Alternative methods of feeding for small or sick neonates

Alternative methods of feeding for small or sick neonates

2Teaching Aids: ENC AF -

Alternative feeding methods

Objectives:

To describe the options available for alternative methods of feeding

Teach a mother how to use an alternative feeding method

To explain how to express breast milk



Indications:

Baby ◦ Not breastfeeding effectively ◦ Not sucking effectively (e.g. preterm, ill, cleft lip/palate)

Mother◦ Is ill ◦ Has flat/inverted nipple or engorged breast◦ Is HIV positive and decides not to breastfeed

Manage as per guidelines for sick neonates*

Start intravenous fluids

Give oral feeds by cup/spoon/ paladai

Start intra-gastric tube feeds

Is the baby able to breastfeed effectively?

Is the baby able to accept feeds by alternative methods?

When offered the breast, the baby roots, attaches well and suckles effectively

Able to suckle long enough to satisfy needs

When offered cup or spoon feeds, the baby opens the mouth, takes milk and swallows without coughing/ spluttering

Able to take an adequate quantity to satisfy needs

Is the baby clinically stable? No

Yes

Yes

No

Is birth weight more than 1250 g?

Yes

No

Initiate breast feeding

No

ActionAssessment

* Assess daily for clinical stability ; once stable, assess for initial feeding method

Yes



Options available:

Cup

Paladai

Spoon

Irrespective of the method, only expressed breast milk has to be fed to

the baby

Expressing breastmilk by hand


Hand expression of breastmilk

Have a clean dry container

Tell the mother to:

1. Wash her hands thoroughly

2. Make herself comfortable

3. Hold a wide necked container under her nipple and areola

4. Place her thumb and first finger behind the nipple (at least 4cm from the tip of the nipple)


Hand expression of breastmilk…

5. Compress and release the breast between her finger and thumb

6. Compress and release all the way around the breast, keeping her fingers the same distance from the nipple

7. Express one breast until the milk just drips, then express the other breast until the milk just drips

8. Alternate between breasts 5 or 6 times, for at least 20 to 30 minutes

9. Stop expressing when the milk no longer flows but drips from the start



Different ways to massage the breast


Mother sits down, leans forward, folds her arms on a table in front of her, rests her head on her arms

Her breasts hang loose and unclothed

The helper works down both sides of the spine at the same time from the neck to just below the shoulder blades

She uses her closed fist with her thumbs pointing forwards

She presses firmly making small slow circular movements with her thumbs and continues for 2-3 min

Back massage


Room temperature : 6 hoursRefrigerator : 24 hours Freezer : 2 weeks (-40C) to 3 months

(-200C)

Storing expressed breastmilk


Alternative methods: Cup feeding

Cup and spoon are easy to clean with soap and warm water


Cups for feeding newborn babies

An ideal cup can hold 50 to 90 mL of milk

It can be glass or plastic and easily washable

Edge should be rounded and smooth

A cup with a lid is useful for storing expressed breast milk


Cups with lips and spouts

Variations of cups with lips and spouts can easily be found

They should be used with extreme caution

It is DANGEROUS to POUR milk into a baby’s mouth


Cup feeding


Cup feeding

Advantages

Simple equipment ; easy to clean

Baby can take what it needs in its own time

Mother can do it herself

Good eye contact between mother and baby


Cup feeding

Steps

Put a measured amount of milk in the cup Infant should be awake and held sitting semi-

upright on caregiver's lap; put a small cloth on his or her front to catch drips of milk

Touch the edge of the cup to the outer parts of the upper lip

Tip the cup so that the milk reaches the baby’s lips


Cup feedingStepsDo not pour the milk into the infant's mouthAllow the infant to take the milk himself (upon

smelling the breastmilk, the baby becomes alert, opens its mouth, and puts its tongue into the milk to start the feed)

Feed the infant slowly; some milk may spill from the infant's mouth

When the infant has had enough, he or she will close his or her mouth and will not take any more. Do not force-feed the infant. Pouring the milk into baby’s mouth can cause

aspiration


Case study: cup feeding

Measuring the correct amount of milk

To measure 30 mL

Use a desert spoon which holds approx. 10 mL

Take 3 spoonfuls of milkPut a mark on the outside of the cup to guide

her how much milk is needed each time

If the baby does not take the required amount:

feed more often or for longer


Paladai feeding

A paladai is a small bowl with a long pointed lip

The advantages are that it is usually faster than spoon or even cup feeding and also that there is less spillage

A disadvantage is the risk of pouring large amounts of milk into the infant’s mouth


Paladai feeding

Steps

Infant should be awake and held sitting semi-upright on caregiver's lap; put a small cloth on his or her front to catch drips of milk

Put a measured amount of milk in the paladai Hold the paladai so that the pointed tip rests

lightly on the infant’s lower lip


Paladai feeding

Steps

Tip the paladai to pour a small amount of milk into the infant’s mouth

Feed the infant slowlyMake sure that the infant has swallowed the

milk already taken before giving any moreWhen the infant has had enough, he or she will

close his or her mouth and will not take any more. Do not force-feed the infant.


Spoon feeding

Advantages ◦ Useful for collecting small

amounts of colostrum in the first days of life

◦ Useful in a baby with cleft lip/palate

Disadvantages ◦ Slow method of feeding◦ Often difficult to manage a

spoon and a milk container while holding the infant semi-upright


Feeding colostrum with a spoon

A grandmother giving colostrum to her grandson 5 hours after delivery

The mother was recovering from a Caesarean section

A health worker helped the mother express


Ensuring adequacy of intake

Weighing him/her once a day and assess

weight gain

Check that (s)he has several wet nappies every

day

Babies who are growing adequately are

receiving enough milk


Summary

Alternative methods - indicated in those who are NOT able to breastfeed effectively

Methods available: Cup, spoon, PaladaiONLY expressed breast milk should be

fedEnsure hygiene and adequacy of intake

while giving feeds by alternative methods

Documents

Alternative methods of feeding for small or sick neonates