J Obstet Gynecol Neonatal Nurs. 2020 Jan;49(1):5-15. doi: 10.1016/j.jogn.2019.10.006. Epub 2019 Nov 27.
To synthesize the extant research on the support of breastfeeding and breast milk feeding and related practices in child care centers (i.e., daycare centers) in the United States and globally.
We used key terms to search Ovid, CINAHL, and PubMed for articles that met eligibility criteria. When potentially relevant articles were identified in PubMed, we used the cited by and similar articles features to identify additional articles. We also examined the reference lists of reviewed studies.
We included original research articles on breastfeeding or breast milk feeding in child care centers published in 2000 or after and available in English. We reviewed titles and/or abstracts of 1,984 articles and abstracted 37 for full-text review. Of these, 16 studies met eligibility criteria and were included in the review.
We abstracted data from the 16 articles to facilitate comparison and identification of patterns related to support of breastfeeding/breast milk feeding and related practices in child care centers. These data included year of publication, setting, design/methodology (and methodologic limitations), type of respondent/sampling unit (e.g., directors and staff members of child care centers, mothers), sample size, outcome measures, and pertinent study findings.
We categorized study findings into three themes: Knowledge, Attitudes, and Experiences of Staff Members in Child Care Centers; Implementation and Adherence to Policies, Practices, and Regulations in Child Care Centers; and Prevalence of Breastfeeding in Child Care Centers. Findings indicated staff members generally had positive attitudes toward breastfeeding but tended to remain neutral regarding encouragement and support of breastfeeding. Training and knowledge about breastfeeding among staff members in child care centers appears limited and focused mainly on the storage and preparation of breast milk; however, staff members indicated the desire to obtain additional education about breastfeeding. Few U.S. child care centers or states have comprehensive, evidence-based policies and regulations to address support for breast milk feeding and breastfeeding. The prevalence of breastfeeding in U.S. child care centers is less than that in other child care settings (home-based child care, etc.), child care centers in other developed countries, and national breastfeeding averages.
We found a general lack of policies and practices to support breastfeeding in child care centers, particularly in the United States. The degree to which this policy/practice deficit contributes to suboptimal breastfeeding rates among women who use child care centers requires further study.
综合美国和全球范围内儿童保健中心（即日托中心）支持母乳喂养和母乳哺育及相关实践的现有研究。
我们使用关键词在 Ovid、CINAHL 和 PubMed 上搜索符合入选标准的文章。在 PubMed 上发现可能相关的文章时，我们使用被引文献和相似文章功能来确定其他文章。我们还检查了已审查研究的参考文献列表。
我们纳入了 2000 年或之后发表的关于儿童保健中心母乳喂养或母乳哺育的原始研究文章，且文章应为英文。我们查阅了 1984 篇文章的标题和/或摘要，并对 37 篇文章进行了全文审查。其中，16 项研究符合入选标准并纳入综述。
我们从 16 篇文章中提取数据，以方便比较和确定与儿童保健中心支持母乳喂养/母乳哺育及相关实践相关的模式。这些数据包括发表年份、背景、设计/方法（及其方法学限制）、应答者/抽样单位类型（例如，儿童保健中心的主任和工作人员、母亲）、样本量、结局指标和相关研究结果。
我们将研究结果归入三个主题：儿童保健中心工作人员的知识、态度和经验；儿童保健中心政策、实践和法规的实施和遵守；以及儿童保健中心母乳喂养的流行率。研究结果表明，工作人员对母乳喂养普遍持积极态度，但在鼓励和支持母乳喂养方面倾向于保持中立。儿童保健中心工作人员的母乳喂养培训和知识似乎有限，主要集中在母乳的储存和准备上；然而，工作人员表示希望获得更多关于母乳喂养的教育。美国很少有儿童保健中心或州有全面的、基于证据的政策和法规来解决对母乳哺育的支持问题。美国儿童保健中心的母乳喂养率低于其他儿童照护场所（家庭式儿童照护等）、其他发达国家的儿童保健中心以及全国母乳喂养平均水平。
我们发现儿童保健中心普遍缺乏支持母乳喂养的政策和实践，特别是在美国。在多大程度上，这种政策/实践不足导致使用儿童保健中心的妇女母乳喂养率不理想，需要进一步研究。
