complexity of infant feeding

diff between full & engorged breast

• hot, tight, painful

• mother may exprience fever

• milk does not flow well- FIL is released and the milk duct are blocked

• baby appears agitated

• warm, firm, tender

• mother feels well

• milk full and ready to come out (oxytocin + prolactin released )

what to do if mother has engorgement?

1. encourage hand expression

2. follow up as soon as possible- ideally within the day

MASTISIS CAUSES

1. STASIS of milk

2. infection due to blocked milk ducts- mother may expirience flu like symptoms

3. inadaquate attachment

4. bra size/type

how can you detect mastisis?

• ask woman if a part of her breast feels hotter than the rest

• visible RED HOT patches

Mastitis treatment

• effective breast drainage

• hand expression

• fluids/rest

• antibitotics if needed

nipple trauma causes

• mastatis

• attachment/toungue tie

• bra type e.g. lace

candida trhush symptoms on breast

• itchiness

• odor

• pain

• soreness/redness

• oral trhish that is painful can be seen in the mouth of the baby

why babies don’t feed

• 2 cold/hot

• exaustion

• illness not detected

• miseed oppurtunity to learn e.g. missing golden hour

how can we help at risk babies with their feeding

• keep warm through skin to skin

• engourange hand expression/ EBM

• regular obs

• glucose measurements

signs of inadequate milk intake

1. low urine output after day 3

2. low stool output

3. urates may be seen in the urine

4. no change in stool colour by day 3

5. excessive weight loss

6. persistent jaundice

colustrum & milk production times

BF for pre-term reduced risk of ?

1. NEC necrotising enterocolitis

2. sepsis

3. chronic lung disease

4. retinopathy

5. re-admission

how can we optimise fat content

• hand expressing 8-10 x day

• use EBM from shorter interval expressions first

• milk is wormed to body temperature to avoid fat loss

breastmilk fortifiers

• used for infants under 1,500g

• mixed in with mother’s milk after 2 weeks

• avoid if history of atopy(allergy)

what do pre-term need to learn?

• sucking reflex- dummies is encouraged

• maturation of swallowing-- encouraged by using the best milk 1st so baby can have that quick let down procedure

• maturation of respiration

• coordination between the 3

what can we do to help mothers and babies with their BF

1. encourage BF after 32-34 wwks

2. encourage let down procedure through hand expressing

3. encourage attachement and position by talking through it if baby is 2 small

4. encourage to use best breast first