breastfeeding an assistive guide -...
TRANSCRIPT
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Breastfeeding
An Assistive Guide
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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
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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!!
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Helping Baby to Latch
• First, make sure the nipple reaches the soft
palate of the baby
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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
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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
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Breastfeeding Positions
Cradle Cross Cradle
Using same side of hand as head to
cradle
Use opposite hand of head to
cradle
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Breastfeeding Positions
Side Lying Dancer
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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
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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
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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
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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
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Common Breast Issues
• Sore nipples
• Plugged Ducts
• Bacterial Mastitis
• Thrush
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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
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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)
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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
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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
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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
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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
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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