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Alternative methods of feeding for small or sick neonates. Alternative feeding methods. Objectives: To describe the options available for alternative methods of feeding Teach a mother how to use an alternative feeding method To explain how to express breast milk. Alternative feeding methods.
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Alternative feeding methods Objectives: • To describe the options available for alternative methods of feeding • Teach a mother how to use an alternative feeding method • To explain how to express breast milk
Alternative feeding methods Indications: • Baby • Not breastfeeding effectively • Not sucking effectively (e.g. preterm, ill, cleft lip/palate) • Mother • Is ill • Has flat/inverted nipple or engorged breast • Is HIV positive and decides not to breastfeed
Assessment Action Manage as per guidelines for sick neonates* No Is the baby clinically stable? Yes Start intravenous fluids Is birth weight more than 1250 g? No Yes Is the baby able to breastfeed effectively? Yes Initiate breast feeding • When offered the breast, the baby roots, attaches well and suckles effectively • Able to suckle long enough to satisfy needs No Is the baby able to accept feeds by alternative methods? Give oral feeds by cup/spoon/ paladai Yes • When offered cup or spoon feeds, the baby opens the mouth, takes milk and swallows without coughing/ spluttering • Able to take an adequate quantity to satisfy needs Start intra-gastric tube feeds No * Assess daily for clinical stability ; once stable, assess for initial feeding method
Alternative feeding methods Options available: • Cup • Paladai • Spoon Irrespective of the method, only expressed breast milkhas to be fed to the baby
Hand expression of breastmilk • Have a clean dry container • Tell the mother to: • Wash her hands thoroughly • Make herself comfortable • Hold a wide necked container under her nipple and areola • Place her thumb and first finger behind the nipple (at least 4cm from the tip of the nipple)
Hand expression of breastmilk… • Compress and release the breast between her finger and thumb • Compress and release all the way around the breast, keeping her fingers the same distance from the nipple • Express one breast until the milk just drips, then express the other breast until the milk just drips • Alternate between breasts 5 or 6 times, for at least 20 to 30 minutes • Stop expressing when the milk no longer flows but drips from the start
Hand expression of breastmilk Different ways to massage the breast
Hand expression of breastmilk Back massage • Mother sits down, leans forward, folds her arms on a table in front of her, rests her head on her arms • Her breasts hang loose and unclothed • The helper works down both sides of the spine at the same time from the neck to just below the shoulder blades • She uses her closed fist with her thumbs pointing forwards • She presses firmly making small slow circular movements with her thumbs and continues for 2-3 min
Hand expression of breastmilk Storing expressed breastmilk • Room temperature : 6 hours • Refrigerator : 24 hours • Freezer : 2 weeks (-40C) to 3 months (-200C)
Alternative methods: Cup feeding Cup and spoon are easy to clean with soap and warm water
Cups for feeding newborn babies • An ideal cup can hold 50 to 90 mL of milk • It can be glass or plastic and easily washable • Edge should be rounded and smooth • A cup with a lid is useful for storing expressed breast milk
Cups with lips and spouts • Variations of cups with lips and spouts can easily be found • They should be used with extreme caution • It is DANGEROUS to POUR milk into a baby’s mouth
Cup feeding Advantages • Simple equipment ; easy to clean • Baby can take what it needs in its own time • Mother can do it herself • Good eye contact between mother and baby
Cup feeding Steps • Put a measured amount of milk in the cup • Infant should be awake and held sitting semi-upright on caregiver's lap; put a small cloth on his or her front to catch drips of milk • Touch the edge of the cup to the outer parts of the upper lip • Tip the cup so that the milk reaches the baby’s lips
Cup feeding Steps • Do not pour the milk into the infant's mouth • Allow the infant to take the milk himself (upon smelling the breastmilk, the baby becomes alert, opens its mouth, and puts its tongue into the milk to start the feed) • Feed the infant slowly; some milk may spill from the infant's mouth • When the infant has had enough, he or she will close his or her mouth and will not take any more. Do not force-feed the infant. Pouring the milk into baby’s mouth can cause aspiration
Case study: cup feeding Measuring the correct amount of milk • To measure 30 mL • Use a desert spoon which holds approx. 10 mL • Take 3 spoonfuls of milk • Put a mark on the outside of the cup to guide her how much milk is needed each time If the baby does not take the required amount: feed more often or for longer
Paladai feeding • A paladai is a small bowl with a long pointed lip • The advantages are that it is usually faster than spoon or even cup feeding and also that there is less spillage • A disadvantage is the risk of pouring large amounts of milk into the infant’s mouth
Paladai feeding Steps • Infant should be awake and held sitting semi-upright on caregiver's lap; put a small cloth on his or her front to catch drips of milk • Put a measured amount of milk in the paladai • Hold the paladai so that the pointed tip rests lightly on the infant’s lower lip
Paladai feeding Steps • Tip the paladai to pour a small amount of milk into the infant’s mouth • Feed the infant slowly • Make sure that the infant has swallowed the milk already taken before giving any more • When the infant has had enough, he or she will close his or her mouth and will not take any more. Do not force-feed the infant.
Spoon feeding • Advantages • Useful for collecting small amounts of colostrum in the first days of life • Useful in a baby with cleft lip/palate • Disadvantages • Slow method of feeding • Often difficult to manage a spoon and a milk container while holding the infant semi-upright
Feeding colostrum with a spoon • A grandmother giving colostrum to her grandson 5 hours after delivery • The mother was recovering from a Caesarean section • A health worker helped the mother express
Ensuring adequacy of intake • Weighing him/her once a day and assess weight gain • Check that (s)he has several wet nappies every day • Babies who are growing adequately are receiving enough milk
Summary • Alternative methods - indicated in those who are NOT able to breastfeed effectively • Methods available: Cup, spoon, Paladai • ONLY expressed breast milk should be fed • Ensure hygiene and adequacy of intake while giving feeds by alternative methods