Exam (elaborations)
CLC Section 3A & 3B
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Exam of 42 pages for the course CLC Section 3A & 3B at CLC Section 3A & 3B (CLC Section 3A & 3B)
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CLC SECTION 3A & 3B QUESTIONS ANDANSWERS
k Lactation Counseling - -observe, explore, and coach
-parents, baby, & other family members know more about their situation & resources than we do
-our job to observe, collect info, & explore mature of presenting issues, & to coach families regarding
feeding & nurturing their babies
-as we seek to understand the nature of the presenting issues, other problems & concerns may be
uncovered
-in our conceptual framework, problems & symptoms are not the same thing (for example, pain w/ BF is
a symptom of a different problem perhaps a poor latch)
-thru BF counseling we seek to ID the true nature of the underlying problems rather than only removing
the presenting symptoms
-once we have gathered enough info about the nature of the problems at hand, we can formulate
potential solutions & propose them to the family
-it is up to the family to choose the solutions they are willing to implement & to carry them out
-it's our responsibility to provide info & suggestions in an open, transparent, non-judgmental manner,
IDing strategies that may be useful for the family, sharing pros & cons of IDed strategies, all in full
acknowledgement that the family will make the final determination regarding what actions to take, if
any, to address IDed challenges
-it's our responsibility to refer families for additional clinical support or other eval as needed, if it is not
available at our workplace or within our scope of practice
-it's our responsibility to ensure adequate follow up for IDed BF problems
Normal BF - -should be enjoyable experience
-shouldnt have pain or discomfort, but they are common
-follow feeding cues signaled by REM, bringing fist to mouth, seeking food w/ lips tongue & head, smack
lips, extend tongue
-crying is late feeding cue
Getting Started w/ BF - -in first hours and days the dyad learn to BF together and move gradually from
self-attached BF to collaborative BF
,-each dyad moves in a unique pattern: one feed may be self-attachment and the next collaborative
-BF moves into more collaborative after baby is able to locate the breast
-both will become more & more comfortable w/ collaborative feeding as they learn together
-baby's arms should not cross over his/her body, but should embrace the breast
-baby's hands knead breast while suckling, do not swaddle hands away
-shouldn't be pain while nursing; after feed. nipple shouldn't be misshapen, abraded, fissured, bruised,
or blanched
-if there is pain, baby should be gently removed and allowed to relatch
Self-Attached BF - -healthy baby should be dried after birth & placed on chest for prolonged S2S
-dyad covers w/ warm blanket
-mom & newborn assessment, eye care, & other procedures are done w/ baby in S2S
-babies warm better in S2S compared to electric warmers (breasts will increase and decrease in temp
according to baby's needs)
-allow newborn baby to find breast & self attach. This may take more than 2 hours when labor analgesia
has been used; do not force baby to breast, doing so may stress baby, decrease willingness, & cause
baby to place tongue on roof of mouth
S2S 9 Distinct Behaviors in Prep for Feeding - -birth cry
-relaxation
-awakening
-activity
-rest
-crawling/sliding
-familiarization
-suckling
-sleeping
Collaborative BF - -as the baby seeks the breast the parent gently assists
Sequence of Successful Feeding - -newborn held S2S or close to breast so feeding cues may be observed
-when baby has cues, baby is brought to breast
-breast should be at normal angle (not held or shaped w/ hand; if large breast put rolled up towel under
breast, do not fold breast upward to see the nipple)
,-collaborative BF may bb initiated when baby exhibits appropriate cues: rooting, increasing
alertness/REM, flexing of legs & arms, mouthing w/ little sucking motions, attempting to bring hand to
mouth, sucking on fist or finger, mouthing motions of lips and tongue
-crying is late feeding cue because it does not usually begin in full term babies until more subtle cues
have failed to elicit the parents attention
-less mature & more disorganized babies may pass quickly from deep sleep (no REM) to crying
-when using collaborative BF strategy, baby is supported by the frame of the parent's body which
provides support needed to keep the baby at the breast
-parent finds a comfortable posture & makes breast accessible to baby
-baby is allowed the freedom to achieve pain-free suckling w/ maximal milk transfer
-BF sessions are best ended by the baby, when feeding ends baby is relaxed, hands are open, arms are
floppy, brow is smooth, toes are curled
Baby Position At Breast For Maximal Milk Transfer - -baby is near breast
-baby's shoulders are supported at base of the neck
-no pressure on back of baby's head, baby must be able to tilt head
-baby's body rotated toward parent's chest (tummy to mummy)
-baby moved towards breast, lining up nose at nipple
-breast is not moved to baby; breast should lie in natural position & baby be brought to breast
-start feed w/ nose opposite nipple assists baby to orient to breast via well-developed sense of smell &
aligns mouth at breast when baby's head tilts back
-as baby chin comes closer to breast, he will gape, opening mouth very wide as head tilts back (if baby
fails to gape, repeat this maneuver)
-consider additional S2S to improve baby's motor state organization for baby who fails to gape or nurse
-do not push nipple into baby's mouth, doing this can result in optimal positioning of nipple or
appropriate compression & release of breast & nipple tissue (can cause pain, damage, & slow flow of
milk)
-head tilt allows lower lip to seal to breast first followed by upper lip
-baby's mouth will appear off-center when compared w/ areola, baby's lower lip will be against breast
much father from nipple than upper lip (asymmetric latch)
-baby seals to breast & begins to suck rapidly (could be 8 or more sucks to 1 swallow), then shifts into
pattern of 2 sucks to 1 swallow or 1 suck to 1 swallow
-2:1 or 1:1 suck to swallow is a time of greater milk transfer; these are interspersed w/ more rapid
sucking sequences & occasional rest periods
, -after colostral stage, baby can transfer several oz of milk in very few minutes when appropriately
latched & hungry
-there is no right length of feed to ensure adequate milk transfer, however babies with consistently short
(<5 min) or long (>20 min) feeds should be assessed to ensure adequate milk transfer
Proof of Success of BF Baby - -baby who is responsive & interactive
-growing well (about an oz a day after 5th day)
-producing at least 6 wet and 4 dirty diapers starting on day 4 and continuing into the early weeks
Concern: Baby Won't Latch: Feeding Refusal That is Continuous - -baby refuses to feed from breast; baby
won't latch, or will & immediately pull off & cry
*Ask yourself: -have baby's weight gain & output been appropriate?
-does baby look dehydrated, jaundice, or malnourished? does baby seem alert & active or lethargic?
-are breasts so full & hard that baby is unable to form teat?
-has baby been forced to breast w/ pressure on back of head?
-what is family's response to baby's refusal?
-if onset is sudden & refusal is continuous, what has changed recently, (i.e. has milk volume increased,
change in family routine, nursing parent taking new meds, nutritional supplements, etc)
*Watch out for: -presence of feeding cues prior to feeding
-process used to bring baby to breast
-visible signs of pain for either members of dyad
*What to do about it: -if breasts are hard & full, sufficient softening should be done before attempting to
feed
-is aggressive latch techniques are used, or pressure on back of baby's head do S2S & allow baby to self-
attach
-baby has trouble w/ increased volume or milk flow, make sure baby is able to move head away from
breast & let milk spray
-observe feed using feeding observation checklist
-is baby refuses to latch, ask that baby be held S2S until feeding cues are observed & baby moves toward
breast
-encourage bringing baby close to breast immediately upon observation of feeding cues, & allow baby to
find breast and self attach (babies need to familiarize before latching as they learn sounds & smells &
tastes of feeding at breast)
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