37-49 HOW DO YOU PREVENT PAINFUL NIPPLES?

The nipples should be kept dry between feeds. Instead of protecting the nipples with lanolin cream, petroleum jelly (Vaseline) or masse cream, it is suggested that a little colostrum or hind milk be left to dry on the nipples after each feed. The milk has anti-infective properties and the fat protects the nipples. Do not use alcohol on the nipples. Avoid vigorous washing or soap on the nipples. Daily exposure to direct sunshine (not through glass which reduces the ultra-violet light) for 5 minutes is helpful.

It is important that the infant is correctly fixed at the breast so that the nipple is not chewed. When removing the infant from the breast, the mother should insert her little finger into the corner of the infant's mouth to break the suction.

CORRECT FIXING OF THE INFANT AT THE BREAST WILL HELP TO PREVENT PAINFUL NIPPLES

37-50 HOW SHOULD YOU TREAT PAINFUL NIPPLES?

Nipples are often painful during the first few days of breast feeding, especially if the infant is very hungry or is not fixing on the breast correctly. Do not let the infant sleep at the nipple until the nipples have toughened.

Cracked nipples are very painful and should be prevented by correctly fixing the infant to the breast and avoiding engorged breasts. Treat cracked nipples with colostrum or hind milk, sunshine and mild analgesics. Alter the position of the infant on the nipple so that it does not suck on the tender area. It may be necessary to stop feeding on that side for 24 hours and express the breast instead. Frequent short feeds when the infant is not hungry are preferable. Reassure the mother that painful nipples heal very quickly. Mothers with painful nipples need a lot of support if they are to continue breast feeding.

37-51 DO BREAST FED INFANTS NEED COMPLEMENTARY FEEDS?

Most breast fed infants do not need complementary (additional) feeds of formula. Complementary feeds may decrease the production of breast milk and the teat may confuse the infant. Only if an infant fails to gain weight, after management to improve the mother's milk supply has been tried, should complementary feeds be used. Some mothers will give complementary feeds if they have to leave their infant for more than a few hours. However, expressing milk into a bottle for the missed feed would be preferable. Expressed breast milk can be safely stored up to 6 hours in a cool place or for 48 hours in a fridge. Breast milk can be safely frozen and stored for 2 weeks in a fridge freezer or 6 months in a deep freeze. Frozen milk should be thawed slowly by placing the container in warm (not hot) water.

37-52 CAN WORKING MOTHERS CONTINUE TO BREAST FEED?

Yes. Mothers can continue to breast feed for many months while working. Breast milk can be expressed at work and this or formula is given to the infant during the day. When at home the mother breast feeds frequently. Ideally it should be possible to take the infant to work or place the infant in a creche at or near the place of work.

37-53 DO DRUGS CROSS INTO THE BREAST MILK?

Almost all drugs that the mother takes by mouth will cross into the breast milk in very small quantities that will not affect the infant. Breast feeding mothers should only take medication that is necessary.

37-54 WHEN SHOULD AN INFANT NOT BE BREAST FED?

1. If, after counselling, the mother has decided that she definitely does not want to breast feed, then the infant should be fed formula. 2. If a mother is unable to breast feed because she is separated from her infant, she should express her milk, manually or with a breast pump, for the infant to be cup fed. 3. If the mother has an inadequate milk supply despite advice and support, and if the infant is not gaining wait by 2 weeks, then complementary feeds should be started to ensure normal growth. 4. If the mother is very ill. 5. If the mother is HIV positive and decides, after counselling, to formula feed her infant.

37-55 WHAT FORMULA FEED SHOULD BE USED FOR A TERM INFANT?

A number of formula feeds are available for term infants (NAN 1, S26, Similac, Lactogen 1, SMA). They are very similar and, therefore, the milk available at the local clinic or the cheapest milk should be bought. Unaltered cows milk, evaporated milk and skimmed milk are not suitable for infants under 6 months of age. Milk creamers must never be used to feed infants.

Bottle fed infants should be fed on demand. If fed according to a schedule, most infants will need to be fed 6 times a day, at 06:00, 10:00, 14:00, 18:00, 22:00 and 02:00. After the first few weeks the 02:00 feed can be missed. Most term infants will take about 100 ml per feed after the first week.

37-56 HOW IS FORMULA MADE UP?

If a mother decides to formula feed her infant, it is very important that she knows how to mix formula correctly. She must also have a source of clean water and know how to clean a cup or bottle and teat.

A level scoop of milk powder (scraped level with a knife and not packed down) is added to 25 ml of clean water in a feeding bottle. The water should have been boiled beforehand and allowed to cool. The bottle and teat must have been cleaned and sterilised by boiling or standing in a disinfecting agent (Milton or half-diluted Jik). Shake the bottle well to mix the feed. Bottles should not be used if they cannot be cleaned properly.

One of the great dangers of formula feeds is to make the mixture too strong or too weak. If too much milk powder is added, the infant may receive too much salt which can be dangerous. If too little milk powder is added, the infant may become malnourished. Another danger is gastroenteritis caused by infected water or dirty bottles and teats. These and other problems of formula feeds can be avoided by breast feeding.

Formula fed infants should be offered a few clear feeds daily if the weather is very hot. Bottle fed infants must be held while feeding. The bottle should not be propped.

Many of the dangers of infection when using bottles and teats can be avoided if cup feeds are used instead.

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