Food Instrument Issuance for Breastfeeding Infants and Mothers

NCHS WIC Program

# Purpose

The WIC program has a Federal mandate to promote and support
breastfeeding. Extensive research, especially in recent years, documents
diverse and compelling advantages to infants, mothers, families and
society from breastfeeding and the use of human milk.

> Breastfeeding success is dependent upon the protection of a mother's
> milk supply. The amount of milk a mother produces depends on the
> frequency and effectiveness of the baby's suck at the breast. Early
> supplements of artificial baby milk (formula) are associated with
> breastfeeding complications and early weaning. Giving supplements of
> artificial baby milk during the first 4 weeks is generally detrimental
> to successful breastfeeding.

# Policy Statement

To ensure a mother's milk supply is fully established, artificial baby
milk will not be provided to breastfed babies before they complete 4
weeks of age, unless medically indicated. Any request for artificial
baby milk by a breastfeeding mother (regardless of infant's age) must be
appropriately assessed by qualified staff to determine the
appropriateness of supplementation for the infant.

# Procedures

1.  During the prenatal period, all pregnant women should be made aware
    of the policy that NCHS WIC does not routinely give formula to
    breastfed infants that are less than 1 month of age. This should be
    done at least at the prenatal enrollment and during the
    breastfeeding class that is given the month before the baby is due.

2.  **For an infant less than 4 weeks old:**

    i.  An **exclusively breastfed** infant should receive the "IBE"
        packet and the mother should receive the "PBE" (or the "BE" if
        she is also being enrolled as a breastfeeding mother or has had
        her PPSR).

    ii. The **combination** breastfed and formula fed infant that is
        less than 4 weeks old will not receive vouchers for formula
        unless medically indicated. The infant should receive the "IBE"
        and the mother should receive the "PBE/BE" packet.

    iii. A fully formula fed infant should receive the "IFC" packet or
         equivalent. The mother should get the "PON" or "NS".

    iv. The exceptions to this policy are extremely rare and should be
        made only after extensive evaluation and counseling by the RD or
        breastfeeding specialist. The minimum amount of acceptable
        formula will be issued and the infant and mother will continue
        to be monitored as appropriate for the situation.

3.  **For an infant more than 1 month old:**

    i.  The mothers should be praised for breastfeeding efforts and
        encouraged to continue exclusively breastfeeding.

    ii. If the baby is being exclusively breastfed, he/she should
        continue to get the IBE packet, or equivalent depending on the
        age of the infant and the mother should get the BE packet.

    iii. If they are combination feeding, or the mother requests
         formula, try to trouble shoot the reason the formula is being
         used or requested. The counseling can be done by the clerical
         staff or can be passed on to a counselor depending on the
         situation. Inform mother of alternatives to formula such as
         manual or electric breast pumps, ways to increase milk supply,
         other medicinal options or whatever issue needs addressing.

    iv. If even after counseling the mother insists on formula, change
        the infant's and the mother's prescription to the following:

+-----------------------+-------------------------+--------------------+
| **Infant Intake**     | **Infant's              | **Mother's**       |
|                       | Prescription**          |                    |
|                       |                         | **Prescription**   |
+-----------------------+-------------------------+--------------------+
| Exclusive             | IBE/IBC/IBCJ            | PBE/BE             |
| Breastfeeding         |                         |                    |
+-----------------------+-------------------------+--------------------+
| Combination Feeding:  | A. IBE                  | A. PBE/BE          |
|                       |                         |                    |
| A. Infant less than   | B. ICC                  | B. PS/BC1          |
| 4wks old              |                         |                    |
|                       |                         |                    |
| B. Infant less than 4 |                         |                    |
| wks old with the      |                         |                    |
| approval of           |                         |                    |
| supervisor due to     |                         |                    |
| extenuating           |                         |                    |
| circumstances.        |                         |                    |
+-----------------------+-------------------------+--------------------+
| Combination Feeding   | ICC/ICCC/ICCJ           | BC1                |
|                       |                         |                    |
| (After age 4wks)      | Enter in ISIS:          |                    |
|                       |                         |                    |
|                       | -   For 1-20 oz/day,    |                    |
|                       |     enter \# of oz. or  |                    |
|                       |     \# of cans up to 7  |                    |
|                       |     of 9 cans or 24     |                    |
|                       |     cans of             |                    |
|                       |     concentrate.        |                    |
|                       |                         |                    |
|                       | -   For 21+ oz/day,     |                    |
|                       |     enter max number of |                    |
|                       |     cans (7 or 24).     |                    |
+-----------------------+-------------------------+--------------------+
| Combination Feeding   | ICC/ICCC/ICCJ           | BC2( if the mother |
|                       |                         | has no medical     |
| (After age 4wks and   | Enter in ISIS quantity  | risks)             |
| needs more than 7     | of formula used/24hrs.  |                    |
| cans of powder or 24  |                         | BC1(if the mother  |
| cans concentrate)     |                         | has a medical risk |
|                       |                         | or it is deemed    |
|                       |                         | appropriate by the |
|                       |                         | RD.                |
+-----------------------+-------------------------+--------------------+
| Formula feeding only  | IFC/IFCC/IFCJ           | PON/NS             |
+-----------------------+-------------------------+--------------------+
|                       |                         |                    |
+-----------------------+-------------------------+--------------------+