DOCSLIB.ORG

Overcoming Breastfeeding Concerns- Part 2

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Overcoming Breastfeeding Concerns- Part 2 9/21/2018 OVERCOMING BREASTFEEDING Presented by: CONCERNS- PART 2 Kary Johnson, IBCLC OVERVIEW • Pacifiers • Pumping • Low Milk Supply • Feeding Multiples • Supplementation • Discharge Guidelines PICTURE FROM HTTPS://WWW.ETSY.COM/LISTING/464346270/BREAST-ENCOURAGEMENT-CARD-BREASTFEEDING 1 9/21/2018 PACIFIERS Step 9: Counsel mothers on the use and risks of feeding bottles, teats and pacifiers. What does the AAP say? •NG/Gavage •“Mothers of healthy term infants should be instructed to use pacifiers at •Hypoglycemia infant nap or sleep time after breastfeeding is well established, at Infant approximately 3 go 4 weeks of age.” •Lab draws • “Pacifier use should be limited to specific medical situations. These include Pain •Circumcision uses for pain relief, as a calming agent, or as part of a structured program •Illness for enhancing oral motor function.” •Medications Maternal •PMAD • NICU: to organize suck, swallow, breathe pattern of premature infant (in addition to reasons above) (AAP, 2012) PACIFIERS Ask yourself…what is the reason for use? Management: • All effort should be made to prevent separation of mom & baby (i.e. newborn nursery) • Avoid overuse • Be careful to not incorrectly pacify infant hunger • Non-nutritive sucking on mother’s breast is a great alternative Overuse or misuse results in: • Decreased breastfeeding duration • Reduced milk supply • Dental issues, difficulty weaning, and use well into childhood 2 9/21/2018 BREAST PUMPING Reasons a mother may need to pump: • Nipple trauma • Low milk supply • Late preterm infants • Maternal infant separation • Back to work/school • NICU admission • Exclusively bottle feeding • Infant conditions • Jaundice, Cleft lip/palate, Trisomy 21 (BOIES ET AL., 2016; LAUWERS & SWISHER, 2016; MANNEL ET AL., 2013; USBC, 2018) BREAST PUMPING GUIDELINES • Pump for 15-20 minutes • Ensure proper flange size • Ensure appropriate suction • Utilize a quality double electric pump to maximize prolactin levels • Use “hands on pumping” • Follow each pumping session with 3-5 minutes of hand expression • Clean appropriately after each use • Refer to CDC guidelines (LAUWERS & SWISHER, 2016) 3 9/21/2018 LOW MILK SUPPLY Perceived: • Frequent feedings or cluster feeding • Growth spurts result in temporary increase in feedings • Misinterpret crying as a symptom of low supply • Breasts not feeling full • Pumping lower milk volume (than another mother) (LAUWERS & SWISHER, 2016; USBC 2018) LOW MILK SUPPLY Milk removal triggers milk production! Encourage mothers on: • Frequent, on demand feedings 8-12x daily • Actual breastfeeding rates and capacities differ for each mother baby dyad • Importance of latch and positioning • Breast compression and massage during feedings • Performing hand expression after feedings to ensure breast emptiness • Utilize IBCLC resources and community support groups (LAUWERS & SWISHER, 2016) 4 9/21/2018 INFANT STOMACH CAPACITY 3 Factors influence breastfeeding frequency: 1. Breast storage capacity 2. Infant stomach capacity 3. Infant’s gastric emptying time (LAUWERS & SWISHER, 2016) INFANT STOMACH CAPACITY •Physiologic stomach capacity is different from anatomic capacity • Physiologic capacity = infant is satisfied • Anatomic capacity = infant is stuffed •Anatomical capacity at day 1 of life is approximately 30ml • Helps to explain the difference in intake amount for exclusively breastfed infants vs. breastfed infants being supplemented 5 9/21/2018 ACTUAL LOW MILK SUPPLY Management: • Frequent removal of milk and emptying Red Flags: of the breast • Previous history of low milk supply • Ensure adequate milk transfer • Multiples • Pump after feedings for extra • Inadequate breast tissue growth in stimulation puberty/pregnancy • Galactagogues • Support! • History of breast surgery • Radiation to chest Referral Suggestions: • Endocrine disorders (hypothyroid, • OBGYN for metabolic lab work • Pediatrician to monitor adequate PCOS) growth and development • Obesity • IBCLC for additional resources, such as • Diabetes a SNS (supplemental nursing system) • Medications (LAUWERS & SWISHER, 2016) BREAST PUMPING If pumping to increase supply: • Pump after all daytime feedings • Decrease pumping frequency once an increase in supply is attained (LAUWERS & SWISHER, 2016; USBC, 2018) 6 9/21/2018 PUMP EARLY, PUMP OFTEN Preterm, Late Preterm and Exclusively Bottle Feeding Considerations: Pump Early: • NEW! - Ideally within the first hour of delivery and after the first feeding • Regardless of delivery mode Pump Often: • Recommend 8 pumping sessions in a 24 hour period • Not to exceed 4 hours without pumping Breast, Bottle, Pump (MORTON ET AL., 2012; STEUER & SMITH, 2018) BACK TO WORK & SCHOOL Mothers need: • Pumping recommendations to prepare for returning to work/school • Once or twice a day right after a feeding is sufficient • Pumping in the morning will provide higher volumes • Pumping recommendations after returning to work/school • Goal: approx. 3, 15-20min session in 8 hr. work day • Education on possible milk supply issues • It is easier to prevent an issue than fix it! • SUPPORT • Policies/laws for breastfeeding & milk expression outside the home. (EVANS ET AL., 2014) 7 9/21/2018 FEEDING MULTIPLES Common Concerns: • Prematurity of the infants • Maternal-Infant/Infant-Infant Separation • Feeding success • Feeding 3 or more babies • Maternal Exhaustion, Lack of Time • Bonding (LAUWERS & SWISHER, 2016; MANNEL ET AL., 2013; USBC, 2018) FEEDING MULTIPLES MANAGEMENT Infant prematurity and/or separation: • Supply and demand – early and often milk removal • Hands on pumping every 3 hours, day and night • Hand expression and skin to skin Feeding Success: • Feed individually until at least 1 baby is assessed for consistent & effective feedings. • Feeding schedule options: • Both babies may eat when the first gets hungry – do not wait for the second to cue! • Both babies may be allowed to follow their own patterns and feed them individually • Use a combination of both methods • Rotate breasts/babies with every feeding or every day (LAUWERS & SWISHER, 2016; MANNEL ET AL., 2013) 8 9/21/2018 FEEDING MULTIPLES MANAGEMENT Feeding 3 or more babies: • Breastfeed 2 at a time and the other(s) on both breasts afterward • Alternate babies so each take turns breastfeeding first • Breastfeed 2 at a time while another person feeds the other baby(ies) • Alternate babies so a different one is fed with alternate means each feeding Maternal exhaustion/lack of time: • Set the expectation that, in the beginning, mom should plan to do nothing else besides feed the babies and sleep • Utilize a flexible feeding schedule • Enlist support (household chores, meals, doctor appointments, etc.) Bonding: • Breastfeed separately at least one time each day • Remember each baby is an individual & has separate needs (LAUWERS & SWISHER, 2016; MANNEL ET AL., 2013) SUPPLEMENTATION Step 6: Do not provide breastfed newborns any food or fluids other than breast milk, unless medically indicated. What does the AAP say? • “Give no supplements (water, glucose water, commercial infant formula, or other fluids) to breastfeeding newborn infants unless medically indicated using standard evidence-based guidelines for the management of hyperbilirubinemia or hypoglycemia.” (AAP, 2012) 9 9/21/2018 SUPPLEMENTATION Supplementation can inhibit Medical reasons for or delay the establishment supplementation include: of a mother’s milk supply, • weight loss >10% • signs of dehydration decrease rates of • lethargy breastfeeding initiation and • hyperbilirubinemia duration, interfere with • hypoglycemia maternal infant bonding, • actual low milk supply alter infant gut flora, and • multiples sensitize the infant to • NICU admission allergens. (HOLMES ET AL., 2013) SUPPLEMENTATION What supplement should be used? How much should be given? 1. Mother’s expressed milk • Follow the pediatrician recommendation/guidelines as this 2. Donor breast milk is variable for each baby. 3. Formula • In general: • Start with 15ml per feeding, if infant is still going to breast. • Supplement by cue and to infant satiety. • Remember infant stomach size • NICU: per MD order (BOIES ET AL., 2016; LAUWERS & SWISHER, 2016) 10 9/21/2018 SUPPLEMENTATION Methods: • Spoon • Cup • Syringe https://www.youtube.com/watch?v=OGPm5SpLxXY • Supplemental Nursing System (SNS) • Bottle https://www.youtube.com/watch?v=jIkFP2MtYcg •When supplementing, it is important to perform paced feeding to: •Help infant coordinate suck/swallow/breathe •Facilitate smooth transition back to breast after supplementing FORMULA FEEDING Mothers who choose to formula feed need support and education too! • Feeding options to make an informed decision • Opportunity to talk about her desires and reasons for feeding choice • Support for her decision • How to safely prepare, store, handle and feed formula (WOOD, 2018) 11 9/21/2018 DISCHARGE GUIDELINES Initial follow up appointment should be scheduled prior to discharge • Term Infants: • Within 48–72 hours after discharge • Infants discharged before 48 hours of age should be seen within 24–48 hours after discharge • Late Preterm & Early Term: • Within 24-28 hours after discharge • NICU: • Within 72 hours after discharge • F/U “with a trained, skilled lactation professional within 2-3 days after discharge” (BOIES ET AL., 2016; EVANS ET AL., 2014; NOBLE ET AL., 2018) QUESTIONS? 12 9/21/2018 REFERENCES American Academy of Pediatrics (2012). Policy statement: Breastfeeding and the use of human milk. Pediatrics, 129(3), 827-841. Doi 10.1542/peds.2011- 3552 Academy of Breastfeeding
Load more

Recommended publications
  • Recognizing When a Child's Injury Or Illness Is Caused by Abuse
    U.S. Department of Justice Office of Justice Programs Office of Juvenile Justice and Delinquency Prevention Recognizing When a Child’s Injury or Illness Is Caused by Abuse PORTABLE GUIDE TO INVESTIGATING CHILD ABUSE U.S. Department of Justice Office of Justice Programs 810 Seventh Street NW. Washington, DC 20531 Eric H. Holder, Jr. Attorney General Karol V. Mason Assistant Attorney General Robert L. Listenbee Administrator Office of Juvenile Justice and Delinquency Prevention Office of Justice Programs Innovation • Partnerships • Safer Neighborhoods www.ojp.usdoj.gov Office of Juvenile Justice and Delinquency Prevention www.ojjdp.gov The Office of Juvenile Justice and Delinquency Prevention is a component of the Office of Justice Programs, which also includes the Bureau of Justice Assistance; the Bureau of Justice Statistics; the National Institute of Justice; the Office for Victims of Crime; and the Office of Sex Offender Sentencing, Monitoring, Apprehending, Registering, and Tracking. Recognizing When a Child’s Injury or Illness Is Caused by Abuse PORTABLE GUIDE TO INVESTIGATING CHILD ABUSE NCJ 243908 JULY 2014 Contents Could This Be Child Abuse? ..............................................................................................1 Caretaker Assessment ......................................................................................................2 Injury Assessment ............................................................................................................4 Ruling Out a Natural Phenomenon or Medical Conditions
    [Show full text]
  • Clinical Update and Treatment of Lactation Insufficiency
    Review Article Maternal Health CLINICAL UPDATE AND TREATMENT OF LACTATION INSUFFICIENCY ARSHIYA SULTANA* KHALEEQ UR RAHMAN** MANJULA S MS*** SUMMARY: Lactation is beneficial to mother’s health as well as provides specific nourishments, growth, and development to the baby. Hence, it is a nature’s precious gift for the infant; however, lactation insufficiency is one of the explanations mentioned most often by women throughout the world for the early discontinuation of breast- feeding and/or for the introduction of supplementary bottles. Globally, lactation insufficiency is a public health concern, as the use of breast milk substitutes increases the risk of morbidity and mortality among infants in developing countries, and these supplements are the most common cause of malnutrition. The incidence has been estimated to range from 23% to 63% during the first 4 months after delivery. The present article provides a literary search in English language of incidence, etiopathogensis, pathophysiology, clinical features, diagnosis, and current update on treatment of lactation insufficiency from different sources such as reference books, Medline, Pubmed, other Web sites, etc. Non-breast-fed infant are 14 times more likely to die due to diarrhea, 3 times more likely to die of respiratory infection, and twice as likely to die of other infections than an exclusively breast-fed child. Therefore, lactation insufficiency should be tackled in appropriate manner. Key words : Lactation insufficiency, lactation, galactagogue, breast-feeding INTRODUCTION Breast-feeding is advised becasue human milk is The synonyms of lactation insufficiency are as follows: species-specific nourishment for the baby, produces lactational inadequacy (1), breast milk insufficiency (2), optimum growth and development, and provides substantial lactation failure (3,4), mothers milk insufficiency (MMI) (2), protection from illness.
    [Show full text]
  • SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment
    Organizational Principles to Guide and Define the Child Health Care System and/or Improve the Health of all Children POLICY STATEMENT SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment TASK FORCE ON SUDDEN INFANT DEATH SYNDROME abstract KEY WORDS Despite a major decrease in the incidence of sudden infant death syn- SIDS, sudden infant death, infant mortality, sleep position, bed- sharing, tobacco, pacifier, immunization, bedding, sleep surface drome (SIDS) since the American Academy of Pediatrics (AAP) released ABBREVIATIONS its recommendation in 1992 that infants be placed for sleep in a non- SIDS—sudden infant death syndrome prone position, this decline has plateaued in recent years. Concur- SUID—sudden unexpected infant death rently, other causes of sudden unexpected infant death that occur AAP—American Academy of Pediatrics during sleep (sleep-related deaths), including suffocation, asphyxia, This document is copyrighted and is property of the American and entrapment, and ill-defined or unspecified causes of death have Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American increased in incidence, particularly since the AAP published its last Academy of Pediatrics. Any conflicts have been resolved through statement on SIDS in 2005. It has become increasingly important to a process approved by the Board of Directors. The American address these other causes of sleep-related infant death. Many of the Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of modifiable and nonmodifiable risk factors for SIDS and suffocation are this publication.
    [Show full text]
  • Definitions of Child Abuse and Neglect
    STATE STATUTES Current Through March 2019 WHAT’S INSIDE Defining child abuse or Definitions of Child neglect in State law Abuse and Neglect Standards for reporting Child abuse and neglect are defined by Federal Persons responsible for the child and State laws. At the State level, child abuse and neglect may be defined in both civil and criminal Exceptions statutes. This publication presents civil definitions that determine the grounds for intervention by Summaries of State laws State child protective agencies.1 At the Federal level, the Child Abuse Prevention and Treatment To find statute information for a Act (CAPTA) has defined child abuse and neglect particular State, as "any recent act or failure to act on the part go to of a parent or caregiver that results in death, https://www.childwelfare. serious physical or emotional harm, sexual abuse, gov/topics/systemwide/ or exploitation, or an act or failure to act that laws-policies/state/. presents an imminent risk of serious harm."2 1 States also may define child abuse and neglect in criminal statutes. These definitions provide the grounds for the arrest and prosecution of the offenders. 2 CAPTA Reauthorization Act of 2010 (P.L. 111-320), 42 U.S.C. § 5101, Note (§ 3). Children’s Bureau/ACYF/ACF/HHS 800.394.3366 | Email: [email protected] | https://www.childwelfare.gov Definitions of Child Abuse and Neglect https://www.childwelfare.gov CAPTA defines sexual abuse as follows: and neglect in statute.5 States recognize the different types of abuse in their definitions, including physical abuse, The employment, use, persuasion, inducement, neglect, sexual abuse, and emotional abuse.
    [Show full text]
  • Pediatric Respiratory Rates Age Rate (Breaths Per Minute)
    Pediatric Respiratory Rates Age Rate (breaths per minute) Infant (birth–1 year) 30–60 Toddler (1–3 years) 24–40 Preschooler (3–6 years) 22–34 School-age (6–12 years) 18–30 Adolescent (12–18 years) 12–16 Pediatric Pulse Rates Age Low High Infant (birth–1 year) 100 160 Toddler (1–3 years) 90 150 Preschooler (3–6 years) 80 140 School-age (6–12 years) 70 120 Adolescent (12–18 years) 60 100 Pulse rates for a child who is sleeping may be 10 percent lower than the low rate listed. Low-Normal Pediatric Systolic Blood Pressure Age* Low Normal Infant (birth–1 year) greater than 60* Toddler (1–3 years) greater than 70* Preschooler (3–6 years) greater than 75 School-age (6–12 years) greater than 80 Adolescent (12–18 years) greater than 90 *Note: In infants and children aged three years or younger, the presence of a strong central pulse should be substituted for a blood pressure reading. Pediatric CUPS Assessment Category Assessment Actions Example Critical Absent airway, Perform rapid initial Severe traumatic injury breathing, or interventions and transport with respiratory arrest or circulation simultaneously cardiac arrest Unstable Compromised airway, Perform rapid initial Significant injury with breathing, or interventions and transport respiratory distress, circulation with simultaneously active bleeding, shock; altered mental status near-drowning; unresponsiveness Potentially Normal airway, Perform initial assessment Minor fractures; unstable breathing, circulation, with interventions; transport pedestrian struck by car and mental status BUT
    [Show full text]
  • Practice Resource: CARE of the NEWBORN EXPOSED to SUBSTANCES DURING PREGNANCY
    Care of the Newborn Exposed to Substances During Pregnancy Practice Resource for Health Care Providers November 2020 Practice Resource: CARE OF THE NEWBORN EXPOSED TO SUBSTANCES DURING PREGNANCY © 2020 Perinatal Services BC Suggested Citation: Perinatal Services BC. (November 2020). Care of the Newborn Exposed to Substances During Pregnancy: Instructional Manual. Vancouver, BC. All rights reserved. No part of this publication may be reproduced for commercial purposes without prior written permission from Perinatal Services BC. Requests for permission should be directed to: Perinatal Services BC Suite 260 1770 West 7th Avenue Vancouver, BC V6J 4Y6 T: 604-877-2121 F: 604-872-1987 [email protected] www.perinatalservicesbc.ca This manual was designed in partnership by UBC Faculty of Medicine’s Division of Continuing Professional Development (UBC CPD), Perinatal Services BC (PSBC), BC Women’s Hospital & Health Centre (BCW) and Fraser Health. Content in this manual was derived from module 3: Care of the newborn exposed to substances during pregnancy in the online module series, Perinatal Substance Use, available from https://ubccpd.ca/course/perinatal-substance-use Perinatal Services BC Care of the Newborn Exposed to Substances During Pregnancy ii Limitations of Scope Iatrogenic opioid withdrawal: Infants recovering from serious illness who received opioids and sedatives in the hospital may experience symptoms of withdrawal once the drug is discontinued or tapered too quickly. While these infants may benefit from the management strategies discussed in this module, the ESC Care Tool is intended for newborns with prenatal substance exposure. Language A note about gender and sexual orientation terminology: In this module, the terms pregnant women and pregnant individual are used.
    [Show full text]
  • Cross-Linguistic Patterns in Infant Babbling
    Cross-linguistic Patterns in Infant Babbling Andreea Geambașu, Mariska Scheel, and Clara C. Levelt 1. Introduction Infants begin to vocalize very soon after birth, and they begin to babble about six months after they are born (Oller, 1980). The babbling stage is distinct from the previous phase of vocalizations in that sounds – or gestures in infants acquiring sign language – are now clearly organized in a syllabic structure. As such, these utterances are the infant’s first linguistic productions. In the works of Stark (1980) and Oller (1980), two stages were identified within the babbling phase. Babies start with reduplicated babbling when they are six to eight months old, and progress into “variegated” (Oller, 1980) or “non- reduplicated” (Stark, 1980) babbling at 10 to 12 months. Work by Koopmans- van Beinum and van der Stelt (1986) outlines a similar line of development, with reduplicated babbling beginning at six months and lasting up until at least 12 months. They do not identify a specific non-reduplicated stage during this period. In addition, Roug, Landberg, and Lundberg (1989) also identified babbling stages similar to those proposed by Oller and Stark, with reduplicated (consonant) babbling beginning at seven months, and variegated babbling beginning at 12 months. The stages identified by these researchers differ only slightly. Where they crucially converge is on the consensus that infants begin their babbling at around six to eight months old, that they begin with reduplicated utterances, and that they transition into producing variegated utterances at around 10 to 12 months. The existence of these two stages has been disseminated in introductory linguistics textbooks for years (e.g., Hoff, 2008).
    [Show full text]
  • Alcohol Abuse in Pregnant Women: Effects on the Fetus and Newborn, Mode of Action and Maternal Treatment
    Int. J. Environ. Res. Public Health 2010, 7, 364-379; doi:10.3390/ijerph7020364 OPEN ACCESS International Journal of Environmental Research and Public Health ISSN 1660-4601 www.mdpi.com/journal/ijerph Review Alcohol Abuse in Pregnant Women: Effects on the Fetus and Newborn, Mode of Action and Maternal Treatment Asher Ornoy 1,* and Zivanit Ergaz 1,2 1 Laboratory of Teratology, The Institute of Medical Research Israel Canada, Hadassah Medical School and Hospital, The Hebrew University of Jerusalem, Ein Kerem, P.O. Box 12271, Jerusalem, 91120, Israel; E-Mail: [email protected] 2 Department of Neonatology, Hadassah Medical School and Hospital, Hadassah Medical Center, Hebrew University, P.O. Box 24035, Jerusalem, 91240, Israel * Author to whom correspondence should be addressed; E-Mail: [email protected]; Tel.: +972-50-624-2125. Received: 16 December 2009 / Accepted: 22 January 2010 / Published: 27 January 2010 Abstract: Offspring of mothers using ethanol during pregnancy are known to suffer from developmental delays and/or a variety of behavioral changes. Ethanol, may affect the developing fetus in a dose dependent manner. With very high repetitive doses there is a 6–10% chance of the fetus developing the fetal alcoholic syndrome manifested by prenatal and postnatal growth deficiency, specific craniofacial dysmorphic features, mental retardation, behavioral changes and a variety of major anomalies. With lower repetitive doses there is a risk of "alcoholic effects" mainly manifested by slight intellectual impairment, growth disturbances and behavioral changes. Binge drinking may impose some danger of slight intellectual deficiency. It is advised to offer maternal abstinence programs prior to pregnancy, but they may also be initiated during pregnancy with accompanying close medical care.
    [Show full text]
  • Bright Futures: Nutrition Supervision
    BRIGHT FUTURES: NUTRITION Nutrition Supervision 17 FUTURES Bright BRIGHT FUTURES: NUTRITION Infancy Infancy 19 FUTURES Bright BRIGHT FUTURES: NUTRITION Infancy Infancy CONTEXT Infancy is a period marked by the most rapid growth and physical development experi- enced throughout life. Infancy is divided into several stages, each of which is unique in terms of growth, developmental achievements, nutrition needs, and feeding patterns. The most rapid changes occur in early infancy, between birth and age 6 months. In middle infancy, from ages 6 to 9 months, and in late infancy, from ages 9 to 12 months, growth slows but still remains rapid. During the first year of life, good nutrition is key to infants’ vitality and healthy develop- ment. But feeding infants is more than simply offering food when they are hungry, and it serves purposes beyond supporting their growth. Feeding also provides opportunities for emotional bonding between parents and infants. Feeding practices serve as the foundation for many aspects of family development (ie, all members of the family—parents, grandparents, siblings, and the infant—develop skills in responding appropriately to one another’s cues). These skills include identifying, assessing, and responding to infant cues; promoting reciprocity (infant’s responses to parents, grand- parents, and siblings and parents’, grandparents’, and siblings’ responses to the infant); and building the infant’s feeding and pre-speech skills. When feeding their infant, parents gain a sense of responsibility, experience frustration when they cannot interpret the infant’s cues, and develop the ability to negotiate and solve problems through their interactions with the infant. They also expand their abilities to meet their infant’s needs.
    [Show full text]
  • Signs of Effective Breastfeeding
    BREASTFEEDING PROTOCOL: Signs of Effective Breastfeeding The Breastfeeding Protocols are based on the City of Toronto’s Breastfeeding Protocols for Health Care Providers (2013) and are co-owned by the City of Toronto, Toronto Public Health Division (TPH) and the Toronto East Health Network, Baby-Friendly Initiative (BFI) Strategy for Ontario. Revised Protocols are being released as they are completed, and they are available available at https://breastfeedingresourcesontario.ca/resource/breastfeeding-protocols-health-care-providers. All revised Protocols, as well as the complete set of 2013 Protocols, are available at www.toronto.ca/ wp-content/uploads/2017/11/9102-tph-breastfeeding-protocols-1-to-21-complete-manual-2013.pdf. For more details on the revision process and terminology, please see the Introduction to Breastfeeding Protocols for Health Care Providers. Funding for this project was received from the Government of Ontario. The views expressed in the publication are the views of the Recipient and do not necessarily reflect those of the Province. Process The process of revising and updating the Protocol followed a clear methodology based on Evidence-Informed Decision Making in Public Health www.nccmt.ca, developed by the National Collaborating Centre for Methods and Tools (NCCMT) and is described in the full Introduction, linked above. Every effort has been made to ensure the highest level of evidence is reflected. Contributors Project Lead: Sonya Boersma, MScN, RN, IBCLC, BFI Strategy for Ontario. Thanks to the following individuals and organizations for their contributions: Revising Authors: Susan Gallagher, BScN, RN, and Tracy Petrou, BScN, RN, IBCLC, Toronto Public Health. External Reviewers: NAME ROLE AND/OR LOCATION ORGANIZATION QUALIFICATIONS Within Ontario Jennifer Abbass-Dick Assistant Professor Central University of Ontario Institute RN, PhD, IBCLC of Technology Lina Al-Imari MD, CCFP, Hon.
    [Show full text]
  • Human Milk Surveillance and Research of Environmental Chemicals: Concepts for Consideration in Interpreting and Presenting Study Results
    Journal of Toxicology and Environmental Health, Part A, 65:1909–1928, 2002 Copyright© 2002 Taylor & Francis 1528-7394/02 $12.00 + .00 DOI: 10.1080/00984100290071793 HUMAN MILK SURVEILLANCE AND RESEARCH OF ENVIRONMENTAL CHEMICALS: CONCEPTS FOR CONSIDERATION IN INTERPRETING AND PRESENTING STUDY RESULTS Judy S. LaKind LaKind Associates LLC, Catonsville, Maryland, USA Nettie Birnbach Professor Emeritus, College of Nursing, State University of New York at Brooklyn, Boca Raton, Florida, USA Christopher J. Borgert Applied Pharmacology and Toxicology, Alachua, Florida, USA Babasaheb R. Sonawane National Center for Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Washington, DC, USA Mary Rose Tully Human Milk Banking Association of North America, Chapel Hill, North Carolina, USA Linda Friedman Rochester, New York, USA This article describes issues related to the interpretation, presentation, and use of data from human milk surveillance and research studies. It is hoped that researchers conduct- ing human milk studies in the future will consider these concepts when formulating study conclusions and presenting data. The key issues discussed are; (1) communication of information on human milk constituents to health care providers and the public; (2) com- plexities associated with assessing risks and benefits when comparing breast-feeding and We thank the following organizations for generously providing support for the workshop: the Department of Health and Human Services, Health Resources and Services Administration; the U.S. Environmental Protection Agency; the National Institute of Child Health and Human Development, National Institutes of Health; the Brominated Flame Retardant Industry Panel of the American Chemistry Council; the Nurses Leadership Council; Penn State University College of Medicine; the Public Health Policy Advisory Board; and the Research Foundation for Health and Environmental Effects.
    [Show full text]
  • Clinical Policy: Neonatal Abstinence Syndrome Guidelines Reference Number: CP.MP.86 Revision Log Date of Last Revision: 09/21
    CEN,:'ENI;'" ~orporation Clinical Policy: Neonatal Abstinence Syndrome Guidelines Reference Number: CP.MP.86 Revision Log Date of Last Revision: 09/21 See Important Reminder at the end of this policy for important regulatory and legal information. Description Maternal drug use and intrauterine exposure of the fetus during pregnancy can lead to drug withdrawal in the infant after delivery. Clinically important neonatal withdrawal most commonly results from intrauterine opioid exposure. However, maternal use of central nervous system depressants (e.g., benzodiazepines, barbiturates and alcohol) and other drugs also results in signs of neonatal symptoms/withdrawal in exposed infants. Neonatal opioid withdrawal syndrome (NOWS), describes opioid-only withdrawal symptoms while Neonatal Abstinence Syndrome (NAS) describes neonates who are at-risk for poly-substance exposure, including opioids. The term NAS will be used here for both polysubstance and opioid-only exposure. Signs of withdrawal will develop in 55 - 94% of neonates exposed to opioids in utero. Typical signs of withdrawal from specific drugs occur based on the half-lives of elimination of the drug. Maternal use of multiple drugs during pregnancy will also have an impact on the onset and severity of NAS. In general though, if one week has elapsed between the last maternal opioid use and delivery, the incidence of NAS is relatively low. Table 1 below lists common drugs abused along with the typical onset of NAS symptoms. Table 1. Common Drug NAS Symptom Onset Drug Typical onset Heroin Within 24 hrs with delay up to 5-7 days or later Methadone 24-72 hrs with delay up to 5-7 days later Morphine & Hydrocodone Within 3 days Buprenorphine Within 40 hrs Ethanol 3-12 hrs Barbiturate 4-7 days with delay up to 14 days Diazepam 12 days Chlordiazepoxide 21 days Policy/Criteria I.
    [Show full text]