Postnatal Care Infant Feeding and Maternal Nutrition in Postnatal Care

7/23/2019 Postnatal Care Infant Feeding and Maternal Nutrition in Postnatal Care

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Infant feeding and maternalnutrition in postnatal care

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Infant feeding and maternal nutrition in postnatal care NICEPathways

Postnatal care pathwayCopyright NICE 2015.

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1 Women and babies

No additional information

2 Maternal health and nutrition

A healthy diet

Advise mothers that a healthy diet is important for everyone and that they do not need to modify

their diet to breastfeed.

Vitamin D

Ensure health professionals recommend vitamin D supplements

Local authorities, primary care and clinical commissioning groups should:

Ensure computerised prompts on vitamin D are integrated into health and social care

systems.

Ensure health professionals recommend and record vitamin D supplement use among at-

risk groups [See page 11] (and other family members, as appropriate) whenever possible.

This could take place during registration appointments with new patients in generalpractice, flu, other vaccine and screening appointments. It could also take place during

routine appointments and health checks including, for example:

NHS Health Check

diabetes check-ups

falls appointments and check-ups

health assessments for looked-after children

the first contact with someone who is pregnant

antenatal and postnatal appointments

medicine use and prescription reviews

health visitor appointments

developmental checks for infants and children.

Developers of standardised electronic and handheld maternity notes and developers of

personal child health records (the 'red book') should add specific questions about the use of

vitamin D supplements.



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Testing vitamin D levels

Health professionals should not routinely test people's vitamin D status unless:

they have symptoms of deficiency

they are considered to be at particularly high risk of deficiency (for example, they have very

low exposure to sunlight)

there is a clinical reason to do so (for example, they have osteomalacia or have had a fall).

Increase availability of vitamin D supplements for at-risk groups

Local authorities should ensure vitamin D supplements containing the recommended reference

nutrient intake are widely available for all at-risk groups by:

Establishing arrangements with a range of settings to promote and distribute them. This

could include local pharmacies, children's centres, midwifery and health visiting services

and GP reception areas.

Considering providing free supplements for at-risk groups.

Encouraging pharmacies and other outlets selling food supplements (such as

supermarkets) to stock the lowest cost vitamin D supplements and promote them to at-risk

groups.

Ensure improvements in the availability of vitamin D supplements are supported by local

awareness-raising activities (see raise awareness of the importance of vitamin D

supplements and training and professional development in the NICE pathway on increasing

vitamin D supplement use among at-risk groups).

Prescribing medication

Health professionals should discuss the benefits and risks associated with any prescribed

medication and encourage the mother to continue breastfeeding, if reasonable to do so. In most

cases, it should be possible to identify a suitable medication which is safe to take during

breastfeeding by analysing pharmokinetic and study data. Appendix 5 of the 'British nationalformulary' (BNF) should only be used as a guide as it does not contain quantitative data on

which to base individual decisions.

Health professionals should recognise that there may be adverse health consequences for both

mother and baby if the mother does not breastfeed. They should also recognise that it may not

be easy for the mother to stop breastfeeding abruptly and that it is difficult to reverse.



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3 Formula feeding

Commissioners and managers should ensure mothers have access to independent advice from

a qualified health professional on the use ofinfant formula. This should include information on

the potential risks associated with formula feeding and how to obtain ongoing advice at home.

Midwives should ensure mothers who choose to use infant formula are shown how to make up

a feed, store and warm formula and how to clean and sterilise bottles and teats before leaving

hospital or the birth centre, or before the mother is left after a home birth. This advice should

follow the most recent guidance from the Department of Health about bottle feeding.

Encourage parents and carers to use a bottle for expressed breast milk, infant formula or cooled

boiled water only.

Discourage parents and carers from adding sugar or any solid food to bottle feeds.

Advise mothers who choose not to breastfeed that there is insufficient evidence to suggest that

infant formula based on partially or extensively hydrolysed cow's milk protein helps to prevent

allergies.

Quality standards

The following quality statement is relevant to this part of the pathway.

Postnatal care quality standard

6. Formula feeding

4 Breastfeeding

Attachment and positioning

Advise women of the following signs of good attachment and positioning:

the baby's mouth is wide open

there is less areola visible underneath the chin than above the nipple

the baby's chin is touching the breast, the lower lip is rolled down and the nose is free

there is no pain.



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If the baby is not attaching effectively, advise teasing the baby's lips with the nipple to open the

mouth.

Review attachment and positioning if breastfeeding causes pain or discomfort.

Successful feeding

Encourage unrestricted breastfeeding frequency and duration.

Reassure women about breast milk supply and help them gain confidence.

Advise women that babies will stop feeding when satisfied.

Advise women of the signs that a baby is successfully feeding:

swallowing is audible and visible

there is a sustained rhythmic suck

the arms and hands are relaxed

the mouth is moist

regular soaked/heavy nappies.

Ensure a mother can demonstrate how to position and attach the baby to the breast and can

identify signs that the baby is feeding well. This should be achieved (and be documented)before she leaves hospital or the birth centre (or before the midwife leaves the mother after a

home birth).

Offer additional breastfeeding support to women who have had a narcotic/general anaesthetic,

a caesarean or delayed contact with their baby.

Ensure breast pumps are available for women who have been separated from their babies and

give instruction on how to use them.

Advise mothers with a family history of allergy to feed the baby only on breast milk. For current

dietary advice see NHS Choices.

Reassure women that they may feel:

brief discomfort at the start of feeds in the first few days; this is not uncommon but should

not persist

softening of their breast during the feed

no compression of the nipple at the end of the feed



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relaxed and sleepy.

Expressing and storing breast milk

Show all breastfeeding mothers how to hand-express breast milk. Advise mothers that

expressed milk can be stored for:

up to 5 days in the main part of a fridge, at 4C or lower

up to 2 weeks in the freezer compartment of a fridge

up to 6 months in a domestic freezer, at minus 18C or lower.

Advise mothers who wish to store expressed breast milk for less than 5 days that the fridge

preserves its properties more effectively than freezing.

Advise mothers who freeze their expressed breast milk to defrost it in the fridge and not to re-freeze it once thawed. Advise them never to use a microwave oven to warm or defrost breast

milk.

Quality standards



5. Breastfeeding

5 Common breastfeeding concerns

Concern Action

Cracked or painful

nipplesAssess attachment and positioning. If pain persists, consider thrush.

Engorged breastsAdvise frequent unlimited feeding, breast massage, hand expression,

analgesia and that the woman has a well-fitting bra.



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Mastitis

Offer assistance with attachment and positioning and advise woman to

continue breastfeeding/hand expression, gently massage affected

breast(s), take paracetamol and increase fluid intake. Advise woman to

contact you urgently if it lasts more than a few hours.

Mastitis lasting

more than a few

hours

Consider antibiotics (urgent action).

Inverted nipples Give extra breastfeeding support.

Breastfeedingconcerns despite

review of

attachment and

positioning

Evaluate for ankyloglossia (urgent action).

Perceived

breastmilk

insufficiency

Reassure woman, review attachment and positioning and evaluate baby's

health.

Sleepy babyAdvise skin-to-skin contact or massage of baby's feet. If no improvement,

assess general health.

Ankyloglossia

NICE interventional procedures guidance

NICE interventional procedures guidance makes recommendations on whether interventional

procedures used for diagnosis or treatment are safe enough and work well enough for routine

use, and whether special arrangements are needed for patient consent. The interventional

procedures NICE considers are usually new, but NICE also issues guidance for established

procedures when there is uncertainty about their safety or how well they work. The following

NICE interventional procedure guidance is relevant to this part of the pathway.



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Division of ankyloglossia (tongue-tie) for breastfeeding

Current evidence suggests that there are no major safety concerns about division of

ankyloglossia (tongue-tie) and limited evidence suggests that this procedure can improve

breastfeeding. This evidence is adequate to support the use of the procedure provided that

normal arrangements are in place for consent, audit and clinical governance.

Division of ankyloglossia (tongue-tie) for breastfeeding should only be performed by registered

healthcare professionals who are properly trained.

Publication of further controlled trials on the effect of the procedure on successful long-term

breastfeeding will be useful.

These recommendations are from Division of ankyloglossia (tongue-tie) for breastfeeding (NICE

interventional procedure guidance 149).

NICE has written information for parents and the public explaining the guidance on division of

ankyloglossia (tongue-tie) for breastfeeding.

Quality standards



5. Breastfeeding

6 Ongoing breastfeeding support

Ensure breastfeeding peer supporters:

contact new mothers directly within 48 hours of their transfer home (or within 48 hours of a

home birth)

offer mothers ongoing support according to their individual needs. This could be delivered

face-to-face, via telephone or through local groups.

Provide continuing and proactive breastfeeding support at home, recording all advice in the

mother's hand-held records.



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Do not provide written materials in isolation but use them to reinforce face-to-face advice about

breastfeeding.

Health visitors and the child health promotion programme team should support mothers to

continue breastfeeding for as long as they choose.

Provide contact details for local voluntary organisations that can offer ongoing support to

complement NHS breastfeeding services.

Quality standards



5. Breastfeeding

Resources

The following implementation tool is relevant to this part of the pathway.

A peer support programme for women who breastfeed: commissioning guide



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Population groups at higher risk of having a low vitamin D status include:

All pregnant and breastfeeding women, particularly teenagers and young women

Infants and children under 5 years

People over 65

People who have low or no exposure to the sun. For example, those who cover their skin

for cultural reasons, who are housebound or confined indoors for long periods

People who have darker skin, for example, people of African, African-Caribbean and South

Asian origin.

Glossary

Diet

in this pathway, the term 'diet' refers to the habitual eating patterns of individuals and groups of

people who are not slimming or eating to manage or treat a medical condition

Emergency

life-threatening or potential life-threatening situation

Follow-on formula

under UK law, follow-on formula may provide the liquid component of a progressively varied diet

for healthy infants aged over 6 months

Healthy eating

there is no standard definition. However it is widely accepted that 'healthy eating' means

following a diet which is low in fat (particularly saturated fat), sugar and salt, and high in fruit,vegetables and fibre-rich starchy foods. More details are available from NHS Choices

Infant formula

under UK law, infant formula is the term used to describe a food intended to satisfy, by itself, the

nutritional needs of infants during the first months of life. The Department of Health advises that

infant formula may be used on its own for the first 6 months



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Non-urgent

continue to monitor and assess

Reference nutrient intake

The amount of a nutrient needed to meet the needs of around 97% of individuals in a group

Significant hyperbilirubinaemia

an elevation of the serum bilirubin to a level requiring treatment

Urgent

potentially serious situation, which needs appropriate action

Visible jaundice

jaundice detected by visual inspection

Weaning

weaning or 'complementary feeding' is the transition from an exclusively milk-based diet to a

diet based on solid foods

Co-sleeping

parents or carers sleeping on a bed or sofa or chair with an infant

SIDS

sudden infant death syndrome

Sources

Postnatal care (2006 updated 2014) NICE guideline CG37

Vitamin D: increasing supplement use among at-risk groups (2014) NICE public health guidance

56



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Maternal and child nutrition (2008) NICE public health guidance 11

Division of ankyloglossia (tongue-tie) for breastfeeding (2005) NICE interventional procedure

guidance 149

Your responsibility

The guidance in this pathway represents the view of NICE, which was arrived at after careful

consideration of the evidence available. Those working in the NHS, local authorities, the wider

public, voluntary and community sectors and the private sector should take it into account when

carrying out their professional, managerial or voluntary duties. Implementation of this guidance

is the responsibility of local commissioners and/or providers. Commissioners and providers arereminded that it is their responsibility to implement the guidance, in their local context, in light of

their duties to avoid unlawful discrimination and to have regard to promoting equality of

opportunity. Nothing in this guidance should be interpreted in a way which would be inconsistent

with compliance with those duties.

Copyright

Copyright National Institute for Health and Care Excellence 2015. All rights reserved. NICE

copyright material can be downloaded for private research and study, and may be reproduced

for educational and not-for-profit purposes. No reproduction by or for commercial organisations,

or for commercial purposes, is allowed without the written permission of NICE.

Contact NICE

National Institute for Health and Care Excellence

Level 1A, City Tower

Piccadilly PlazaManchester

M1 4BT

www.nice.org.uk

[email protected]

0845 003 7781



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Documents

Postnatal Care Infant Feeding and Maternal Nutrition in Postnatal Care