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Got Milk??


Learning Objectives. Recognize the importance of breastfeeding as a public health issue. Identify the risks of formula feeding. Describe influences that motivate ... – PowerPoint PPT presentation

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Title: Got Milk??

Got Milk??
  • Feeding the Next Generation

Learning Objectives
  • Recognize the importance of breastfeeding as a
    public health issue
  • Identify the risks of formula feeding
  • Describe influences that motivate mothers to
    choose breastfeeding
  • Identify challenges in early breastfeeding and
    discuss appropriate management.
  • Discuss resources for accurate information

Healthy People 2010
Goal CDC 2008 Data
75 of mothers initiating breastfeeding 74.2
50 of mothers continuing any breastfeeding until 6 months of age 43.1
25 of mothers continuing any breastfeeding until 12 months of age 21.4
25 of mothers exclusively breastfeeding through 6 months of age 11.9
  • AAFP Breastfeed for at least a year.
    Physicians should support nursing beyond infancy,
    nursing during pregnancy, and/or tandem nursing.
  • WHO Breastfeed for a minimum of 2 years
    (exclusively for 6-9 months).
  • AAP Breastfeed for at least 1 year and as long
    as mutually desired.

Percentage of Children Who Are Breastfed at 6 Months of Age, Among Children Born in 2007 (Provisional)

Source National Immunization Survey, Centers for Disease Control and Prevention, Department of Health and Human Services
  • International Code of Marketing of Breast Milk
  • No promotion or free samples of breast milk
    substitutes to mothers or families
  • All formula labels and information to state
    benefits of breastfeeding and health risk of
  • No free or subsidized substitutes to health
    workers or facilities

Widely Known Benefits
  • Decrease maternal blood loss due to
  • Decrease ovarian and breast cancer (21/28)
  • Delayed ovulation
  • Decreased pregnancy-induced long-term obesity
  • Decreased illnesses/hospitalizations in infant
  • Decreased work absenteeism
  • Decrease in diarrhea, lower RTI, DM, bacteremia,
    meningitis, botulism, uti, NEC
  • Ecologic benefitsdecreased cans, bottles, bags

POLICY STATEMENT Breastfeeding and the Use of Human Milk Section on Breastfeeding
Risks of Formula Feeding
  • Adults not breastfed as babies have
  • Higher rates of obesity
  • Higher blood pressure
  • Higher rates of type II DM
  • Lower intelligence test scores

Reduced Risk for Breastfed Babies
Condition Effect Duration of Feeding
Acute Otitis Media 50 3-6 mo exclusive
Atopic Dermatitis 42 gt3 months
Gastrointestinal infection 64 any
Lower RTI 72 gt4 months
Asthma 27 gt3 months
Overweight 4 Incremental increase for each month
Type I diabetes 27 gt3 mo
Type II diabetes 39
Childhood leukemia 19 gt6 months
Societal Benefits
  • Lower costs for families and governmentFREE
  • Lower healthcare costs due to decreased illness
  • Lower ecological impact

Global Benefits
  • Exclusive breastfeeding reduces risk of neonatal
    mortality by 55-87
  • Following WHO-recommended breastfeeding practices
    alone would prevent gt6000 under-five child deaths
    every day!!

Link with Obesity??
  • Bottle Feeding and Self-Regulation
  • Bottle-fed infants more likely to empty the
    bottle or cup in late infancy whether formula or
    breast milk
  • Bottle-feeding alters ability of infant to
    self-regulate milk intake

  • Recommended as a primary prevention strategy to
    reduce overweight and obesity
  • Benefits extend into adolescence and adult life
  • Exclusive breastfeeding shows stronger effect
  • Benefits still seen when controlling for
    confounders such as socioeconomic status,
    parental BMI, maternal smoking

Risk of formula feeding
  • Consume larger volumes
  • Gain weight more rapidly
  • Increase weight is predominantly adipose tissue

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Contraindications to Breastfeeding
Breastfeeding and the Use of Human Milk Section
on Breastfeeding
  • Use of street drugs
  • Galactossemia
  • Uncontrolled use of alcohol
  • HIV
  • Active, untreated TB
  • Chemotherapy or radioactive isotopes
  • Active HSV on breast
  • Active varicella infection

POLICY STATEMENT Breastfeeding and the Use of Human Milk Section on Breastfeeding
Not Contraindicated
  • Hepatitis A,B,or C
  • Tobacco Abuse
  • Occasional, single, alcoholic drink
  • Hyperbilirubinemia in infant
  • CMV carrier

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  • Regina is a 17 yo G1P1 who just delivered an
    infant male at 36 weeks by SVD after a long
    labor. During her prenatal care she expressed
    some interest in breastfeeding after discussing
    the benefits with you. Her mother and aunts did
    not breastfeed, she will be living with her
    boyfriends family, and she would like to finish
    high school after her 6 weeks of leave. She
    intends to use depot provera for contraception.
    Immediately following delivery she briefly holds
    the baby and then states she is tired and would
    like the infant to go to the nursery. The nurses
    note an initial poor latch and suck.

Barriers for Regina
  • Teenager
  • Lack of exposure/family support
  • Long labordehydration
  • Late pre-term infant
  • Return to school
  • Poor latch/suck

Evidence-based interventions
  • CDC sites 6 interventions with evidence of
  • Maternity care practices
  • Support for breastfeeding in the workplace
  • Peer support
  • Educating mothers
  • Professional support
  • Media and social marketing

Common ConcernsFamily Support
  • Clinician should find ways to engage father,
    grandmother, others in the care of the newborn
  • Identify and point out areas of competence for
    support people
  • Identify ways support people can help mother and
    be involved in feeding
  • Continue to praise the behaviors we want to see

Common Concerns--Latch
  • Asymmetric latch
  • Neck extended
  • Wide open mouth with lower jaw far below nipple
  • Fish lips
  • Bring baby to breast
  • Infant mouth should cover much of areola
  • Initial latch may hurt, but pain should resolve

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Common ConcernsInverted Nipples
  • Good to assess prenatally
  • Refer to lactation specialist during pregnancy
  • Can use nipple shields and breast pump for flat
  • True inverted nipples are rare

Common ConcernsBreast surgery
  • Most will still lactate some
  • Less likely with breast reduction

Common ConcernsPlugged Ducts
  • Sore lump from milk duct being plugged with milk
  • Risk of mastitis
  • Moist heat
  • Nurse frequently and first on affected side
  • Massage are to loosen plug

Common Concerns--Mastitis
  • Flu-like symptoms with breast pain
  • S. aureus is the usual etiologic organism
  • S. pyogenes, H. influenza, H. parainfluenza, E.
    coli, E. faecalis also implicated occasionally
  • Dicloxicillin or cephalexin 500mg qid drug of
  • Consider TMP-SMX or clinda if concern for MRSA
  • Continue breastfeeding often
  • Use massage, warm heat, ibuprofen

Common ConcernsNipple Pain
  • Caused by poor positioning/latch
  • Consider candida, eczema, Raynauds, tight
  • Warm, moist compresses
  • Lanolin ointment
  • Try different positions

Common Concerns--Candida
  • Pain during and after feedings
  • Infant with thrush
  • Nipples can appear cracked or fissured
  • Vesicles can be present
  • Nystatin oral for baby and topical for mother
  • Gentian violet

Common Concerns--Breast Milk Supply
  • Delayed lactogenesisprimips, obesity, DM, HTN,
    stressful birth, c-section
  • Failed lactogenesisbreast surgery,
    hypothyroidism, PCOS, Sheehans syndrome,
    insufficient mammary tissue
  • Infrequent feedings
  • Early formula introduction

Breast Milk Supply
  • Infant cries or not content at end of feeding
  • gt7 weight loss
  • Stools lt 3/day after day 4
  • lt1 wet diaper for each day of life
  • Regain birth weight by 10-14 days
  • Gain 15-30 gm/day

  • Increase maternal rest and fluids
  • More frequent feeds
  • Pumping after feeds to increase supply
  • If needed, supplement with syringe, cup, spoon
  • Fenugreek
  • Brewers Yeast
  • Reglan

Common Concerns--Medications
  • Refer to
  • Medications and Mothers Milk (Hale)
  • Drugs in Pregnancy and Lactation (Briggs)

Common Concerns--Contraception
  • Insufficient evidence to establish positive or
    negative effect of hormonal contraception on milk
    quality and quanity
  • Consider non-hormonal methods first

Common ConcernsPumping and Storing
  • Important to have time and space at work
  • Good quality electric pump
  • Chill ASAP
  • Can be at room temp for 4-8 hours
  • Refrigerate for 5 days
  • Freeze for longer storage

Vitamin D
  • AAP policy revision 2008-- 400 IU daily starting
    in the first few days after birth to prevent
  • Supplementation should continue through
    adolescence for those not consuming equivalent to
    32 oz of milk/day

Prevention of Rickets and Vitamin D Deficiency in
Infants, Children, and Adolescents Carol L.
Wagner, MD, Frank R. Greer, MD and the Section on
Breastfeeding and Committee on Nutrition
  • Exclusively breastfed infants should receive 1
    mg/kg/day starting at 4 months and continuing
    until they are eating sufficient iron-containing
  • Clinical Report
  • Diagnosis and Prevention of Iron Deficiency and
    Iron-Deficiency Anemia in Infants and Young
    Children (03 Years of Age)
  • Robert D. Baker, MD, PhD, Frank R. Greer, MD and
    The Committee on Nutrition ting sufficient iron
    containing foods

Breastfeeding Resources
  • Academy of Breastfeeding Medicine (
  • AAP Breastfeeding Residency Curriculum and New
    Mothers Guide to Breastfeeding
  • La Leche League International Partnership for
    Optimal Lactation Management and Support
  • Breastfeeding and the Law (