Nipple shield

Abstract: OBJECTIVE. We aimed to provide information that can be used as a guide to clinicians when advising breastfeeding mothers on normal lactation with regard to the frequency and volume of breastfeedings and the fat content of breast milk. METHODS. Mothers (71) of infants who were 1 to 6 months of age and exclusively breastfeeding on demand test-weighed their infants before and after every breastfeeding from each breast for 24 to 26 hours and collected small milk samples from each breast each time the infant was weighed. RESULTS. Infants breastfed 11 3 times in 24 hours (range: 6 –18), and a breastfeeding was 76.0 12.6 g (range: 0 –240 g), which was 67.3 7.8% (range: 0 –100%) of the volume of milk that was available in the breast at the beginning of the breastfeeding. Left and right breasts rarely produced the same volume of milk. The volume of milk consumed by the infant at each breastfeeding depended on whether the breast that was being suckled was the more or less productive breast, whether the breastfeeding was unpaired, or whether it was the first or second breast of paired breastfeedings; the time of day; and whether the infant breastfed during the night or not. Night breastfeedings were common and made an important contribution to the total milk intake. The fat content of the milk was 41.1 7.8 g/L (range: 22.3– 61.6 g/L) and was independent of breastfeeding frequency. There was no relationship between the number of breastfeedings per day and the 24-hour milk production of the mothers. CONCLUSIONS. Breastfed infants should be encouraged to feed on demand, day and night, rather than conform to an average that may not be appropriate for the mother-infant dyad.

Abstract: Objective: To determine whether, in infants with a tongue-tie and a feeding problem, the current medical treatment (referral to a lactation consultant) or immediate division works best and enables the infants to feed normally. Methods: Between March and July 2002, all the babies in the district of Southampton with tongue-ties were followed in order to see if they had any feeding problems. If they developed problems, the mothers gave written consent and were enrolled in an ethics committee approved, randomized, controlled trial, comparing 48 h of intensive lactation consultant support (control) with immediate division. Results: A total of 201 babies had tongue-tie, of whom 88 had breast-feeding or bottle-feeding problems. Thirty-one were not enrolled, so 57 were randomized. Of the 29 controls, one improved (3%) and breast-fed for 8 months, but 28 did not. At 48 h, these 28 were offered division, which all accepted, and 27 improved (96%) and fed normally. Of the 28 babies who had immediate division, 27 improved and fed normally but one remained on a nipple shield (P < 0.001). Twenty-four mothers breast-fed for 4 months (24/40, 60%). Overall, division of the tongue-tie babies resulted in improved feeding in 54/57 (95%) babies. Conclusions: This randomized, controlled trial has clearly shown that tongue-ties can affect feeding and that division is safe, successful and improved feeding for mother and baby significantly better than the intensive skilled support of a lactation consultant.

Abstract: In the World Health Organization/United Nations Children's Fund document Baby-Friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care, neonatal care is mentioned as 1 area that would benefit from expansion of the original Ten Steps to Successful Breastfeeding. The different situations faced by preterm and sick infants and their mothers, compared to healthy infants and their mothers, necessitate a specific breastfeeding policy for neonatal intensive care and require that health care professionals have knowledge and skills in lactation and breastfeeding support, including provision of antenatal information, that are specific to neonatal care. Facilitation of early, continuous, and prolonged skin-to-skin contact (kangaroo mother care), early initiation of breastfeeding, and mothers' access to breastfeeding support during the infants' whole hospital stay are important. Mother's own milk or donor milk (when available) is the optimal nutrition. Efforts should be made to minimize parent-infant separation and facilitate parents' unrestricted presence with their infants. The initiation and continuation of breastfeeding should be guided only by infant competence and stability, using a semi-demand feeding regimen during the transition to exclusive breastfeeding. Pacifiers are appropriate during tube-feeding, for pain relief, and for calming infants. Nipple shields can be used for facilitating establishment of breastfeeding, but only after qualified support and attempts at the breast. Alternatives to bottles should be used until breastfeeding is well established. The discharge program should include adequate preparation of parents, information about access to lactation and breastfeeding support, both professional and peer support, and a plan for continued follow-up.

Abstract: Breastfeeding is the very means by which humans have thrived and developed as a species [...]