Transcript Alternative methods

Alternative methods of feeding
for small or sick neonates
Alternative feeding methods
Objectives:

To describe the options available for alternative
methods of feeding

Teach a mother how to use an alternative feeding
method

To explain how to express breast milk
Teaching Aids: ENC
AF - 2
Alternative feeding methods
Indications:

Baby
◦ Not breastfeeding effectively
◦ Not sucking effectively (e.g. preterm, ill, cleft lip/palate)

Mother
◦ Is ill
◦ Has flat/inverted nipple or engorged breast
◦ Is HIV positive and decides not to breastfeed
Teaching Aids: ENC
AF - 3
Assessment
Is the baby clinically stable?
Action
No
Manage as per guidelines
for sick neonates*
Yes
Is birth weight more than 1250 g?
No
Start intravenous
fluids
Yes
Initiate breast feeding
Yes
Give oral feeds by
cup/spoon/ paladai
Yes
Is the baby able to breastfeed
effectively?
 When offered the breast, the baby roots,
attaches well and suckles effectively
 Able to suckle long enough to satisfy needs
No
Is the baby able to accept feeds
by alternative methods?
 When offered cup or spoon feeds, the baby
opens the mouth, takes milk and swallows
without coughing/ spluttering
 Able to take an adequate quantity to satisfy
needs
No
Start intra-gastric
tube feeds
* Assess daily for clinical stability ; once stable, assess for initial feeding method
Alternative feeding methods
Options available:

Cup

Paladai

Spoon
Irrespective of the method, only expressed breast
milk has to be fed to the baby
Teaching Aids: ENC
AF - 5
Expressing breastmilk by hand
Hand expression of breastmilk

Have a clean dry container

Tell the mother to:
1. Wash her hands thoroughly
2. Make herself comfortable
3. Hold a wide necked container under her nipple and areola
4. Place her thumb and first finger behind the nipple (at least
4cm from the tip of the nipple)
Teaching Aids: ENC
AF - 7
Hand expression of breastmilk…
5. Compress and release the breast between her finger and
thumb
6. Compress and release all the way around the breast,
keeping her fingers the
same distance from the nipple
7. Express one breast until the milk just drips, then express
the other breast until the milk just drips
8. Alternate between breasts 5 or 6 times, for at least 20 to 30
minutes
9. Stop expressing when the milk no longer flows but drips
from the start
Teaching Aids: ENC
AF - 8
Hand expression of breastmilk
Different ways to massage the breast
Teaching Aids: ENC
AF - 9
Hand expression of breastmilk
Back massage

Mother sits down, leans forward,
folds her arms on a table in front
of her, rests her head on her arms

Her breasts hang loose and
unclothed

The helper works down both
sides of the spine at the same time
from the neck to just below the
shoulder blades

She uses her closed fist with her
thumbs pointing forwards

She presses firmly making small
slow circular movements with her
thumbs and continues for 2-3 min
Hand expression of breastmilk
Storing expressed breastmilk



Room temperature : 6 hours
Refrigerator
: 24 hours
Freezer
: 2 weeks (-40C) to 3 months (-200C)
Alternative methods: Cup feeding
Cup and spoon are easy
to clean with soap and
warm water
Teaching Aids: ENC
AF - 12
Cups for feeding newborn babies

An ideal cup can hold
50 to 90 mL of milk

It can be glass or plastic
and easily washable

Edge should be
rounded and smooth

A cup with a lid is useful
for storing expressed
breast milk
Teaching Aids: ENC
AF - 13
Cups with lips and spouts

Variations of cups with
lips and spouts can
easily be found

They should be used
with extreme caution

It is DANGEROUS to
POUR milk into a
baby’s mouth
Teaching Aids: ENC
AF - 14
Cup feeding
Teaching Aids: ENC
AF - 15
Cup feeding
Advantages

Simple equipment ; easy to clean

Baby can take what it needs in its own time

Mother can do it herself

Good eye contact between mother and baby
Teaching Aids: ENC
AF - 16
Cup feeding
Steps

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Put a measured amount of milk in the cup
Infant should be awake and held sitting semi-upright on
caregiver's lap; put a small cloth on his or her front to catch
drips of milk
Touch the edge of the cup to the outer parts of the upper
lip
Tip the cup so that the milk reaches the baby’s lips
Teaching Aids: ENC
AF - 17
Cup feeding
Steps




Do not pour the milk into the infant's mouth
Allow the infant to take the milk himself (upon smelling the
breastmilk, the baby becomes alert, opens its mouth, and
puts its tongue into the milk to start the feed)
Feed the infant slowly; some milk may spill from the infant's
mouth
When the infant has had enough, he or she will close his or
her mouth and will not take any more. Do not force-feed
the infant.
Pouring the milk into baby’s mouth can cause aspiration
Teaching Aids: ENC
AF - 18
Case study: cup feeding
Measuring the correct amount of milk
To measure 30 mL

Use a desert spoon which holds approx. 10 mL
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Take 3 spoonfuls of milk
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Put a mark on the outside of the cup to guide her how
much milk is needed each time
If the baby does not take the required amount:
feed more often or for longer
Teaching Aids: ENC
AF - 19
Paladai feeding

A paladai is a small bowl
with a long pointed lip

The advantages are that it is
usually faster than spoon or
even cup feeding and also
that there is less spillage

A disadvantage is the risk of
pouring large amounts of
milk into the infant’s mouth
Teaching Aids: ENC
AF - 20
Paladai feeding
Steps


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Infant should be awake and held sitting semi-upright on
caregiver's lap; put a small cloth on his or her front to catch
drips of milk
Put a measured amount of milk in the paladai
Hold the paladai so that the pointed tip rests lightly on the
infant’s lower lip
Teaching Aids: ENC
AF - 21
Paladai feeding
Steps

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
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Tip the paladai to pour a small amount of milk into the
infant’s mouth
Feed the infant slowly
Make sure that the infant has swallowed the milk already
taken before giving any more
When the infant has had enough, he or she will close his or
her mouth and will not take any more. Do not force-feed
the infant.
Teaching Aids: ENC
AF - 22
Spoon feeding

Advantages
◦ Useful for collecting small
amounts of colostrum in the
first days of life
◦ Useful in a baby with cleft
lip/palate

Disadvantages
◦ Slow method of feeding
◦ Often difficult to manage a
spoon and a milk container
while holding the infant semiupright
Teaching Aids: ENC
AF - 23
Feeding colostrum with a spoon

A grandmother giving
colostrum to her
grandson 5 hours after
delivery

The mother was
recovering from a
Caesarean section

A health worker helped
the mother express
Teaching Aids: ENC
AF - 24
Ensuring adequacy of intake

Weighing him/her once a day and assess weight gain

Check that (s)he has several wet nappies every day

Babies who are growing adequately are receiving enough
milk
Teaching Aids: ENC
AF - 25
Summary
Alternative methods - indicated in those who are
NOT able to breastfeed effectively
 Methods available: Cup, spoon, Paladai
 ONLY expressed breast milk should be fed
 Ensure hygiene and adequacy of intake while
giving feeds by alternative methods

Teaching Aids: ENC
AF - 26