Breastfeeding Basics

June 2015
 Objectives
At the end of this presentation, the learner will be able to:
Educate their patients about the benefits of
breastfeeding.
Assist their patients with some of the basic
breastfeeding positions.
Recognize and treat common breastfeeding
challenges.
Inform others about what is needed to create a baby-
friendly office and hospital.

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 All family physicians have a unique role in
the promotion of breastfeeding.

Family Physicians Supporting Breastfeeding

AAFP Policy and Position Statement on Breastfeeding

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 American Academy of Family
Physicians
Family physicians should have the
knowledge to promote, protect, and support
breastfeeding.

Family Physicians Supporting Breastfeeding

AAFP Policy on Breastfeeding

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 American Academy of Family
Physicians
Breastfeeding is the physiologic norm for both
mothers and their children. Breastmilk offers
medical and psychological benefits not available
from human milk substitutes. The AAFP
recommends that all babies, with rare exceptions,
be breastfed and/or receive expressed human milk
exclusively for the first six months of life.

Family Physicians Supporting Breastfeeding

AAFP Policy on Breastfeeding

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 American Academy of Family
Physicians
Breastfeeding should continue with the addition of
complementary foods throughout the second half
of the first year. Breastfeeding beyond the first
year offers considerable benefits to both mother
and child, and should continue as long as
mutually desired.

Family Physicians Supporting Breastfeeding

AAFP Policy on Breastfeeding

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 Benefits of Breastfeeding
Breastfeeding has benefits for:
Infants
Mothers
Family
Society

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 Benefits of Breastfeeding to
Infants
Decreased morbidity and mortality from infections
Respiratory

Gastrointestinal

Decreased risk of SIDS

Optimal nutrition
Species-specific nutrients

No overfeeding

Improved outcomes for premature infants

Fewer infections

Decreased risk of NEC

Earlier discharge

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 Benefits of Breastfeeding
to the Older Child
Functional competent immune system
Protective effect against type-2 diabetes
Decreased risk of some childhood leukemias (with longer
duration)
Optimal growth and development
Decreased prevalence of overweight/obesity 10%
reduction
Increased IQ
Normal development of the mouth and jaws
Decreased risk of dental occlusion

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 Benefits of Breastfeeding to
Mothers
Immediately after birth
Decreased risk of postpartum hemorrhage
Delayed onset of menses
- Decreased incidence of iron deficiency
- Child spacing
Long-term health
Decreased risk of breast, ovarian, and uterine cancers
Decreased risk of central obesity and metabolic
syndrome

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 Benefits of Breastfeeding to
Families
Financial costs
Breastfeeding is free vs. the cost of formula and
accessories
Decreased medical care costs
Less lost work time

Decreased emotional stress caused by illness

Healthier mother and baby short term and long term

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 Benefits of Breastfeeding to
Society
Lower health care costs

Higher work productivity

Environmentally friendly
No waste
No product transportation or packaging
No grazing land

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 Contraindications to
Breastfeeding
Mothers with HIV (in the United States)
Mothers with human T-cell lymphotropic virus type I
or II
Mothers with active herpes lesions on the breast
(can breastfeed once healed)
Mothers with untreated active tuberculosis or
varicella infant should be separated from mother
but can be fed breastmilk
Infants with type 1 galactosemia

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 Getting Off to a Good Start

Early breastfeeding increases success

Early experience with breastfeeding is critical and
non supportive hospital experiences and lack of
support from healthcare providers have been
identified as barriers to breastfeeding, especially
among African American women. (HHS Blueprint for Action on
Breastfeeding)

Baby Friendly Hospital Initiative

- 10 steps to successful breastfeeding

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 Baby Friendly Hospitals

10 steps to successful breastfeeding

1. Written breastfeeding policy
2. Staff trained to implement the policy
3. All pregnant women informed about benefits and
management of breastfeeding
4. Help mothers initiate breastfeeding within 30
minutes after birth
5. Show mothers how to breastfeed and how to
maintain lactation when separated

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 Baby Friendly Hospitals

10 steps to successful breastfeeding

6. Give newborns no food or drink besides
breastmilk unless medically indicated
7. Practice rooming in
8. Encourage breastfeeding on demand
9. Give no pacifiers or artificial nipples to
breastfeeding infants
10. Foster breastfeeding support groups and refer
mothers to them on discharge

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 The First Breastfeeding
Provide skin-to-skin contact from the moment of birth.
Do not separate mom and baby.
Vitamin K and hepatitis B injections, and eye ointment
can wait until after first feeding
Ideally, first feed will happen within 30
minutes, during babys quiet alert period
Okay if first feeding is not optimal

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 Positioning is Critical

The infant needs access to the breast.

Both mother and infant need to be comfortable.
Commonly recommended positions include the
cradle, cross-cradle, football, and side-lying.
More recently, biological nurturing or laidback
breastfeeding has been promoted.

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 Moms Positioning

Back support
Roll bed or sit in supportive chair

Elbow support
Lots of pillows

Prevent back strain

Foot stool

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 Cross-Cradle Position

Position the baby at breast height

Roll the baby belly to belly
Line up the baby nose to nipple
Hold the babys head behind his/her ears

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 Football Hold

Position the baby at breast height

Roll the baby belly to belly.
Line up the baby nose to nipple.
Hold the babys head behind his/her ears.
Blanket roll or pillow to provide wrist support.

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 Cradle Hold

Position the baby at breast height.

Roll the baby belly to belly.
Line up the baby nose to nipple.
Hold the babys head in the bend of the elbow or
on the forearm.

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 Side-lying Position

Side lying facing the baby belly to belly.

Line up the baby nose to nipple.
Hold the babys head behind the ears for the
latch.
Support both mom and baby with
pillows.

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 Supplementation

Remember, colostrum is adequate in the first

newborn days.
Supplement only if medically necessary.
Academy of Breastfeeding Medicine has
hypoglycemia protocol.
Ideally supplement with colostrum.
Colostrum has more calories than D5.

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 Signs of Good Breastfeeding
in the Newborn Period
Frequent feedings, at least eight times in 24-hour period
Episodes of rhythmic sucking with audible swallows
What goes in comes out
- At least one to two wet cloth diapers in the first two
days, then six to eight wet cloth diapers every 24 hours
- Transitional stools first two days, yellow by day four
- After day three, at least three bowel movements >1
tablespoon in 24 hours (usually four to 10 small stools
per day)

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 Jaundice
Ensure that infant has adequate intake
- Jaundice in breastfed infants most commonly associated
with inadequate feeding
More frequent and effective breastfeeding prevents and treats
jaundice.
Breastmilk jaundice
- Begins after day of life 5-7
- Total bilirubin >12 mg/dL
- Occurs in less than 1 in 200
- Increased bilirubin reabsorption from intestine
- May last several weeks to months

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 Painful Breasts
What to do about them
Painful nipples due to poor latch
Engorgement
Mastitis

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 Painful Nipples
Normal latch-on pain vs. abnormal pain
Abnormal pain usually due to poor latch
Persistent pain, cracks, and bleeding are not
normal
Ensure appropriate positioning and latch
Applying lanolin cream or breastmilk to nipples
may be soothing

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 Engorgement
Development of swollen, tender breasts as the
mature milk comes in
Combination of milk, as well as interstitial
edema, increased blood and lymphatic flow
Can cause difficulties with latching as breast is
full and nipple flattens
A common time for women to stop nursing,
which can be managed preventively or actively

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 Treatment of Engorgement
Prevention anticipatory guidance
Frequent nursing
Cool compresses
Warm breasts before nursing
If trouble latching, express a small amount prior
to the infant latching on

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 Mastitis
Breast inflammation with fever, breast pain,
erythema, and general malaise
Estimated to occur in 20% of women
If the breast is red and tender, but no fever or
systemic symptoms, then it is more likely to be a
plugged duct
Risk factors: Decreased feedings, poor latch with
decreased milk removal and possible trauma, rapid
weaning, oversupply, pressure on the breast,
maternal fatigue, and malnutrition

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 Mastitis
Most common organisms: Penicillin-resistant S.
aureus, followed by strep and E. coli
Treatment: Pencillinase-resistant penicillins such as
dicloxacillin or flucloxacillin, cephalexin, clindamycin,
or erythromycin
Important to continue regularly emptying the breast
Adequate fluids and nutrition
Analgesia consider anti-inflammatory

Academy of Breastfeeding Medicine Clinical Protocol #4: Mastitis

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 Breastfeeding Friendly Office
A physicians practice that enthusiastically promotes
and supports breastfeeding through the combination of
a conducive office environment and education of
healthcare professionals, office staff, and families.

Academy of Breastfeeding Medicine Clinical Protocol #14:

Breastfeeding-Friendly Physicians Office:
Optimizing Care for Infants and Children

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 Billing and Coding
Mothers Issues ICD-9
Nipple Abscess 675.0 Breast Engorgement 676.2
Breast Abscess 675.1 Disorder of Breast, other and
Mastitis NOS 675.2 unspecified 676.3
Agalactia (failure of lactation)
Breast/Nipple Infection, other
specified 675.8 676.4
Suppressed Lactation 676.5
Breast/Nipple Infection,
unspecified 675.9 Unspecified Disorder of
Lactation 676.9
Retracted Nipple 676.0
Postpartum Care; Lactating
Cracked Nipple 676.1
Mother Supervision V24.1

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 Billing and Coding
Babys Issues ICD-9
Failure to Thrive, newborn <28 days 779.34
Change in Bowel Habits 787.99
Weight loss 783.21
Jaundice, neonatal 774.6
Slow feeding, newborn <28 days (feeding problems)
779.31
Fussy Baby 780.91
Dehydration, neonatal 775.5

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 AAFP Policies and Position
Paper
Breastfeeding, Family Physicians Supporting (Position Paper)
Introduction
History
Health Effects
Key Recommendations
Appendices 1-6
Ten Steps to Successful Breastfeeding

Breastfeeding (Policy Statement)

Hospital Use of Infant Formula in Breastfeeding Infants

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 Questions

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