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Bringing Home Baby: Now what?

Bringing Home Baby: Now what?. Clinical rounds October 5, 2011. We waited 9 months for this …. First days for new parents. Breastfeeding Post-partum depression Risk for shaken baby syndrome. Breastfeeding – . Just because it’s natural, doesn’t mean it’s easy. Goals:

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Bringing Home Baby: Now what?

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  1. Bringing Home Baby:Now what? Clinical rounds October 5, 2011

  2. We waited 9 months for this …

  3. First days for new parents • Breastfeeding • Post-partum depression • Risk for shaken baby syndrome

  4. Breastfeeding – • Just because it’s natural, doesn’t mean it’s easy

  5. Goals: Early postpartum to 75%. At 6 months to 50%. At 12 months to 25%. Exclusively at 3 mos to 40%. Exclusively at 6 mos to 17% 2011 in US (in WA): 74.6% (89%) 44.3% (60.2%) 23.8% (35%) 35% (49.1%) 14.8% (23%) Healthy People 2010 -- Increase the proportion of mothers who breastfeed their babies:

  6. Can we do better? Yes we can!

  7. Baby-Friendly Hospital Initiative

  8. The Ten Steps To Successful Breastfeeding • Have a written breastfeeding policy that is routinely communicated to all health care staff. • Train all health care staff in skills necessary to implement this policy. • Inform all pregnant women about the benefits and management of breastfeeding. • Help mothers initiate breastfeeding within one hour of birth. • Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.

  9. The Ten Steps To Successful Breastfeeding (cont) • Give newborn infants no food or drink other than breastmilk, unless medically indicated. • Practice “rooming in”-- allow mothers and infants to remain together 24 hours a day. • Encourage breastfeeding on demand. • Give no pacifiers or artificial nipples to breastfeeding infants. • Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

  10. Keys to successful breastfeeding • Frequency • Appropriate latch

  11. Questions, questions … • I don’t know the answer, who else can help? • Lactation consultants! • Swedish Lactation • 386-MOMS • La Leche League of Washington • WIC? • Other parents!

  12. Increasing milk supply • Fenugreek • Mother’s Milk tea • Metoclopramide • Domperidone

  13. First days for new parents • Breastfeeding • Post-partum depression • Risk for shaken baby syndrome

  14. Risks for Postpartum Depression History of depression Depressive symptoms in pregnancy Family history of depression Premenstrual or OCP related mood changes

  15. Screening • Edinburgh Postnatal Depression Scale • As early as 3 days postpartum is predictive of mood at 4-8 weeks • Score>12 needs further eval and follow up • Score 5-12 should be re-screened in 1 month

  16. Prevention? Postpartum counseling reduces symptoms Antenatal interventions did not changed rates of postpartum depression Intrapartum support did not change symptoms Giving patients information does not change the incidence

  17. Where to turn - resources • “Speak Up When You’re Down” • Postpartum Support International • Counseling • Psychiatry (Dr. Zantop)

  18. Treatment Close follow up Medication if indicated Peer support can be beneficial Counseling can help, but may be difficult logistically Always ask about suicidality and thoughts of harming baby

  19. First days for new parents • Breastfeeding • Post-partum depression • Risk for shaken baby syndrome

  20. Shaken Baby Syndrome • 40% of child abuse deaths occur among children less than 12 months of age • Abusive head trauma – most common cause of lethal child abuse • AHT – diagnosis of injury instead of how injury occurred • Incidence: 30 per 100,000 person-years

  21. For child abuse: Younger parents Less education Perceived stress Parental depression Parental substance abuse Domestic violence Single parent with unrelated adult in home For AHT specifically Perinatal illness Parental substance abuse Prior history of abuse of child or other family members Incessant crying Risk factors

  22. Normal distribution of infant crying

  23. Period of PURPLE Crying

  24. SLEEP! • Listen to parents’ concerns • There is no single correct answer • Parents are looking for suggestions

  25. For parents: say “it’s okay to walk away” Make sure child is somewhere safe (like crib) See if someone else can come and help Go to another room and do something specific to calm down Know that it won’t always be like this

  26. And they just keep getting bigger…

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