MOM/BABY INFANT

NUTRITION POLICY &

LACTATION CARE
REFRESHER
Mom/Baby RN will:

 Document the desired feeding method for the newborn in the

newborn's chart

 Distribute the admission folder/breastfeeding information packet

upon admission

 Encourage skin-to-skin and 24-hour rooming-in. All infants regardless of

feeding method will practice rooming in, mother-baby separation will be
minimized
 ROOMING IN

 Neither breastfed nor bottle fed babies will be separated from their mothers at any time.
Mothers who've undergone a C-Section should be given appropriate care but the practice
of keeping mom and baby together will apply

 The medical and nursing staff conduct newborn procedures at the mother’s bedside
whenever possible and avoid frequent separations or absences of the newborn from the
mother for more than a total of one hour in a 24-hour period

 MCH staff are expected to provide ongoing support, discuss safety issues, and explain how
to request help when needed
 ROOMING IN
 Separation of mother and baby for more than one hour while in hospital will occur only if:
 medically justifiable
 safety-related reason
 an informed decision (maternal request for separation)
 Justification is documented in EMR

 If the mother insists her infant be cared for in the infant treatment area, staff will explore her understanding of the
importance of rooming in and the reasons for the request. Education and justification for interruption of rooming-
in will be documented by RN

 Mother should be provided access to feed her infant at any time and with a plan that infant will be brought to
mother for feedings whenever the infant shows feeding cues

 Staff should work to resolve any medical reasons, safety-related reasons, or maternal concerns.
 TEACH & ASSESS:

 Teach manual breast massage techniques

 Teach infant feeding cues, assess newborn's readiness to feed and assist with
breastfeeding positioning and latch when the newborn cues and document
 Assess and document breastfeeding using LATCH scores done on every shift

 Educate family on the assessment of effectiveness of feeding to include signs

of satiation and wet or soiled diapers
 Eliminate bottles from bassinets and rooms
 Assess breasts and nipples for any issues that may affect feeding and
document findings
 Encourage parents to view the educational video on GetWell Network
HOW TO ACCESS NETWORK
VIDEOS

2
PHYSIOLOGY OF LACTATION

 Expulsion of the placenta -Estrogen and

progesterone levels fall and signal milk production
 Lactogenesis Stage 1- Colostrum is available to
newborn
 Lactogenesis Stage 2- Effective infant sucking builds
milk supply
 Ejection reflex: Sucking stimulates prolactin (anterior
pituitary) and oxytocin (posterior pituitary)
 Frequency of feeding regulates milk supply
EARL
Y
CUES

LATE
CUES
How to assist mom with
breastfeeding

Please watch this video

 https://www.youtube.com/watch?v=7FJuBn
2bgNk
Tickle baby's lips with Aim baby's lower lip away from
nipple. This will help baby Aim nipple just above the base of your nipple. Baby's
open their mouth wide. baby's top lip. Make lips should be turned outward
sure baby's chin is not like a fish. Baby should lead into
tucked into their chest. the breast chin first and then
latch onto breast. Baby's tongue
should be extended, and breast
should fill baby's mouth
 Before latch
During latch

 Unswaddle baby
 No dimples in baby’s cheeks
 Stomach to stomach
 No clicking/smacking noises
 Nipple to nose
 Mom has no nipple pain
 Nipple pointing up in baby’s
mouth  Mom feels pulling, not pinching
 Guide baby’s neck and
 Baby’s mouth is wide open
shoulders to breast

 Chin should come in contact

with breast first
 Signs of a proper latch

 Lips are flanged or turned out  Baby's chest and stomach rest against
mom’s body, baby's head is straight, not
turned to the side
 Tongue is over lower gum

 Baby's chin touches breast

 Baby stays on breast
 Baby's mouth opens wide around breast,
 not just the nipple
Nipple is NOT pinched or compressed after
feed
 Baby's lips turn out

 Latch is comfortable and pain free

 Baby's tongue cups under your breast
 Signs latch is not effective

 Mom has sore, tender, red, raw, or cracked nipples

 Baby is fussy, frustrated, or hungry after a full feeding session
 Baby is latched only on nipple
 Breastfeeding is painful
 Baby latches on and then lets go of the breast often
 Baby falls asleep at the breast often
 Baby is not voiding & stooling enough for their age
 Baby’s lips are tucked in when latched and not flanged outward (like a fish)
 Nipple temporarily changes shape after a nursing session (like the shape of
lipstick)

BABY’S FULLNESS CUES

 Opens fists

 Softens the body

 Relaxed forehead

 Falls asleep, stay asleep at least 1.5 hours

 Appropriate diaper output for age

 Active and alert with a strong cry

 Mouth and lips are moist and pink

EFFECTIVENESS OF
FEEDING
Encourage breastfeeding on
demand

 No restriction regarding frequency or duration of breastfeeding

 Look for hunger cues, instead of timing

 Supports appropriate milk supply

 Reduces risk of engorgement

 Helps baby feel satisfied

 Latching issues?

PLACE UNSWADDLED BABY SKIN TO SKIN

 Warm baby will be more alert

 Mom will notice subtle feeding cues when baby

is not swaddled

 Hand express milk to baby’s lips

 Spoon, syringe, finger feed

 Encourages milk production

HAND EXPRESSION
 If baby is having difficulty
latching

• Keep infant upright & swaddled for warmth. Hands should be in

swaddle during this type of feed

• Bring to mouth and allow for infant to take sips

• Do not pour liquid into mouth

• No notable difference to bottles for average time per feed

BREASTFED INFANTS WHO ARE

SUPPLEMENTED
 If supplementation is provided staff will inform
mothers about avoidance of routine use of
artificial nipples

 Devices other than bottles and artificial nipples

will be offered; spoon, cups, syringe, finger
method etc. and parents will be educated on
use
 These methods are encouraged for first day for
infants who are sleepy and difficulty latching
 Not recommended as primary feeding modalities
past 24hrs
 Babies must be able to latch and/or bottle feed prior to
discharge
HOW TO DOCUMENT A LATCH SCORE
To be done in BABY’S chart at least once per shift
LATCH SCORE
 What to do with LATCH Score

 A Latch Score should be recorded at least once per shift in baby’s chart
by RN taking care of baby

 An infant who scores <7 :

Contact an IBCLC and/or enter a consult for lactation IN CERNER
 Breast assessment every shift

 If mom is engorged, please advise: Use warm pack for 5 minutes and hand massage &
manually express for 1-2 minutes before putting baby to breast or pumping

 If nipples are sore, bruised, cracked, or bleeding, please provide Purelan and ensure baby is
getting a deep latch when breastfeeding
 Teach to gently break the suction on the nipple with a clean finger to detach the baby,
rather than pulling the baby from the breast
 Purelan is used for sore or dry nipples, but will not heal nipple without appropriate
breastfeeding troubleshooting

 Nipples shields, nipple creams, ointments, or other topical preparations for mothers will be used
only if clinically indicated and requested after a clinical consultation with the lactation specialist

 Lactation referral in Cerner for any of the above issues

 SUPPLEMENTATION
 Formula will not be given to any breastfed infant unless
medically indicated and ordered OR by the mother’s
documented request after being adequately informed of
negative effects of supplementing
 When breastfeeding mothers request a human milk
substitute, the staff caring for the dyad will explore the
mother's rationale for the request and explore any
concern she has. The staff will educate the mother on the
possible negative effects of human milk substitutes .
Parents will be provided with a pamphlet titled "Formula
Feeding Your Baby" This education and counseling will
be documented in the EMR . Should the mother decide to
feed her infant a breast milk substitute after-receiving
counseling and education, her choice to do so will be
respected and supported by the staff.
 INDICATIONS FOR FORMULA

 Maternal
 HIV infection
If there is a medical indication for the use of
 Human t-lymphotrophic virus type I or II
human milk substitutes, a physician order will be
obtained and will be documented in the EMR. The  Substance abuse and/or alcohol abuse
following are acceptable indications for formula  Active, untreated tuberculosis
use per the Joint Commissions Perinatal Care Core  Taking certain medications
Measures:
 Any medications where the risk of morbidity outweighs
the benefits of breast milk feeding
 Radiation therapy (chemotherapy)
 Active Varicella
 Active herpes simplex virus with open breast lesions

 Infant
 Galactosemia
 PACED BOTTLE FEEDING

 This feeding method is recommended for all healthy infants, whether fully bottle fed, or fed
from breast and bottle

 This feeding method slows down the flow of milk into the nipple and the mouth, allowing the
baby to eat more slowly, and take breaks

 Allows infant to be more in control of the feeding pace; teaches baby to portion control

 Reduces the risk of overfeeding

 Linked to decrease risks for chronic diseases such as obesity, HTN, diabetes
PACED FEEDING PREVENTS
OVERFEEDING

For the first 4-6 months of a baby’s life, sucking

and swallowing is a reflex–an automatic behavior
babies cannot help. When baby feels pressure on
the roof of the mouth, the reflex is triggered.

Why does this matter? Because when a baby’s

mouth fills with milk, they automatically swallow.
In other words, babies can and do drink milk even
if they aren’t actually hungry.

In fact, it’s not unusual for a breastfed baby to be willing

to take a bottle after breastfeeding (this willingness is
not a reliable sign of low milk supply or hunger).
 Paced Bottle Feeding Steps

 Choose a slow flow nipple

 Hold baby in your lap in a semi-upright position, supporting the head and neck
 When baby shows hunger cues, tickle baby’s lip so baby opens mouth wide
 Insert nipple into baby’s mouth, making sure the baby has a deep latch
 Hold the bottle flat (horizontal to the floor)
 Let the baby begin sucking on the nipple without milk, then tip the bottle just enough to fill the
nipple about halfway with milk
 Let baby suck for about 3-5 continuous swallows—20-30 seconds
 After 3-5 continuous swallows, tip the bottle down, giving baby a little break
 After a few seconds, when baby begins to suck again, tip bottle up to allow milk to flow into the
nipple
 Continue until baby shows fullness signs - no longer sucking after the break, turning away or
pushing away from the nipple
 FORMULA FEEDING TEACHING

Mothers who choose to feed infants breast milk substitutes will be educated by RNs on the
following topics
 Appropriate hand hygiene
 Cleaning utensils and equipment
 Appropriate reconstitution
 Accuracy of measurement of ingredients
 Safe handling of product and equipment
 Proper storage of product and equipment
 Appropriate feeding methods
 Eye-to-eye contact
 Hold baby close
 Powdered infant formula is not sterile
 HOT WATER SHOULD BE USED TO
PREPARE FORMULA TO KILL ANY
MICROBES IN FORMULA POWDER
 For infants under 3 months of age, those who were born prematurely and those who have a
weakened immune system
 Boil the water and let it cool for about 5 minutes. Then, add it to a clean bottle and add
the formula based on the instructions on the container
 Before feeding the baby, test the formula’s temperature by putting a few drops on the inside
of your wrist. It should feel warm, not hot.
 Use prepared infant formula within 1 hour from start of feeding and within 2 hours
of preparing it. If your baby does not finish the entire bottle of formula, throw away leftover
formula.
 If you do not plan to start feeding your baby with the prepared formula right away,
put it in the refrigerator immediately. Use formula in the refrigerator within 24 hours. Throw
out formula if you can’t remember how long you have kept it in the refrigerator.
 Families will be provided education by MCH staff and lactation
consultants as necessary on the importance of continuing breast
feeding for first 6 months of life

 Staff will ensure that all mothers who have chosen to formula feed
their newborn are able to correctly sanitize equipment and safely
prepare a bottle of infant formula during the early postpartum
period and before discharge from hospital

 Staff should ensure that mothers are aware of effective techniques

for formula feeding their baby

 All information given should follow guidance from the Department

of Health. Information should be reinforced by offering the WHO
How to Prepare Formula for Bottle Feeding at Home
pamphlet (available in English, Spanish & Arabic)
 NICU MOMS

 Please ensure all NICU moms have a pump in room and educate
on use
 Initiate pumping within 6 hours of birth
 Education:
 Massage both breasts first for few minutes
 Pump using the initiation mode
 Follow with hand expression for ~2 minutes per breast
 Pump every 3 hours, OR 8 times in 24 hours, including at
night
HOW TO USE PUMP

First press
START

Then press
INITIATE
Then, instruct mom to button
increase pressure as high as
possible without
experiencing pain, mom
should be comfortable. Mom
 Initiate mode will cycle on for 15
can adjust the pressure
throughout pumping session minutes and will turn off
automatically
 Use regular mode if mom got
Ensure flange fit is correct
CLEANING PUMPING EQUIPMENT

 Provide basin and soap to clean all

pumping parts after every use. Teach
parents to separate all pieces of
pumping kit. Tubing does not get
cleaned or sterilized

 Provide Medela quick clean bag for

once per day steam sterilization of
pumping equipment
BREASTMILK STORAGE
GUIDELINES
PACIFIERS

 Pacifiers or artificial teats will not be recommended or routinely given to

healthy, breastfed infants
 May make it more difficult for baby to attach to the breast
 Interferes with cue-based feeding, possibly missing a breastfeed, leading to
decreased milk supply

 Exceptions to use of pacifiers or artificial nipples will include:

 Pre-term infants in the special care nurseries or those with medical conditions that
would benefit from non-nutritive suckling
 Newborns undergoing painful procedures when breastfeeding for comfort is not
available. If a pacifier is used, it will be discarded following the procedure
PACIFIERS & BREASTFEEDING

 Pacifier use in the breastfed infant should be delayed until breastfeeding is well
established
 Usually around 3-4 weeks of life

 When is breastfeeding well established?

 Milk supply has increased

 Infant is breastfeeding 8-12 times in 24 hours
 Infant is satisfied after feedings
 Infant is gaining weight
 Mother can hear baby swallowing during feedings
 Adequate voiding and stooling according to expected norms
EDUCATED PARENTS WHEN TO
CONTACT HEALTH CARE PROVIDER
Encourage to breastfeed for first
6 months

WHY?
 Exclusive breastfeeding for 6 months provides the nurturing, nutrients and
energy needed for physical and neurological growth and development
 Beyond 6 months, breastfeeding continues to provide energy and high-
quality nutrients that, jointly with safe and adequate complementary feeding,
help prevent hunger, undernutrition and obesity.
 Breastfeeding ensures food security for infants
 Breastfeeding is a non-polluting, non-resource intensive, sustainable and
natural source of nutrition and sustenance.
 Breast-milk substitutes add to greenhouse gas emissions at every step of
production, transport, preparation and use.