The cup-versus-bottle debate: a theme from an ethnographic study of the supplementation of breastfed infants in hospital in the United kingdom

Feeding Neonates by Cup: A Systematic Review of the Literature

Objective WHO and UNICEF recommend cup feeding for neonates unable to breastfeed in low-resource settings. In developed countries, cup feeding in lieu of bottle feeding in the neonatal period is hypothesized to improve breastfeeding outcomes for those initially unable to breastfeed. Our aim was to synthesize the entire body of evidence on cup feeding. Methods We searched domestic and international databases for original research. Our search criteria required original data on cup feeding in neonates published in English between January 1990 and December 2014. Results We identified 28 original research papers. Ten were randomized clinical trials, 7 non-randomized intervention studies, and 11 observational studies; 11 were conducted in developing country. Outcomes evaluated included physiologic stability, safety, intake, duration, spillage, weight gain, any and exclusive breastfeeding, length of hospital stay, compliance, and acceptability. Cup feeding appears to be safe though intake may be less and spillage greater relative to bottle or tube feeding. Overall, slightly higher proportions of cup fed versus bottle fed infants report any breastfeeding; a greater proportion of cup fed infants reported exclusive breastfeeding at discharge and beyond. Cup feeding increases breastfeeding in subgroups (e.g. those who intend to breastfeed or women who had a Caesarean section). Compliance and acceptability is problematic in certain settings. Conclusions Further research on long-term breastfeeding outcomes and in low-resource settings would be helpful. Research data on high risk infants (e.g. those with cleft palates) would be informative. Innovative cup feeding approaches to minimize spillage, optimize compliance, and increase breastfeeding feeding are needed.

ABM Clinical Protocol #3: Supplementary Feedings in the Healthy Term Breastfed Neonate, Revised 2017

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.

Clarifying nipple confusion

Nipple confusion, an infant's difficulty with or preference for one feeding mechanism over another after exposure to artificial nipple(s), has been widely debated. This is in part due to conflicting statements, one by the American Academy of Pediatrics in 2005 suggesting that infants should be given a pacifier to protect against Sudden Infant Death Syndrome, and the other by the World Health Organization in 2009 stating that breastfeeding infants should never be given artificial nipples. Despite the limited and inconsistent evidence, nipple confusion is widely believed by practitioners. Therefore, there is a unique opportunity to examine the evidence surrounding nipple confusion by assessing the research that supports/refutes that bottle feeding/pacifier use impedes breastfeeding efficacy/success/duration. This review examined 14 articles supporting and refuting nipple confusion. These articles were reviewed using the Johns Hopkins Nursing Evidence-Based Practice Rating Scale. Based on our review, we have found emerging evidence to suggest the presence of nipple confusion only as it relates to bottle usage and found very little evidence to support nipple confusion with regards to pacifier use. The primary difficulty in conclusively studying nipple confusion is establishing causality, namely determining whether bottles'/pacifiers' nipples are causing infants to refuse the breast or whether they are simply markers of other maternal/infant characteristics. Future research should focus on prospectively examining the causality of nipple confusion.

A model infant feeding policy for Baby-Friendly designation in the USA

BACKGROUND

In June 2010, the Communities Putting Prevention to Work program (Centers for Disease Control and Prevention) funded a New Jersey (NJ) Office on Nutrition and Fitness, Department of Health and Senior Services project to reduce obesity and increase exclusive breastfeeding by increased implementation of the Baby-Friendly Hospital Initiative in the state of NJ. At baseline, NJ had no Baby-Friendly hospitals and no hospital was using an infant feeding policy that conformed to standards required by Baby-Friendly USA for designation.

GOAL

To create a model infant feeding policy that would be adaptable for use at multiple NJ hospitals preparing for Baby-Friendly designation.

METHODS

Project consultants created a policy based on existent policies from the American Academy of Pediatrics, the Academy of Breastfeeding Medicine, certified Baby-Friendly hospitals, and guidance from Baby-Friendly USA. This policy was submitted to Baby-Friendly USA, the US body responsible for Baby-Friendly designation.

RESULTS

Baby-Friendly USA requested changes; after adaptations, the policy was made available to targeted NJ hospitals via a statewide portal. The hospitals made relevant adaptations for their setting, and those that were ready submitted the policy during the Baby-Friendly designation process. The policy was acceptable to Baby-Friendly USA.

CONCLUSION

A collaborative initiative can use a single breastfeeding policy template as an aid toward Baby-Friendly designation. Such work streamlines the process and saves time and resources.

Which method of breastfeeding supplementation is best? The beliefs and practices of paediatricians and nurses

The aims of the present study were to assess the practices of breastfeeding supplementation methods, and to explore the opinions and beliefs of health professionals with regard to breastfeeding supplementation methods and the nipple confusion phenomenon. The study was cross-sectional in design, and participants were recruited from five hospitals in Toronto, Ontario. All of the nurses and attending paediatricians in postpartum floors and level II nurseries were invited to participate in the study. A total of 87 nurses and 16 paediatricians completed the survey questionnaire. Bottle feeding was the most common breastfeeding supplementation method used in the nurseries followed by cup feeding. Only 15.0% of the level II nurses agreed that frequent bottle feeds lead to the nipple confusion phenomenon, compared with 44.4% of the postpartum nurses and 56.2% of the paediatricians. Findings demonstrated considerable variation in the practices and beliefs surrounding supplementation methods. A randomized controlled trial comparing the safety, efficiency and subsequent breastfeeding rates of different breastfeeding supplementation methods is warranted.

Parental distress around supplementing breastfed babies using nasogastric tubes on the post-natal ward: a theme from an ethnographic study

There is abundant evidence of the benefits of breastfeeding. In the UK, supplementation in hospital has consistently been shown to be associated with shortened duration of breastfeeding. This paper reports on a subset of the data from an ethnographic study that explored the expectations, beliefs and experiences of mothers and health professionals concerning supplementation, using a variety of methods, of breastfed babies in an English maternity unit in 2002. This paper aims to describe the expectations, beliefs and experiences of mothers and health professionals concerning supplementation by nasogastric (NG) tube on the post-natal ward. Participant observation was carried out on day and night shifts and at weekends over 9 months. Mothers, midwives, neonatal nurses, health care assistants and senior paediatricians were interviewed. Categories and themes were generated. The researchers' constructs of 'the essential method', when the tube was the method needed for medical reasons, and 'the chosen method', when other methods of oral feeding should have been possible, emerged. The latter included time pressures and the avoidance of any form of oral activity that might perhaps make return to the breast more difficult. The data concerning the use of NG tubes for supplementation yielded the specific theme of parental distress. In the absence of evidence that supplementation by NG tube on the post-natal ward is associated with greater breastfeeding success than other methods, the use of the tube to avoid any form of 'oral confusion' should be discontinued. Its use primarily to save time should not be considered acceptable.

Uso do copinho no alojamento canguru

OBJETIVO: avaliar o manejo das mães no uso do copinho e analisar os aspectos que interferem para administração dessa técnica. MÉTODOS: a amostra foi composta de 30 binômios mãe/bebê. O estudo desenvolvido foi transversal de correlação. Foram realizadas coletas nos prontuários das mães e do bebê, executada uma observação das mães ofertando a dieta no copinho e aplicado um questionário com perguntas sobre o uso do copo. A análise dos resultados foi realizada por meio do programa software estatístico, SPSS 13.0. Aplicou-se testes de estatística descritiva, mais especificamente a distribuição das freqüências e das percentagens relativas de cada dado observado. Em relação à associação entre as variáveis estudadas foram utilizados os seguintes testes: teste Qui-Quadrado, com nível de significância de 5% (p<0,05) e o teste de Correlação Bivariada com o grau de correlacionamento linear de Spearman (R), utilizando o nível de significância de 5% (p<0,05). RESULTADOS: há relação significante da postura do bebê, posição do copo, volume administrado e orientação dos profissionais de saúde às mães sobre o uso do copinho. CONCLUSÃO: o copinho pode ser manejado pelas mães, mas estas necessitam de orientações sobre o uso da técnica pelos profissionais de saúde; principalmente em relação ao cuidado com a posição do copo e volume de leite.