Presenter: Phyllis Stell Crowley, MS, RD, CD, IBCLC

PHCNPG Treasurer

Moderator: Lauren Melnick, MS, RD, LD

PHCNPG Secretary

Administrator: Maria Bournas, MS, RD, LDN

Women’s Health Membership Chair

Identify some common breastfeeding concerns

Describe signs and symptoms

Relate prevention and treatment strategies

Recognize lactation support staff

In the hospital, the baby will not latch on:

-medications during L&D

-vigorous suctioning of baby at birth

-abnormalities of baby’s mouth (cleft lip)

-artificial nipple preference

-shape of mom’s nipples (flat, inverted, large)

-tight frenulum (membrane under tongue)

-anxious feeding schedule

Mother:

- pain/discomfort

- worry about infant not getting enough milk

Infant:

- fussy at the breast

- no audible swallowing

- puckering inward of upper and lower lips

- poor weight gain

- poor output (insufficient stool/wet diapers)

Proper/correct latch positions

Assess infant’s anatomy upon latch

Determine audible swallowing

Verify adequate weight gain/output

Laid-back

Cradle

Cross-cradle

Clutch or Football

Side-lying

Image from- http://www.llli.org/faq/positioning.html

Image from- http://www.llli.org/faq/positioning.html

Image from- http://www.llli.org/faq/positioning.html

Image from- http://www.llli.org/faq/positioning.html

Image from- http://www.llli.org/faq/positioning.html

Proper alignment

Areolar grasp

Areolar compression

Audible swallowing

Asymmetric http://www.youtube.com/watch?v=NO5ZDKynaD0

Dr. Jack Newman Breastfeeding

Video- “Asymmetrical Latch”

Minimum of 6 wet diapers at day 4 or 5

After first 72 hours, minimum of 3 soft, yellow

stools/day in the first month of life

Regained birth weight by 2 weeks

Gain of .5 oz/day (average) during the first

month of life

At the beginning of a feed- transient pain

Lasting longer than 30 seconds- positional

Throughout entire feed- shallow breastfeeding,

unusual infant oral anatomy, strong suckling, or

unusual nipple anatomy

After feedings or in between- vasospasm

(white) or Raynaud’s phenomenon (white, blue

and/or red)

Poor positioning and shallow breastfeeding

Baby’s lips tucked in and not flanged out

Removing baby from breast without breaking

suction first

Nipple too large in baby’s mouth

Tongue tie, short tongue, receding chin, tight

frenulum

Strong sucking, clamping, clenching

Engorgement

Vasospasm or Raynaud’s phenomenon

Misuse of breast pumps and/or parts

Tight bras, wet breast pads, irritating creams

Poor positioning and shallow breastfeeding

Candida/thrush

Baby clamping down

Removing baby from breast without breaking

suction first

Overabundant milk supply

Blisters

Infected Montgomery glands

Referred pain from mastitis

Misuse of breast pumps and/or parts

Good positioning and latch-on

Avoiding pacifiers

Air-drying nipples

Frequent feedings (prevents engorgement and

a ravenously hungry baby with a strong suck)

Find the cause and correct it

Good position and latch-on

Alternating positions

Express milk before putting baby to breast

Breastfeed on least sore breast first

Apply nipple care product between feedings to

decrease pain

Wear breast shells between feedings to

prevent clothing friction or pressure

Distention of mammary tissue

Breasts filling with milk around the second or

third day postpartum; known as “coming in of

mother’s milk”

Occurs when the tissue distention is

preventable, extreme or the result of

unphysiologic cause

This type is preventable

Correlated with delayed initiation of first

feeding(s), severely limiting feedings and

formula supplementation

Frequent breastfeeding to remove milk

Warm showers or compresses reduces

accumulation of milk in the ducts

Applying cold packs after breastfeeding causes

vasoconstriction, thereby reducing vasocongestion

and discomfort

Reverse pressure softening is treatment of choice

for areolar engorgement

Express some milk to soften tissue before bringing

baby to the breast

Frequent breastfeeding with a correct latch,

audible swallowing and transfer of milk

Empty breasts completely at each feeding

Perceived

Actual

Baby is fussy

Lack of maternal confidence

Slow weight gain

Lack of lactation knowledge and how to assess

sufficient milk supply

Baby eagerly takes formula

Baby wants to breastfeed constantly

Breasts not feeling full or small

Polycystic Ovary Syndrome (PCOS)

Insulin resistance

Prolactin resistance

Thyroid disorders

Estrogen

Progesterone

Insufficient glandular tissue/development

Determine if perceived or actual

If Actual, refer for medical assessment/treatment

Initiate strategies to increase milk production

(frequency, complete emptying, feed on demand)

Correct mismanagement: position/latch;

encourage to listen for audible swallowing

Help with identification of support

Domperidone (Motilium)

Metoclopromide (Reglan)

Thyrotropin-releasing hormone

Prenatal breast enlargement

Postpartum physiologic engorgement

Milk drips from breast during suckling

Newborn begins to regain weight by 7-10 days

Newborn has at least 3 soft stools (each the

size of a quarter) per day in the first month

Responds to hunger cues

Audible swallowing

Newborn ends feeding and appears satiated

Candida albicans is a fungus that thrives in

warm, moist areas (infant’s mouth/mother’s

nipples) and can cause thrush

Candida is naturally occurring and lives in the

human body in balance

Factors that cause Candida to be out of

balance, are: pregnancy, illness or antibiotic

overuse

An overgrowth causes the infection known as

candidiasis/thrush

Mother:

- nipples are bright red or purple

- stabbing, shooting, deep pain in breasts

(especially after feeding)

Infant:

- white patches in the mouth

- diaper rash that is red or red with raised

dots

- feeding poorly or refusing to eat

- restless and irritable

Pregnancy

Illness

Antibiotic overuse

Suppressed immune systems

Diabetes and anemia increases risk

Pacifiers and bottle nipples

Throw away disposable breast pads as soon as they become wet

Air dry the nipples

Wash hands often

Wash infant’s toys in hot, soapy water and rinse well

Avoid pacifier and bottle nipple use

If used, boil daily for 20 minutes all breast pump parts that come in contact with the milk

Manage and get treatment for illnesses, diabetes and anemia

If suspected, refer to physician for medical

assessment and medications

Topical treatment: nystatin

Systemic treatment: diflucan

Course of treatment: 14 days (entire course of

treatment needs to be completed)

Concerns expressed by mothers:

- fatigue

- worries about milk production

- difficult to leave their babies

- felt extra work & family stress

- challenges with child care

Concerns expressed by mothers:

- financial demands

- inability to sleep

- milk leaking at work/school

- location and break time to express

- fear of losing job

Breastfeeding Plan:

- length of maternity leave (3 or 6 months)

- flex schedule (part or full time)

- telecommute/day care on site

- seek support (family and employer)

- expressing/pumping plan

Plan to breastfeed at least twice before leaving

baby in day care

Breastfeed as soon as arriving at day care after

work or school

Breastfeed often when with baby at home and

at night

Choose day care close to work/school

Lactation educators (completion of 45 hr, 60 hr

or 90 hr LEAARC Approved Courses);

Lactation Education Accreditation and Approval

Review Committee- LEAARC

IBCLCs (International Board Certified Lactation

Consultants); certified by the International

Board of Lactation Consultant Examiners or

IBLCE

Biancuzzo, M. Breastfeeding the Newborn-Clinical Strategies for

Nurses, 2003, Mosby Inc.

Lauwers, J. and Swisher, A. Counseling the Nursing Mother- A

Lactation Consultant’s Guide, 2011, Jones & Bartlett Learning,

LLC

Lawrence, R.A. and Lawrence, R.M. Breastfeeding- A Guide for

the Medical Profession, 2005, Mosby, Inc.

Mannel, R., Martens, P., and Walker, M. (Editors), Core Curriculum

for Lactation Consultant Practice, 2008, Jones and Bartlett

Publishers

Morhrbacher, N. Breastfeeding Answers Made Simple- A Guide

for Helping Mothers, 2010, Hale Publishing, L.P.

Riordan, J. and Wambach, K. Breastfeeding and Human

Lactation, 2010, Jones & Bartlett Publishers, LLC

http://www.lactationtraining.com/our-courses/online-courses/lactation-

consultant-training-program?gclid=CMOukOjLs7wCFdGDQgodRnUAHA

http://iblce.org/

http://www.ilca.org/i4a/pages/index.cfm?pageID=3832

http://www.leaarc.org/

http://www.cdc.gov/breastfeeding/

http://mchb.hrsa.gov/pregnancyandbeyond/breastfeeding/

http://www.ilca.org/i4a/pages/index.cfm?pageid=1

http://www.usbreastfeeding.org/

http://www.llli.org/

CPEU Certificate: All attendees will receive an evaluation survey and a link for the CPEU certificate by

March 2, 2014.

About Our DPGs: Women’s Health: http://www.womenshealthdpg.org/

Public Health/Community Nutrition: http://www.phcnpg.org/

Recorded Webinars: http://www.phcnpg.org/page/webinars

Follow the instructions for getting the CPEU (Code 175) certificate.

Speaker’s Contact Information: Phyllis S. Crowley, MS,RD,IBCLC at pcrowley@utah.gov or 801-538-6823

If you have questions about CPEU, please feel free to e-mail Takakotagami@mchsi.com