Pediatric tut 1

Contraindications of breast feeding for mother & child:

Mother

Relative CI:

• Psychiatric disorder

• Acute fever, TB, chronic nephritis, breast abscess, septicaemia, post-partum psychosis

Temporary CI:

• Inverted nipples, cracks of nipples, and fissures.

Absolute CI:

• Cancer treated with anticancer agents

Child

Absolute CI:

• Galactosemia (galactose from lactose in breast milk may worsen condition)

• Phenylketonuria

• Any condition where child cannot suck

Describe phenylketonuria (PKU).

An autosomal recessive genetic disorder where there’s a deficiency in the phenylalanine hydroxylase enzyme (PAH), so phenylalanine isn’t metabolized and becomes phenyl ketones (phenylpyruvate, phenylacetate, phenethylamine). They accumulate and cause brain damage.

PKU features:

Describe galactosemia.

A disorder or inability to breakdown galactose or its metabolite galactose-1-phosphate (gal-1-P).

Galactosemia features.

Types of breast milk.

1. Colostrum: produced at the latest stage of pregnancy; high in protein, low in carbohydrates

2. Traditional milk: between week 1 and 2 after delivery; fat and sugar content increase.

3. Breast milk: 10 days from delivery; high in carbohydrates but low in protein.

Breast milk composition:

• Nutritional components

• Minerals & vitamins

• Hormones & GF

• Microbial communities

• MicroRNAs

Evaluating adequacy of BF:

1. Infant sleeps 2-3 hrs after BF.

2. Weight gain

3. 6-8 well-formed stools per day

4. Breasts soft after

5. Milk analysis

6. Frequent feeding approx. 10 times/day.

Poor weight gain causes even after breast feeding.

• Technique problem (most common cause): flutter sucking—ineffective suckling—decreased BF frequency

• Infant health problems or deformity: congenital mouth anomalies—cleft lip

• Maternal health problems: decreased nutritional status—decreased hydration—-retained placenta

Evaluation of infant for poor weight gain.

• Routine history (frequency or duration) of feeding

• Pain when nursing—→ stress—→ dec. prolactin & oxytocin

• No. of bowel movements/stools < 3 or 4 times/day

• Physical examination of infant mouth and suckling

• Maternal breasts examination

• Observation of technique and attachment (latching)

Management of poor weight gain

1. Correction of technique and attachment

2. Increase frequency and duration of feeding

3. Electric pump bw feedings to express milk (increases prolactin production)

4. Monitor baby weight every 2-4 days; weight gain should be 20-30 g/day.

Baby’s weight should be:

At birth: 3-3.5 kg

4 months: 6 kg

8 months: 8 kg

12 months: 9 kg

Equations:

How can a mother increase her milk supply?

• Using a pump at least 5 or 6 times a day.

• Nursing as much as possible.

If a mother is not present or sick and can’t nurse, what other options are available.

• Cup feeding

• Finger feeding

When might finger feeding be used.

• Mother is unable to breast feed.

• Baby refuses to feed or too sleepy

• Baby is getting trained, weak or too lazy to suck