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BREASTFEEDING Adequate communication between obstetric and pediatric care professionals immediate postdelivery period in the immediate postdelivery.

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Presentation on theme: "BREASTFEEDING Adequate communication between obstetric and pediatric care professionals immediate postdelivery period in the immediate postdelivery."— Presentation transcript:

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4 BREASTFEEDING

5 Adequate communication between obstetric and pediatric care professionals immediate postdelivery period in the immediate postdelivery period greatly facilitate will greatly facilitate helping the breastfeeding. It is equally important that all health care personnel involved in careing for mothers and infants basic breastfeeding knowledge so that can provide accurate and consistent information. possess basic breastfeeding knowledge so that they can provide accurate and consistent information.

6 Before hospital discharge anticipatory guidance regarding the breastfeeding process her partnerother supporting family members. Before discharge, anticipatory guidance regarding the breastfeeding process should be provided to the patient, her partner, and other supporting family members. Follow-up visits Follow-up visits should be arranged. easily access The patient should be given information on how to easily access further breastfeeding support if it in needed. anticipatory guidance regarding the breastfeeding process her partnerother supporting family members. Before discharge, anticipatory guidance regarding the breastfeeding process should be provided to the patient, her partner, and other supporting family members. Follow-up visits Follow-up visits should be arranged. easily access The patient should be given information on how to easily access further breastfeeding support if it in needed.

7 most mothers can produce an adequate quantity of milk most infants can nurse effectively and consume an adequate volume most mothers can produce an adequate quantity of milk and most infants can nurse effectively and consume an adequate volume, specific maternal and infant Risk factors infant at risk for inadequate breastfeeding. specific maternal and infant Risk factors can place an infant at risk for inadequate breastfeeding. that risk factors are assessed routine prenatal care It is assumed that risk factors for breastfeeding problems are assessed as part of routine prenatal care, although some mothers may present with limited or no prenatal care. most mothers can produce an adequate quantity of milk most infants can nurse effectively and consume an adequate volume most mothers can produce an adequate quantity of milk and most infants can nurse effectively and consume an adequate volume, specific maternal and infant Risk factors infant at risk for inadequate breastfeeding. specific maternal and infant Risk factors can place an infant at risk for inadequate breastfeeding. that risk factors are assessed routine prenatal care It is assumed that risk factors for breastfeeding problems are assessed as part of routine prenatal care, although some mothers may present with limited or no prenatal care.

8 Findings maternal breast examination adversely affect adequacy of milk production inverted nipplesseverely asymmetrical or tubular breastsprior breast surgeries Findings of the prenatal maternal breast examination that may adversely affect adequacy of milk production (such as inverted nipples, severely asymmetrical or tubular breasts, and prior breast surgeries )should be forwarded to the pediatric care professional. This information also should be discussed with the patient supportive and realistic fashion This information also should be discussed with the patient in a supportive and realistic fashion. lack of breast growth during pregnancy red flag Particular, lack of breast growth during pregnancy is a red flag and should be communicated from the obstetric to the pediatric care professional. Findings maternal breast examination adversely affect adequacy of milk production inverted nipplesseverely asymmetrical or tubular breastsprior breast surgeries Findings of the prenatal maternal breast examination that may adversely affect adequacy of milk production (such as inverted nipples, severely asymmetrical or tubular breasts, and prior breast surgeries )should be forwarded to the pediatric care professional. This information also should be discussed with the patient supportive and realistic fashion This information also should be discussed with the patient in a supportive and realistic fashion. lack of breast growth during pregnancy red flag Particular, lack of breast growth during pregnancy is a red flag and should be communicated from the obstetric to the pediatric care professional.

9 inverted nipple tubular breasts

10 Appropriate maternal history Appropriate maternal history includes: Amount and timing of prenatal care and education Amount and timing of prenatal care and education Medical complications Medical complications Obstetric complications Obstetric complications Medical history breast surgeries Medical history (especially breast surgeries, infertility, endocrine problems,and past breastfeeding difficulties) Family history Family history (atopy, breastfeeding problems) Psychosocial history Psychosocial history (Substance abuse, mental illness, sexual abuse, family support of breastfeeding). Appropriate maternal history Appropriate maternal history includes: Amount and timing of prenatal care and education Amount and timing of prenatal care and education Medical complications Medical complications Obstetric complications Obstetric complications Medical history breast surgeries Medical history (especially breast surgeries, infertility, endocrine problems,and past breastfeeding difficulties) Family history Family history (atopy, breastfeeding problems) Psychosocial history Psychosocial history (Substance abuse, mental illness, sexual abuse, family support of breastfeeding). Maternal History

11 Appropriate infant history Appropriate infant history includes: Medical complications Medical complications Postnatal feeding and elimination patterns Postnatal feeding and elimination patterns Infant temperament and sleep patterns Infant temperament and sleep patterns Appropriate infant history Appropriate infant history includes: Medical complications Medical complications Postnatal feeding and elimination patterns Postnatal feeding and elimination patterns Infant temperament and sleep patterns Infant temperament and sleep patterns Infant History

12 New mothers should be encouraged to: New mothers should be encouraged to: Nurse at each breast at each feed Nurse at each breast at each feed Starting with the breast offered last at the prior feeding Starting with the breast offered last at the prior feeding (This will help her achieve an optimal milk supply) it is perfectly normal to fall asleep after the first breast and refuse the second. However, it is perfectly normal for a newborn to fall asleep after the first breast and refuse the second. It is preferable an infant to drain the first breast well before switching him to the other breast It is preferable to allow an infant to drain the first breast well before switching him to the other breast New mothers should be encouraged to: New mothers should be encouraged to: Nurse at each breast at each feed Nurse at each breast at each feed Starting with the breast offered last at the prior feeding Starting with the breast offered last at the prior feeding (This will help her achieve an optimal milk supply) it is perfectly normal to fall asleep after the first breast and refuse the second. However, it is perfectly normal for a newborn to fall asleep after the first breast and refuse the second. It is preferable an infant to drain the first breast well before switching him to the other breast It is preferable to allow an infant to drain the first breast well before switching him to the other breast

13 should not interrupt a feeding just to switch to the second side The mother should not interrupt a feeding just to switch to the second side the infant will spontaneously release the first breast after sufficient draining Typically, the infant will spontaneously release the first breast after sufficient draining Timing each side is not necessary Timing each side is not necessary Limiting the time at the breast has no effect on nipple soreness correct latch and positioning are crucial Limiting the time at the breast has no effect on nipple soreness but correct latch and positioning are crucial should not interrupt a feeding just to switch to the second side The mother should not interrupt a feeding just to switch to the second side the infant will spontaneously release the first breast after sufficient draining Typically, the infant will spontaneously release the first breast after sufficient draining Timing each side is not necessary Timing each side is not necessary Limiting the time at the breast has no effect on nipple soreness correct latch and positioning are crucial Limiting the time at the breast has no effect on nipple soreness but correct latch and positioning are crucial

14 Many new parents expect their baby to cry when he is hungry Many new parents expect their baby to cry when he is hungry crying is a la t e sign o f hunger di ff icul t t o calm and la t ch t o t he breas t But need to be informed that crying is a la t e sign o f hunger and can result in an infant who is di ff icul t t o calm and la t ch t o t he breas t guidance rooming- in 24 hous a day the parents to notice early infant hunger cues Anticipatory guidance and rooming- in 24 hous a day allow the parents to notice early infant hunger cues such as Increased alertness Flexin of the extremities, Flexin of the extremities, Mouth and tongue movements, Mouth and tongue movements, Cooing sounds, Cooing sounds, Rooting,bringing the fist toward the mouth, or sucking on fin Rooting,bringing the fist toward the mouth, or sucking on fin Many new parents expect their baby to cry when he is hungry Many new parents expect their baby to cry when he is hungry crying is a la t e sign o f hunger di ff icul t t o calm and la t ch t o t he breas t But need to be informed that crying is a la t e sign o f hunger and can result in an infant who is di ff icul t t o calm and la t ch t o t he breas t guidance rooming- in 24 hous a day the parents to notice early infant hunger cues Anticipatory guidance and rooming- in 24 hous a day allow the parents to notice early infant hunger cues such as Increased alertness Flexin of the extremities, Flexin of the extremities, Mouth and tongue movements, Mouth and tongue movements, Cooing sounds, Cooing sounds, Rooting,bringing the fist toward the mouth, or sucking on fin Rooting,bringing the fist toward the mouth, or sucking on fin

15 informationlatch –on In addition to information regarding latch –on and positioning of the infant positioning of the infant, the mother should be instructed on expected breastfeeding routines which can vary widely Typically, newborns will nurse 8 to 12 times or more/ day for 10 to 15 minutes per breast

16 interval between feedings from the beginning of one nursing to the beginning of the next. The interval between feedings is figured from the beginning of one nursing to the beginning of the next. Frequent breastfeeding in the first few days: Minimizes postnatal weight loss Minimizes postnatal weight loss Decreases bilirubin levels Decreases bilirubin levels Helps establish a good milk supply Helps establish a good milk supply

17 a great deal of variation from infant to There is a great deal of variation from infant to infant during a 24 –hour period infant and during a 24 –hour period, Although every 2 to 3 hours is the average every 2 to 3 hours is the average

18 MILK SUPPLY FOR BREASTFED NEONATES (THE FIRST WEEK) (THE FIRST WEEK) First 24 hoursSome milk may be expressed Day2 Milk should come-in (lactogenesis stage 2) Day3 Milk should come-in (lactogenesis stage 2) Day4 Milk should come-in (lactogenesis stage 2) Day5 Milk should be present, breasts may be firm or leaking > Day6 Breasts should feel softer after nursing Adapted with permission from Clin Perinatol.1999;

19 Without anticipatory guidance new mothers often compare their infants to bottle-fed infants misinterpret the Normal Higher frequency of breastfeeding to mean they have insufficient milk. Without anticipatory guidance, new mothers often compare their infants to bottle-fed infants and misinterpret the Normal Higher frequency of breastfeeding to mean they have insufficient milk.. As infants get older: As infants get older: They nurse more efficiently They nurse more efficiently The frequency and duration of feedings decrease The frequency and duration of feedings decrease

20 Feeding Routine FOR BREASTFED NEONATES (THE FIRST WEEK) First hours Infant put skin-to-skin in delivery room 2-4 hours Infant/mother sleep 4-24 hours Breastfeeding every 1.5 to 3 hours (8-12 × in 24 hours) Day2 Breastfeeding every 1.5 to 3 hours (8-12 × in 24 hours) Day3 Breastfeeding every 1.5 to 3 hours (8-12 × in 24 hours) Day4 Breastfeeding every 1.5 to 3 hours (8-12 × in 24 hours) Day5 hear Should hear baby swallow milk : start 1 loner interval(up to 5 hours) >Day6 Continue frequent breastfeeding with 1 longer interval: Baby appears satisfied As long as the milk supply is established:may not be the norm for a term breastfed infant before 2 to 3 months. Adapted with permission from clin Peninatol.1999:26:

21 Nursing Styles Infants have been classified by their feeding behaviors Infants have been classified by their feeding behaviors recognizing the difference in infants and responding to them The key to appropriate counseling is recognizing the difference in infants and responding to them Infants have been classified by their feeding behaviors Infants have been classified by their feeding behaviors recognizing the difference in infants and responding to them The key to appropriate counseling is recognizing the difference in infants and responding to them

22 INFANT BREASTFEEDING STYLES Attention to infant cues for the acceptance of a range of styles is helpful in optimizing breastfeeding TypeDescription Barracuda (or “Excited,effective”) Grabs the nipple and sucks energetically for 10 to 20 minutes Excited Ineffective Very eager and active at the breast, frustrated and crying when no milk results Procrastinator(Slow to start) Waits until the milk appears before sucking, does well once started Gourmet (Slow feeder) Licks and tastes little drops of milk before latch-on: attempts hurry are met with vigorous infant protest Rester (Protracted feeder) Prefers to breastfeed for a few minutes, then rest a few minutes,resulting in a longer than usual nursing time

23 Neonate Behaviors After the usual 1 to 2 hours of quiet alertness After the usual 1 to 2 hours of quiet alertness immediately after birth immediately after birth (The ideal time to initiate breastfeeding) (The ideal time to initiate breastfeeding) many infants fall into deep sleep,with many infants fall into deep sleep,with only brief, partial arousals for several only brief, partial arousals for several hours hours This is a normal pattem and does not indicate a need for supplementation. This is a normal pattem and does not indicate a need for supplementation. After the usual 1 to 2 hours of quiet alertness After the usual 1 to 2 hours of quiet alertness immediately after birth immediately after birth (The ideal time to initiate breastfeeding) (The ideal time to initiate breastfeeding) many infants fall into deep sleep,with many infants fall into deep sleep,with only brief, partial arousals for several only brief, partial arousals for several hours hours This is a normal pattem and does not indicate a need for supplementation. This is a normal pattem and does not indicate a need for supplementation. Sleepy Infant

24 Sometimes Sometimes Unwrapping,gentle massage,holding upright, motion, changing a diaper, talking,or holding the infant skin-to-skin against the mothers chest Unwrapping,gentle massage,holding upright, motion, changing a diaper, talking,or holding the infant skin-to-skin against the mothers chest may arouse t he sleepy in f an t may arouse t he sleepy in f an t Infants have short wakeful Infants have short wakeful periods throughout the first periods throughout the first 2 days that can be missed. 2 days that can be missed. Sometimes Unwrapping,gentle massage,holding upright, motion, changing a diaper, talking,or holding the infant skin-to-skin against the mothers chest may arouse the sleepy infant I Infants have short wakeful periods throughout the first 2 days that can be missed. Sleepy Infant … Sleepy Infant … Neonate Behaviors

25 Rooming – in Rooming – in where the infant sleeps in close proximity to the mother, allows the mother to recognize subtle hunger cues mother received a large quantity of narcotics or sedativeslonger periods of sleep and may need to be awakened after 4 hours to feed The newborn whose mother received a large quantity of narcotics or sedatives may have longer periods of sleep and may need to be awakened after 4 hours to feed Rooming – in Rooming – in where the infant sleeps in close proximity to the mother, allows the mother to recognize subtle hunger cues mother received a large quantity of narcotics or sedativeslonger periods of sleep and may need to be awakened after 4 hours to feed The newborn whose mother received a large quantity of narcotics or sedatives may have longer periods of sleep and may need to be awakened after 4 hours to feed Sleepy Infant… Neonate Behaviors

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28 But Crying results in But Crying results in Increased work,energy expenditure, and swallowing of air, which may precipitate vomiting Increased work,energy expenditure, and swallowing of air, which may precipitate vomiting Depletes metabolic reserves hypoglycemia disrupts early breastfeeding behavior Depletes metabolic reserves, which may precipitate hypoglycemia, and disrupts early breastfeeding behavior Crying is a very late sign of hunger Crying is a very late sign of hunger go to sleep without nursing or before they have finished the entire feeding. Babies who cry for a long time may become exhausted and go to sleep without nursing, or before they have finished the entire feeding. But Crying results in But Crying results in Increased work,energy expenditure, and swallowing of air, which may precipitate vomiting Increased work,energy expenditure, and swallowing of air, which may precipitate vomiting Depletes metabolic reserves hypoglycemia disrupts early breastfeeding behavior Depletes metabolic reserves, which may precipitate hypoglycemia, and disrupts early breastfeeding behavior Crying is a very late sign of hunger Crying is a very late sign of hunger go to sleep without nursing or before they have finished the entire feeding. Babies who cry for a long time may become exhausted and go to sleep without nursing, or before they have finished the entire feeding.

29 Frequent feeding will diminish crying episodes Frequent feeding will diminish crying episodes. Efforts should be made to minimize crying. Efforts should be made to minimize crying. Frequent feeding will diminish crying episodes Frequent feeding will diminish crying episodes.. Efforts should be made to minimize crying. Efforts should be made to minimize crying.

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31 Physical examination infant a general examination, vital signs, growth percentiles percentage weight change from birth Physical examination of the infant should include a general examination, vital signs, growth percentiles and percentage weight change from birth, and a more detailed oral-motor examination (mandible size, frenulum, rooting, sucking) a more detailed oral-motor examination (mandible size, frenulum, rooting, sucking) Presence of congenital anomaly and overall tone should be noted Presence of congenital anomaly and overall tone should be noted Physical examination o f the i ii infant should include a aa a general examination, vital signs, growth percentiles a nd percentage weight change from birth, and a more detailed oral-motor examination (mandible size, frenulum, rooting, sucking) Presence of congenital anomaly and overall tone should be noted Assessment of the Breastfeeding Infant

32 Breastfeeding Observation Breastfeeding Observation. physician to observe a feeding evaluate positioninglatch milk letdown milk transfer. It is helpful for the physician to observe a feeding and evaluate positioning, latch, milk letdown,and milk transfer. maternal responses to the feeding Also note maternal responses to the feeding (painful,pleasurable, anxious, relaxed) hospital staff should observe and document these breastfeeding observations at least twice daily. The hospital staff should observe and document these breastfeeding observations at least twice daily. Breastfeeding Observation Breastfeeding Observation. physician to observe a feeding evaluate positioninglatch milk letdown milk transfer. It is helpful for the physician to observe a feeding and evaluate positioning, latch, milk letdown,and milk transfer. maternal responses to the feeding Also note maternal responses to the feeding (painful,pleasurable, anxious, relaxed) hospital staff should observe and document these breastfeeding observations at least twice daily. The hospital staff should observe and document these breastfeeding observations at least twice daily. Assessment of the Breastfeeding Infant

33 Latch: Latch: The infant’s mouth should be wide open with lips flanged outward (“fish lips”) encompassing the nipple and a significant part of the areola The infant’s mouth should be wide open with lips flanged outward (“fish lips”) encompassing the nipple and a significant part of the areola Important in assessing latch ability of the infant to latchquality of the latch presence of audible swallowing maternal sensation Some of the factors that are Important in assessing latch include the ability of the infant to latch, quality of the latch, presence of audible swallowing, characteristics of the anatomy and physiology of the nipple, maternal sensation, and …. Latch: Latch: The infant’s mouth should be wide open with lips flanged outward (“fish lips”) encompassing the nipple and a significant part of the areola The infant’s mouth should be wide open with lips flanged outward (“fish lips”) encompassing the nipple and a significant part of the areola Important in assessing latch ability of the infant to latchquality of the latch presence of audible swallowing maternal sensation Some of the factors that are Important in assessing latch include the ability of the infant to latch, quality of the latch, presence of audible swallowing, characteristics of the anatomy and physiology of the nipple, maternal sensation, and …. Assessment of the Breastfeeding Infant Good attachmentPoor attachment

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35 Weight Changes: The most accurateappraisal the adequacy of breastfeeding is the serial measurement of the infant’s naked weight The most accurate appraisal of the adequacy of breastfeeding is the serial measurement of the infant’s naked weight Weight Changes: The most accurateappraisal the adequacy of breastfeeding is the serial measurement of the infant’s naked weight The most accurate appraisal of the adequacy of breastfeeding is the serial measurement of the infant’s naked weight Assessment Assessment of the of the Breastfeeding Infant Breastfeeding Infant

36 Nearly all infants lose weight for the first 2 to 4 days after birthNearly all infants lose weight for the first 2 to 4 days after birth A weight loss greater than 7% of birth weight may be excessive even if lactogenesis and milk transfer seem not to be proceeding normally. A weight loss greater than 7% of birth weight may be excessive even if lactogenesis and milk transfer seem not to be proceeding normally. Significant dehydration: Significant dehydration: First 24 h : > 4 % weigth loss First 24 h : > 4 % weigth loss 24 – 48 h : > 8 % weigth loss 24 – 48 h : > 8 % weigth loss > 72 h : > 10 % weigth loss > 72 h : > 10 % weigth loss Nearly all infants lose weight for the first 2 to 4 days after birthNearly all infants lose weight for the first 2 to 4 days after birth A weight loss greater than 7% of birth weight may be excessive even if lactogenesis and milk transfer seem not to be proceeding normally. A weight loss greater than 7% of birth weight may be excessive even if lactogenesis and milk transfer seem not to be proceeding normally. Significant dehydration: Significant dehydration: First 24 h : > 4 % weigth loss First 24 h : > 4 % weigth loss 24 – 48 h : > 8 % weigth loss 24 – 48 h : > 8 % weigth loss > 72 h : > 10 % weigth loss > 72 h : > 10 % weigth loss Assessment Assessment of the of the Breastfeeding Infant Breastfeeding Infant

37 Once lactogenesis stage 2 is completed Once lactogenesis stage 2 is completed, an infant who did not lose excessive weight an infant who did not lose excessive weight who is nursing effectively to begin gaining weight by day 4 or 5 at a rate of approximately 15 to 30 g per day and who is nursing effectively should obtain enough milk to begin gaining weight by day 4 or 5 at a rate of approximately 15 to 30 g per day most breastfed infants will exceed their birth weight by 10 to 14 days gain At this rate, most breastfed infants will exceed their birth weight by 10 to 14 days, and gain g / week for the first 2 months g / week for the first 2 months Once lactogenesis stage 2 is completed, an infant who did not lose excessive weight a nd w ww who is nursing effectively s hould obtain enough milk t tt to begin gaining weight by day 4 or 5 at a rate of approximately 15 to 30 g per day A t this rate, m mm most breastfed infants will exceed their birth weight by 10 to 14 days, and g ain g / week for the first 2 months Assessment Assessment of the of the Breastfeeding Infant Breastfeeding Infant

38 A breastfed infant who weighs less than birth weight at 2 weeks requires careful evaluation and intervention A breastfed infant who weighs less than birth weight at 2 weeks requires careful evaluation and intervention Assessment Assessment of the of the Breastfeeding Infant Breastfeeding Infant

39 Evaluation Patterns Evaluation Patterns Urine output usually exceeds fluid intake (U.O.> I) for the first 3 to4 days after birth a physiologic response to contract the extracellular fluid space Urine output usually exceeds fluid intake (U.O.> I) for the first 3 to4 days after birth, a physiologic response to contract the extracellular fluid space Stoolling and voiding patterns after the first few days are good indicators of adequate milk intake Stoolling and voiding patterns after the first few days are good indicators of adequate milk intake Evaluation Patterns Evaluation Patterns Urine output usually exceeds fluid intake (U.O.> I) for the first 3 to4 days after birth a physiologic response to contract the extracellular fluid space Urine output usually exceeds fluid intake (U.O.> I) for the first 3 to4 days after birth, a physiologic response to contract the extracellular fluid space Stoolling and voiding patterns after the first few days are good indicators of adequate milk intake Stoolling and voiding patterns after the first few days are good indicators of adequate milk intake

40 Evaluation Patterns Evaluation Patterns Urine Output: Urine Output: By 5 to 7 days voiding colorless, dilute urine 6 or more times per day ( > = 6 / day) By 5 to 7 days the breastfed newborn should be voiding colorless, dilute urine 6 or more times per day ( > = 6 / day) Evaluation Patterns Evaluation Patterns Urine Output: Urine Output: By 5 to 7 days voiding colorless, dilute urine 6 or more times per day ( > = 6 / day) By 5 to 7 days the breastfed newborn should be voiding colorless, dilute urine 6 or more times per day ( > = 6 / day)

41 Evaluation Patterns Evaluation Patterns Stool output and character also are particularly useful indicators of adequate milk intake The normal green-black meconium should change to transitional green The normal green-black meconium stool should change to transitional green, then to soft, seedy yellow stool by day 4 or 5 by day 4 or 5 after birth. Evaluation Patterns Evaluation Patterns Stool output and character also are particularly useful indicators of adequate milk intake The normal green-black meconium should change to transitional green The normal green-black meconium stool should change to transitional green, then to soft, seedy yellow stool by day 4 or 5 by day 4 or 5 after birth.

42 Evaluation Patterns Evaluation Patterns Anticipatory guidance is essentialAnticipatory guidance is essential because normal human milk stools are quite loose may be confused with diarr if parents are accustomed to seeing the firm brown stools typical of formula-fed infants because normal human milk stools are quite loose and may be confused with diarrhea if parents are accustomed to seeing the firm brown stools typical of formula-fed infants Insufficient milk intake ( > 5 day) the presence of meconium stools infrequent( 5 day) may be signaled by the presence of meconium stools, green –brown transitional, stools, infrequent(<3per day) stools, or scant stools. Evaluation Patterns Evaluation Patterns Anticipatory guidance is essentialAnticipatory guidance is essential because normal human milk stools are quite loose may be confused with diarr if parents are accustomed to seeing the firm brown stools typical of formula-fed infants because normal human milk stools are quite loose and may be confused with diarrhea if parents are accustomed to seeing the firm brown stools typical of formula-fed infants Insufficient milk intake ( > 5 day) the presence of meconium stools infrequent( 5 day) may be signaled by the presence of meconium stools, green –brown transitional, stools, infrequent(<3per day) stools, or scant stools.

43 Evaluation Patterns Evaluation Patterns By 5 to 7 days of age By 5 to 7 days of age, well–nourshied breastfed infants pass a medium-sized yellow stool at least times a day well–nourshied breastfed infants usually pass a medium-sized yellow stool at least times a day Some infants stool after most feedings Some infants stool after most feedings. After the first month volume of each stool increases but frequency decreases After the first month the volume of each stool increases but the frequency decreases Evaluation Patterns Evaluation Patterns By 5 to 7 days of age By 5 to 7 days of age, well–nourshied breastfed infants pass a medium-sized yellow stool at least times a day well–nourshied breastfed infants usually pass a medium-sized yellow stool at least times a day Some infants stool after most feedings Some infants stool after most feedings. After the first month volume of each stool increases but frequency decreases After the first month the volume of each stool increases but the frequency decreases

44 ELIMINTION PATERNS IN BREASTFED NEONATES THE FIRST WEEK FIRST 24 HOURS 1 wet diaper in 24 hours 1meconium stool in 24 hours Day wet diapers in 24 hours 1meconium stool in 24 hours Day wet diapers in 24 hours stool changes Day 4 Urine light yellow, 4-6/day Transition stools In 24 hours Day 5 Urine coloress,6-8/day 3-4yellow stools In 24 hours Day 6+ Urine colorless,6-8/day 4 stools : once established stool In 24 hours (frequency may diminish) Adapted with mission from clin perinatol. 1999:26:

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