Published online June 29, 2009
PEDIATRICS Vol. 124 No. 1 July 2009, pp. e104-e111 (doi:10.1542/peds.2008-3668)
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ARTICLE

State and Regional Variation in Regulations Related to Feeding Infants in Child Care

Sara E. Benjamin, PhD, MPH, RDa, Elsie M. Taveras, MD, MPHa,b, Angie L. Cradock, ScDc, Elizabeth M. Walker, MSd, Meghan M. Slining, MS, MPHe and Matthew W. Gillman, MD, SMa,f

a Obesity Prevention Program, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
b Division of Pediatrics, Children's Hospital Boston, Boston, Massachusetts
c Harvard Prevention Research Center and
f Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
d Center for Children's Health Innovation, Nemours Health and Prevention Services, Newark, Delaware
e Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina

OBJECTIVE: The purpose of this study was to compare state and regional variation in infant feeding regulations for child care facilities and to compare these regulations to national standards.

METHODS: We reviewed regulations for child care for all US states and Washington, DC, and examined patterns according to type of facility and geographic region. We compared state regulations with national standards for feeding infants in child care. The standards included were: (1) infants are fed according to a feeding plan from a parent or physician; (2) breastfeeding is supported by the child care facility; (3) no solid food is given before 6 months of age; (4) infants are fed on demand; (5) infants are fed by a consistent caregiver; (6) infants are held while feeding; (7) infants cannot carry or sleep with a bottle; (8) caregivers cannot feed >1 infant at a time; (9) no cow's milk is given to children <12 months of age; (10) whole cow's milk is required for children 12 to 24 months of age; and (11) no solid food is fed in a bottle.

RESULTS: The mean number of regulations for states was 2.8 (SD: 1.6) for centers and 2.0 (SD: 1.3) for family child care homes. No state had regulations for all 11 standards for centers; only Delaware had regulations for 10 of the 11 standards. For family child care homes, Ohio had regulations for 5 of the 11 standards, the most of any state. States in the South had the greatest mean number of regulations for centers (3.3) and family child care homes (2.2), and the West had the fewest (2.3 and 1.9, respectively).

CONCLUSIONS: Many states lacked infant feeding regulations. Encouraging states to meet best-practice national standards helps ensure that all child care facilities engage in appropriate and healthful infant feeding practices.

Key Words: breastfeeding • child care • infant feeding • nutrition • policies

Abbreviations: CFOC—Caring for Our Children

Accepted Mar 2, 2009.


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