APPROACH TO NOT ENOUGH BREASTFEEDING.pptx

This informs about causes of not enough breastmilk

1. Insufficient Milk Syndrome DR. D. Gunasingh MD DCH FIAP Professor of pediatrics SRM Medical College Hospital & Research Centre

2. Over view P erceived/real Insufficient Milk Situations of not enough milk Confidence building Breast Pumps Galactogogues Supplemental milk

3. Optimal infant and young child feeding is defined as initiation of breast feeding within one hour, exclusive breastfeeding, from birth to six months of age, and thereafter continued breastfeeding for two years or beyond, with adequate, safe and proper additional foods and liquid, to meet the nutritional needs of a young child.

4. NFHS 4

5. 2004.6.5 Under-5 deaths preventable through universal coverage with individual interventions (2000)

6. Insufficient Milk Syndrome The term insufficient milk syndrome refers to real as well as perceived inadequate breast milk. This term does not qualify whether the mother failed to produce adequate milk or the infant is unable to extract available milk by breast-feeding. One of the important barriers for exclusive breastfeeding from birth to six months of age is the mother’s feeling that she does not have enough breast milk

7. Why optimal feeding and almost 90% of the mothers switched to mixed feeding as they believed that they did not have enough milk. Malnourished Prone for infections risk of death is increased. Stunted Brain development affected Lower IQ

8. Solution to Insufficient milk syndrome . Formula is widely viewed by mothers and doctors alike as the solution to breastfeeding problems rather than a cause or contributor to breastfeeding problems .

9. Reliable Indicators of the Baby Getting Enough Milk: Adequate weight gain: Reaching birth weight by 2 weeks. Weight gain 500 grams or more per month during the first 6 months of life. Use Growth Charts to monitor. Passing light-colored urine about 6 times or more per day by 4 days of age, if the child is exclusively breast-fed.

10. Up to 3to 4 days the urine output and number of stools are less because the baby is getting only small quantity of colostrum. The change of stool colour to yellow by 4 to 5 days is a sign of adequate breast feeding.

11. Possible signs that indicate the baby is not getting enough milk : The baby is not satisfied and is crying after feeds. Wants frequent feeds (more than 12 feeds). Short feeds(less than 5 mts ) or prolonged feeds (more than 30 mts ). Having infrequent stools and hard dry or green stools.

12. Primary Insufficient Lactation Hypoplasia of breast, Retained placenta Surgical reduction or augmentation of breast. Only minimal or no breast enlargement after delivery is more likely to have inadequate milk.

13. Secondary Insufficient Lactation REASONS WHY A BABY MAY NOT GET ENOUGH BREASTMILK

14. Management Health care provider who is dealing with breast feeding problems should have undergone formal training and should have experience Assessment of Attachment and periodic Weight monitoring Confidence building measures Give practical help. Tell the mother to breast-feed at least 8 times a day and a minimum 2 night feeds Minimum 5 minutes and maximum 30 minutes suckling at each breast After complete emptying of one breast only she should go to the next breast so that the baby gets both foremilk and hind milk. If the child is already on non-breast-milk / complementary feeds help her to reduce them without compromising on the weight gain of the baby

15. Beginning of Bottle feeding is may be the end of breastfeeding. Stop bottle feeding use only paladai/cup/spoon to feed. Mother should be taught to how to comfort a crying child, namely, placing over the forearm or shoulder with pressure on the abdomen. Tell the mother about the advantages of breast-feeding and the dangers of artificial feeding The mother should be reviewed periodically at least once a week to give confidence. The baby also should be monitored for weight gain. It is better to use weight chart

16. Demand feeding is advised in a healthy term child. Schedule feeding with EBM is advised in a pre-term / LBW / sick child whose sucking may not be effective. Audio- Visual aids may be used for more effective Counseling. I use it for teaching attachment and expressing breast milk. The pediatrician may give contact number to call for help in breastfeeding problems.

17. In the new born period: Immediately after delivery the newborn should be given uninterrupted skin- to- skin contact by the mother and initiate breast feeding immediately or at least within one hour Triple Feeding Technique: If there is an abnormal weight loss in the first week or failure to gain weight after a week triple feeding technique is advised. Direct breast feeding 5-10 mts per side then supplement with ad libitum(giving milk as long as child wants) Expressed Breast Milk followed by pumping of residual milk until breasts are empty . This should be continued till the child get adequate weight gain

18. In preterm delivery Pumping with an electric pump should be initiated within 6to 12 hours and continued 8 to 12 times per day until the milk is well established.

19. Galactogogues : (Recommendation by The Academy of Breastfeeding Medicine) If increased frequency of breastfeeding or pumping or expression has not been successful one may try galactogogues . Domperidone is the only galactogogue evaluated in a randomized controlled trial and shown to be safe and effective in increasing breast milk production. The usual dosage is 10 to 20 mg three to four times per day taken for 3 to 8 weeks. Most women respond within 3 to 4 days, but some women respond in 24 hours, and some require 2 to 3 weeks to get maximum effect

20. Case scenarios 1 B/O Meena   10 weeks old weighing 5.6 kgs  come for vaccination and complaints that  the child is crying excessively. She googled  and found out  that the crying is often due to not enough breast milk. So she is giving formula by using bottle whenever the child is crying excessively.She is of complaining of sore nipple. Weight at 6 weeks is 4.5 How will you approach?

21. Case scenarios-2 B/O Dhanya IDM  just born, You have given the baby to the mother for breast feeding. Mother says there is no milk  and the baby also crying and not sucking and wants you to advise some  formula feeds till she gets enough milk. The CBG is 40mg.

22. Case scenarios-3 B/O Valli born  Preterm 34 Weeks come for review at 7 days , exclusively breastfed.Birth weight is 1.5 Kg, now weighing 1 kg Mother says she does not  have any problem with breast feeding . You find attachment is ok. How will you approach?

23. Prevention: Pre-natal counseling which includes breast-feeding counseling and breast examination. Help mother to initiate breastfeeding within one hour If there are any mother or infant risk factors intervene early to maximize milk production When the infant is unable to extract milk regularly and effectively the mother should express the residual milk either manually or by electric breast pumps. This EBM may be used to supplement the infant.

24. Allow uninterrupted skin to skin contact and never separate mother and baby Follow-up visits on Days 3, 7, 14, and 28 days and assess weight loss, weight gain and frequency and duration of feeding. All maternity hospitals should follow the 10 steps in BFHI(Baby Friendly Hospital Initiative)  

25. Increasing the frequency of breastfeeding and complete emptying will augment breast milk supply Perceived insufficient milk is more common Real insufficient milk is uncommon Secondary insufficient milk is more common than primary Weight gain and the frequency of urination are the only reliable indicators of enough breast-milk

26. Approach not enough milk rationally and manage appropriately Irrational prescription of supplemental feeding will do more harm Supplemental feeding may be necessary in a rare situation Most pre-term and low-birth-weight babies can grow appropriately on exclusive breast-feeding.

27. Happy breast feeding….