Breastfeeding Newborns and Infants

Presenters:

Kimberly Bundley Christina Matem Saffie Bangura

Exclusive breastfeeding for the first 6 months of life is recommended

American Academy of Pediatrics (AAP)
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Presentation Outline
Part A: Breast anatomy and benefits of breastfeeding Part B: Nurse Teachings and cultural beliefs Part C: Breastfeeding Review

Part D: Nurse Management

Part E: Resources for Breastfeeding

Part A: Breast Anatomy

Human milk provides the best nutrition for infants!!!

Composition of Breast Milk

Anti-infective

Growth factors
Enzymes-for digestion and absorption of nutrients Fatty acids- promotes brain growth and development

Breast milk production is in response to:

Hormones Stimulation Milk being removed from the breast

Benefits of Breastfeeding
Infant
Decreases rates of SIDS.
Decreases incidence and severity of type I and type 2 diabetes, lymphoma, leukemia, Hodgkin's disease, asthma, bacterial meningitis, diarrhea, respiratory infection, otitis media and UTI. Enhances cognitive development and jaw development. Reduces risk of postneonatal infant mortality, obesity and hypercholesterolemia.

Mother
Promotes unique bonding experience with child. Lowers risk of HTN, hypercholesterolemia, and cardiovascular diseases. Facilitates earlier return to prepregnancy weight. Decreases risk of postmenopausal osteoporosis. Decreases postpartum bleeding and more rapid uterine involution Less expensive than bottle feed, readily available and convenient.

Encourage Breastfeeding - right from the start!

Provide pregnant moms information on:
What to do in the hospital to start nursing off right Normal breastfeeding What to expect as baby grows

This is called Anticipatory Guidance

Part B- Nurse Teachings

Frequency of feedings- at least 8 to 12 times in a 24hr period. Feeding pattern varies per baby. Infants should be fed whenever they exhibit feeding cues. Keeping the baby close is the best way to observe and respond to infant feeding cues. It is recommended that the mother and breastfeeding infant sleep in close proximity to promote breast feeding. Duration of feedings- average time for early feedings is 30 to 40 minutes or approximately15 to 20 minutes per breast.

Breastfeeding Positions

Signs of Effective Breastfeeding

Infant
Latches without difficulty. Has bursts of 15 to 20 sucks/swallowing at a time. Audible swallowing is present. Easily releases breast at end of feeding. Infant appears content after feeding. Has at least three substantive bowel movements and six to eight wet diapers every 24 hours after day 4.

Mother
Onset of copious milk production by day 3 or 4. Uterine contractions and increased vaginal bleeding while feeding (first week or less). Feels relaxed and drowsy while feeding. Increased thirst. Breast soften or lighten while feeding. With milk ejection, can feel warm rush or tingling in breasts, leaking of milk from opposite breast.

When Not to Breastfeed??

New borns who have galactosemia. Mothers with active TB. Mothers with positive human T-cell lymphocyte virus type I or type II. HIV infected mothers

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When to Express Breast Milk?

When breasts engorge.
When the mothers nipples are sore or damaged. When mother and baby are separated (e.g. due to hospitalization of baby or mother). When the mother leaves the infant with a caregiver and will not be present for feeding.

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Storage of Breast Milk

Store milk in hard plastic or glass with an airtight seal. Freshly pumped milk can be stored at room temperature (16-29C/60-85F) for up to 8hrs and can be refrigerated ( 4C/39F) for up to 8 days. Milk can be frozen for up to 6 months in the freezer compartment of a two door refrigerator ( <-5C/25F), and up to 12 months in a freezer (<-4C/24F). Remember to date containers before storing them.

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Understanding Different Cultural Beliefs

Muslim Women Breastfeeding for 24 months is customary. A small piece of softened date is rubbed on the newborns palate before the first feeding. Provide privacy- women choose to express breast milk or bottle-feed formula while in the hospital. South Asian/Pacific Islanders/Sub-Saharan African Women

Believe colostrum is harmful or inadequate so breastfeeding is restricted for a period of days after birth.
Believe feeding mothers with honey and clarified butter will help clear out meconium.
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Understanding Different Cultural Beliefs Contd

Mexican Women Practice los dos- combining breastfeeding and commercial infant formula to benefit from both respectively. Korean Women Eat seaweed soup and rice to enhance milk production.

Chinese/ Hispanics/ Vietnamese/ East Indians/ Arab Women

Believe in energy forces of hot and cold or yin and yang. Hot foods are considered best for new mothers.

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Part C: Breast Feeding Review

A Breastfeeding Review is an assessment of how breastfeeding is going to be done.
It must be completed anytime a breastfeeding mom is requesting formula, or asks for an increase in the amount of formula she already receives from WIC. The purpose of the review is to address concerns and help find solutions that enable continued breastfeeding, and to minimize or delay the use of formula.

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An overview of the Breastfeeding Review

A Breastfeeding Review is an assessment of how breastfeeding is going It must be completed anytime a breastfeeding mom is requesting formula, or asks for an increase in the amount of formula she already receives from WIC The purpose of the review is to address concerns and help find solutions that enable continued breastfeeding, and to minimize/delay the use of formula

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Who can do a Breastfeeding Review and issue formula checks to breastfeeding infants?
Only Competent Professional Authorities (CPAs and nutritionists) trained in breastfeeding support may do a Breastfeeding Review

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Where a Breastfeeding Review starts

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A walkthrough of a Breastfeeding Review

1. Establish rapport with the client by introducing yourself Hello April. My name is Martha.

2. Tell the client the reason for the discussion

I understand you have some breastfeeding concerns.

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A walkthrough of a Breastfeeding Review

3. Show respect for the client and engage her in discussion about how she is feeding her baby and what her plans are Most new mothers have questions about feeding their baby. 4. Use open-ended questions and active listening skills to find out why the client is requesting formula Tell me why you think your baby needs formula today.

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A walkthrough of a Breastfeeding Review

5. Affirm the clients feelings or concerns and engage the client in the discussion while offering support and encouraging continued breastfeeding Being a new mom is exhausting. The first few weeks can be challenging. Lets figure out a plan so you can continue to breastfeed. Its going to get easier! 6. Allow the client to share thoughts and try to avoid dominating the conversation

Tell me more about that.

What have you tried that seems to makes breastfeeding work better for you and your baby?

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A walkthrough of a Breastfeeding Review

7. Target education to the clients needs and avoid providing unneeded information

It sounds like you want some help in figuring out how deal with your sore nipples. I have information I can share with you. Would you like to hear more? 9. Discuss the information in any handouts provided
On page 35 of this booklet Ill give you is a list of things we discussed about dealing with sore nipples. I placed a bookmark so you can go back for a quick review.

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A walkthrough of a Breastfeeding Review

10. Ask for the clients feedback on the usefulness of the information What information was useful for you? What other questions do you have?

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When formula is Issued to a breastfeeding baby

CPA shall educate and counsel the mother that adding formula to her babys diet will have a negative effect on her breast milk production and may end breastfeeding.

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What if there is no CPA available to do a Breastfeeding Review?

Affirm the moms concerns and explain that staff who can determine the food package are not available. Encourage her to keep breastfeeding and inform her that giving formula may decrease her ability to make milk. Offer support within your skill level. Schedule as soon as possible with a CPA who can do a BFR or refer to community resources to do a BFR, if available. Offer to have someone

contact her by phone.

Suggest resources for formula.

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Part D: Nurse Management

Breast Care Teach mother to avoid washing nipples with soap to prevent drying effect. Instruct to use modifies lanolin with reduced allergens on dry or sore nipples. Allow use of breast shells to prevent bra or clothing from touching sore nipples

Teach to wear well fitted bras and breast pads to control leakage.
Diet Encourage mother to eat well balanced diet consisting of nutrient-dense foods. Calcium, minerals, and fat-soluble vitamins should be adequate. Rest Encourage to sleep when baby sleeps and breast feeding in a side-lying position promotes rest for the mother. Seek assistance from family members to complete household chores, if possible.
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Nurse Management Contd

Medication use Antemetabolite and cytotoxic medications e.g. cocaine, heroin, amphetamines, and phencyclidine are absolutely contraindicated. Avoid Ergot alkaloids (e.g. bromocriptine, cabergoline, ergotamine)and pseudoephedrine because they reduce milk production. Refrain from alcohol consumption because it can adversely affect milk production and ejection. Smoking impairs milk production. Limit caffeine use (found in coffee, tea, chocolate, and soft drinks) because it leads to anemia in the infant, as well as irritability and poor sleep patterns.
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Part E: Breast Feeding Resources

Read books in the clinic The LLL Answer Book, Amy Spanglers book, Breastfeeding Keep it Simple Visit http://www.doh.wa.gov/cfh/WIC/breastfeeding.htm

Visit http://www.babycenter.com/
Review self study materials
Read and study the WIC client handouts Attend regional WIC breastfeeding trainings

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References
Lowdermilk, D.L., Perry, S.E., Cashion, K., Alden, K.R. (2012). Maternity and Womens Health Care. (10th ed.). St. Louis, Missouri: Mosby Elsevier Inc.

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The END!!!

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