66511_FMxx_FINAL.qxd 12/3/09 2:07 PM Page i Breastfeeding Management for the Clinician USING THE EVIDENCE Second Edition Marsha Walker Executive Director National Alliance for Breastfeeding Advocacy Board of Directors Massachusetts Breastfeeding Coalition Weston, Massachusetts 66511_FMxx_FINAL.qxd 12/3/09 2:07 PM Page ii World Headquarters Jones and Bartlett Publishers Jones and Bartlett Publishers Jones and Bartlett Publishers 40 Tall Pine Drive Canada International Sudbury, MA 01776 6339 Ormindale Way Barb House, Barb Mews 978-443-5000 Mississauga, Ontario L5V 1J2 London W6 7PA [email protected] Canada United Kingdom www.jbpub.com Jones and Bartlett’s books and products are available through most bookstores and online booksellers. To contact Jones and Bartlett Publishers directly, call 800-832-0034, fax 978-443-8000, or visit our website, www.jbpub.com. 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Production Credits Publisher: Kevin Sullivan V.P., Manufacturing and Inventory Control: Therese Connell Acquisitions Editor: Emily Ekle Composition: Arlene Apone Acquisitions Editor: Amy Sibley Cover Design: Scott Moden Associate Editor: Patricia Donnelly Cover Image Credit: © Anastasia Bobrova/ShutterStock, Inc. Editorial Assistant: Rachel Shuster Printing and Binding: Malloy, Inc. Production Editor: Amanda Clerkin Cover Printing: Malloy, Inc. Marketing Manager: Rebecca Wasley Library of Congress Cataloging-in-Publication Data Walker, Marsha. Breastfeeding management for the clinician : using the evidence / Marsha Walker. — 2nd ed. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-0-7637-6651-1 (alk. paper) ISBN-10: 0-7637-6651-8 (alk. paper) 1. Breastfeeding. 2. Infants—Nutrition. 3. Evidence-based medicine. I. Title. [DNLM: 1. Breast Feeding. 2. Evidence-Based Medicine. 3. Lactation—physiology. WS 125 W182b 2011] RJ216.W346 2011 649’.33—dc22 2009033393 6048 Printed in the United States of America 13 12 11 10 09 10 9 8 7 6 5 4 3 2 1 66511_FMxx_FINAL.qxd 12/3/09 2:07 PM Page iii Ļ Dedication ļ As always, my work is dedicated to my growing family: Hap, my husband, for his unlimited patience and support (especially with IT); Shannon, my daughter, wife to Tom, and mother of breastfed Haley, Sophie, and Isabelle; Justin, my son, husband to Sarina and father of Ella. I can’t ask for more than this. iii 66511_FMxx_FINAL.qxd 12/3/09 2:07 PM Page iv 66511_FMxx_FINAL.qxd 12/3/09 2:07 PM Page v Ļ Contents ļ Preface .................................................. .ix Part I The Context of Lactation and Breastfeeding 1 1 Influence of the Biospecificity of Human Milk . 3 Introduction . 3 Colostrum . 5 Clinical Implications: Allergy and Disease . 6 Nutritional Components . 14 Defense Agents . 41 Human Milk Fortification . 46 Milk Treatment and Storage . 48 Summary: The Design in Nature . 55 Appendix 1-1: Summary Interventions Based on the Biospecificity of Breastmilk . 69 Appendix 1-2: Human Milk Banks in North America . 72 2 Influence of the Maternal Anatomy and Physiology on Lactation . 75 Introduction . 75 Functional Anatomy of the Breast . 80 Nipple Preparation . 88 Breast Augmentation . 88 Breast Reduction . 91 v 66511_FMxx_FINAL.qxd 12/3/09 2:07 PM Page vi vi Contents Breast Anomalies . 94 Nipple Anomalies . 95 Hormones of Lactation . 96 Lactogenesis II . 106 Lactogenesis III . 113 Volume of Milk Production Over Time . 116 The Newborn Stomach . 116 Summary: The Design in Nature . 121 Appendix 2-1: Summary Interventions Based on the Maternal Anatomy and Physiology of Lactation . 131 3 Influence of the Infant’s Anatomy and Physiology . 133 Introduction . 133 Functional Infant Anatomy and Physiology Associated with Breastfeeding . 133 Putting It All Together . 167 Tools . 168 Summary: The Design in Nature . 185 4 Influence of Peripartum Factors, Birthing Practices, and Early Caretaking Behaviors . 191 Introduction . 191 Birth Interventions and Breastfeeding . 191 Maternity Care Practices and Breastfeeding . 196 Separation . 208 Crying . 210 Supplementation . 212 Summary: The Design in Nature . 241 Appendix 4-1: Summary Interventions Based on Peripartum Factors, Birthing Practices, and Early Caretaking Behaviors . 257 Part II Infant-Related Challenges to Breastfeeding 261 5 First 24–48 Hours: Common Challenges . 263 Introduction . 263 Clinician Influence . 263 Positioning of the Mother . 265 66511_FMxx_FINAL.qxd 12/3/09 2:07 PM Page vii Contents vii Positioning of the Infant . 269 Latch . 274 Nipple Shields . 294 Reluctant Nurser . 297 Sleepy Infant . 298 Fussy Infant . 308 Decision Trees . .319 Problem of Hypoglycemia . 319 Summary: The Design in Nature . 334 Appendix 5-1: Summary Interventions on Shield Use . 345 6 Beyond the Initial 48–72 Hours: Infant Challenges . 347 Introduction . 347 Neonatal Jaundice . 347 Hypernatremic Dehydration . 363 Slow Weight Gain . 368 Breastfeeding Preterm Infants . 378 Breastfeeding Late Preterm Infants . 400 Summary: The Design in Nature . 407 Appendix 6-1: Summary Interventions on Slow Infant Weight Gain: Breastfeeding Techniques Useful in Slow Weight Gain Situations . 427 7 Physical, Medical, and Environmental Problems and Issues . 431 Introduction . 431 Twins and Higher Order Multiples . 431 Anomalies, Diseases, and Disorders That Can Affect Breastfeeding . 443 Syndromes and Congenital Anomalies . 464 Upper Airway Problems . 467 Gastrointestinal Disorders, Anomalies, and Conditions . 470 Metabolic Disorders . 483 Congenital Heart Disease . 489 Neurological Diseases, Deficits, Impairments, and Disorders . 493 Summary: The Design in Nature . 499 66511_FMxx_FINAL.qxd 12/3/09 2:07 PM Page viii viii Contents Part III Maternal-Related Challenges to Breastfeeding 519 8 Maternal Pathology: Breast and Nipple Issues . 521 Introduction . ..