Clickers Please!

Channel #48
A mom is asking you how she should feed
her babywhat is your opinion?
A. Human Milk
B. Human Milk and Commercial Artificial
Milk
C. Commercial Artificial Milk
D. I have no opinion

Let the evidence guide us!

Infant Feeding
NURS3590
Seattle University
Carrie Miller PhD, RN, CNE, IBCLC
Agenda
Review of A/P
Recent History of Infant Feeding
Breastfeeding
Formula Feeding
Trouble shooting
Essential Understandings
The breast.
Puberty
Adulthood
Pregnancy
Muscle
Subcutaneous fat Lactation

Areola
Lactogenesis I
Nipple Lactogenesis II
Lactiferous Lactogenesis III
sinuses
Milk ducts

Alveolen Ladewig, London & Davidson,

2010
Ribs
Hormonal WILL BE TESTED!
Estrogen
Readies the uterus for labor, making more
receptive to Oxytocin in labor
Progesterone
Maintains pregnancy
Prolactin
Milk maker
Oxytocin
Contractor and milk pusher
 Adult-20 year-Never pregnant

Note areola color, spacing and nipple eversion

Denise Both & Kerri Frischknecht, Breastfeeding: An Illustrated Guide

to Diagnosis and Treatment Elsevier 2008
Adult-20 weeks pregnant
Understand concept of pseudoanemia !

Note areola color, spacing and nipple shape & eversion

Preparing for lactation, breast changes, lactogenesis I

Denise Both & Kerri Frischknecht, Breastfeeding: An Illustrated

Guide to Diagnosis and Treatment Elsevier 2008
Four days postpartum
Check
notebook for
where to
listen to
HR/Lungs

Note size change, areola size, color and nipple eversion

Lactogenesis II
Denise Both & Kerri Frischknecht, Breastfeeding: An Illustrated Guide to Diagnosis
and Treatment Elsevier 2008
Historical Relevance 1970-1980
Infant feeding research
Infant Opposition to medical advice
feeding International Code of
Evolving Marketing WHO, 2012
1929 AMA

1940-1960
Formula feeding seen
as preferred method
for infant feeding
WWII
Apple, 2006; Foss, 2010; 1990-Today
Golden, 1996; Spock, 1953;
Stevens et al, 2009; Wolf, Call to Breastfeed
2001
OSG, 2011
Today
Recommendations
WHO & AAP
Exclusive for 6 months
Use of complementary foods starting at 6
months
Breastfeed for up to 2 years and beyond
Cultural issues
No cows milk before one year of age- milk
protein incredibly large
 Rates of Breastfeeding in US

http://www.statehealthfacts.org/comparebar.jsp?ind=501&cat=10&sub=117&yr=1&typ=2
&rgnhl=1
 Rates-High and Low
Highest States-Top Four
Oregon 91.9% California 92.8%
Washington 91.8% Montana 91.2%

Lowest Rates-Ever Breastfed

Mississippi 61.3%
West Virginia 59.3%
Louisiana 56.9%

Centers for Disease Control, Breastfeeding Report Card 2014

Rates According to Race/Age
Benefits
Correct nutrition Appropriate weight
Less waste gain
Perfect volume Fewer allergies
Evolves with time Some studies:
No mixing, no increase scores on
mistakes Cognitive tests
Antibodies Always available
Helps to establish Cheaper
immune system No recalls!
Breastfeeding Basics-Latch & Positioning

http://www.youtube.
com/watch?v=Zl
n0LTkejIs&featur
e=related

http://www.youtube.
com/watch?v=0o
QHe1eYsnE
During normal breastfeeding, where does the
mothers nipple lie in the infants mouth?
A. At the junction of the hard
palate and soft palate
B. At the junction of the soft palate
and uvula
C.At the junction of uvula and
epiglottis

Nipple can extend up to 4cm when in the babys mouth!

A good latchessential!
Wide gap
Flanged lips
Bring nipple far into
babys mouth
Audible swallow
Jaw movement

Denise Both & Kerri Frischknecht, Breastfeeding: An

Illustrated Guide to Diagnosis and Treatment Elsevier
2008
Dads voice
can calm
baby down!
 Twins

Denise Both & Kerri Frischknecht, Breastfeeding: An Illustrated Guide to

Diagnosis and Treatment Elsevier 2008
A mother is concerned about tandem nursing
my be harmful to her new baby or older
breastfeeding child. Your first recommendation
would be:
A. Wean the older child
B. Tandem breastfeeding is not
harmful to either child
C. Reduce the time the older child is
at the breast
D. Feed the first baby first, before
feeding the older child
Tandem Nursing
Milk adjusts to
younger child

Milk flavor changes

Toddlers may wean

on their own

Denise Both & Kerri Frischknecht,

Breastfeeding: An Illustrated Guide to
Diagnosis and Treatment Elsevier 2008
But some just cant breastfeed
Ill mother
Cancer
Complications from birth
Depressed to point of psychosis
Unable to produce due to metabolic issues
Stressors
Cultural bias
Prefer formula
Paternal concerns
Jealousy an issue
Is it ever a challenge?
Incapable.?
Cleft palate
Diseases: HIV especially
Motivation
Must be learned
Back to Work..can be done!
Maternal culture and comfort
What is your comfort level?
How long is too long?
Pinch Test
Pathophysiologic

Inverted Nipple

Hypotropic breast tissue

note the wide spacing
Breastfeeding Challenges.
What about after Sore Nipples
breast surgery? .Blistersbleeding
Augmentation oh my.
Reduction Issues surrounding
Piercings positioning & Latch
Trauma Comfort measures
Reconstruction Reassurance
Nipple shields
 Augmentation & Reduction

Denise Both & Kerri Frischknecht,

Breastfeeding: An Illustrated Guide to
Diagnosis and Treatment Elsevier
2008
Yikesthis really hurts!

Yeast-treat both mom

and baby

Fissure/cracked
Use APO
 Mastitis
Continue to
breastfeed
Warm compresses
Pain management
Antibiotics

Denise Both & Kerri Frischknecht, Breastfeeding:

An Illustrated Guide to Diagnosis and Treatment
Elsevier 2008
Artificial Baby Milk (Formula)
Proper methods to prepare
Mixing formula
WIC provides formulaand strong
advocates of Breastfeeding
Safety Issues
Counterfeit Formulas
Recalls
2010recall of Similac for Beetle partsyummy!
Higher incidence of diarrhea, respiratory infections
Safety Issues.
Mead Johnson Formula May Contain
Metal Particles
February 23, 2006
A recall is being conducted by Mead Johnson Co. for
its GENTLEASE powdered infant formula, lot number:
BMJ19, use by 1 Jul 07. This lot was found to contain
metal particles of up to 2.7 millimeter in size.
Lactation Suppression-
Minimal Stimulation to breasts
OTC Comfort Medications
Comfort measures
Massage for comfort only
Ice packs to breasts
Breast binding with sports bra (2)
Lactogenesis II will occur
Use cabbage if breasts engorged
Antihistimine dry up secrection (milk)
 My baby wont latch.HELP!
Attempt to latch/feed every 3 hours
Skin to skin as much as possible
Manual expression of breasts
Spoon or cup feed
http://newborns.stanford.edu/Breastfeeding/HandExpress
ion.html
Insurance Pumping
Hands on pumping
http://newborns.stanford.edu/Breastfeeding/MaxProducti
on.html
Am I making enough milk?
Hormonal- still bleeding,
retained placenta?
(progesterone)
Frequency
Moms Rest
Diet
Anxiety
Medications
When does milk come in? 3-
5 days
When does milk come in for 1 st

time mom after vaginal birth?

A. 24 hours
B. 48 hours
C. 3 to 5 Days
D. 5-10 Days

After a Cesarean birth? Up to 7 days

How do I know my baby is getting
enough?
Day One
5-7 ml
Day Three
22-27 ml
Day 10
45-60 ml
Frequency
8-12x/24hr
 FIGURE 1 Relationship between volume of milk expressed per day and
gestational age at delivery

Henderson, J. J. et al. Pediatrics 2008;121:e92-e100

Copyright 2008 American Academy of Pediatrics
What about?
Can I use for birth Can I feed if I am
control? Possible adopting a baby?
however Works best if breasts
Requires feeding at the have produced before
breast q2-3 h Bonding
No pacifiers SNS
No supplementation: Milk banks
EVER http://www.hmbana.org/
Can I use a Pacifier?
Breast or bottle?
Term or preterm?
Learn to suck and
breathe
When is it okay to
use with breast
babies?
My nipples are so sore!!!
#1 reason is
LATCH!
Could be
yeastor skin
breakdownor
infection.but
most of the
time.LATCH!
Can I take this medicine?
Most meds are Avoid
compatible with ASA
breastfeeding.avoid Pseudoepherdrine
anything that dry the Stimulants
milk Chronic use of pain meds
Acetaminophen
Ibuprofen Can I drink wine or beer?
Cough drops Ideally no. Babies dont
Antacids metabolize alcohol the same.
Digestive aids Drink after feed. Wait 2-3 h/1
glass of wine. Party: Pump and
dump or substitution bc body
takes time to process alcohol
OMG! What is that?????
Melinda and Baby Grace
Melinda gave birth 48 hours ago. She
states her nipples are getting sore and she
is concerned the baby is not getting
enough milk.
Baby grace has lost 5.6% since birth
Goes to breast every 1.5-2 hours
Has 2 voids and 3 mec stools
Baby Grace has NAD
How would you respond to her concerns?
No lecheno leche
Support and cultural safety is key.
Keep in mind individuality
Listenlistenlisten!
Respectful to feeding issues
Cultural Issues surrounding breastfeeding
Some cultures may believe colostrum is bad
When to call IBCLC? No need
to memorize!
Multiples
Maternal request
No latch in 12 hours
Weight loss concerns
Flat or inverted nipples
Maternal illness
Preterm delivery or late preterm
Newborn infection
Teen mother
Nipple pain or injury
Mastitis
Engorgement
Any reason a bedside nurse needs help with lactation
concerns!
Essential Understandings
Memorize!
Breast feeding is optimal nutrition in majority of
situations
Frequency: 8-12 times/24 hours
Latch
Skin-to-skin
Outputs-voids and stools
Health Care surveillance
Weight gain/loss No lost any more than 10%
Maternal rest, stress management
Good nutrition
Milk comes in between day 3-5varies
Conclusion
Breast is Optimal!
Feed early and feed often!
Support moms to make best choice for
them and their babies
EducateEducateEducate!!!
Be respectful to individuality and family
dynamics
Encourage informed choice with infant
feeding
Thank you so much!!!!!

millerca@seattleu.edu
206-296-2196
Helpful Web links
Hands-on Pumping
http://newborns.stanford.edu/Breastfeeding/MaxProductio
n.html
Manuel Expression
http://newborns.stanford.edu/Breastfeeding/HandExpressi
on.html
Le Leche League in Washington
http://www.llli.org/Web/Washington.html
WIC
http://www.fns.usda.gov/wic/
References
Baby Friendly USA (2010) Baby friendly hospital initiative. Retrieved from http://www.babyfriendlyusa.org/eng/index.html
Behnke, A. (2003). The physical and emotional effects of postpartum hormone levels. International Journal of Clinical Endocrinology, 18(2);11
CDC: Breastfeeding Report Card. Retrieved from: http://www.cdc.gov/breastfeeding/data/reportcard.htm
Hale, T. (2006). Medications and mothers milk. (12th ed.). Hale publishing.
Roidan, J. & Wambach, K. (2010). Breastfeeding and human lactation. (4th ed.) Jones & Bartlett Publishers
Smith, L. (2007) Comprehensive lactation consultant exam review. (2nd ed.) Jones & Bartlett Publishers
Stevens, E., Patrick, T. & Pickler, R. (2009). A history of infant feeding. The Journal of Perinatal Education, 18(2); 32.
Unicef-Breastfeeding and HIV (2010) Retrieved from: http://www.unicef.org/programme/breastfeeding/hiv.htm