Transcript Breastfeeding Success Kirsten E. Crowley, MD Edited May, 2005 The big push  American Academy of Pediatrics   WHO and UNICEF   “Exclusive breastfeeding is ideal nutrition and sufficient to.

Breastfeeding
Success
Kirsten E. Crowley, MD
Edited May, 2005
The big push
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American Academy of Pediatrics
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WHO and UNICEF
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“Exclusive breastfeeding is ideal nutrition and
sufficient to support optimal growth and development
for approximately the first 6 months after birth.”
Infants should be breastfed for at least the first four
months of life, and if possible 6 months
Healthy People 2010 Objective
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Increase the number of mothers breastfeeding
postpartum to 75%, at 6 months to 50%, and at 1 year
to 25%
Benefits to the Baby
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Protects against
Infection
 Illness
 allergies
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Provides species-specific nutrition and
hormones
May enhance development and
intelligence
Confers long term benefits
Protection against infection
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The studies
In first year of life, incidence of diarrheal
illness among breastfed infants was half that
of formula-fed infants
 Infants who were exclusively formula-fed had
a 70% increase in their risk of developing an
ear infection
 Formula-fed infants were 17 times more likely
to be admitted for pneumonia
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More infection studies
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Associated with a lower incidence of RSV
infection during the first year of life
Relative risk of developing a UTI of 0.38
compared to formula-fed infants
In the NICU
Among babies born at more than 30 weeks,
confirmed NEC was 20 times more common
in formula-fed babies
 The incidence of sepsis/meningitis are
significantly reduced in human milk fed VLBW
infants
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Other illness
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There is an inverse relationship between
breastfeeding and morbidity
Breastfed infants have gastroesophageal
reflux episodes of significantly shorter
duration
Breastfeeding is protective against SIDS
Toddlers who were breastfed appear to be
healthier
Protection against allergies
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In allergic families, formula introduction in
the first week of life and weaning at less
than 4 months were associated with
increased allergies later in life
Eczema was less common and milder
Breastmilk = 22%
 Soymilk formula = 63%
 cow’s milk formula = 70%
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Enhances development and
intelligence
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Controversial of course
Some studies have shown higher IQ and
improved cognitive development in
breastfed children
Psychomotor and social development may
be improved as well
Long term benefits
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Lower incidence of
diabetes
 childhood cancer and breast cancer
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May influence LDL concentration and
mortality from ischemic heart disease
Decreased cavities
Better response to vaccines
Benefits to mom
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Delays fertility due to lactational
amenorrhea
Reduces risk of breast, uterine, ovarian,
and endometrial cancer
Enhances emotional health
Decreases insulin requirements
Decreases osteoporosis
Promotes postpartum weight loss
Societal benefits
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Encourages optimum child spacing
Improves vaccine effectiveness
Decreased expense of food (formula for one
year is between $1160 and $3915)
Decreased medical expenses
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1000 bottle-fed infants had 2033 excess office visits,
212 excess days in the hospital, and 609 more
prescriptions = $459-$808 per family per year
Reduced absenteeism due to child illness
Protects the environment (bottles, packages,
etc.)
So, how are we doing?
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In 1998
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64% of women initiated breastfeeding
29% were still breastfeeding at 6 months
16% were breastfeeding at one year
highest rates in several generations
Rates still fall short of the Healthy People goals
of 75% initiation, 50% at 6 months, and 25% at
one year
U.S. breastfeeding rates are the second lowest
of all industrialized nations
Who tends to breastfeed?
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Most common among women who are
college educated
 white
 married
 older than 30 years
 middle or higher income levels
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More prevalent in the western regions of
the country
What affects success?
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Maternity hospital routines
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accuracy and timeliness of breastfeeding assistance
are the most important
Birth weight and health of the newborn
Peer attitudes
Length of maternity leave
Employer’s willingness to make
accommodations
Opinion of the child’s father
Aggressive marketing of formula
Promoting success
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Women who are better informed regarding
the benefits of breastfeeding and the
breastfeeding process are more likely to
initiate (and probably maintain)
breastfeeding
An interesting study
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Kistin et al.
First controlled trial of prenatal maternal
counseling by MDs
Counseling increased the rate of initiation
and duration of breastfeeding in a
predominantly low-income, urban, African
American population
National Assessment of
Physicians’ Breast-feeding
Knowledge, Attitudes,
Training, and Experience
Freed, et al. JAMA.. 1995; 273(6): 472-476
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Residents and practitioners in peds, FP,
and OB/gyn were lacking in
Breastfeeding knowledge base
 Ability to give appropriate advice
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The role of the pediatrician
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Promote and support
Become knowledgeable and skilled in
physiology and clinical management
Provide education
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Parents, Colleagues, Nurses, Residents
Become familiar with local resources
Develop and promote policy
Encourage insurance coverage
Promote breastfeeding friendly workplaces
Assessing for success
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The input (milk transfer)
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The output (urine & stool)
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The ultimate (weight)
The intake
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Goal is 8-12 feedings per day
Feedings should last 10-15 minutes when
the baby is a newborn
Understand the cues
Sleep arousal
 Increased alertness
 Hand to mouth
 Tongue or mouth movements
 Crying (late stage of hunger)
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The output
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Urine
Before the milk is in: one void for each day of
age
 After the milk arrives: 6-8 times per day
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Stool
Days 1-4: meconium
 Day 4-4 weeks: 4 yellow, seedy BM per day
 1-4 months: varies from one per feed to once
a week
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The ultimate judge:
The Weight
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Initial loss
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8-10% of birthweight
Return to birthweight
10-14 days
 Aggressive intervention if not by 2 weeks
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Rate of gain for full term babies
First 2 months = 30 grams per day
 > 2 months = 20-30 grams per day
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Assess the Latch!
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Incorrect latch is one of the most common
etiologies for poor weight gain
Observation of the mother - infant dyad is
extremely important!
Correct latch
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Mother
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Mom holds breast back from areola and nipple with
C-hold
Use manual stimulation to erect the nipple
Tickle the baby’s lips gently
Wait for baby to open mouth like a yawn
Center nipple quickly while pulling baby in close to the
breast
Initial latch may be painful, but abates as nursing
progresses
Correct latch
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Baby
Tip of nose and chin touching breast
 Tummy to tummy
 Lips flanged over areola - fish lips
 Gums bypass nipple and are over areola
(where the milk sinuses are)
 Movement of facial and jaw muscles, ear
wiggling
 Look for suck-swallow patterns
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Assessment of suck
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Tongue comes over the gumline
Cupping of tongue at the lip
Feel up and down motion of the posterior
tongue
Strength of suck
Nursing positions
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Cradle hold
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Mom upright in comfortable chair with pillows in the
lap and feet supported
Tummy to tummy
Head in straight line
Ear, shoulder, and hips in straight line
Baby’s body at breast level (boppy pillow)
Baby’s head in crook of elbow
Baby’s back supported with forearm
Cup breast with free hand
Cradle hold
Boppy pillow
Nursing positions
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Football hold
Mom in same position
 Baby’s body and legs under mom’s arm
 Head snugly in mom’s hand with neck
grasped by thumb and pinky and head on
palm and other fingers
 Pillows under the baby (boppy)
 Avoid flexing baby’s head too much
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Football hold
Nursing positions:
Lying Down
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Helpful after a
cesarean section
Good for tired moms
Eases nighttime
feedings early on if
the dyad is cosleeping
Common problems
(and how to fix them)
Sore nipples
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Discomfort at the beginning is OK
Improper position is the main cause
Can also be caused by infection or inappropriate
nipple care
Treatment
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Position correctly
Begin feeding on least sore nipple
Frequent shorter feeds
Rub expressed milk onto nipple/areola
Air dry nipples
Pump if nipples are too painful
Engorgement
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Occurs on the second to fourth days
Results from hormone changes that suddenly
increase milk production
Temporary!!!: The supply becomes balanced
within a few days
Treatment
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Nurse frequently, around the clock
Heat and massage before feeding
Express some milk if baby can’t latch
May be harmful to supply if not relieved
Mastitis
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Bacterial breast infection
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Symptoms
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caused by inadequate emptying of milk
achy, flu-like
breast pain, redness, tenderness
fever/chills
Treatment
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Dicloxicillin 250 mg QID x 10 days
Keflex 500 mg QID x 10 days
Rest, fluids, pain meds, nurse often or pump after
feeds, moist heat
Candidiasis
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Rapid development of extremely sore
nipples, burning or itching, shooting pain
Look for deep pink areas on mom and
thrush or diaper candidiasis in baby
Treat both mom and baby
Topical antifungal for both, oral nystatin
 Wash anything in contact with baby’s mouth
or breast
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Breastfeeding jaundice
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Exaggerated physiologic jaundice due to lack of
food in GI tract and increased enterohepatic
circulation
Usually occurs in second to third day
Treatment
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Increase feeding frequency
Mom should pump if baby is sleepy or poor feeder
Feed baby EMM or formula only
Use alternate feeding systems if necessary
Watch baby’s weight