DC/Maryland Breastfeeding-Friendly Childcare Provider Recognition Awards

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Nomination/Site Inspection Form

Email *

Childcare Provider Name *

Childcare Provider Address: *

Nominator (first and last name)* *

Contact Person (Office Manager or Human Resource Manager)* *

Is Contact Person aware of this nomination? *

Yes

No (we ask that you notify them prior to completing the nomination)

Contact Person E-mail Address* *

Phone Number* *

Type of Childcare Provider

Family/Home-based

Center-based

Head Start/Early Head Start

Drop-in Childcare

Number of Infants, Toddlers, and Young Children Currently in Care (enter number for each age group) *

Number of volunteers/teachers caring for children birth to 36 months (include all adults who care directly for these children: lead, assistant, aide, floaters, etc.)

Check all criteria that you can verify:

Practices will be recognized as follows:

Drop-in Childcare (e.g., faith-based organizations, gyms, community centers, etc.): Bronze Award: 6-8 points, Silver Award: 9-15 points, Gold Award: ≥ 16 points (at least 1

gold criteria must be met)

Family/Home-based: Bronze Award: 6-8 points, Silver Award: 9-15 points, Gold Award: ≥ 16 points (at least 1
gold criteria must be met)
Center-based/Head Start: Bronze Award: 6-10, Silver Award: 11-18, Gold Award: ≥ 19 points (at least 2 gold
criteria must be met)

Bronze (1 Point each; check all criteria that you can verify)

Display culturally appropriate posters, pamphlets, pictures, and photographs of breastfeeding parents and children to communicate that the program supports breastfeeding.

Information about how the program supports breastfeeding is shared with newly enrolled families.

Provide educational resources about breastfeeding to parents that are objective, do not include infant formula advertising, and are not from any formula company. These can include handouts, pictures, books, DVDs, and/or websites.

The program shares a daily breastfeeding report/infant feeding plan with families.

Babies are fed on demand, unless other arrangements are requested by the family.

Breastfeeding parents have access to a clean, private, comfortable place to nurse or express human milk that is not a bathroom.

The breastfeeding space has an electrical outlet, sink with running water in the room or nearby, and a refrigerator to store expressed milk if needed.

Silver (2 Points each; check all criteria that you can verify)

Staff who care for children ages 0-3, and at least one administrator complete training that addresses: A) the benefits of breastfeeding B) infant feeding in response to baby's cues C) promoting and supporting breastfeeding parents/babies D) storage and handling of human milk

Breastfeeding families are instructed on how to properly label and store human milk for use in the childcare program.

A list of community breastfeeding resources is available for families, and staff refer families when appropriate.

Children’s books and/or toys that normalize breastfeeding are available to children in classrooms.

Breastfed babies do not receive other food or drink unless prior approval is given by families.

Breastfeeding parents are allowed and encouraged to directly breastfeed around other children.

Parents are encouraged to introduce solid foods at developmentally appropriate times per their primary care provider’s recommendations.

Gold (3 Points each; check all criteria that you can verify)

A written policy addresses the following and is available for reference: A) a private space is available for breastfeeding parents to use; B) staff will encourage and assist parents to provide human milk to their children; C) infants will be fed on demand, and families will be informed about the child’s feeding preferences; D) staff will be trained on breastfeeding support practices, and handling/storage of human milk.

Staff records demonstrate training on the breastfeeding policy.

Lactation Support Provider on staff.

Arrangements are made with families if the supply of human milk is gone, and baby is still hungry.

Annual staff evaluations include a review of breastfeeding support activities.

BRAG ABOUT YOUR PROGRAM: Please share with us additional information about the breastfeeding supports you provide and what makes your program unique. Thanks!

A copy of your responses will be emailed to the address you provided.

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