Infant Feeding

1. Infant Feeding Julia Cross

2. Areas for discussion • Why breast feeding is important • Tips to help with successful breastfeeding • What to do when problems arise • Advice to give parents on formula feeding • How to make up a formula feed • Types of formula • Weaning

3. Why Breastfeed? • Practical Advantages • Easily transportable, all equipment provided by nature! • At the right temperature (great for night feeds) • Less washing up! No bottles to sterilise • Never runs out • Can do one-handed so can catch up on reading a book, eating etc • Enviromental benefits

4. Benefits to baby • Helps protect against: • GI infections and vomiting • Ear infections • Chest infections • Urine infections • Childhood diabetes (evidence suggests need exclusive breast feeding for 6 months) • Eczema (evidence suggests need exclusive breast feeding for 6 months) • Obesity • Asthma • Constipation • Colic • Thrush • Studies show breastfed babies have fewer GP appointments!!

5. Benefits to mother • Weight loss (~500kcal/day) • Helps reduce risk of: • Ovarian cancer • Breast cancer • ?Osteoporosis • Positive effect on mood • Emotionally very satisfying (when it works well)

6. Current Recommendations • DOH and WHO recommendations are for exclusive breastfeeding for 6 months • When weaning the baby onto solids at 6 months continue breast feeding, initially offering solids after a breastfeed • The WHO recommends continuing a daily feed to the age of 2yrs

7. Latest Statistics on Breastfeeding • Breastfeeding initiation rate is 76% for UK, 78% in England (2005 IFS) • By 6wks 75% of mothers had given their baby milk other than breast milk • One third described problems with breastfeeding in the first few weeks, this was more common if mixed feeding (52%) • 1 in 8 women continued to experience problems beyond the first few weeks • Mothers who received help were more likely to continue breast feeding • 90% of mothers who gave up breastfeeding within 6 weeks would have preferred to feed for longer

8. How to Breastfeed • Support his back, shoulders and neck. He should be able to tilt his head back easily. And he shouldn't have to reach out to feed. • TUMMY TO MUMMY

9. Hold your baby close to you, with his nose level with the nipple. • Wait until your baby opens his mouth really wide with the tongue down. You can encourage him to do this by gently stroking his top lip. • Quickly bring your baby even closer to your breast. • Your baby will tilt his head back and come to your breast chin first. He should take a large mouthful of breast. Your nipple should go towards the roof of his mouth. 

11. Common Breastfeeding Problems • Insufficient milk • Rejection of breast • Painful nipples • Breastfeeding too tiring • Mastitis/blocked ducts • Thrush

12. A Dummy Guide to Feeding Problems • Insufficient Milk • Get expert help to ensure baby is latching on properly • Reassure it is normal to have to feed often in the early days (8-12 feeds is average in newborns) • Try feeding every hour and offering both breasts at each feed (Supply and Demand) • Make sure baby is staying on breast long enough to get rich hindmilk at the end of the feed (mum’s often think the baby is just comfort sucking at this stage and take baby off too early) • Avoid giving supplemental feeds, or aim to reduce gradually (unless under specialist advice) • Ensure mother is drinking enough water and resting • Some people find fennel tea helpful

13. Rejection of breast • May be engorged (try expressing off a little milk to help the baby latch on) • Excessive rooting (Toronto Wrap) • Nipple confusion from mixed feeding • Skin to skin • Seek advice from breastfeeding counsellor • Painful nipples • Usually due to poor attachment, so encourage to seek advice • Avoid soap etc, keep dry (change breast pads regularly), try lansinoh (lanolin ointment) • Some suggest rubbing a little breast milk onto the nipple at the end of feeds

14. Too tiring • Try feeding lying down (and having a quick cat nap when baby sleeps) • Ensure eating and drinking enough • See if others can help with chores

15. Mastitis • Mastitis presents as a sore, red breast and flu-like symptoms. Often high temperature and rigors. Blocked ducts may cause redness and pain without systemic features • Rest (if possible go to bed with baby by your side) • Feed regularly from affected side to clear the blocked duct • Apply heat • Remove bra, ensure no tight fitting garments as these can cause blocked ducts and mastitis • Massage affected area under warm shower, massaging in the direction of the nipple • Ibuprofen reduces inflammation in ducts and some evidence suggests using for 5 days. Sometimes may avert need for antibiotics • May need antibiotics (fluclox/amox or erythromycin if allergic) • If recurrent consider sending breastmilk for culture • Beware cracked nipples causing mastitis, when treated with antibiotics may then cause breast thrush • Often due to poor attachment so seek advice

17. Thrush • Thrush is often described as a shooting, razor-blade like sensation or a deep pain in the breast • Nipples may be sore, red and shiny • Baby may or may not have symptoms • Often associated with recent antibiotic treatment (especially if for mastitis secondary to cracked nipples) • If local to nipple treat mother and baby with daktarin oral gel 24mg/ml QDS (off licence). Apparently adheres better than nystatin. Daktarin cream is not suitable • Fluconazole loading dose 150-400mg followed by 100-200mg OD for at least 10 days + topical Rx (off licence). St. Georges suggests 400mg on first day, then 200mg OD for 14 days. Passes into breastmilk but at lower doses than is licensed for use in infants • If expressing and storing milk advise not to do so until infection cleared as thrush survives in the freezer • Teats, dummies etc should be disposed of at weekly intervals • Hot wash clothes in contact with affected breast (eg. Bras)

18. “Is my baby getting enough?” • If you feed frequently, on demand and for as long as the baby wants they will get enough • Signs a baby is taking enough milk: • Plenty of wet nappies • Usually 2-5 poos/day (not after about 6wks) • Awake and alert for some of the time • Growing and gaining weight

19. Normal Breast fed poo, often has seedy appearance

20. Other bits and boobs • Colostrum in the first few days is golden coloured, sticky and is small in quantity • Breasts usually become full around 3rd day, frequent feeds and warmth will help if uncomfortable. Encourage to express milk if too swollen to allow baby to latch on • A tingling sensation one to two minutes after the baby starts feeding is the “let-down” reflex. A baby may sometimes splutter as the milk shoots out. • Green poo often suggests a baby is getting the foremilk but not hindmilk (in a well baby) • After about 6 weeks some breast fed babies will only open their bowels every 3-10days. This is normal but would suggest constipation in a formula fed baby • Smoking is not a contraindication to breast feeding but suggest trying to smoke after a feed to reduce amount of nicotine in breastmilk. • Hep C is not a contraindication, HIV is in Western World but probably still beneficial in developing countries

21. Advice on Formula Feeding • Be aware that if also intending to breast-feed it may interfere with milk supply and cause problems with attachment • Does not offer the same benefits to baby as breastmilk • Increased risk of infection so important to follow the instructions for making feeds carefully • Unlike breast fed babies, will need cooled boiled water to drink especially on hot days as milk does not vary in content/nature • If changing from breast to bottle expect change in poo to more paste like, smellier and often darker

22. How to make up a formula feed • All the equipment used for feeding your baby needs to be sterilised before use • Wash hands before preparing feed • Water should be freshly drawn, boiled and left to cool for LESS than 30 minutes • Add water to bottle FIRST, then level scoops of powder (level with a knife) • Shake well to mix • Throw away any leftover feed • Only make up feeds at the time they are required, do not prepare in advance

23. Types of Formula • Wide variety, most cow’s milk based • Soy formula • Goat’s milk formula (no longer available in EU) • Specialist formulas eg. • Enfamil lactofree, SMA LF • Neocate, neutramigen, pregestimil • Infatrini

24. Weaning • Ideally not until 6 mths of age, but certainly not before 17 weeks • Wait for a baby to be able to sit up and take an interest in food • Lower calorific and nutritional value than milk so introduce slowly • Offer “first tastes” at the end of a milk feed • Good first foods are banana, avocado, root vegetable purees etc • If introducing food before 6 mths there is a long list of foods to avoid because of allergy risk • Avoid peanuts until 5yrs of age as choking hazard • Cow’s milk (full-fat) can be introduced from 1yr of age