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Clinical Management of Breastfeeding
Anil Mokashi, Santosh Nimbalkar
CHAPTER 1:
Lactation, Breastfeeding and Infant Feeding
Exclusive Breastfeeding
Predominant Breastfeeding
Complementary Feeding
Partial Breastfeeding
Bottle Feeding
Breastfeeding and Low Birth Weight Babies
Breastfeeding and Malnutrition
Breastfeeding and Cognitive Development (Knowledge-based Development)
Risk of not Breastfeeding
Advantages of Proper Complementary Feeding
Colostrum
Mature Milk
Foremilk
Hindmilk
Mechanisms of Protection against Infection
Differences between Human Milk and Animal Milk
Dangers of Artificial Feeding and Bottle Feeding
Recommendations
CHAPTER 2:
Production and Intake of Breast Milk
Introduction
Anatomy of the Breast
Milk Production: the Prolactin Reflex
Signs and Sensations of an Active Oxytocin Reflex
Milk Flow: Oxytocin Reflex
Control of Breast Milk Production within the Breast
Attachment at Breast—Inside the Mouth Appearance
Attachment at Breast—Outside the Mouth Appearance
Consequences of Poor Attachemnt
Causes of Poor Attachment
Feeding Reflexes in Baby
Summary
CHAPTER 3:
Assessing and Observing a Breastfeed
Introduction
How to Assess a Breastfeed?
How Does the Mother Hold Her Baby While Breastfeeding (Fig. 3.2)?
How Does the Mother Hold Her Breast?
Breastfeed Obseravation Form
Body Position
Signs that Breastfeeding is Going Well
Signs of Possible Difficulty
Response
Signs that Breastfeeding is Going Well
Signs of Possible Difficulty
Emotional Bonding
Signs that Breastfeeding is Going Well
Signs of Possible Difficulty
Anatomy
Signs that Breastfeeding is Going Well
Signs of Possible Difficulty
Suckling
Signs that Breastfeeding is Going Well
Signs of Possible Difficulty
Time Spent Suckling
Sign that Breastfeeding is Going Well
Sign of Possible Difficulty
CHAPTER 4:
Feeding History
Introduction
How to Take a Feeding History?
Use the Mother's Name and the Baby's Name (If Appropriate)
Ask Her to Tell You about Herself and Her Baby in Her Own Way
Look at the Child's Growth Chart (Indian Growth Charts)
Ask the Questions that will Tell You the Most Important Facts
Be Careful Not to Sound Critical
Take Time to Learn about More Difficult, Sensitive Things
CHAPTER 5:
Listen What She Says, Tell What She Needs
Introduction
Basic Counseling Skills
Skill 1: Use Helpful Nonverbal Communication
Skill 2: Ask Open Questions
Skill 3: Use Responses and Gestures
Which Show Interest
Skill 4: Reflect Back What the Mother Says
Skill 5: Empathize—Show that You Understand How She Feels
Skill 6: Avoid Words Which Sound Judging
Listening and Learning Exercises
Asking Open Questions
Reflecting Back What a Mother Says
Empathizing
Judging Words
Judging Questions
In Clinical Practice
Mistakes to Avoid
CHAPTER 6:
Baby-friendly Hospital
Introduction
Ten Steps to Successful Breastfeeding
Antenatal Counseling for Breastfeeding
With Mothers in Groups
With Each Mother Individually
Dangers of Prelacteal Feeds
Advantages of Rooming-in and Demand Feeding
How to Help a Mother with an Early Breastfeed?
Avoid Hurry and Noise
Observe a Breastfeed
Help with Positioning If Necessary
Give Her Relevant Information
Answer the Mother's Questions
Sources of Help for Breastfeeding Mothers
Supportive Family and Friends
Postnatal Check, within 1 Week and 6 Weeks
Help from Community Health Workers
Breastfeeding Support Group
What to Do Before A Mother Leaves A Maternity Facility?
CHAPTER 7:
Positioning a Baby at the Breast
Introduction
Give A Mother Help Only If She has Difficulty
How to Help A Mother Who is Sitting?
How to Help A Mother Who is Lying Down?
Other Positions in Which A Mother Can Breastfeed
CHAPTER 8:
Build Confidence and Give Support
Introduction
Skills for Building Confidence and Giving Support
Skill 1: Accept What a Mother Thinks and Feels
Skill 2: Recognize and Praise What the Mother and Baby are Doing Right
Skill 3: Give Little Relevant Information and Check Understanding
Skill 4: Use Simple Language
Skill 5: Make One or Two Suggestions, Not Commands
CHAPTER 9:
Breast Problems
Introduction
Management of Flat and Inverted Nipples (Figs 9.2 to 9.4)
Breast Engorgement
Causes of Breast Engorgement
Prevention of Breast Engorgement
Treatment of Breast Engorgement
Blocked Duct and Mastitis
Symptoms of Blocked Duct and Mastitis
Causes of Blocked Duct and Mastitis
Treatment of Blocked Duct and Mastitis
Additional Treatment
Treatment of Candida Infection (Figs 9.7A to C)
Management of Sore Nipples
First Look for a Cause
Give Appropriate Treatment
Then Advice the Mother
CHAPTER 10:
Not Accepting Breastfeed and Crying
Introduction
Kinds of Refusal
Why A Baby May Refuse to Breastfeed?
Is the Baby Ill, in Pain or Sedated?
Is there a Difficulty with the Breastfeeding Technique?
Possible Causes
Has a Change Upset the Baby?
Possible Causes
Is It “Apparent” and Not “Real” Refusal?
How to Help A Family with A Baby Who Refuses to Breastfeed or Cries A Lot?
Look for A Cause
Listen and Learn
Take a History
Assess a Breastfeed
Examine the Baby
Build Confidence and Give Support
Praise What the Mother and Baby are Doing Right
Give Relevant Information
Make One or Two Suggestions
If She Has an Oversupply of Breast Milk
Give Practical Help
Treat or Remove the Cause If Possible
Illness
Pain
Sedation
Breastfeeding Technique
Changes which Upset a Baby
If It Is a Distraction
If It Is Self-weaning
CHAPTER 11:
Expressing Breast Milk
Introduction
Expressing Breast Milk
Stimulating Prolactin (Milk Secretion) Reflex
Stimulating the Oxytocin (Milk Flow) Reflex
How to Stimulate the Oxytocin Reflex?
How to Express Breast Milk by Hand?
How Often A Mother Should Express Milk?
To Establish Lactation, to Feed a Low Birth Weight (LBW) or Sick Newborn
To Keep Up Her Milk Supply to Feed a Sick Baby
To Relieve Symptoms, Such As Engorgement or Leaking at Work
To Leave Milk for a Baby while She is Out at Work
Breast Pump
Rubber Bulb Pump
Syringe Pump
How to Use a Syringe Pump
CHAPTER 12:
Inadequate Milk
Introduction
Signs that A Baby may Not Be Getting Enough Breast Milk
Reliable
Possible
How to Find out If A Baby is Getting Enough Breast Milk or Not
Check the Baby's Weight Gain
Check the Baby's Urine Output
Reasons for Baby Not Getting Enough Milk
Breastfeeding Factors
Mother: Psychological Factor
Mother: Physical Condition
Baby's Condition
Factors that Do Not Affect the Breast Milk Supply
CHAPTER 13:
How to Increase Breast Milk and Relactation?
Introduction
How to Help a Mother to Increase Her Milk?
How to Help a Woman to Increase Her Breast Milk Supply?
How to Help a Mother to use a Breastfeeding Supplementer?
CHAPTER 14:
Preparation of Top Feeds
Introduction
Approximate Amount of Formula Needed Per Day
Approximate Amount of Milk Needed by Month
How to Measure Sugar and Milk Powder?
How to use Commercial Infant Formula?
CHAPTER 15:
Breastfeeding Low Birth Weight and Sick Babies
Introduction
How to Help Breastfeeding if a Baby is Low Birth Weight?
How to Feed a Baby by Cup?
How to Help Breastfeeding if a Baby is Sick ?
If a Baby is in the Hospital
If a Baby Can Suckle Well
If a Baby Suckles, But Less than before at Each Feed
If a Baby is Unable to Take Expressed Milk from a Cup
Amount of Milk for Babies Who cannot Breastfeed
What Milk to Give
Amount of Milk to Give
CHAPTER 16:
Kangaroo Mother Care
Introduction
When to Start Kangaroo Mother Care?
Kangaroo Position
Duration
Length
Staffing
Monitoring Baby's Condition
Temperature
Observing Breathing and Well-Being
What to Do in Case of Apnea
Danger Signs
Benefits of Kangaroo Mother Care
CHAPTER 17:
HIV and Infant Feeding
Introduction
Risk of HIV Transmission Through Breastfeeding
Alternatives of Breastfeeding
For Infants Less Than 6 Months of Age
For Children over 6 Months of Age
Other Options for All Ages
Replacement Feeding
CHAPTER 18:
Breastfeeding in Special Situations
Introduction
Breastfed Twins
How to Deal with Common Challenges?
Does Breastfeeding Take More Time Than Bottle Feeding?
A Rigid Time Bound or Flexible Demand Feeding Schedule
How to Hold Two Babies to Nurse at the Same Time?
Can She Produce Enough Milk to Nourish Two?
How to Know If Babies Are Getting Enough Milk?
Breastfeeding A Cleft Lip/Palate Baby
Breastfeeding and Working Mother
Adoption and Breastfeeding (Figs 18.5A and B)
Tandem Nursing
CHAPTER 19:
Infant Milk Substitutes Act
The Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992, as Amended in 2003 (Ims Act)
Bibliography
INDEX
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