Managing Lactation Failure in Mothers of Inpatient SAM children

1. Managing Lactation Failure in Mothers of Inpatient SAM children

2. Admission history

3. Mother breast feeding status • Partial lactation failure, breast milk insufficient to satisfy baby needs. • Baby positioning was incorrect, Inappropriate latching. • Baby’s nostrils usually stuffed, Patient removed from breast with slight irritability and mostly bottle fed. • Breast feed was only offered 2-3 times in the day hours. Baby was not breast fed in the night. • Mother was anemic and feeling weak.

4. Treatment (Child & Mother) • I/V medications were given according to SC protocol • Proper breast feeding technique was taught to the mother and was convinced for breast feeding. • Mothers was fed with 2 sachets of plumpy-nut and hospital food was encouraged with good water intake and Micronutrient supplementation. • F100D was started to the child through Supplementary suckling technique 2 hourly.

5. Supplementary Suckling technique (SST) Sketch diagram used to reluctance of mothers to pose for photographs due to cultural constraints in Khyber Pukhtoonkhwa

6. Treatment Continued…. • The breast milk was assessed by expressing milk on the day of admission and monitored on daily basis by the staff nurse noting improvement day by day. Mother gave history of breast fullness on day 2 of SST. The mother noted increase in milk production by milk dripping on day 5 after feeds. On admission baby had ineffective suckling with rapid and shallow sucks forcing the cheeks inside. The suckling improved till discharge and baby had slow deep sucks with mouth fullness and pausing while suckling. • Baby’s weight was monitored and the quantity of F100D was halved when baby achieved 20gm/kg/day weight gain and was discontinued the following day. • The patient was discharged when the baby maintained 10gm/kg/day weight gain on breast milk alone. The patient was discharged after 8 days of inpatient care.

7. Discharge status

8. Apparent Comparison Admission Discharge

9. Counseling mother…. • Diet counseling of the mother was done in support of breast feeding. • The mother was convinced about the facts of proper breast feeding and she helped 6 admitted mothers through SST and motivational counseling. • On discharge the mother promised to work as an activist and convince mothers in her approach. • The home based SST technique was taught to the mother for helping other mothers in her surrounding.

10. Follow-up status • Baby has gained further weight and is reacting efficiently to external stimulus • Baby taking interest in feeding and playing. • Mother satisfied with breast feeding and loves her baby more than ever before. • Mother has succeeded to re-establish breast feeding for three mothers in her neighborhood through counseling, experience sharing and home based Supplementary Suckling Technique. • On follow –up mother spoke to another admitted mother on staff request and convinced her for re-establishment of breast feeding.

11. Follow-up status (Anthropometry)

12. Shahsawar with parents on follow-up visit

13. Mother Comments

14. Making it possible! On Arrival After treatment