2017 HCHB_digital

Baby Feeding
Breastfeeding is best for babies and recommended by the World Health
Organization, the New Zealand Ministry of Health, health professionals and
maternity services in New Zealand and globally. Breast milk is nutritionally wellbalanced,
easily absorbed, economical, safe and always at the right temperature.
For the mother it is a time saver compared with cleaning, sterilising and making
bottles of formula.
It is also protective against breast and ovarian cancer and may help a
woman return to her pre-pregnancy weight sooner. Breastfeeding allows close
body contact with the baby which encourages bonding and gives a baby vital
antibodies (especially in colostrum – produced in the first few days) that helps
protect against infections. Babies who are breastfed are less likely to develop
allergies, eczema, childhood diabetes, and to die suddenly in their sleep.
Beginning breastfeeding
Breastfeeding is easy for some women but can be tricky for others to begin with.
Some women may need a lot of support and help.
Each feed should start on the opposite breast to the one used at the beginning
of the last feed. The baby should not suck on the nipple alone, but take in part or
all of the areola (the pigmented area around the nipple) as well. This allows the
nipple and areola to be drawn right to the top of the baby’s mouth for effective
feeding. If the nipple alone is suckled the baby’s tongue flattens and pinches the
tip of the nipple against his hard palate, causing damage (cracked nipples) and
making feeding less effective for the baby.
Babies may make audible swallowing sounds when breast milk flows fast at
the start of the feed. Allow the baby to completely empty one breast before
swapping to the other. To release the baby’s latch (eg, to change sides) the
mother can gently slide her little finger (clean) into the corner of baby’s mouth.
Exclusive breastfeeding is recommended for the first four to six months.
Around this time, a baby should be started on plain, smooth, and soft solid foods
in addition to breastfeeding. Encourage mothers to continue breastfeeding until
their baby is at least one year old.
Weaning
Advise mothers wishing to wean (finish breastfeeding) to reduce feeding gradually,
eg, drop one feed a day, then, after a while, drop another feed. If breasts become
engorged, expressing a little milk will make them more comfortable. Tablets are
rarely recommended to stop breastfeeding due to side effects.
Initial assessment
Be mindful that new mums may be exhausted and fragile. Becoming a parent
TREATMENT OPTIONS
Category Examples Comments
Products for cracked
nipples and breastcare
while breastfeeding
Products for thrush on
the nipples
Products for reflux
Sterilising products
Products for expressing
milk
Other products
[GENERAL SALE] eg, creams (Lansinoh*,
Lucas Papaw ointment, Medela Purelan,
Mustela 9 Months Nursing Comfort)
eg, breast-care (Manuka Health Breast
Pads [contain manuka honey]), NUK
Breast Gel Cushions*, NUK Nursing
Pads*, Rite Aid Hydrogel Breast Discs)
[PHARMACY ONLY MEDICINE]
eg, clotrimazole (Canesten cream),
miconazole
[GENERAL SALE]
eg, Gaviscon infant sachets
eg, Avent 3 in 1 Electric Steam Steriliser,
Milton tablets, NUK microwave/electric
sterilising equipment*
eg, NUK manual pump*, NUK electric
pump,* NUK Breast Milk Containers*,
Closer to Nature electric pump
eg, Lansinoh range* (gel packs, nursing
pads, pour spouts, storage bages) NUK
Orthodontic Shaped Teats/Soothers*,
NUK Glass and BPA-free bottles*, MAM
Anticolic bottles
eg, Neil Med Naspira Nasal-Oral Aspirator
Cracked nipples are usually caused by poor latching or from comfort sucking (slipping back onto the nipple
for long periods after nutritional feeding has slowed). Do not stop feeding but try to get a better latch –
contact a midwife, Plunket nurse, La Leche League or a lactation consultant for help.
Nipple shields are not generally recommended except for women with inverted nipples or on the advice of
a lactation consultant. Breast pads containing manuka honey relieve nipple discomfort as well as absorbing
excess milk. Breast gel cushions can be used warm to stimulate milk flow or cold to relieve discomfort.
Nursing pads absorb any leakage between feeds.
Treat mother and baby simultaneously. Use a regular topical antifungal cream, such as clotrimazole or
miconazole, on the mother’s nipples and wipe off before breastfeeding. Apply nystatin oral drops to the inside
of the baby’s mouth (see Oral Health) and an antifungal cream to their bottom.
Mixes with and stabilises stomach contents preventing reflux and regurgitation. Not to be used in babies
under one year except under medical supervision.
Clean all equipment put in a baby’s mouth, such as feeding bottles, nipple shields and pacifiers using
detergent, hot water and a brush. Sterilise all equipment used for babies under three months in addition to
washing.
Expressing can be done by hand, manual pump, battery pump or electric pump. Expressed milk can be
refrigerated or frozen. Inverted nipples can be helped by using a breast pump briefly before feeding to bring
the nipple outwards.
Specialised teats (eg, for babies with cleft palates) are also available. Pacifiers may reduce the risk of sudden
unexpected death in infancy but are best used after breastfeeding has been established. Keep clean, sterilise
frequently and check for loose parts or cracks regularly.
Nasal-oral aspirators allow nasal mucus to be removed efficiently.
Products with an asterisk have a detailed listing in the Baby Feedingsection of OTC Products, on page 220.
Page 18 HEALTHCARE HANDBOOK 2017-2018 Common Disorders