Infant Feeding Flashcards
(41 cards)
1
Q
what are the feeding cues?
A
- Sucking movements
- Sucking noises
- Lip licking
- Head movement from side to side
- Rapid eye movement
- Restlessness
- Crying ( a late cue)
2
Q
what is responsive feeding?
A
- Feed baby in response to feeding cues
- Feed baby when baby is in need of comfort
- Feed baby in response to mum’s needs eg if breasts are full/ wanting to sit down and cuddle her baby/ feed before going out
3
Q
what is effective positioning and attachment?
A
- C - close- close to mum’s body
- H - head free so baby can tilt head back
- I - in line- baby should not be twisted
- N - nose to nipple- this gets baby in the right position for good attachment
4
Q
what are the four positions for BF?
A
- football hold
- laid back
-side lying - cradle
5
Q
how do we enable effective attachment?
A
- Wait for gape – baby to have a wide open mouth
- Mother assists her baby towards her breast with its head tilted back and chin leading
- Bottom lip touches breast well away from the base of the nipple and nipple aimed towards the rear of the roof of the baby’s mouth
6
Q
what are the signs of effective attachment?
A
- Mother is comfortable during feed – sucking does not cause pain
- The baby is contented and stays on the breast
- Baby’s mouth is wide open
- Baby’s chin indents the breast
- Baby’s cheeks are full and round
- Areola – if any is visible then more will be visible above the baby’s top lip
- No clicking sounds when baby is feeding
- Nipple not changing shape after a feed
- Sucking is appropriate to the age of the baby ( usually rapid initially, then deep and rhythmic with pauses and audible swallows)
- Suck : swallow ratio no more than 2:1
7
Q
wet nappies
effective attachment and ineffective attachment
A
Increase with days of life until day 6, then 6 wet heavy daily
less than recommended or none
8
Q
dirty nappies?
effective attachment and ineffective attachment
A
First 24hrs: pass meconium
Day 3-4: 2 or more changing stools
Day 5: 2 a day, yellow, running still meconium after day 3.
Less than 2/day
9
Q
number and length of feeds?
effective attachment and ineffective attachment
A
At least 8-10 in 24hrs
Baby feeds for 5-40 min at most feeds.
Less than 8 feeds in 24hrs or constant feeding. Consistently feeding for less than 5 min or longer than 40 min.
10
Q
sucking patterns?
effective attachment and ineffective attachment
A
Sucking-swallowing 2:1
No clicking heard, gulping may be present
Frequent sucking before swallowing, clicking or other sounds.
11
Q
offer second breast?
effective and ineffective attachment?
A
Offered, baby feeds from 2nd or not
Mother restricts baby to one breast or insist on 2 per feed.
12
Q
shape of nipple?
effective and ineffective attachment?
A
Same as when feed began or slightly elongated and rounded.
misshapen or pinched at the end
13
Q
behaviour after feeds?
effective and ineffective attachment?
A
Content after most feeds
Unsettled, irritable
14
Q
baby’s condition
effective and ineffective attachment?
A
Active, alert.
No jaundice (or physiological day 3-5)
Sleepy, difficult to wake up
Severe Jaundice
15
Q
mother comfort?
effective and ineffective attachment
A
Breast and nipples comfortable.
Sore or damaged nipples.
Engorged breast or mastitis
16
Q
weight?
effective and ineffective attachment
A
Has lost <10% from birth weight
Lost >10% from birth weight
17
Q
Breastfeeding assessment involves what?
A
- take a history - listen to the mum
- Assess maternal/infant wellbeing - signs of nipple trauma/ engorgement/ mastitis - baby’s tone, fontanelles, skin colour, eyes and mouth
- Assess baby’s urine/stool output
- Observe a complete breastfeed
- Assess position and attachment at the breast
- Assess sucking pattern
- Observe breast/nipple anomalies
- Assess infants mouth and jaw
- Encourage skin to skin
- Use positive compassionate language
- Produce care plan and document
18
Q
how does expressing work?
A
As colostrum changes to more mature milk the volume will gradually increase. Expressing frequently (at least 8–10 times in 24- hours, including overnight) will help establish the milk supply. EBM in a cup.
19
Q
how do you hand express?
A
- Get comfy – preferably in a warm, quiet room where you can relax undisturbed. Place the container within easy reach.
- It can be helpful to start by gently massaging your breasts (make sure your hands are warm). Start off with long strokes from your armpit, working towards your nipple.
- Next, cup your breast in a C-shape using your finger and thumb (2cm to 3cm back from your nipple). Your finger and thumb should be opposite each other – if you imagine that your breast is a clock, your thumb would be at 12 o’clock and your finger at 6 o’clock
- Gently press your thumb and fingers together, release your fingers and repeat in a rhythmic movement. It may take a few minutes so be patient! Gradually your breast milk (or colostrum) will start to slowly drip out. Keep going, try to build up a rhythm – you’re doing really well!
- When you notice your milk flow slowing down, move your hands around your breast so you are expressing from a different area (position your finger and thumb at 11 o’clock and 5 o’clock) and repeat the process.
20
Q
how do you support mums with supplementation?
A
Support mum to hand express at least 8 in 24 hrs and feed EBM to baby via cup. Avoid supplementation with formula as this can impact on breast milk supply and affect the gut flora and lead to infection, Can take away the bonding from mum, Can reduce milk supply as not as much stimulation, Can make those lose the instinct of suckling at the breast.
21
Q
how do you assess effective milk transfer?
A
- Active feeding – long, slow, rhythmic sucking and swallow with pauses.
- Cheeks stay rounded, not hallow during sucking
- Baby seems calm and relax during feeds
- Comes off the breast on their own
- Mouth looks moist
22
Q
after having this discussion and providing support then what do you do?
A
Think about whether you need to involve the multidisciplinary team/ community peer support to help support this mum and baby
Remember to document your feeding plan in the maternity record
23
Q
what are signs of hypoglycaemia?
A
- lethargy
- apnoea
cyanosis
weak or high pitched cry
poor feed and jitteriness
24
Q
what babies are at risk of hypogylcaemia?
A
- diabetic mothers
- premature
-IUGR/SGA
-Macrosomia
-Reluctant/slow to feed
-mother on beta blockers
-hypoxia
-metabolic disorders
25
History of anxiety and depression. Its 6 hours post birth. You come to carry out a postnatal assessment and newborn examination. Kirsty is wishing to breastfeed, but Euan is in his cot and so far has not been to the breast. Kirsty says Euan is sleepy, and each time she has tried him at the breast he has been reluctant to feed.
How do we help?
1. Lots of unhurried/uninterupted skin contact to encourage milk hormones – oxytocin and prolactin.
2. Encourage parents to look out for feeding cues and offer the breast at least 8/24hrs, help with positioning and attachment in these optimal times.
3. Offer the breast using different feeding positions and alternate breasts. Remember biological ‘laid back’ feeding. Supporting parents with a sleepy baby – biological nuturing.
4. Support with hand expressing – put this on baby’s upper lip to encourage, if unsuccessful store any colostrum collected.
5. Lots of reassurance and support – it is important to inform mums that milk supply develops as the days progress and this early on it is normal to have minimal amounts.
6. Look our for hypoglycaemia signs e.g. jittery and general observations to make sure baby is well.
26
what is also important to consider thinking about with sleepy babies?
However, it is 6 hours post birth and it is normal for baby to be sleepy. Therefore, we aren’t necessarily looking for things like jaundice. Healthy term babies have plenty of fat sore which will keep them going.
If baby is fall asleep during feeds and it has been a short feed, try switch feeding, which is moving baby to the other breast if baby starts to dose off.
It is also important to think about the causes as to why baby maybe be sleepy also:
* Type of birth
* Drugs in labour (oxytocin used for induction? Diamorphine?)
* Exhaustion after difficult birth
* Separation from mother
* Sick babies
* Respiratory issues
* Cardiac issues
* Infections
* Hypoglycemia2
27
You come to carry out postnatal visit and newborn examination. Nantale reports very sore cracked nipples. Baby Penny is breastfed, but she seems very unsettled and is constantly feeding. She comes on and off the breast and feeds are very long. They gave her a formula bottle last night. Nantale has taken asprin over night as her nipples were so sore and her C/S wound is very tender. Julie says she has some Cocodamol in the cupboard and wonders whether this would be effective pain relief
how do you help?
- Take a history
- Lots of empathy and compassion
- Feeding assessment
- Support with position and attachment- use different feeding positions
- Moist wound healing for nipples – use breastmilk
- Hand expressing to support with frequent feeding if required- feed EBM by cup
- Skin to skin contact
- Check for tongue tie
- Pain relief
- Ongoing support (Midwife, Support workers, IFA, peer support)
28
how do we help cracked/sore nipples?
Sore and cracked nipples are signs of ineffective positioning and attachment. Therefore, priorities is to solve this. Go through CHIN and try different positions. purified lanolin may assist with healing by a process called moist wound healing.
29
how do we help if a mother wishes to supplement?
- Discuss reasons surrounding this and offer support accordingly
- Supplement with mother’s own expressed breast milk If EBM unavailable/not sufficient could consider donor breast milk
- Formula milk only if the first two options not available or if the mother makes a fully informed decision
- Use of cup/spoon where possible
30
is aspirin safe when breastfeeding?
as a painkiller should be avoided because of the increased risk of Reye’s syndrome in paediatric viral infections. The amount transferring is a very small but as there are suitable alternatives, it is best avoided.
. Whilst it isnt recommended regularly as a painkiller at a dose of 600mg four times a day it is compatible with breastfeeding in low dose of 75-150mg daily
31
is co-dolomol okay to take during pregnancy?
Codine is no longer recommended as routine medication for Breastfeeding mothers. Using the half life of codeine as 3 hours – it takes 15 hours for a dose to be regarded as no longer in breastmilk. Try ibuprofen.
32
what is the neonatal complications with codine?
- Breathing Problems
- Lethargy
- Poor Feeding
- Drowsiness
- Bradycardia
33
Day 3- You come to carry out postnatal visit and newborn examination. Evie breastfeeding exclusively. Cat reports that Evie is very sleepy. Dave is changing a nappy and you notice the stool is still black. When you weigh Evie, she has lost 10.5% of her birth weight and you notice that she looks like she has a tan. Cat says she is feeling overjoyed that she had a physiological breech birth, but is now anxious that the baby is not feeding well. Vaginal thrush infection is also bothering Cat. Wishing she had more support around as she is quite isolated.
how do we help?
- Take a history
- Perform a thorough breastfeeding assessment
- Make a plan with the parents that is SUSTAINABLE and supportive of babies clinical needs and mothers milk supply
- Lots of skin contact
- Optimise position and attachment and ensure baby is feeding 8/24hrs
- Sleepy babies and those with a poor suck may need woken for feeds
- Consider breast compressions to support with active feeding Supporting parents with a baby who has lost weight
- Consider expressing after feeds and offer all EBM via cup if possible
- Supplementation with formula should only be considered If EBM volumes are low and do not improve after 2-3 expressions.
- Consider donor milk first
- Monitor output and repeat weight in 24hrs
- Identify the cause
- Unrestricted skin to skin and laid back position
- Regular breastfeeds 3 hourly
- Support mother to express milk and feed to baby
- Review baby and reweigh in 24 hours
- Maximise breastmilk
- Compassion, encouragement and reassurance and value all breastmilk that baby has received
Consider referral to breastbuddies and contact paeds about weight loss and jaundice.
34
what is the plan at a 10% weight loss?
- Exclude infection or illness
- Consider additional support from breastfeeding team or Infant Feeding Advisor and/or paediatric review (depending on local policy)
- For sleepy babies or those with a poor suck, consider switch feeding and breast compressions*
- Express breastmilk after each feed and offer to baby by cup
- Weigh again in 24-48 hours
- If no or minimal weight increase or further loss, see plan 3
35
You come and carry out a postnatal visit and newborn examination. Chloe says she thinks Ethan is feeding well. She also feels she may be coming down with the flu. Last night she was feeling unwell and had hot flushes and sweating. Right breast feels hard and tender. Chloe says she is feeling a little shaken up with events around Ethan's birth, and keeps replaying the resuscitation over and over in her mind. Chloe says she finds it difficult to make new friends and she is feeling isolated. Chloe says she feels quite constipated and that she is suffering from haemorrhoids
how do we help?
- Take a history
- Feeding Assessment
- Support with position and attachment when required
- Support with breast care (analgesia and heat before a feed to support with breast drainage)
36
what are the causes of mastitis?
- ineffective drainage of milk
- Engorgement
- Blocked ducts
- Sudden discontinuation of feeding
- Long breaks in between feeds (night)
- Nipple trauma
- Tight fitting clothing (bra)
- Tight pressure from finger pressing into the breast during feeds
- Injuries, such as bumps or knocks from toddlers
37
what do you do if mastitis is suspected?
- Keep breastfeeding
- Feed baby more frequently
- Feed from sore side first if possible
- Ensure effective attachment to the breast (Feeding Assessment)
- Alternate feeding positions (dangle feeding)
- Hand expressing before attaching baby If Mastitis is suspected...
- Warm the breasts before feeds
- Cold compress between feeds (be careful as frequent use can reduce milk supply)
- GENTLE stoking of the breast whilst feeding from above the lump towards the nipple
- Check clothing
- Analgesia
- May require antibiotics
- US if recurring mastitis
38
treatment for antibiotics?
- Not all cases of mastitis need antibiotics or admission to hospital
- Self help measures, if caught early are often enough
39
when do we need to treat mastitis with antibiotics?
- When self help measures are not helping
- Red area becomes worse or lump becomes larger
- Discharge from nipple
- ‘Flu like’ symptoms (pyrexia, rigors, tachycardia and dizzy)
40
what antibiotics are given to women with mastitis?
Common antibiotics for treating Mastitis The World Health Organisation (WHO) recommend Flucloxacillin 500 milligrams four times a day as first line treatment with erythromycin 250- 500milligrammes four times a day or cefalexin 250-500 milligrams four times a day if the mother is penicillin allergic
41
do you continue to use that breast if you have mastitis?
Milk production may drop from the affected breast for a few days during the worst of the symptoms, but it is important for a baby to continue breastfeeding from that side to help prevent the infection from turning into an abscess.
