breastfeeding an assistive guide -...
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Breastfeeding
An Assistive Guide
Objectives • Benefits of Breastfeeding
• Basic Nutritional Counseling
• Colostrum
• How to assess a newborn’s feeding habits
• Positioning and Latching
• Milk Storage
• Assistive agents to increase milk supply
• Mastitis
• Weaning
Benefits for Baby
Strong evidence decrease in LRI, diarrhea, otitis media,
bacteremia, bacterial meningitis, botulism, UTI, NEC
Protective effects: SIDS, IDDM, Crohn’s. Ulcerative
Colitis, lymphoma, allergies
Enhancement in visual and cognitive function,
NOT just nutrition-provides
information/protection and nuturing cues to baby
HEALTHY BABY!!
Benefits for Mother
• Decreased postpartum bleeding
• No periods while breastfeeding!
• Lose weight faster-burn up to 500 cal/day
• Stronger bones so less postmenopausal hip fractures Decreases lifetime risk of ovarian cancer and pre-menopausal breast cancer
• Reduced health care cost for families and fewer sick days needed to care for ill children
Maternal Nutrition is Key!!!
• Maintain 1800-2000 calorie diet
• Drink to thirst: forcing fluids does NOT increase milk supply
• Continue to take prenatal vitamin
• Calcium supplements: 1200-1500 mg/day – Make sure Vitamin D levels are appropriate too
• Vitamin C 120mg/day
• Special Considerations – Vegetarian/Vegan: may need supplemental Vitamins
B12, B6, A
– Low carbohydrate diet- may change the taste and smell of breast milk
Other Nutritional Considerations
• Caffeine- limit to 200mg day
– Two cups of home-brewed coffee, tea, or soda
– One regular-sized barista brewed coffee/tea
• Alcohol
– Best is to abstain
– Peak levels noted after 30-60 minutes on empty
stomach, 60-90 minutes if eating
• Best is to have occasional drink right after nursing to allow
metabolism to get rid of levels by the next feed
Other Nutritional Considerations
• What you eat may affect the baby
– A small percentage of babies react to foods in
mother’s diet
– Signs may include eczema, congestion, crying, and
sleeping issues
– Trial and error is the best way to reduce these irritants
to baby
• Common foods to avoid
– Sage, parsley, oregano, thyme, peppermint
(gum/mints/tea)
– Cabbage, Jasmine
Colostrum
• Production starts at 20 weeks
• May be thick in consistency and yellow in color
• Lasts for about 3 days
• Seals the lining of the infant’s intestinal system to decrease the adherence of bacteria
• Helps baby to excrete meconium, which decreases the risk of jaundice.
• High in protein and minerals
• Low in fat and lactose
• Contains IgA immunoglobins which boost the immune system
From Colostrum to Breast milk • Colostrum transitions to breast milk within the first
week
• Composition 88% water
• More balanced composition of protein, minerals, fats, carbohydrates
• Continues to promote immunoglobulin A to stimulate the immune system
• Increases Lactobacillus bifidus in the infant’s GI system
• Contains CCK (Cholecystokinin), a hormone that makes mom and baby sleepy and more relaxed – Proposed to be the hormone that helps prevents
postpartum blues/depression
First Week of Breastfeeding
• Babies are born with brown fat layers
– An energy source baby can use for first 96 hours of
life
– They EXPECT it to take time for the milk to come in!
• Baby’s stomach at birth is the size of a marble.
By day 10 size of an egg.
• Milk supply grows from 30cc on day one and up
to 900cc on day 40.
• Normal for Baby’s weight to drop up to 10% in
first week
– Will then increase 6oz day or 1.5lb/mo for the first four
months
First Week of Breastfeeding
• Breast should be offered within first hour of life.
• First 24 hours: Baby may only suck 2-3x at the breast
• First 24-48hr: Baby cluster feeds
– In a block of 4-5 hrs the baby will feed 15-20min on each breast then sleep 20-60min and repeat the cycle
• After 48 hours: Offer the breast every 3 hours during the day and on demand at night
• Supplement? General rule is to wait until the breast milk is well established ~ 2wks
First Week of Breastfeeding
• During days 1-3 after birth, if baby is left
unrestricted at the breast, they can obtain about
30ml/day of colostrum (1 ounce)
• By day 5, milk volume can rapidly rise to
600ml/24hr (20 ounces for whole day)
• Do not pump to try to determine how much milk
you are making
– Learn to understand the habits of your infant
– If not rooting after a feeding, has received enough
Assessing Adequate Intake of
Milk
• Inspect the urine – 24-48hrs of life: first urine may be orange-red in color
– Day 3-4: breastfed babies should make 3-4 wet
diapers per day with urine that looks like clear water
• Inspect the stool – First 72-96 hours: Meconium will pass first and
appear greenish black
– After 96 hours, should start turning golden brown
• Stool may appear loose and “seedy”—this is ok
– Expect 3-4 passages of stool per day
• This is the number one sign that the baby is gaining
weight
Baby Weight Gain Chart
Baby’s Age Average weight gain
per week
Average weight gain
per Month
Birth to Day 4
Up to 10% loss of birth
weight
n/a
Day 4 to 4 months
6oz 1.5 lbs
4-6 months
4-5oz 1 lb
6-12 months 2-4oz 0.5 lb
Helping Baby to Latch
• First, make sure the nipple reaches the soft
palate of the baby
Helping Baby to Latch
• Make sure baby’s entire upper and lower lip are wide open and covering as much of areola as possible—this creates the seal
Positioning Baby for
Breastfeeding
• Use positions that are comfortable for the baby
AND FOR YOU!
• Try different positions and alternate between
them if possible
• Position: Football
Breastfeeding Positions
Cradle Cross Cradle
Using same side of hand as head to
cradle
Use opposite hand of head to
cradle
Breastfeeding Positions
Side Lying Dancer
Storing Breast Milk: Guidelines LOCATION TEMP DURATION COMMENTS
COUNTERTOP ROOM TEMP UP TO
77*F OR 25*c
6-8HRS KEEP CONTAINERS
COVERED
INSULATED
COOLER/BAG
5-39*F OR -15-4*c 24HRS KEEP ICE PACKS IN
CONTACT WITH MILK, LIMIT
OPENING
REFRIGERATOR 39*F or 4*C 5 DAYS STORE MILK IN THE BACK
OF THE MAIN BODY OF THE
REFRIGERATOR
FREEZER
COMPARTMENT
5*F or -15*c 2 weeks STORE MILK IN THE BACK
OF THE FREEZER
FREEZER
COMPARTMENT-
SEPARATE DOORS
0*F OR -18* 3-6 MTHS MILK STORED FOR
LONGER PERIODS ARE
SAFE BUT SOME OF THE
LIPIDS UNDERGO
DEGRADATION RESULTING
IN LOWER QUALITY.
DEEP FREEZER -4*F OR -20*C 6-12 MTHS
How to Increase Milk Supply
• Fenugreek- helps increase the milk making hormone prolactin – Available over the counter
– 3 tablets 3 times per day
– Side effects to mom: increased gas, may increase maternal blood sugar
• Reglan/Metoclopramide- prescription needed – Usually used for nausea
– Does pass through breast milk– may affect GI tract of infant
• Notifiy pediatrician prior to use
– Possible side effects to mom: muscle spasms, depression, anxiety and glucose changes
How to Increase Milk Supply
• Domperidone/Motilium – Not FDA approved in USA
– Can be obtained on internet from Canada and Mexico
– Some pharmacies in USA do compound it
• Check with your pediatrician
• Other Herbs (not FDA approved) – Blessed thistle: may cause nausea or diarrhea – Alfalfa and Lactuca Virosa
• Not to be used by women with lupus or on blood thinner meds
– Goats Rue or French Lilac
• May notice increased sweating
– Shantavari
• Used in Australia for GI issues. Popular in China to help develop mammary glands
Medications that can Decrease Milk
Supply
• Pseudoephedrine or ephedrine
– Found in cold medicines like sudafed or weight loss
products
• Birth control pills that contain high doses of
estrogen
– Estrogen counteracts the effects of prolactin
– Progesterone only pills, Mirena IUD, and Paragard
IUD have no issues
Common Breast Issues
• Sore nipples
• Plugged Ducts
• Bacterial Mastitis
• Thrush
Sore Nipples • Usually due to poor baby positioning
– May be a high palate or tongue-tied
• May occur if pressing on breast too hard to see
the baby’s nose when latching
• Occurs more in women with fair skin
• Higher occurrence in women with inverted
nipples
• Nipple appears scabbed and red
• Treatment – Okay to continue to breastfeed
– Make sure to let breast milk air dry on nipple—the antimicrobial
components of the milk help them heal
– Lanolin cream available over the counter
– Jack Newman’s cream—available by prescription
Plugged Ducts • May occur anywhere in breast due to poor drainage
• No fever and onset of pain is gradual
• Causes: inadequate latch, tight bra, prior breast
surgery/implants, thick breast creams, diet high in
saturated fats
• Treatment
– Massage milk towards nipple when feeding baby
– Warm compresses on breast or soak in hot shower
– NSAIDs (i.e Motrin)
– Increase frequency of feeds
• Lecithin supplement : contain 1600mg phosphatide
(granulated better than liquid)
Bacterial Mastitis • Infection of the breast caused by bacteria
• Risk factors: ineffective latch, tight bra,
engorgement, and nipple trauma
• Signs: flu like symptoms, fever >101F, chills, red
and tender breast in one area of breast
– It’s rarely on both sides
• Treatment
– 7-14 days of antibiotic (needs prescription)
– Fluids/Motrin or Tylenol
– Safe to continue to breastfeed and drain the breast.
• Healthy full term baby GI can kill bacteria
Breast Candidiasis (Thrush) • Breast infection due to yeast
• Differences from bacterial mastitis
– Red/white rash with a flaky appearance on skin
– “Shooting pains” through nipple into breast
• Risk factors: infant with oral thrush, diaper rash,
diet high in sugar, recent antibiotic use
• Treatment
– Diflucan (by prescription)
– Treat infant of thrush/diaper rash (see the pediatrician)
– Re-sterilize bottles/pacifiers
– Jack Newman’s Cream or gentian violet
– Clean diaper area
WEANING- BIOLOGICAL AND
CULTURAL PROCESS
• World Health Organization recommends at least
6 months in industrial countries
• Gradual weaning is recommended to prevent
pain, plugged ducts or mastitis
– Stop the feeds with the lowest yields of milk
– Pump to relieve pressure if needed
– Ice packs, cabbage leaves
– Ibuprofen 400mg-600 mg every 6 hours for discomfort
– Minimize stimulation of breast
– Takes TIME & PATIENCE
WEB SITE RESOURCES
• lowmilksupply.org
• kellymom.com
• cdc.gov
• bfar.org
• www.aap.org (parents corner)
• www.acnm.org (gotmom.org)
• www. acog.org
• www.illi.org (La Leche League)
• National breastfeeding hotline (800) 994-9662
When to Call Your OBGYN or Pediatricain
• Mom
– Fever >101
– Painful, red breast lump that does not go away with
massage over 24 hours
– Shooting pains through nipple that do not go away
with massage over 24 hours
• Baby
– If baby is not making at least 4 wet diapers and 4
stool-filled diapers per day
– Baby’s mouth seems like it has thrush
– Diaper rash that doesn’t go away with normal
treatments
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