Tag Archive for: Gyakorlati útmutatók

Mastitis – Causes and Management

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A mastitis a mell gyulladásos állapota, amelyhez fertőzés társulhat. Általában a laktációval összefüggésben lép fel, ezért laktációs vagy puerperális mastitisnek is nevezik. Esetenként fatális lehet, amennyiben nem megfelelően kezelik. A mastitis súlyos szövődménye a melltályog, amely lokalizált gennygyülem a mell állományán belül. Ezek az állapotok számottevő nehézséget jelentenek, és jelentős költséggel járnak. A legújabb kutatások kimutatták, hogy a mastitis megnöveli a HIV szoptatás útján való átvitelének kockázatát.

Egyre nyilvánvalóbb, hogy a mell nem elég hatékony kiürítése, ami a nem megfelelő szoptatási technika eredménye, fontos hajlamosító tényező, mégis, a mastitis még mindig a mell-fertőzés szinonímája az egészségügyi szakemberek fejében. Ezek a szakemberek gyakran képtelenek a mastitisben szenvedő nőknek olyan segítséget nyújtani, ami lehetővé teszi a szoptatás folytatását, és javasolják szükségtelenül a szoptatás abbahagyását.
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Promoting and Supporting Breast-Feeding

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Jay Moreland, Jennifer Coombs

Am Fam Physician 2000;61:2093-100,2103-4.

The family physician can significantly influence a mother’s decision to breast-feed. Prenatal support, hospital management and subsequent pediatric and maternal visits are all-important components of breast-feeding promotion. Prenatal encouragement increases breast-feeding rates and identifies potential problem areas. Hospital practices should focus on rooming-in, early and frequent breast-feeding, skilled support and avoidance of artificial nipples, pacifiers and formula. Infant follow-up should be two to four days postdischarge, with liberal use of referral and support groups, including lactation consultants and peer counselors.

Breast-feeding is the best form of nutrition for infants.1,2 Family physicians can have a significant impact on the initiation and maintenance of breast-feeding, if they have sufficient knowledge of breast-feeding benefits and the necessary clinical management skills or habits.
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RELACTATION – A review of experience and recommendations for practice

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Elizabeth Hormann and Felicity Savage.

World Health Organization
Department of Child and Adolescent Health and Development, 1998

Introduction

WHO recommends exclusive breastfeeding for at least the first 4 and if possible the first 6 months of an infant’s life, and continued breastfeeding with adequate complementary food for up to two years of age or more. Yet many infants stop breastfeeding in the first few weeks or months and, as a result, are at increased risk of illness, malnutrition and death.

Breastfeeding can however be re-established. A woman who has stopped breastfeeding her child, recently or in the past, can resume the production of breastmilk for her own or an adopted infant, even without a further pregnancy.
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Postpartum Breastfeeding Assessments

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Verity Livingstone

Journal SOGC February 1996

Abstract

Despite a high initiation rate of breastfeeding in hospital, most mothers stop breastfeeding within a few weeks, “The window of professional unavailability” and lack of breastfeeding management skills among health professionals are partly to blame. This article, the third in a series, reviews the physiology of ongoing lactation, and outlines a protocol for post-partum breastfeeding that can be incorporated into routine postpartum management.

It reviews the early detection of infants at risk for breastfeeding difficulties and insufficient milk intake. It outlines topics for discussion and anticipatory guidance at age appropriate intervals including breastfeeding and sexuality, introduction of solids, and child led weaning.
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In-Hospital Lactation Assessment

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Verity Livingstone

Journal SOGC January 1996

Abstract

Obstetricians and family physicians play a privotal role in helping mothers to initiate lactation and to establish succesful breastfeeding in hospital. They can ensure that hospital policies and practices support breastfeeding, they can identify mothers and infants at risk for difficulties, and can offer early management advice.

This article outlines standardized in-hospital breast feeding protocols and assessments that can be used by health professionals on the wards.

A teljes cikk letölthető a Vancouver Breastfeeding Centre oldaláról.
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Prenatal Lactation Assessment

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Verity Livingstone

Journal SOGC 1994 November

Abstract

Obstetricians and physicians play key roles in preparing pregnant women for breastfeeding. By performing a careful prenatal lactation assessment in the third trimester, maternal and infant risk factors for lactation and breastfeeding difficulties can be identified.

Anticipatory guidance and early intervention can help mothers to achive their breastfeeding goals and can help families to follow the recommended infant feeding guidelines. This article outlines a standardized prenatal assessment protocol that can be used by physicians in their offices.

A cikk teljes szövege letölthető a Vancouver Breastfeeding Centre oldaláról
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Protecting Breast-feeding – Family physicians’ role

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Verity H. Livingstone

Can Fam Physician. 1992 August; 38: 1871-1876

Many mothers express a desire to breast-feed but are unable to initiate successful lactation, overcome minor difficulties, or maintain an adequate milk supply due to hospital routines and lack of appropriate advice from health care professionals.

“Doulas” were traditional female assistants who helped mothers breast-feed. Physicians must assume this role and promote breast-feeding prenatally, protect it in hospital, and support it postnatally.

A tejes cikk a PubMed Central oldaláról vagy a Vancouver Breastfeeding Centre oldaláról letölthető
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A diagnostic approach to breastfeeding problems

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Verity Livingstone

The Canadian Journal of Pediatrics February 1990

One-third of breastfeeding mothers stop within the first two months because they cannot solve their infant feeding difficulties, not because they wish to stop breastfeeding. This early weaning rate is unacceptably high, according to current infant feeding recommendations. The World Health Organization suggests that weaning should not occur until the second year, yet less than 10% of infants in Canada are receiving breast milk by one year.

Breastfeeding problems include: infant failure to thrive, early supplementation due to inadequate milk supply, infant distress, or maternal discomfort and distress. The etiology or underlying cause(s) should be carefully identified before appropriate management is instituted and preventive measures taken.
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The Family Physician’s Role in Preventing Early Termination of Breastfeeding

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Verity Livingstone
Can Fam Physician 1986;32:2162-2169

Summary

Despite the high rate of breastfeeding among mothers as they leave the hospital, early termination of breastfeeding continues to be a problem. A new mother needs considerable education, support and, often, early intervention, not only to initiate breastfeeding successfully, but also to prevent breastfeeding problems occuring and to continue breastfeeding successfully for several months. Knowledgeable health-care providers are the key to promoting and protecting breastfeeding, yet in the community, many of these mothers, lacking the support of such knowledgeable advisers, often terminate early.

Family physicians are in a key position to help teh nursing dyad.
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