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Stages of Lactation Lactogenesis I: Development of the breast to prepare for breastfeeding (Week 16 of pregnancy - day 2 postpartum) Breast size increases as epithelial cells differentiate into secretory cells for milk production. Lactogenesis II: Onset of lactation (Day 3 postpartum - day 8 postpartum) Delivery of the placenta triggers a rapid drop in progesterone and elevated levels of prolactin The junction complexes between the alveoli close Onset of copious amounts of breastmilk production occurs Lactogenesis Lidocaine 3% HCL Cream (CidalEaze)- Multum (Galactopoiesis): Maintenance of established lactation (Day 9 postpartum - involution) The established secretion of breastmilk is now controlled by the autocrine system Often discussed in terms of supply versus demand.

The tongue will drop from the roof of the mouth, moving forwards to lick the nipple. It is important to note that a crying infant will position their tongue in their palate, and attempting to place an infant to the breast in this state inhibits the rooting reflex and the development of sucking.

Sucking and swallowing occurs at a frequency of at least once per second when breastmilk is actively flowing but will increase if the milk flow lessens or ceases. Feeding therefore begins as short and fast bursts of sucking, but progresses to long help ed continuous sucks as the feed is Lidocaine 3% HCL Cream (CidalEaze)- Multum. Suck and swallow cycle: The infant draws the nipple, areola and underlying breast tissue deep into their mouth, creating a seal with their lips and Lidocaine 3% HCL Cream (CidalEaze)- Multum. The nipple is held between the upper gum and the tongue that is covering the lower gum.

Peristaltic motions of the tongue form a Lidocaine 3% HCL Cream (CidalEaze)- Multum that moves milk to the back of the oral cavity to stimulate swallowing. The soft palate rises and closes off nasal passages, with the larynx moving up and forward to close Lidocaine 3% HCL Cream (CidalEaze)- Multum trachea and propel milk into the oesophagus.

The larynx moves to the previous position and the infant lowers their jaw to begin a new cycle. As neonates are predominately nose-breathers, breathing continues throughout the cycle, however if the bulk of the milk bolus enters the pharynx at the onset of swallowing, brief swallowing apnoea Lidocaine 3% HCL Cream (CidalEaze)- Multum. If further apnoeas occur with feeding, or the feeds are disorganised, pacing and review by Speech and Language Therapy may be required.

Admission Documentation On Lidocaine 3% HCL Cream (CidalEaze)- Multum each neonate, infant or child will have a feeding history documented within by the admitting doctor and nurse. This includes: Intention to breastfeed or breastfeeding history Current nutritional requirements and feeding regime, including any recent alterations to this pattern Infant growth, hydration and development Medications and allergies Lidocaine 3% HCL Cream (CidalEaze)- Multum Reported feeding difficulties for the patient or mother If the family do not wish to breastfeed, any requested milk substitutes should be noted and consent should be obtained and documented Consent should also be sought for the use of dummies for non-nutritive sucking Where possible, breastfeeding mothers are encouraged to stay with their child during admission to facilitate unrestricted breastfeeding.

Any circumstances that might make it difficult for the mother to be present during the admission should be discussed, and the times that she will be available to optimise breast feeding documented. Growth monitoring Anthropometric measurements, including analysis of weight, head circumference and length, are an integral aspect to the Prefest (Estradiol, Norgestimate)- Multum and nutritional management of neonates, infants and children.

Twice weekly measurements occur on Sunday night for discussion on Monday ward round, and Wednesday night for discussion on Thursday ward round. Please see a member of the local nursing education team for further information and assistance.

Demand breastfed infants may have Lidocaine 3% HCL Cream (CidalEaze)- Multum recorded more frequently to gauge a more accurate assessment of feeding. Management Lidocaine 3% HCL Cream (CidalEaze)- Multum Support Readiness to feed Beginning oral feeding is a team decision that places the infant and their family at the centre of the care, and as such, parents should be included in these early discussions. Clinically, this decision is based on the medical status of the infant, the ability to maintain respiratory and cardiovascular stability, to remain alert for feeding, to coordinate suck, swallow and breathe patterns, to communicate hunger and fullness, and to cope with the positioning and handling associated with feeding.

Communicating feed timing with parents is vital. This ensures that the infant and mother are provided with maximum opportunities for breastfeeding. Hunger cues include stirring before a feed or at feed times, increasing movements and becoming more active, rooting reflexes, hand to mouth movements, sucking, opening the mouth in response to touch. Crying is a late sign of hunger. COCOON page with Baby Feeding Cues Poster and Circle Of Care Optimising Outcomes for Newborns (COCOON).

Disengagement cues include cessation of surgeons, closing their mouth, spilling milk from their mouth, turning their head away from the breast, putting a hand up, gagging and pushing the nipple out of their mouth with their tongue.

While a rapid transition to sleep may be a disengagement cue, some infants who are just learning to breastfeed may need to be woken or prompted during their feed. Unwrapping the infant, exposing and stimulating a foot, or stroking the jaw line may assist them to continue showing interest in their feed. Readiness to feed should be documented within the feed assessment (refer to below). Positioning and attachment The health professional should Lidocaine 3% HCL Cream (CidalEaze)- Multum skilled in assisting mothers to consistently achieve correct positioning and attachment at each breast.

Mothers will then feel more confident and skilful in their ability to independently attach and position their baby to their breast to feed. To avoid muscular strain and soreness, it is important that the mother finds a comfortable position Lidocaine 3% HCL Cream (CidalEaze)- Multum breastfeed. Ensure privacy is facilitated. Reclined Position: The mother lies in a semi-reclined position, well supported with pillows.

This position is particularly useful if the baby Lidocaine 3% HCL Cream (CidalEaze)- Multum having difficulty attaching or require assistance for fast milk flow. Cradle Hold: this is the most common feeding position. In the cross-cradle hold, the baby is held using the opposite arm to the breast being used. To ensure that feeding is not a negative experience, break the cycle and settle the baby before again trying at the breast. Ensure that the baby has sufficient postural support Lidocaine 3% HCL Cream (CidalEaze)- Multum stabilise their position at the breast.

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