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    <meta name="author" content="Denise Fisher" />
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      <h1 id="top">2.3.3 Maintenance of breastfeeding</h1>
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    <p>
		Following extensive world-wide research the World Health Organization concluded that optimum health and developmental outcomes for children are achieved when they are breastfed for a minimum of two years with the addition of appropriate complementary foods after six months of age.
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      <div class="section" id="Exclusive_breastfeeding"><h2>Exclusive breastfeeding</h2>
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      <p> Mothers are to receive education and support to exclusively breastfeed their infants until their infants are 6 months old. </p>
      <p> Obviously this standard of care must start from birth. Unless there is an acceptable medical indication breastfed babies in hospital should be exclusively breastfed. </p>
      <p> All breastfeeding mothers should be offered information on how they can continue to breastfeed and provide breastmilk if and when they return to work. </p>
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    <table class="callout"><thead><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_01.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background: repeat-x url(design/callout_02.png);"><img src="design/callout_02.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_03.png" width="10" height="10" alt="" /></td></tr></thead><tfoot><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_07.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background-image: url(design/callout_08.png);"><img src="design/callout_08.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_09.png" width="10" height="10" alt="" /></td></tr></tfoot><tbody><tr><td class="middleleft" style="background: repeat-y url(design/callout_04.png);"><img src="design/callout_04.png" width="10" height="80" alt="" /></td><td class="body"><h3></h3>
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        <p class="listTitle"> Acceptable medical indications for full or partial breastmilk substitution: </p>
        <ul>
          <li>
            <p class="listTitle"> Infant conditions: </p>
            <ul>
              <li> Some inborn errors of metabolism; <span style="font-style: italic;"> eg </span> classic galactosaemia, maple syrup urine disease, phenylketonuria </li>
              <li> very low birth weight or very preterm infants </li>
              <li> hypoglycaemia in a compromised infant (eg preterm, SGA, significant hypoxic or ischaemic stress, ill, or infants of a mother with diabetes). Intravenous correction is the most successful management. </li>
            </ul>
          </li>
          <li>
            <p class="listTitle"> Maternal conditions: </p>
            <ul>
              <li> HIV positive, where replacement feeding in the home situation will be acceptable, feasible, affordable, sustainable and safe </li>
              <li> serious illness </li>
              <li> some maternal medications, eg radioactive iodine, cytotoxic chemotherapy </li>
            </ul>
          </li>
        </ul>
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      <div class="section" id="The_use_of_dummies_pacifiers_"><h2>The use of dummies (pacifiers)</h2>
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      <p>What guidance does your hospital/community procedures give you for educating parents about dummy/pacifier use?</p>
      <p class="listTitle">Does it include:</p>
      <ul>
        <li>Dummy/pacifier use is discouraged for at least the first 4 weeks to permit establishment of breastfeeding.</li>
        <li>
          <p class="listTitle">If a mother wants to use a dummy</p>
          <ul>
            <li>don't start it before 4 weeks, and then only if breastfeeding is well established</li>
            <li>only use the dummy when settling the baby to sleep</li>
            <li>don't use the dummy to delay, or mask feeding cues</li>
            <li>be aware of the risk of reducing breastfeeding frequency and therefore breastmilk supply, which is the most common reason given for premature weaning</li>
          </ul>
        </li>
      </ul>
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      <div class="section" id="Commencing_complementary_foods"><h2>Commencing complementary foods</h2>
    <div class="columns"><div class="column" style="width: 50%">
        <div class="captionBox"><img width="300" height="199" src="images/complementary_foods.jpg" alt="Breastmilk + appropriate complementary foods from 6 months." /><p>Breastmilk + appropriate complementary foods from 6 months.</p></div>
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          <p>The education given to all mothers will include encouragement to exclusively breastfeed for 6 months before introducing appropriate complementary foods while continuing breastfeeding for at least another 6 - 18 months.</p>
          <p> All staff should be able to explain why complementary foods and drinks are not recommended before 6 months, and why prolonged breastfeeding for 2 years or more is recommended by the World Health Organisation for all infants. </p>
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      <div class="section" id="Overt_support_of_breastfeeding"><h2>Overt support of breastfeeding</h2>
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      <p>All written materials intended for mothers should be accurate and effective, and free from the promotion of breastmilk substitutes, bottles, artificial nipples/teats and dummies/pacifiers.</p>
      <p>Breastmilk substitutes and equipment for artificial feeding are stored out of sight.</p>
      <p>All handouts or sample bags given to new parents are free of promotion of artificial feeding and contain no samples of foods or drinks or artificial baby milk or redeemable vouchers for these products. When complementary foods are advertised it should state they are not suitable for an infant less than 6 months of age.<br /></p>
      <p>Free or low-cost samples or supplies of breastmilk substitutes are not given to mothers.</p>
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      <div class="section" id="Refer_to_your_Policy"><h2>Refer to your Policy</h2>
    <table class="callout"><thead><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_01.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background: repeat-x url(design/callout_02.png);"><img src="design/callout_02.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_03.png" width="10" height="10" alt="" /></td></tr></thead><tfoot><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_07.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background-image: url(design/callout_08.png);"><img src="design/callout_08.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_09.png" width="10" height="10" alt="" /></td></tr></tfoot><tbody><tr><td class="middleleft" style="background: repeat-y url(design/callout_04.png);"><img src="design/callout_04.png" width="10" height="80" alt="" /></td><td class="body"><img src="design/books.png" class="icon" alt="" /><h3></h3>
      <div>Find the Policy statements that address:<br /><ul><li>the giving of supplements to newborn infants</li><li>the use of dummies (pacifiers) and teats (artificial nipples)<br /></li><li>the duration of exclusive breastfeeding and educational information to be given regarding complementary foods</li><li>the regulation and display of materials covered by the WHO Code on the Marketing of Breastmilk Substitutes</li></ul></div>
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      <div class="section" id="Activity"><h2>Activity</h2>
    <table class="callout"><thead><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_01.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background: repeat-x url(design/callout_02.png);"><img src="design/callout_02.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_03.png" width="10" height="10" alt="" /></td></tr></thead><tfoot><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_07.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background-image: url(design/callout_08.png);"><img src="design/callout_08.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_09.png" width="10" height="10" alt="" /></td></tr></tfoot><tbody><tr><td class="middleleft" style="background: repeat-y url(design/callout_04.png);"><img src="design/callout_04.png" width="10" height="80" alt="" /></td><td class="body"><img src="design/group.png" class="icon" alt="" /><h3></h3>
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        <p>
				Form a small group of colleagues to review all the literature that is given to mothers. Include literature on topics not directly related to breastfeeding also.
			</p>
        <p class="listTitle">Review them for:</p>
        <ul>
          <li>Compliance with the WHO Code - ie. free from promotion of breastmilk substitutes, bottles, teats and dummies</li>
          <li>Accuracy and effectiveness of the content</li>
          <li>Inclusion of the importance of breastfeeding in healthy eating literature, diabetes prevention literature, contraceptive choices, etc.</li>
        </ul>
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    </td><td class="middleright" style="background: repeat-y url(design/callout_06.png);"><img src="design/callout_06.png" width="10" height="80" alt="" /></td></tr></tbody></table>
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      <div class="section" id="What_should_I_remember_"><h2>What should I remember?</h2>
    <table class="callout"><thead><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_01.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background: repeat-x url(design/callout_02.png);"><img src="design/callout_02.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_03.png" width="10" height="10" alt="" /></td></tr></thead><tfoot><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_07.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background-image: url(design/callout_08.png);"><img src="design/callout_08.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_09.png" width="10" height="10" alt="" /></td></tr></tfoot><tbody><tr><td class="middleleft" style="background: repeat-y url(design/callout_04.png);"><img src="design/callout_04.png" width="10" height="80" alt="" /></td><td class="body"><img src="design/remember.png" class="icon" alt="" /><h3></h3>
      <div>
        <ul>
          <li>the acceptable medical indications for a breastfed baby to receive complementary artificial formula or a breastmilk substitute<br /></li>
          <li>recording of all the information regarding the giving of a breastmilk substitute is required</li>
          <li>the earliest age a parent should consider offering a pacifier/dummy to their infant</li>
          <li>the earliest age an infant should be commenced on complementary foods</li>
          <li>how long to recommend to mothers that they continue breastfeeding after commencing complementary foods</li>
        </ul>
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    </td><td class="middleright" style="background: repeat-y url(design/callout_06.png);"><img src="design/callout_06.png" width="10" height="80" alt="" /></td></tr></tbody></table>
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      <h1>Breastfeeding Policy Orientation</h1>
      <ol>
        <li>1.0 <a href="topic_1-0.html">Introduction</a></li>
        <li>2.0 <a href="topic_2-0.html">The Baby Friendly Initiative</a><ol><li>2.1 <a href="topic_2-1.html">Steps 1 &amp; 2; Points 1 &amp; 2</a></li><li>2.2 <a href="topic_2-2.html">Step/Point 3</a></li><li>2.3 <a href="topic_2-3.html">Initiating, managing &amp; maintaining breastfeeding</a><ol><li>2.3.1 <a href="topic_2-3-1.html">Initiating breastfeeding</a></li><li>2.3.2 <a href="topic_2-3-2.html">Managing Breastfeeding</a></li><li class="current">2.3.3 <img src="design/bullet_arrow_right.png" alt="*" title="You are here" /><a href="topic_2-3-3.html">Maintenance of breastfeeding</a></li></ol></li><li>2.4 <a href="topic_2-4.html">Step 10 / Point 7</a></li><li>2.5 <a href="topic_2-5.html">Point 6</a></li><li>2.6 <a href="topic_2-6.html">Breast-milk Substitutes</a></li></ol></li>
        <li>3.0 International Policies<ol><li>3.1 <a href="topic_3-1.html">The WHO Code</a></li><li>3.2 <a href="topic_3-2.html">Infant &amp; Young Child Feeding</a></li></ol><hr /></li>
        <li class="appendix"> <a href="references.html">List of references</a></li>
        <li class="appendix"> <a href="contents.html">Course contents</a></li>
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