1 Predictable Newborn Patterns Birth & Beyond California: Breastfeeding Training & QI Project

2 Objectives Identify three infant states of consciousness Identify nursing responses and interventions –Infant is sleepy, difficult to awaken –Infant is crying, difficult to soothe Describe the normal infant feeding pattern Identify three infant feeding cues Describe practices that maximize infant behaviors in the first hours and days of an infant’s life

3 Infant States of Consciousness Thoman, Early development of sleeping behavior in infants, 1975 Two Sleep States Transition State Three Awake States Quiet Sleep Active Sleep Drowsy Quiet Alert Active Alert Crying

Latch 1,2,3 Troubleshooting Breastfeeding in the Early Weeks The Healthy Children Project 4

5 The Interactive Baby State Infants breastfeed and families bond during the Quiet Alert State De Chateau, Develop Med Child Neurol, 1977

6 Predictable Infant Responses To wake a sleeping baby To calm a crying baby

7 Predictable Infant Responses Variety to awaken Repetition to soothe

8 Predictable Infant Responses Variety to awaken –Skin to skin –Rubbing –Patting –Humming –Singing –Talking –Diaper off –Cool cloth –Eye to eye –Visitors removed –Others? Repetition to soothe –Skin to skin –Humming –Singing –Swaddling –Rocking –Walking –Visitors removed –Others?

9 Why Do Some Moms Not Know How to Quiet or Wake Their Baby? “The Lost Art”

10 Societal Shift: From Villages to Nuclear Families Childbearing Women Wise Women Teens & kids Vertical System Wise Women in Retirement Centers Childbearing Women at Work Teens in School Kids in Daycare/School Compartmentalized System

11 Activity: Newborn Infant Feeding Pattern Sleep/Wake Cycling Effect on Infant Feeding Pattern

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13 Baby A Q4H Q2H Q1/2H XX XX X 2 XXXXXXX 2 8

14 The Normal Infant Feeding Pattern is Cluster Feeding Feeding pattern characterized by closely bunched feedings May be followed by extended periods of sleep Normal newborn feeding behavior Usually starts on second night Often interpreted as sign of insufficient milk

15 Baby’s Second Night Baby misses the habitat of the womb Mother’s chest is the new “habitat” Baby’s second night pattern: Feed – Snuggle – Sleep Newborn sleep cycle: Drowsy – Active Sleep – Quiet Sleep

16 Feeding Cues Soft sounds: grunts Wiggling Hand to mouth Lip smacking Sucking motions Rooting

17 Feeding Cues CRYING is a LATE feeding cue!

18 How Often Should I Feed My Baby? If she opens her mouth, bring her to the breast to latch on She needs all the colostrum she can get Your breasts need as much stimulation as possible to establish a good milk supply Take every opportunity – no matter how short

19 Recommended Newborn Feeding Frequency “During the early weeks of breastfeeding, mothers should be encouraged to have (at least) 8 to 12 feedings at the breast every 24 hours, offering the breast whenever the infant shows early signs of hunger…” AAP Breastfeeding Policy Statement, Pediatrics, 2005

20 Definition of a Feeding Baby actively initiates suckle Baby has a wide gaping mouth –Baby’s jaw glides –Baby’s swallow is audible –Baby ends the feeding –Baby is satisfied

21 When Left Skin-to-Skin in the First Hours After Birth Lifts head and lunges to breast Searching behaviors Ability to self attach Klaus, Your Amazing Newborn, 1998

22 Breastfeeding: Baby’s Choice

23 Maximizing Infant Behaviors: Immediately Following Birth Skin-to-skin Allow familiarization time Do not rush breastfeeding Delay bath and procedures AAP Breastfeeding Policy Statement, Pediatrics, 2005

24 Maximizing Infant Behaviors: The First Few Days Skin-to-skin Allow babies to “re-boot” if needed Encourage and explain cluster feeding Refer babies who “refuse” the breast to the lactation consultant

25 Amazing Talents of the Newborn: A Video Guide for Health Care Professionals and Parents Video provided by Marshall Klaus, MD

26 Babies Need Their Hands Hands help to initiate feeding and to soothe Take off the blanket Take off the mittens

27 Let the Baby Do It The breast is home

28 Summary Newborns have predictable sleep-wake cycles and feeding patterns Parents may need to be taught: –What feeding cues are and when to feed the baby –The normal pattern of cluster feeding –Interventions to wake a sleepy baby –Interventions to calm a crying baby

29 Photo Credits Slide 1 – Die Gattin des Kunstlers by Josef Danhauser circa 1839 Slide 5 – courtesy Marshall Klaus Slide 6 – by Microsoft Clipart Slide 7 – by Microsoft Clipart Slide 9 – Mothers and Children c – Slide 16 – Skin to skin, hand to mouth, courtesy Miller Children’s Hospital