Lactation counselling

ROLE OF OCCUPATIONAL THERAPY

1. Lactation counselling Ms. Kaaynat Khan Occupational Therapist

2. Definition Importance of breastfeeding Anatomy associated with breastfeeding Physiology of breastfeeding Breastfeeding

3. Breastfeeding , also known as nursing, is the feeding of  babies  and young children with milk from a woman's  breast. Health professionals recommend that breastfeeding should begin within the first hour of a baby's life and continue as often and as much as the baby wants. Definition

4. Why breast feeding is important?

5. Less blood loss following delivery Better uterus shrinkage Less postpartum depression Lactational amenorrhea :delays the return of menstruation and fertility  Decreased risk of breast cancer, cardiovascular disease and rheumatoid arthritis Breastfeeding is less expensive than infant formula . Other benefits

6. Anatomy of Breast

7. Physiology of breastfeeding

8. Definition How to assess? What to assess? What to do? Lactation counselling

9. Lactation counselling is defined as the use of an interactive helping process to assist in maintenance of successful   breastfeeding What do you mean by lactation counselling?

10. History: Breast feeding history form Observation of feeding Palpation Examination How to assess?

11. What do you notice about the mother? How does the mother hold her baby ? What to assess?

12. Observe Size and shape of breast (may affect confidence) Size and shape of nipple (may affect attachment) Dripping milk (sign of active oxytocin reflex) Full, soft, engorged Fissures, white spots Redness (inflammation or infection) At end of feed, protracted or squashed Scars (breast surgery, previous abscess) What is the condition of the mother's breasts

13. Palpate Both breasts : Look for mother's face for signs of pain or tenderness Feel for : Generalized fullness, hardness, engorgement Localized hardness, hot areas, lumps Nipples Ask mother to show how easily her nipples stretch out (protract) (she places her finger and thumb on the areola either side of her nipple, and tries to stretch the nipple out)

14. There are several common breast conditions which sometimes cause difficulties with breastfeeding: Flat or inverted nipples, long or big nipples; Engorgement; Sore nipples and nipple fissure.

15. How does the mother hold her breast during a feed ?

16. What do you notice about the baby? Does the baby look well attached to the breast ? How does the mother put her baby onto her breast ? Is the baby suckling effectively? Does the baby seem satisfied?

17. Oral motor reflexes Rooting reflex Sucking reflex Swallowing reflex Reflexes

18. Positioning Breast exercises for latching difficulties Oral motor stimulation for reflex integration OCCUPATIONAL THERAPY INTERVENTION

19. Laid back position Recline back about 45 degrees Wherever you like to nurse—on the couch, in bed, on a recline and baby lies face down on top of mother’s breast with his arms hugging breast on both sides. Good for babies with reflux, since gravity will help with digestion . Types of position

20. Football hold/ clutch hold Baby tucked under arm off to the side and held with one arm while mother support breast with the other arm. If you’re holding baby on the right side, baby will latch onto your right breast while you support it with your left hand. Good for mothers having c-section (there’s less rubbing on the incision ) Premature child

21. Side lying position Lie down on your side with baby facing you. (You can put a breastfeeding pillow or a roll-up towel behind baby to support her back.) Baby nurses from the breast that’s resting on the bed. Good for mothers having c-section (there’s less rubbing on the incision).

22. Cross cradle hold Bring baby across your body, tummy to tummy, so if baby is nursing on your left side, you hold baby—supporting his neck—with your right arm and support the breast with your left hand. Good for feeding premature

23. Cradle hold Support baby with the arm on the same side as the breast she’s feeding from, not the opposite arm.

24. Upright breastfeeding Koala or upright football hold, have baby sit upright, facing mother and straddling knee. Support baby with the arm on the same side as baby is feeding and support breast with the opposite hand For babies with reflux , since gravity will help with digestion

25. Double-cradle hold This breastfeeding position allows moms of multiples to nurse in tandem, often with a breastfeeding pillow under both babies. Each baby lays in the crook of each elbow, crisscrossing each other in lap . Double-football hold In this hold, babies’ bodies rest on pillows along sides and under arms.

26. Large Nipples Hard for a new born to latch. Even average sized nipples can seem too big if your baby is premature. Solution Suction of a breast pump to make nipples longer and thinner before beginning to breastfeed. Nipple shield when placed over the nipple, the shape of the shield is smaller and easier for a baby to grasp in his mouth. Latching problems

27. Severe breast engorgement Common in the first few weeks of breastfeeding: colostrum is turning into transitional breast milk. Transitional breast milk stage - milk production - swollen and hard, nipples flatten out. Solutions   Pumping or hand expressing a little Frequent feeding

28. Before feeding or expressing , stimulate the mother's oxytocin reflex. Warm compress on breasts,/ warm shower; Massage neck and back; Massage breast lightly; Stimulate her breast and nipple skin; After feeding Cold compresses or clean cabbage leaves to reduce the swelling .

29. Reverse pressure softening The mother uses her fingers to press against the tissue in a circle around the nipple. This leaves an indented area where the baby can now latch.

30. Sore breast Causes Poor attachment to the breast Tongue-tie - ineffective use of tongue infection Solution Prevention- Provide stability for the baby’s shoulders, spine and hips with no pressure on the baby’s head, and the baby needs to be facing the mother and not having to turn his head to latch on.

31. Feeding the baby in response to his cues. Pacifiers and bottles should be avoided. Babies suck on a pacifier or bottle nipple quite differently than at the breast and, for some, this leads to a shallow, pain-inducing latch at the breast. Treatment Warm, moist compresses to nipples before and after feeding. Hard plastic breast shells

32. Advice Not to wash breasts more than once a day, and not to use soap, or rub hard with a towel. Breasts do not need to be washed before or after feeds. washing removes natural oils from the skin, and makes soreness more likely. Suggestion to rub little expressed breast milk over the nipple and areola with her finger after breastfeeding . this promotes healing.

33. Flat or inverted nipples Most nipples improve around the time of delivery without any treatment . Solution Nipple shield Use a hand breast pump, or a syringe to pull her nipple out. Stimulating the nipple Shaping the breast To shape her breast, a mother supports it from underneath with her fingers, and presses the top of the breast gently with her thumb. She should be careful not to hold her breast too near the nipple.

34. Premature Small mouth- harder to get a good latch. Less energy to suck and draw the milk out of the breast, tire out quickly. Solution Nipple shield Oral feeds should begin as soon as the baby tolerates them. Babies <30-32 weeks GA- let baby suck on mothers finger while on tube feeds- stimulates digestive tract, helps weight gain. Frequent breaks in between

35. Perioral stimulation ranging from 5 to 15 min Perioral stimulation followed immediately by pacifier for NNS. Pacifiers during gavage feeds Sweet pacifier Semi-demand gavage feeds & pacifier during feeds Tactile/ kinesthetic whole body stimulation Oral stimulation

36. Patterned orocutaneous therapy e ‘pulsating pacifier.

37. Nuk brush Excellent stimulation devices for the mouth and tongue Rubbing these devices around the mouth, on the cheeks, gums and tongue

38. Music therapy pacifier activated lullaby Positive feedback in the form of music/mother’s voice as an auditory input in direct response to efficient sucking .

39. Oral support during feeding

40. Thank you