In this lecture, we will discuss
anticipatory guidance for new parents.
So here’s a typical case,
a 23-year-old mom, who doesn’t may
be have too much parental support
has just delivered her first baby.
She is excited, but she is really nervous
because she doesn’t know how to be a parent.
What are the important things
you should discuss with her
while she is still in the
hospital after delivery?
This comes up a lot in pediatrics.
So one of the things we really like
to talk about is breastfeeding
and it’s important to understand all the
benefits for breastfeeding that occur,
both for the baby
and for the mother.
So for the baby, breastfed
babies have fewer infections.
They are less likely
to get pneumonia,
bronchiolitis and otitis
media among others.
The reason is because the mother’s
breast milk has antibodies
against common infections
already built into it.
Also, if the mother has the infection,
which is common that both the mother and
the baby would have the same infection
the mother is making antibodies not
only for herself but also for the baby.
Additionally for the baby, there is a
higher bioavailability in breast milk
of calcium, zinc and
many other nutrients.
So it’s better to get it out of breast
milk than it is out of formula.
Also, by breastfeeding, there is
improved maternal/infant bonding.
Also, there is an improved infant response
to vaccines when they’re breastfed.
There is a reduced risk of SIDS
or sudden infant death syndrome
and breastfed babies have
fewer weight gain problems.
There are also benefits for the mother.
She will have a faster weight
loss after being pregnant.
She will have faster constriction
of her uterine muscle
which will result in less
leaking after her delivery.
She will have decreased risk of breast
cancer and ovarian cancer in her life
if she breastfed her children.
Breast milk is much cheaper than formula
so she doesn’t have to pay for formula.
basically, mother is going to have
some time off from menstruation
as a result of breastfeeding.
It is somewhat effective birth control.
I wouldn’t necessarily advertise that,
but it is time off for menstruation
and sometimes moms appreciate that.
Additionally, it’s easier than bottle
feeding once the experience is there.
Bottle feeding is more
work than breastfeeding
once you know what you’re doing.
So is there a downside
Most pediatricians would say, no there
always promote breastfeeding.
I agree with them, always
but there a few very rare problems
that breastfeeding can occur.
So for example one is in women who are
a having hard time with milk coming in
or hard time with a latch.
The baby may get dehydrated.
We have absolutely seen very
rarely an infant coming in with a
very high sodium level as a
result of breastfeeding failure.
Parents should be aware of that
and if it’s not going right, they
should have someone they can call
or somewhere they can go to get
help with their breastfeeding.
Another one is sometimes breastfed
babies are more likely to get jaundiced.
That’s not really a downside, the
kids do fine and they get better
but parents should be aware that
there might be a prolonged or
a renewed episode of jaundice
in a baby who is breastfed.
Okay, let’s keep going about breastfeeding.
Breastfeeding is recommended
because the benefits are so great
and downsides are so rare.
It’s recommended over a formula
in virtually all infants.
There are, however, a few
contraindications for breastfeeding.
One is if mother is HIV
positive and the baby is
in a developed country
like the United States,
breastfeeding is not indicated.
Currently, if the mother is actively
engaged in illegal drug use,
we do not recommend breastfeeding
because that baby is now being
exposed to those drugs.
There are also some maternal
medicines for example chemotherapy
which would obviate the ability
for the mother to breastfeed.
So how do you approach a
mother about breastfeeding?
First, have a breastfeeding
policy in your hospital.
That improves likelihood of
success in breastfeeding.
Establish breastfeeding as early as
possible, within about 30 minutes of birth
and allow infants to live with the mother
in the hospital, not in a separate room.
Mother/infant skin to
skin time is important.
This is very important.
Baby will stay warm, they will bond
and breastfeeding is more successful.
In the hospitals, we should
provide lactation consultants
when needed to help
mothers with problems.
And we should provide formula companies
from giving free material to parents.
So how do you know if the infant
is getting enough breast milk?
How does the mother know if
the baby is growing or not?
The first is we should emphasize
the role of colostrum.
It is expected in the first
few days of this baby’s life
that the baby will lose weight.
The baby was born with too
much water on board anyway.
The baby was already effectively
carrying a backpack of fluid,
so that they may get by
with just eating colostrum.
Colostrum is smaller in volume,
so when the breastfeeding starts,
it’s not particularly high in volume,
but that material is incredibly
valued and filled with antibodies.
So what we expect is the
mother going to feel like
not much is going on for
the first day or two,
but she should keep trying
because on day three or four,
the milk is going to come in.
Sometimes, women report feeling a rush
or a feeling of warmth all over them
and then the milk
comes in, in power.
That’s classic and that's what we expect.
And that colostrum, although it’s
lower in volume is very valuable.
So for the first two days, we
don’t expect much from this baby.
The baby should have may
be one to two wet diapers
and really should have
one to two stools a day.
That’s classic for a breastfed baby.
The infant should not lose
more than 7% of birth weight.
So we allow a certain amount of weight loss
but it shouldn’t be much more than that.
The infant should feed
8-12 times per day.
We’re talking at least
every two to three hours.
If the infant’s going for a
long time without feeding,
that’s a problem and we
should check that out.
Lastly, the infant should regain that
birth weight within 14 days of life.
If not, we might have a problem.