BFI Flashcards
What does BFI stand for?
Baby friendly initiative
Ways to minimise supplementation in the early days after birth?
Encourage skin to skin - help calm mother and baby and stimulate milk production.
Offer support with positioning and attachment - effective milk transfer will lessen the need for supplementation.
Suggest a laid back position which encourages a babies natural feeding reflex and enables a mother to rest and relax.
Show the mother how to hand express
If baby and mother are distressed - offer the mother a hot drink and help settle the baby.
How can supplementation affect BF?
Undermines a mother’s confidence in herself to BF
‘Nipple/teat’ confusion
Interferes with physiology resulting in less frequent feeds
Affects milk production/removal
What are the benefits of responsive bottle feeding?
Supports a closer bond between the baby and the parent or main caregiver
Helps baby feel safe and secure as they are not being fed by many different people
Encourages natural appetite and prevents over feeding
What information would you give to parents wanting to bottle feed?
First infant formula for the first year of life
All brands have a similar nutritional makeup to comply with legislation
No need to spend money on expensive brands
Fine to swap brands
Wash feeding equipment in hot soapy water prior to sterilisation
Ensure all surfaces where feeds will be prepared are routinely cleaned and disenfected
Water used must be 70 degrees
What are the key concepts of responsive bottle feeding?
Look out for feeding queues - rooting around, suckling on hand, smacking their lips.
Feeding to be carried out mostly by the parent or primary caregiver - helps baby feel safe and secure
Hold baby close, in a semi upright position
Rub above the top lip with the teat to invite the baby to open their mouth
Gently insert the teat and watch for them to behind sucking
Hold the bottle horizontally with just enough milk to cover the hole in the teat - prevents the milk from flowing to fast, making it difficult for the baby to control his suck/swallow/breathe reflex.
watch for observable signs baby needs a break - splaying hands, turning head, spitting out the milk. (Can either drop the bottle to cut off the supply or removed completely to allow the baby to have a break).
Important not to encourage baby to complete the feed of showing signs of having enough as overide’s their natural appetite control and risks over feeding which results in reflux, vomiting and discomfort.
Key concepts of a breastfeeding assessment?
Feeding behaviour - generally calm and relaxed during and after a feed
Sucking patterns - from day three onwards short period of rapid sucks (used to release oxytocin and ‘let down’ the milk), then changes to deep Rythmic sucks as the ducts fill with milk 1-2 sucks a swallow during active feeding.
As milk volume decreases and becomes richer in fat, sucking pattern may change to more of a quiver.
Frequency of feeds - 3-4 feeds in the first 24 hours and a minimum of 8 after the first 24 hours.
Length of feeds - 5-40 minutes if every feed is short or really long or baby doesn’t come off the breast spontaneously, review positioning and attachment.
the mothers breasts - should be comfortable and not misshapen should look round not flattened.
Dummies nipple shields and infant formula - interfere with the establishment of lactation, dummies have the additional risk of reducing the frequency of feeds.
Urine and stool output - after day 3 should be a minimum of 2 soft yellow stools, weight nappies should increase daily until day 5 minimum of six wet heavy nappies.
Weight - any weight loss greater than 7 percent may be an indication of possible insufficient milk intake
Skin colour - frequent feeds of colostrum, helps the baby clear meconium out of the gut, helps prevent reabsorption of bilirubin which can increase the risk and severity of physiological jaundice
Less than 24 hours of age - urgent referral
More than 24 hours of age - biliflash or serum bilirubin within 6 hours.
What is hand expressing used for?
Tempt baby to feed
Provide colostrum if baby is a little sleepy during the first few days
Stimulate milk production
Provide colostrum for sick/ pre term babies on the neonatal unit.
help mothers to soften breasts by removing a little milk if they become full.
Help mothers self manage blocked ducts and can prevent and reduce symptoms of mastitis.
Provide an alternative to giving a supplement if the baby is not feeding effectively.
Key concepts of hand expressing
1) gentle breast massage to stimulate oxytocin release
2) cup breast with thumb and fingers in a c shape 2-3cm from the base of the nipple.
3) gently squeeze bringing the finger and thumb together in a rhythmic action - avoid sliding fingers as causes breast tissue damage
4) if no milk appears after a few minutes move the fingers forward or back slightly to find the right spot
5) continue into no more milk comes out, move fingers around to express from different sections of the breast.
6) milk can be collected in a sterile cup or bottle, or using a syringe.
Key principles of attachment
Nice wide open mouth - head free to tilt back and chin leading (asymmetrical attachment)
Large mouthful of breast
Nipple to rest at the back of the mouth at the junction of the hard and soft palate
More aerola above the top lip
Round full cheeks
Hear swallowing
Should not be painful
Key principles of effective positioning
Sit up, lie down, lay back
Close
Head free
In line - head and body should be in line, so does not have to twist neck.
N - nose to nipple
How to support mother and baby with effective breastfeeding
Encourage cuddles (skin to skin)
Ensure mothers comfortable and relaxed
Ensure chins concept is in place
Keeping baby calm by stroking, talking or rocking the baby.
Point out feeding queues
Show the mother how to hand express a little milk to tempt her baby
Tease the baby to open their mouth by gently rubbing the nipple above his top lip
Be patient and don’t rush the process
Why does breastfeeding matter for baby?
Reduces the risk of infections, allergies sudden infant death syndrome, insulin dependant diabetes, and childhood leukaemia.
Why does breastfeeding matter for mum?
Reduces the risk of breast cancer, ovarian cancer and osteoporosis.
Why does breastfeeding matter long term?
Reduces the risk of cardiovascular disease and obesity in both the mother and baby.
