State and regional variation in regulations related to feeding infants in child care.
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.
Benjamin
Sara E
SE
Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts, Massachusetts 02215, USA. sara_benjamin@harvardpilgrim.org
Taveras
Elsie M
EM
Cradock
Angie L
AL
Walker
Elizabeth M
EM
Slining
Meghan M
MM
Gillman
Matthew W
MW
D001942:Breast Feeding; D002656:Child Day Care Centers / Q000331:legislation & jurisprudence / Q000592:standards*; D003430:Cross-Sectional Studies; D006801:Humans; D007223:Infant; D007225:Infant Food / Q000592:standards*; D014481:United States