DOCSLIB.ORG

Breastfeeding Mythbusters Julie K

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Breastfeeding Mythbusters Julie K Breastfeeding MythBusters Julie K. Prussack, MD Northern Michigan Family Medicine Update June 27, 2019 Disclosures None Objectives 1. Identify common breastfeeding myths. 2. Support breastfeeding dyads in common experiences and struggles including low milk supply, feeding expressed breastmilk, maternal alcohol use, maternal diagnostic imaging, and maternal anesthesia. 3. Access InfantRisk Center, LactMed, and KellyMom resources. Myth #1 Formula is equivalent to breastmilk. Truth #1 Breastmilk is has many nutritional and health benefits, tailored for each specific child. WIC Supplemental Nutrition Branch. California Department of Health Services. March 2005. Excess Health Risks with Not Breastfeeding Excess Outcome Risk (%) For full-term infants Otitis media 100 Atopic dermatitis 47 Gastrointestinal infection 178 Hospitalization for lower respiratory tract diseases 257 Asthma, with family history 67 Asthma, no family history 35 Childhood obesity 32 Type 2 diabetes mellitus 64 Acute lymphocytic leukemia 23 Acute myelogenous leukemia 18 Sudden infant death syndrome 56 For pre-term infants Necrotizing enterocolitis 138 For never breastfeeding mothers Breast cancer 4 Ovarian cancer 27 The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011. URL: https://www.ncbi.nlm.nih.gov/books/NBK52680/ Excess Outcome Risk (%) For full-term infants Otitis media 100 Atopic dermatitis 47 Gastrointestinal infection 178 Hospitalization for lower respiratory tract diseases 257 Asthma, with family history 67 Asthma, no family history 35 Childhood obesity 32 Type 2 diabetes mellitus 64 Acute lymphocytic leukemia 23 Acute myelogenous leukemia 18 Sudden infant death syndrome 56 For pre-term infants Necrotizing enterocolitis 138 For never breastfeeding mothers Breast cancer 4 Ovarian cancer 27 Myth #2 Eating *this* will increase your milk supply. Truth #2 The best way to increase milk supply is to directly feed or express milk. Establishing milk supply • Skin-to-skin immediately after birth • Latch within the first hour • “Empty” breasts at least 8-12 times daily Baby tracking app, SmallNest, reported that on average, parents of 2,000 U.S. and Canadian babies reported 16-18 feeds per 24 hours ABM clinical protocol #5: peripartum breastfeeding management for the healthy mother and infant at term, revision 2013. Breastfeeding Medicine. Vol. 8, No. 6, 2013. URL: https://www.bfmed.org/protocols Increasing milk supply • Assess latch and transfer • Continue to drain breasts, including overnight when prolactin is highest • Medications: metoclopramide, domperidone (not FDA approved) • Hydrate and eat to thirst/hunger • Limited evidence for herbs and supplements ABM clinical protocol #9: use of galactogogues in initiating or augmenting maternal milk production, second revision 2018. Breastfeeding Medicine. Vol. 13, No. 5, 2018. URL: https://www.bfmed.org/protocols Myth #3 Baby needs more breastmilk. Truth #3 An infant’s milk intake stabilizes or decreases as they grow. Newborn stomach size How much breast milk does a baby need? Medela. https://www.medelabreastfeedingus.com/article/169/how-much-breast- milk-does-a-baby-need From 1 month to 6 months • Infants typically need 19-30 ounces per day • Average of 1-1.25 ounces per hour • If 8 feedings, bottles of 3-4 ounces per feed • After 6 months, with introduction of solids, intake may gradually decrease to 14-19 ounces per day at 1 year • Can use milk calculator at: https://kellymom.com/bf/pumpingmoms/pumping/milkcalc/ Bonyata, K. How much breast milk will my baby need? Kellymom.com. Updated 1/14/18. URL: https://kellymom.com/bf/pumpingmoms/pumping/milkcalc/ But baby wants more milk! • Breastfeeding offers more than just nutrition • Can overfeed with the bottle • Encourage paced bottle feeding with slow flow nipple The Milk Mob. Institute for Advancement of Breastfeeding & Lactation Education. URL:http://lacted.org/libr-iable-samples/ Resources for parents and caregivers http://www.nancymohrbacher.com/articles/2013/12/3/for-the-caregiver- of-a-breastfed-baby.html https://kellymom.com/bf/pumpingmoms/employed-moms/childcare- breastfed-baby/ Myth #4 You need to pump & dump. Truth #4 There is often no need to “pump & dump” for anesthesia, imaging, alcohol, or medications. Anesthesia Wanderer et al. Anesthesia & Breastfeeding: More Often Than Not, They Are Compatible. Infographic. Anesthesiology: October 2017, Vol.127, A15. Imaging • Radiographic studies do not make milk radioactive! • Mammograms can be done, although with decreased sensitivity. Best done immediately after draining breasts. • Per American College of Radiology, it is safe to continue breastfeeding after iodinated or gadolinium-based contrast agents. Manual on Contrast Media. American College of Radiology. Version 10.3, 2018. URL: https://www.acr.org/- /media/ACR/Files/Clinical-Resources/Contrast_Media.pdf American College of Radiology “Because of the very small percentage of iodinated or gadolinium-based contrast medium that is excreted into the breast milk and absorbed by the infant’s gut, we believe that the available data suggest that it is safe for the mother and infant to continue breast- feeding after receiving such an agent… [If the mother chooses to “pump & dump,”] There is no value to stop breast feeding beyond 24 hours.” Manual on Contrast Media. American College of Radiology. Version 10.3, 2018. URL: https://www.acr.org/- /media/ACR/Files/Clinical-Resources/Contrast_Media.pdf Alcohol in Breast Milk • Alcohol is found in the breast milk in approximately the same concentration as in the blood, and similarly leaves the breast milk as it is metabolized by the mother • Legal limit to drive 0.08%=percent alcohol in breast milk at legal limit • Percent alcohol in apple juice: 0.06-0.66% • Percent alcohol in non-alcoholic beer: <0.5% Gorges et al. Estimates of Ethanol Exposure in Children from Food not Labeled as Alcohol-Containing. J Anal Toxicol. 2016 Sep; 40(7): 537–542. Alcohol in Breast Milk • Highest concentration at 30- 60 min. after drinking • On average, one drink is metabolized completely in 2 hours (nomogram by Motherisk: https://www.ncbi.nlm.nih.gov/p mc/articles/PMC2213923/pdf/1 1852608.pdf) Alcohol in Breast Milk • Thomas Hale (2017): “…mothers who ingest alcohol in moderate amounts can generally return to breastfeeding as soon as they feel neurologically normal.” • Alcohol does decrease oxytocin release and therefore inhibit let-down reflex and production • Studies have shown that weight, linear growth, and psychomotor development can be affected by moderate drinking in breastfeeding mothers Hale, Thomas. Medications and Mothers’ Milk, 2017 edition. Springer Publishing, 2017: 348-350. Medication Safety • InfantRisk Center at Texas Tech University • (806) 352-2519 8AM- 5PM Central Time • InfantRisk.org • InfantRisk App ($9.99) • MommyMeds App ($3.99) Medication Safety • LactMed • https://toxnet.nlm.nih.gov/ newtoxnet/lactmed.htm • LactMed App (Free) L1 L2 L3 L4 L5 Compatible Limited Data No Data - Limited Data Hazardous -Probably Probably - Possibly compatible compatible hazardous Tylenol Sertraline Oxycodone Codeine Amiodarone Ibuprofen Benadryl Bupropion Marijuana Isotretinoin Amoxicillin Flagyl Doxycycline Chantix Kombucha Loratadine Guaifenesin Nicotine Tizanidine Fluorouracil Dextrometh- Methylphen- Hormonal Colchicine Methotrexate orphan idate Contraception Metformin Prednisone Sumatriptan Glimepiride Tamoxifen Myth #5 You cannot breastfeed while pregnant. Myth #5 It is generally safe to breastfeed in low-risk pregnancies. Breastfeeding during pregnancy • Nipple stimulation does release oxytocin, but in a similar or lesser amount than with sexual activity • Oxytocin receptors are sparse until 38 weeks and are also blocked by progesterone • Only a few small observational studies have been done, but there is no evidence to suggest an increase in miscarriage or preterm delivery Flower, Hilary. A New Look at the Safety of Breastfeeding During Pregnancy. KellyMom.com, 2013. URL: https://kellymom.com/pregnancy/bf-preg/bfpregnancy_safety/ Breastfeeding during pregnancy Can be complicated by: • Nursing aversion • Nipple sensitivity • Decreased milk supply • Change in milk taste/composition • Self-weaning AAFP Breastfeeding Position Paper “Breastfeeding during a subsequent pregnancy is not unusual. If the pregnancy is normal and the mother is healthy, breastfeeding during pregnancy is the woman’s personal decision. If the child is younger than two years, the child is at increased risk of illness if weaned.” Breastfeeding, Family Physicians Supporting (Position Paper). American Academy of Family Physicians, 2014. URL: https://www.aafp.org/about/policies/all/breastfeeding-support.html AAFP Breastfeeding Position Paper “Breastfeeding the nursing child during pregnancy and after delivery of the next child (tandem nursing) may help provide a smooth transition psychologically for the older child.” Breastfeeding, Family Physicians Supporting (Position Paper). American Academy of Family Physicians, 2014. URL: https://www.aafp.org/about/policies/all/breastfeeding-support.html More Myths… • Most infants sleep through the night by 6 months. • Formula will help my infant sleep through the night. • Supplemental formula will help my infant gain weight better than supplemental breast milk. • Maternal dietary fiber makes babies more gassy/fussy. • You cannot make enough milk by exclusively pumping. • Smoking mothers should not breastfeed. • People with a history of breast surgery cannot breastfeed. • Transgender and adoptive parents cannot breastfeed..
Load more

Recommended publications
  • Methadone Maintenance Program: Clinical Practice Guideline
    College of Physicians and Surgeons of Britsh Columbia Methadone Maintenance Program: Clinical Practce Guideline February 2014 Revised July 2014 | Updated September 2015 Methadone Maintenance Program: Clinical Practice Guideline CONTENTS Preface .................................................................................................... 1 Introduction ............................................................................................ 2 1. The History of Methadone .................................................................................................................. 2 2. Authorization to Prescribe Methadone .............................................................................................. 2 2.1 Full Authorization ...................................................................................................................... 3 2.2 Temporary Authorization .......................................................................................................... 4 2.3 Hospitalist Authorization ........................................................................................................... 4 3. Pharmacology of Methadone ............................................................................................................. 4 3.1 Absorption ................................................................................................................................. 5 3.2 Duration of Action/Metabolism ...............................................................................................
    [Show full text]
  • The Key to Increasing Breastfeeding Duration: Empowering the Healthcare Team
    The Key to Increasing Breastfeeding Duration: Empowering the Healthcare Team By Kathryn A. Spiegel A Master’s Paper submitted to the faculty of the University of North Carolina at Chapel Hill In partial fulfillment of the requirements for the degree of Master of Public Health in the Public Health Leadership Program. Chapel Hill 2009 ___________________________ Advisor signature/printed name ________________________________ Second Reader Signature/printed name ________________________________ Date The Key to Increasing Breastfeeding Duration 2 Abstract Experts and scientists agree that human milk is the best nutrition for human babies, but are healthcare professionals (HCPs) seizing the opportunity to promote, protect, and support breastfeeding? Not only are HCPs influential to the breastfeeding dyad, they hold a responsibility to perform evidence-based interventions to lengthen the duration of breastfeeding due to the extensive health benefits for mother and baby. This paper examines current HCPs‘ education, practices, attitudes, and extraneous factors to surface any potential contributing factors that shed light on necessary actions. Recommendations to empower HCPs to provide consistent, evidence-based care for the breastfeeding dyad include: standardized curriculum in medical/nursing school, continued education for maternity and non-maternity settings, emphasis on skin-to-skin, enforcement of evidence-based policies, implementation of ‗Baby-Friendly USA‘ interventions, and development of peer support networks. Requisite resources such as lactation consultants as well as appropriate medication and breastfeeding clinical management references aid HCPs in providing best practices to increase breastfeeding duration. The Key to Increasing Breastfeeding Duration 3 The key to increasing breastfeeding duration: Empowering the healthcare team During the colonial era, mothers breastfed through their infants‘ second summer.
    [Show full text]
  • Breastfeeding Management in Primary Care-FINAL-Part 2.Pptx
    Breastfeeding Management in Primary Care Pt 2 Heggie, Licari, Turner May 25 '17 5/15/17 Case 3 – Sore nipples • G3P3 mom with sore nipples, baby 5 days old, full term, Breaseeding Management in yellow stools, output normal per BF log, 5 % wt loss. Primary Care - Part 2 • Mother exam: both nipples with erythema, cracked and scabbed at p, areola mildly swollen, breasts engorged and moderately tender, mild diffuse erythema, no mass. • Baby exam: strong but “chompy” suck, thick ght frenulum aached to p of tongue, with restricted tongue movement- poor lateral tracking, unable to extend tongue past gum line or lower lip, minimal tongue elevaon. May 25, 2017, Duluth, MN • Breaseeding observaon: Baby has deep latch, mom Pamela Heggie MD, IBCLC, FAAP, FABM Addie Licari, MD, FAAFP with good posioning, swallows heard and also Lorraine Turner, MD, ABIHM intermient clicking. Mom reports pain during feeding. Sore cracked nipple Type 1 - Ankyloglossia Sore Nipples § “Normal” nipple soreness is very minimal and ok only if: ü Poor latch § Nipple “tugging” brief (< 30 sec) with latch-on then resolves ü LATCH, LATCH, LATCH § No pain throughout feeding or in between feeds ü Skin breakdown/cracks-staph colonizaon § No skin damage ü Engorgement § Some women are told “the latch looks ok”… but they are in pain and curling their toes ü Trauma from pumping ü § It doesn’t maer how it “looks” … if mom is uncomfortable Nipple Shields it’s a problem and baby not geng much milk…set up for low ü Vasospasm milk supply ü Blocked nipple pore/Nipple bleb § Nipple pain is
    [Show full text]
  • Improving Delayed Lactogenesis and Suppressed Lactation in At-Risk Mothers
    Improving Delayed Lactogenesis and Suppressed Lactation in At-Risk Mothers Jean Rucks Rhodes, PhD, CNM, IBCLC High breastfeeding initiation rates show that most mothers in the U.S. want to breastfeed and are trying to do so. However, low breastfeeding rates among infants who are six and 12 months of age indicate that many mothers do not continue breastfeeding as recommended. These rates suggest that mothers, in part, may not be getting the support they need, such as from healthcare provid- ers, family members, and employers.... The early postpartum period is a critical time for establishing and supporting breastfeeding. CDC 2016 Breastfeeding Report Card 1 WHITE PAPER EXECUTIVE SUMMARY Although breastfeeding initiation is at an all-time high New evidence suggests babies’ feeding behaviors of 81%, rates of breastfeeding exclusivity and du- have an important role in determining lactation suc- ration lag behind national goals. Women who stop cess. These unique infant sucking patterns in the first breastfeeding before meeting their goals often report few days of life appear to program mothers’ breasts they did not have enough milk. for optimal milk production. New breast pump initia- tion technology that mimics early newborn sucking The ability to initiate, build and maintain breast milk is a potentially viable and safe intervention to provide volumes sufficient to meet an infant’s needs are de- at-risk mothers with additional breast stimulation for pendent on complex interwoven factors. Additionally, optimal milk production outcomes. there are multiple maternal risk factors for delayed milk production and suppressed lactation: In many lactation situations, interventions aren’t start- ed until a mother reports problems.
    [Show full text]
  • Impact of Recreational and Medical Marijuana Use During Pregnancy and Lactation on the Newborn
    If it’s Legal it Can’t be all Bad… can it? Impact of Recreational and Medical Marijuana use during Pregnancy and Lactation on the Newborn Moni Snell MSN RN NNP-BC Neonatal Nurse Practitioner NICU Regina Qu’Appelle Health Region Objectives Understand the current use, risks and differences between medical (CBD) and recreational (THC) marijuana Discuss evidence based education for women and current management strategies for caring for newborns exposed to THC through pregnancy and breastfeeding Discuss the impact of increased newborn exposure to recreational and medical marijuana with it’s legalization Marijuana… common term for Recreational Cannabis in the form of dried leaves, stems or seeds Anticipated legalization in Canada July 2018 Currently legal in 29 states in the US Recreational use and self –medication with cannabis is very common • Cannabis: pot, grass, reefer, weed, herb, Mary Jane, or MJ Peak use is in the 20’s and 30’s : women’s • Contains over 700 chemicals, about 70 of reproductive years which are cannabinoids • Hash and hash oil also come from the cannabis plant Cannabis Ingredients Tetrahydrocannabinol (THC) is the chemical that makes people high Cannabidiol (CBD) is known for its medicinal qualities for pain, inflammation, and anxiety o CBD does not make you feel as high Different types of cannabis and effects depend on the amount of THC or CBD, other chemicals and their interactions THC content is known to have increased over the past several decades Oils have higher percentage of THC and THC in edible cannabis products can vary widely and can be potent THC content/potency of THC confiscated by DEA in US has been steadily increasing Consequences could be worse than in the past, especially among new users or in young people with developing brains ElSohly et al, (2016) Changes in cannabis potency over the last 2 decades (1995-2014): Analysis of current data in the United States.
    [Show full text]
  • Drugs Affecting Milk Supply During Lactation
    VOLUME 41 : NUMBER 1 : FEBRUARY 2018 ARTICLE Drugs affecting milk supply during lactation Treasure M McGuire SUMMARY Assistant director Practice and Development There are morbidity and mortality benefits for infants who are breastfed for longer periods. Mater Pharmacy Services Occasionally, drugs are used to improve the milk supply. Mater Health Services Brisbane Maternal perception of an insufficient milk supply is the commonest reason for ceasing Conjoint senior lecturer breastfeeding. Maternal stress or pain can also reduce milk supply. School of Pharmacy University of Queensland Galactagogues to improve milk supply are more likely to be effective if commenced within three weeks of delivery. The adverse effects of metoclopramide and domperidone must be Associate professor Pharmacology weighed against the benefits of breastfeeding. Faculty of Health Sciences Dopamine agonists have been used to suppress lactation. They have significant adverse effects and Medicine and bromocriptine should not be used because of an association with maternal deaths. Bond University Gold Coast nipple stimulation. Its release is inhibited by dopamine Introduction Keywords Breast milk is a complex, living nutritional fluid from the hypothalamus. Within a month of delivery, breastfeeding, that contains antibodies, enzymes, nutrients and basal prolactin returns to pre-pregnant levels in non- cabergoline, domperidone, galactagogues, lactation, hormones. Breastfeeding has many benefits for breastfeeding mothers. It remains elevated in nursing metoclopramide, prolactin babies such as fewer infections, increased intelligence, mothers, with peaks in response to infant suckling. probable protection against overweight and diabetes Drugs that act on dopamine can affect lactation. and, for mothers, cancer prevention.1 The World In response to suckling, oxytocin is released from Aust Prescr 2018;41:7-9 Health Organization recommends mothers breastfeed the posterior pituitary to enable the breast to https://doi.org/10.18773/ exclusively for six months postpartum.
    [Show full text]
  • Low Milk Supply Is When Your Baby Is Not Getting Enough Milk to Gain Weight
    Increasing Your Milk Supply Most women have enough milk for their babies. Low milk supply is when your baby is not getting enough milk to gain weight. You may see these signs • baby is not content after most feeding • baby does not have lots of wet and dirty diapers • baby gains weight slowly for age How to prevent • breastfeed as soon as possible after birth • hold your baby skin-to-skin • make sure your latch is comfortable. If you have questions about latch please contact a public health nurse • breastfeed often (8 or more times in 24 hours) • hand express or use a breast pump if baby is unable to latch • do not give unnecessary formula feedings What to do The most important thing is to breastfeed often – more feeding makes more milk. • offer both breasts at each feeding • switch breasts when your baby’s sucking slows down • use gentle breast massage before and during feeds Express your breastmilk • hand express or pump your milk after as many feedings as you can • if your baby is not latching, express or pump your milk at least 7 times during the day and one time during the night • feed baby extra milk (expressed breast milk or formula) if your baby is not growing well with breastfeeding Take care of yourself • rest when your baby sleeps • drink to thirst and eat well • avoid alcohol and nicotine If you do not see an increase in your milk supply, talk to your Health Care Provider about a prescription medicine called Domperidone (Motilium) • this medicine is safe for baby • the usual dose is from 1 to 3 pills, 3 or 4 times a day • milk supply should improve within 1 to 2 weeks • there may be minor side effects (i.e.
    [Show full text]
  • New Abm Logo!
    SUMMER 2018 BREECH! SUMMER2018 BP Portrait Winner DAME SARAH STOREY ON NATURAL TERM BREASTFEEDING THE PRIVILEGED ROLE OF OFFERING BREASTFEEDING SUPPORT NEW ABM LOGO! Meet our 2018 Pam’s Prize Winner BREASTFEEDING1 THROUGH IVF The importance of supporting women who haven’t been able to meet their breastfeeding goals Professor Amy Brown, ABM Breastfeeding Counsellor We don’t really need research to physiological protection throughout tell us that a positive breastfeeding the body. Breastfeeding helps experience can be an amazing boost maintain the hormone levels the for maternal mental health. Anyone body would expect after birth, who has met their breastfeeding keeps levels of oxytocin raised and goals knows that although it can be can help the body combat tough, the rewards are usually inflammation caused by a lack of worth it. Even when everything else sleep or pain after the birth1. All feels like its falling apart, these factors – psychological and breastfeeding can be a life raft. A physiological - help explain the common message emerging from lower levels of postnatal depression my research is often ‘Breastfeeding in women who breastfeed2. felt like the one thing I got right’. But although breastfeeding can be Likewise, from a scientific beautiful, sadly, we know that far perspective, we can see the too many women struggle to have 2 that fabulous experience. Although in the first few weeks saying they most women say that they want to weren’t ready to do so3. breastfeed, in the UK, more women have given a bottle of formula by But where does that leave women? the end of the first week than are Other than literally holding the baby exclusively breastfeeding3.
    [Show full text]
  • Lactation Counseling for Mothers of Very Low Birth Weight Infants: Effect on Maternal Anxiety and Infant Intake of Human Milk
    ARTICLE Lactation Counseling for Mothers of Very Low Birth Weight Infants: Effect on Maternal Anxiety and Infant Intake of Human Milk Paula M. Sisk, PhDa, Cheryl A. Lovelady, PhDa, Robert G. Dillard, MDb, Kenneth J. Gruber, PhDc aDepartment of Nutrition and cSchool of Human Environmental Sciences, University of North Carolina, Greensboro, North Carolina; bWake Forest University School of Medicine, Winston-Salem, North Carolina The authors have indicated they have no financial relationships relevant to this article to disclose. ABSTRACT OBJECTIVE. Although it is well documented that breastfeeding promotes health and development of very low birth weight (VLBW) infants, lactation initiation among mothers of VLBW infants is low. Mothers are anxious about the health of their www.pediatrics.org/cgi/doi/10.1542/ peds.2005-0267 children, and medical staff may be reluctant to promote breastfeeding out of doi:10.1542/peds.2005-0267 concern for increasing that anxiety. Therefore, the purpose of this study was to Key Words examine whether mothers of VLBW infants who initially planned to formula feed very low birth weight, lactation, were different in terms of their level of anxiety and maternal stress compared with anxiety, counseling, human milk mothers who had planned to breastfeed their infants. The aims of this study were Abbreviations VLBW—very low birth weight to (1) determine whether counseling mothers of VLBW infants who had initially IFG—initial formula feed group planned to formula feed on the benefits of breast milk would increase their stress IBG—initial breastfeed group and anxiety levels, (2) assess whether mothers who initially had not planned to STAI—State-Trait Anxiety Inventory PSS-NICU—Parental Stress Scale: breastfeed changed their plans after counseling to provide breast milk, and (3) Neonatal Intensive Care Unit measure the amount of breast milk expressed by mothers who initially planned to WIC—Special Supplemental Nutrition Program for Women, Infants and formula feed.
    [Show full text]
  • Recognizing When Things Are Are Things Heading South? Well, It's All About the Clues
    Investigating for Low Milk Supply Objectives Recognizing When Things are 1. Differentiate the three main categories of milk production problems. 2. List at least 3 risk factors for lactation problems in the early postpartum 3. Relate the importance of current pregnancy history to lactation capability 4. Explain the impact of infant suck on What’s going on? maternal milk production Lisa Marasco MA, IBCLC, FILCA [email protected] © 2019 ~No disclosures~ Are things Gathering good clues Start by listening to mom’s story heading south? Is there really a problem? No Reassure, educate Yes Take a detailed history Risk factors for delays Breastfeeding Management Yes Further Observations Infant assessment Well, it’s all Feeding assessment about the clues Maternal Assessment Differentiate delayed, primary and/or secondary causes Early weight loss Start Here → Is baby getting enough? >7%? >10%? Vag Lots of smaller stools OR Delivery Less often but blow-outs C-sect Once milk comes in, baby Delivery should start to gain 30- 45g/day in the first 1-2 mo Flaherman, et al. (2015). Early weight loss nomograms for exclusively breastfed newborns. Pediatrics How does baby look and act? Use day 2 weight as baseline for % loss - Noel-Weiss 2011 © Lisa Marasco 2019 1 Investigating for Low Milk Supply APPROXIMATE weight gain for babies in the 25th to 75th percentiles Week 1 Initially, loses up to 7-10% of birth weight (Note: weight at 24 hours may be more accurate true birth weight) Week 2 Regains to birth weight, or has started to gain 1oz (30g) per day WHO Velocity Weeks 3 & 4 Gains 8-9 oz (240-270g) per week Growth Charts Month 2 Gains 7-10 oz (210-300g) per week Month 3 Gains 5-7oz (150-210g) per week From: Riddle & Nommsen-Rivers (2017).
    [Show full text]
  • The Motherisk Alcohol and Substance Use Helpline: 10 Years of Experience and Counting
    THE MOTHERISK ALCOHOL AND SUBSTANCE USE HELPLINE: 10 YEARS OF EXPERIENCE AND COUNTING Eunji Kim, Moumita Sarkar, Yvette Navioz, Gideon Koren, Adrienne Einarson The Alcohol and Substance use Helpline; The Motherisk Program, The Hospital for Sick Children, Toronto, Canada ABSTRACT The Motherisk Alcohol and Substance Use Helpline at The Hospital for Sick Children in Toronto, Canada, is a unique telephone service providing evidence-based information on the negative effects associated with alcohol and substance use in pregnancy and lactation. We describe the characteristics of the service, the demographics of the callers, and the inquiries made during its first ten years of service. Since its inception in November 1998 until November 2008, almost 20,000 calls had been received with 60% of calls initiated by pregnant and breastfeeding women, the remainder from various health care providers. Most women exposed to alcohol and substances were of Caucasian descent (80%), employed (65%), and married (46%) with some level of post-secondary education (52%). The demographics of the callers deviate from the well-documented cohort of women at risk of engaging in alcohol and substance use in pregnancy and lactation, confirming that a selective group of women is more likely to use the services offered by the Motherisk program. Thus, further efforts are required to reach out to the subgroup of women at high risk of continuing their harmful behaviors during pregnancy and lactation. Key Words: Alcohol; pregnancy; fetal alcohol spectrum disorder; substance use; childbearing age lcohol consumption is a wide spread following gestational exposures.6-9 Fetal Alcohol social behavior with reported use by 77% Spectrum Disorder (FASD) describes the physical Aof Canadian women 15 years and older.1 and neurological abnormalities resulting from Other substances such as tobacco and illicit drugs prenatal exposure to alcohol with symptoms are also used recreationally by many women of ranging from neurobehavioral and neurocognitive childbearing age.
    [Show full text]
  • Licit and Illicit Drug Use During Pregnancy: Maternal, Neonatal and Early Childhood Consequences
    SUBSTANCE ABUSE IN CANADA 2013 Licit and Illicit Drug Use during Pregnancy: Maternal, Neonatal and Early Childhood Consequences By Loretta Finnegan With A Call to Action by Franco Vaccarino and Colleen Dell This document was published by the Canadian Centre on Substance Abuse (CCSA). CCSA activities and products are made possible through a financial contribution from Health Canada. The views of CCSA do not necessarily represent the views of the Government of Canada. The subjects in the photographs used throughout this publication are models who have no relation to the content. The vignettes are fictional and do not depict any actual person. Suggested citation: Finnegan, L. (2013). Substance abuse in Canada: Licit and illicit drug use during pregnancy: Maternal, neonatal and early childhood consequences. Ottawa, ON: Canadian Centre on Substance Abuse. © Canadian Centre on Substance Abuse 2013. CCSA, 75 Albert St., Suite 500 Ottawa, ON K1P 5E7 Tel.: 613-235-4048 Email: [email protected] This document can also be downloaded as a PDF at www.ccsa.ca. Ce document est également disponible en français sous le titre : Toxicomanie au Canada 2013 : Consommation de drogues licites et illicites pendant la grossesse : Répercussions sur la santé maternelle, néonatale et infantile ISBN 978-1-77178-041-4 Licit and Illicit Drug Use during Pregnancy: Maternal, Neonatal and Early Childhood Consequences Prepared for the Canadian Centre on Substance Abuse Loretta P. Finnegan, M.D., LLD, (Hon.), ScD (Hon.); President, Finnegan Consulting, LLC; Professor of Pediatrics, Psychiatry and Human Behavior, Thomas Jefferson University (Retired); Founder and Former Director of Family Center, Comprehensive Services for Pregnant Drug Dependent Women, Philadelphia, PA; Former Medical Advisor to the Director, Office of Research on Women’s Health, National Institutes of Health, U.S.
    [Show full text]