Transcript Breastfeeding Fundamentals

EPIC Breastfeeding
®
2016 Program
“Breastfeeding Fundamentals”
Breastfeeding education
Copyright © 2007 Georgia Chapter, American Academy of Pediatrics. All rights reserved.
Faculty Disclosure Information
• In accordance with ACCME* Standards for
commercial support, all faculty members are
required to disclose to the program audience
any real or apparent conflict(s) of interest to the
content of their presentation. I would like to
disclose the following:
* Accreditation Council for Continuing Medical Education
Program Objectives
• Describe two risk factors of mothers choosing
not to breastfeed
• Discuss why physicians play critical roles in a
woman’s decision to breastfeed
• Demonstrate how to assist with effective
breastfeeding techniques
• Review access to lactation support services in
the community
EPIC Breastfeeding
Program Partners
• Georgia Chapter - American Academy of
Pediatrics
• Georgia Department of Public Health
• Georgia WIC
• Georgia OB/GYN Society
• Academy of Family Physicians
AAP’s Breastfeeding
Policy Statement
“The American Academy of Pediatrics reaffirms
its recommendation of exclusive breastfeeding
for about 6 months, followed by continuation of
breastfeeding for 1 year or longer as mutually
desired by mother and infant.
AAP Policy Statement: Breastfeeding and the Use of Human Milk, Feb. 13, 2013,
Healthy People 2020
Number
MICH-21
Objective
2020 Target
%
Increase the proportion of infants who are breastfed:
MICH-21.1
Ever
81.9
MICH-21.2
At 6 months
60.6
MICH-21.3
At 1 year
34.1
MICH-21.4
Exclusively through 3 months
46.2
MICH-21.5
Exclusively through 6 months
25.5
MICH-22
Increase the proportion of employers that have
worksite lactation support programs
38.0
MICH-23
Reduce the proportion of breastfed newborns who
receive formula supplementation within the first 2
days of life
14.2
MICH-24
Increase the proportion of live births that occur in
facilities that provide recommended care for
lactating mothers and their babies
8.1
Georgia’s Breastfeeding Rates
CDC’s Breastfeeding Report Card 2014
Ever Breastfed
70.3%
Breastfed for 6 months
40.1%
Breastfed for 12 months
20.7%
Exclusively breastfed for 6
months
14.5%
Support for Minorities
• It’s All Natural
• Launched by the Office of Women's Health
• Discuss benefits, myths, and challenges
• www.womenshealth.gov/itsonlynatural
• Reaching our Sisters Everywhere (ROSE)
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Support and information for women of color
Started here in Atlanta
Baby Cafe
Breastfeedingrose.org
Disease and Risk Reduction in
Breastfed Infants and Children
Acute Otitis Media
50%
Atopic Dermatitis
42%
Gastrointestinal Infections
64%
Lower respiratory infections, hospital
rate
72-77%
Asthma
26-40%
Obesity
24%
Type I Diabetes
30%
Type II Diabetes
40%
Childhood Leukemia
20%
http://pediatrics.aappublications.org/c
ontent/125/5/e1048.shortA
Maternal Disease Risk Reduction
from Breastfeeding
Diabetes
12%
Metabolic syndrome
8.4%
Ovarian Cancer
21%
Breast Cancer
4.3%
Coronary Artery Disease
23%
Aortic Calcifications
22%
Coronary Calcifications
15%
http://pediatrics.aappublications.org/content/125/5/e1048.short
Challenges for Physicians
• Lack of breastfeeding knowledge
and training
• Discomfort examining and
discussing breasts
• Discomfort treating mother and baby
• Lack of time
• Concerns about reimbursement
and coding
The Three “B’s” of Breastfeeding
BRAIN
BREAST
MILK RELEASE
MILK PRODUCTION
BABY
MILK TRANSFER
•Copyright © 2003, Rev 2005 American Academy of Pediatrics
What are Early Infant Feeding Cues?
– Sucking sounds
– Hand to mouth movements
– Rapid eye movement
– Soft cooing or sighing sounds
– Restlessness
Crying is a late hunger cue
What is a Good Latch?
• Wide open mouth (check angle at corner)
• Mouth filled with breast tissue
• Flanged lips – “Fish lips”
Jack Newman, MD
Assisting with a Good Latch:
•
Cradle hold
Football
Side lying
Photo © Roni M. Chastain, RN
Copyright © 2003, Rev 2005 American Academy of Pediatrics
Laid back
Cross cradle
What are the Signs of
Effective Milk Transfer?
• Audible swallowing
• Appropriate output
(i.e. urine/stools)
• Weight gain of 5oz a
week after day 4
What Increases Milk Production?
Milk Removal!
Role of Physicians
Help parents develop realistic expectations
OB/Gyn Prenatal Visit
• Mothers need to hear from their OB that
breastfeeding is important
• Encourage breastfeeding classes
• Discuss why her breasts are changing
• Educate the expectant mother and her partner
• Do not give out any formula coupons or
freebies with formula branding to patients
Pediatric/FP Prenatal Visit
• Ask open ended questions
– What are you thinking about breastfeeding?
– What have your friends and family said about
breastfeeding?
– What breastfeeding plans do you have when
returning to work?
– What do you know about the benefits of breast
milk?
• Help mom set realistic expectations
• Discuss potential barriers and suggest
possible solutions
What are Maternal Risk Factors
for
Unsuccessful Breastfeeding?
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Breast surgery or trauma
Breast or nipple abnormality
Absence of prenatal breast changes
Previous breastfeeding difficulty
Birth interventions
Separation from infant
Mother’s perception of insufficient milk
supply
• Unrelieved fullness or engorgement
What are Infant Risk Factors for
Unsuccessful Breastfeeding?
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Birth interventions and/or trauma
Prematurity
Acute or chronic disease
Oral anomalies
Hyperbilirubinemia or hypoglycemia
SGA, LGA or IUGR
Persistent sleepiness or irritability
Inability to maintain an effective latch
After Birth
Skin to skin
Breastfeeding
In the Hospital
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Practice skin to skin
Limit procedures
Avoid separation
Rooming in – limit visitors
Exclusive breastfeeding is encouraged
– Avoid use of supplements and pacifiers
Exclusive Breastfeeding
• No food or drink other than breastmilk
• Mothers own milk is the first choice
• No promotion of breast milk
substitutes, bottles or pacifiers given to
parents.
• If supplementation is necessary staff
have specific protocols/policies to
follow
Separation of Mother and Baby
• Start pumping ASAP
– Pump and hand express every 2-3 hours
– Use a hospital grade pump
– Pump at baby’s bedside if possible
• Hand expression
– Increases volume collected
– Can be used while single pumping
– www.newborns.stanford.edu/Breastfeeding/
HandExpression
• Encourage Skin to skin
Baby’s First Office Visit
• What to Do…
– Schedule visit within 1-2 days of hospital
discharge
– Evaluate weight loss / gain
– Evaluate breastfeeding frequency / duration
– Evaluate outputs i.e. urine / stool
– Look for signs of jaundice
– Observe the baby breastfeed
Breast Problems to Avoid
• Engorgement
• Plugged milk ducts
• Nipple Pain / Trauma
• Mastitis
• Candidiasis / Thrush
Engorgement
The Breastfeeding Atlas, 3rd Edition
Nipple Pain and Trauma
The Breastfeeding Atlas, 3rd Edition
Bilateral Mastitis
The Breastfeeding Atlas, 3rd Edition
Plugged Duct
• Presents as a hard, red, tender area
on the breast
• May progress into mastitis
• Have the patient
– Feed frequently on infected side
– Massage area during breastfeeding
– Change positioning at the breast
– Check bra’s for correct fit and avoid
underwire bras
Yeast Infection
Treat Mom and Baby
Maternal Emotions
• Perinatal Mood Disorders
• Edinburg Postpartum Depression scale
• Every provider has responsibility to assess
mother’s mood
• Acknowledge and validate feelings of
frustration, anxiety, inadequacy, etc.
• Project Healthy Moms Warmline in GA is
1.800.933.9896(x234)
Medications
Usually the risk of NOT breastfeeding is greater than
the risk of exposure through breastmilk
Resources:
• “Medication and Mothers Milk”
• LactMed @ http://toxnet.nlm.nih.gov/cgibin/sis/htmlgen?LACT
• Poison control - 404.616.9000 or 1.800.222.1222
Maternal Medications
Short list of contraindicated medications:
Lithium
Phenindione
Amiodarone
Retinoids
Chemotherapy agents
Chloramphenicol
Drugs of Abuse
Ergotamine
Gold salts
Tetracyclines (chronic
use >3 weeks)
Radioactive Compounds
Hot Topics
• Bed Sharing vs Co-sleeping
• Pacifiers
• Supplementation
• Starting solids
• Returning to work
• Contraception
• Milk Sharing
• Vitamin D
ICD 10 Codes for the Infant
P92.8
P92.3
Feeding problems, newborn
Under feeding of the newborn
R68.12
Fussy baby/infant
P59.3
Jaundice (breastmilk)
P59.9
Jaundice (unspecified)
P92.6
Failure to thrive
R63.6
Underweight
Q38.1
Ankyloglossia
ICD 10 Codes for the Mother
092.70
Unspecified disorders of lactation
092.5
Suppressed lactation
R53.83 Fatigue
Z39.1
091.03
091.23
Care and examination of lactating
mother
Sore nipples
Nonpurulent mastitis associated with
lactation
The Breastfeeding Friendly
Physician Office
• Have a breastfeeding policy
• Train staff
• Provide a supportive environment
– No free formula samples
– No commercial advertisements
• Encourage exclusive breastfeeding
Community Resources
• Hospitals
– Support groups
– Lactation clinics
• WIC
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Breastfeeding food packages
Breast pumps
Lactation assistance
Peer counselors
La Leche League
Georgia Breastfeeding Coalition
ZIPMilk
Baby Café
“While breastfeeding may not seem
the right choice for every parent, it is
the best choice for every baby.”
Breastfeeding: Your Guide to a Healthy, Happy Baby, 2005