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Remer S, Russell R, Furman L. "All in Breastfeeding": An Approach to Improving Breastfeeding Support at the Rainbow Center for Women and Children. Health Promot Pract 2023; 24:1148-1150. [PMID: 35611509 DOI: 10.1177/15248399221096414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It has been well documented in the literature that breastfeeding has many benefits for mothers and their infants. The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for the first 6 months of life and continued breastfeeding until the age of 1 or longer as desired by the mother and infant; however, many mothers face barriers to achieving this goal. More specifically, we noticed that at our Rainbow Center for Women and Children (the Center), few mothers were able to achieve exclusive or sustained breastfeeding. This study aimed to determine stakeholder views at the Center regarding barriers to breastfeeding in an underserved patient population and to develop a Breastfeeding Intervention Bundle from these responses to improve breastfeeding rates. We then surveyed participants including mothers, providers, and staff about support and comfort with knowledge gained over the period of the Intervention. While our study was unable to document a clear or sustained improvement in participant support or comfort related to breastfeeding over a 6-month period, we furthered our knowledge about barriers to breastfeeding and concluded that interventions to improve breastfeeding rates will likely need to be initiated at the systems level, not only at the individual patient and provider level, and with joint support from all stakeholders.
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Affiliation(s)
- Sarah Remer
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Rebekah Russell
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Lydia Furman
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Pediatrics, Rainbow Babies and Children's Hopital, Cleveland OH
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2
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Strong G, Gober M, Walker M. Speaking the Same Language: A Call for Standardized Lactation Terminology in the United States. J Hum Lact 2023; 39:121-131. [PMID: 36511175 DOI: 10.1177/08903344221131041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Genae Strong
- Loewenberg College of Nursing, University of Memphis, Memphis, TN, USA
| | - Merrilee Gober
- National Lactation Consultant Alliance, Inc, Atlanta, GA, USA
| | - Marsha Walker
- National Lactation Consultant Alliance, Inc, Atlanta, GA, USA
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3
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Conover N, Vanderpool J, Ginsberg J, Kawan M, Spatz DL. Establishing a Breastfeeding Consortium for Clinicians in Pediatric Outpatient Care. MCN Am J Matern Child Nurs 2023; 48:24-29. [PMID: 36136072 DOI: 10.1097/nmc.0000000000000877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Creating a supportive environment for breastfeeding mothers in the primary care setting has been shown to improve breastfeeding rates and duration. An important aspect of establishing a breastfeeding-friendly practice is to engage and educate health care providers. To increase consistency of breastfeeding care and interventions across a large primary care network, we established an Ambulatory Breastfeeding Consortium (ABC) focused on information sharing and discussion centered on care of breastfeeding and lactating families. The COVID-19 pandemic further highlighted the need to share up-to-date education and guidance, and the importance of the role of primary care providers in breastfeeding support. The ABC has been effective in engaging primary care nurses and other clinicians and disseminating information while encouraging discussion on the importance of providing informed care to breastfeeding families. Although more breastfeeding-specific education is recommended for clinicians, the ABC serves as a model for primary care clinicians to improve their knowledge and provide support for families through education, shared experience, and awareness across many pediatric primary care network sites.
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Kawan M, Gregory EF, Spatz DL. Improving breastfeeding care & support in a large, urban, pediatric primary care practice. J Pediatr Nurs 2022; 70:e3-e8. [PMID: 36424329 DOI: 10.1016/j.pedn.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 10/06/2022] [Accepted: 10/14/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND SPECIFIC AIMS Human milk/breastfeeding is the gold standard for infant nutrition. Interventions in pediatric primary care could improve breastfeeding exclusivity and duration. Our specific aims were two-fold: 1) Accurately measure breastfeeding indicators and 2) Implement AAP Breastfeeding-Friendly Pediatric Office Practice Recommendations. MATERIALS AND METHODS In 2018, a single, urban, large primary care pediatric practice initiated a Quality Improvement project to improve breastfeeding outcomes. Stakeholders met to discuss metrics of interest, develop documentation templates, review data capture, and plan interventions to support breastfeeding. Practice based interventions to improve measurement included: piloting documentation templates, incorporation of default templates office-wide, and developing tracking tools for both use of templates and breastfeeding outcomes. Interventions to support breastfeeding occurred simultaneously and included workflow redesign to increase nurse-provided breastfeeding education, partnering with community-based lactation consultants for outpatient support, staff education, and National Breastfeeding Month activities. RESULTS Since initiation of the data analytic tool, breastfeeding data has been analyzed from over 30,000 visits (86% Medicaid-insured, 82% Black race). Currently, 80% of providers use default templates that allow standardized data capture. At first newborn visit, 74% of infants were breastfed. At six months, 36% of infants were breastfed; 23% exclusively. Standardized documentation of infant feeding status improved and has remained consistent. Breastfeeding duration did not significantly improve despite practice interventions. CONCLUSIONS Pediatric primary care measurement tools are feasible and critical to understand breastfeeding continuation. Increased resources and interventions to support breastfeeding in Primary Care are necessary to improve outcomes.
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Affiliation(s)
- Meg Kawan
- Children's Hospital of Philadelphia, United States of America
| | - Emily F Gregory
- Children's Hospital of Philadelphia, United States of America
| | - Diane L Spatz
- Children's Hospital of Philadelphia, United States of America; University of Pennsylvania School of Nursing, United States of America.
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5
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HUG Your Baby: Preparing Nurse Practitioner Students to Support Breastfeeding. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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6
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Blitman E, Biderman A, Yehoshua I, Adler L. Breastfeeding mothers' experiences with community physicians in Israel: a qualitative study. Int Breastfeed J 2022; 17:62. [PMID: 36042492 PMCID: PMC9425787 DOI: 10.1186/s13006-022-00506-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The guidelines of all leading professional organizations recommend providing adequate support and education regarding breastfeeding; yet many mothers feel that they receive inadequate information from their health care providers in the primary care setting. This is in line with studies that demonstrate that physicians' knowledge about breastfeeding is lacking. The aim of this study was to expand our understanding of the breastfeeding-related experiences of mothers with primary care physicians (PCPs). METHODS In this qualitative study, we interviewed breastfeeding mothers in Israel in the first six months after delivery. The interviews were conducted between December 2020 and May 2021. We used thematic analysis to explore women's attitudes and experiences with their PCPs regarding breastfeeding concerns. All authors read the transcribed interviews and independently marked statements regarding breastfeeding. Then, in a joint process, codes, subthemes and themes were defined. Each subtheme was backed up with a quote from the interviews. RESULTS We interviewed 13 women aged 24 to 37. We identified four main themes. The first of these was physicians' inconsistent attitudes toward breastfeeding. Some were indifferent, while others related to breastfeeding solely in the context of infant development. Some were supportive, while others opposed breastfeeding. Several women revealed physicians' inappropriate and disturbing attitudes to breastfeeding. The second theme was physicians' lack of knowledge regarding medical treatment for breastfeeding issues. This theme included lack of knowledge, incorrect treatment of breastfeeding problems, and contradictions among HCPs. The third was mothers' preference for alternative resources, including individualized breastfeeding counselling, maternity and childcare nurses, mothers' groups (in person or online), and family and friends over medical treatment for breastfeeding problems. The fourth theme involved mothers' suggestions for PCPs, which highlighted the importance of communication, prenatal physician-initiated dialogue on breastfeeding, expanding professional knowledge on breastfeeding, and increasing the availability of treatment for breastfeeding problems. CONCLUSION The women in this study reported unsatisfactory breastfeeding support by PCPs and incorrect or inadequate treatment of medical problems related to breastfeeding. They also felt they had no medical experts to approach with breastfeeding-related problems. We believe that physicians should expand their knowledge on breastfeeding medicine so that they can provide comprehensive patient-centered treatment to both mothers and infants. Education programs for improving knowledge and skills in breastfeeding issues should be implemented throughout the medical training.
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Affiliation(s)
- Elia Blitman
- Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel.,Department of Family Medicine and Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Aya Biderman
- Department of Family Medicine and Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Clalit Health Services, Southern District, Beer-Sheva, Israel
| | - Ilan Yehoshua
- Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel.,Department of Family Medicine and Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Limor Adler
- Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel. .,Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Abstract
Breastfeeding and human milk are the normative standards for infant feeding and nutrition. The short- and long-term medical and neurodevelopmental advantages of breastfeeding make breastfeeding or the provision of human milk a public health imperative. The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for approximately 6 months after birth. Furthermore, the AAP supports continued breastfeeding, along with appropriate complementary foods introduced at about 6 months, as long as mutually desired by mother and child for 2 years or beyond. These recommendations are consistent with those of the World Health Organization (WHO). Medical contraindications to breastfeeding are rare. The AAP recommends that birth hospitals or centers implement maternity care practices shown to improve breastfeeding initiation, duration, and exclusivity. The Centers for Disease Control and Prevention and The Joint Commission monitor breastfeeding practices in United States hospitals. Pediatricians play a critical role in hospitals, their practices, and communities as advocates of breastfeeding and, thus, need to be trained about the benefits of breastfeeding for mothers and children and in managing breastfeeding. Efforts to improve breastfeeding rates must acknowledge existing disparities and the impact of racism in promoting equity in breastfeeding education, support, and services.
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Affiliation(s)
- Joan Younger Meek
- Department of Clinical Sciences, Florida State University College of Medicine, Orlando, Florida
| | - Lawrence Noble
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Mount Sinai, New York.,New York City Health+Hospitals Elmhurst
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8
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Abstract
Breastfeeding and human milk are the normative standards for infant feeding and nutrition. The short- and long-term medical and neurodevelopmental advantages of breastfeeding make breastfeeding, or the provision of human milk, a public health imperative. The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for approximately 6 months after birth. Furthermore, the AAP supports continued breastfeeding, along with appropriate complementary foods introduced at about 6 months, as long as mutually desired by mother and child for 2 years or beyond. These recommendations are consistent with those of the World Health Organization (WHO). Medical contraindications to breastfeeding are rare. The AAP recommends that birth hospitals or centers implement maternity care practices shown to improve breastfeeding initiation, duration, and exclusivity. The Centers for Disease Control and Prevention (CDC) and The Joint Commission monitor breastfeeding practices in US hospitals. Pediatricians play a critical role in hospitals, their practices, and communities as advocates of breastfeeding and, thus, need to be trained about the benefits of breastfeeding for mothers and children and in managing breastfeeding.
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Affiliation(s)
- Joan Younger Meek
- Department of Clinical Sciences, Florida State University College of Medicine, Orlando, Florida
| | - Lawrence Noble
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, New York.,New York City Health+Hospitals/Elmhurst
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9
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Glassman ME, Blanchet K, Andresen J, Lewis RA, Rosenthal SL. Impact of Breastfeeding Support Services on Mothers' Breastfeeding Experiences When Provided by an MD/IBCLC in the Pediatric Medical Home. Clin Pediatr (Phila) 2022; 61:418-427. [PMID: 35369737 DOI: 10.1177/00099228221086375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Addressing breastfeeding issues enables mothers to reach their breastfeeding goals. We embedded a breastfeeding consultation service run by a pediatrician/International Board Certified Lactation Consultant (MD/IBCLC) in a medical home. This mixed-methods study investigated breastfeeding preparedness and the service's perceived benefits. Mothers with breastfeeding issues/concerns identified at well-baby appointments were referred to the service. Telephone interviews and chart reviews were conducted with 28 participating mothers approximately 1 month after the visits. Breastfeeding Self-Efficacy Scale scores improved significantly from the time of the in-person appointment to 1 month later. Most mothers felt unprepared for breastfeeding despite prenatal efforts. Trust in the pediatrician's recommendation, easy access, and insurance coverage were key factors in seeking the service. Reassurance provided by the MD/IBCLC increased mothers' confidence to breastfeed. The COVID-19 pandemic heightened feelings of isolation and anxiety due to lack of hands-on support from friends and family during the birth hospitalization and when at home.
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Affiliation(s)
- Melissa E Glassman
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA.,NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Kelly Blanchet
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Jane Andresen
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Rachel A Lewis
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Susan L Rosenthal
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA.,Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
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10
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Nassar L, Van Zandt SN, Nassar G, Nassar R. Increasing Breastfeeding Rates Through Continuity of Care. CLINICAL LACTATION 2022. [DOI: 10.1891/cl.2021-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BackgroundContinuity of care is important in many aspects of medicine, as evidenced by the patient-centered medical home model. The newborn period is an especially important time for continuity of care, as this time sets the stage for lifelong health. Breastfeeding, which is known for its positive health benefits for both mother and child, is the gold standard for infant feeding. While inpatient lactation support is a common amenity available during hospital admission, support can be more difficult to obtain once a patient is discharged. To help eliminate this barrier, a process was put in place within an Eastern Pennsylvania health network’s seven office locations to standardize outreach to the mother-infant dyad.MethodsA quality improvement retrospective chart review comparing pre- and post-intervention rates of exclusive and non-exclusive breastfeeding was completed using one health system’s Electronic Health Record (EHR). A referral process was established to capture dyads born within the health network’s hospital who were going to be followed at one of the seven pediatric offices outpatient. Mothers were called and followed to see how they were progressing with their breastfeeding goals. Any problems were addressed by the health network’s International Board-Certified Lactation Consultants (IBCLCs) and Certified Lactation Counselor (CLC).ResultsLactation rates at the pediatric practice were observed to have increased at both 6 months and 12 months post-intervention compared to pre-intervention.ConclusionProactively scheduling and providing outreach immediately following birth may promote increased breastfeeding rates.
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11
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Spatz DL. Improving Lactation Education and Support in Primary Care. MCN Am J Matern Child Nurs 2021; 46:301. [PMID: 34398832 DOI: 10.1097/nmc.0000000000000752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Diane L Spatz
- Dr. Diane L. Spatz is a Professor of Perinatal Nursing & the Helen M. Shearer Professor of Nutrition at the University of Pennsylvania. She holds a joint appointment with the Children's Hospital of Philadelphia (CHOP) where she is a nurse scientist in lactation with the Center for Nursing Research & Evidence Based Practice. Dr. Spatz can be reached via email at
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12
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Atwah AF, Koshak EA, Alhussaini BH, Alsaedi SA. The Prevalence and Trends of the Early Introduction of Cow Milk to Newborns at Tertiary Care Center: A Risk of Atopy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136686. [PMID: 34206183 PMCID: PMC8296947 DOI: 10.3390/ijerph18136686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/18/2021] [Accepted: 06/20/2021] [Indexed: 11/16/2022]
Abstract
Although all health organizations recommend exclusive breastfeeding (EBF), few neonates meet these recommended goals. The early intake of cow milk formulas (CMFs) has been linked to several childhood illnesses, including atopic diseases. Therefore, this study aimed to evaluate the prevalence of early exposure to CMFs in the nursery of a tertiary care hospital in Jeddah, Kingdom of Saudi Arabia. A retrospective review was conducted on the medical records of feeding practices of neonates born in King Abdulaziz University Hospital (KAUH) at Jeddah, Kingdom of Saudi Arabia. Two months from each year (May and December) were selected over the last five years. Approval from the ethical research committee at KAUH was obtained. Eight hundred and ninety-four different neonate files were reviewed. Four hundred and eighty-seven (54.5%) were males. Out of the total of 894, 838 (93.7%) newborns experienced an early introduction to CMFs, 797 (89.1%) received mixed CMF and breast milk, 41 (4.6%) received CMF only, and 56 (6.3%) received exclusive breastfeeding (EBF). Surprisingly, EBF has declined over time, from 39% in May 2016 to 1% in December 2020. The prevalence of early exposure to CMF was very high in newborns at KAUH nursery, and this prevalence was trending upwards. Extensive teaching programs on EBF and allergy prevention for mothers and related health care providers are highly recommended
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Affiliation(s)
- Ali F. Atwah
- Department of Pediatrics, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Correspondence:
| | - Emad A. Koshak
- Department of Medicine, Faculty of Medicine in Jeddah, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Bakr H. Alhussaini
- Department of Pediatrics, Faculty of Medicine in Jeddah, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (B.H.A.); (S.A.A.)
| | - Saad A. Alsaedi
- Department of Pediatrics, Faculty of Medicine in Jeddah, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (B.H.A.); (S.A.A.)
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Abstract
BackgroundTelelactation is a modality for delivering remote clinical lactation care using telecommunications technology. Sonder Health, in partnership with Amwell, began offering synchronous video telelactation services to health plans and employer groups in 2016.MethodsWe completed a retrospective data analysis on a randomized selection of 1,087 telelactation visits covered by a health plan or employee-sponsored health plan conducted between 2016–2019. Our aim is to describe a telelactation model and review selected visits for technical modalities utilized, clinical workflow, top self-reported chief conditions, patient satisfaction, visit duration, acuity levels, alternative care options, peak visit time, visits conducted during or after business hours, and days visits took place, and discuss the potential for telelactation to bridge the gaps in timely access to IBCLC-level breastfeeding support.ResultsUsing a 5-star rating system, 95% of patients gave a 5-star rating; 52% of visits occurred outside normal business hours. Top three conditions identified: latching (31%), supply (24%), and nipple/breast pain (15%). Without access to the service, 59% reported they would have accessed an urgent care, emergency department, retail health clinic, or other office appointment; 41% reported they would have sought care “nowhere.”ConclusionsThis telelactation program provided access to skilled, comprehensive clinical lactation care and documents a strong use case for telelactation services.
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Jalali F, Kamiab Z, Khademalhosseini M, Daeizadeh F, Bazmandegan G. Nursing strikes among infants and its affecting factors in Rafsanjan city. J Med Life 2021; 14:56-60. [PMID: 33767786 PMCID: PMC7982258 DOI: 10.25122/jml-2020-0118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The infant’s refusal to breastfeed can be a stressful and concerning matter for a mother. This study aimed to investigate the frequency and factors leading to nursing strikes in Rafsanjan city. This descriptive study was performed on infants who had been referred to the pediatrician’s office with a complaint of a nursing strike. The research sample included 70 infants, and all the required data, including the causes of the nursing strike and the demographic information of the mother and the infant, were collected using a checklist. The Statistical Package for the Social Sciences (SPSS) software version 20 was used to analyze the data. The percentage was used to express qualitative indices, and the mean and standard deviation were used to express quantitative indices. The results showed that the most common factors contributing to the infants’ breast refusal were playfulness and distraction (50%) and recent vaccinations in the last 12 days (48.6%). Besides, the most common maternal factors affecting breast refusal were level of education (67.1%), recent acute stress (41.4%), and inadequate milk production (35.7%). The results of the present study showed that playfulness and distraction of the baby, recent vaccination, use of a pacifier, level of education and recent stress of the mother, breastfeeding program, and insufficient milk production are the most common reasons for nursing strikes.
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Affiliation(s)
- Fatemeh Jalali
- Clinical Research Development Unit, Ali-Ibn Abi-Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.,Department of Pediatrics, Ali-Ibn Abi-Talib Hospital, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Zahra Kamiab
- Clinical Research Development Unit, Ali-Ibn Abi-Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.,Department of Family Medicine, Ali-Ibn Abi-Talib Hospital, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Morteza Khademalhosseini
- Clinical Research Development Unit, Ali-Ibn Abi-Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.,Department of Pathology, Ali-Ibn Abi-Talib Hospital, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Fatemeh Daeizadeh
- Clinical Research Development Unit, Ali-Ibn Abi-Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Gholamreza Bazmandegan
- Clinical Research Development Unit, Ali-Ibn Abi-Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.,Department of Family Medicine, Ali-Ibn Abi-Talib Hospital, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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15
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Vanguri S, Rogers-McQuade H, Sriraman NK. ABM Clinical Protocol #14: Breastfeeding-Friendly Physician's Office-Optimizing Care for Infants and Children. Breastfeed Med 2021; 16:175-184. [PMID: 33599542 DOI: 10.1089/bfm.2021.29175.sjv] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Swathi Vanguri
- Department of Obstetrics and Gynecology, Crozer-Keystone Health System, Upland, Pennsylvania, USA
| | | | - Natasha K Sriraman
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia, USA.,Division of General Academic Pediatrics, Children's Hospital of the King's Daughters, Norfolk, Virginia, USA.,Division of Community Health & Research, Eastern Virginia Medical School, Norfolk, Virginia, USA
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16
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Improving breastfeeding duration through creation of a breastfeeding-friendly pediatric practice. J Am Assoc Nurse Pract 2021; 33:1273-1281. [PMID: 33534287 DOI: 10.1097/jxx.0000000000000521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/18/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Breastfeeding is the gold standard for infant feeding. In the United States, 83.2% of women initiate breastfeeding on their infant's birth. When the infant reaches 6 months of age, however, only 57.6% of mothers are still breastfeeding, and a mere 24.9% are breastfeeding exclusively. LOCAL PROBLEM Breastfeeding rates in rural areas are below the national averages. The greatest disparities exist in minorities and individuals with lower educational and socioeconomic status. METHODS A preintervention/postintervention design was used for this quality improvement project. The Model for Improvement's Plan, Do, Study, Act cycle guided the project processes. Breastfeeding rates were obtained at each well-child visit from newborn through 4 months of age. On completion, mean preimplementation and postimplementation breastfeeding rates were compared to determine effectiveness. INTERVENTIONS A breastfeeding support initiative was implemented at a multisite rural Illinois pediatric practice. An evidence-based breastfeeding policy was developed, staff education sessions were conducted, private lactation rooms were created, and breastfeeding photographs/posters were displayed throughout the offices. Lactation support services were publicized via signs and social media postings. RESULTS Overall breastfeeding rates were higher at each time point after implementation. Statistically significant increases occurred at the newborn and 1-month visits, with a modest improvement at 2 and 4 months. CONCLUSIONS This project demonstrated an improvement in breastfeeding duration rates. It is anticipated that this practice-wide standard of care change will promote breastfeeding throughout the first 12 months of life.
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Pereira NM, Maresh A. Trends in outpatient intervention for pediatric ankyloglossia. Int J Pediatr Otorhinolaryngol 2020; 138:110386. [PMID: 33152977 DOI: 10.1016/j.ijporl.2020.110386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/12/2020] [Accepted: 09/12/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Anecdotally, there has been an increase in ankyloglossia referrals and frenotomy procedures performed in recent years. Many studies have characterized frenotomy indications and outcomes, but none have quantified how the frequency of referrals and interventions have changed over time in the outpatient setting. This study analyzes temporal trends in the diagnosis and intervention of ankyloglossia in a pediatric otolaryngology practice to further clarify how patterns of management of this condition have changed over time. METHODS This study was a retrospective chart review of patients evaluated for ankyloglossia in an outpatient pediatric otolaryngology clinic between 2008 and 2018. The chi-square test for trend was used to assess yearly changes in the referral numbers, surgical interventions, and procedure indication prevalence proportions of interest. RESULTS Referral numbers and frenotomy procedures increased as a percentage of total office visits from 2008 to 2018 (P = 0.0026, P < 0.0001). The trend in frenotomies was especially pronounced in the 0 to 2-month age group (P < 0.0001) but was not observed in the 2 months to 1-year (P = 0.30) or 1- to 4-year (P = 0.40) age groups. Frenotomy performed for concerns of feeding (P < 0.0001) increased over the study period, but there was no significant increase in procedures performed for speech concerns (P = 0.13). CONCLUSION Significant increases in referrals for frenotomy and number of frenotomy procedures performed are demonstrated, especially in young infants for feeding concerns. It is unlikely representative of a true increase in the incidence of ankyloglossia, but rather the result of cultural and clinical factors driving referrals and intervention.
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Affiliation(s)
- Nicola M Pereira
- Weill Cornell Medical College, 1300 York Ave., New York, NY, USA.
| | - Alison Maresh
- Department of Otolaryngology - Head and Neck Surgery, Weill Cornell Medicine, 1305 York Ave, 5th Floor, New York, NY, USA.
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Cortés Rico O, Gallego Iborra A, García Aguado J, Pallás Alonso CR, Rando Diego Á, San Miguel Muñoz MJ, Sánchez Ruiz-Cabello FJ, Colomer Revuelta J, Esparza Olcina MJ, Galbe Sánchez-Ventura J, Mengual Gil JM. [Childhood and adolescence PAPPS summary 2020]. Aten Primaria 2020; 52 Suppl 2:149-160. [PMID: 33388113 PMCID: PMC7801204 DOI: 10.1016/j.aprim.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 08/18/2020] [Indexed: 11/25/2022] Open
Abstract
Four important topics about children and adolescents in our Primary Care activity are presented in this update document: support for breastfeeding, promotion of physical activity, prevention of child injuries due to traffic accidents, and screening for major depression.
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Affiliation(s)
- Olga Cortés Rico
- Centro de Salud Delicias Sur, Servicio Aragonés de Salud, Zaragoza, España.
| | - Ana Gallego Iborra
- Centro de Salud Delicias Sur, Servicio Aragonés de Salud, Zaragoza, España
| | | | | | - Álvaro Rando Diego
- Centro de Salud Delicias Sur, Servicio Aragonés de Salud, Zaragoza, España
| | | | | | | | | | | | - José M Mengual Gil
- Centro de Salud Delicias Sur, Servicio Aragonés de Salud, Zaragoza, España
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Kummer L, Duke N, Davis L, Borowsky I. Association of Social and Community Factors with U.S. Breastfeeding Outcomes. Breastfeed Med 2020; 15:646-654. [PMID: 32856942 DOI: 10.1089/bfm.2020.0083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: To explore, in a large, nationally representative U.S. sample of children, potential independent associations between social and community factors and breastfeeding outcomes, using the Social Ecological Model as a theoretical framework. Materials and Methods: A secondary data analysis of the 2011-2012 National Survey of Children's Health was conducted (N = 29,829). Multivariate logistic regression was performed to estimate associations between predictor variables (parental emotional support, neighborhood social support, neighborhood safety, neighborhood amenities, and medical home) and breastfeeding outcomes (breastfeeding initiation [BFI] and exclusive breastfeeding for 6 months [EBF6m]). For predictor variables reaching statistical significance in the adjusted models, we performed subgroup analyses by race-ethnicity. Results: After adjusting for individual- and family-level sociodemographic and maternal-child health factors, living in a neighborhood with 4 amenities was associated with 1.54 (95% confidence interval [CI] 1.06-2.23) times the odds of BFI, compared to children living in neighborhoods with no amenities. There was a negative association (adjusted odds ratio [aOR] 0.83; 95% CI 0.70-0.99) between neighborhood social support and BFI, although living in a supportive neighborhood was associated with 1.37 (95% CI 1.11-1.69) times the odds of EBF6m. There was a negative association (aOR 0.71; 95% CI 0.54-0.93) between perceived neighborhood safety and EBF6m. The observed associations differed by race-ethnicity. Conclusion: Community-level structural and social support factors influence breastfeeding outcomes, independent of previously described individual level sociodemographic factors, and the observed associations differ by race-ethnicity. These findings have implications for the development of "breastfeeding-friendly" communities and public policies.
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McCoy MB, Heggie P. In-Hospital Formula Feeding and Breastfeeding Duration. Pediatrics 2020; 146:peds.2019-2946. [PMID: 32518168 DOI: 10.1542/peds.2019-2946] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In-hospital formula feeding (IHFF) of breastfed infants is associated with shorter duration of breastfeeding. Despite evidence-based guidelines on when IHFF is appropriate, many infants are given formula unnecessarily during the postpartum hospital stay. To account for selection bias inherent in observational data, in this study, we estimate liberal and conservative bounds for the association between hospital formula feeding and duration of breastfeeding. METHODS Infants enrolled in the Minnesota Special Supplemental Nutrition Program for Women, Infants, and Children were selected. Breastfed infants given formula were matched with infants exclusively breastfed (n = 5310) by using propensity scoring methods to adjust for potential confounders. Cox regression of the matched sample was stratified on feeding status. A second, more conservative analysis (n = 4836) was adjusted for medical indications for supplementation. RESULTS Hazard ratios (HR) for weaning increased across time. In the first analysis, the HR across the first year was 6.1 (95% confidence interval [CI] 4.9-7.5), with HRs increasing with age (first month: HR = 4.1 [95% CI 3.5-4.7]; 1-6 months: HR = 8.2 [95% CI 5.6-12.1]; >6 months: HR = 14.6 [95% CI 8.9-24.0]). The second, more conservative analysis revealed that infants exposed to IHFF had 2.5 times the hazard of weaning compared with infants who were exclusively breastfed (HR = 2.5; 95% CI 1.9-3.4). CONCLUSIONS IHFF was associated with earlier weaning, with infants exposed to IHFF at 2.5 to 6 times higher risk in the first year than infants exclusively breastfed. Strategies to reduce IHFF include prenatal education, peer counseling, hospital staff and physician education, and skin-to-skin contact.
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Affiliation(s)
- Marcia Burton McCoy
- Special Supplemental Nutrition Program for Women, Infants, and Children, Division of Child and Family Health, Minnesota Department of Health, St Paul, Minnesota;
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21
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Sutter C, Davis EC, Lundquist A, Koress V, Isberg K, Bryant-Cromwell M, Meline B, McBride BA, Fiese BH. Breastfeeding Information and Support Across Multiple Sources: Identifying Opportunities for Coordinated Care. CLINICAL LACTATION 2020. [DOI: 10.1891/clinlact-d-19-00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To support mothers to breastfeed for recommended durations, information and support are needed from multiple sources. Our previous research indicated not all mothers in our community receive support, with mothers at greater risk of breastfeeding cessation (e.g., lower educational attainment, enrolled in Special Supplemental Nutrition Program for Women, Infants, and Children [WIC]), receiving supports at lower rates. In addition, receiving support was not always linked to breastfeeding outcomes. Building from these findings, the current report presents a case study of one community and calls for efforts to coordinate care across contexts. Perspectives are provided by lactation professionals in WIC and hospital settings. In addition, a mother who experienced inconsistencies in information and support when she encountered breastfeeding challenges discusses her experiences. Clinical implications are provided for coordinating care across community and healthcare contexts in our community and beyond.
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Eilers MA, Hendrick CE, Pérez-Escamilla R, Powers DA, Potter JE. Breastfeeding Initiation, Duration, and Supplementation Among Mexican-Origin Women in Texas. Pediatrics 2020; 145:peds.2019-2742. [PMID: 32188643 PMCID: PMC7111493 DOI: 10.1542/peds.2019-2742] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Mexican-origin women breastfeed at similar rates as white women in the United States, yet they usually breastfeed for less time. In our study, we seek to identify differences in Mexican-origin women's breastfeeding intentions, initiation, continuation, and supplementation across nativity and country-of-education groups. METHODS The data are from a prospective cohort study of postpartum women ages 18 to 44 recruited from 8 Texas hospitals. We included 1235 Mexican-origin women who were born and educated in either Texas or Mexico. Women were interviewed at delivery and at 3, 6, 12, 18, and 24 months post partum. Breastfeeding intentions and initiation were reported at baseline, continuation was collected at each interview, and weeks until supplementation was assessed for both solids and formula. Women were classified into 3 categories: born and educated in Mexico, born and educated in the United States, and born in Mexico and educated in the United States. RESULTS Breastfeeding initiation and continuation varied by nativity and country of birth, although all women reported similar breastfeeding intentions. Women born and educated in Mexico initiated and continued breastfeeding in higher proportions than women born and educated in the United States. Mexican-born and US-educated women formed an intermediate group. Early supplementation with formula and solid foods was similar across groups, and early supplementation with formula negatively impacted duration across all groups. CONCLUSIONS Nativity and country of education are important predictors of breastfeeding and should be assessed in pediatric and postpartum settings to tailor breastfeeding support. Support is especially warranted among US-born women, and additional educational interventions should be developed to forestall early supplementation with formula across all acculturation groups.
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Affiliation(s)
- Michelle A. Eilers
- Population Research Center, The University of Texas at Austin, Austin, Texas
| | - C. Emily Hendrick
- School of Community Health Sciences, University of Nevada, Reno, Reno, Nevada; and
| | | | - Daniel A. Powers
- Population Research Center, The University of Texas at Austin, Austin, Texas
| | - Joseph E. Potter
- Population Research Center, The University of Texas at Austin, Austin, Texas
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Bochner RE, Kuroki R, Lui K, Russell CJ, Rackovsky E, Piper L, Ban K, Yang K, Mandal P, Mackintosh L, Mirzaian CB, Gross E. Variations in Care for Breastfed Infants Admitted to US Children's Hospitals: A Multicenter Survey of Inpatient Providers. Hosp Pediatr 2019; 10:70-75. [PMID: 31826917 DOI: 10.1542/hpeds.2019-0199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Studies have revealed an association between hospitalization of breastfed infants and weaning posthospitalization. It is unknown what steps inpatient providers at children's hospitals are currently taking to support breastfeeding mothers of hospitalized infants, their comfort providing breastfeeding counseling, and what training they receive. METHODS We conducted a multicenter survey study of pediatric providers who care for infants hospitalized at 3 urban, tertiary-care children's hospitals over a 12-month period. A convenience sample of nurses, residents, and attending physicians agreed to participate. Participants completed a 24-question questionnaire addressing provider practices, comfort with breastfeeding counseling, and previous breastfeeding education. Data were summarized as medians (interquartile ranges) and frequencies (percentages). Kruskal-Wallis and χ2 tests were used to compare between provider types. RESULTS A total of 361 out of 1097 (33%) eligible providers completed the survey: 133 (21%) nurses, 166 (45%) residents, and 62 (63%) attending physicians. Provider practices varied by provider type. We observed a general trend that providers do not routinely review breastfeeding techniques, directly observe feeds, or use standardized breastfeeding assessment tools. Residents and attending physicians were more likely than nurses to feel comfortable with breastfeeding counseling (P = .02). Residents were more likely than nurses and attending physicians to have received breastfeeding education in the last 3 years (P < .001). CONCLUSIONS Practices, comfort, and previous education varied by provider type. There was a general pattern that providers do not routinely perform certain practices. Further studies are needed to determine if inpatient provider practices affect weaning posthospitalization and if inpatient quality improvement initiatives will help mothers continue breastfeeding posthospitalization.
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Affiliation(s)
- Risa E Bochner
- Department of Pediatrics, University Hospital of Brooklyn, State University of New York Downstate Medical Center and Kings County Hospital Center, Brooklyn, New York;
| | - Robyn Kuroki
- Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Karen Lui
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Christopher J Russell
- Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Elia Rackovsky
- Department of Pediatrics, Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, New York
| | - Laura Piper
- Department of Pediatrics, Cincinnati Children's Hospital and College of Medicine, University of Cincinnati, Cincinnati, Ohio; and
| | - Kathryn Ban
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Katharine Yang
- Department of Internal Medicine, Los Angeles County + University of Southern California Medical Center and Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Purnima Mandal
- Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Liza Mackintosh
- Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Christine B Mirzaian
- Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Elissa Gross
- Department of Pediatrics, Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, New York
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Milinco M, Cattaneo A, Macaluso A, Materassi P, Di Toro N, Ronfani L. Prevalence of breastfeeding in a baby-friendly pediatric practice: an experience in Trieste, Italy. Int Breastfeed J 2019; 14:44. [PMID: 31673275 PMCID: PMC6815012 DOI: 10.1186/s13006-019-0239-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 09/30/2019] [Indexed: 11/10/2022] Open
Abstract
Background In a pediatric practice in Italy, actions were undertaken to apply the recommendations for a breastfeeding-friendly physician’s office and to promote the adoption of a semi-reclined or laid-back maternal position in breastfeeding. The aim of this study is to evaluate the effect of the actions implemented, in terms of prevalence of exclusive breastfeeding. Methods A historical cohort study was carried out using administrative data routinely collected. All women who gave birth in 2016 and registered their newborns with the pediatric practice were included, only mothers of preterm newborns < 30 weeks gestational age were excluded. The main actions undertaken were: employment of a breastfeeding peer supporter; ensuring unlimited daily access in case of breastfeeding difficulties; provision of individual support to breastfeeding mothers in a dedicated room and advice on the laid-back position; scheduling of weekly meetings of small groups for breastfeeding support. Each infant was followed up for five months. The main study outcomes were duration of exclusive breastfeeding (only breast milk and no other liquids or solids, except for drops of syrups with nutritional supplements or medicines) and prevalence at five months. Results A total of 265 newborn infants with a gestational age greater than 30 weeks were registered with the pediatric practice during the study period, about 18% of all infants born in Trieste in that period. Complete data were available for 252 of these (95.1%). The rate of exclusive breastfeeding at five months of age was higher than the one reported for the whole infant population of Trieste and of the Friuli Venezia Giulia Region (62.3% vs. 42.9% vs. 30.3%) in the same period. Conclusions The implementation of breastfeeding-friendly pediatric practice and the application of laid-back breastfeeding may improve the rate and duration of exclusive breastfeeding.
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Affiliation(s)
- Mariarosa Milinco
- 1Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Adriano Cattaneo
- 1Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | | | | | | | - Luca Ronfani
- 1Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
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Quality Improvement Learning Collaborative Improves Timely Newborn Follow-Up Appointments. Jt Comm J Qual Patient Saf 2019; 45:808-813. [PMID: 31607501 DOI: 10.1016/j.jcjq.2019.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/12/2019] [Accepted: 08/12/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND American Academy of Pediatrics guidelines indicate that newborns should follow up with their primary care providers within three days of discharge from the newborn nursery. Many barriers exist to achieving timely follow-up, with potential implications on a newborn's health. The goal of this project was to improve rates of timely newborn follow-up through a nine-month quality improvement learning collaborative (QILC). Timely newborn follow-up was defined as an appointment scheduled within three days of newborn discharge. METHODS Both inpatient hospitalist and outpatient pediatric practices were eligible to participate. Inpatient and outpatient practices aimed to have 75% of newborns scheduled appropriately by six months into the project. In addition, outpatient practices aimed to have 60% of newborns seen appropriately by their provider. All practices aimed to have their progress sustained at conclusion of the QILC. Practices submitted data at baseline and nine subsequent phases. Monthly webinars featured a quality improvement didactic, data review, and discussion of practices' changes, successes, and challenges. RESULTS Eleven practices and 24 physicians participated in the QILC. Aggregate data from the practices showed continual improvement in all measured newborn scheduling metrics throughout the nine-month learning collaborative, with sustainment of progress over the last three months of the QILC. CONCLUSION A QILC is successful for increasing timely newborn follow-up for both the newborn hospitalist and outpatient pediatrician. Pediatric providers can learn from others' strategies and successes to incorporate meaningful changes in their practice.
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27
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Erfina E, Widyawati W, McKenna L, Reisenhofer S, Ismail D. Exploring Indonesian adolescent women's healthcare needs as they transition to motherhood: A qualitative study. Women Birth 2019; 32:e544-e551. [PMID: 30928175 DOI: 10.1016/j.wombi.2019.02.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Marriage and underage childbirth is a phenomenon of increasing incidence globally. Adolescent mothers simultaneously encounter multiple developmental challenges related to transition into adulthood, marriage, pregnancy and mothering responsibilities. Despite this, studies investigating postpartum care needs for adolescent mothers are limited. AIMS The aim of this study was to explore adolescent mothers' postnatal inpatient experiences and healthcare needs as they moved towards their maternal roles. METHODS A descriptive qualitative design was adopted to better understand experiences of adolescent mothers during their transition to becoming mothers. Data were collected using in-depth interviews with eleven adolescent mothers in hospital settings in South Sulawesi, Indonesia and analysed using thematic analysis. RESULTS Four major themes emerged: (1) breastfeeding problems, (2) disempowerment in caring for the baby, (3) health care encounters, and (4) health care needs for adolescent motherhood transition. DISCUSSION Breastfeeding problems and feeling disempowered in caring for their babies after birth was experienced by all adolescent mothers in this study. Furthermore, the health care provided was limited to mandatory hospital tasks with staff failing to recognize adolescent mothers' broader needs. The findings suggest that adolescent mothers need compassionate health education, support and psychological care from midwives in the postpartum ward before hospital discharge. CONCLUSION The results highlight important issues in postnatal care provision for adolescent mothers in improving their maternal roles during the transition period. Specific, appropriate interventions for adolescent mothers are needed to support their transition and adaptation to their new roles.
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Affiliation(s)
- Erfina Erfina
- Doctoral Programme, Faculty of Medicine, Health Sciences and Nursing, Gadjah Mada University, Jl. Bulaksumur, Caturtunggal, Kec. Depok, Kabupaten Sleman, Yogyakarta, 55281, Indonesia; Faculty of Nursing, Hasanuddin University, Jl. Perintis Kemerdekaan KM 10, Tamalanrea, Makassar, 90245, Indonesia; School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia.
| | - Widyawati Widyawati
- Doctoral Programme, Faculty of Medicine, Health Sciences and Nursing, Gadjah Mada University, Jl. Bulaksumur, Caturtunggal, Kec. Depok, Kabupaten Sleman, Yogyakarta, 55281, Indonesia; School of Nursing, Faculty of Medicine, Health Sciences and Nursing, Gadjah Mada University, Jl. Bulaksumur, Caturtunggal, Kec. Depok, Kabupaten Sleman, Yogyakarta, 55281, Indonesia.
| | - Lisa McKenna
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia.
| | - Sonia Reisenhofer
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia.
| | - Djauhar Ismail
- Doctoral Programme, Faculty of Medicine, Health Sciences and Nursing, Gadjah Mada University, Jl. Bulaksumur, Caturtunggal, Kec. Depok, Kabupaten Sleman, Yogyakarta, 55281, Indonesia; Department of Child Health, Faculty of Medicine, Health Sciences and Nursing, Gadjah Mada University, Jl. Bulaksumur, Caturtunggal, Kec. Depok, Kabupaten Sleman Yogyakarta, 55281, Indonesia.
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Havens JME, Wines M. Screening for Mothers at Risk to Wean Early and Referral to a Lactation Support Person for Prolonging Breastfeeding. J Perinat Educ 2019; 28:51-60. [PMID: 31086475 PMCID: PMC6491151 DOI: 10.1891/1058-1243.28.1.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This project trialed the breastfeeding control (BFC) scale of the Breastfeeding Attrition Prediction Tool (BAPT) to identify mothers at high risk to wean early and to determine the effectiveness of a prenatal consult with a lactation support person on breastfeeding duration and intensity. Results indicated that mothers with lower scores on the BAPT-BFC scale showed a trend for decreased breastfeeding intensity at 8 weeks postpartum. Experimental and control groups had similar BAPT-BFC scores and breastfeeding intensity at 8 weeks. Overall, women who had low BAPT-BFC scores tended to be breastfeeding less at 8 weeks compared with mothers who scored very high. This finding would suggest the BAPT-BFC is a helpful tool for predicting breastfeeding success.
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Ramos MM, Sebastian RA, Sebesta E, McConnell AE, McKinney CR. Missed Opportunities in the Outpatient Pediatric Setting to Support Breastfeeding: Results From a Mixed-Methods Study. J Pediatr Health Care 2019; 33:64-71. [PMID: 30217618 DOI: 10.1016/j.pedhc.2018.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 06/10/2018] [Accepted: 06/16/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Outpatient pediatric providers play a crucial role in the promotion of breastfeeding. We conducted a mixed methods study to measure provider knowledge, attitudes, and current practices around breastfeeding counseling. METHOD In New Mexico in 2016 and 2017, we conducted a knowledge, attitudes, and practice survey of outpatient pediatric providers (i.e., nurse practitioners, physicians, and physician assistants) and conducted focus groups with outpatient pediatric providers. RESULTS Seventy-seven providers responded to the survey, and 17 participated in three focus groups. Fewer than half of providers surveyed reported asking how long mothers plan to breastfeed at initial well-baby examinations. One quarter of participants (28.2%) erroneously reported that hepatitis C was an absolute contraindication to breastfeeding. Just half of respondents had received continuing education within the past 3 years about managing common breastfeeding problems. DISCUSSION We identified missed opportunities for outpatient pediatric providers to support breastfeeding and a need for continuing provider education.
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Affiliation(s)
- Mary M Ramos
- Mary M. Ramos, Assistant Professor, Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM..
| | - Rachel A Sebastian
- Rachel A. Sebastian, Medical Sociologist, Child Policy Research Consulting, LLC, Fort Wright, KY
| | - Emilie Sebesta
- Emilie Sebesta, Professor, Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM
| | - Adrienne E McConnell
- Adrienne E. McConnell, Health Education Consultant, Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM
| | - Courtney R McKinney
- Courtney R. McKinney, Program Manager, Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM
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Brzezinski L, Mimm N, Porter S. Pediatric Nurse Practitioner Barriers to Supporting Breastfeeding by Mothers and Infants. J Perinat Educ 2018; 27:207-219. [PMID: 31073267 DOI: 10.1891/1058-1243.27.4.207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Infant health and development outcomes are positively affected by breastfeeding. Despite the multitude of breastfeeding benefits to mothers and infants along with strong recommendations for exclusive breastfeeding from government agencies and professional associations, the rate of exclusive breastfeeding during the first six months of life remains low. Strongly positive attitudes make pediatric nurse practitioners, especially those in primary care settings, ideally positioned to encourage, support, and provide breastfeeding management to mothers and infants. However, pediatric nurse practitioners may report breastfeeding education and breastfeeding skills deficits along with other barriers to optimal breastfeeding care.
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Martin E, Vickers B, Landau R, Reece-Stremtan S. ABM Clinical Protocol #28, Peripartum Analgesia and Anesthesia for the Breastfeeding Mother. Breastfeed Med 2018; 13:164-171. [PMID: 29595994 DOI: 10.1089/bfm.2018.29087.ejm] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols, free from commercial interest or influence, for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Erin Martin
- 1 Department of Anesthesiology, University of California , San Diego, California
| | - Barbara Vickers
- 2 Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University , Baltimore, Maryland
| | - Ruth Landau
- 3 Department of Anesthesiology, Columbia University , New York City, New York
| | - Sarah Reece-Stremtan
- 4 Division of Anesthesiology, Pain, and Perioperative Medicine , Children's National Health System, Washington, District of Columbia
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