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DuringPostpartum/MaternalCareVisit:Continuetoencourage andsupport. Ask about breastfeeding duration and success. Advocate exclusive breastfeeding to 6 months. Be prepared to refer to s peci c lactation specialists

and/or community resources when needed.

Duringthe3-to5- DayPediatricVisit:Assess,prescribe VitaminD, andplan ahead. Be sure to initiate a conversation with the patient.

Suggested conversation starters include:How is feeding going? Do you have any concerns about your breasts orhow breastfeeding is going?

How often is your baby breastfeeding?How is the milk owing?Is your baby latching well?

After Discharge From Maternity/Newborn Nursery

Signs Breastfeeding is Going Well Baby latches onto areola, not just nipple Infant suckles using jaw, not just lips Infant makes swallowing sound Infant can latch on both breasts

Signs Breastfeeding is NOT Going Well >7%infantweight lossfrombirthweight at3-to5-day pediatricvisit Infrequentwet/soiled diapers(fewer than3-4 urinediapers/24 hrs.,

fewer than 3-4 stools/24 hrs.) Mothers nipples are red, cracked (likely due to latch problem)

Ideally, observe breastfeeding and look for signsof how breastfeeding is going.

Ifthere aresigns breastfeedingis notgoingwell, interveneasnecessary,(e.g.,providetelephoneand in-officesupport,refermotherto alactationspecialistand/orsupportgroup).In addition: Reinforce on-demand feeds and no supplementation

will increase milk supply. Remindmothersnotto takeformulasamples,if offered. Remind mother to stay hydrated whenever

breastfeeding the baby. Discuss bene ts of exclusive breastfeeding for the

rst 6 months of life, and the bene ts of continuedbreastfeeding through 12 months. Explore barriers,work through solutions, and provide resources, supportand community referrals.

AtAnyVisit:Verifysuccess, anticipatechallengesand sprolongedbreastfeeding. Remind mother to give the baby 400 IU

D drops daily until at least 1 liter or quwhole milk is given daily.

Referthe motherto alactationspecialistagroup whenever needed. Keep referral ieach exam room.

Discuss return-to-work plans and breasHospital-grade and personal electric puavailable throughWIC programs and viprograms, including Medicaid, in select

Fluoridesupplements arenot indicatedin

Select Coding Options

For Breastfeeding EncoFeeding problem, newborn Feeding problem, infant >28d Ne onat al j aund ice D eh yd ra ti on , n eo na ta l Weight loss Blocked milk duct Breast engorgement, ductal 6Nipple infection Nipple, sore Sup ervi si on o f l ac ta ti on Other specied follow-up exam V

Source: www.aap.org/breastfeeding/ les/pdf/Consult the LactMed database about speci c drugs: http://toxnet.nlm.nih.gov.

An ti - A nt i- D ia bet es An al ge si csHypertensives Infectives medications

Methyldopa Clindamycin Insulin Morphineand(Aldomet) derivativesLabetalol Ampicillin- Glyburide(infants Acetaminophen

sulbactam glucosemaybe(Unasyn) monitored,but

adverseeffectsarerare)

Nifedipine Fluconazole Metformin Ibuprofen(Procardia) Gentamicin

CommonMedicationsthat areCompatible withBreastfeeding

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During Prenatal Care:Encourageexpectantmotherstobreastfeedexclusively forsix months.

What you say to expectant mothers and theirfamilies makes a real difference. If you recommendexclusive breastfeeding, more new mothers willbreastfeedforlongerperiodsoftime.

Letthemknow:

Iencourage expectantmothers tobreastfeedexclusivelyforthe rstsixmonths.I recommendtheycontinuebreastfeedingthroughthe babys rst year.

Breast milk is the safest and best food for your baby.Formula just does not give you and your baby thesame protection against diseases.

The longer you breastfeed your baby, the better forboth of you. It is important to your babys health and

helps you regain your shape. It also lowers your risk for some cancers, diabetes and heart disease.

It can be hard at rst for somemoms and babies, but itgets easier.

Get off to a good start byrequesting that the babybe placed on your chest,skin-to-skin, immediatelyafter birth. Most babieswill breastfeed during therst hour.

MothersCan Breastfeed IfThey HaveCesareanDeliveries

Initiate breastfeeding immediately, uposition on the side or sitting up.

TakeMedicationsMost medications can be taken whileLactMed Database about speci c drug

HaveHadBreastSurgery(includingbreastaugmentationor re Augmentationm ammoplasty:Breastfee

milk supply. Breastreduction:Monitor infant grow

be insufficient. Breastbiopsyinvolving anareolarin

by augmenting production in the uninfant growth since milk supply cou

HaveHepatitis BInitiate breastfeeding after infant receglobulin and rst dose of the three-dos

HaveHepatitis CHepatitisC isnot acontraindication foif nipples are cracked or bleeding.

Thefollowingare absolutecontraindi Areinfected withHIV Areinfected withHTLV(Human T-

TypeIorII Useillegaldrugs Aretaking cancerchemotherapyage

withDNAreplication andcell divisi

Breastfeeding confers uniquehealth benefits to infants andmothers. Health care providersand staff can play a criticalrole in promoting exclusivebreastfeeding and increasingduration of breastfeeding. Your counseling and support efforts should start whilethe patient is pregnant, and

continue through the neonatalperiod and beyond.

This pocket guide has beendeveloped to support youin this effort. Please help usmake breastfeeding the norm.

MothersCannot Breastfeed IfThey