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Baby Behavior Baby Behavior Newborn Stomach Getting Enough?

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Baby Behavior Baby Behavior Newborn Stomach Getting Enough? 9/2/2014 Goldilocks and Her Milk Supply: Too Much? Too Little? Or Just Right! Do we know what is normal and common? Ronda Seifert RN BSN IBCLC Strong Families AZ Breastfeeding Coordinator Arizona Department of Health Services Health and Wellness for all Arizonans Health and Wellness for all Arizonans Baby Behavior Baby Behavior WIC in California found that moms interpreted If you want to learn more : normal infant behavior as meaning that baby is not getting enough: http://strongfamiliesaz.com/ • Crying 1. Create login (quick and free) • Waking 2. Click “Professional Development” What about… 3. “Web-based Professional Development • Hunger and Satiety Cues Opportunities” 4. “Baby Behaviors” Health and Wellness for all Arizonans Health and Wellness for all Arizonans Newborn Stomach Getting Enough? Health and Wellness for all Arizonans Health and Wellness for all Arizonans 1 9/2/2014 Normal Weight Gain What Is Normal? Baby’s Age Average Weight Gain • Baby behavior and feeding cues 0-4 months 4 – 7 ounces per week • Stomach size & feeding frequency 4-6 months 4 – 5 ounces per week • Diaper counts and weight gain • Cluster feeding & Growth spurts 6-12 months 2 – 4 ounces per week • Development and appearance Health and Wellness for all Arizonans Health and Wellness for all Arizonans Supply Issues Priorities • Feed the baby • Protect the milk supply • Fix the problem Mom is in the driver’s seat. Health and Wellness for all Arizonans Health and Wellness for all Arizonans Getting Enough? Getting Enough? Unreliable ways to tell if baby is getting enough at • How is breastfeeding going? the breast: • How often feeding? • Feeding frequently • How many poop/pee diapers? • Long nursing sessions • What color is the poop? • Sleeping through the night • Breast fullness or emptiness • Weight gain (from lowest weight)? • Amount mom can pump • How is baby behaving? • Taking bottle after feedings • Fussiness at the breast Health and Wellness for all Arizonans Health and Wellness for all Arizonans 2 9/2/2014 Low Milk Supply: Symptoms • Baby has fewer than three stools per day in the first 3-4 weeks Perceived Low Milk Supply is • Not gaining weight well (at least 4-7 ounces Low Milk Supply per week) • Baby does not feed 8-12 times per day Health and Wellness for all Arizonans Health and Wellness for all Arizonans Common Causes Critical Thinking • Scheduled feeds or skipped feeds • Is it a supply issue? • Baby has begun supplemental formula or solid • Is it a transfer issue? foods • Is there a health issue for mom or baby? • Mother has begun birth control • Mom and baby are separated and mom is not The possible causes are many. expressing milk while away. Some are common, some not common. Health and Wellness for all Arizonans Health and Wellness for all Arizonans Feed the Baby AAP’s Supplementation 1. Mother’s own milk/colostrum • At breast when possible 2. Pasteurized donor banked human milk • Mom’s colostrum/milk when possible 3. Hypoallergenic infant formula • Donated breastmilk from milk bank if possible 4. Elemental infant formula • Hypoallergenic formula – temporary 5. Bovine milk based infant formula “medicine” 6. Soy infant formula • Age-appropriate amounts 7. Water/Glucose Water Health and Wellness for all Arizonans Health and Wellness for all Arizonans 3 9/2/2014 Supplementing Typical Feed Amount AVERAGE REPORTED INTAKES OF COLOSTRUM Baby’s Age Per Feed Intake per Day BY HEALTHY BREASTFED INFANTS First Week 1-2 ounces 10-20 ounces Time Intake (mL/feed) Weeks 2 and 3 2-3 ounces 15-25 ounces 1st 24 hours 2–10 5 mL≈1 tsp 30 mL ≈ 1 oz Month 1-6 3-5 ounces 25-35 ounces 24–48 hours 5–15 (Mohrbacher & Kendall-Tackett, 2005) 48–72 hours 15–30 72–96 hours 30–60 http://www.bfmed.org/Resources/Protocols.aspx Health and Wellness for all Arizonans Health and Wellness for all Arizonans Protect the Supply Protect the Supply How much is enough? Guidelines for 24 hr milk production – Mom should produce 600 ml (20 oz) by day 10 Ideal >750 ml Supply and Demand: – If mom is not pumping 350 ml by day 10, then mom needs to Borderline 350-500ml use strategies to improve milk The more milk that is removed, supply. – Hand expression is best to Low <350 ml the more milk that is made. collect colostrum (spoon, syringe, etc) The less milk that is removed, the less milk that is made. Health and Wellness for all Arizonans Health and Wellness for all Arizonans Low Milk Supply: Strategies Low Milk Supply: Prevention • Put the baby to the breast often • Position/Latch • Increase the numbers of feedings or remove milk • Feed often – 8-12 times per day with pump. • Let baby release at end of feed • Offer baby unlimited access to the breast • Avoid long intervals between feeds • Skin-to-skin • Get help if there is an issue • Rest and relax • Breastfeed on one side and pump on the other • Express milk when separated. Health and Wellness for all Arizonans Health and Wellness for all Arizonans 4 9/2/2014 Fix the Problem Warning Signs • Newborn who is more than 10% below • Find and fix the problem birthweight • Critical skills: • Not regained birthweight at 2 weeks old • Stools have not turned yellow by 7 days old – Lactation-specific knowledge • No urine output for 12 hours; no stool for 24 – Helping experience in lactation • Any clinical signs of dehydration – Critical thinking • 2 – 3 months old gaining < 20 g/day – Communication • Baby with lack of weight gain, significant jaundice, or unexplained weight loss at any age Health and Wellness for all Arizonans Health and Wellness for all Arizonans Low Milk Supply Returning to Exclusive Breastfeeding The baby is in need of medical attention. Health and Wellness for all Arizonans Health and Wellness for all Arizonans Critical Thinking Priorities • What is mom’s goal? • Feed the baby • Is baby getting enough? • Protect the milk supply • How long since mom gave birth? • Fix the problem • How much is baby being supplemented? • Is baby breastfeeding well? Mom is in the driver’s seat. Health and Wellness for all Arizonans Health and Wellness for all Arizonans 5 9/2/2014 Feed the Baby Feed the Baby • Get a weight check to start • Monitor poop and pee diapers and weight • Consider getting weight checks at least weekly gain to ensure adequate weight gain • By about day 5* • In baby under 3 months, anything below 20 g – Minimum of 1 poopy diaper every 8 hours, AND per day or about 5 oz per week means needs minimum of 1 pee diaper every 4 hours more supplementation • If close to time, mom can try to breastfeed and if still no poop or pee, supplemental feed *Around 6 weeks, stooling patterns change again Health and Wellness for all Arizonans Health and Wellness for all Arizonans Protect the Supply Protect the Supply • If during the first two weeks, suggest 2 – 3 • No more than one 5-hour break in a 24 hour days of marathon pumping and feeding to period for best results ramp up supply • Mother care is important, too • Offer both sides or pump from other side • Other things moms try • Cluster pumping/breastfeeding especially during day with 8-12 sessions the goal for 24 hours Health and Wellness for all Arizonans Health and Wellness for all Arizonans Other Tips Other Tips • Use breast compressions during feeds • May be able to supplement less in the • Use breast massage during and hand morning when supply is generally higher expression after pumping • Consider alternate feeding methods, ie • Pump 2 min after last milk OR 20 - 30 minutes – Supplemental Nursing System, finger feeding, etc. • Hand express after or between breastfeedings – Or paced bottle feeding – Carefully consider pros/cons Health and Wellness for all Arizonans Health and Wellness for all Arizonans 6 9/2/2014 Returning to Exclusive Other Causes of Low Supply • Cut back on supplemnentaion by a ½ ounce per feeding with a day or two between cut-backs • Health or anatomical problems with baby that • Any poop/pee decrease or lack of adequate prevent good milk transfer weight gain, bump supplement back up and • Uncontrolled maternal anemia reevaluate • Signs to consider cutting back faster – greater • Hypothyroidism interest at the breast, greater poop/pee output, • Previous breast surgery greater weight gain, baby shows signs of fullness • Hormonal problems at the breast, not wanting to finish the • Maternal medications supplement • Smoking Health and Wellness for all Arizonans Health and Wellness for all Arizonans Low Milk Supply Scenario A 19-year-old client has delivered an infant who was 37 ½ weeks gestation age. Mom reports that in addition to breastfeeding, baby has been receiving formula during hospital stay and also Refer mom and/or baby to their HCP and IBCLC at home. Baby is five days old and mom reports that she has been trying to breastfeed but now her nipples are very sore and she doesn’t know what to do. Health and Wellness for all Arizonans Health and Wellness for all Arizonans What Would You Do? Scenario More info: • Baby did not spend any time in NICU • Baby has 6+ wet and 3+ poop diapers What do you suspect might be happening? • Mom estimates that baby is receiving an additional 1-2 oz of formula about 7 times per What other information would you like to have? day • Mom reports that her breasts have started to feel firm and a little uncomfortable Health and Wellness for all Arizonans Health and Wellness for all Arizonans 7 9/2/2014 What Would You Do? What do you suspect might be happening? Over abundant Milk Supply/Oversupply Is there anything else you might want to know? What information and suggestions might you share with this mother? Health and Wellness for all Arizonans Health and Wellness for all Arizonans Oversupply Oversupply: Vicious Cycle • Oversupply can have similar symptoms as a • Lipids (fats) stimulate cholecystokinin baby with colic, reflux disease, and allergies • Cholecystokinin produces satiety (fullness) • Before considering oversupply as a possible • Mother produces large volume of milk factor, be sure baby is gaining more than the • Infant does not get to the higher fat, last milk average 2 pounds per month.
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