1. Infant Feeding
Julia Cross

2. Areas for discussion Why breast feeding is important
Tips to help with successful breastfeeding
What to do when problems arise
Advice to give parents on formula feeding
How to make up a formula feed
Types of formula
Weaning

3. Why Breastfeed? Practical Advantages
Easily transportable, all equipment provided by nature!
At the right temperature (great for night feeds)
Less washing up! No bottles to sterilise
Never runs out
Can do one-handed so can catch up on reading a book, eating etc
Enviromental benefits

4. Benefits to baby Helps protect against:
GI infections and vomiting
Ear infections
Chest infections
Urine infections
Childhood diabetes (evidence suggests need exclusive breast feeding for 6 months)
Eczema (evidence suggests need exclusive breast feeding for 6 months)
Obesity
Asthma
Constipation
Colic
Thrush
Studies show breastfed babies have fewer GP appointments!!

5. Benefits to mother Weight loss (~500kcal/day) Helps reduce risk of:
Ovarian cancer
Breast cancer
?Osteoporosis
Positive effect on mood
Emotionally very satisfying (when it works well)

6. Current Recommendations
DOH and WHO recommendations are for exclusive breastfeeding for 6 months
When weaning the baby onto solids at 6 months continue breast feeding, initially offering solids after a breastfeed
The WHO recommends continuing a daily feed to the age of 2yrs

7. Latest Statistics on Breastfeeding
Breastfeeding initiation rate is 76% for UK, 78% in England (2005 IFS)
By 6wks 75% of mothers had given their baby milk other than breast milk
One third described problems with breastfeeding in the first few weeks, this was more common if mixed feeding (52%)
1 in 8 women continued to experience problems beyond the first few weeks
Mothers who received help were more likely to continue breast feeding
90% of mothers who gave up breastfeeding within 6 weeks would have preferred to feed for longer

8. How to Breastfeed
Support his back, shoulders and neck. He should be able to tilt his head back easily. And he shouldn't have to reach out to feed.
TUMMY TO MUMMY

9. Hold your baby close to you, with his nose level with the nipple.
Wait until your baby opens his mouth really wide with the tongue down. You can encourage him to do this by gently stroking his top lip.
Quickly bring your baby even closer to your breast.
Your baby will tilt his head back and come to your breast chin first. He should take a large mouthful of breast. Your nipple should go towards the roof of his mouth. 

11. Common Breastfeeding Problems
Insufficient milk
Rejection of breast
Painful nipples
Breastfeeding too tiring
Mastitis/blocked ducts
Thrush

12. A Dummy Guide to Feeding Problems
Insufficient Milk
Get expert help to ensure baby is latching on properly
Reassure it is normal to have to feed often in the early days (8-12 feeds is average in newborns)
Try feeding every hour and offering both breasts at each feed (Supply and Demand)
Make sure baby is staying on breast long enough to get rich hindmilk at the end of the feed (mum’s often think the baby is just comfort sucking at this stage and take baby off too early)
Avoid giving supplemental feeds, or aim to reduce gradually (unless under specialist advice)
Ensure mother is drinking enough water and resting
Some people find fennel tea helpful

13. Rejection of breast Painful nipples
May be engorged (try expressing off a little milk to help the baby latch on)
Excessive rooting (Toronto Wrap)
Nipple confusion from mixed feeding
Skin to skin
Seek advice from breastfeeding counsellor
Painful nipples
Usually due to poor attachment, so encourage to seek advice
Avoid soap etc, keep dry (change breast pads regularly), try lansinoh (lanolin ointment)
Some suggest rubbing a little breast milk onto the nipple at the end of feeds

14. Too tiring
Try feeding lying down (and having a quick cat nap when baby sleeps)
Ensure eating and drinking enough
See if others can help with chores

15. Mastitis
Mastitis presents as a sore, red breast and flu-like symptoms. Often high temperature and rigors. Blocked ducts may cause redness and pain without systemic features
Rest (if possible go to bed with baby by your side)
Feed regularly from affected side to clear the blocked duct
Apply heat
Remove bra, ensure no tight fitting garments as these can cause blocked ducts and mastitis
Massage affected area under warm shower, massaging in the direction of the nipple
Ibuprofen reduces inflammation in ducts and some evidence suggests using for 5 days. Sometimes may avert need for antibiotics
May need antibiotics (fluclox/amox or erythromycin if allergic)
If recurrent consider sending breastmilk for culture
Beware cracked nipples causing mastitis, when treated with antibiotics may then cause breast thrush
Often due to poor attachment so seek advice

17. Thrush
Thrush is often described as a shooting, razor-blade like sensation or a deep pain in the breast
Nipples may be sore, red and shiny
Baby may or may not have symptoms
Often associated with recent antibiotic treatment (especially if for mastitis secondary to cracked nipples)
If local to nipple treat mother and baby with daktarin oral gel 24mg/ml QDS (off licence). Apparently adheres better than nystatin. Daktarin cream is not suitable
Fluconazole loading dose mg followed by mg OD for at least 10 days + topical Rx (off licence). St. Georges suggests 400mg on first day, then 200mg OD for 14 days. Passes into breastmilk but at lower doses than is licensed for use in infants
If expressing and storing milk advise not to do so until infection cleared as thrush survives in the freezer
Teats, dummies etc should be disposed of at weekly intervals
Hot wash clothes in contact with affected breast (eg. Bras)

18. “Is my baby getting enough?”
If you feed frequently, on demand and for as long as the baby wants they will get enough
Signs a baby is taking enough milk:
Plenty of wet nappies
Usually 2-5 poos/day (not after about 6wks)
Awake and alert for some of the time
Growing and gaining weight

19. Normal Breast fed poo, often has seedy appearance

20. Other bits and boobs
Colostrum in the first few days is golden coloured, sticky and is small in quantity
Breasts usually become full around 3rd day, frequent feeds and warmth will help if uncomfortable. Encourage to express milk if too swollen to allow baby to latch on
A tingling sensation one to two minutes after the baby starts feeding is the “let-down” reflex. A baby may sometimes splutter as the milk shoots out.
Green poo often suggests a baby is getting the foremilk but not hindmilk (in a well baby)
After about 6 weeks some breast fed babies will only open their bowels every 3-10days. This is normal but would suggest constipation in a formula fed baby
Smoking is not a contraindication to breast feeding but suggest trying to smoke after a feed to reduce amount of nicotine in breastmilk.
Hep C is not a contraindication, HIV is in Western World but probably still beneficial in developing countries

21. Advice on Formula Feeding
Be aware that if also intending to breast-feed it may interfere with milk supply and cause problems with attachment
Does not offer the same benefits to baby as breastmilk
Increased risk of infection so important to follow the instructions for making feeds carefully
Unlike breast fed babies, will need cooled boiled water to drink especially on hot days as milk does not vary in content/nature
If changing from breast to bottle expect change in poo to more paste like, smellier and often darker

22. How to make up a formula feed
All the equipment used for feeding your baby needs to be sterilised before use
Wash hands before preparing feed
Water should be freshly drawn, boiled and left to cool for LESS than 30 minutes
Add water to bottle FIRST, then level scoops of powder (level with a knife)
Shake well to mix
Throw away any leftover feed
Only make up feeds at the time they are required, do not prepare in advance

23. Types of Formula Wide variety, most cow’s milk based Soy formula
Goat’s milk formula (no longer available in EU)
Specialist formulas eg.
Enfamil lactofree, SMA LF
Neocate, neutramigen, pregestimil
Infatrini

24. Weaning
Ideally not until 6 mths of age, but certainly not before 17 weeks
Wait for a baby to be able to sit up and take an interest in food
Lower calorific and nutritional value than milk so introduce slowly
Offer “first tastes” at the end of a milk feed
Good first foods are banana, avocado, root vegetable purees etc
If introducing food before 6 mths there is a long list of foods to avoid because of allergy risk
Avoid peanuts until 5yrs of age as choking hazard
Cow’s milk (full-fat) can be introduced from 1yr of age