Transcript BREASTFEEDING is - Louisiana Breastfeeding Coalition

Educating Physicians In Their Communities (EPIC)
BEST for Louisiana:
Breastfeeding Education
Support, & Training
1
Acknowledgement
EPIC BEST (Educating Practices [Physicians] In their Community –
Breastfeeding Education, Support and Training) is an American
Academy of Pediatrics, NJ Chapter/Pediatric Council on Research and
Education (AAP NJ/PCORE) curriculum (2011) developed with support
from the Centers of Disease Control and the NJ Department of Health
and Senior Services (Grant # 3U58DP002002-01S2). Use of any or all
content of EPIC BEST is to be acknowledged and any changes to the
content must have the prior approval of AAP NJ/PCORE.
2
Conflict of Interest/Disclosure
No relevant financial relationship(s) exist for any
of the program presenters, faculty and planners.
3
Objectives
At the end of this training, staff will be able to:
• Follow the AAP recommendations on human milk
• Define the link between breastfeeding and obesity
prevention
• Practice care coordination to support exclusive
breastfeeding
• Describe how breastfeeding support plays a role in
practices being obstetric and pediatric patients'
medical homes
• Create an office breastfeeding team
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BREASTFEEDING is ..….?
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“Normal Feeding”!
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Breastfeeding lowers the risk for:
•
•
•
•
•
•
Ear infections
Asthma, allergies, eczema
Bronchiolitis and Pneumonia
Diarrhea and vomiting
Necrotizing enterocolitis
Hospitalization
If 90% of US babies were
breastfed as recommended, 900
lives would be saved every
year, and $13 billion health care
dollars would be saved.
Bartick, M. and Reinhold, R., The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis.
Pediatrics. 2010
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Other benefits of Breastfeeding
“Dose Dependent”
Obesity
any Breastfeeding vs. None
Type 1 Diabetes Mellitus
BF > 3 months
Type 2 Diabetes Mellitus
any BF vs. None
Cancer:
1. ALL
2. AML
BF > 6 months
BF > 6 months
Sudden Infant Death
Syndrome
any BF vs. None
S. Ip, et al.
AHRQ Review
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Breastfeeding Protective Factors
for Mothers
1. Type 2 Diabetes Mellitus
breastfeeding for women
`
for each year of
2. Pre-menopausal Breast Cancer
breastfeeding
for each year of
3. Ovarian Cancer
for any vs. no breastfeeding
and evidence for dose response
4. Post-partum Depression
for short
breastfeeding vs. no breastfeeding
S. Ip, et al.. AHRQ Evid Rep Technology Assess. 2007 Apr;(153):1-186.
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Costs of Not Breastfeeding for Mothers
• The economic cost to society for women who
breastfeed less than recommended is predicted at
over
- $17.6 billion per year related to Heart attacks,
Hypertension, Breast cancer, Premenopausal ovarian cancer
& Type 2 Diabetes
• Low US breastfeeding rates are associated annually
with
- 5,000 cases of breast cancer
- 54,000 cases of hypertension
- 14,000 heart attacks in women
“Cost Analysis of Maternal Disease Associated with Suboptimal Breastfeeding,” Melissa C. Bartick, MD, MSc, Alison M. Stuebe, MD, MSc, Eleanor Bimla
Schwarz, MD, MS, Christine Luongo, MSc, Arnold G. Reinhold, MBA, and E. Michael Foster, PhD. Obstetrics & Gynecology, July 2013. Published online on June
6, 2013.
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Who can Breastfeed?
Almost All!
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AAP Breastfeeding Policy
Recommendations:
Clinicians and staff should:
• Recommend human milk for ALL infants, unless
medically contraindicated (rare contraindications)
• Support exclusive breastfeeding for the first 6 months
• Provide continued support for breastfeeding at least 1
year and beyond
• Provide parents with complete and current information
on the benefits and techniques of breastfeeding
AAP Policy Statement: Breastfeeding and the Use of Human Milk 2010 (Revised 2012)
See Resource CD!
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The Joint Commission (TJC)
Perinatal Care Core Measure
• TJC = Hospital Accreditation
• “Perinatal Care Core Measure on Exclusive Breast Milk
Use at Hospitals Discharge” (data collection)
• Exclusive breastfeeding includes:
– mother breastfeeding
– infant fed expressed mother’s milk
– infant fed human milk from approved milk bank
• Supplementation should be for rare medical reasons
with breast milk as the preferred supplement
• Top performing hospitals have less than 10% of healthy
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term infants supplemented
Reasons for
Discontinuing Breastfeeding
Partner
Someone Else to Feed
Soreness/cracked
Baby w/ difficulty
Work/School
Not enough milk
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Ahluwalia IB et al. Why Do Women Stop Breastfeeding? Findings from PRAMS. Pediatrics 2005.
Maternal Sleep and Breastfeeding
Women who breastfeed sleep just as well if not better than
formula feeding mothers
Montgomery-Downs, H. E. et al. Pediatrics 2010;126:e1562-e1568
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Obesity Trends* Among U.S. Adults
Behavior Risk Factor Surveillance System, 1990
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
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Obesity Trends* Among U.S. Adults
BRFSS, 1997
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
≥20%
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Obesity Trends* Among U.S. Adults
BRFSS, 1998
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
≥20%
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Obesity Trends* Among U.S. Adults
BRFSS, 2000
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
≥20%
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Obesity Trends* Among U.S. Adults
BRFSS, 2001
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
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Obesity Trends* Among U.S. Adults
BRFSS, 2004
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
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Obesity Trends* Among U.S. Adults
BRFSS, 2005
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
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Obesity Trends* Among U.S. Adults
BRFSS, 1990, 2000, 2010
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
2000
1990
2010
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
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When Does Obesity Begin?
Obesity often begins in infancy!
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How does breastfeeding prevent obesity?
Hormones and other factors in the milk?
Effects on the child’s metabolic system?
Baby learns early on to self-regulate his intake in
a more healthy way.
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Breastfeeding Leads to Self-Regulation
Exclusive breastfeeding
at breast
Combination breastfeeding
Formula feeding,
Breast/bottle
Expressed breast milk
in bottle
All formula in a bottle
27%
47%
56%
Percentage of
7-month-olds
who emptied
their bottles
according to
feeding method
68%
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Pediatrics. 2010 Jun;125(6):e1386-93. Epub 2010 May 10.
Breastfeeding Among U.S. Children
2000–2010
CDC National Immunization Survey
LA Ever:
60.6%
LA @ 6
mo: 31%
LA @ 12
mo: 15%
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Encourage and
Support Breastfeeding!
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© Addie Imseis and USBC, 2010
Influences on Breastfeeding Choice
GrandMother’s
Practices
Father’s
Opinions
To Breastfeed or
Not to
Breastfeed
Co-Worker’s
Viewpoints
Friend’s
Viewpoints
Role Modeled
Behaviors
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Everyone Has A Role In
Supporting Breastfeeding
•
•
•
•
Front Desk
Office Staff
Nursing Staff
PCP
– Clinical Management
– Identify appropriate referrals
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Office Environment/Support
• Pictures of breastfeeding
• “Breastfeeding Welcome Here”
decals
• Knowledgeable and supportive
reception and office staff
• Acceptance of public
breastfeeding
• Private space for
breastfeeding/pumping
(especially for breastfeeding
staff)
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What message do you send?
From the Ross employee manual…
“Never underestimate the role
of nurses. If they are sold and
serviced properly they can be
strong allies. A nurse who
supports Ross is like another
salesman.”
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See Resource CD!
The Medical Home
Community Resource Model
Parenting Support
Early
Intervention
Preventive
Care
Home-visiting
network
Primary Care
Medical Home
Developmental
Services
Developmental
Services
See Resource CD!
Lactation Support
Early Child
Mental
Health
Services
Acute
Care
Early Care
and Education
Chronic
Care
Child Care Resource
and Referral Agency 33
Breastfeeding and Health Care Reform
• 2010 Patient Protection and Affordable
Care Act
• Section 7(r) of the Fair Labor Standards
Act – Break Time for Nursing Mothers
Provision
 reasonable break time and suitable space
to express breast milk after the birth of her
child.
• More recent laws mandate insurance
coverage of breastfeeding supplies and
support.
Find Federal Support for Breastfeeding Resources at www2.aap.org/breastfeeding.
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Help mothers know their rights!
Louisiana Regulations include:
• A mother can breastfeed her infant in any place that a mother
and her infant have a right to be.
• Child care centers cannot discriminate against breastfed infants.
• HB 635, Act No. 87- Enacts R.S. 17:81(W), requires city, parish,
and other local public school boards to adopt policies to require
schools to provide certain accommodations for employees to
express breast milk.
• Act 331 of the 2011 Regular Session of the Louisiana Legislature
enacts La. R.S. 47:305.67 to create an exemption from state
sales and use tax for breastfeeding items beginning October 1,
2011.
For more info, visit:
www.louisianabreastfeedingcoalition.org/legislation/louisiana-laws/
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Working mothers need support
© USBC 2010
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Providing Anticipatory Guidance
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© USBC 2010
Are you talking about breastfeeding?
A recent study of prenatal breastfeeding discussions
at the University of Pittsburgh School of Medicine:
• Published Dec 2013 in Obstetrics and Gynecology
• 172 first pre-natal visits were audio-recorded
• 36 OB residents, 6 midwives, and 5 nurse
practitioners
• Less than 1/3 of visits included discussion of BF
• Only 2% included explicit recommendations that BF
is superior to artificial feeding
Demirci JR, Bogen DL, Holland C, Tarr JA, Rubio D, Li J, Nemecek M, Chang JC.
Characteristics of breastfeeding discussions at the initial prenatal visit. Obstet Gynecol. 2013 Dec;122(6):1263-70
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Start the Conversation…
the Sooner, the Better!
On Initial History and Physical, ask:
• “Any past surgeries or problems with your
breasts?” (only if interested in BF info.)
• “How did you feed your other babies?”
• “Have you thought about how you’ll
feed this baby?”
• “What do you think/know about
breastfeeding?”
– Avoid asking “breast or bottle?”
– Use open-ended questions.
– Avoid forcing her to state a clear feeding plan.
See Resource CD!
http://massbreastfeeding.org/providers/bfprenatal/
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Other questions to ask during
initial history/physical
• If she has breastfed before: “How long did you breastfeed for? Why did
you stop? Are you still breastfeeding? Any problems with
breastfeeding?” Past problems are a red flag.
• “What made you choose bottle feeding?” Acknowledge concerns and
explore beliefs.
• “Did you know that breastfeeding is healthier for you? It’s linked with a
lower risk of breast cancer, ovarian cancer, and osteoporosis. It may
lower risks of many lifelong chronic diseases in your child, such as
diabetes and obesity.”
• If mother has a personal or family history of other diseases linked with
lower rates of breastfeeding (e.g., inflammatory bowel disease,
diabetes, etc.), she should know that her child may be at particular risk.
You may be the only person to tell her this information.
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http://massbreastfeeding.org/providers/bfprenatal/
Incorporating Breastfeeding
into Prenatal Care
On subsequent visits:
• “Are you noticing changes in your breasts?” Use as an
opportunity to tell her “Your breasts are getting ready to
make milk,” and to continue to explore concerns mentioned
earlier. Can check (or teach mom to check) nipples for
inversion and breasts for asymmetry.
• “How does your partner feel about breastfeeding?” Include
partner in discussions. Discuss benefits to a mother’s health,
bonding, and benefits to child’s health. Acknowledge
partner’s concerns.
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http://massbreastfeeding.org/providers/bfprenatal/
At later visits…prepare mothers to
receive supportive practices
• Skin-to-skin
• Early breastfeeding initiation
• No supplementation unless
medically indicated
• Feeding on cue (watch the
baby, not the clock!)
• Rooming-in day and night
• Make her aware of
postpartum resources
© USBC 2010
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Family Centered Care
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Caring for the Dyad
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© USBC 2010
First Pediatric Visit
• Ask open-ended questions
• How is breastfeeding
going?
• Tell me about your baby’s
latch.
• What are your
expectations?
• Who is your support
system?
Give Encouragement, Support and Praise!
*Reinforce that frequent feeding is not an indicator of
insufficient milk supply.
See Resource CD!
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Signs of Breastfeeding Success
Frequent:
-Feed on cue 8 -12 times in 24 hrs
Effective:
-Visual or audible swallowing
-Adequate wet and dirty diapers
-Breastfeeding does not hurt!
Exclusive:
-Baby regulates milk supply and
learns to suckle effectively
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Visual or Audible Swallowing
Click on the picture to link to the video
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Anatomy of Breast, Baby's Mouth,
Latch and Suckling
See Resource CD!
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Common Concerns
• Sore Nipples
• Fussy Baby
• Milk Supply
• Weight Gain
• Medications
• Loss of independence
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Tongue Tie
Photo Courtesy of Jane Morton, MD
Courtesy of Kay Hoover, MEd, IBCLC
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Jaundice
• Breastfeeding jaundice:
 Assess etiology and management (AAP Guidelines)
 Exclusive breastfeeding can usually be preserved
 Ensure frequent feedings and adequate voiding
output
• Breast milk jaundice
 Not dangerous
 May persist for weeks
 Verify indirect bilirubin
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Late Preterm Infant
• Tires easily
• Disorganized suck-swallow-breathe
• Weak suck, low tone, inability to sustain
sucking
• At risk for apnea; inadequate lung volume
• Potential delay in lactogenesis (milk
production) due to preterm birth and some
maternal conditions
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International Board Certified
Lactation Consultants
• Provides specialized
lactation care
• Evaluates and helps
prevent & resolve
breastfeeding
challenges
• Collaborates with
health care providers
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2-4 Week Pediatric Visit
1. Support exclusive breastfeeding
2. Discuss “cluster feedings”
3. Continue to promote “ad lib” feeds
4. Reassess weight and concerns for low milk supply
5. Inquire about mother’s diet, medications , birth
control plans, and plans to return to work
6. Ask about other caregivers’ support
7. Anticipate an eventual possible need for pumping and
storing milk
Give Encouragement, Support and Praise!
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Fussy/ Colicky Baby
• Common reason for
formula introduction and
early weaning
• Interpreted by parents as
“mother does not have
enough milk,” which in most
cases is not reason for baby’s
fussiness or frequent cues
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Concerns for Low Milk Supply / Weight Gain
• Many times it is a perception and not a reality
• Prevention through self-confidence and relaxation
• Fears increase risks of formula introduction and early
weaning
• Assessment is required
• Best assessment is weight
check
• Consider referral to lactation
consultant if low milk supply or
slow weight gain is established
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Check It Out Before Saying No!
Medications and Breastfeeding
• Most medications are compatible
with breastfeeding
• Evidence-based resources
– LactMED
– AAP Policy Statements/Papers
“The Transfer of Drugs and Therapeutics into
Human Breast Milk: An Update on Selected
Topics”
Medications and Mother’s Milk,
by Thomas Hale, PhD
– Infant Risk Center
–
See Resource CD!
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4-8 Week Pediatric Visit
•
•
•
•
•
•
Continue to ask open-ended questions
Review safe breastfeeding/sleeping environment
Assess back-to-work or school issues
Discuss signs of mastitis
Discuss changes in stooling pattern
Provide positive messages!
Give Encouragement, Support and Praise!
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Returning to Work or School
Influencing factors
•
•
•
•
•
Type of work
Worksite accommodations
Baby’s age upon return
Support system
Child care arrangements
www.louisianabreastfeedingcoalition.org/community/child-care-centers/
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First Maternal Care Visit
• Assess the breast
• Look out for
–
–
–
–
Mastitis
Nipple infections
Milk production
Breast masses
• Discuss contraception
Continue to Give Encouragement, Support and Praise!
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2-4 Month Pediatric Visit
• Delay introduction of complementary foods
until 6 months
• Continue to support exclusive breastfeeding!
• Continue to support breastfeeding through
any transitions back to work/school
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Don't Miss Opportunites to Support
Breastfeeding at Sick Visits
Continue breastfeeding through:
• Gastroenteritis
• Colds
• Flu
• Ear infections
• Urinary Tract Infection (UTI)
• Vaginitis
“Use every patient encounter
to promote and support continued breastfeeding.”
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Older Child
Discuss and review:
• Continued breastfeeding
benefits for one year and
older
• Perfectly normal!
• Public perception varies
• After weaning, earlier
return of ovulation and
menstrual cycle for mother
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Breastfeeding During Pregnancy
• Breastfeeding during a subsequent pregnancy is not
unusual.
• If the pregnancy is normal and the mother is healthy,
breastfeeding during pregnancy is the woman's
personal decision.
• If the nursing child is less than 2 yrs., then weaning
increases the child’s risk for illness.
• Breastfeeding the older child after delivery of the
next child (tandem nursing) may help provide a
smooth transition psychologically for the older child.
Breastfeeding, Family Physicians Supporting (Position Paper). Accessed from
http://www.aafp.org/about/policies/all/breastfeeding-support.html.
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Community Breastfeeding Support
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Community and Peer Support
• WIC Staff and WIC peer counselors
• La Leche League groups
• Local hospital support groups and
outpatient lactation clinics
• The Louisiana Breastfeeding Coalition
www.louisianabreastfeedingcoalition.org
• Find breastfeeding resources and support
by zip code at www.zipmilk.org
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Louisiana’s WIC Mission and Vision
• Mission: To safeguard the health of low-income
women, infants, and children up to age 5 who are
at nutrition risk by providing nutritious foods to
supplement diets, information on healthy eating,
and referrals to health care
• Vision: WIC is the go-to resource for nutrition and
wellness for income-eligible families
See Resource CD!
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WIC Policy
• Each WIC site shall designate and
train a staff person to coordinate
breastfeeding promotion and
assistance to participants and
staff.
• Each WIC site shall provide
breastfeeding support equipment
for breastfeeding women
requiring assistance.
WIC Provides Breast Pumps!
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Prenatal Breastfeeding
Referrals and Education
• All prenatal women shall receive
– information, encouragement to breastfeed
– Breastfeeding education bag
– referral to the Breastfeeding Peer Counselor
Program at the initial prenatal WIC visit, unless
medically contraindicated.
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Why Peer Counselors?
•
•
•
•
•
Serve as a model for breastfeeding
Establish a connection with families
Help mothers manage common concerns
Provide ongoing encouragement
Adjunct to regular WIC services by offering
breastfeeding help outside the usual workday
• Fill the gap in services after hospital discharge for
seamless continuity of care
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Breastfeeding & Clinic Practices
 Encourage breastfeeding in the waiting room
 Provide a private breastfeeding area
 Display WIC-approved breastfeeding promotions
 Schedule BF mom and baby appointment together
Exception: Hospitalized Infant or Mother
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Bureau of Family Health (BFH)
Louisiana Department of
Health and Hospitals
Office of Public Health
Center for Community &
Preventive Health
Jan 2013 : Merger of 2 programs
Maternal
& Child
Health
Family
Planning
BFH
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Overview: Bureau of Family Health
(not an inclusive list)
Data
• PRAMS
• Mortality
Surveillance
• Data linkage
& analysis
Health Education
/Communication
• Partners for
Healthy Babies
(Media Helpline
& website)
• SIDS/Safe
Sleep
• BreastfeedingThe GIFT
• Child Care
Health
Consultants
• Sexual
Violence
Prevention
Clinical
• Family
Planning
• Teen
Pregnancy
Prevention
Support
Services
• Nurse Home
Visiting (NFP
& Parents as
Teachers)
• Early
Childhood
Systems
Policy
• Obesity
Prevention
• Health
Equity
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Bureau of Family Health
Data & Action
Systems &
Quality
Assurance
Prevention
Programs &
Innovation
Policy &
Health Equity
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Partners for Healthy Babies
1-800-251-BABY (2229) or www.1800251baby.org
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Hospital-Based Initiatives
• The GIFT (Louisiana DHH-OPH-BFH)
– A quality improvement and designation program for LA
birthing facilities
– Resources, support and recognition for best practice
implementation that are aligned with the Ten Steps
– Encourages continued progress toward pursuit of BabyFriendly designation
– 24 GIFT designated birthing facilities as of November 2013
• Baby-Friendly Hospital Initiative
– Global initiative, with Baby-Friendly USA, Inc. in America
– 170 US Baby-Friendly facilities (over 20,000 worldwide)
– No “Baby-Friendly” hospitals in LA, but many are working
towards Baby-Friendly designation
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The Ten Steps to Successful Breastfeeding
1.
Have a written breastfeeding/infant feeding policy that is routinely
communicated to all staff.
2. Train all health care staff in the skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of
breastfeeding.
4. Help mothers initiate breastfeeding within one hour of birth.
5. Show mothers how to breastfeed and how to maintain lactation, even if they
are separated from their infants.
6. Give infants no food or drink other than breast-milk, unless medically
indicated.
7. Practice rooming in - allow mothers and infants to remain together 24 hours
a day.
8. Encourage breastfeeding on demand.
9. Give no pacifiers or artificial nipples to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers
to them on discharge from the hospital or birth center.
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Encourage and
Support Breastfeeding!
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© Addie Imseis and USBC, 2010
Ten Steps to Support Parents’ Choice to Breastfeed Their Baby
American Academy of Pediatrics, 1999, Rev. 2003
10. Expand the network of support for breastfeeding.
support for breastfeeding
9. Communicate
in the office environment.
See Resource CD!
breastfeeding by providing accurate
8. Support
information about maternal issues.
appropriate anticipatory guidance that supports exclusive
7. Use
breastfeeding until infants are about 6 months old.
6.
5.
4.
3.
Show mothers how to breastfeed and how to maintain
lactation when they will be away from their babies.
Encourage mothers to breastfeed on demand.
Assess infants during early follow-up visits.
Inform women and families about the benefits and management of
breastfeeding.
2. Train all staff in skills necessary to support breastfeeding.
1.
Make a commitment to the importance of breastfeeding.
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Getting Started!
1. Designate a breastfeeding team leader
2. Get behind the leader
3. Develop a plan
4. Scan your office
5. Establish a breastfeeding
education routine
6. Identify local resources
See Resource CD!
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Supporting Breastfeeding is
Good Business!
• Breastfeeding support is a billable visit
• Bill for time if >50% of the visit is for counseling
• Use ICD-9 codes for diagnoses such as:
 Weight loss
 Jaundice
 Feeding problem in a newborn
 Fussy baby
• Bill for care provided for the mother,
often as a new patient
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www2.aap.org/breastfeeding/files/pdf/coding.pdf
Resources and Leave-Behinds
• Please spend some time getting familiar with
the Resource CD!
• The Health Care
Provider’s Guide
to Breastfeeding
iPhone App
– Link provided in
Resource CD
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“Each mother’s decision about how she feeds her
baby is a personal one. Because of the
ramifications of her decision on her baby’s health as
well as her own, every mother in our nation
deserves information, guidance, and support with
this decision from her family and friends, the
community where she lives, the health professionals
on whom she relies, and her employer.”
- Kathleen Sebelius, Secretary
U.S. Department of Health and Human Services
Surgeon General Call to Action 2011
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Thank you!
85
Acknowledgements
Funding for program has been provided by:
The Louisiana Department of Health and Hospitals-Office of Public
Health- Women, Infants and Children Program and the Bureau of
Family Health and the United States Breastfeeding Committee.
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Acknowledgements- New Jersey
Funding for program has been provided by:
The New Jersey Department of Health and
Senior Services, the Office of Nutrition &
Fitness
Special thanks to:
Baby-Friendly USA
EPIC BEST, AAP PA Chapter
NJ BFHI EPIC Curriculum Committee:
Alicia Dermer, MD, FABM, IBCLC, Cassandra P.
Leahy BA, RN, MSN, LCCE, IBCLC, Ellen
Shuzman, PhD, RN, NEA-BC, CLC, Florence
Rotondo, IBCLC, RLC, Jeanine HearneBarsamian, BSN, MA, IBCLC, RLC, Joan Santa
Croce, RN, MSN, Joyce McKeever,
RN,MS,IBCLC,LCCE, Kay O’Keefe, RN, MA,
Mary Ditri, MA, Maryellen Dykeman, Michelle
Brill, MPH, Pamela Rosser, Rickie Kashdan,
MPH, Rose St. Fleur, MD, Rosemarie Dimarie
CD (DONA), IBCLC
The NJ Baby Friendly Hospital
Initiative is a program of PCORE,
the quality improvement arm of
the American Academy of
Pediatrics, New Jersey Chapter.
Lori Feldman-Winter, MD, FAAP
Medical Director, BFHI
Fran Gallagher, MEd
Executive Director
Harriet Lazarus, MBA
Program Director
Shreya Durvasula
Program Manager
AAP NJ/ NJ PCORE
3836 Quakerbridge Road,
Hamilton, NJ 08619
(609) 588-9988
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