Introduction to the MAITS guideon infant feeding difficulties

Himali de Silva & Maya Asir

MAITS: Multi Agency International Training and Support

The remit of MAITS:To provide training and resources for people supporting individuals with disabilities and/or mental health challenges in low-resource settingsThe main ways in which MAITS provides support: - Funding experienced professionals around the globe to

provide face-to-face training in their own country or abroad

- Developing materials and resources that can be used on the ground, such as MAITS Guides

Why Guide on working with vulnerable infants

• Due to changes to neurology and anatomy caused by prematurity, birth trauma and congenital anomalies, infants with ‘additional needs’ require more support to establish and maintain breastfeeding.

• Practical support should be available to all mothers to establish and maintain successful breastfeeding.

• The Guide fills a gap in the existing training available for people working in low resources settings, e.g. WHO Breastfeeding, Essential Newborn Care.

• Existing training focuses on some vulnerable populations, but no specific reference is given to the diverse groups of children falling under the ‘ill’ category.

• Some of the generic advice in existing programmes may not be effective, and can sometimes be harmful for specific populations e.g. infants with birth asphyxia.

MAITS Guide - How is it different?

• The Guide is also beneficial for infants <6 months admitted with malnutrition without a known cause.

“In addition to causative factors such as low birth weight, persistent diarrhoea and chronic underlying

diseases or disability, the development of severe acute malnutrition in infants under 6 months of age

commonly reflects suboptimal feeding practices, especially breastfeeding practices”

http://www.who.int/elena/titles/sam_infants/en

• MAITS Guide focuses on ‘how’ and not ‘why’.

Aim of the Guide

The guide is aimed at improving the knowledge and skills of healthcare professionals to support breastfeeding and nutrition in vulnerable infants.

Scope of the Guide

• Train the trainer model• Includes guidelines for specific populations: preterm,

hypertonic and hypotonic infants and cleft lip/palate• Focuses on areas of difficulty specific to vulnerable

infants, e.g. readiness for feeding, muscle tone, changes to suck patterns, swallow safety and after-feeding care

• Includes practical sessions and video footage• Encourages health workers to problem-solve

intervention strategies based on assessment findings

Sample page and video

Sample page from special populations

Who the Guide is for

This guide is designed to be delivered to healthcare professionals who:• have knowledge about infant feeding • have preferably completed training through a

breastfeeding programme (e.g. WHO, UNICEF) • are currently supporting vulnerable infants to breastfeed

in Neonatal Units / Special Care Units

Anyone delivering the guide needs to be specifically trained to do so

How the Guide is organised

The training programme has two compulsory components:

• classroom-based teaching• practical sessions

Classroom-based teaching

There are 4 modules which need to be delivered in the correct sequence. Each module will take 45 minutes–1½ hours (allowing for translation time).

Module 1: Lactation (optional module):-importance of breastmilk -breastmilk production

Module 2: Understanding infants with feeding difficulties:-types of feeding difficulties-assessment and breastfeeding checklist

Classroom-based teaching

Module 3: Intervention:-breastfeeding positions-intervention strategies

Module 4: Special populations:-premature infants-infants with high muscle tone-infants with low muscle tone-cleft lip/palate

Practical sessionsPractical sessions are delivered throughout the training, in facilities that care for newborn infants who need specialist support

Practical session 1: Observation onlyPractical session 2: Carry out breastfeeding checklist and assess infants feedingPractical session 3: Observe interventional strategiesPractical session 4: Apply interventional strategiesPractical session 5: Consolidation of skills

Sample timetableDay 1 9am-12pm: module 1 (optional) + module 212pm-1pm: practical 1 1pm-2pm:lunch break2pm-3pm:module 3 3pm-4pm:practical 2 Day 2 9pm-10pm: practical 3 10pm-12pm: module 4 12pm-1pm: practical 4 1pm-3pm:lunch break3pm-4pm:practical 5

Timeline and Next Steps• Draft version of Guide written, based on trials in Malawi

and Uganda• Draft completed with feedback from specialists• Guide to be trialed in Sri Lanka in November 2016• Guide to be finalised by February 2017• Infant outcome data to be collected pre and post training

in Sri Lanka• Aim to integrate into existing breastfeeding and essential

newborn care training• Scope to form a platform for generating research and

evidence-base

Contact details

• MAITS: www.maits.org.uk Mel Adams, MAITS director of operations: mel@maits.org.uk• Himali de Silva: desilva.himali@gmail.com• Maya Asir: mayasir83@hotmail.com