PUBLIC HEALTH & BREASTFEEDING General Practice Training 2011.
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Transcript of PUBLIC HEALTH & BREASTFEEDING General Practice Training 2011.
PUBLIC HEALTH &
BREASTFEEDING
General Practice Training
2011
DH RECOMMENDATION
“As a global public health recommendation, infants should be exclusively breastfed for the first 6 months of life to achieve optimal growth, development and health.”WHO 2001
Breastfeeding mothers are now a "protected characteristic" under the Equality Act 2010.
The Lancet, 1994
Immunisation is preventative medicine par excellence. If a new vaccine became available that could prevent 1 million or more child deaths a year and that was moreover, cheap, safe, administered orally and required no cold chain, it would become an immediate public health imperative.
Breastfeeding could do all this and more, but it requires its own ‘warm chain’ of support that is skilled care for mothers to build their confidence and show them what to do, and protect them from
harmful practices.
Evidence Base
Healthy Weight, Healthy Lives (2008) Scientific Advisory Committee on Nutrition
(2008) Child Health Promotion Programme (2008) Infant and Maternal Nutrition Guidelines
NICE(2008) Ip S et al 2007(research based benefits of
breastfeeding)
Public Health
Breastfeeding has a major role within public health. It promotes health and prevents disease in both the short and long term for mother and baby
Exclusive breastfeeding for around 6 months, and then continued breastfeeding alongside the introduction of solids for the first year,achieves the greatest benefits
90% of women stop breastfeeding long before they had planned (Infant Feeding Survey 2005)
Potential savings
Breastfed babies have 15% fewer GP consultations during the first 6 months of life than formula-fed babies
Reduction in common childhood illnesses and long-term health problems means: Improved public health Money saved - £35 million on hospital admission
Gastroenteritis (DH) Reduced workload for GP’s
UNICEF BABY FRIENDLY INITIATIVE
Provides a framework for the implementation of best practise for NHS Trusts and other health care facilities
Within the community the seven point plan for the Protection, Promotion and Support of Breastfeeding in the Community
Implementing Baby Friendly
• Seven point plan for community settings
• Antenatal information
• Effective support and appropriate referral
• Appropriate prescribing
• Care with advertising
The Seven Point Plan for the Promotion, Protection and Support of Breastfeeding
1. Policy
2. Staff training
3. Information for pregnant women
4. Support to breastfeed
5. Exclusive breastfeeding
6. A welcoming atmosphere
7. Support groups
Incidence of breastfeeding 1990 - 2005
Local statistics for breastfeeding initiation and duration at birth & six weeks
0%10%20%30%40%50%60%70%80%90%
100%
Initiation 6-8 weeks
Q1 09/10
Q2 09/10
Q3 09/10
Q4 09/10
Why breastfeed?Risks of formula feeding to babies
Increased incidence of gastroenteritis Increased incidence of ear, chest infections and
wheeze Higher risk of diabetes Increased risk of obesity Increased risk eczema and allergies Increased risk of childhood cancers Ip S et al 2007(research based benefits of
breastfeeding)
Risks of not breastfeeding- for mothers
Increased risk of pre & post menopausal breast cancer
Increased risk of ovarian cancer Increased incidence of osteoporosis Delayed involution of the uterus
Infant Feeding Survey 2005
Most common reported problem in the first two weeks is sore breasts/nipples or perceived insufficient milk supply
Approximately less than 2% of women have a true milk insufficiency
Most milk insufficiency is perceived due to unrealistic expectations or mismanagement of breastfeeding
Common Problems
Sore nipples
Mastitis / breast abscess
Thrush - topical and ductal
Low weight gain
SORE NIPPLES- mostly associated with poor attachment
Review positioning and attachment with midwife / health visitor / breastfeeding counsellor
Moist wound healing, do not allow nipples to become dry
Other causes: Eczema, bacterial infection, thrush, Tongue-tie or high arched palate in baby, Raynauds syndrome etc
MASTITIS
Inflammatory condition of the breast which may/may not be accompanied by infection
Reported incidence of <10% of lactating women
Majority of cases in the first 12 weeks Only approximately 1/3rd are infected
Treatment
IT IS VITAL THAT BREASTFEEDING IS NOT INTERRUPTED
optimise attachment frequent feeding hand expressing if required begin feeds on affected breast all fours feeding position
as this prevents drainage of the breast and may worsen the symptoms
position the tongue and chin in line with the inflammation warm compress before feeding cold compress after feeds bed rest analgesia/anti-inflammatory (Ibuprofen) refer to breast feeding policy
Antibiotics – where appropriate
Flucloxacillin 250mg qds Amoxycillin 250-500mgs tds If allergic to penicillin Erythromycin 250-500mgs qds Cephalexin 250-500mg qds Most antibiotics are safe in lactation, loose stools etc
possible but not clinically important, may cause static weight gain. Beware of Thrush!
Breast Abscess
Unusual, can be caused by mismanagement of blocked duct/mastitis
May require aspiration or surgical drainage In most cases, breastfeeding can continue, if
mother wishes, depending on the location of the abscess
Breastfeeding can continue on the non affected side
Thrush – Topical
Signs in mother• Nipple may be super sensitive, red, shiny
and itchy• May be blanching of the nipple• Pain while feeding not improved by correct
positioning and attachment• Nipple trauma • Previous antibiotic treatment
Thrush - Ductal
Intense breast pain when, previously, breastfeeding has been pain-free
No relief from altered position/attachment Pain experienced deep within the breast and
continues after feed Healed nipple trauma Antibiotic treatment
Signs in baby
Baby may show one or more of the following symptoms or none
Pulling off the breast, fussy feeder White plaques on the oral mucosa Windy, fretful or difficult to settle Nappy rash
Treatment of Thrush
Treat the mother and baby simultaneously Mother: Miconazole cream apply a smear to the
nipple after each feed Baby: Miconazole oral gel (not licensed for babies
under 4 months, but can be prescribed) Education on correct application of cream & oral gel
needed Refer for extra help with breastfeeding
Ductal Thrush Treatment
Fluconozole 150 – 300 mgs load dose 50 -100 mgs BD x 10 days.NB Not licensed for lactating women (WHO recognise as compatible with breastfeeding)0.6mg/kg/day the amount that gets through in breast milk6.0mg/kg/day is the amount that can be given to a baby within licence(Thomas Hale – “Medication in Mothers Milk”)
Poor Weight Gain
If no medical reason diagnosed: Improve milk transfer through correct positioning and
attachment Encourage more frequent feeding (2 hourly) Breast compression while feeding Use both breasts at each feed Expressing and supplementing with expressed breast milk, by
cup Encourage contact with practitioner trained to support
breastfeeding and peer support network to build mothers confidence
The Dilemma of Prescribing
“ Recommendations for the lactating mother are probably over-cautious and mothers who need treatment should not be prevented from breastfeeding if the drug is likely to be safe”.
Wendy Jones PhD MRPharmS
Prescribing during breastfeeding
BNF cautious in pregnancy and breastfeeding Thomas Hale – assesses risk Breastfeeding Network - Wendy Jones, Pharmacist Ideally breastfeed immediately before medication
and should be avoided for 1 – 2 hours after any dose of medication( the time of highest plasma concentrations)
Consider alternatives
Recommended booklist
1. Medications and Mothers’ Milk 14th edition 2010, Thomas Hale PhD - ISBN – 978-0-9823379-9-8
2. Breastfeeding Answers Made Simple - Nancy Mohrbacher, IBCLC, FILCA - ISBN-13: 978-0-9845039-0-2
3. Breastfeeding & Human Lactation, Jan Riordan – ISBN – 0-7637-4585-5
4. Textbook of Human Lactation, Thomas Hale & Peter Hartmann – ISBN - 978-0-9772268-9-4
5. Breastfeeding a Guide for Medical Profession, Ruth & Robert Lawrence – ISBN 0-8151-2615-8
6. The Breastfeeding Atlas, Barbara Wilson-Clay & Kay Hoover – ISBN – 0-9672758-1-4
Useful links
UNICEF Baby Friendly - www.babyfriendly.org.uk Lactation Consultants GB – www.lcgb.org ABM – www.abm.me.uk La Leche – www.laleche.org NCT – www.nctpregnancyandbabycare.com
Online training for GPs – http://www.cks.nhs.uk/breastfeeding_problems www.breastfeedingnetwork.org.uk
E-Groups: Lacthelpers - groups.yahoo.com/subscribe/lact-helpers-UK