1. Predictable Newborn Patterns Birth & Beyond California: Breastfeeding Training & QI Project With funding from the federal Title V Block Grant 1

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 2

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

4. 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 5 De Chateau, Develop Med Child Neurol, 1977

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

7. 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? 8

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

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

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

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13. 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 14

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 15

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

17. Feeding Cues 17 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 18

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 19

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 20

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 21

22. Breastfeeding: Baby’s Choice 22

23. Maximizing Infant Behaviors: Immediately Following Birth Skin-to-skin Allow familiarization time Do not rush breastfeeding Delay bath and procedures 23 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 24

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

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

27. Let the Baby Do It The breast is home 27

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 28