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Maternal Trouble Signs
Nipple pain
Nipple trauma
Copyright © 2003, Rev 2005 American Academy of Pediatrics
Illustration by Tony LeTourneau
Infant Assessment
Proper positioning at the breast Proper latch and lip closure Sufficient areola in infant’s
mouth Tongue extends over lower gums Adequate jaw excursion
with suckling Effective swallowing motion Coordination of suck-swallow-
breathe
Breastfeeding Evaluation
Copyright © 2003, Rev 2005 American Academy of Pediatrics
Infant Assessment
Encourage at least 8–12 feedings per day.
Alternate the breast that is offered first.
Allow infant to nurse on at least one side until infant falls asleep or comes off the breast to increase
fat and calorie consumption.
Feeding Pattern
Copyright © 2003, Rev 2005 American Academy of Pediatrics
Infant Assessment
Weight Loss Average loss of 5% over the first
3–4 days. Loss greater than 7% mandates
careful evaluation of breastfeeding.
Weight Gain Begins with increase in mother’s
milk production by at least day 4–5.
Expect gain of 15–30 g/day (1/2 to 1 oz per day) through the first 2–3 months of life.
Infant Weight
Copyright © 2003, Rev 2005 American Academy of Pediatrics
Infant Assessment
Problem Poor infant weight gain. Inadequate milk supply or milk transfer.
Solution Weigh infant, feed infant, weigh again. Evaluate infant at the breast. Correct latch and positioning. Improve milk production and transfer. Increase frequency and duration
of feeding.
Infant Weight
Copyright © 2003, Rev 2005 American Academy of Pediatrics
Infant Assessment
6–8 pale or colorless voids/day by day 5.
Loose, yellow, curd-like stools after most feedings through first month.
Constipation unusual in the first month—may indicate insufficient milk intake.
EVALUATE Infrequent stools are common
after the first month in the healthy breastfed infant.
Elimination Pattern
Copyright © 2003, Rev 2005 American Academy of Pediatrics
AAP Policy Statement
Initiate in the first hour.
Keep newborn and mother together in recovery and after.
Avoid unnecessary oral suctioning.
Avoid traumatic procedures.
Recommended Breastfeeding Practices
Copyright © 2003, Rev 2005 American Academy of Pediatrics
AAP Policy Statement
Continuous rooming-in.
Respond to early breastfeeding cues. Rooting Fist to mouth Early arousal
Crying is a late hunger sign.
Recommended Breastfeeding Practices
Copyright © 2003, Rev 2005 American Academy of Pediatrics
AAP Policy Statement
Avoid pacifiers in early weeks until breastfeeding is well established.
Avoid supplemental bottles, unless medically indicated.
Recommended Breastfeeding Practices
Copyright © 2003, Rev 2005 American Academy of Pediatrics
Medical Indications for Supplementation Very low birth weight or some
premature infants Hypoglycemia that does not respond
to breastfeeding Severe maternal illness Inborn errors of metabolism Acute dehydration not responsive to
routine breastfeeding or excessive weight loss
Maternal medication use incompatible with breastfeeding
Adapted from Powers NG, Slusser W.Pediatr Rev. 1997;18:147–161
Copyright © 2003, Rev 2005 American Academy of Pediatrics
AAP Policy Statement
Formal evaluation of breastfeeding
in first 24–48 hours and again at 3–5 days and 2–3 weeks of age
Assess Infant weight General health Breastfeeding Jaundice Hydration Elimination pattern
Recommended Breastfeeding Practices
Copyright © 2003, Rev 2005 American Academy of Pediatrics
AAP Policy Statement
Do not give water, juice, or solids in the first 6 months.*
Initiate iron supplements only if indicated clinically in the first 6 months.
Include iron-rich foods after 6 months of age.
Supplement with vitamin D daily, beginning during the first 2 months.
Provide fluoride after 6 months if household water supply is deficient.
Avoid cow’s milk before 12 months.
Recommended Breastfeeding Practices
Copyright © 2003, Rev 2005 American Academy of Pediatrics
*There is a difference of opinion among AAP experts on this matter. The Section on Breastfeeding acknowledges that the Committee on Nutrition supports introduction of complementary foods between 4 and 6 months of age where safe and nutritious complementary foods are available.
AAP Policy Statement
Strong position of support based on published evidence of improved outcomes
Knowledgeable and skilled in physiology and management of breastfeeding
Collaboration with the obstetric community
Age-appropriate breastfeeding education
Role of Pediatricians and Other Health Care Professionals in Protecting, Promoting, and Supporting Breastfeeding
Copyright © 2003, Rev 2005 American Academy of Pediatrics
AAP Policy Statement
Promote hospital policies that facilitate breastfeeding
Eliminate mother-infant separation
Eliminate formula discharge packs
Role of Pediatricians and Other Health Care Professionals in Protecting, Promoting, and Supporting Breastfeeding
Copyright © 2003, Rev 2005 American Academy of Pediatrics
Photo © La Leche League International
AAP Policy Statement
Promote community resources Communicate with lactation support
personnel Encourage third-party payer
coverage for breastfeeding services, supplies, and consultation
Support breastfeeding in the workplace
Role of Pediatricians and Other Health Care Professionals in Protecting, Promoting, and Supporting Breastfeeding
Copyright © 2003, Rev 2005 American Academy of Pediatrics
Positive media image of breastfeeding
Breastfeeding education during medical training
Family and societal support for breastfeeding
Breastfeeding as cultural norm
AAP Policy StatementRole of Pediatricians and Other Health Care Professionals in Protecting, Promoting, and Supporting Breastfeeding
Copyright © 2003, Rev 2005 American Academy of Pediatrics
Photo © La Leche League International