Integrated Maternal and Newborn Care Basic Skills Course ...

Reference Manual
Breastfeeding the LBW Baby in KMC
• Explain to the mother the benefits of breast milk, especially for a LBW baby.
• The baby is ready to start breastfeeding when he/she starts moving the tongue and
mouth and shows interest in sucking his/her fingers or the mother’s skin.
• Start breastfeeding when the baby is awake.
• Promote frequent breastfeeding (about every 2-3 hours).
• Help the mother get in a comfortable position on an armless chair in a quiet place, if
possible.
• Before starting to breastfeed, loosen the cloth wrap around the baby.
• With the baby in skin-to-skin contact, follow the same steps for attachment and
positioning as for the normal baby.
• Being small, the baby will need more frequent breastfeeding, with several pauses during
feeding. The baby needs to be allowed to feed while he/she still shows interest in
sucking.
• If the baby gags, coughs, or spits up, teach the mother to take the baby off the breast
and the cloth wrap, hold the baby covered against her chest until she/he quiets down
and breathes normally before retrying again. If the ejection reflex is strong, express a
little milk before restarting feeding.
• When the mother’s breasts are engorged, express enough breast milk to make the
areola soft enough to introduce into the baby’s mouth to facilitate his/her sucking.
• Some babies may need additional support:
o Wait until the baby is awake.
o Loosen the wrap around the baby.
o Hold the baby with the mouth close to the nipple.
o Express a few drops of breast milk.
o Let the baby smell and lick the nipple and open the mouth.
o Express milk into the baby’s open mouth.
o Wait for the baby to swallow the milk.
o Repeat the procedure until the baby closes his/her mouth and will not take any more
milk even after stimulation.
o Alternatively, milk can be expressed from the breast into a clean container that has
been sterilized by boiling for 10 minutes, and feed the baby by cup, spoon, or a
suitable traditional feeding device.
Note: If the infant cannot suck/accept feeds, he/she needs referral for care
at a higher level facility. Do not introduce milk into the mouth of the baby
who cannot swallow.
Counsel the Mother and Family about KMC
Counsel the mother and the family:
• On the benefits of KMC.
• To use an extra cloth or towel beneath the baby’s bottom to avoid soiling of the mother’s
clothes, and change the cloth/diaper frequently. If a cloth is used, advise to always use a
clean, dry cloth for the newborn’s diaper.
Integrated maternal and newborn care
Basic skills course
145