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2017 HCHB_digital

Baby Feeding

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

CONTINUING OTC EDUCATION for the first time can be both joyous and stressful, so make life easier for them by keeping your aisles free of clutter and wide enough to fit a buggy or pram through. Keep baby products in an easy to reach location and provide a small box of toys for any accompanying toddlers to play with. Greet them with a smile and ask how you can help. Ensure you can confidently talk about the baby products you stock but women with "yes" answers to the Refer to Pharmacist questions will need to talk to a pharmacist. Breastfeeding problems Do not offer advice about breastfeeding unless you really know what you are talking about – incorrect advice in this area may affect milk production, feeding, or a mother's confidence. Instead, refer the woman to her midwife, Plunket, La Leche League or a local lactation consultant. Engorged breasts Sometimes breasts can become engorged, causing pain and difficulty in “latching” the baby. The mother can try expressing just a little milk before latching, and to make herself feel more comfortable, if this is a problem. Mastitis Mastitis (infected, blocked milk ducts) may follow engorgement. Symptoms usually include breast pain, warmth, redness and swelling in one area of the breast with fever and flu-like symptoms. Antibiotics prescribed by a doctor or midwife are often needed if symptoms persist for longer than 24 hours. Encourage frequent milk removal during mastitis. Cracked nipples For cracked nipples apply a soothing cream (see Treatment options previous page) and get help with technique – the baby is probably latching incorrectly. Low milk supply Some mothers worry that they do not have enough milk, often in response to a baby feeding more often than normal. Reassure the mother that babies naturally go through growth periods, and will feed more frequently during this time. Generally, if a baby appears healthy and active AND is gaining weight AND having six or more very wet nappies a day, then the milk supply is fine. In most cases, the mother’s supply adjusts to this increased demand within a couple of days and the baby soon resorts back to its regular feeding schedule. Occasionally, a baby may not be getting enough milk due to incorrect latching or sucking, or rarely due to an underproduction of milk by the mother. Encourage the mother to get help with her technique, to rest and relax whenever she can, and to make sure she is eating and drinking well. She should also contact her midwife, La Leche League, or lactation consultant for further advice. Reflux in babies Reflux in babies is common and is thought to be caused by an immature lower Refer to PHARMACIST • Any mother with symptoms of mastitis, such as breast pain, redness, swelling, fever or flu-like symptoms. • Any baby who is not gaining weight or appears unwell. • Anybody planning to take or buy any medicine, supplement or herbal remedy for a woman who is breastfeeding or for a baby. • Any mother with possible signs of depression (eg, crying, feelings of helplessness, inability to cope, difficulty sleeping, reduced appetite or no enjoyment in things that would usually be enjoyable). oesophageal sphincter (the band of tissue that prevents the contents of the stomach from rising up the oesophagus). Symptoms include distress or arching of the back when feeding, irritability, coughing and frequent hiccups. Colic may also coexist with reflux. Parents should take their baby to a doctor for a proper diagnosis if reflux is suspected. Bottle-feeding Health professionals have a responsibility to promote and support breastfeeding although, if a woman decides to bottle-feed, she will need support and advice. Infant formula Cow’s milk must not be used for infants aged less than one because it contains higher levels of protein and salt and not enough iron and other nutrients necessary for a growing baby. Infant formula is formulated to contain differing levels of whey and casein depending on the baby’s age, as well as all the recommended essential vitamins and minerals. Dermatitis, vomiting, diarrhoea and colic may be caused by lactose intolerance or cow’s milk protein intolerance (CMPI). Advice must be sought from Plunket, a midwife, or a doctor before giving lactose-free or non-dairy formulas long term. Use good quality bottles and teats that are the right flow for the baby’s age (slow for young babies through to faster flow for older babies). Keep powdered formula covered and use within four weeks of opening. Wash hands and clean all feeding equipment thoroughly before preparing formula. Sterilise all equipment if a baby is less than three months old. Formula should be made up with cold, previously boiled, water. Prepared formula should not be used if it has been out of the refrigerator for more than two hours. Never reheat any prepared formula that has already been warmed or partially consumed. For more information on infant formula as well as preparing baby food see Baby Food and Infant Formula at www.foodsafety.gov Page 19

  • Page 1 and 2: HEALTHCARE HANDBOOK incorporating t
  • Page 3 and 4: 2017-2018 HEALTHCARE HANDBOOK PUBLI
  • Page 5 and 6: Index Common Disorders Acne--------
  • Page 7 and 8: Asthma and COPD CONTINUING OTC EDUC
  • Page 9 and 10: Head and scalp • Condition of hai
  • Page 11 and 12: HELP KIDS BE THEMSELVES AGAIN NEW L
  • Page 14 and 15: NUROFEN ZAVANCE* IS ABSORBED UP TO
  • Page 16 and 17: Acne Acne is a common skin problem
  • Page 18 and 19: Allergies An allergy occurs when th
  • Page 20 and 21: Asthma and COPD Asthma New Zealand
  • Page 24 and 25: Bites and Stings Bites and stings c
  • Page 26 and 27: Bruises, Scars, Spider Veins Bruise
  • Page 28 and 29: Childhood Diseases and Immunisation
  • Page 30 and 31: Childhood Diseases and Immunisation
  • Page 32 and 33: Childhood Diseases and Immunisation
  • Page 34 and 35: Childhood Diseases and Immunisation
  • Page 36 and 37: Childhood Pain and Baby Teething Pa
  • Page 38 and 39: Colds A cold is a contagious viral
  • Page 40 and 41: Cold Sores Cold sores are fluid-fil
  • Page 42 and 43: Constipation Constipation is the te
  • Page 44 and 45: Contraception & Sexual Wellbeing Co
  • Page 46 and 47: Contraception: Emergency Emergency
  • Page 48 and 49: Coughs: Dry Coughs are called dry o
  • Page 50 and 51: Coughs: Productive Coughs are consi
  • Page 52 and 53: Cuts, Abrasions and Blisters This t
  • Page 54 and 55: Cystitis [Bladder Infection] Cystit
  • Page 56 and 57: Dandruff Dandruff is a common condi
  • Page 58 and 59: Dermatitis/Eczema Dermatitis is a g
  • Page 60 and 61: Diabetes Diabetes is a condition in
  • Page 62 and 63: Diarrhoea and Vomiting Diarrhoea an
  • Page 64 and 65: Dry Skin Dry skin is skin that lack
  • Page 66 and 67: Ear Conditions Our ears allow us to
  • Page 68 and 69: Eye Conditions Almost two-thirds of
  • Page 70 and 71: Eye Conditions (continued) Type Sym
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    Eyes: Contact Lenses Contact lenses

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    Fever What is fever Fever is define

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    Foot Care Common foot problems incl

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    Fungal Infections: Superficial Supe

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    Fungal Nail Infections (Onychomycos

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    Gout Historically known as the “d

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    Haemorrhoids Haemorrhoids (also cal

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    Hair Loss Alopecia is the medical t

  • Page 88 and 89:

    Hay Fever Hay fever (also called in

  • Page 90 and 91:

    Hay Fever (continued) TREATMENT OPT

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    Headache Headaches are common and c

  • Page 94 and 95:

    Head Lice Head lice (pediculosis ca

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    Heart Health Cardiovascular (CV) di

  • Page 98 and 99:

    Indigestion, Heartburn and Gastriti

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    Influenza Influenza (flu) is a comm

  • Page 102 and 103:

    Influenza (continued) TREATMENT OPT

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    Iron Deficiency Iron is an essentia

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    Irritable Bowel Syndrome Irritable

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    Menopause Menopause - the “change

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    Migraine Migraines are a type of se

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    Muscular Aches, Pains and Tightness

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    Nappy Rash Nappy rash is a red rash

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    Oral Health Oral health disorders i

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    Osteoarthritis Osteoarthritis is th

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    Osteoporosis Osteoporosis (meaning

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    Period Pain and Endometriosis Perio

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    Poisonings Any substance that has t

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    Pregnancy Tests and Supplements Hom

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    Preventive Health There are certain

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    Probiotics and Prebiotics Probiotic

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    Psoriasis Psoriasis is a long-term

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    Scabies Scabies is a very contagiou

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    Shingles Shingles (herpes zoster) i

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    Sinus and Nasal Problems Sinuses ar

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    Sleep Problems and Snoring Sleep is

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    Smoking Cessation Almost 5000 New Z

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    Sore Throat Sore throats are very c

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    Strains and Sprains Sprains and str

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    Sun Care Sunburn Sunburn occurs fro

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    Sun Care: Eye Protection Protecting

  • Page 152 and 153:

    Sweating: Excessive (Hyperhidrosis)

  • Page 154 and 155:

    Toothache Toothache is the term use

  • Page 156 and 157:

    Travel Health (including Vaccinatio

  • Page 158 and 159:

    Travel Sickness Travel, or motion,

  • Page 160 and 161:

    Urinary Incontinence Urinary incont

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    Urticaria (Hives) Urticaria refers

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    Vaginal Health The vagina is a clos

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    Varicose Veins and Support Stocking

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    Vitamins and Dietary Supplements Vi

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    Warts Warts are benign (non-cancero

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    Weight Loss Obesity has reached epi

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    Worms Pinworms (Enterobius vermicul

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    Wound Care Our skin acts as a barri

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    Wound Care (continued) Wound type M

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    Glossary WHAT DOES THAT WORD MEAN?

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    Chapter References (continued) Diar

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    Chapter References (continued) Gord

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    Significant learning opportunity: W

  • Page 188 and 189:

    PharmacyToday A part of your everyd

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    OTC Medicines: Interactions When se

  • Page 192 and 193:

    OTC Medicines: Interactions OTC Med

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    OTC Medicines: Interactions OTC Med

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    OTC Medicines: Interactions OTC Med

  • Page 198 and 199:

    OTC Medicines: Precautions OTC Medi

  • Page 200 and 201:

    OTC Medicines: Precautions OTC Medi

  • Page 202 and 203:

    OTC Medicines: Adverse Effects OTC

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    Herbal Supplements: Interactions He

  • Page 206 and 207:

    Herbal Supplements: Interactions He

  • Page 208 and 209:

    Herbal Supplements: Interactions He

  • Page 210 and 211:

    Herbal Supplements: Interactions He

  • Page 212 and 213:

    Drugs in Sport Treating Athletes Me

  • Page 214 and 215:

    Drugs in Aviation AVIATION - PRECAU

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    Drugs in Pregnancy Drug use in preg

  • Page 218 and 219:

    NZ Support Groups ADHD Association

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    NZ Support Groups New Zealand AIDS

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    HEAT or INFLAMMATION Unlike heat ru

  • Page 224 and 225:

    OTC Products Over-the-counter produ

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    OTC Products Index Foot Care - Fung

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    »» Acne CRYSTADERM CREAM AFT PHAR

  • Page 230 and 231:

    »» Childhood Pain and Baby Teethi

  • Page 232 and 233:

    »» Colds BONNINGTON’S IRISH MOS

  • Page 234 and 235:

    CODRAL RELIEF MAX STRENGTH COLD & F

  • Page 236 and 237:

    OTRIVIN JUNIOR GLAXOSMITHKLINE CONS

  • Page 238 and 239:

    DULCOLAX SANOFI CONSUMER HEALTHCARE

  • Page 240 and 241:

    BENADRYL MUCUS RELIEF DOUBLE ACTION

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    »» Dandruff COCO-SCALP AFT PHARMA

  • Page 244 and 245:

    EAR CLEAR WILSON CONSUMER PRODUCTS

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    »» Foot Care - Fungal Infections

  • Page 248 and 249:

    TELFAST ORAL LIQUID SANOFI CONSUMER

  • Page 250 and 251:

    NUROFEN ZAVANCE RECKITT BENCKISER (

  • Page 252 and 253:

    MOOV HEAD LICE SOLUTION DOUGLAS PHA

  • Page 254 and 255:

    GAVISCON DUAL ACTION LIQUID RECKITT

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    CODRAL COLD & FLU + COUGH JOHNSON &

  • Page 258 and 259:

    »» Irritable Bowel Syndrome GASTR

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    VOLTAREN EMULGEL GLAXOSMITHKLINE CO

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    TURMERIC EXTRA STRENGTH GOOD HEALTH

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    PREGNOSIS EARLY PREGNANCY TEST DIP

  • Page 266 and 267:

    »» Sexual Wellbeing - Contracepti

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    SUDAFED PE SINUS DAY + NIGHT RELIEF

  • Page 270 and 271:

    NICORETTE INHALATOR JOHNSON & JOHNS

  • Page 272 and 273:

    STREPSILS PLUS LOZENGES RECKITT BEN

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    TRAVACALM TRAVEL BAND WILSON CONSUM

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    CRYSTADERM CREAM AFT PHARMACEUTICAL

  • Page 278 and 279:

    An ENHANCED ELearning Experience As

  • Page 280 and 281:

    Product Index ANIME LUBRICANT 50ML-

  • Page 282 and 283:

    Manufacturer’s Index AFT Pharmace

  • Page 284:

    Topiramate Actavis Topiramate 25mg,

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