CPDIN
FOCUS INFANT FEEDING
This module is about infant feeding OBJECTIVES
After completing this module you should: • Be able to recognise and advise on common breastfeeding problems, and signpost mothers to other HCPs as appropriate
• Revise the differences between the various types of infant formulae used in babies with Cow's Milk Protein Allergy (CMPA)
• Revise the differences between CMPA and lactose intolerance in terms of incidence, symptoms and types of formulae used
• Know which types of formulae have less of an evidence base to support their use This article was supported by Aptamil Follow On Milk
about bottles, how will I know how much to feed or how often? And either way, how will I know my baby is getting enough?” All of these questions, and many more, will be running through the mind of every expectant parents. Especially so with first-time mums, but not exclusively, since occasionally the whole experience of infant feeding can be stressful and prompt questions of how to do things differently next time round. Young mothers can be frequent visitors to the pharmacy, and as such represent a great opportunity to build valuable relationships as well as bringing in repeat business that will long outlast the baby-feeding years. There is no shortage of information out there for them, but there is still a need for some confident face-to-face advice to help alleviate worries and provide reassurance.
“H
Whether a mum chooses to go with breast or bottle, our role is to be her advocate and support her in whatever choice she has made.
Breastfeeding Firstly, let’s consider breastfeeding. We know the World Health Organisation currently recommends exclusive breastfeeding until a baby is six months old, but any period of breastfeeding will still have benefits for both mother and baby. Historically,
22 - PHARMACY IN FOCUS
ow should I feed my baby? Is breastfeeding difficult? And what
our breastfeeding rates have been relatively low compared with other regions of the UK. Figures from the last UK Infant Feeding survey in 2010 are now outdated, but more recent data is available for Northern Ireland in the report ‘Breastfeeding on the Island of Ireland’, published by the Institute of Public Health (IPH) in Ireland in 20151
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Encouragingly this found that breastfeeding rates in NI had risen from 40% to 45% over the previous decade. Although 45% seems low compared to the 63% quoted in the 2010 UK study, it is worth pointing out that the UK figures included babies who received even a single breastfeed in hospital, whereas the IPH data is a measure of the percentage of babies still being breastfed upon hospital discharge, which is arguably a truer reflection of actual numbers.
Because relatively few mothers opt for breastfeeding, those who do can sometimes find it difficult to get advice from within their family or peer group. While the old adage that ‘it takes a village to raise a child’ may well be true, the fact is that most of the village are feeding their babies in a different way, and so advice on how to deal with common problems can be harder to come by. In the pharmacy, we can help with some of these.
“Is my baby getting
enough milk?” Explore first of all why this question is being asked. It can help to reassure that for the first month, while milk supply is being established, feeding 8-12 times daily is quite normal. It may also be reassuring to mention that feeds will become less frequent, and often shorter, as the baby gets older, which can be welcome news to a tired new mum. Also, breastfeeding takes time, and while it is difficult to define what is ‘normal’ because every baby is different, newborns can nurse for up to 15-20 minutes on each side (though sometimes less), so it can help to ask the mother how long she is feeding for before changing sides. Breastmilk starts off as quite watery foremilk to satisfy thirst, before changing in consistency to thicker hindmilk, with a higher fat content that satisfies hunger for longer. This means that changing sides too soon can mean the baby only getting the foremilk, so they may get hungry again much sooner than would otherwise be the case.
That said, many health professionals advocate watching the baby instead of the clock. A satisfied baby will come off the breast when they have had enough. If they have had 6-8 wet nappies and are settled and content between feeds and gaining weight, then it is very likely that they are getting enough milk. If a mother is still worried, she should speak with her
midwife if within the first 14 days or health visitor after that, who will be able to provide 1-1 advice and assess technique etc.
Engorgement Breasts feeling lumpy or hard is normal as long as milk is flowing normally. With engorgement, breasts can be hot and painful, and it can be difficult to feed due to the nipple being stretched flat. The only solution to this is to drain away excess milk by feeding or expressing with a pump or by hand to relieve the pressure. Hot compresses can also help. The problem usually resolves once milk production adjusts to the baby’s needs, but if problems persist then help may be needed to assess latch and technique.
Blocked milk duct This is characterised by a localised red, painful lump, and is the result of milk not being emptied. This can be due to poor positioning of the baby (pressing on the duct), tight clothing or underwired bras. Milk itself is the cause of the blockage and must be cleared in order to relieve pressure. Gentle massage and hot compresses can help, as can checking latch and positioning, and wearing a suitable nursing bra.
Cracked nipples This can be the result of baby not latching on deeply enough. The end
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