Supporting Oral Nutrition for Exclusively Breastfed Infants
Breastfeeding provides nutritional, immunological and emotional benefits for the growth and development of infants, improves maternal health, and provides economic benefits to the family and the healthcare system. As a result, breastfeeding is strongly supported nationally and internationally.
Exclusive breastfeeding is recommended for a healthy full-term infant for the first six months, with the introduction of age appropriate iron-rich foods, and continued breastfeeding for two years and beyond.
When an infant and parent present with breastfeeding challenges, a holistic assessment and understanding of maternal goals is needed to provide an individualized approach to management. Infant breastfeeding may require adjustments to latch, positioning, pacing and/or routine among other factors. Inadequate milk transfer may lead to poor emptying of the breast, thus limiting production and breastmilk supply that compounds feeding issues and infant growth. In these situations, the parent and infant should be referred to a lactation consultant or healthcare professional with breastfeeding knowledge and skill to support them both.
Breastmilk supply should be optimized through infant stimulation at the breast, pumping and, or other lactation supports. High calorie formula supplementation can also be considered as a bridge during times when breastmilk supply is low until optimal volumes are achieved.
If breastmilk supply remains inadequate or if the infant is tiring easily, it may be necessary to provide expressed breastmilk supplementation via bottle, at breast supplemental system, cup or enteral feed. Some families may decide to introduce infant formula. High calorie breastmilk supplementation may also be explored depending on breastmilk availability, volume accepted, and growth needs.
Breastfeeding may not be achievable for some parents and infants. In this situation, parents should be supported by the healthcare team to determine a feeding method that is both achievable and desirable to the parent and infant. A discussion supporting an informed feeding decision is recommended.