Child Health Training May 2013 Breastfeeding Child Health Training May 2013

Reasons for promotion U.N.I.C.E.F Research cost saving. Benefits to mum Benefits to baby Benefits to environment.

Great for Premature babies Eyes – Retinopathy of prematurity Guts - NEC Brains – early cognitive benefits Lasting cognitive benefits. Protection from infection. Skin to skin contact and its benefits. Healthier outcomes generally.

Breastfeeding Training Pack © UNICEF UK Baby Friendly Initiative Separation and stress Preterm baby receiving high-tech care Term baby, separated for 6 hours Normal stress hormone level 10 9 8 7 6 5 4 3 2 1 One hour of skin contact can reduce stress hormone levels by 75% Breastfeeding Training Pack © UNICEF UK Baby Friendly Initiative

Bottle fed babies Trying to make their experience similar to that of a breastfed infant

Multi –Tasking - a benefit no one talks about.

‘Instant’ protection from infection Broncho-mammary pathway Pathogens inhaled Antibodies incorporated into breastmilk Antibodies produced and sent to breasts Milk-producing cells in breast Pathogens ingested Entero-mammary pathway Breastfeeding Training Pack © UNICEF UK Baby Friendly Initiative

How it works technical stuff Both breasts receive message Baby suckles NERVE IMPULSES HORMONES Pituitary gland stimulated Breastfeeding Training Pack © UNICEF UK Baby Friendly Initiative

A unique relationship Breastfeeding Breastmilk is much more than a method of feeding Breastmilk than food Breastfeeding Training Pack © UNICEF UK Baby Friendly Initiative

The suck/swallow pattern of a feed Beginning of feed - short, rapid sucks Active feeding - long, slow, rhythmic sucking and swallowing, with pauses End of feed - ‘flutter sucking’ with occasional swallows Breastfeeding Training Pack © UNICEF UK Baby Friendly Initiative

‘Seeing’ what the baby is getting Active feeding (1:1 or 1:2 swallowing) ‘Flutter sucking’ (fewer swallows) Breastfeeding Training Pack © UNICEF UK Baby Friendly Initiative

Principles of Positioning Baby’s head and body in line (with freedom to tilt head back) Baby held close to mother Nose to nipple Sustainable Breastfeeding Training Pack © UNICEF UK Baby Friendly Initiative

Effective attachment – external view This is what we need to see when a baby is attached correctly at the breast ! Breastfeeding Training Pack © UNICEF UK Baby Friendly Initiative

Breastfeeding Training Pack © UNICEF UK Baby Friendly Initiative Poor positioning. Baby not close to mum. Baby on nipple centrally. Mouth not wide open. Clothes getting in way of close contact. Breastfeeding Training Pack © UNICEF UK Baby Friendly Initiative

Effects of poor attachment Mother Sore nipples Engorgement Mastitis Poor milk supply Loss of confidence Baby Feeding very frequently Frustrated Poor weight gain Jaundiced Hypernatraemia Breastfeeding Training Pack © UNICEF UK Baby Friendly Initiative

Breastfeeding Training Pack © UNICEF UK Baby Friendly Initiative Nipple trauma This nipple is damaged on the tip and at the base. What has caused this trauma? Breastfeeding Training Pack © UNICEF UK Baby Friendly Initiative

Early detection of Problems Prevention better than cure. Positioning very important.

Failure to gain weight Most commonly problems with Positioning. Mums expectations re feeding…. Feed length and quantity. Lack of rest for mum. minimal impact Maternal diet. Less that 2% of mothers can breastfeed.

BNF says re Medications Many medications have very little information on effects on the infant. Drugs which have known effects - Details are listed under the relevant drug in the BNF

Medications and BF Thomas Hale Medications and mothers milk. Drugs in Breast milk. 08444124665 B.N.F. suitability of breastfeeding with details of drug. Also research based medication details aimed at General Practitioners.

Common Problems and solutions What would you say is most common Breast feeding problem?

Breastfeeding Training Pack © UNICEF UK Baby Friendly Initiative Mastitis – treatment Effective breast drainage – (always get mum to have attachment checked) Hand expression Anti-inflammatory therapy Analgesics Fluids Rest Antibiotics Breastfeeding Training Pack © UNICEF UK Baby Friendly Initiative

Mastitis (inflammation of the breast) Caused by stasis of milk Begins with a blocked duct Affects one or two lobes of one breast May or may not be infected Can produce flu-like symptoms (with or without infection) Breastfeeding Training Pack © UNICEF UK Baby Friendly Initiative

Mastitis What may have caused this condition? Breastfeeding Training Pack © UNICEF UK Baby Friendly Initiative

Breastfeeding Training Pack © UNICEF UK Baby Friendly Initiative Thrush (Candida) Symptoms seen in mothers who have had or regularly suffer Thrush. In BF circles we are encouraged to treat mum and baby. Breastfeeding Training Pack © UNICEF UK Baby Friendly Initiative

Ductal Thrush Examination and enquiry into signs and symptoms, in Baby café prior to request for treatment.

Tongue tie can lead to poor milk transfer and damaged nipples Breastfeeding Training Pack © UNICEF UK Baby Friendly Initiative

Breastfeeding training for General Practitioners One line 25 min training suitable for CPPE / CPD portfolio. Unicef Baby Friendly training

Sources of support…… Midwives, Health Visitors. Assistant Practitioners. Peer supporters. Baby Café Lactation consultants National suitable web sites for self help

BFN Breastfeeding Network Bumps to breastfeeding _ best beginnings BFN Breastfeeding Network Bumps to breastfeeding _ best beginnings. Small wonders. NHS Choices – Breastfeeding. Baby friendly website.BFI Unicef

Dietetics.

Dietetics web address. http://www.cdc.gov/nccdphp/dnpa/growthcha rts/training/modules/module3/text/module3 print.pdf  

Local support. Sure start centres. Active kids programmes Local support. Sure start centres ? Active kids programmes ? Dieticians Healthy food input from school nurse. Upbeat kids, upbeat families. School nurses. Start 4 Life.

Cream, cheese added to meals which should be all full fat foods. Check iron levels. Orange juice with meals increases uptake of iron. Healthy start vitamins. Behaviour management ?