Pediatric Primary Care (13 page)

7.  If baby latches incorrectly, the mother can insert her finger to break the suction, and repeat latch-on attempts until baby is latched correctly.

8.  Common breastfeeding positions are cradle position (see
Figure 5-4
),
cross cradle and football holds, (see
Figure 5-5
)
and side-lying position (see
Figure 5-6
).

9.  Trained practitioners should regularly observe latch-on, milk transfer, and feeding during hospitalization.

Figure 5-2
Positioning the baby nipple to nose (3 photos).

Source:
Lauwers J, Swisher A.
Counseling the Nursing Mother: A Lactation Consultant's Guide.
5th ed. Sudbury, MA: Jones & Bartlett Learning; 2011.

Figure 5-3
Sucking action (breast and bottle).

Source:
Lauwers J, Swisher A.
Counseling the Nursing Mother: A Lactation Consultants Guide.
5th ed. Sudbury, MA: Jones & Bartlett Learning; 2011.

Figure 5-4
Madonna (cradle) position: A) front view, B) side view.

Source:
Riordan J, Wambach K.
Breastfeeding and Human Lactation.
4th ed. Sudbury, MA: Jones & Bartlett Learning; 2010.

Figure 5-5
A) Cross-cradle hold, B) football hold.

Source:
Riordan J, Wambach K.
Breastfeeding and Human Lactation.
4th ed. Sudbury, MA: Jones & Bartlett Learning; 2010.

Figure 5-6
Side-lying position.

Source
: Riordan J, Wambach K.
Breastfeeding and Human Lactation
. 4th ed. Sudbury, MA: Jones & Bartlett Learning; 2010.

10.  The mother's nipple should not be pinched, bruised, or creased at the end of a feeding (see
Figure 5-7
).

C.  Signs of milk transfer in infant.

1.  Observe sustained, rhythmic suck/swallow pattern with intermittent pauses.

2.  Listen for audible swallowing.

3.  Baby's arms and hands should be relaxed at the end of the feeding.

4.  Baby's oral mucous membranes should be moist after feedings.

5.  Baby should appear satisfied after feedings.

D.  Signs of milk transfer in mother.

1.  Mother feels strong tugging sensation when baby is sucking that is not painful.

2.  Mother feels uterine contractions and increased lochia flow during initial days postpartum.

3.  Milk may leak from opposite breast during feedings.

4.  Mother may feel relaxed or drowsy during feedings.

5.  Breast softens after feeding (after milk supply is established).

6.  Nipples are elongated, but not pinched or bruised after release of latch.

E.  Assessing infant weight gain.

1.  Parents should be aware of baby's birth and discharge weight.

2.  Encourage parents to keep daily journal of first week to track feedings, output.

3.  Healthy, breastfeeding infants may lose 3-7% of birth weight in initial days.

4.  After Mom's milk is in, infant should gain 0.5-1 oz/day (4-7 oz/week).

5.  Babies often regain birth weight by 10-14 days of age, double it by 6 months, triple it by 1 year.

6.  Exclusively breastfed infants tend to be leaner than bottle-fed infants in second 6 months of life.

Figure 5-7
Normal nipple postfeed and creased nipple postfeed.

Source:
Riordan J, Wambach K.
Breastfeeding and Human Lactation
. 4th ed. Sudbury, MA: Jones &Bartlett Learning; 2010.

F.  Assessing infant output.

1.  Colostrum acts as laxative, encouraging expulsion of meconium in first days.

2.  Effective and regular breastfeeding helps to prevent jaundice in early days.

3.  Infants showing signs of jaundice should be assessed carefully for ineffective breastfeeding.

4.  Bowel movements become lighter in color, then turn to a mustard color, seedy consistency by day 4 or 5.

5.  Babies who are breastfeeding well should have 2-3 large mustard color, seedy stools/day.

6.  Inadequate stools are a red flag for ineffective breastfeeding.

7.  Stool output may decrease to one stool every few days after first few weeks.

8.  Urine output is less helpful than stool output in assessing adequate milk intake.

9.  Exclusively breastfed baby should produce one wet diaper on day 1, two on day 2, three on day 3, and so on, for first week.

10.  By end of first week, baby should have six soaking wet, pale yellow diapers/day.

VIII.  SEPARATION OF MOTHER AND INFANT

A.  Pumping.

1.  All mothers should be taught how to hand express their milk after birth.

2.  If small number of feedings must be missed, Mom can hand express or use a battery-operated pump to express milk from both breasts every few hours.

3.  Lengthy separation warrants use of hospital-grade, piston-style pump with double hookup system to efficiently remove breastmilk 6-8 times/ 24 hours for approximately 15 minutes each session.

4.  Even the smallest quantity of expressed colostrum or milk can be fed to infant via eyedropper, syringe, or cup.