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For GPs… HARD FACTS, DANGEROUS HALF- TRUTHS, TOTAL NONSENSE about

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For GPs… HARD FACTS, DANGEROUS HALF- TRUTHS, TOTAL NONSENSE about Powered By Docstoc
					                                                                                                        8/3/2009




                                                          For GPs…
                                                          Antenatal,
                                                          Baby &
                                                          Child health
                                                          Child health
                                                          services in Brisbane’s North
                                                          Saturday July 11, 2009
                                                          Royal Children’s Hospital, Herston




                                                                                   With Thanks to our
Proudly brought to you in collaboration by:                                                Sponsors:
GPpartners | Royal Brisbane and Women’s Hospital
Royal Children’s Hospital | Community Child Health Services
Child and Youth Mental Health Services




               HARD FACTS, DANGEROUS HALF-
               TRUTHS, TOTAL NONSENSE about
                  BABY FRIENDLY HEALTH
                        INITIATIVE

                                                                        BRIDGET ROACHE IBCLC
                                                                             BFHI Project Manager
                                                              Royal Brisbane and Women’s Hospital
                                                                   Women's and N b
                                                                   W       '              Services
                                                                               d Newborn S i




                                                                                                              1
                                                      8/3/2009




             Queensland Statistics

Infant Nutrition Project 2006 – 2007:
…exclusive breastfeeding for six months is linked
  to improved health outcomes, including the
  prevention of chronic diseases
     Q Health targets:
        At least 60% exclusive breastfed at 3 mths
        At least 50% exclusive breastfed at 6 mths

     38.1% at 2 mths
     9.5% at 5 mths




Baby Friendly Health Initiative Accreditation
has been identified as a priority issue in the
following documents –

• NHMRC. Food for Health. Dietary Guidelines
  for Children and Adolescents in Australia. 2003.
  “Hospitals are encouraged to adopt the Baby
  Friendly Hospital Initiative and the Ten Steps to
  Successful Breastfeeding.”




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                                                                              8/3/2009




The Best Start. Report on the inquiry into the
health benefits of breastfeeding. House of
Representatives Standing Committee on
health and Ageing. August 2007.
Recommendation 14.
R            d i 14
• That the Department of Health and Ageing fund the Australian College
   of Midwives to run the Baby Friendly Hospital Initiative in Australia,
   to facilitate the accreditation of all maternity hospitals.
Recommendation 15.
• That the Department of Health and Ageing work with the Australian
   Council on Health care Standards (and/or equivalent accreditation
   organisation) towards including Baby Friendly Hospital status as part of
                       p
   the accreditation process.
Recommendation 16.
• That the Commonwealth Government, when negotiating future
   Australian health care agreements, require state and territory
   governments to report on the number of maternity wards in public
   hospitals that have been accredited under the Baby Friendly Hospital
   Initiative




Eat Well Australia. An Agenda for Action for
Public Health Nutrition 2000 – 2010. “Review
progress and identify ways to accelerate the
uptake of the Baby Friendly Hospital Initiative
in ll        i hospitals”
i all maternity h i l ”
• N.B. BFHI National endorsed a name change
  from Baby Friendly Hospital Initiative to Baby
  Friendly Health Initiative in 2007 to be
                  y        y
  inclusive of Baby Friendly Initiative
  Communities.

   [




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                                                               8/3/2009




     10 Steps to Successful Breastfeeding
1. Have a written breastfeeding policy that is routinely
   communicated to all health care staff.
2.
2 Train all health care staff in skills necessary to
   implement this policy.
3. Inform all pregnant women about the benefits and
   management of breast feeding.
4.   Place babies in skin-to-skin contact with their mothers
     immediately following birth for at least an hour and
     encourage mothers to recognise when their babies are
     ready to breastfeed, offering help if needed.
5.   Show mothers how to breastfeed, and how to maintain
     lactation even if they should be separated from their
     infants.




                   10 Steps (cont)
6. Give newborn infants no food or drink other
    than breast milk, unless medically indicated.
7. Practice       i i       that i ll
7 P ti rooming-in – th t is, allow mothers andth      d
    infants to remain together – 24 hours a day.
8. Encourage breastfeeding in response to feeding
    cues.
9. Give no artificial teats or pacifiers (also called
    dummies or soothers) to breastfeeding infants.
                           )                 g
10. Foster the establishment of breastfeeding
    support and refer mothers on discharge from
    the facility.




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                                                         8/3/2009




               HARD FACTS
• Breastfeeding rates improve (initiation &
  du at o )
  duration)
• BFHI reverses detrimental practices
• Breastfeeding reduces obesity, asthma, eczema,
  diabetes, some childhood cancers, ulcerative
  colitis
• Protect against maternally perpetrated child
  maltreatment, particularly child neglect (Mater ‘09)
• Breastfeeding is cheap




                                                               5
                                                     8/3/2009




       DANGEROUS HALF-TRUTHS
   •   One bottle won’t hurt
   •   Scheduled feeding sets a routine
   •   Let the baby cry
   •   “Sucky” babies need a dummy




One bottle won’t hurt…… when there is no
Medical Indication for supplementation
• Effects maternal confidence
                               g
• Less interest in breastfeeding – interferes with
  establishment of milk supply
• Increased risk of maternal engorgement
• Increase in neonatal jaundice
• Possible sensitisation to CMPA
             baby s
• Alters the baby’s immune environment in the gut
• Exclusive breastfeeding for 4 weeks to return to
  original gut flora




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                                                                                                                      8/3/2009




Composition of human milk & cow’s milk (per
litre)

                                               Colostrum                                   Mature Milk   Cow’s Milk

    Water                                                                                  871           872
    Energy                                     2520                                        3150          2770
    Protein                                    17-85                                       9             35
    Fat                                        20                                          39            43
    Lactose                                    23-53                                       72            49
    NPN                                        0.47                                        0.42          0.21
    Calcium                                    0.31                                        0.35          1.25
    Iron                                       0.80                                        0.3-0.9       0.25
    Sodium                                     0.48                                        0.15          1.40
   Source: Brodribb W. 2006. Breastfeeding Management in Australia, ABA, Mothers Direct Pty Ltd




                       Cow’s Milk Protein Allergy

      • Symptoms occur often, but not always, within
                                                  CMP
        the first weeks after the introduction of CMP.
      • Many children with CMPA develop symptoms
        in at least two of the following organ systems:
                – gastrointestinal (50–60%)
                – skin (50–60%)
                                    (20–30%)
                – respiratory tract (20 30%)
      The symptoms associated with CMPA can range
        from mild to moderate to severe




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                                                                                       8/3/2009




                                  CMPA
• Incidence is lower in exclusively breast-fed
  infants compared to formula-fed or mixed-fed
  infants.
• About 0.5% of exclusively breast-fed infants
  show reproducible clinical reactions to CMP
• Most of these are mild to moderate.
     y
• May be related to the fact that the level of CMP
  present in breast milk is 100 000 times lower
  than that in cow’s milk




                                   CMPA
• Immunomodulators present in breast milk and
  differences in the gut flora in breast-fed and
  formula-fed          may
  formula fed infants ma contribute to the
  decreased prevalence of CMPA in breast-fed
  compared to formula-fed infants
• Severe forms of CMPA are very rare in
  exclusively breast-fed infants



Guidelines for the diagnosis and management of cow’s milk protein allergy in infants
Yvan Vandenplas1, Martin Brueton2, Christophe Dupont3, David Hill4, Erika Isolauri5,
   Sibylle Koletzko6, Arnold P Oranje7 and Annamaria Staiano8
Archives of Disease in Childhood 2007;92:902-908




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                                                         8/3/2009




Anaphylaxis to CMPA:
• Life altering diagnosis
• No 4 in the top 8 food-induced allergens
                 p                    g
  responsible for 90% of food anaphylaxis
• Up to 10 die each year
• Many more require urgent medical
  treatment
• 2% of infants under 2 years of age
• Often have egg and peanut allergies
                             Australia Anaphylaxis Inc
                                                 2006




        TOTAL NONSENSE
• BFHI is only useful in 3rd world
         i
  countries
• BFHI is the responsibility of
  midwives
• Breastfeeding is an optional extra
• Powderer infant formula is sterile




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                                                               8/3/2009




                  The aim of all care

               mothers to be
    • Ensure mothers-to-be are healthy before, and
      during pregnancy, have safe birthing and remain
      safe after birthing.




    • Giving newborns the best chance in life including
      giving these babies the ideal diet in its simplest and
      best formula in the safest way- breastfeeding
                    BREAST MILK IS BEST




                       Education


Provide the correct information on-

•   The benefits of breastfeeding
•   The techniques of breastfeeding
•   How to avoid and overcome challenges
•   Encourage and assist mothers to keep up their
    great work




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                                                                 8/3/2009




              RBWH medical staff
                 Roache (2009) RBWH found
• 100% of doctors did not receive orientation on
  breastfeeding policy
• 100% did not receive training in breastfeeding and lactation
  management
• 100% do not teach mothers how to position and attach
  babies for feeding
• 100% could not describe manual breast expression
  technique
            ld               li i    help
• 100% could not state 3 policies to h l promote
  breastfeeding.
• Breastfeeding advice left to midwives and lactation
  consultants.
Where does this leave these doctors when they become
  trainee GPs?




Antenatal Patient Health Record
12 - 18WKS:
BENEFITS OF BREASTFEEDING:
  For Baby:
• Breastmilk meets baby’s nutritional needs for the first 6
  months
• Provides immunity against diseases such as gastroenteritis
  and infections
• Breastfeeding lowers the risk of being overweight, obesity
    d di b     i hildh d d d l h d
  and diabetes in childhood and adulthood
• Babies who are breastfed have higher IQ scores and better
  jaw development
• Breastmilk changes from feed-to-feed and over time, to
  meet the baby’s changing needs
• Breastmilk is easily digested by baby




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                                            8/3/2009




For Mother:
• Assists with weight loss
  Early     kli    i i i bleeding ft
• E l suckling minimises bl di after
  birth and helps the uterus to return to
  pre-pregnant state
• Full breastfeeding delays the return of
  fertility
          y
• Minimises the risk of pre-menopausal
  breast cancer and ovarian cancer
• Protects against osteoporosis




For Family:
• Breastfeeding is cheaper compared to
  formula feeding
• Breastfeeding is safe, convenient and
  environmentally friendly
• A healthier baby means reduced costs
     doctor s
  in doctor’s visits and medication




                                                 12
                                                                       8/3/2009




BABY-LED FEEDING:
• The baby feeds when hungry, this
            healthier i habits d
  promotes h l hi eating h bi and
  weight gain
• Reduces breast engorgement
• Recognises baby’s feeding cues and
  helps establish breastmilk supply
• Helps breasts to regulate milk
  production




                      20 WKS:
• INITIATING BREASTFEEDING:
      g          y       g
• Recognises early feeding cues:
   –   Seeking, turning head towards breast
   –   Searching movements of the mouth
   –   Increased alertness (rapid eye movement under closed eyelids)
   –   Flexing of legs and arms
   –   Attempting to bring hand to mouth
   –   Sucking on fist or finger
   –   Mouthing motions of the lips and tongue
   –   Head bobbing
• Rhythmic jaw action which changes with milk transfer
• Audible swallowing
• Baby self removal (detaches) at completion of feed




                                                                            13
                                            8/3/2009




    POSITIONING and ATTACHMENT of BABY:
    •   Baby’s head and body in alignment
    •                      mother s
        Baby held close to mother’s body
    •   Baby’s baby well supported
    •   Baby approaches breast
    •   Chin is touching breast
    •   Baby’s mouth is quite wide open




UNICEF/WHO 2009




                                                 14
                                                         8/3/2009




   26 WKS:
    BENEFITS OF ROOMING-IN:
    • Promotes successful initiation of breastfeeding
    • Longer duration of breastfeeding and exclusivity
    • Mothers produce mature milk earlier
    • Promotes “cue” feeding for baby
    • Baby’s have a lower incidence of jaundice
      Rooming in
    • Rooming-in decreases incidence of hospital
      acquired infections
    • Promotes maternal attachment




   a




UNICEF/WHO 2009




                                                              15
                                                         8/3/2009




 30-32 WKS:

  MAINTENANCE OF MILK SUPPLY:
  • Expressing manually
    – Expressing within 6 hours of birth if separation
      occurs
    – Stimulating a milk ejection reflex
    – Positioning of container
      Switch to th breast
    – S it h t other b     t
  • Assess infant to determine adequate hydration




  30-32 WKS:
BENEFITS OF “SKIN TO SKIN” CONTACT:
• Improved temperature regulation of baby
• Improved spontaneous breastfeeding
  behaviour
• Helps maternal attachment behaviour
• Reduces stressful behaviour in baby
• Babies cry for a shorter length of time when
  held skin to skin
• Continuation of breastfeeding longer at 4
  months of life




                                                              16
                                            8/3/2009




34 WKS:
REVIEW BREASTFEEDING
  INFORMATION:
• Benefits of breastfeeding
• Initiating breastfeeding
• Positioning and attaching a baby for
  breastfeedingg
• Benefits of rooming-in and skin to skin
  contact
• Maintaining milk supply




36 WKS:


 10
“10 STEPS TO SUCCESSFUL
  BREASTFEEDING”:
• RBWH commitment to become BFHI
• List of the “10 Steps to Successful
  Breastfeeding”
  B      f di ”




                                                 17
                                                        8/3/2009




                        The way ahead

Jones 2009 RBWH Breastfeeding Symposium;
• Reintroduce information regarding breastfeeding to
  medical students, interns and registrars
• Build a cooperative approach to providing pregnant
    and recently pregnant women with information
    regarding breast feeding
• Have a uniform set of instructions provided by both
  midwifery and medical staff




              Promoting breast feeding


•   Its up to us all to provide a
    unified, consistent and simple
    promotion of breast feeding.

•   Learning and working
    together, complementing each
    others efforts- all for the
    benefit of mothers and babies

•   The Baby Friendly Health
    Initiative Project is a good
    start.




                                                             18
                                                  8/3/2009




Breastfeeding = long term health:

Mammalian evolution promotes survival advantage




                                                       19

				
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Description: For GPs… HARD FACTS, DANGEROUS HALF- TRUTHS, TOTAL NONSENSE about