Transcript UNICEF Baby Friendly Initiative

Understanding Weight Loss
in breastfed babies
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What is normal weight loss?
Why do babies lose weight?
How to identify a concern
What to do first
All Wales Guidelines
Breastfeeding Matters
What is a normal weight loss?
• Babies born in the UK to lose weight in the
first few days due to fluid loss
• Many hospitals identify a 10% weight loss from birth as ok
• Recent studies indicate 7% may be more normal
• The time taken for the baby to regain birth weight &
• The time to establish a pattern of weight gain is important
Breastfeeding Matters
Why do babies lose more than expected?
• They are not getting enough milk!
A baby should have regained his birth weight by 14 days
• Infrequent feeding
• Insufficient milk transfer
• Underlying illness
Breastfeeding Matters
Why do babies lose more than expected?
• Infrequent feeding
Missed feeding cues
Regime imposed
Clock watching
Sore nipples
Equal reduction in milk supply
Full breasts, Mastitis
Embarrassment
Misunderstanding of normal bf pattern
Poor advice i.e. ‘top ups’
Breastfeeding Matters
Why do babies lose more than expected?
• Insufficient milk transfer
poor position
poor latch / attachment
ineffective suck /swallow pattern
inhibited milk ejection
Inhibited milk production
Reducing milk supply
Breastfeeding Matters
To weigh or not to weigh?
• Weighing is one of several tools to assess growth & well
being
• Weight must be accurate, scales in good order
• Recorded accurately, significance understood
• Currently no nationally agreed protocol
• But it should be frequent enough to pick up problems
with feeding especially in first 2 weeks. NICE, BFI
• Reflects what has happened over a period of time
• Not the most immediate sign that feeding is not effective
• Anxiety is only caused by over weighing with no help or
explanation
Breastfeeding Matters
Assessment!
• Weighing is one of several tools to assess growth & well being
Output
V input
Behaviour of mum
Condition & behaviour
of baby
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Breastfeeding Matters
What are we worried about?
• Extreme weight loss is accompanied by dehydration &
possibly hypernatraemia ( high sodium levels)
• Dehydration Blood thicker, baby’s heart works harder, can clog up
the blood vessels leading to vital organs; kidneys, liver or brain.
• Hypernatraemia is doubly dangerous; baby dehydrated and
sodium levels high. When the sodium in the blood is too high, it
poisons the cells.
• Brain cells are particularly at risk,
which is why hypernatraemic dehydration can
make a baby have fits and behave abnormally
• Can be fatal
Breastfeeding Matters
What to look out for
• ‘good baby’
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Infrequent feeding – less than 8 feeds/24hours
Sleeping through the night
Mother has sore/trauma to nipples
Sleepy baby
Jaundiced
‘constipated’, dry clean nappies
Low grade fever
excessive irritability
Weight loss of more than 12%
Breastfeeding Matters
First things first!
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Evaluate feeding by observation & discussion
Check position of mum
Attachment of baby
Assess output
Discuss pattern of feeds
Use BFI checklists
Assess weight (if not already done)
Re-visit
Breastfeeding Matters
Signs feeding is going well
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Before attachment
Mother’s position
Mother relaxed and comfortable
Breast hanging or lying naturally
Easy access to nipple/areola
Hair/clothing do not restrict mother’s view
Baby’s position
Baby’s head and body in line
Baby held close to mother’s body
Baby’s whole body supported
Baby’s nose opposite nipple
Attaching to the breast
Baby reaches or roots for the breast
Mother waits for baby to open mouth wide
Baby opens mouth wide
Mother brings baby swiftly towards breast
Baby’s chin/lower lip/tongue touches
breast first
...and not well
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Mother not relaxed, e.g. shoulders tense
Breast squashed or restricted
Access to nipple/areola restricted
Mother’s view restricted by hair/clothing
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Baby has to twist head and neck to feed
Baby not held close to mother’s body
Only shoulders or head supported
Baby’s lower lip/chin opposite nipple
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No response to the breast
Mother does not wait for baby to ‘gape’
Baby does not open mouth wide
Mother does not move baby in swiftly
Baby’s top lip touches the breast first
Breastfeeding Matters
Signs feeding is going well
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Observations
Baby’s chin touches the breast
Baby’s mouth wide open
Baby’s cheeks soft and rounded
Baby’s lower lip turned outwards
If visible, more areola seen above baby’s
top lip3
Breasts remain round during a feed
Signs of milk release (e.g. leaking)
Baby’s behaviour
Baby stays attached to the breast
Baby calm and alert at the breast
Slow, deep sucking bursts with pauses
No noise other than swallowing
Rhythmic swallowing seen
At the end of the feed
Baby releases the breast spontaneously
Breasts appear soft
Nipple is same shape as before feed
Skin of nipple/areola appears healthy
...and not well
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Baby’s chin does not touch the breast
Baby’s mouth pursed, lips point forward
Baby’s cheeks tense or pulled in
Baby’s lower lip turned in
More areola seen below bottom lip
(or equal)
Breasts look stretched or pulled
No signs of milk release
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Baby slips off the breast
Baby restless or fussy
Rapid shallow sucks
Smacking or clicking sounds
Occasional or no swallowing seen
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Mother takes baby off the breast
Breasts are hard or inflamed
Nipple is wedge-shaped or squashed
Nipple/areola is sore or cracked
Breastfeeding Matters
Identified the problem…?
• You have the knowledge and skills to help
• Give mum the right information to address;
• Infrequent feeding
Missed feeding cues, regime imposed, poor advice,
embarrassment, misunderstanding of normal bf pattern
• Insufficient milk transfer
poor position, poor latch, inhibited milk ejection, poor
swallowing
Breastfeeding Matters
Confidence & support
Mothers quickly lose confidence in breastfeeding
• Your support is essential
• You can give accurate information
• Show confidence in her ability
• You can value breastfeeding
• You can develop a plan of action with her;
Skin contact, feed both breasts, min 8 feeds, feed diary,
re-weigh
Breastfeeding Matters
Identified more than 10% loss?
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More intensive support
Discuss with BF colleague
Check breastfeeding history
Breast compression
Switch nursing
Check for signs of illness
Pump after feeds, offer EBM via cup
Re-weigh 24-48 hours
Breastfeeding Matters
More than 12%
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Refer to paediatrician for investigation
Intensive breastfeeding support
Double pumping preferable
Supplementation is necc if bf assessed as ineffective;
EBM via cup
Formula feed via cup or supplementer (avoid top ups)
IV fluids
• Continue breastfeeding, as milk supply increases reduce
formula
• Continue to monitor weight 2x week until trend towards
normal weight gain
Breastfeeding Matters
All Wales Weight Loss Guidelines
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Task and Finish Group
Building on comprehensive work
Compatible with BFI Best Practice Standards
For distribution this Spring
Clear guidance but will not supersede clinical
judgements
Breastfeeding Matters
To summarise
• ‘Keeping your fingers crossed’ is not good
enough now!
• Remember the theory of breastfeeding;
Good attachment, feed the baby, move the milk
• Practice the skills of teaching positioning and
attachment
• Learn the signs of good attachment;
curled out lips, round cheeks, chin indenting, swallowing
• Increase knowledge
• Develop practice, improve outcomes
Breastfeeding Matters
Give a baby something to smile about!
Breastfeeding Matters