por la parte superior de las caderas.• El cinturón de los hombros cruza la clavícula y el centro del pecho.

La ley de California dispone que todos los niños DEBEN viajar adecuadamente sujetos en un asiento de seguridad para niños, elevador u otro sistema de sujeción en el asiento de atrás, hasta que el niño tenga 8 años de edad O mida 4’9” de altura.

Las excepciones son:• No hay asiento de atrás.• Los asientos de atrás son asientos auxiliares orientados a los lados.• El sistema de sujeción de los niños pasajeros (child passenger restraint system o CPRS, en inglés) no puede instalarse correcta mente en el asiento trasero.• Todos los asientos traseros ya están ocupados por niños menores de 7 años.• Razones médicas exigen que el niño no pueda viajar en el asiento de atrás. El tribunal puede pedir prueba suficiente de la condición médica del niño.

Adicionalmente, la ley estatal estable que un niño no puede viajar en el asiento delantero de un vehículo a motor con un air bag activo para pasajeros si el niño es: Menor de un año de edad, pesa menos 20 libras o está viajando orientado hacia atrás en un CPRS.

Referencia: www.chp.ca.gov o póngase en contacto con la oficina de colocación de asiento de seguridad para niños Child Safety Seat Fitting Station de la Patrulla de Caminos de California (California Highway Patrol o CHP, en inglés) para mayor información y/o asistencia para la instalación de su CPRS. La CHP también ofrece lo siguiente:• Eventos de revisión de asientos de seguridad para niños.• Presentaciones, clases y seminarios sobre seguridad del tráfico.• Folletos educativos.• El programa de detección Spotter Program donde el público puede denunciar a niños sin sujeción llamando a 1-800-TELL-CHP.• Eliminación de Asientos de seguridad para niños en oficinas de CHP.

Safe Sleeping Handouts

The Los Angeles County Inter-Agency Council on Child Abuse and Neglect (ICAN) is the o�cial county agent coordinating the development of services for the prevention, identi�cation and treatment of child abuse and neglect. ICAN Associates is a private, nonpro�t corporation that works in partnership with ICAN to address these issues by providing services and materials, including sponsorship and coordination of media campaigns, community educational forums and projects, special events, newsletters, and funding. ICAN Associates provides support for direct and indirect services to prevent child abuse, and enables integration and collaboration among child service agencies. ICAN and ICAN Associates have partnered with First 5 LA to raise awareness about the Infant Safe Sleeping Campaign and save families from the preventable tragedy of losing an infant due to unsafe sleeping practices.

info@safesleepforbaby.com | www.safesleepforbaby.comICAN Associates, 4024 N. Durfee Ave., El Monte, CA 91732 (626) 455-4585

Safe Sleep for BabyL.A. County Infant Safe Sleeping CampaignSponsored through a partnership between the Los Angeles County Inter-Agency Council on ChildAbuse and Neglect (ICAN) and First 5 LA.

Your Training Tool Kit Includes:

Training DVD A Space of My Own: Reducing Sleep-Related Infant Deaths in L.A. County, Training Video #1

Training Materials (English and Spanish) Training Points and Facts Frequently Asked Questions

L.A. County Infant Safe Sleeping Campaign PowerPoint Presentation PowerPoint for Community Members (English and Spanish) PowerPoint for Providers (English only)

Safe Sleep Flyer (English and Spanish)

Safe Sleep Pamphlets (English and Spanish)

Home Visit Safety Checklist for Providers (English and Spanish)

Pledges Parent/Caregiver Pledge (English and Spanish) Provider/Community Members Pledge (English only)

Quizzes 11-Question Quiz (English and Spanish) Picture Quiz for Parents/Caregivers (English and Spanish)

L.A. County Infant Safe Sleeping Campaign Fact Sheet (English and Spanish)

Contact Us

ican4kids.org

The Los Angeles County Inter-Agency Council on Child Abuse and Neglect (ICAN) is the o�cial county agent coordinating the development of services for the prevention, identi�cation and treatment of child abuse and neglect. ICAN Associates is a private, nonpro�t corporation that works in partnership with ICAN to address these issues by providing services and materials, including sponsorship and coordination of media campaigns, community educational forums and projects, special events, newsletters, and funding. ICAN Associates provides support for direct and indirect services to prevent child abuse, and enables integration and collaboration among child service agencies. ICAN and ICAN Associates have partnered with First 5 LA to raise awareness about the Infant Safe Sleeping Campaign and save families from the preventable tragedy of losing an infant due to unsafe sleeping practices.

Safe Sleep for BabyL.A. County Infant Safe Sleeping CampaignSponsored through a partnership between the Los Angeles County Inter-Agency Council on ChildAbuse and Neglect (ICAN) and First 5 LA.

The Facts: Approximately 70 infants die from unsafe sleep-related deaths in Los Angeles County each year. (This represents one baby every �ve days.) Unsafe sleeping is the leading preventable cause of infant death in Los Angeles County. People who have lost their babies often say, "No one ever told me about the risks of su�ocation."

What Can Happen?Babies under the age of 1 year are at risk of su�ocating while: Sharing a bed Sleeping in a cluttered crib or bassinet Sleeping on their side or on their stomach Sleeping on unsafe sleep surfaces such as couches and chairs, or in places that are unfamiliar to the baby

The Safest Way to Put a Baby to Sleep: Share a room, not a bed Place babies to sleep in a crib or bassinet Place babies on their back every time at night and for naps Give babies space to breathe no pillows, bumpers, blankets or toys in the crib or bassinet

Frequently Asked Questions & AnswersRefer to the Frequently Asked Questions sheet included in this tool kit.

info@safesleepforbaby.com | www.safesleepforbaby.comICAN Associates, 4024 N. Durfee Ave., El Monte, CA 91732 (626) 455-4585

Contact Us

ican4kids.org

The Los Angeles County Inter-Agency Council on Child Abuse and Neglect (ICAN) is the o�cial county agent coordinating the development of services for the prevention, identi�cation and treatment of child abuse and neglect. ICAN Associates is a private, nonpro�t corporation that works in partnership with ICAN to address these issues by providing services and materials, including sponsorship and coordination of media campaigns, community educational forums and projects, special events, newsletters, and funding. ICAN Associates provides support for direct and indirect services to prevent child abuse, and enables integration and collaboration among child service agencies. ICAN and ICAN Associates have partnered with First 5 LA to raise awareness about the Infant Safe Sleeping Campaign and save families from the preventable tragedy of losing an infant due to unsafe sleeping practices.

Safe Sleep for BabyL.A. County Infant Safe Sleeping CampaignSponsored through a partnership between the Los Angeles County Inter-Agency Council on ChildAbuse and Neglect (ICAN) and First 5 LA.

info@safesleepforbaby.com | www.safesleepforbaby.comICAN Associates, 4024 N. Durfee Ave., El Monte, CA 91732 (626) 455-4585

Contact Us

Frequently Asked Questions:

Is it safe to place a baby to sleep in a car seat or stroller?It's not safe to place a baby to sleep in a car seat or stroller because of the way the baby is positioned in these carriers. Babies should always be placed on their back to sleep. This is the only way to help make sure their mouth and nose remain unblocked so they can breathe properly.

Is it safe to use a sling?Slings are not safe for babies because they could block a baby's mouth or nose just as blankets and pillows in a crib or bassinet could block a baby's airway.

Can I swaddle my baby?Yes, swaddling is safe when a baby is small but be sure to use a light receiving blanket. Popular San Marcos blankets are dangerous because they are too heavy and warm for an infant. Once babies reach 5-6 months, they often don't want to be swaddled and parents can use a sleep onesie instead.

What if I am breastfeeding?Breastfeeding is encouraged. Remember to place baby to sleep in a safe separate sleep environment.

What if my baby likes sleeping on his stomach? What if this is the only way he'll sleep for long periods of time? The safest way for a baby to sleep is on his back. When babies sleep on their stomach or side, they are at risk of choking or su�ocating.

My baby has breathing problems/My baby was born prematureWhat's the best way to place my baby to sleep? If your baby has a medical condition, talk to your medical practitioner, pediatrician or doctor about any special care your child may need.

I was told something different when I gave birth at the hospital. The information and recommendations by the Infant Safe Sleeping Campaign are based on data gathered by the L.A. County Coroner's O�ce, which investigates all unexplained infant deaths in the county, and from the American Academy of Pediatrics.t

ican4kids.org

Every 5 days, a baby in L.A. County suffocates while sleeping.

Is your baby sleeping safely?

SafeSleepForBaby.cominfo@safesleepforbaby.com

Share a room, not a bed

Lay baby down to sleepin a crib or bassinet

Place babies on theirback every time— atnight and for naps

Give babies space tobreathe — no pillows,bumpers, blanketsor toys

1

2

3

4

ican4kids.org

The Los Angeles County Inter-Agency Council on Child Abuse and Neglect (ICAN) is the o�cial county agent coordinating the development of services for the prevention, identi�cation and treatment of child abuse and neglect. ICAN Associates is a private, nonpro�t corporation that works in partnership with ICAN to address these issues by providing services and materials, including sponsorship and coordination of media campaigns, community educational forums and projects, special events, newsletters, and funding. ICAN Associates provides support for direct and indirect services to prevent child abuse, and enables integration and collaboration among child service agencies. ICAN and ICAN Associates have partnered with First 5 LA to raise awareness about the Infant Safe Sleeping Campaign and save families from the preventable tragedy of losing an infant due to unsafe sleeping practices.

L.A. County Infant Safe Sleeping Campaign

Home Visit Safety Checklist for Providers

Is your baby sleeping safely?

SafeSleepForBaby.com

Things to look for:

A separate sleeping space for the baby.

Crib or bassinet in the room.

Baby not sharing a bed.

This separate sleeping space should have:

A �rm mattress with a �tted sheet.

No bedding (blankets, pillows, bumpers).

No clutter (stu�ed animals, toys).

Room temperature should not be too warm.

If room temperature is comfortable for an adult, no extra heat is needed. No smoking in the area.

ican4kids.org

Please share these infant safe sleeping tips with all new

mothers/fathers, caregivers and

grandparents:

On the back to sleep for every sleep. Parents and caregivers should alw

ays place infants on their backs for naps and at night.

Place babies to sleep on a firm sleep surface. A

crib, bassinette or portable crib/play yard w

ith a firm m

attress is recomm

ended.

Keep your baby’s sleep area close to, but separate from

where you and others

sleep. Room

sharing without bed-sharing is recom

mended.

Keep soft objects and loose bedding out of the crib to reduce the risk of SID

S and suffocation. Soft objects, such as pillow

s and pillow-like toys, blankets, and bum

per pads should be kept out of a baby’s sleeping environm

ent.

Breastfeeding is recom

mended, as it is associated w

ith a reduced risk of SIDS.

Mothers should be careful about breastfeeding in bed or any situation w

here you may

fall asleep with your baby w

hile breastfeeding. Always place the baby back in his or

her crib or bassinette once breastfeeding is done.

Regulate your baby’s tem

perature never allowing them

to get overheated. Heavy

blankets and warm

rooms are not recom

mended for babies as each m

ight lead to the overheating of the baby. The area w

here the baby sleeps should be well ventilated at a

temperature that is com

fortable to a lightly clothed adult.Supervised, aw

ake “tumm

y time” is recom

mended. A

lthough babies should always

be placed to sleep on their backs for naps and at night, supervised, awake “tum

my

time” is recom

mended on a daily basis.

For materials, including our Safe Sleep for B

aby Tool K

it, please visit w

ww

.safesleepforbaby.com or call (626) 455-4585

The Los Angeles C

ounty Inter-Agency C

ouncil on Child

Abuse and N

eglect (ICA

N) is the official C

ounty agent coordinating the developm

ent of services for the prevention, identification and treatm

ent of child abuse and neglect. ICA

N

Associates is a private, non-profit corporation that w

orks in partnership w

ith ICA

N to address these issues through

providing services and materials, including sponsorship and

coordination of media cam

paigns, comm

unity educational forum

s and projects, special events, newsletters, and funding.

ICA

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ssociates provides support for direct and indirect services to prevent child abuse, and enables integration and collaboration am

ong child service agencies. ICA

N and IC

AN

A

ssociates have partnered with First 5 LA

in this two-year

Infant Safe Sleeping Cam

paign to raise awareness and

educate about

infant unsafe

sleeping practices

to save

families from

the preventable tragedy of losing their young infants due to unsafe sleeping practices.

info@safesleepforbaby.com

| ww

w.safesleepforbaby.com

| ICAN

Associates, 4024 N

. Durfee Ave., El M

onte, CA 91732 | (626) 455-4585

Co

ntact U

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IS YO

UR B

AB

Y SLE

EP

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AFE

LY?

Don

't wa

ke up

to traged

y

LA

CO

UN

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FA

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AFE S

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AM

PA

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Sponsored through a partnership between

Los Angeles C

ounty Inter-agency Council on C

hild Abuse and N

eglect (ICA

N) and First 5 LA

Over the past three years in Los A

ngeles County, m

ore than 200 infants under the age of one have died as a result of unsafe sleep practices. That represents one baby every five days. U

nsafe sleeping practices include babies (1) accidentally smothered w

hile co-sleeping with parents or (2) suffocated by excess item

s, including stuffed toys/blankets, in the sleeping area.

Unsafe sleeping is the leading preventable cause of infant death in Los A

ngeles County.

ican4kids.org

LOS ANGELES COUNTY INFANT SAFE SLEEPING CAMPAIGN PLEDGE(1 Day to 1 Year)

PLEDGE TO USE INFANT SAFE SLEEPING PRACTICES

I, _______________________________________________________, have learned the importance of a safe place for babies when they sleep.

• I understand that infants can be accidentally suffocated both by items or by people next to a sleeping baby.

• I understand that it is safest for infants to room-share but not bed-share.

• I understand that it is safest for infants to sleep in a space of their own (crib or bassinette.)

• I understand that crib bumper pads, soft toys, soft bedding and blankets are too dangerous to be placed in an infant’s sleeping area (crib or bassinette.)

• I understand that unsafe sleeping is the number one preventable cause of infant death in Los Angeles County.

I pledge to use infant safe sleeping practices to join the effort to help prevent these tragic deaths.

Signed by:

___________________________________________________________Name Date

LA COUNTY INFANT SAFE SLEEPING CAMPAIGN Sponsored through a partnership between

Los Angeles County Inter-agency Council on Child Abuse and Neglect (ICAN) and First 5 LA

info@safesleepforbaby.com | www.safesleepforbaby.com | ICAN Associates, 4024 N. Durfee Ave., El Monte, CA 91732 | (626) 455-4585

ican4kids.org

LOS ANGELES COUNTY INFANT SAFE SLEEPING CAMPAIGN PROVIDER PLEDGE

(1 Day to 1 Year)

ACKNOWLEDGEMENT OF RECEIPT OF IMPORTANT INFORMATION ON INFANT SAFE SLEEPING

AND PLEDGE TO SHARE INFORMATION ABOUT INFANT SAFE SLEEPING PRACTICES

I, _______________________________________________________, attended a presentation about Infant Safe Sleeping arranged by the Los Angeles County Infant Safe Sleeping Campaign and understand the importance of the information presented. I also received “Safe Sleep Tips for Infants” brochures in English and Spanish. I understand that infants can be accidentally suffocated both by bed-sharing with adults or by clutter in the infant’s sleeping area, including toys, blankets and other soft items placed near the infant. I understand that it is safest for infants to room-share but not bed-share with an adult and that the safest sleeping surfaces are clutter free (no blankets, pillows, toys, crib bumper pads, etc.), not on a soft surface (e.g., soft bedding, sofas, chairs etc.) and in a space of their own (crib or bassinette). I have learned that unsafe sleeping is the leading cause of preventable infant death in Los Angeles County.

As a professional/active community member, I pledge to share information about safe sleeping for infants and teach others about unsafe sleeping practices for infants. I will also provide this important information with the families with whom I work who may be providing care for infants or who know of others who are caring for infants.

I will do what I can to join in the effort to help prevent these tragic deaths.

Signed by:

________________________________________________________________________________________Name Title, Organization Date

_________________________________________________________________________________Phone E-Mail Address

LA COUNTY INFANT SAFE SLEEPING CAMPAIGN Sponsored through a partnership between

Los Angeles County Inter-agency Council on Child Abuse and Neglect (ICAN) and First 5 LA

info@safesleepforbaby.com | www.safesleepforbaby.com | ICAN Associates, 4024 N. Durfee Ave., El Monte, CA 91732 | (626) 455-4585

ican4kids.org

QUIZ1. Of these, what is the leading preventable cause of deaths for infants (1 day to 1 year old) in Los Angeles County?

a. Shaken Baby Syndromeb. Failure to Thrivec. Automobile Accidents (improper use of car seats)d. Unsafe sleeping environments

2. True/False: Infants are more vulnerable to sleeping related deaths in the first six months.a. Trueb. False

3. True/False: Every 5 days in L.A. County, an infant under the age of 1 suffocates while sleeping.a. Trueb. False

4. Which of the following is not a cause of infant unsafe sleeping related deaths? a. Overheatingb. Sleeping Alonec. Airway obstructiond. Suffocation

5. True/False: The safest way to prepare a crib is by placing pillows, blankets and a bumper pad in it.a. Trueb. False

6. True/False: Infants placed to sleep on their backs will choke on their own throw-up.a. Trueb. False

7. What is the safest position to place an infant to sleep?a. On their backb. On their sidec. On their stomach

8. Infants should be placed to sleep on a ________ mattress?a. Firmb. Softc. Adultd. Foam

9. The American Academy of Pediatrics does NOT recommend which of the following:a. Room sharing without bed-sharingb. Using pacifiers, as they reduce the risk of SIDSc. Breastfeedingd. Infants may sleep on their sides for naptime, but must sleep on their backs during the nighttime

10. True/False: Supervised “tummy time” includes allowing an infant to sleep on their stomach?a. Trueb. False

11. True/False: Infant sleeping related deaths are preventable?a. Trueb. False

ANSWERS1. Of these, what is the leading preventable cause of deaths for infants (1 day to 1 year old) in Los Angeles County?

a. Shaken Baby Syndromeb. Failure to Thrivec. Automobile Accidents (improper use of car seats)d. Unsafe sleeping environments

2. True/False: Infants are more vulnerable to sleeping related deaths in the first six months.a. Trueb. False

3. True/False: Every 5 days in L.A. County, an infant under the age of 1 suffocates while sleeping.a. Trueb. False

4. Which of the following is not a cause of infant unsafe sleeping related deaths? a. Overheatingb. Sleeping Alonec. Airway obstructiond. Suffocation

5. True/False: The safest way to prepare a crib is by placing pillows, blankets and a bumper pad in it.a. Trueb. False

6. True/False: Infants placed to sleep on their backs will choke on their own throw-up.a. Trueb. False

7. What is the safest position to place an infant to sleep?a. On their backb. On their sidec. On their stomach

8. Infants should be placed to sleep on a ________ mattress?a. Firmb. Softc. Adultd. Foam

9. The American Academy of Pediatrics does NOT recommend which of the following:a. Room sharing without bed-sharingb. Using pacifiers, as they reduce the risk of SIDSc. Breastfeedingd. Infants may sleep on their sides for naptime, but must sleep on their backs during the nighttime

10. True/False: Supervised “tummy time” includes allowing an infant to sleep on their stomach?a. Trueb. False

11. True/False: Infant sleeping related deaths are preventable?a. Trueb. False

LA COUNTY INFANT SAFE SLEEPING CAMPAIGN Sponsored through a partnership between

Los Angeles County Inter-agency Council on Child Abuse and Neglect (ICAN) and First 5 LA

info@safesleepforbaby.com | www.safesleepforbaby.com | ICAN Associates, 4024 N. Durfee Ave., El Monte, CA 91732 | (626) 455-4585

ican4kids.org

QUIZ1. Of these, what is the leading preventable cause of deaths for infants (1 day to 1 year old) in Los Angeles County?

a. Shaken Baby Syndromeb. Failure to Thrivec. Automobile Accidents (improper use of car seats)d. Unsafe sleeping environments

2. True/False: Infants are more vulnerable to sleeping related deaths in the first six months.a. Trueb. False

3. True/False: Every 5 days in L.A. County, an infant under the age of 1 suffocates while sleeping.a. Trueb. False

4. Which of the following is not a cause of infant unsafe sleeping related deaths? a. Overheatingb. Sleeping Alonec. Airway obstructiond. Suffocation

5. True/False: The safest way to prepare a crib is by placing pillows, blankets and a bumper pad in it.a. Trueb. False

6. True/False: Infants placed to sleep on their backs will choke on their own throw-up.a. Trueb. False

7. What is the safest position to place an infant to sleep?a. On their backb. On their sidec. On their stomach

8. Infants should be placed to sleep on a ________ mattress?a. Firmb. Softc. Adultd. Foam

9. The American Academy of Pediatrics does NOT recommend which of the following:a. Room sharing without bed-sharingb. Using pacifiers, as they reduce the risk of SIDSc. Breastfeedingd. Infants may sleep on their sides for naptime, but must sleep on their backs during the nighttime

10. True/False: Supervised “tummy time” includes allowing an infant to sleep on their stomach?a. Trueb. False

11. True/False: Infant sleeping related deaths are preventable?a. Trueb. False

ANSWERS1. Of these, what is the leading preventable cause of deaths for infants (1 day to 1 year old) in Los Angeles County?

a. Shaken Baby Syndromeb. Failure to Thrivec. Automobile Accidents (improper use of car seats)d. Unsafe sleeping environments

2. True/False: Infants are more vulnerable to sleeping related deaths in the first six months.a. Trueb. False

3. True/False: Every 5 days in L.A. County, an infant under the age of 1 suffocates while sleeping.a. Trueb. False

4. Which of the following is not a cause of infant unsafe sleeping related deaths? a. Overheatingb. Sleeping Alonec. Airway obstructiond. Suffocation

5. True/False: The safest way to prepare a crib is by placing pillows, blankets and a bumper pad in it.a. Trueb. False

6. True/False: Infants placed to sleep on their backs will choke on their own throw-up.a. Trueb. False

7. What is the safest position to place an infant to sleep?a. On their backb. On their sidec. On their stomach

8. Infants should be placed to sleep on a ________ mattress?a. Firmb. Softc. Adultd. Foam

9. The American Academy of Pediatrics does NOT recommend which of the following:a. Room sharing without bed-sharingb. Using pacifiers, as they reduce the risk of SIDSc. Breastfeedingd. Infants may sleep on their sides for naptime, but must sleep on their backs during the nighttime

10. True/False: Supervised “tummy time” includes allowing an infant to sleep on their stomach?a. Trueb. False

11. True/False: Infant sleeping related deaths are preventable?a. Trueb. False

LA COUNTY INFANT SAFE SLEEPING CAMPAIGN Sponsored through a partnership between

Los Angeles County Inter-agency Council on Child Abuse and Neglect (ICAN) and First 5 LA

info@safesleepforbaby.com | www.safesleepforbaby.com | ICAN Associates, 4024 N. Durfee Ave., El Monte, CA 91732 | (626) 455-4585

ican4kids.org

Which is safe?

A

B

D

C

E

None of the Above

Is Your Baby Sleeping Safely?

Why?

LA COUNTY INFANT SAFE SLEEPING CAMPAIGN Sponsored through a partnership between

Los Angeles County Inter-agency Council on Child Abuse and Neglect (ICAN) and First 5 LA

info@safesleepforbaby.com | www.safesleepforbaby.com | ICAN Associates, 4024 N. Durfee Ave., El Monte, CA 91732 | (626) 455-4585

ican4kids.org

Which is safe?

A

B

D

C

E

None of the Above

Is Your Baby Sleeping Safely?

Why?

LA COUNTY INFANT SAFE SLEEPING CAMPAIGN Sponsored through a partnership between

Los Angeles County Inter-agency Council on Child Abuse and Neglect (ICAN) and First 5 LA

info@safesleepforbaby.com | www.safesleepforbaby.com | ICAN Associates, 4024 N. Durfee Ave., El Monte, CA 91732 | (626) 455-4585

ican4kids.org

Answer: None

70 babies die each year from unsafe sleeping in LA County.Unsafe sleeping is the leading preventable cause of

infant death in Los Angeles County.Don't wake up to a tragedy.

LA COUNTY INFANT SAFE SLEEPING CAMPAIGN Sponsored through a partnership between

Los Angeles County Inter-agency Council on Child Abuse and Neglect (ICAN) and First 5 LA

info@safesleepforbaby.com | www.safesleepforbaby.com | ICAN Associates, 4024 N. Durfee Ave., El Monte, CA 91732 | (626) 455-4585

This is Safe.

ican4kids.org

Maternal and Child Health Access 12/12

Safe Sleep

It is very important that your baby have a safe sleeping area. In the first year of life, babies are at risk of Sudden Infant Death Syndrome (SIDS) and some babies die while sleeping because they suffocate. Suffocation happens when an infant’s nose is blocked even for a short time by a pillow, stuffed animal, blanket or other object.

You can reduce your baby’s risk of SIDS and suffocation:

Breastfeed: Nursing your baby reduces the risk of SIDS.

Back to sleep: Your baby should always sleep on his or her back, not on his/her side or stomach.This includes naps.

Smoke-free: No one should smoke around your baby.

The sleeping surface must be firm and flat: Waterbeds, bean bag chairs, sagging mattresses, sofas,couches, and armchairs are very dangerous. Babies should never sleep on any of these.

Keep soft objects out of sleep area: There should be no pillows, heavy blankets, comforters, quilts,stuffed animals, crib bumpers, or other soft items in baby’s sleep area.

Don’t overheat your baby: Dress your baby in light sleep clothing and keep the room at atemperature that is comfortable for you. Do not wrap your baby in blankets, especially thickpolyester blankets that can overheat baby. Popular San Marcos blankets are dangerous becausethey are too heavy and warm for an infant. A sleep sack or footed pajamas are best.

The safest place for your baby is in the same room with you, especially in a bassinet or crib next to your bed or a co-sleeper attached to your bed. This will make it easier to feed, comfort and monitor your baby during the night.

If baby sleeps with you in your bed, follow these guidelines in addition to those above to make it as safe as possible:

Do not bring your baby into your bed with you if youor your partner have drunk alcohol, used drugs ortaken medications that will make you extra sleepy.

Pets and other children should not be in the samebed with your baby.

Do not sleep with your baby if you or your partnersmoke cigarettes.

Do not sleep with your baby on a waterbed, saggingmattress, bean bag chair, sofa, couch, recliner, orarmchair.

Do not put your baby on twin beds that have beenpushed together.

Maternal and Child Health Access 12/12

Sueño Seguro

Es muy importante que su bebé tenga un área donde pueda dormir de manera segura. En el primer año de vida, los bebés corren el riesgo del Síndrome de Muerte Repentina Infantil (SIDS por sus siglas en inglés o “Muerte de cuna”) y algunos han muerto de asfixia mientras dormían. La asfixia ocurre cuando la nariz del bebé es bloqueada incluso por un corto tiempo por una almohada, un muñeco de peluche, una cobija u otro objeto.

Usted puede reducir el riesgo de Síndrome de Muerte Repentina Infantil y asfixia para su bebé:

Amamantar: Dar pecho reduce el riesgo de muerte de cuna.

Ponga a su bebé a dormir boca arriba: Su bebé siempre debe dormir sobre su espalda, no de lado o boca abajo. Esto también es necesario durante las siestas.

Un ambiente libre de humo: Nadie debe fumar cerca de su bebé.

La superficie donde duerme debe ser firme y plana: Las camas de agua, los colchones hundidos, los sofás y los sillones son muy peligrosos. Los bebés nunca deben dormir en alguno de éstos.

Mantenga los objetos suaves fuera del área de dormir: No debe haber almohadas, cobijas pesadas, colchas, muñecos de peluche, protectores de cuna u otros artículos blandos en el área de dormir del bebé.

No deje que su bebé tenga demasiado calor al dormir: Vista a su bebé con ropa de dormir ligera y mantenga el cuarto a una temperatura que sea cómoda para usted. No lo envuelva en cobijas, especialmente mantas gruesas de poliéster que puedan sobrecalentar al bebé. Las cobijas como la San Marcos son peligrosas porque son demasiado pesadas y calientes para un bebé. Los sacos de dormir o mamelucos son los mejores.

El lugar más seguro para su bebé es cerca de usted en la misma habitación, especialmente en un moisés o cuna junto a su cama o en una co-cama unida a la suya. Esto hará más fácil darle de comer, reconfortarlo y monitorear a su bebé durante la noche.

Si su bebé duerme con usted en su cama, hay otras precauciones que debe tomar, además de las recomendaciones anteriores: No acueste a su bebé en la cama con usted si usted o su

pareja han bebido alcohol, usado drogas o han tomado medicamentos que producen somnolencia.

Las mascotas y otros niños no deben dormir en la misma cama con su bebé.

No duerma con su bebé si usted o su pareja fuma.

No duerma con su bebé en una cama de agua, un colchón hundido, un sofá, un sillón, o un sillón reclinable.

No ponga a su bebé en camas gemelas que han sido Empujadas juntas.