infant feeding in the first 30 days of life families grow healthy with wic
TRANSCRIPT
Families Grow Healthy with WIC
Please pull out the objectives for today and spend a few minutes reviewing.
Throughout today we will revisit these objectives to “chart our route to our final destination”.
Objectives
Families Grow Healthy with WIC
1. Welcome and Warm Up Activity
2. Review of Objectives & Agenda
3. Review of Healthy Habits Begins at Birth
4. Breastfeeding Support Policy
5. Review of Counseling Skills
6. Morning Break
7. Baby Behavior Skills
8. Baby Nutrition Questions Form
Morning Agenda
Families Grow Healthy with WIC
9. Lunch and Physical Activity
10. Infant Feeding Choices
11. Afternoon Break
12. Infant Feeding Choices Continued
13. Next Appointment
14. That reMinds me – Idea 2B Used
15. Questions & Answers
16. Trainers’ Gathering
Afternoon Agenda
Families Grow Healthy with WIC
Think about a positive experience you have had supporting a WIC Mom’s
feeding choice…
Share with a partner
Sharing Successes
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Keys to Success
From local agencies that have already implemented “no formula in the first 30 days”
Lessons learned
14 years/few months
Many say “it’s not as hard as we thought”
That reMinds Me….
Families Grow Healthy with WIC
Provide breastfeeding education to prenatal women at each visit.
Include a reminder that no formula will be issued in first 30 days.
Result:
Less mothers are asking for formula after delivery.
Keys to Success
Families Grow Healthy with WIC
Earn healthy bucks for correct answers.
Healthy Buck = Raffle TicketRaffle at end of the day.
$
Write your name on the back.$
$ Place your healthy bucks in box.
Earn Healthy Bucks
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Healthy Habits Begin at Birth
Focused on pregnant, postpartum and breastfeeding women and infant participants
Helped staff become more familiar with food package changes
Promoted and support breastfeeding
Ensured appropriate formula feeding
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Work as a table
Write answers on Quiz
When complete – Raise Hand
1st TWO tables to get ALL questions CORRECT will get
Healthy Bucks!
Questions in Envelope
Let’s Play Cash Cab
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HHBB Review(Healthy Habits Begin at Birth)
1. Beginning in October, fully breastfed babies on WIC will receive twice the amount of baby fruits and vegetables as other babies from age 6 to 12 months.
Answer: True
64 (4-ounce jars per month) vs.
32 (4-ounce jars per month)
Families Grow Healthy with WIC
HHBB Review
2. Beginning in October, a mom who is breastfeeding and receiving more than half of the full formula package for her baby can receive a food package until ____ months postpartum.
Answer: 6
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3. Beginning in October, an 8 month old baby on WIC who is fully formula fed will receive more formula than WIC currently provides.
Answer: False
Baby will receive LESS formula ------
7 cans powdered formula vs. 9 cans WIC currently provides
HHBB Review
Families Grow Healthy with WIC
4. To make plenty of breastmilk in the first month, breastfeed often, at least ____ times in 24 hours.
Answer: 8
HHBB Review
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5. It’s great for a baby to learn to hold her bottle on her own.
Answer: False
Babies should be HELD for bottle feeding!
HHBB Review
Families Grow Healthy with WIC
6. After the first week, a baby should have ____ wet diapers a day.
Answer: 6 to 8
HHBB Review
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7. Beginning in October, WIC will not routinely provide formula for breastfed babies in the first month because giving formula interferes with breastmilk production.
Answer: True
HHBB Review
Families Grow Healthy with WIC
Invite prenatal and postpartum mothers to attend a breastfeeding support group.
Result:
Mothers learn about & see other women breastfeeding.
They see that a support system is available for them.
Keys to Success
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How can you support your
Breastfeeding Moms?
Breastfeeding Support Policy
1. Supporting fully and combination breastfeeding moms
2. Conducting complete assessment
3. The second month appointment
Breastfeeding Support
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Policy Review
Keep In Mind
This is just one step in supporting breastfeeding.
State WIC is requiring 20 hours of breastfeeding training for all WIC staff (by 2011).
This policy meets the new federal regulations. You can still influence the final rule by sending in your comment to USDA by February, 2010.
Families Grow Healthy with WIC
Breastfeeding Support Policy
Supports breastfeeding mothers and babies by not routinely issuing formula during the first 30 days because formula:
interferes in the development of full milk production, and
decreases the chances that a mother will continue breastfeeding.
Families Grow Healthy with WIC
WIC is committed to:
Providing timely counseling and education
Scheduling of a second month appointment
Additional incentives based on Institute of Medicine recommendations
Breastfeeding Support Policy
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Conducting Complete Assessment
The Components:
Dialogue with Mom
Baby Nutrition Questions
ISIS Questions
Counseling Questions
Breastfeeding Support Policy
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The Second Month Appointment
A follow up breastfeeding assessment and counseling by a lactation specialist
Local agencies established procedures and protocols for the second month appointment based on the Breastfeeding Policy 600XXX
Breastfeeding Support Policy
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How comfortable do you feel about implementing the policy in your agency?
ON A SCALE OF 1 to 10
Who says 1, 2, or 3?
Who says 4, 5, or 6?
Who says 7, 8, 9, or 10?
Breastfeeding Support Policy
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Breastfeeding Support Policy
Research: More moms are breastfeeding their babies until 1 year of age
How can we best support a combination breastfeeding dyad?
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Let’s Define:
Who is a Lactation Specialist?
“not routinely issuing formula”
Breastfeeding Support Policy
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Who is a lactation specialist?
Any staff who have >20 hours of breastfeeding education and training
CLE, IBCLC, CLC, RDs, PCs
Your agency will designate a lactation specialist based on your definition
Breastfeeding Support Policy
Families Grow Healthy with WIC
“…not routinely issuing formula during the first 30 days”
“not routinely”
not habitually,
not in an expected or customary manner
not generally
Breastfeeding Support Policy
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Reasons for issuing formula:
USDA interim regulation states, “not routinely issuing formula”
There will be moms who will ask for formula
Anticipating gradual change
Value in data collection
Breastfeeding Support Policy
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Have your Registered Dietitians see postpartum women for infant enrollment.
Results:
Participants not asking for formula due to prenatal education.
WNAs want to see postpartum mothers.
Keys to Success
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Breastfeeding Support Policy # 1
Part One:
Supporting Fully and
Combination Breastfeeding Moms
How are we going to support our breastfeeding moms?
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The 3-Step Strategy
A way to talk with mothers about breastfeeding to help them overcome challenges.
3-Step Strategy:
1. Ask open-ended questions2. Affirm her feelings3. Educate
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Step 1: Open-Ended Questions
Open-Ended Questions:
Many answers
Find out what the mother “thinks”
Start a conversation
Start with “What” or “How”
“What do you know about Breastfeeding?”
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Avoid Closed-Ended Questions
Closed-ended questions:
“Yes”, “No” or very short answers
Don’t encourage a mother to share her thoughts
Many begin with “do”
“Do you plan to breastfeed?”
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Open or Closed Ended?
What does that feel like?
Where do you live?
What time is it?
How do you feel about that?
Is he still in the house?
What’s a good plan for you?
Closed
Open
Closed
Open
Closed
Open
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Open-Ended Questions
Review list of open ended questions
Circle questions that might be helpful
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Need to Know More?
Don’t understand what the mother is thinking…
There are ways to get more information:
Extending
Clarifying
Reflecting
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Getting More Information
Extending questions help you get more information. For example:
Could you tell me a little more about that?
What else can you tell me about breastfeeding?
When you say breastfeeding hurts, could you tell me a little more about that?
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Clarifying questions find out what she really means. For example:
When you say that it would be uncomfortable, are you saying it would be uncomfortable for you, or for someone else who might see you?
When you say it hurts, are you saying it hurts the entire time you are breastfeeding?
Getting More Information
Families Grow Healthy with WIC
Reflecting shows her you understand what she said; often we use statements.
For example: So you think your mother doesn’t want you to
breastfeed
So you feel uncomfortable breastfeeding in front of your family
So you feel your baby is still hungry after you feed her
Getting More Information
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Helpful hints Using mother’s name Repeating her own words Adding extra words
“Why not?”
vs.
“Margie, can you tell me about why you don’t think that’s a good idea?”
Getting More Information
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Pull out the “Ways of Getting More Information” activity sheet.
In pairs or trios, think of ways you could get more information after a mother says the statement on the sheet.
Write extending or clarifying questions or reflective statements for these statements made by mothers.
Getting More Information
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Step 2: Affirm Her Feelings
Figure out what a mother is concerned about…
Affirm her feelings
Feelings are normal & okay Shows respect Builds confidence Feels “safe” to open up & listen to ideas
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Affirming Statements
“I’ve heard a lot of women say that.” “That’s a pretty common reaction or belief.” “I felt that way too.” “My mother told me the same thing.” “Most women go through a period like that
after the baby is born.” “I can tell you are a concerned mom and
want the best for your baby.”
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Activity: Affirm Her Feelings
Pull out the page titled “Affirming Activity”.
In pairs or trios, read the statements & write affirming responses.
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Step 3: Educate
Only share information related to her concerns or questions
Give information in small amounts
Have repeated conversations
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Explore/Offer/Explore
Explore before giving information:
Ask what she already knows or does Offer information Explore their reaction after giving information
How can you use this information? How might this work for you? What do you think about this?
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Activity: Putting it All Together
Read the 2 conversations
In pairs or trios discuss the following:
What did the counselors do well?
How could the counselors improve?
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THINK to yourself:
Which of these materials do you currently use?
Which ones would you like to use in the future?
Education Materials
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Baby Behavior Study
What does my baby need?
Why is he always crying?
Is it normal for her to wake up 4 times a night?
How can I tell if she is hungry?
Why can’t I calm him down?
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Study Messages on Cues
Babies can tell moms what they want by using their bodies and noises – cues.
Babies are not always hungry when they cry.
Learning your baby’s cues and how to respond will make you both happy.
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Results - Baby Behavior Study
All Sites Combined: More exclusive Breastfeeding Food
Packages selected.
Intervention = 43.6% Control = 16.5%
Less formula given:
3.4% reduction in Formula Feeding 7% reduction in distribution of cans of
formula while caseload increased 3.6%
This project has been funded at least in part with Federal funds from the USDA, Food & Nutrition Service.
Families Grow Healthy with WIC
Baby Behavior
Misunderstanding their baby’s behavior was the reason many of the mothers we talked to:
Stopped breastfeeding
Gave too much formula and ran out
Gave solid foods too early
Gave unhealthy foods to their babies
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Inappropriate feeding may lead to overweight.
Parents want to know more about their baby!
Baby Behavior
Families Grow Healthy with WIC
Moms believe babies: cry because of hunger, wake because of hunger, and that formula and cereal will prevent this.
They think their babies will stay full longer if they are overfed.
Mothers are pressured by others to feed.
Focus Groups (2003)
Baby Behavior
Families Grow Healthy with WIC
Parents need tools to
help them believe
they can handle their
infants’ crying and
waking behavior
without overfeeding.
Glanz J Occup Med 1992; 34: 1071-8.
Baby Behavior
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Infant “States”
Group of behaviors that occur together:
NCAST Keys to Caregiving
Body movement
BODY
EYES BREATH
Eye movement
Breathing (fast or slow) How much they respond
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Crying
Irritable
Quiet Alert
Drowsy
Active Sleep
Quiet Sleep
Increasing intensity
Baby “States”
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Crying
Tears
Jerking motions
Responds slowly to comforting measures
Color changes
Tight muscles
Rapid breathing
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Common before feeding
Irritable
Lots of body & facial movement
Eyes open but may not want to interact
Sometimes fussy
Sensitive to what’s going on inside & outside their bodies
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Requires effort to control!
Quiet Alert
Little body movement
Eyes open and wide
Steady, regular breathing
Highly responsive
Wants to learn and play
Can be tiring for young babies
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Easily startled
Drowsy
Variable movement
Irregular breathing
Opens and closes eyes
Eyes glazed
Takes time to react
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Active Sleep
Moves every now & then
Breathing pattern changes
Facial twitches
Rapid Eye Movement (REM)
Easy to wake
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Hard to wake
Quiet Sleep
No body movement
Rhythmic breathing
Bursts of sucking
Startles but does not wake
Does not respond
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Healthy infants will try to control their own state and give cues to “tell” others what they need.
Adapted from: NCAST Keys to Caregiving
Help Baby Control State
Caregivers can play an important role in helping infants feel comfortable and safe.
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To awaken use variety Use different positions, touch, words Will take longer if very drowsy or in deep sleep Can take longer for very young infants
Helping Baby Change States
To soothe use repetition Addresses the baby’s needs Repeat actions or words over and over May take time if infant is very upset Change in position or situation might help
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Interactions will have both types of cues, caregivers need to look for pattern.
Kelly et al. Promoting First Relationships, NCAST Pub 2003
Types of Infant Cues
Engagement “Near You” cues:
Young infants try to tell caregivers when they want to interact
Disengagement “Need a break” cues:
Young infants try to tell caregivers when they need to “take a break” or do something different.
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Understanding Baby Cues
Key Messages
Babies show their parents what they need with cues.
Babies let you know when they want to be with you or need a break.
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Babies wake often in the first few months.
Babies need to dream and wake up to be healthy.Babies wake less often as they get older.
Messages on Infant Sleep
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Whole Group:
How many times on average do babies wake up at night (10pm – 6am)?
At 2 mo? _______
At 4 mo? _______
At 6 mo? _______
Your Turn
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Average waking at night is:
Peirano et al. J Pediatr 2003; 143: 70-9.
Average Night Waking
Babies wake when sick, uncomfortable, or because of a change of routine.
Too much waking is stressful and should be investigated (before infants are switched from breastfeeding to formula).
2-3 times by 2 months
2 times by 4 months
1 time at 6 months
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AS
QS
Wake
Starts in active sleep
Infants sleep 13-14 hrs. per day from 2-12 Mo. (but not all at once!) They spend equal time in active & quiet sleep.
Babies sometimes wake up because moms put them down in Active Sleep.
Newborn Sleep Cycle
Quiet Sleep
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At 2-3 months, infants begin with shorter Active Sleep cycles then move into Quiet Sleep
QS
Wake
AS
AS
QS
Sleep Cycle of 2-Month Old
Moms might find it’s easier to put baby down to sleep…
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QSFall asleep in Quiet Sleep and sleep more like mom and dad.
QS
AS
ASQS
Much easier to put baby down to sleep…
Sleep Cycle of 4+ Month-Old
Wake
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As they mature, infants can link cycles together. (won’t require caregiver with every cycle)
So, infants will sleep longer and will not be as easy to wake as they get older.
Peirano et al. J Pediatr 2003; 143: 70-9.
Infant Sleep Patterns
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Active Sleep (REM) is important for brain development.
Babies dream and blood flows to the brain bringing nutrients to active brain cells
Images stimulate brain function
Quiet sleep is deep sleep, no dreaming or movement, important for the brain to rest.
Peirano et al. J Pediatr 2003; 143: 70-9.
Infant Sleep State
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Peirano et al. J Pediatr 2003; 143: 70-9.
Waking & Active Sleep
Beneficial for Mother & Baby.
Waking and Active sleep are important for the brain development of the baby.
Waking may be essential to survival—needs must be met for breathing, feeding, warmth.
Breastfeeding mothers’ hormonal cycles are interrupted by night feeds, not having periods may lower risk for hormone related cancers.
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Breastfed infants wake more than formula-fed infants and:
Spend more time in Active Sleep
Digest breast milk more quickly
o best for growth & development
Formula-feeding moms can promote Active Sleep by putting babies “back to sleep” and using pacifiers.
Horne et al. Ped Resp Rev 2004; 5: 190-8.
Infant Feeding & Sleep
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Key Messages –
Active vs. Quiet Sleep
Why Active Sleep is good for babies
Sleep cycles
How sleep patterns change
Tips for sleepy parents
Healthy Sleep
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Baby Marcus is 4 weeks old. His mother tries to put him down after falling asleep at the breast but he:
Wakes up,
Cries loudly
Active or Quiet Sleep?
Was he in active or quiet sleep?
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Baby Anna is 4 months old. Her mother tries to put her down after falling asleep at the breast.
She stays asleep!
Active or Quiet Sleep?
Is she in active or quiet sleep?
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Crying makes adults want to help. (Important for survival)
All babies cry
Crying begins in first hours of life, and on average, peaks at 2.6 hours per day at 6 wks.
Crying decreases over the next 10 weeks, much better by 3-4 months.
“Normal” Crying
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Watch for these pre-crying signs:
Turning or pushing away
Stretching out of fingers
Tense muscles in his or her face & body
Pre-Crying
“I need a break” Cues
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Is there a “Hunger Cry”?
Hungry babies might cry but they will also:
Bring their hands to their face
Clench their hands
Flex their arms and legs
Root
Make sucking motions and noises
All these behaviors together help us know baby is hungry.
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Help parents learn to stay calm. Parents can often prevent or
control crying.
Encourage them to get help from friends & family.
Help parents learn their baby’s cues. They won’t stop all crying but
they will feel more in control. Ask them to try your ideas.
Help Parents Deal with Crying
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Baby Tanya is 3 weeks old. 10-15 min. after nearly all feedings she becomes:
Fussy, Arches her back, Stiffens her hands & legs.
Why is this Baby Crying?
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Baby Luz is 3 weeks old. Every evening between 6 to 8 p.m. she becomes:
Quite Fussy,
Closes her eyes,
Tightens her face,
Cries unless she is constantly held & rocked.
Why is this Baby Crying?
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Baby Elena is 4 weeks old. Despite being fed an hour ago, she begins to cry:
Draws her fist toward her chin,
Pulls legs into her body,
Moves her head from side to side.
Why is this Baby Crying?
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Key messages
Crying is normal
Babies cry for many reasons, not just because they are hungry
Babies show other cues when they are hungry
Why do Babies Cry?
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For pregnant women at For pregnant women at the end of their the end of their
pregnancypregnancy
Getting to Know Your Baby
Contains facts and tips Contains facts and tips to help new moms cope to help new moms cope during the first 6 weeks during the first 6 weeks postpartumpostpartum
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Let’s Play Simon Says!
“Simon Says”
Stand up and walk around your table clockwise one time and sit back down
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Breastfeeding Support Policy #2
Conducting Complete AssessmentDIALOGUE
WITH MOMS
ISIS
QUESTIONS
COUNSELING
QUESTIONS
BABY NUTRITION
QUESTIONS
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Assessment
Conducting Complete Assessment
BABY NUTRITION
QUESTIONS
DIALOGUE
WITH MOMS
ISIS
QUESTIONS
COUNSELING
QUESTIONS
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In pairs discuss what other questions you would ask about Sammie and Carrie
Baby Nutrition Questions
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Sammie and Carrie
In pairs or trios, review scenarios What are the feeding issues for both
scenarios? What are some additional open-ended
questions you would ask each of these mothers?
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New Breastfeeding Support Policy
Support Fully and Combination Breastfeeding
mothers
Reviewed Counseling and Baby Behavior skills
Started on Components on Complete Assessment
Baby Nutrition Questions
Dialogue with Moms = Driving Down that Route Soon
Review of Morning
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Open or Closed?
Is this question open or closed-ended?
“Is your baby sleeping well?”
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Is this question open or closed-ended?
You are planning to breastfeed, right?
Open or Closed?
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Question
What are the minimum number of hours of training a lactation specialist needs to have?
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True or False
True or False: A one month old baby falls asleep in quiet sleep.
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Infant Feeding Crossroads
Fully Breastfeeding?Formula Feeding?
Combination Feeding?
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Fully Breastfeeding
With your partner discuss:
What will be different for fully breastfeeding moms and babies?
How will you discuss your breastfeeding services with mothers?
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What will be different?
Moms and babies will receive the largest amount and most variety of foods.
At 6 months babies will receive baby fruits, vegetables and meats.
Fully breastfed babies receive MORE baby food than other babies.
Babies will no longer receive juice.
Fully Breastfeeding
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What resources might be available?
Lactation specialists (IBCLC, CLE, CLC, Peer Counselor)
Breast Pumps
Education Materials and Classes
Community Resources
o La Leche League, Public Health Nurses
Fully Breastfeeding
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Key to Success
Designate a “Lactation Specialist” for the day to…
Provide pregnant and breastfeeding women with needed support and help
Be accessible to staff for any breastfeeding help and questions
Result:
Staff feel more confident.
Breastfeeding mother’s needs are met!
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“Your WIC Foods”
Overview of new food packages
What do you see that is new?
What differences do you notice between the packages?
How will you use this tool to encourage as much breastfeeding as possible?
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Formula Feeding
With your partner discuss:
What will be different for
Formula feeding moms and babies?
How will you discuss formula feeding with moms?
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What will be different? Babies will receive less formula. The amount of formula will change according to
baby’s age. Babies will receive baby food starting at 6
months. Babies won’t receive as much baby foods as
breastfed babies. Babies will no longer receive juice.
Formula Feeding
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What will you discuss?
Always holding baby while feeding
Proper preparation of formula
Formula Feeding
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Cash Cab
How do you plan to support
your fully breastfeeding Moms
starting Oct 1?
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Cash Cab
How do you plan to support
your fully formula feeding Moms
starting Oct 1?
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With your partner discuss:
What will be different for…
Combination feeding moms and babies?
How will you discuss combination feeding using “Your WIC Foods” to support breastfeeding?
Combination Feeding
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What will be different? 2 Categories – mostly and some.
Babies will receive less formula.
The amount of formula will change according to baby’s age.
Babies will receive baby food starting at 6 months.
Babies won’t receive as much baby foods as fully breastfed babies.
Babies will no longer receive juice.
Combination Feeding
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What are some of the reasons breastfeeding moms ask for formula?
I’m going back to work or school.
I want formula just in case…
I don’t have enough milk.
My family members want to feed my baby too.
I (or my baby) have a health issue and can’t fully breastfeed.
Combination Feeding
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Assessment
Conducting Complete Assessment
BABY NUTRITION
QUESTIONS
DIALOGUE
WITH MOMS
ISIS
QUESTIONS
COUNSELING
QUESTIONS
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Let’s watch our WIC actors as they model a challenging breastfeeding scenario.
Find your “Observer’s Checklist”
Combination Feeding
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Work in trios – (Roles)
1. Counselor 2. WIC mom3. Observer
Role play the “Gloria/Gustavo” scenario.
How will you counsel the mom?
What tools would you use?
Combination Feeding
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What went well?
What were some issues?
What tools did you use?
Combination Feeding
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Switch roles
Now role play “Sammie” scenario.
How will you counsel the mom? What tools would you use?
Combination Feeding
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What went well?
What were some issues?
What tools did you use?
Combination Feeding
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Key to Success
At anytime when a fully or combination breastfeeding mom asks for formula, have a lactation specialist see her to assess her breastfeeding.
Result:
Increase in breastfeeding duration
Decrease in formula issuance
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WIC Reference Tools
Guidelines for Referrals
Formula Table
Breastfeeding Resource List
Report: “Amount of formula issued by your agency”
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Guidelines for Referrals
Health & Nutritional Condition
May need referral to support mother
May affect infant’s growth pattern
May still fully breastfeed
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Guidelines for Referral
Breastfeeding Infant is:
Twins
Jaundice
Constipated
Yes
No
Yes
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Breastfeeding Resource List Online
California Breastfeeding Coalition
La Leche League
United States Breastfeeding Committee
Office of Women’s Health
Resources
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Data Collection
Report: Amount Formula Issued by your agency
Recognize your employees who excel in breastfeeding promotion
Identify the training needs
Monitor your exclusive breastfeeding rates
(fully, mostly, and some bf)
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Honk if you love Breastfeeding
Come up with a bumper sticker slogan to support fully breastfeeding in the first 30 days.
Use only 15 words or less
Write on flipchart paper w/markers
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What Would You Do?
In pairs or trios discuss how you would counsel Carrie’s mother.
What are the feeding issues?
What questions would you ask?
What actions would you take?
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Activity Time
What are the feeding issues?
What questions would you ask?
What actions would you take?
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What Would You Do?
Questions to ask Tell me about a typical feeding. Let’s talk more about her diapers. Tell me more about how your baby sleeps.
Things to do Refer to Lactation Specialist or send to the
Emergency Department Weigh the baby Issue Combination Package Schedule appointment for next month
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Assessment
Conducting Complete Assessment
BABY NUTRITION
QUESTIONS
DIALOGUE
WITH MOMS
ISIS
QUESTIONS
COUNSELING
QUESTIONS
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ISIS Documentation
Must enter:
Reason for formula issuance
Input into the child INEP ISIS Screen
Families Grow Healthy with WIC
ISIS defaults to “fully breastfeeding” package when “combination feeding” is entered.
You will have to change to “C”
ISIS will automatically issue just one month of Food Instruments.
Issue Food Instruments
Families Grow Healthy with WIC
Fully Breastfeeding Package (BE7)
BE7 for fully BF mom; BM8 for Fully Multiples
IB1 = 0-5 mo. fully breastfed, no check for infants
IB2 = 6-11 mo, fully breastfed, infant foods
Issue Food Instruments
Families Grow Healthy with WIC
Mostly Breastfeeding Package
Infant codes: IC1, ICQ, and IC2
Mom certified for 1 year
Mom receives more variety of foods
Codes: BC5 -X,L,S,T,H,P,G
Issue Food Instruments
Families Grow Healthy with WIC
Some Breastfeeding Package (BO6)
Infant codes: IO1, IOQ, IO2, and IO3
Mom receives checks up to 6 months
Mom may choose to attend breastfeeding support up to 1 year.
Mom codes: BO6 and B06N
Issue Food Instruments
Families Grow Healthy with WIC
Combination Feeding
Must be in second month
Must be with a lactation specialist
Fully Breastfeeding
Based on needs of mom and baby
Schedule Next Appointment
Families Grow Healthy with WIC
Assessment
Completed Assessment
BABY NUTRITION
QUESTIONS
DIALOGUE
WITH MOMS
ISIS
QUESTIONS
COUNSELING
QUESTIONS
Families Grow Healthy with WIC
The Second Month Appointment
Fully breastfeeding mothers may see lactation specialist if needed.
All combination feeding mothers see a lactation specialist who will:
Conduct complete assessment
Determine the need for continued formula
Provide appropriate breastfeeding support and counseling
Families Grow Healthy with WIC
Your Souvenir
Complete Assessment Checklist for supporting your breastfeeding moms
Families Grow Healthy with WIC
1. Supporting Fully and Combination breastfeeding moms
2. Components of Complete Assessment
3. The Second Month Appointment
Breastfeeding Support Policy
Families Grow Healthy with WIC
Today you heard 5 Keys for Success from agencies who have already implemented the new 30 day policy.
Take the keys out of the toolbox Pass the keys clockwise until you hear
“STOP!” Share how you might apply the “key” at
your agency Use your “That reMinds Me” form
Review Keys to Success