How a baby breastfeeds

Question 1

Effect of poor attachment

Answer 1

Ineffective removal of the milk
Pain
Trauma

Question 2

Why is good positioning needed?

Answer 2

Needs to be able to be maintained or may cut breastfeeding short and the infant will not benefit from the full fat milk at the end of the feed. This would then encourage the build up of FIL which will reduce milk supply

Question 3

Key principals of positioning and attachment

Answer 3

Close = baby is close to mother
Head free= so the baby can tilt their head back to allow the chin to lead when attaching to the breast
In line = the baby’s head and neck are in alignment to avoid twisting
Nose to nipple = will encourage rooting and the tilting of the head backwards to scoop the breast in the mouth

Question 4

Importance of closeness when feeding

Answer 4

Brining the breast to the infant can distort the shape of the breast

Question 5

Why is it important to avoid holding the back of the infant’s head and support the neck?

Answer 5

1. It is critical for successful breastfeeding. Need to support the neck so the head can freely move to find the correct position to lead with the chin, keep the nose free and open the mouth wide.
2. It also allows the infant to extend its neck and stabilise its airway during the suck-swallow breathe reflex.
3. Holding the head can flex the neck which can cause an obstruction and may block the nose against the breast

Question 6

Why should mothers not press her breast with her fingers?

Answer 6

They may do if they are supporting the head and need to make a gap to allow the infant to breathe. But this can prevent milk flow and interfere with attachment

Question 7

Why should babies be in line?

Answer 7

To enable the infant to open its mouth wide, with the tongue on the base of the mouth to scoop up the breast.
Avoiding twisting of the head and neck to protect the airway and encourage a successful suck-swallow-breathe reflex.

Question 8

Nose to nipple

Answer 8

Encourages the infant to tilt its head backwards and lead with the chin. The tongue will then remain at the base of the mouth so that the nipple is aimed towards the junction of the hard and soft palate.
The chin should lead and will indent the breast, the lower lip will flange outwards and the infant will scoop the breast into the mouth.

Question 9

Painful perineum

Answer 9

Consider sitting on a pillow

Question 10

Supporting the breast

Answer 10

Some mothers may find this helpful if their breasts are soft or large.
This can be done by placing the fingers flat against the ribs, under the breast, with the thumb at a right angle to the fingers.
Avoid shaping the breast as this may inhibit the flow of breastmilk and potentially cause trauma

Question 11

Common positions

Answer 11

The cradle position where the mother sits upright, and the infant’s neck and shoulders are supported by the mother’s forearm or bend in the elbow. Ensure head is not restricted
The cross-cradle position is similar except the baby is supported by the forearm and the neck and shoulders by the mother’s hand. It is important for a free head
The underarm hold is good for post C-section to avoid pressure on the wound. Again, the mother sits upright, and she hold the infant to the side, tucking the infant’s trunk under her arm with its feet towards her back
Lying down is useful if the mother is tired or has a sore perineum. The infant faces the breast, body in alignment and nose to nipple

Question 12

Good signs of attachment

Answer 12

Wide-open mouth, tongue at the base of the mouth, scooping a large mouthful of breast
Chin indenting the breast
Full checks
Rhythmic sucks and the sound of swallowing
Seeing milk at the sides of the mouth
More areola visible above the top lip than the bottom
Baby finishes feed and comes off the breast spontaneously

Question 13

What will happen if the infant doesn’t open their mouth wide enough?

Answer 13

This will result in nipple sucking which causes sore nipples and ineffective milk removal, which may result in insufficient milk supply. This may then lead to stasis of breastmilk, leading to engorgement, blocked ducts, mastitis and possible abscess

Question 14

Signs of ineffective attachment in the feeding pattern

Answer 14

At the beginning of a feed before milk ejection, the sucking bursts are rapid, shallow and long with infrequent pauses to swallow.

If this continues it can be a sign of poor milk transfer

Very long feeds and frequent feeds/very short

Colic and frothy, watery stool

Breast refusal

Question 15

Urine and stool output

Answer 15

Are important indicators that feeding is going well.

If feeding is going well then you would expect the stool to change to yellow by day four or five

Question 16

Urates

Answer 16

Look like orange, pinkish crystals may be found in the nappy. Parents should be informed that they are salts in the urine and this is normal for some infants in the first few days. But it can be a sign that the infant needs to feed more often or more effectively

Question 17

Weight loss

Answer 17

All infants are expected to lose weight. A normal wight loss is up to 7% of the birth weight and then a minium of 20g should be gained per day.
By day 14 the birth weight should be been regained.
Weight loss of 7-12% indicated that the infant is not getting enough
Over 12% needs to be referred to either GP or peads

Question 18

Assessing a nappy

Answer 18

Day 1-2 = two + wet nappies and one dirty (mec)
Day 3-4 = three or more wet nappies and three or more dirty (changing)
Day 4-6 = five or more wet and three or more dirty nappies (yellow)
Up to 6 weeks = 6 + wet nappies and at least two yellow stools

Question 19

Nipple confusion

Answer 19

The interference of artificial nipples such as teats and dummies with the successful initiation of breastfeeding. BFI advises against dummies.