Nutrition Interventions for Children with Special Health Care Needs

Chapter 4 - Breastfeeding
Table 4-1: Nutrition Interventions for Breastfeeding
Assessment Intervention Evaluation/Outcome
Infant will demonstrate age appropriate
growth. Mother will maintain milk supply
If low milk supply is observed, refer mother to a
lactation consultant (LC) for further evaluation and
intervention.
Is maternal milk supply adequate?
A mother may have low milk supply if any of the
following are observed:
Mother should begin pumping with a hospital grade
pump, at least 8-10 times per day.
Consider beginning a galactogogue
• Infant has inadequate weight gain or slow
growth velocity
• Insufficient number of feedings or length of
feeds/day
• Quantify milk supply through pre/post
breastfeeding weights or pumping log
• History of no change in breast size prenatally
or within 1-2 weeks after birth
• Infant appears hungry after feeding or eats
more often than every 2 hours
• Infant requires supplemental formula feeds for
growth
54 Nutrition Interventions for Children With Special Health Care Needs
Baby receives adequate nutrition from
breastfeeding for optimal growth
If milk supply is clearly good (high pumping
volumes), but baby is not transferring milk
effectively:
Is milk transfer effective?
Improve latch:
In a mother with good milk supply, if latch
is effective there should be clear evidence
appropriate milk transfer, such as:
• optimize position
• asymmetric latch techniques
Referral to LC if:
• changes to position/latch not helping
• suspect problem with baby’s sucking
• Mother has significant pain
• Active sucking throughout most of a 10 -20
minute period at one or both breasts (baby
should not be mostly sleepy)
• Most sucking with “long draws” (not short,
rapid sucks)
• Evidence of swallowing after every 1-2 sucks
• Baby satisfied when comes off of the breast
• Pre-post weights using digital scale (accurate
to +/- 2 grams) show adequate intake.
• There should not be significant pain
Remember: the amount of time spent at the
breast is not an accurate indication of the amount
of milk the baby is getting