Ten Steps For Clear Eyesight Without Glasses - A Quick Course
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Storing milk in a freezer for up to 12 months may be acceptable. Small amounts of milk can be added to previously expressed milk, but the fresh milk should be chilled before adding to already frozen milk.
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Room should be left in the container for expansion during freezing. The best storage containers are hard plastic or glass containers. It is best to avoid clear plastic containers because of the possible leaching of BPA into the milk during warming. Warming and thawing of milk should not be done in the microwave. Thawing can be accomplished by placing the frozen milk in the refrigerator overnight, or with the use of a bowl of warm water or running warm water.
Because any thawed milk that has been partially consumed must be discarded, it is advisable to use small containers to avoid unnecessary waste. Routine supplementation of healthy, term breastfeeding infants is not recommended unless medically indicated. Mothers who supplement their nursing infants with infant formula are at risk of a decrease in their milk supply caused by decreased demand.
In addition to potential loss of milk, supplementation should be used only when medically indicated 60 because it can also interfere with other psychosocial and neurodevelopmental benefits of breastfeeding. Common situations that require infant supplementation include infant hypoglycemia not responsive to breastfeeding, insufficient maternal milk supply, delay in lactation, excessive infant weight loss, infant illness such that feeding at the breast is not effective, and maternal-infant separation.
Methods of supplementation include cup feeding, finger feeding with a syringe attached to a feeding tube, using a supplemental feeding tube at the breast, and bottle feeding. One method is not necessarily more suitable than another, and the choice of method depends on individual evaluation of the mother-infant pair.
Parents need professional guidance when supplementation is necessary, and consultation with a certified lactation consultant or other knowledgeable health care professional is recommended. Sunlight has historically been the primary source of vitamin D for humans.
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Human milk contains low levels of vitamin D, leaving breastfed babies, especially dark-skinned babies, at increased risk of rickets. It is recommended that all babies receive IU of vitamin D supplementation daily beginning soon after birth. Babies receiving mL or more of vitamin D-fortified infant formula do not need additional vitamin D supplementation.
The period following the birth of a premature infant can be overwhelming for families. The advice and support of a trusted family physician can be invaluable to parents confronted with unforeseen decisions and numerous uncertainties. Some relatively mature preterm infants may be able to breastfeed right away. Family physicians can provide immediate guidance on maintaining lactation when mother-infant separation is required. Preterm human milk differs from term human milk, in that it has a higher concentration of protein, immunoglobulin A, infection-fighting cells, immune modulators, and anti-inflammatory factors, and it provides short- and long-term health advantages for preterm infants.
The decrease in necrotizing enterocolitis appears to outweigh any short-term increase in growth achieved with preterm formula feeding.
Evidence of improved feeding tolerance, earlier full enteral feeds, and decreased risk of atopic diseases has been inconsistent to date. A meta-analysis of 20 studies concluded that breastfeeding is associated with long-term cognitive advantages and that preterm infants derive more benefit than full-term infants.
Preterm infants who are provided human milk in the neonatal intensive care unit NICU have lower rates of rehospitalization. However, protein fortification may be necessary for smaller or more fragile preterm infants. Studies have shown that preterm infants show greater cardiac and respiratory stability when breastfeeding rather than bottle-feeding. In addition to promoting physiologic stability in premature infants, skin-to-skin contact i.
Mothers of preterm infants should be presented with information about the benefits of breastfeeding and human milk for the premature infant. A woman who is hesitant to make a long-term commitment to breastfeeding can be encouraged to nurse or express colostrum and milk for her infant until hospital discharge. The mother of a preterm infant faces many challenges, such as infant illness; maternal-infant separation; infant feeding difficulties at the breast; the possibility of prolonged pumping; and the emotional and physical stress of juggling personal care with other commitments to her family, job, and newborn.
When family physicians work as part of a medical team of neonatologists, nurses, social workers, dietitians, and lactation consultants, they can be effective in supporting the successful initiation and continuation of breastfeeding the preterm infant. Newborns born at 35 to 37 weeks of gestation have special nutritional needs and require extra lactation support compared with newborns who are full term.
These babies tend to be sleepy and are at high risk of not feeding effectively enough at the breast to support sufficient growth. This increases their risk of hypoglycemia and dehydration. Because of their relative immaturity, they are also at risk of delayed hepatic bilirubin excretion leading to jaundice. There are 17 nonprofit human milk banks in the United States and Canada that are members of the Human Milk Banking Association of North America, with four additional banks in the developing stage www.
Each milk bank carefully screens donors and then pasteurizes and distributes human milk from donors to a variety of infant and child populations in need. In recent years, a new trend of casual milk sharing has emerged among some mothers, in which unpasteurized milk is shared with or sold to other mothers, without benefit of medical screening. One study found that milk purchased anonymously over the Internet frequently was contaminated 82 , though these results may not be generalizable to situations in which donor and recipient mothers are acquainted and shipping is not necessary.
Age and health status of the recipient baby should also be considered, and mothers should make a fully informed decision in their particular situation, weighing the risks of unscreened and unpasteurized human milk from a donor versus risks of artificial infant formula. Mothers of twins and higher order multiples should be encouraged to breastfeed.
Mothers of multiples will need additional support for breastfeeding. Most mothers can fully breastfeed twins. Success with breastfeeding triplets and even quadruplets has been reported. One study showed adequate supply, with mothers of twins producing twice the volume of milk with adequate nutrient composition compared with mothers of singletons, and mothers of triplets capable of producing more than three liters per day. Physicians need to recognize that, while breastfeeding multiples is a challenge, with support, it can be successful. They must be prepared to counsel prior to delivery and support breastfeeding with reassurance of adequate supply, along with the usual recommendations of proper rest, nutritious diet, and the need for intensive support and help.
Physicians should be familiar with techniques for increasing milk supply and recognize that even partial breastfeeding is beneficial. Family physicians often care for adoptive parents.
The physician should discuss with the adoptive mother the option to breastfeed her child. A knowledgeable physician or lactation consultant may help the mother develop a milk supply before or after an adoption. The family physician who is supporting lactation induction or relactation should begin as early as possible in the adoptive process.
The physician should facilitate placing the newborn to the breast as soon as possible after the birth of the adopted child. Many adoptive mothers are physiologically capable of producing milk, to a greater or lesser extent. A multiparous woman will likely produce significantly more milk than a nulliparous mother. It is also important to be knowledgeable about the informal milk-sharing resources in communities and on the Internet and to counsel adoptive mothers about the potential risks of such arrangements.
Suckling at the breast has developmental advantages for babies. In many cases, the opportunity to emotionally bond during nursing is the primary benefit of breastfeeding for adoptive mothers and babies. As recommended by the World Health Organization, breastfeeding ideally should continue beyond infancy, but this is not the cultural norm in the United States and requires ongoing support and encouragement. It has been estimated that a natural weaning age for humans is between two and seven years.
The longer women breastfeed, the greater the decrease in their risk of breast cancer. There is no evidence that extended breastfeeding is harmful to mother or child. Emerging research on nutrient content of human milk into the second year of lactation suggests that breast milk continues to offer significant nutritional and immunological benefits. If the child is younger than two years, the child is at increased risk of illness if weaned.
Breastfeeding the nursing child during pregnancy and after delivery of the next child tandem nursing may help provide a smooth transition psychologically for the older child. Weaning has nutritional, behavioral, and psychosocial components. In this sense, weaning begins with the introduction of solids around the middle of the first year.
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Complete weaning, or complete cessation of breastfeeding, ideally should be a gradual process accomplished over a long period. There is no evidence that a specific age of weaning is necessary or mandated. Like other developmental milestones, weaning takes place when a child is ready, physically and psychologically. Anthropological data suggest a wide range of normal self-weaning ages, from 2. The role of the family physician involves knowledge of the physiologic norm for weaning and the provision of culturally sensitive anticipatory guidance and counseling to mothers and families during the process.
It is important to recognize and counsel mothers about the difference between weaning and a nursing strike because mothers may misinterpret an abrupt breast refusal—especially in an infant younger than one year of age—as a sign that the baby is ready to wean. It is also important to avoid inappropriate recommendations for premature weaning for noncontraindications. If the mother chooses to wean, she can be supported to go about it gradually to lessen the risk of engorgement, plugged ducts, galactoceles, mastitis, and breast abscess for herself; emotional trauma for herself and the child; and the risk of infectious illnesses, dehydration, and malnutrition in the child.
Medications to decrease or stop milk production are not necessary and should be avoided. If the mother is interested, she can be encouraged to try a partial, rather than complete, weaning. In rare cases in which abrupt weaning is necessary, the advice of a lactation consultant should be sought to minimize the risks.
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Regardless of the reasons for weaning, whether premature and abrupt or gradual and mother- or child-led, many mothers feel a sense of grief or loss as breastfeeding ends. Approval and support of breastfeeding by the father is associated strongly with the decision to breastfeed.