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Improving Breastfeeding: Sensory Components of Kangaroo Care.

Improving Breastfeeding: Sensory Components of Kangaroo Care. Susan Ludington, CNM, PhD, FAAN Walters Chair & Professor of Pediatric Nursing Susan.ludington@case.edu Case Western Reserve University, Cleveland. Evolutionary Perspective.

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Improving Breastfeeding: Sensory Components of Kangaroo Care.

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  1. Improving Breastfeeding: Sensory Components of Kangaroo Care. Susan Ludington, CNM, PhD, FAAN Walters Chair & Professor of Pediatric Nursing Susan.ludington@case.edu Case Western Reserve University, Cleveland

  2. Evolutionary Perspective • Mammals have inborn behavioral program to care for newborns • Mothers also have innate programs a) tactile approach-Rubin, Klaus & Kennell b) auditory- pitch, sensitivity c) visual- enface position (Robson)

  3. Why are we interested? • Other than breastfeeding benefits, starting breastfeeding early now meets the American Academy of Pediatrics’s 2005 and 2006 guidelines for care of fullterm newborns and preterm newborns.

  4. AAP BF Guidelines • #3 of 15 recommendations on page 498 says: “Healthy infants should be placed and remain in direct skin-to-skin contact with their mothers immediately after delivery until the first feeding is accomplished. American Academy of Pediatrics, Section on Breastfeeding. 2005. Breastfeeding and the Use of Human Milk Policy Statement. Pediatrics 115(2), 496-506.

  5. AAP Breastfeeding Guidelines “The alert, healthy newborn is capable of latching on to a breast without specific assistance within the first hour of birth. Dry the infant, assign APGAR scores and perform the initial physical assessment while the infant is in skin-to-skin contact with the mother. The mother is the optimal heat source for the infant. Delay weighing, measuring, bathing, needle sticks and eye prophylaxis until after the first feeding is complete” (pg. 498, Recommendation #3) American Academy of Pediatrics, Section on Breastfeeding. 2005. Breastfeeding and the Use of Human Milk Policy Statement. Pediatrics 115(2), 496-506.

  6. KC integrates all senses so BF is accomplished without difficulty • Maternal scent enhances learning (Goubet et al. 2002) Scent of milk produces proximity behavior and suckling

  7. Evolutionary Perspective • Olfactory- mothers recognize infant by scent within 24 hours of birth • Vestibular- mothers and women move towards infants

  8. Infant innate behaviors • Visual- seeks breast and eyes even when on chest-seeks black and white contrast (Trevathan 1983, Bampton 1981) • Vestibular- crawls to breast within one hour of birth • Tactile- hand, mouth and body touch of the mother’s breast and nipple

  9. And so, • They Crawl to the Breast spontaneously • Let’s watch film now.

  10. Infant innate behaviors • Auditory- familiarity from the womb regulates sucking • Gustatory- prefer sweet, ready for breastmilk and latches on • Proprioceptive-flexion, containment and proximity are calming • Sleep- after feeding, quiet sleep then active sleep, learning and memory

  11. What we do STOPS innate behaviors • Separating from mother- decreases oxytocin, stops search • Gastric suctioning- stops search and suck • C-section- flat oxytocin, no pulses delays BF and attachment

  12. What we do STOPS innate behaviors • Epidural- blunts release of oxytocin so delay in innate behaviors • Bottle, nipple or cup feedings- reduce oxytocin release

  13. Ultimate Sensory Environment • Skin-to-Skin Contact • Maternal • Paternal • Significant Others

  14. This Environment Provides Input that Promotes BF • Auditory • Gustatory • Olfactory • Proprioception • Tactile • Vision

  15. Auditory: Hearing • Heart Beat – calming, decreases stress responses, increases attentiveness, sustains feeding duration • -Maternal Voice – attention getting when on right side, should be used as “setting” event to start feeding sequence • Mother may be reassured to hear normal infant sounds

  16. Auditory: Infant Capabilities • Infant hears maternal voice and sounds in womb and moves toward voice after birth • Infant hears heart beat and background sound in womb and is comforted by being on chest near heart beat

  17. Auditory: Effect on Infant • Auditory stim = Cognitive stim • Continual maternal presence increases auditory stim • Kangaroo Care infants have enhanced cognitive developments (Feldman et al. 2002, Ogi et al. 2001, Ohgi et al. 2002, Tessier et al. 2003) • Auditory contact of KC enhances infant neurobehavioral development (Perlman 2003)

  18. Gustatory: Taste • Mother’s milk, first feed is nipple feed, and lots of saliva (good immunity as well as nerve growth factor) • Mother’s milk is sweet to infant, preferred food, does not like sour tastes

  19. Gustatory: Taste • 1st feed should be at breast to program infant for nipple feeds (neuroplasticity) • Nipple feeds assist in prevention of caries by supporting protein substrates of enamel, resistance to strep mutans, and programming of 1st and subsequent dentition

  20. Olfactory: smell • Mom’s body odor is familiar from womb, is arousing, attention getting, ,maternal odor enhances memory, and starts memory of feeding sequence in hippocampus (Natalie Goubet). • Milk odor is recognizable quickly, signals feeding process and starts hormonal cascade in infant (Marlier et al., 1998). • Pheromones allow recognition of father/human being and starts nipple search

  21. Olfactory: smell • Familiar odors are relaxing (Rangel & Leon, 1995). • Breast odor starts newborn crawling (Varendi and Porter, 2001) or it may be instinctual as in paternal KC studies

  22. Proprioception: sense of space and body parts, proximity • Proximity to nipple starts infant’s search and maternal letdown • Being on a human stirs instinct to find nipple • Flexed, contained position reduces distracting movements & reduces stress, facilitating feeding activity • For first feed have infant turn to right to be on breast, and no head turn to left x 3 months is best (lateralization and asymmetric tonic neck reflex)

  23. Proprioception Continued • Contained holding of infant calms moms and decreases sympatho-adrenal activity (Uvnas-Moberg, 1998,2001) • Holding releases oxytocin in mom and baby for promotion of physiologic adaptation (Uvnas-Moberg, 1998)

  24. Kangaroo Care’s Containment • Soothes infant • Reduces crying • Reduces body movement distraction so infant suckles better • Conserves energy & O2 for growth, birth recovery (Ludington 1990) and warmth (Bauer et al. 1998 &1999) even in first hour postbirth (Christidis et al. 2003)

  25. Kangaroo Care’s Containment • Having infant in KC immediately after birth helps prevent hypoglycemia • “thermoregulation is necessary to prevent hypoglycemia and given the importance of thermoregulation, skin to skin contact should be promoted and KC encouraged in the first 24 hours post birth” ____, 2006. Australian Journal of Nursing

  26. Kangaroo Care’s Containment • American Academy of Breastfeeding Medicine wrote: “Separation of infant from mother at birth is less than optimal management of the breastfeeding dyad to treat hypoglycemia. Separation of mother and baby is inappropriate (pg.40) because skin to skin contact immediately after birth in a stable infant is the recommended routine because it actually is more likely to result in euglycemia.” Chantry CJ, 2005 What should the lactation consultant know about Academy of Breastfeeding Medicine breastfeeding management protocols? J. Human Lactation 21(1), 39-41. “Dstick of 37% in asymptomatic infant in 1st 3 hours after birth is normal and does not require treatment” (pg.39) because serum glucose is 10-15% higher than whole blood glucose. If serum glucose is < 35 then intervene.” Chantry, p. 39

  27. Kangaroo Care’s Containment • Flexion promotes neuromuscular maturation • Reduces transepidermal water loss – 2nd to increased ambient humidity (>50% in KC) (Sauer et al., 1984) and 2nd to increased sleep (TEWL is higher in quiet awake than sleep [kahn et al., 1987]). Reduced TEWL improves immune status of skin (Tagami et al., 2001), conserves energy (Maurer et al., 1984), keep skin smooth and flexible (Tagami et al., 2001)

  28. Tactile – Touch • Touch starts hormonal cascade: • Reduce maternal gastrin level • Increase release of oxytocin (Nissen et al., 1996) • Increase release of prolactin (Nissen et al., 1996) • Increase release of other vagally controlled GI hormones that improve GI function and anabolic metabolism (Uvnas-Moberg, 1999) • Increased release of cholecystokinin from gut – cholecystokinin assist Mat-infant attachment and keeps infant approaching mother (Shayit & Weller, 2001), and improves digestion • Decrease in cortisol (Amico et al., 1994) • Decrease in maternal BP (Uvnas-Moberg, 1996)

  29. Tactile Infant Effects • Increases gastrin secretion for better GI motility, • is consoling to infant, permits attainment of feeding state • Stroking by infant of maternal skin releases oxytocin and prolactin in mother

  30. Tactile Continued • Ventral stim is vagal stimulation. Vagal stimulation: • enhances GI hormone activity • Enhances digestion • Enhances metabolism • Induces oxytocin release

  31. Tactile Continued • Holding infant makes mothers feel warmer (breasts warm up with infant on them [Ludington-Hoe et al., 2000; Ludington-Hoe et al., 2006]) • Warmth soothes mom, helping her sleep • Mom sleeps (Dombrowski et al., 2001; Swinth et al., 2003; Uvnas-Moberg, 1999) • Increases prolactin and pulse release of oxytocin (Uvnas-Moberg, 1999).

  32. Tactile Continued • Moms are eager to hold. Holding starts oxytocin release which facilitates BF and attachment (Tessier et al., 1998), and better parenting (Feldman et al., 2003).

  33. Tactile Continued KC in general increases: -maternal affectionate behaviors -maternal love (Gloppestad 1998; Tessier et al., 1998) -time spent with infant (Klaus et al., 1972; Grossman et al., 1983; Hales et al, 1977; Bauer et al., 1999)

  34. Tactile Continued • Kangaroo Care in general increases: -pleasant sensations in limbic brain (Olausson et al., 2002) -maternal competence, confidence, grief resolution (Affonso et al., 1989; 1993) -incorporation of family into infant’s caregiving (Pearson & Andersen, 2001) -improves all aspects of BF (Ludington-Hoe & Ben-Orr, 2004) ESPECIALLY MILK PRODUCTION – biggest barrier to continuance of breastfeeding

  35. Cutaneous Neurobiology • Skin reponds to pleasant touch in infant or mother by: -releasing neuropeptides cholecystokinin & opioids (Weller & Feldman, 2003) that stimulate limbic brain, digestion processes

  36. Cutaneous Neurobiology Continued -Warm touch increases skin blood flow, keeping infant warm (Yosipovitch et al., 2003) -Warm touch releases calcitonin gene-related peptides (CGRP) that elevate skin temperature (Noguchi et al, 2003; Yuzurihara et al., 2003)

  37. Cutaneous Neurobiology continued -Warm touch stimulates cytokine expression in stratum corneum –enhances barrier to reduce infection (Kikuchi et al., 2003) -Warm environment improves cytokine expression more than cold (Kikuchi et al., 2003)

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