session 11 baby cannot feed at breast

SESSION 11 IF BABY CANNOT FEED AT THE

BREAST

Breastfeeding Promotion and Support A Training Course for Health Professionals

Adapted from the Baby Friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care (Section 3)

WHO/UNICEF 2009

Session Objectives:At the end of this session, participants will be able to:1. Describe why hand expression is useful and how

to hand express2. Explain how to cup feed an infant3. Method of storing and thawing expressed

breastmilk4. Practice assisting to learn how to hand express

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1. Describe Why Hand Expression Is Useful And How To Hand Express

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Why Might It Be Useful For A Mother To Know How To Hand Express?

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10 Steps to Successful Breastfeeding

STEP 5:Show mothers how to breastfeed and how

to maintain lactation even if they should be separated from their infants

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Why learn to Hand Express?Useful to know how to hand express :1. For breast comfort

Relieve engorgement/blocked duct/tender nipple

2. To help baby to breastfeed eg to soften areola so that baby can attach3. To keep up/increase milk production4. To obtain milk when:

—baby is unable to breastfeed—mother and baby are separated—To provide milk for milk bank

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Hand expression

Advantages compared to breast pumps• No worries about missing part or faulty

equipment• Very effective & quick• Prefer skin-to-skin stimulation • Usu gentler than a pump• Less risk of cross-infection

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How To Hand Express?

Key steps:1. Encourage milk to flow2. Compress breast over the ducts3. Repeat in all parts of the breast

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KEY STEPS

1.Encourage milk to flow:Mother can help oxytocin reflex to work

• Being comfortable & relaxed• Thinking about her baby/looking at baby• Warming her breast• Massaging breast • Gently rolling nipple between fingers

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Hand Expression

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Breast Expression Technique

• Wash hands with soap and clean water• Using clean/sterile container

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2.Find The Milk Ducts

1.Feel for the ducts (near outer edge of the areola)2.Place thumb on the duct and place first finger on opposite side3.Support breast with other fingers

X

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3.Compress The Breast Over The Ducts

4. Gently press thumb and first finger slightly back toward the chest wall

5. Then press thumb and first finger together -this will helps milk flow towards nipple

6. Release the pressure and repeat compress and release movement until milk drips out

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4.Repeat In All Parts Of The Breast

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When to Express Breastmilk?

• If baby not able to suckle Express soon after delivery (by 6 hours preferably)• When baby cannot feed at the breast :

Mothers are away from their baby Breasts are overfull or blocked duct Want some hind milk to rub on sore

nipples

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How Long to Express Breastmilk?Reason Length

To get colostrums – baby not able to suck

5-10 min every 1-2 hours

To increase milk production

20 min every 2 hours (at least 6 times or more per 24 hours)

Just softening the areola 3 or 4 timesTo clear a blocked duct Compress & massage until

the lump has clearedWorking mother 15 min or 30 min

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Expressing Colostrum

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• Preterm babies and sick babies may take very small feeds at first.

• Encourage small frequent feeds of colostrum. • Do not dismiss small amounts that mother

expressed. • May be express into a spoon, syringe ,small cup

or directly into the baby’s mouth

Milk Expression: Points To Note

• Not to touch mother’s breast when teaching hand expression

• May take few tries to succeed• Mother should not squeeze the nipple itself• Avoid sliding or rubbing her fingers along

the breast when compressing

• PRACTICAL

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Feeding Expressed Breastmilk To Baby

Babies who are not fed at breast can be fed by:• Naso-gastric or oro-gastric tube (cannot suckle &

swallow)• Syringe or dropper (Usu for colostrum ,not more

than 0.5 ml at a time)• Spoon – risk of aspiration• Direct expression into the baby’s mouth (cleft

palate)• Cup Feeding

Assess individually 20

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Cup FeedingUsed for baby :• Who are able to swallow

but cannot (yet) suckle well enough.—have difficulty attaching

well—attach & suckle for a short

time—tire quickly before obtain

enough milk• 30-32 weeks gestation can

often begin to take feeds from a cup. 22

HOW TO FEED A BABY BY CUP• Sit baby upright or semi-upright on your lap

• Support baby’s back, head and neck

• Hold cup to baby's lips. The cup rests lightly on baby's lower lip, and edges of cup touch the outer part of the baby's lip.

• Tilt cup so that milk just reaches baby's lips.

• DO NOT POUR the milk into baby's mouth. Just hold cup to baby’s lips and let him take it himself .

• When baby has had enough, baby will close his mouth and will not take any more.

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Cup Feeding a Baby

Advantages

• Readily available• Allow baby to control

amount & rate of feeding• Avoid nipple confusion• Less chance of

contamination• Pleasant for baby• Let baby use his tongue

and to learn tastes• Stimulates baby’s digestion• Encourages coordinated

breathing/suck/swallow

Disadvantages

• Milk can be wasted if the baby dribbles

• Prefer cup more if baby do not go to breast regularly

• SCN Nurse may prefer cup feeding

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Cup Feeding a Baby

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A cup does not need to be sterilised in the same way as a bottle and teat.

It has an open, smooth surface that is easy to clean by washing it in hot soapy water.

Avoid tight spouts, lids or rough surfaces where milk may stick

Baby can progress from tube feeding to cup feeding to fully BF PRACTICAL

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Other method of feeding – Supplementary Nursing System

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Other method of feeding – S N S with Syringe

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CUP FEEDING IS SIMPLER

Breast Pump• Not always practical, affordable or available• Preferable to express milk by hand. • Help mother to choose an effective pump, show her

how to use • Usually helpful to stimulate oxytocin reflex before

pumping by sitting comfortably relaxing. • Double pumping increases mother’s prolactin level –

for large volumes of milk / short time to pump.• Mother does not need to keep pumping if the milk is

flowing.• Ensure mother to sterilise pump if she intends to

feed baby. • Avoid the rubber bulb type hand pumps - damage

mother’s nipples, difficult to clean and the milk cannot be used for feeding a baby.

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3. Storing and Thawing Expressed Breastmilk

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Storing Expressed Breastmilk

General guidelines:• Wash hands when handling

• Choose suitable container :– glass/plastic with cover– clean/sterile (wash with hot soapy water and rinse with hot water)

• Store only the amount required in one container that the baby take at one feeding

• Labelled with name and date. Use oldest milk first.

• Feeding of fresh milk is encouraged.32

Storing Expressed Breastmilk

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Storage MethodMethod of storage Healthy Baby Ill Baby

Fresh MilkRoom Temperature

(25° – 37°C)4 hrs 4 hrs

Air condition Room15° – 25°C

8 hrs -

< 15°C 24 hrs -Refrigerator (2° – 4°C) < 8 days 48 hrs

Frozen MilkFreezer compartment inside refrigerator (1 door fridge)

2 weeks 2 weeks

Freezer part of a refrigerator-freezer (2 doors fridge)

3 months 3 months

Separate deep freeze 6 months 3 months

Thawed in a refrigerator 24 hrs(do not refreeze)

12 hrs(do not refreeze)

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8 daysRefrigerator

(2° – 4°C)

Breastmilk Storage

6 monthsDeep freeze

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3 monthsFreezer part of a

refrigerator-freezer

Maintain Cold Chain During Transportation

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Thawing• Frozen breastmilk may be thawed

slowly in a refrigerator and used within 24 hours.

• It can be defrosted by standing in a jug of warm water and used within one hour.

• Do not boil milk or heat it on stove, over a direct fire or in microwave oven

– destroys some of its properties and can scald baby’s mouth.

**Milk should not be stored above 37°C37

Thawing• Warm only the amount of milk

that will be used at one feeding. Milk cannot be saved once it has been warmed.

• The fat may separate out in small globules. Gently shake it to re- combine the fat with the rest of liquid.

• Feed the milk to baby with a cup.

• A spoon may be used for small amounts.

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Summary

• If mother & baby are separated, teach and help mother to maintain lactation

• Various ways of milk expression but hand expression is preferred

• EBM can be given by various method • Proper management of EBM is important to

ensure babies’s health

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SESSION 11 SUMMARY IF BABY CANNOT FEED AT THE BREAST

Session 11 Knowledge check

• List four reasons why it is recommended that mothers learn to hand express.

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Why learn to Hand Express?Useful to know how to hand express :1. For breast comfort

Relieve engorgement/blocked duct/tender nipple

2. To help baby to breastfeed eg to soften areola so that baby can attach3. To keep up/increase milk production4. To obtain milk when:

—baby is unable to breastfeed—mother and baby are separated—To provide milk for milk bank

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Session 11 Knowledge check

• List four reasons why cup feeding is preferred to feeding than other means if the baby cannot breastfeed.

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Cup Feeding a Baby

Advantages

• Readily available• Allow baby to control amount & rate of feeding• Avoid nipple confusion• Less chance of contamination• Pleasant for baby• Let baby use his tongue and to learn tastes• Stimulates baby’s digestion• Encourages coordinated breathing/suck/swallow

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THANK YOU

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