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Maternal Trouble Signs  Nipple pain  Nipple trauma Copyright © 2003, Rev 2005 American Academy of Pediatrics Illustration by Tony LeTourneau.

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Presentation on theme: "Maternal Trouble Signs  Nipple pain  Nipple trauma Copyright © 2003, Rev 2005 American Academy of Pediatrics Illustration by Tony LeTourneau."— Presentation transcript:

1 Maternal Trouble Signs  Nipple pain  Nipple trauma Copyright © 2003, Rev 2005 American Academy of Pediatrics Illustration by Tony LeTourneau

2 Maternal Trouble Signs  Engorgement Copyright © 2003, Rev 2005 American Academy of Pediatrics

3 Infant Assessment  Proper positioning at the breast  Proper latch and lip closure  Sufficient areola in infant’s mouth  Tongue extends over lower gums  Adequate jaw excursion with suckling  Effective swallowing motion  Coordination of suck-swallow- breathe Breastfeeding Evaluation Copyright © 2003, Rev 2005 American Academy of Pediatrics

4 Infant Assessment  Encourage at least 8–12 feedings per day.  Alternate the breast that is offered first.  Allow infant to nurse on at least one side until infant falls asleep or comes off the breast to increase fat and calorie consumption. Feeding Pattern Copyright © 2003, Rev 2005 American Academy of Pediatrics

5 Infant Assessment  Weight Loss  Average loss of 5% over the first 3–4 days.  Loss greater than 7% mandates careful evaluation of breastfeeding.  Weight Gain  Begins with increase in mother’s milk production by at least day 4–5.  Expect gain of 15–30 g/day (1/2 to 1 oz per day) through the first 2–3 months of life. Infant Weight Copyright © 2003, Rev 2005 American Academy of Pediatrics

6 Infant Assessment  Problem  Poor infant weight gain.  Inadequate milk supply or milk transfer.  Solution  Weigh infant, feed infant, weigh again.  Evaluate infant at the breast.  Correct latch and positioning.  Improve milk production and transfer.  Increase frequency and duration of feeding. Infant Weight Copyright © 2003, Rev 2005 American Academy of Pediatrics

7 Infant Assessment  6–8 pale or colorless voids/day by day 5.  Loose, yellow, curd-like stools after most feedings through first month.  Constipation unusual in the first month—may indicate insufficient milk intake. EVALUATE  Infrequent stools are common after the first month in the healthy breastfed infant. Elimination Pattern Copyright © 2003, Rev 2005 American Academy of Pediatrics

8 AAP Policy Statement  Initiate in the first hour.  Keep newborn and mother together in recovery and after.  Avoid unnecessary oral suctioning.  Avoid traumatic procedures. Recommended Breastfeeding Practices Copyright © 2003, Rev 2005 American Academy of Pediatrics

9 AAP Policy Statement  Continuous rooming-in.  Respond to early breastfeeding cues.  Rooting  Fist to mouth  Early arousal  Crying is a late hunger sign. Recommended Breastfeeding Practices Copyright © 2003, Rev 2005 American Academy of Pediatrics

10 AAP Policy Statement  Avoid pacifiers in early weeks until breastfeeding is well established.  Avoid supplemental bottles, unless medically indicated. Recommended Breastfeeding Practices Copyright © 2003, Rev 2005 American Academy of Pediatrics

11 Medical Indications for Supplementation  Very low birth weight or some premature infants  Hypoglycemia that does not respond to breastfeeding  Severe maternal illness  Inborn errors of metabolism  Acute dehydration not responsive to routine breastfeeding or excessive weight loss  Maternal medication use incompatible with breastfeeding Adapted from Powers NG, Slusser W. Pediatr Rev. 1997;18:147–161 Copyright © 2003, Rev 2005 American Academy of Pediatrics

12 AAP Policy Statement  Formal evaluation of breastfeeding in first 24–48 hours and again at 3–5 days and 2–3 weeks of age  Assess  Infant weight  General health  Breastfeeding  Jaundice  Hydration  Elimination pattern Recommended Breastfeeding Practices Copyright © 2003, Rev 2005 American Academy of Pediatrics

13 AAP Policy Statement  Do not give water, juice, or solids in the first 6 months.*  Initiate iron supplements only if indicated clinically in the first 6 months.  Include iron-rich foods after 6 months of age.  Supplement with vitamin D daily, beginning during the first 2 months.  Provide fluoride after 6 months if household water supply is deficient.  Avoid cow’s milk before 12 months. Recommended Breastfeeding Practices Copyright © 2003, Rev 2005 American Academy of Pediatrics *There is a difference of opinion among AAP experts on this matter. The Section on Breastfeeding acknowledges that the Committee on Nutrition supports introduction of complementary foods between 4 and 6 months of age where safe and nutritious complementary foods are available.

14 AAP Policy Statement  Strong position of support based on published evidence of improved outcomes  Knowledgeable and skilled in physiology and management of breastfeeding  Collaboration with the obstetric community  Age-appropriate breastfeeding education Role of Pediatricians and Other Health Care Professionals in Protecting, Promoting, and Supporting Breastfeeding Copyright © 2003, Rev 2005 American Academy of Pediatrics

15 AAP Policy Statement  Promote hospital policies that facilitate breastfeeding  Eliminate mother- infant separation  Eliminate formula discharge packs Role of Pediatricians and Other Health Care Professionals in Protecting, Promoting, and Supporting Breastfeeding Copyright © 2003, Rev 2005 American Academy of Pediatrics Photo © La Leche League International

16 AAP Policy Statement  Promote community resources  Communicate with lactation support personnel  Encourage third-party payer coverage for breastfeeding services, supplies, and consultation  Support breastfeeding in the workplace Role of Pediatricians and Other Health Care Professionals in Protecting, Promoting, and Supporting Breastfeeding Copyright © 2003, Rev 2005 American Academy of Pediatrics

17  Positive media image of breastfeeding  Breastfeeding education during medical training  Family and societal support for breastfeeding  Breastfeeding as cultural norm AAP Policy Statement Role of Pediatricians and Other Health Care Professionals in Protecting, Promoting, and Supporting Breastfeeding Copyright © 2003, Rev 2005 American Academy of Pediatrics Photo © La Leche League International

18 Breastfeeding Jaundice  Inadequate breastfeeding  Inadequate caloric intake  Occurs in first few days of life Copyright © 2003, Rev 2005 American Academy of Pediatrics


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