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Breastfeeding - Frequently Asked Questions

MN WIC Program

Will there be any allowance for Mostly-Breastfed premature babies who are less than a month old to receive liquid concentrate? (i.e., due to the lack of preservatives in powder formula, the potential risk of contamination, and a premature infant's increased vulnerability) (07/29/09)

Concentrate formula may be provided if appropriate for the situation. The food package rule specifies powder formula in the first month, so concentrate would be an exception for special circumstances, and should be documented.

If the infant is on a medical formula (Food Package 3) evaluate whether small containers of the RTF/RTU might be more appropriate.

Remember that breastfeeding is important for all infants, and even more important for premature infants. Encourage the mother to fully breastfeed and provide her with the information and support to do so.

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If WIC is so supportive of breastfeeding, why does WIC provide so much formula? (07/29/09)

WIC promotes breastfeeding as the standard for infant feeding. To help WIC moms and babies get off to a great start with, and continue, full breastfeeding, we are relying on:

  • CPAs to provide anticipatory guidance during pregnancy,
  • A good breastfeeding assessment, support and counseling in the early postpartum period, and
  • Continued support and counseling throughout the duration of breastfeeding

We expect that most breastfeed infants will receive no formula in the first month. The CPA assessment is to determine if any formula is needed and, if needed, to provide the minimum amount to meet the assessed need.

With adequate support, the larger amounts of formula are rarely, if ever, needed for a breastfed infant.

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WIC is a supplemental food program. Why doesn't WIC provide a maximum of 4-5 cans/month instead of 9-10 cans, even for formula-fed infants? If participants had to purchase formula, they might choose to fully or partially BF instead. (07/29/09)

The maximum allowed quantities of formula that WIC may provide are specified in the federal interim rule. USDA is accepting comments on the interim rule through February 1, 2010. To comment on the allowable amounts of formula, go to: http://www.fns.usda.gov/wic/regspublished/foodpackages-interimrule.htm.

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What is the most formula that an infant can receive, for the mother to continue receiving a Food Package after 6 months? (07/29/09)

Fully-Breastfeeding and Mostly-Breastfeeding women are eligible for food benefits after 6 months. Refer to the Food Package Reference Guide for Breastfeeding Dyads. Infants 6 months and older may receive up to 4 cans of powdered contract formula in the Mostly-Breastfeeding category. CPAs should carefully assess actual formula needs and issue the minimum amount needed, not automatically issue 4 cans.

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WIC a federal program, so aren't participants entitled to the full 9 cans? (07/29/09)

WIC is a federal health and supplemental nutrition program. Full breastfeeding is best for the health of mother and infant. A stated intent of the new food package rule is to:

"...align the WIC food packages with the Dietary Guidelines for Americans (DGA) and current infant feeding practice guidelines of the American Academy of Pediatrics, better promote and support the establishment of successful long-term breastfeeding,..."

The food package must be based on nutritional need - if any formula is provided, the amount must be based the infant and mother's assessed need. Participants are entitled to be fully informed about their infant feeding decisions, the differences between breastfeeding and formula feeding, and the impact that supplementing will have on their milk supply. WIC then supports their decision.

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Can local agencies set their own policy (limits) on the number of cans of formula they will provide breastfed infants? (07/29/09)

No. Local agencies must follow policy and guidelines established by Minnesota WIC to best support breastfeeding. Every participant should be approached as an individual. If a participant requests formula, any formula which is provided must be based on that infant's assessed need.

It is the CPA's responsibility to work with moms during pregnancy and postpartum, to encourage and support full breastfeeding. If any formula is prescribed, CPAs should provide the minimum amount to meet that need.

For example, if a participant requests formula you might proceed like this:

  • Please tell me about why you're requesting formula today. Depending upon her response you might:
  • Affirm: "I can see why you're concerned" or "Other women have had those same concerns." Or Probe for more information.
  • Then determine if the situation can be resolved through counseling.
  • Use the 3-step counseling model to probe for any additional factors influencing her decision, then affirm and educate based on the information. If she is concerned about milk supply; however your assessment indicates feeding is going well, offer her support such as seeing her again next month, referring to a peer, referring to breastfeeding support groups, providing written information, etc.
  • If no, before providing the education, assess when she is breastfeeding, when she is using formula, and how much formula she is using. For example you could ask her: When did (baby's name) first breastfeed today? About how long did (baby's name feed?) How do you determine when she/he is done breastfeeding?
  • When you determine how long formula has been fed/or why she plans to start formula, the amount used per day, opportunities for increasing the amount of breastfeeding, opportunities for pumping, and any other relevant information determine the appropriate amount of formula to prescribe, if any.

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Are standards being developed to determine Mostly-BF vs. Some-BF? (Times per day or ounces?) (07/29/09)

The amount of formula (if any) that an infant is assigned will determine the mother's eligibility for the various food packages. Always assess the infant first. Refer to the Food Package Reference Guide for Breastfeeding Dyads.

With all breastfeeding dyads, assess breastfeeding including frequency. The following is a table that may be helpful in determining the minimum amount of formula to provide, if the CPA determines formula is appropriate.

Estimating the minimum amount of formula to meet the need identified by the CPA.

  • Counsel to encourage as much breastfeeding as possible.
  • If you determine it is appropriate to issue formula, use the chart below to determine the minimum number of cans of powdered formula to assign.
How much
formula is
fed per day?
How many days per week is formula fed?
Once or twice/week
(1-2 days/week)
About 1/2 the time
(3-5 days/week)
Almost every day
(6-7 days/week)
≥ 3 oz1 can per month1 can per month1 can per month
4-8 oz1 can per month1 1/2 cans per month*2 1/2 cans per month*
9-12 oz1 can per month3 cans per month4 cans per month
13-16 oz1 1/2 cans per month*3 1/2 cans per month*5 cans per month
17-20 oz2 cans per month4 1/2 cans per month*6 1/2 cans per month*

*Half cans can be provided by giving 1 can in the first month, and 2 cans the next month.

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Can you change Mom's food packages during her certification period? For example, a mother is providing some breastmilk and at 6 months receives 7 cans of formula from WIC. Then a few months later, CPA & Mom determine that she needs (and wants) only 4 cans. Can her Food Package be changed so that she can receive food benefits? What if she isn't still certified? (07/29/09)

Yes - if a mother receives 4 cans (or less) of powder contract formula after baby's 6 months of age, she is eligible for the "Mostly-Breastfeeding" food package. If her certification was not already extended, the CPA should extend her breastfeeding certification. Also see the question that follows.

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If a mom is in a current 6 month breastfeeding certification, will her cert extend to 1 year automatically with the CHIP release at the end of July? Or will we need to plan to recertify her again at 6 months? (07/29/09)

CHIP will continue to function as it currently does. CHIP will not automatically extend the breastfeeding certification past 6 months. You will need to use the Breastfeeding Recert/Out of State Transfer to extend the certification. Information on how to do this was provided at the conference and available on-line (click link).

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Is it possible to change from postpartum Non-BF to any of the breastfeeding categories? (07/29/09)

A woman who is breastfeeding or providing breastmilk to her infant(s) on the average of at least once per day should be assigned WIC type "Breastfeeding". The mother's food package category must correspond to the infant's food package. CPAs must correctly assign WIC Type and keep the WIC Type as "Breastfeeding" as long as the woman is breastfeeding or providing breastmilk.

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Is it federal regulation that we may no longer provide a "Some-BF" woman with a food package? Currently we provide a food package to any breastfeeding woman, even if they are only providing breastmilk once per day. (07/29/09)

Yes – the federal regulations state that women whose infants are receiving 5 or more cans of formula ("Some-BF" Food Package) after 6 months, are no longer eligible to receive food benefits. Some-breastfeeding women may remain in a certification and continue to receive education/counseling and referrals.

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If the woman is still Some-BF at her baby's 9 months of age mid-cert, would we still offer BF support and education at that time? (07/29/09)

Yes. Continue to offer breastfeeding support and education as needed for all breastfeeding women, including "Some-BF" women.

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What does the state law say regarding time for BF moms to pump during the work day? (07/29/09)

The law states (with emphasis added):

"181.939 NURSING MOTHERS. An employer must provide reasonable unpaid break time each day to an employee who needs to express breast milk for her infant child. The break time must, if possible, run concurrently with any break time already provided to the employee. An employer is not required to provide break time under this section if to do so would unduly disrupt the operations of the employer.

The employer must make reasonable efforts to provide a room or other location, in close proximity to the work area, other than a toilet stall, where the employee can express her milk in privacy. The employer would be held harmless if reasonable effort has been made.

For the purposes of this section, "employer" means a person or entity that employs one or more employees and includes the state and its political subdivisions."

You can find a link to the state laws in the Local Agency Breastfeeding section of the MN WIC website.

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We promote breastfeeding by saying that breast milk has everything a baby needs, yet health care providers recommend supplementing with Vitamin D. Doesn't that suggest that breast milk does not have all that is needed? Some people want to feed their baby formula because it has Vitamin D and might have other nutrients we don't know about yet. Is there enough research for all ethnic backgrounds? (07/29/09)

All humans, including infants, need vitamin D. Vitamin D is made by the body when skin is exposed to adequate sunlight. Milk and a few other foods are also fortified with vitamin D, although recent research suggests that a higher level of fortification may be needed. Sun exposure in Minnesota is very limited much of the year – due to the angle of the sun and the need to cover our skin during the cold winter months. Even during summer months when the sun is most directly overhead, the use of sunscreens to protect against the dangers of excessive sun exposure decreases vitamin D synthesis. And the darker the skin, the longer the needed exposure for adequate vitamin D synthesis.

All infants need a source of vitamin D, and even more so if mother was vitamin D deficient in pregnancy. Infants who are formula-fed do receive vitamin D from formula (because it is added to the formula); however breastmilk has many components that formula lacks. We recommend full breastfeeding with a vitamin D supplement for the infant and, as indicated, for the mother.

For additional information on Vitamin D:

The reason formula has vitamin D is because it is added. Manufacturers continue to change formula composition, adding different nutrients and other components – always attempting to make it more like breastmilk. However there are still many components of breastmilk that are not found in formula. A visual aid might be helpful in explaining that breastmilk has important things not found in formula. Go to: http://www.cdph.ca.gov/programs/breastfeeding/Documents/MO-HowDoesFormPosterEng.pdf

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