ISBN-10:
1581109512
ISBN-13:
9781581109511
Pub. Date:
10/01/2015
Publisher:
American Academy of Pediatrics
Breastfeeding Telephone Triage and Advice / Edition 2

Breastfeeding Telephone Triage and Advice / Edition 2

by Maya Bunik

Other Format

Current price is , Original price is $69.95. You
Select a Purchase Option (Spiral Bound)
  • purchase options
    $57.37 $69.95 Save 18% Current price is $57.37, Original price is $69.95. You Save 18%.
  • purchase options

Overview

Breastfeeding Telephone Triage and Advice / Edition 2


Created by a leading breastfeeding and phone care practitioner, this newly revised problem-solver helps nurses, lactation professionals, and other medical staff confidently advise breastfeeding mothers. It is ideal for use with the acclaimed Pediatric Telephone Protocols.

Key features include
- Completely updated and revised
- Enhanced from black-and-white to more than 50 illuminating color photos to help triage professionals zero in on caller problems
- More information included on maternal depression, which a high risk for early cessation
- New protocols on child care policies/suggestions, separate from returning to work and early weight loss at birth hospital, first week
- Stresses the importance of support groups vs. the abundance of apps and blogs that perpetuate myths

Important content updates include:
- Swaddling and safe sleep added to co-sleeping protocol
- More information on tongue tie
- Update on idiopathic granular mastitis and breast pain
- Caution in exclusive pumping protocol
- New chart on donor human mild vs commercial fortifiers
- New chart on making the office breastfeeding friendly
- Early weight loss graphs and information added to the low milk supply protocol
- Special circumstances added like placental encapsulation, tattoos, etc.

Product Details

ISBN-13: 9781581109511
Publisher: American Academy of Pediatrics
Publication date: 10/01/2015
Pages: 117
Sales rank: 981,856
Product dimensions: 8.60(w) x 10.90(h) x 0.40(d)

About the Author


Maya Bunik, MD, MSPH, FABM, FAAP, is a professor of pediatrics at the University of Colorado School of Medicine and director of the Primary Care Teaching Clinic at Children’s Hospital Colorado. As a practicing pediatrician, she has been helping mother-baby pairs with breastfeeding for more than 25 years. Her experience also includes serving as medical director of the Pediatric Advice Line Call Center at Children’s Hospital Oakland.

Read an Excerpt

CHAPTER 1

ALCOHOL USE (MOTHER)

Definition

Alcohol transfers readily into human milk according to the mother's blood alcohol level. Peak levels usually are seen within an hour of ingestion.

TRIAGE ASSESSMENT QUESTIONS

Go to ED Now

• Symptoms of irritability or sedation in baby

Reason: evaluation of baby for alcohol intoxication

Home Care

* Mother ingested one drink — glass of wine (5 ounces), beer (12 ounces), or cocktail (1.5

* ounces of 80 proof) — and feels unaffected.

Mother ingested more than the safe limit of one drink in 2 hours.

HOME CARE ADVICE

(1) Single "Celebratory" Alcoholic Beverage: An occasional glass of wine (5 ounces), beer (12 ounces), or cocktail (1.5 ounces of 80 proof) is acceptable. You should nurse first, have the drink, and then wait at least 2 hours. If you feel affected by the drink and your breasts feel uncomfortably full, you should pump and dump the milk.

(2) Drinking in Excess: If you want to drink more, you should pump and dump for at least 8 hours or until you no longer feel affected by the alcohol. Waiting about 2 hours per drink is required for complete metabolism of alcohol in a 180-pound woman. Once your blood level is down, your milk level is also down and, therefore, safe for your baby. Only time eliminates alcohol from your system; drinking water or caffeine, exercising, or pumping more does not work.

(3) Test Strips for Alcohol: Because some mothers cannot self-assess if they feel affected, test strips are growing in popularity. Hand-expressed drops of milk can be placed on the strip, or the strip can be dipped into a small sample of human milk. Milkscreen home test for alcohol in breast milk (available at Target, Walmart, and Amazon) detects the presence of alcohol at 13.1 mg/dL or greater in human milk.

BACKGROUND INFORMATION

• It is well-known that alcohol is hazardous to the fetus in pregnancy.

• If careful, the mother can consume alcohol in moderation without harm to her nursing baby.

• Low-level drinking during breastfeeding is not associated with shorter breastfeeding duration or adverse developmental outcomes in infants at 12 months.

• Heavy drinking by the mother (more than one drink in 2 hours) may affect the ability to safely care for her baby.

• Alcohol inhibits oxytocin release and the letdown process while it is in the mother's bloodstream, so suggestions that drinking beer can enhance milk supply are incorrect (previously, the yeast and barley in home brew was felt to be a galactagogue).

ALLERGY (SPECIAL CIRCUMSTANCES)

Definition

Variety of symptoms attributed to intake of milk, such as eczema, rash, or hives; wheezing; congestion; red, itchy eyes; irritability or colic; vomiting; constipation or diarrhea; or green stools with mucus or blood.

Current evidence does not support maternal dietary restrictions during pregnancy and lactation, even for peanuts or tree nuts.

TRIAGE ASSESSMENT QUESTIONS

See Other Protocol

• Fussiness, Colic, and Crying in the Breastfed Baby on page 41

• Spitting Up (Reflux) on page 96

• Gassiness in the Breastfed Baby on page 44

See Within 3 Days in Office (by Appointment)

• Baby having any symptoms or signs suspicious of allergy, such as eczema, rash, or hives; wheezing; congestion; red, itchy eyes; irritability or colic; vomiting; constipation; or diarrhea

Reason: possible allergy to a substance transmitted in mother's milk, such as bovine milk proteins

• Any blood or mucus in stools

Reason: possible allergy

• Family history of allergies

Reason: possible allergy

• Extremely fussy most of the time, not just during late afternoon and evening hours as with more traditional or usual colic periods

Reason: possible allergy

Caution: Conclusions about allergy to dairy should not be made over the telephone because many of these symptoms can occur with other conditions. Dairy allergy occurs in only 2 to 3 of 100 babies. If mother continues to be concerned about possible allergic cause, she can bring diaper or stool sample to an office visit to be tested for blood.

Home Care

* Trial elimination of dairy from mother's diet

HOME CARE ADVICE

(1) Dairy Suspicion: If you feel strongly about dairy as cause of symptoms in your baby,

• First eliminate drinking milk.

• If no improvement with milk elimination, next eliminate all milk products, including cheese and ice cream, for 2 weeks to see if it causes any change in your baby's behavior or symptoms.

• Read ingredients of all food products and avoid products that contain milk powder, casein, or whey (all of which can be found in many prepared foods).

• These diets are difficult to maintain and can be associated with unnecessary early breastfeeding cessation.

(2) Call Back If: Your baby seems sick, or home care advice is not helping.

BACKGROUND INFORMATION

• Allergy symptoms in a baby who ingests human milk when the mother has ingested bovine milk, artificial colors or preservatives, eggs, wheat, chocolate, or nuts.

• Food hypersensitivity is not immunoglobulin E mediated (not anaphylaxis).

• Human milk has been found to be protective, or at least may delay presentation, of allergic manifestations of eczema, wheezing, asthma, and allergies.

• Usually occurs in the context of a family history of food allergies, but not always.

BITING BREAST, ONSET AT 6 MONTHS (BABY, LATER)

Definition

Infant biting at breast when breast is offered or at the end of a feeding when nursing is finished.

Infant cannot bite and drink milk at the same.

TRIAGE ASSESSMENT QUESTIONS

See Other Protocol

• Nursing Strike or Refusal on page 84

• Sore Nipples on page 93

See Today or Tomorrow in Office (by Appointment)

• Breast or nipple wound from bite that looks infected

Reason: may need antibiotics

Home Care

* Infant biting at beginning of feed

Reason: infant offered breast but not hungry

* Infant biting at end of feed

Reason: infant finished with feeding

HOME CARE ADVICE

(1) Disengage Biting Infant: Make sure your infant comes off quickly from the breast. Biting needs to be addressed immediately.

(2) Indicate Firmly, "No Biting": Touch your infant on the lips and say, "No biting." If you reacted by screaming or crying, your infant may have received the message. Some infants even refuse to go to the breast for a short period (see Nursing Strike or Refusal on page 84).

(3) "Disappear": You should quickly set your infant down in a safe place and leave the room.

(4) Anticipate Possible Biting During Future Feedings: An infant needs to be hungry for nursing. Once finished, your infant needs to come off quickly.

(5) Watch for Infection: If bite breaks the skin, watch the bite mark on the breast closely because of increased risk of infection.

(6) Call Back If: Advice not helping. See within 3 days in office (by appointment).

BACKGROUND INFORMATION

• Prior to 6 months of age, crying or fussing was associated with hunger but now may indicate just wanting to be held or played with. Putting the older infant to the breast when not hungry is not uncommon and sorting out this transitional period can be challenging.

• Simultaneous tooth eruption may cause the infant to exhibit teething behaviors and make him more likely to bite.

BREAST MASS (MOTHER)

Definition

Lump or change in the breast that does not improve with nursing or pumping (Plugged ducts and mastitis are the most common reasons for breast mass.)

TRIAGE ASSESSMENT QUESTIONS

Go to ED Now (or to Office With PCP Approval)

• Fever, chills, or feel systemically ill

Reason: if mastitis, may need treatment with oral antibiotics or hospitalization for intravenous antibiotics

See Other Protocol

• Breast Pain (for mastitis and plugged duct) on page 6

• Color Change of Human Milk on page 16

See Today or Tomorrow in Office (by Appointment)

• Localized redness on skin surface or tenderness of breast

• Pain with palpation

Reason: if mastitis, may need antibiotics

See Within 3 Days in Office (by Appointment)

• New lump

R/O fibrocystic disease versus other mass

• Rubbery mass

R/O lipoma versus other mass

• Soft and squishy or feels as if it is fluid filled

R/O galactocele

• Lumpy and tender breasts all over

R/O fibrocystic disease of breast, granulomatous mastitis Reason: not sure mother can discern these aspects of lump, so presence of any new lump necessitates evaluation and may need ultrasound or biopsy

Home Care

* Localized tender cord of tissue

R/O plugged duct

* Lump that improves with pumping

R/O plugged duct

* History of trauma to the breast, inflammation, bruising, or hematoma in breast tissue

HOME CARE ADVICE

(1) Pain Control: You may take ibuprofen (eg, Advil, Motrin); because of its anti-inflammatory properties, it is the best choice for pain. Acetaminophen (eg, Tylenol) can be added if needed. Both medications are compatible with nursing.

(2) Plugged Ducts

Warm Comfort: Try a warm pack (eg, hot water bottle, barley pack that can be put in microwave for this use) on the plugged duct site prior to feeding or pumping.

Massage: Apply direct pressure to the breast, pushing thickened area toward the nipple (almost pushing it out) while your baby is feeding there or while anually or electronically expressing milk.

Lecithin: Some clinicians recommend soy lecithin for plugged ducts, but no research studies support use of this herbal preparation. Soy lecithin is a naturally occurring fatty acid and available in capsule or liquid form. Dose is 1 tablespoon of granules once daily or 1 to 2 capsules (1,200 mg each) 3 to 4 times a day.

Good-Fitting Bra: Be sure to wear a good-fitting supportive bra; areas of tightness can impede milk flow.

Trauma of the Breast: If history of breast trauma, bruising hematoma or fat necrosis may be associated. These should all resolve with time.

(3) Call Back If: Advice not helping. See within 3 days in office (by appointment).

BACKGROUND INFORMATION

Causes

Solid Tumor: Fibroadenoma, including ectopic breast adenomas (axilla, chest wall, vulva); lipoma.

Post-mastitis Abscess.

Papilloma: Benign epithelial tumor.

Fibrocystic Disease: Hormonally mediated benign proliferation of alveolar system with variable degrees of pain, tenderness, and palpable thickening or nodules.

Granulomatous Mastitis: Usually presents as mastitis or a breast mass and requires a biopsy for diagnosis; usually requires anti-inflammatory drugs, such as prednisone or methotrexate, for treatment (very rare).

Galactocele: Benign cystic tumor containing milk or a milky substance in the breast caused by a protein plug that blocks off the outlet; may be associated with oral contraceptive use.

Inflammation Due to Trauma, Hematoma.

Fat Necrosis: Benign condition that consists of fatty tissue that has been bruised or injured in the breast.

Cancer: Should be considered in persistent breast masses, but it is reassuring that only 3% of those with diagnosed breast cancer are pregnant or lactating.

BREAST PAIN (MOTHER)

Definition

Pain of the larger breast area not confined to nipple region

TRIAGE ASSESSMENT QUESTIONS

Go to ED Now (or to Office With PCP Approval)

• Fever, chills, or feel systemically ill

Reason: if mastitis, may need treatment with oral antibiotics or hospitalization for intravenous antibiotics

See Other Protocol

• Sore Nipples (for Raynaud disease of the nipple/ vasospasm) on page 93

• Breast Mass on page 4

• Engorgement on page 25

See Today or Tomorrow in Office (by Appointment)

• Localized redness on skin surface, generalized tenderness of breast, or both

Reason: may mistake these symptoms for engorgement and may not be able to self-assess to rule out mastitis adequately

• Pain with palpation

Reason: if mastitis, will need outpatient antibiotics

See Within 3 Days in Office (by Appointment)

• Nipples or areolar area pink, shiny, or flakey

R/O yeast infection

• Shooting (from nipple to back) or burning pain

R/O yeast infection

• Maternal antibiotics at time of delivery

R/O yeast infection

• Mother prone to yeast infections

R/O yeast infection

• Maternal diabetes

R/O yeast infection

• Chronic breast tenderness despite treatment with antibiotics or antifungals

R/O bacterial infection of lactiferous ducts or coexisting bacterial and candidal infections

• Eczema-like appearance to nipples or skin over breast (dry, red, itchy)

R/O eczema

• Exposures to irritant (eg, soaps, laundry detergent with dye/fragrance)

R/O contact dermatitis

• Unilateral nipple that looks as if it has eczema

R/O Paget disease

Home Care

Feeling of fullness or hardness to both breasts

R/O engorgement

One-sided, localized pain to a specific area within breast

R/O plugged duct

Palpable lump or cord of tissue

R/O plugged duct

HOME CARE ADVICE

(1) Pain Control: You may take ibuprofen (eg, Advil, Motrin); because of its anti-inflammatory properties, it is the best choice for pain. Acetaminophen (eg, Tylenol) can be added if needed. Both medications are compatible with nursing.

(2) Comfort Measures: Cold pack can be placed on breasts for comfort.

(3) Pain With Letdown: Some clinicians recommend evening primrose oil, an herbal preparation that is rich in alpha-linolenic acid, although no research studies support its use.

(4) Engorgement Suspected

Frequent Feedings: Breastfeed approximately every 2 hours (10–12 feedings in 24 hours). If you are too uncomfortable to breastfeed or your baby cannot latch on because of engorged breasts, express milk manually or with a hand or mechanical pump at least every 3 hours (but more frequently if able).

Warm Comfort: Taking a warm shower or placing a warm washcloth on breasts before nursing may help get milk flowing.

Cold Comfort: More severe engorgement may require cool compress, such as a gel or an ice pack. Refrigerated, raw, clean cabbage leaves may also provide relief because of their coolness and ability to shape around the breast.

Reverse-Pressure Softening Technique: Gentle 2-handed pressure on the breast to push edema away from the areola may help your baby latch better.

(5) Plugged Duct Suspected

Warm Comfort: Try a warm pack (eg, hot water bottle, barley pack that can be put in microwave for this use) on the plugged duct site prior to feedings or pumping.

Massage: Apply direct pressure to the breast, pushing thickened area toward the nipple (almost pushing it out) while your baby is feeding at the breast or while manually or electrically expressing milk.

Lecithin: Some clinicians recommend soy lecithin for plugged ducts, but no research studies support use of this herbal preparation. Soy lecithin is a naturally occurring fatty acid and available in capsule or liquid form. Dose is 1 tablespoon of granules once daily or 1 to 2 capsules (1,200 mg each) 3 to 4 times a day.

Good-Fitting Bra: Be sure to wear a good-fitting supportive bra; areas of tightness can impede milk flow.

(6) Check Pump Settings: If pumping ensure that suction settings are at a comfortable level. Many mothers assume that "max" level is better.

(7) Call Back If: Advice not helping. See within 3 days in office (by appointment).

(Continues…)


Excerpted from "Breastfeeding Telephone Triage and Advice"
by .
Copyright © 2019 Maya Bunik.
Excerpted by permission of American Academy of Pediatrics.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

Table of Contents


Triage Assessment Questions
A
Alcohol Use
Allergy
B
Biting Breast, Onset at 6 Months
Breast Mass
Breast Pain
Breast Pain, Chronic >1 Week
Breastfeeding in the First Few Weeks: Simplify Your Life (Advice Only)
Breastfeeding Station Supplies (Advice Only)
C
Child Care and Breastfeeding (Advice Only)
Clicking or Noisy Nursing
Color Change of Human Milk
Constipation in the Breastfed Baby
Contraception, Lactation Amenorrhea Method (Advice Only)
Cosleeping/Bed-Sharing and Breastfeeding (Advice Only)
D
Distraction, Onset at 4 Months
E
Early Weight Loss, Birth Hospital or First Week
Emotional Symptoms With Letdown
Engorgement
Environmental Exposures and Toxins
Exclusive Pumping
Expression of Human Milk: Pumping, Parts and Cleaning Equipment, Hand Expression(Advice Only)
F
Fathers (Advice Only)
Feeding More Frequently
Feeding the Baby With Cleft Lip or Palate
Feeding the Baby With Hypotonia
Feeding the Baby With Trisomy 21 (Down Syndrome)
Fortification of Human Milk Recipes (Advice Only)
Fussiness, Colic, and Crying in the Breastfed Baby
G
Gassiness in the Breastfed Baby
I
Itching of the Breast/Nipple Area
J
Jaundice, Newborn
L
Late Preterm Newborn
Lifestyle or Personal Care Questions (Advice Only)
Long-term Breastfeeding (Advice Only)
Low Milk Supply
Low Milk Supply in Older Baby >6 Months
M
Marijuana Use
Maternal Anesthesia/Analgesia (Advice Only)
Maternal Contraindications/Causes for Concern With Breastfeeding (Advice Only)
Maternal Illnesses (Advice Only)
Maternal Ingestion of Foods and Herbs (Advice Only)
Maternal Medications (Advice Only)
Maternal Methicillin-Resistant Staphylococcus Aureus
Maternal Postpartum Depression
Maternal Postpartum Vaginal Bleeding
Maternal Smoking and Cessation
Milk Leaking From Newborn’s Breasts (Galactorrhea)
Milk Storage and Return to Work/School
Mistaken Milk Ingestion, Milk Sharing
Multiples (Advice Only)
N
Newborn Contraindications to Breastfeeding (Advice Only)
Nipple Abnormality: Flat/Short, Inverted, Large, or Bulbous
No Latch or Inability to Latch
Nursing Strike or Refusal
Nursing With Pregnancy
O
Overactive Letdown/Overabundant Milk Supply
P
Pacifiers and Slow-Flow Nipples (Advice Only)
R
Referral to Local Resources (Advice Only)
Refusing Bottle, Preferring to Nurse
S
Sleepy Newborn
Sore Nipples
Spitting Up (Reflux)
Substances of Abuse (Illicit Drugs)
T
Tandem Nursing
Taste Change of Human Milk
Tongue-tie
V
Vitamin D Supplementation
W
Weaning
 
Appendixes
Appendix A. Breastfeeding Touch Points for Overcoming Obstacles to Exclusivity....... 99
Appendix B. Quick Reference for Pain With Breastfeeding.......................................... 103
References for All Protocols........................................................................................... 105

Customer Reviews

Most Helpful Customer Reviews

See All Customer Reviews