Conflicting Recommendations about Breast Milk in the Child Care Setting can Create Barriers to Breastfeeding

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Imagine you are a new mother planning to return to work following your maternity leave. You’ve heard the recommendations from international and national health organizations to continue exclusive breastfeeding for the first six months of your baby’s life. Because of these recommendations and the countless health benefits associated with breastfeeding for both you and your baby, you decide to continue breastfeeding. You overcome the logistical challenges — finding the space and time to pump, storing, labeling and so-on — to make sure you can supply your child with milk when they are at child care. You’ve overcome all the hurdles, right? Maybe not.

Stored Breastmilk

In an effort to support breast milk in the child care setting, several government agencies have established best practices or recommendations for the handling of breast milk. Unfortunately, some of these recommendations can conflict with those made by another agency. These inconsistencies are plentiful and can lead to misinformation, confusion, and the dumping of perfectly good breast milk.

To illustrate the impact of these inconsistent recommendations:

Scenario 1: On Monday at 8:00 a.m., a parent leaves a bottle of freshly pumped breast milk with his/her baby’s child care provider. The breast milk is still in the refrigerator on Wednesday at 12:00 p.m. (52 hours later). May the child care provider serve the breast milk?

  1. The breast milk should be dumped. The Food and Drug Administration (FDA) recommends the refrigeration of breast milk for no more than 24 hours.
  2. The breast milk can be served. The Centers for Disease Control and Prevention (CDC) recommends the refrigeration of breast milk for up to five days. At the same time, the USDA’s Child and Adult Care Food Program (CACFP) recently released guidance on infant feeding permits the refrigeration of breast milk for up to three days. The old CACFP guidance recommended the refrigeration of breast milk for only 48 hours, which would have resulted in the breast milk being dumped in this scenario!

Scenario 2: Three hours ago, baby’s child care provider removed a bottle of breast milk from the refrigerator and left it on the counter. May the child care provider serve the bottle of breast milk?

  1. The breast milk should be dumped. The FDA recommends that perishable items, including milk, should not be left out of the refrigerator or without a cold source for more than two hours.
  2. The breast milk can be served. The CDC’s recommendations state that breast milk can remain at room temperature for 6-8 hours. Similarly (but still not exactly the same), the recommendations published by Let’s Move!, a national initiative launched by First Lady Michelle Obama, states “freshly expressed milk can sit safely at room temperature for up to eight hours.”

Inconsistent recommendations can be a barrier to breastfeeding by creating confusion for mothers and child care providers, thereby discouraging the use of breast milk.

Government bodies at all levels should work together to provide consistent recommendations that are aligned with research and scientific reasoning. Further, government bodies should critically evaluate their recommendations and commentary regarding breastfeeding and breast milk to ensure their tone matches their stated goals – to support nursing mothers and infants.

While barriers to breastfeeding remain numerous, major efforts have being taken to support nursing mothers. In the past five years, federal and state laws have been enacted to provide protections for nursing mothers in the workplace, but still more must be done so that nursing mothers have less unnecessary hurdles to overcome when choosing breastfeeding.


Michelle Hersh, J.D., Staff Attorney at the Public Health Law Center at Mitchell Hamline School of Law.