ASSESSMENT OF THE BREASTFED INFANT
Category: Child Health
Abstract : ASSESSMENT OF THE NEONATE The assessment of the breastfed infant includes an
evaluation of its voiding and elimination patterns; feeding routines; jaundice;
and, most importantly, weight. In addition, the mother should be examined for
pain or irritation of her breast and nipples and for signs and symptoms of undue
stress or fatigue. Healthy breastfed neonates should not lose more than 1
ASSESSMENT OF THE NEONATE
The assessment of the breastfed infant includes an
evaluation of its voiding and elimination patterns; feeding routines; jaundice;
and, most importantly, weight. In addition, the mother should be examined for
pain or irritation of her breast and nipples and for signs and symptoms of undue
stress or fatigue.
Healthy breastfed neonates should not lose more than 10% of
their birth weight, and they should regain birth weight by the time they are
aged 10-14 days.
Newborns should have a minimum average weight gain of 20
g/d between ages 14 and 42 days. The
average weight gain during this time is
34 g/d for girls and 40 g/d for boys. In addition, breastfed neonates tend to
gain weight faster than formula-fed neonates for the first 2-3 months, and the
rate begins to slow at 6-12 months. Breastfed infants also tend to have leaner
bodies than those of formula-fed infants. In the first 48 hours after birth, the
neonate may void as infrequently as a couple times a day. Once the mother's milk
supply is established, the baby voids after most feedings, usually 6-8 times a
day.
As the mother's milk supply is established, the infant's stool
changes from green-black meconium to yellow yogurtlike stools with seedy curds.
This transition usually occurs by the infant's fifth day of life. Compared with
formula-fed infants, breastfed infants tend to have more frequent and
higher-volume bowel movements during their first 2 months of life. At weeks 4-6,
an infant should pass at least 3 yellow stools of sufficient volume per day. If
he or she doesn't, the possibility of inadequate milk intake must be
considered.
The number of stools gradually decreases after this time; by
2-3 months, several days or a week may pass before an infant has a stool. As
discussed in Factors Affecting the Maternal Milk Supply, incomplete breast
emptying frequently causes insufficient milk production. An inadequate frequency
or duration of breastfeeding is a common preventable cause of decreased milk
production and thus intake. The expected frequency of breastfeeding in newborns
is once every 2-3 hours.
Breastfeeding should last approximately 10-15
minutes per breast and should include active suckling with short pauses and
frequent audible swallows. Essentials of early follow-up Early follow-up of the
mother-infant dyad supports breastfeeding and the continued good health of the
neonate. Although assessing the infant's weight and state of hydration (skin
turgor, capillary refill, hydration of mucous membranes) is vitally important,
the interaction between infant and mother must also be assessed. Early
breastfeeding is fatiguing and possibly overwhelming, especially for the
primiparous mother.
In addition to the physiologic assessment of the
infant, the staff should encourage the mother and discuss ways to decrease her
fatigue (eg, napping when the infant is napping, waking the infant during the
day if its day-night cycle is switched, taking walks, talking with other mothers
and friends). Postpartum depression may occur in the early postpartum period.
Early recognition is essential for appropriate treatment.
Women often do
not see their obstetricians until 6 weeks after delivery; therefore, the
physician who is caring for the infant and mother becomes an important link in
the care of the infant and mother. A mother who has depression often has
difficulties with her daily activities, including breastfeeding. The early
follow-up visit helps with the early identification of problems and with the
initiation of appropriate intervention.
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