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Copp Module: Common Office Practice Pediatric Problems (A Module of Iap Tamilnadu State Chapter 2017)

This document provides information about a COPP module on common office pediatric problems organized by the Tamil Nadu state chapter of IAP in 2017. It lists the scientific advisors, conveners, coordinators and academic committee members involved in organizing the module. The next sections provide an overview of breastmilk insufficiency presented by Dr. Manikumar S., including identifying insufficient milk, physiological aspects, proper positioning and attachment, and common causes at various stages. Prevention of breastfeeding issues in term and preterm babies is also discussed.

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235 views32 pages

Copp Module: Common Office Practice Pediatric Problems (A Module of Iap Tamilnadu State Chapter 2017)

This document provides information about a COPP module on common office pediatric problems organized by the Tamil Nadu state chapter of IAP in 2017. It lists the scientific advisors, conveners, coordinators and academic committee members involved in organizing the module. The next sections provide an overview of breastmilk insufficiency presented by Dr. Manikumar S., including identifying insufficient milk, physiological aspects, proper positioning and attachment, and common causes at various stages. Prevention of breastfeeding issues in term and preterm babies is also discussed.

Uploaded by

iannikki
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COPP MODULE

COMMON OFFICE PRACTICE PEDIATRIC PROBLEMS


[A MODULE OF IAP TAMILNADU STATE CHAPTER 2017]
TEAM
Scientific advisors Dr P Ramachandran,Dr S Balasubramanian
Conveners Dr S Thirumalai Kolundu,Dr Sunil Srinivasan
Scientific Coordinator Dr A Somasundaram
Academic coordinators Dr S Narmada,Dr R.V Dhakshayani
Academic committee [MODERATORS]
Dr NC Gowrishankar,
Dr T N Manohar,
Dr K Nedunchelian,
Dr Rema Chandramohan,
Dr R Somasekar,
Dr S Thangavelu,
Dr V V Varadarajan
• 1.Dr.R.V.Dhakshayani • 10.Dr.A.Somasundaram
• 2.Dr.Hemchand K Prasad • 11.Dr.P.Sudhakar
• 3. Dr.E.Mahender • 12.Dr.Sudharsana Skanda
• 4.Dr.S.Mangalabharathi • 13.Dr.N.Suresh
• 5.Dr.C.Manigandan • 14.Dr.So.Sivabalan
• 6.Dr.S.Manikumar • 15.Dr.S.Srinivas
• 7.Dr.S.Giridar • 16.Dr.Venkateswaran
• 8.Dr.S.Narmada • 17.Dr.C.Vijayabhaskar
• 9.Dr.R.Selvan • 18.Dr Palaniraman
• 19.Dr B.Sumathi
Dr. Manikumar S,
DCH, DNB(Peds), DM(Neonatology)
• Consultant Pediatrician / Neonatologist in Kasthuri Hospital, Tambaram
• Numerous awards to his credit
• Paper presentations
– Characteristics of smear positive pulmonary tuberculosis in infants’ inIX National Conference of
pediatric Infectious diseases, 2006 held at Chennai as a poster presentation
– An Audit on Kasai’s hepato-porto- enterostomy’ in the Indo-BritishConference on pediatric
gastroenterology, hepatology and Nutrition,(IBCON-PEDGASTRO), 2006 held at New Delhi as a
posterpresentation
• Publications
– ‘Rhinocerebral Mucormycosis in an Adolescent with Type 1 DM’-Annals of Tropical pediatrics,2008;28
p297-300
– Hypernatremic dehydration – a case series – med ejournal, July -August 2014 Volume - 4 Number – 4
– Delivery room management in Chennai pedicon souvenir, 2013Nonthriving young infant – a review,
Indian Journal of Practical Pediatrics, 2015; 17(1):10-15edit
Breastmilk not sufficient
Dr Manikumar S
DCH, DNB(Peds), DM(Neo)
Moderator
Dr. Somasekar
Overview
• Introduction
• Identifying insufficient milk
• Physiological aspects
• Proper positioning and attachment
• Common causes at various stages
• Prevention
Introduction
• Perception vs real insufficient milk
–Nearly 50% in normal term mothers perceive so
–Only 5% of the perceived ones are real
Reasons for perceived insufficient milk
• Unaware of normal behaviour
• Inability to express large volumes
• Does not experience let-down
• Soft breasts
• Frequently fussy infant but gaining weight normally
• Growth spurts = needs frequent nursing
How to identify?
The normal pattern
One wet nappy Two wet nappy Three wet nappy
The normal pattern
Four wet nappy Five wet nappy Till day 3
The weight trend in term neonates

Birth Birth weight regained at


day 5-7 (max 10 days)

Wt loss
1-2% per day

Max wt loss 10%


At 3-4 days (max 5 days)
The weight trend in preterm neonates

Birth Birth weight regained at


day 7-10 (max 14 days)

Wt loss
2-3% per day

Max wt loss 15%


At 5-7 days
Cue based feeding – the biologic norm

Used from Women’s and Newborn Services, Royal Brisbane and Women’s Hospital, July 2013.
Feeding cues
Crying is a late sign of hunger!
Physiologic aspects - Hormones
Autocrine control

Feedback Inhibitor
of Lactation
Assessing adequacy of breast milk
• Maternal history • LATCH tool
• Baby history – Latch
– Satiety – Audible swallowing
– Urine, stool – Type of nipple
– Weight – Comfort (breast/nipple)
• Positioning – Hold (positioning)
• Attachment
• Frequency
• Duration
• Look for milk transfer
Test-weighing
• Weigh naked baby
– Before and after
breastfeeding episode
• Rationale

• Review of 32 studies found


– “Regardless of whether the
clinical assessments were performed by nurses,
mothers, or lactation educators, the differences
between the clinical estimates and the test weight
estimates of milk intake were large and random.”

Scanlon KS, Alexander MP, Serdula MK et al. Assessment of Infant Feeding: The
Validity of Measuring Milk Intake Nutrition Reviews 2002; 60(8):235-251
Breastfeeding positions
What can you see?
Delayed initiation

• Caesarean delivery
– most consistent risk factor
• Low family income
• Maternal age <25 years
• Low maternal education
• No prenatal visit
• Preterm birth

Esteves TM et al. Factors associated to breastfeeding in the first hour of life: systematic review. Rev Saude Publica. 2014 Aug;48(4):697-708.
Delayed Lactogenesis - II in term mothers

Factor associated Treatment


Retained placenta D&C
Caesarean delivery
Maternal obesity Informed support
Diabetic mother
Prolactin deficiency Domperidone
Inadequate stimulation Gentle hand massage, pump sos
Colostrum not removed Frequent feeding and/or expression
Hypoplastic mammary gland Identify early
Drugs / hormones Reduce exposure
Galactogogues
• Ensure proper removal of milk before using them
• Only as a last resort
• Domperidone 10 mg thrice daily for 1-2 weeks has the best
evidence
• Herbal galactogogues difficult to standardise

Zuppa et al, Safety and Efficacy of Galactogogues: Substances that Induce, Maintain and Increase Breast Milk
Production J Pharm Pharmaceut Sci (www.cspsCanada.org) 13(2) 162 - 174, 2010
Preterm mothers
Factor Cause Treatment
Poor breast Shortened gestation Increase frequency of
development pumping

Stress, fatigue Inhibition of milk Stress management,


ejection relaxation techniques

Mother – baby Inadequate stimulation Pump nearby, KMC


separation
Inadequate expression Autocrine inhibition Double pumping
Cessation of breastfeeding before 6 months
• Risk factors
– Teenage mother
– Low level of knowledge on breastfeeding duration
– Return to work within 12-weeks
– Caesarean birth
– Perceived inadequate milk supply
– Depression among the mother

Mangrio E, Persson K, Bramhagen AC Sociodemographic, physical, mental and social factors in the cessation of breastfeeding before 6
months: a systematic review. Scand J Caring Sci. 2017 Jun 1. [Epub ahead of print]
Breastfeeding support in term babies
• Can be given by both trained volunteers and health professionals
• Successful breastfeeding associated with
– face-to-face contact (rather than contact by telephone)
– volunteer support
• a specific schedule of four to eight contacts
– 3-5 days after discharge
– 2 more visits before the 6 weeks vaccination
– Vaccination visits should have breastfeeding support
• more helpful if visits are predictable, scheduled, and include ongoing visits

McFadden A et al. Support for healthy breastfeeding mothers with healthy term babies Cochrane Database Syst Rev. 2017 Feb
28;2:CD001141.
Thank You!

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