Presentation on theme: "PUBLIC HEALTH & BREASTFEEDING"— Presentation transcript:
1 PUBLIC HEALTH & BREASTFEEDING General Practice Training2011
2 DH RECOMMENDATION“As a global public health recommendation, infants should be exclusively breastfed for the first 6 months of life to achieve optimal growth, development and health.”WHO 2001Breastfeeding mothers are now a "protected characteristic" under the Equality Act 2010.
3 The Lancet, 1994Immunisation is preventative medicine par excellence. If a new vaccine became available that could prevent 1 million or more child deaths a year and that was moreover, cheap, safe, administered orally and required no cold chain, it would become an immediate public health imperative.Breastfeeding could do all this and more, but it requires its own ‘warm chain’ of support that is skilled care for mothers to build their confidence and show them what to do, and protect them from harmful practices.
4 Evidence Base Healthy Weight, Healthy Lives (2008) Scientific Advisory Committee on Nutrition (2008)Child Health Promotion Programme (2008)Infant and Maternal Nutrition Guidelines NICE(2008)Ip S et al 2007(research based benefits of breastfeeding)
5 Public HealthBreastfeeding has a major role within public health. It promotes health and prevents disease in both the short and long term for mother and babyExclusive breastfeeding for around 6 months, and then continued breastfeeding alongside the introduction of solids for the first year,achieves the greatest benefits90% of women stop breastfeeding long before they had planned (Infant Feeding Survey 2005)90% of women who stop breastfeeding before their infant is 6 weeks do not want to. They experience problems, and/or lack of up to date information and support to continue.
6 Potential savingsBreastfed babies have 15% fewer GP consultations during the first 6 months of life than formula-fed babiesReduction in common childhood illnesses and long-term health problems means:Improved public healthMoney saved - £35 million on hospital admissionGastroenteritis (DH)Reduced workload for GP’s
7 UNICEF BABY FRIENDLY INITIATIVE Provides a framework for the implementation of best practise for NHS Trusts and other health care facilitiesWithin the community the seven point plan for the Protection, Promotion and Support of Breastfeeding in the Community
8 Implementing Baby Friendly Seven point plan for community settingsAntenatal informationEffective support and appropriate referralAppropriate prescribingCare with advertising
9 The Seven Point Plan for the Promotion, Protection and Support of Breastfeeding 1. Policy2. Staff training3. Information for pregnant women4. Support to breastfeed5. Exclusive breastfeeding6. A welcoming atmosphere7. Support groups
11 Local statistics for breastfeeding initiation and duration at birth & six weeks Initiation: Q1 – 79%, Q2 – 78%, Q3 – 77%, Q4 – 77%6-8 weeks: Q1 – 45.19%, Q2 – 48.84%, Q£ %, Q4 – 53.38%
12 Why breastfeed? Risks of formula feeding to babies Increased incidence of gastroenteritisIncreased incidence of ear, chest infections and wheezeHigher risk of diabetesIncreased risk of obesityIncreased risk eczema and allergiesIncreased risk of childhood cancersIp S et al 2007(research based benefits of breastfeeding)
13 Risks of not breastfeeding - for mothers Increased risk of pre & post menopausal breast cancerIncreased risk of ovarian cancerIncreased incidence of osteoporosisDelayed involution of the uterus
14 Infant Feeding Survey 2005Most common reported problem in the first two weeks is sore breasts/nipples or perceived insufficient milk supplyApproximately less than 2% of women have a true milk insufficiencyMost milk insufficiency is perceived due to unrealistic expectations or mismanagement of breastfeeding
15 Common Problems Sore nipples Mastitis / breast abscess Thrush - topical and ductalLow weight gain
16 SORE NIPPLES- mostly associated with poor attachment Review positioning and attachment with midwife / health visitor / breastfeeding counsellorMoist wound healing, do not allow nipples to become dryOther causes: Eczema, bacterial infection, thrush, Tongue-tie or high arched palate in baby, Raynauds syndrome etc
17 MASTITISInflammatory condition of the breast which may/may not be accompanied by infectionReported incidence of <10% of lactating womenMajority of cases in the first 12 weeksOnly approximately 1/3rd are infected
18 Treatment IT IS VITAL THAT BREASTFEEDING IS NOT INTERRUPTED optimise attachmentfrequent feedinghand expressing if requiredbegin feeds on affectedbreastall fours feeding positionas this prevents drainage of the breast and may worsen the symptomsposition the tongue and chinin line with the inflammationwarm compress before feedingcold compress after feedsbed restanalgesia/anti-inflammatory(Ibuprofen)refer to breast feeding policy
19 Antibiotics – where appropriate Flucloxacillin 250mg qdsAmoxycillin mgs tdsIf allergic to penicillinErythromycin mgs qdsCephalexin mg qdsMost antibiotics are safe in lactation, loose stools etc possible but not clinically important, may cause static weight gain. Beware of Thrush!
20 Breast AbscessUnusual, can be caused by mismanagement of blocked duct/mastitisMay require aspiration or surgical drainageIn most cases, breastfeeding can continue, if mother wishes, depending on the location of the abscessBreastfeeding can continue on the non affected side
21 Thrush – Topical Signs in mother Nipple may be super sensitive, red, shiny and itchyMay be blanching of the nipplePain while feeding not improved by correct positioning and attachmentNipple traumaPrevious antibiotic treatment
22 Thrush - DuctalIntense breast pain when, previously, breastfeeding has been pain-freeNo relief from altered position/attachmentPain experienced deep within the breast and continues after feedHealed nipple traumaAntibiotic treatment
23 Signs in babyBaby may show one or more of the following symptoms or nonePulling off the breast, fussy feederWhite plaques on the oral mucosaWindy, fretful or difficult to settleNappy rash
24 Treatment of Thrush Treat the mother and baby simultaneously Mother: Miconazole cream apply a smear to the nipple after each feedBaby: Miconazole oral gel (not licensed for babies under 4 months, but can be prescribed)Education on correct application of cream & oral gel neededRefer for extra help with breastfeeding
25 Ductal Thrush Treatment Fluconozole 150 – 300 mgs load dosemgs BD x 10 days.NB Not licensed for lactating women (WHO recognise as compatible with breastfeeding)0.6mg/kg/day the amount that gets through in breast milk6.0mg/kg/day is the amount that can be given to a baby within licence(Thomas Hale – “Medication in Mothers Milk”)
26 Poor Weight Gain If no medical reason diagnosed: Improve milk transfer through correct positioning and attachmentEncourage more frequent feeding (2 hourly)Breast compression while feedingUse both breasts at each feedExpressing and supplementing with expressed breast milk, by cupEncourage contact with practitioner trained to support breastfeeding and peer support network to build mothers confidence
27 The Dilemma of Prescribing “ Recommendations for the lactating mother are probably over-cautious and mothers who need treatment should not be prevented from breastfeeding if the drug is likely to be safe”.Wendy Jones PhD MRPharmS
28 Prescribing during breastfeeding BNF cautious in pregnancy and breastfeedingThomas Hale – assesses riskBreastfeeding Network - Wendy Jones, PharmacistIdeally breastfeed immediately before medication and should be avoided for 1 – 2 hours after any dose of medication( the time of highest plasma concentrations)Consider alternatives
29 Recommended booklistMedications and Mothers’ Milk 14th edition 2010, Thomas Hale PhD - ISBN –Breastfeeding Answers Made Simple - Nancy Mohrbacher, IBCLC, FILCA - ISBN-13:Breastfeeding & Human Lactation, Jan Riordan – ISBN –Textbook of Human Lactation, Thomas Hale & Peter Hartmann – ISBNBreastfeeding a Guide for Medical Profession, Ruth & Robert Lawrence – ISBNThe Breastfeeding Atlas, Barbara Wilson-Clay & Kay Hoover – ISBN –