FALL SENSE OF SECURITY….

The Deleterious EffectsOf Timing,

Scheduling, Measuring,

and Recording….

Edith Kernerman, IBCLC © 2014

What’s the Issue?

7-10% wt loss… oh no!

MW policy: feed q2 hrs after 1st

24 hrs

Hospital policy: feed q3 hrs at most

1st 24 hrs 2–10ml/feeding; 24–48 hrs 5–15ml;

48–72 hours 15–30ml; 72–96 hrs 30–60

15-20 minutes/side

RECORDING BREASTFEEDING

How Often Should A Baby Feed

How much should a baby take in a feeding

Feeding in utero

Evidence on volume

Evidence on frequency

HORNELL

8-12 x / 24 hrs!!!!

Average of:3.9x/24 hrs to 15.9x/24 hrs??

Conclusion

In Sweden

“If these infants were fed according to a

schedule, they would probably not reach as

many breastfeeding sessions, and it would

take longer to reach full breastfeeding.

Actually, our experience is that the sooner you

terminate the application of a regulated

feeding schedule, the sooner will they make

progress in breastfeeding.”

“So what we practice here, and which is

associated with very early attainment of full

breastfeeding, is to guide the mother in

observing her infant's discrete signs of

interest PLUS positioning the infant at the

breast as soon as there are signs of shifts

in behavioral state from sleep to a more

active state..

Kerstin Nyqvist, PhD

HOW MANY CALORIES ARE IN LUNCH?

? calories does this particular baby

need in any given feeding?

How Babies Really Grow on a Daily Basis

•

• •

••

••

• •

• ••••

•

Adapted from Adriano Cattaneo

Volume and Frequency…

Caloric Content

Volume and Frequency of Breastfeedings and Fat Content of Breast Milk Throughout the Day

Results

Infants breastfed 11 ± 3 times in 24 hours (range: 6–18), and a breastfeeding was 76.0 ±12.6 g (range: 0–240 g), which was 67.3 ± 7.8% (range: 0–100%) of the volume of milk that was

available in the breast at the beginning of the breastfeeding. Left and right breasts rarely produced the same volume of milk. The volume of milk consumed by the infant at each breastfeeding depended on whether the breast that was being suckled was the more or less

productive breast, whether the breastfeeding was unpaired, or whether it was the first or

second breast of paired breastfeedings; the time of day; and whether the infant breastfed during the night or not. Night breastfeedings were common and made an important

contribution to the total milk intake. The fat content of the milk was 41.1 ± 7.8 g/L (range: 22.3–61.6 g/L) and was independent of breastfeeding frequency. There was no relationship between the number of breastfeedings per day and the 24-hour milk production of the mothers.

Kent et al

Conclusions

HOW MUCH DOES A BABY NEED?

PARENT DEMAND FEEDINGS

BABY WISE AND PDF

Babywise' advice linked to dehydration, failure to thriveMatthew Aney

FTT LOW SUPPLY

EARLY WEANING

SLOW GROWTH

DEHYDRATION

SLOW DEVELOPMENT

WARNING FROM AMERICAN ACADEMY

OF PEDIATRICS

Baby went

for heart

surgery

within the

same week

What Mothers Of “Measured” Babies Say…

“It is not nice either … because it takes time from her (the infant) when I must sit and pump that often and every time… it is killing us … “

“There is a feeling that one is forced to expose oneself and give professional carersaccess to oneself and one's body in order to overcome breastfeeding difficulties. Mothers feel like objects in such situations,care mostly focuses on the infant's milk intake, breasts and milk production.I feel like a big experimental animal, in came trainees and doctors just to look at me almost like a monkey in a cage. It was like here we have someone with strange problems, take the opportunity to watch her while you can “

Different advice, sometimes advocating fixed feeding intervals and fixed positions, reinforces exposure and complicates an understanding of the infant's breastfeeding signals making it difficult for the mother to interpret and respond to them. Being unable to perform in the manner determined by carers, the mother evaluates herself as a less worthy human with a less worthy infant.

“I did not spend time being with the infant. Instead I spent time with the pump … Breastfeeding would have taken the same time but then I would have been with the infant … I spent time on the wrong things”

Excerpts from: Severe breastfeeding difficulties: Existential lostness as a mother-Women's lived experiences of initiating breastfeeding under severe difficulties. Palmer, L., et al

1. Aney, Matthew Babywise' advice linked to dehydration, failure to thrive AAP News 1998; 14:21

2. Bystrova K, Widström AM, Matthiesen AS, Ransjö-Arvidson AB, Welles-Nyström B, Vorontsov I, Uvnäs-Moberg K. Early lactation performance in primiparous and multiparous women in relation to different maternity home practices A randomised trial in St Petersburg. Int Breastfeed J. 2007 May 8;2:9. PubMed PMID: 17488524; PubMed Central PMCID: PMC1878468.

3. Haase B, Barreira J, Murphy PK, Mueller M, Rhodes J. The development of an accurate test weighing technique for preterm and high-risk hospitalized infants. Breastfeed Med. 2009 Sep;4(3):151-6. PubMed PMID: 19739951.

4. Hall WA, Shearer K, Mogan J, Berkowitz J. Weighing preterm infants before & after breastfeeding: does it increase maternal confidence and competence?. MCN Am J Matern Child Nurs. 2002 Nov-Dec;27(6):318-26; quiz 327. PubMed PMID: 12439133.

5. Hassiotou F, Hepworth AR, Williams TM, Twigger AJ, Perrella S, Lai CT, Filgueira L, Geddes DT, Hartmann PE. Breastmilk cell and fat contents respond similarly to removal of breastmilk by the infant. PLoS One. 2013 Nov 6;8(11):e78232. PubMed PMID: 24223141; PubMed Central PMCID: PMC3819380.

6. Hurst NM, Meier PP, Engstrom JL, Myatt A. Mothers performing in-home measurement of milk intake during breastfeeding of their preterm infants: maternal reactions and feeding outcomes. J Hum Lact. 2004 May;20(2):178-87. PubMed PMID: 15117517.

7. Iacovou M, Sevilla A. Infant feeding: the effects of scheduled vs on-demand feeding on mothers' wellbeing and children's cognitive development. Eur J Public Health. 2013 Feb;23(1):13-9. PubMed PMID: 22420982; PubMed Central PMCID: PMC3553587.

8. Kent JC, Mitoulas LR, Cregan MD, Ramsay DT, Doherty DA, Hartmann PE. Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics. 2006 Mar;117(3):e387-95. PubMed PMID: 16510619.

9. Khan S, Hepworth AR, Prime DK, Lai CT, Trengove NJ, Hartmann PE. Variation in fat, lactose, and protein composition in breast milk over 24 hours: associations with infant feeding patterns. J Hum Lact. 2013 Feb;29(1):81-9. PubMed PMID: 22797414.

10. Mitoulas LR, Kent JC, Cox DB, Owens RA, Sherriff JL, Hartmann PE. Variation in fat, lactose and protein in human milk over 24 h and throughout the first year of lactation. Br J Nutr. 2002 Jul;88(1):29-37. PubMed PMID: 12117425.

11. Noel-Weiss J, Woodend AK, Peterson WE, Gibb W, Groll DL. An observational study of associations among maternal fluids during parturition, neonatal output, and breastfed newborn weight loss. Int Breastfeed J. 2011 Aug 15;6:9. PubMed PMID: 21843338; PubMed Central PMCID: PMC3174114.

REFERENCES

10. Noel-Weiss J, Woodend AK, Groll DL. Iatrogenic newborn weight loss: knowledge translation using a study protocol for your maternity setting. IntBreastfeed J. 2011 Aug 15;6(1):10. PubMed PMID: 21843331; PubMed Central PMCID: PMC3178467.

11. Palmér L, Carlsson G, Mollberg M, Nyström M. Severe breastfeeding difficulties: Existential lostness as a mother-Women's lived experiences of initiating breastfeeding under severe difficulties. Int J Qual Stud Health Well-being. 2012;7PubMed PMID: 22312409; PubMed Central PMCID: PMC3272819.

12. Renfrew MJ, Lang S, Martin L, Woolridge MW. Feeding schedules in hospitals for newborn infants. Cochrane Database Syst Rev. 2000;PubMed PMID: 10796125.

13. Savenije OE, Brand PL. Accuracy and precision of test weighing to assess milk intake in newborn infants. Arch Dis Child Fetal Neonatal Ed. 2006 Sep;91(5):F330-2. PubMed PMID: 16717082; PubMed Central PMCID: PMC2672832.

14. Savenije OE, Brand PL. Weighing before and after feeding: an unreliable method for estimating milk intake in infants. Ned Tijdschr Geneeskd. 2007 Dec 8;151(49):2718-22. PubMed PMID: 18225793.

15. Scanlon KS, Alexander MP, Serdula MK, Davis MK, Bowman BA. Assessment of infant feeding: the validity of measuring milk intake. Nutr Rev. 2002 Aug;60(8):235-51. PubMed PMID: 12199299.

16. Shakespeare J, Blake F, Garcia J. Breast-feeding difficulties experienced by women taking part in a qualitative interview study of postnatal depression. Midwifery. 2004 Sep;20(3):251-60. PubMed PMID: 15337281.

17. Vieira GO, Martins CC, Vieira TO, Oliveira NF, Silva LR. Factors predicting early discontinuation of exclusive breastfeeding in the first month of life. J Pediatr (Rio J). 2010 Sep-Oct;86(5):441-4. PubMed PMID: 20737114.

18. Watson J, Hodnett E, Armson BA, Davies B, Watt-Watson J. A randomized controlled trial of the effect of intrapartum intravenous fluid management on breastfed newborn weight loss. J Obstet Gynecol Neonatal Nurs. 2012 Jan;41(1):24-32. PubMed PMID: 22834720.

19. Wight, N. E., Cordes, R, ABM Clinical Protocol #3: Hospital Guidelines for the Use of Supplementary Feedings in the Healthy Term Breastfed Neonate, Revised 2009 BREASTFEEDING MEDICINE Volume 4, Number 3, 200

20. Wilson-Clay B. Prejudice against test weighing, like tongue-tie division, should be re-assessed. Arch Dis Child. 2006 Dec;91(12):1042. PubMed PMID: 17119088; PubMed Central PMCID: PMC2082996.

21. Weighing babies to assess milk intake is unreliable BMJ. 2006 November 11; 333(7576): 1012.

REFERENCES

education

LISTEN PEOPLE, IT’S ALL ABOUT

THE TRAINING!!!

Contact Info

Edith@breastfeedinginc.ca

Fb: /edith.kernerman

ibclc

ca.linkedin.com/pub/edith-kernerman/2a/837/56

www.breastfeedinginc.ca