High 5 for Mom & Baby Renewal 2025

High 5 Renewal Application 2025

High 5 Renewal Application 2025

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Kansas Hospitals and Birth Centers: use this online form to apply for renewal of recognition as a High 5 for Mom & Baby facility. If helpful, you can download an offline sample to gather the information to enter into the official online form below. If your facility is recognized as High 5 Premier (all ten practices), please use the streamlined renewal form available here instead of the below form.

If you have questions about High 5 for Mom & Baby or the renewal process, please contact program coordinator Cara Gerhardt coordinator@high5kansas.org. Thank you for your continued commitment to helping ensure successful breastfeeding for Mom & Baby!

Note: upon submission of the below form, an email confirmation will be sent to the address entered in the email field below. If you want to save a partial form for later completion, please use the Save Draft function at the bottom of the form.

High 5 Renewal Basic Information

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The following Facility Self-Assessment questions relate to the evidence-based High 5 for Mom & Baby practices supporting successful breastfeeding.

High 5 recognized facilities should answer questions relating to the five or more practices being followed.

Note: High 5 for Mom & Baby Premier facilities (implementing all 10 practices) should use the streamlined form at https://healthfund.org/a/high5-premier-renewal-25 instead of this form.

The High 5 for Mom & Baby Practices:

  1. Facility will have a written maternity care and infant feeding policy addressing the High 5 for Mom & Baby practices supporting breastfeeding
  2. Facility will maintain staff competency in lactation support
  3. All pregnant women will receive information and instruction on breastfeeding
  4. Assure immediate and sustained skin-to-skin contact between mother and baby after birth
  5. All families will receive individualized infant feeding counseling
  6. Give newborn infants no food or drink other than breastmilk unless medically indicated
  7. Practice “rooming in” – allow mothers and infants to remain together 24 hours a day
  8. Families will be encouraged to feed their babies when the baby exhibits feeding cues, regardless of feeding methods
  9. Give no pacifiers or artificial nipples to breastfeeding infants
  10. Provide mothers options for breastfeeding support in the community (such as a telephone number, walk-in clinic information, support groups, etc.) upon discharge

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