Managing Lactation Failure in Mothers of Inpatient SAM children
Admission history
Date of Admission
14/09/2011
Child History
Name
Shahsawar (male child)
Age
4.5 Months
Weight
3.5 Kgs
height
58cm
Z score
<-4SD
Diagnosis
Dysentery, dehydration, fever, presented in semiconscious state
Child’s Nutritional status
Severely wasted, lethargic, feeble to suckle, refusing breast milk due to
bottle feeding
Mother History
Mother’s Nutritional status
Anemic and complaining of insufficient milk production. Patient is the
ninth child and mother gives history of insufficient milk syndrome for
all previous 8 children.
Mother breast feeding status
• Partial lactation failure, breast milk insufficient to
satisfy baby needs.
• Baby positioning was incorrect, Inappropriate latching.
• Baby’s nostrils usually stuffed, Patient removed from
breast with slight irritability and mostly bottle fed.
• Breast feed was only offered 2-3 times in the day hours.
Baby was not breast fed in the night.
• Mother was anemic and feeling weak.
Treatment (Child & Mother)
• I/V medications were given according to SC protocol
• Proper breast feeding technique was taught to the
mother and was convinced for breast feeding.
• Mothers was fed with 2 sachets of plumpy-nut and
hospital food was encouraged with good water intake
and Micronutrient supplementation.
• F100D was started to the child through Supplementary
suckling technique 2 hourly.
Supplementary Suckling technique (SST)
Sketch diagram used to reluctance of mothers to pose for photographs due to cultural constraints in Khyber Pukhtoonkhwa
Treatment Continued….
• The breast milk was assessed by expressing milk on the day of
admission and monitored on daily basis by the staff nurse
noting improvement day by day. Mother gave history of breast
fullness on day 2 of SST. The mother noted increase in milk
production by milk dripping on day 5 after feeds. On admission
baby had ineffective suckling with rapid and shallow sucks
forcing the cheeks inside. The suckling improved till discharge
and baby had slow deep sucks with mouth fullness and pausing
while suckling.
• Baby’s weight was monitored and the quantity of F100D was
halved when baby achieved 20gm/kg/day weight gain and was
discontinued the following day.
• The patient was discharged when the baby maintained
10gm/kg/day weight gain on breast milk alone. The patient was
discharged after 8 days of inpatient care.
Discharge status
Category
Admission
Discharge
Date
14/09/2011
21/09/2011
Age
4.5 Months
4.5 Months
Weight
3.5 Kg
4.12 Kg
height
58cm
58 cm
Z score
<-4SD
<-3SD
Diagnosis
Dysentery, dehydration, fever,
presented in semiconscious
state
Complications settled, baby
interactive
Nutritional status
Severely wasted, lethargic,
feeble to suckle, refusing breast
milk due to bottle feeding
Suckling re-established, 600 gm
of weight gain.
24gm/kg/day weight gain
Mothers nutritional status
Anemic and complaining of
insufficient milk production.
Patient is the ninth child and
mother gives history of
insufficient milk syndrome for all
deliveries.
Breast fullness, mother and baby
satisfied, mother misconception
cleared by re-establishment of
Breast feeding.
Apparent Comparison
Counseling mother….
• Diet counseling of the mother was done in support of
breast feeding.
• The mother was convinced about the facts of proper
breast feeding and she helped 6 admitted mothers
through SST and motivational counseling.
• On discharge the mother promised to work as an
activist and convince mothers in her approach.
• The home based SST technique was taught to the
mother for helping other mothers in her surrounding.
Follow-up status
• Baby has gained further weight and is reacting efficiently to
external stimulus
• Baby taking interest in feeding and playing.
• Mother satisfied with breast feeding and loves her baby more
than ever before.
• Mother has succeeded to re-establish breast feeding for three
mothers in her neighborhood through counseling, experience
sharing and home based Supplementary Suckling Technique.
• On follow –up mother spoke to another admitted mother on
staff request and convinced her for re-establishment of breast
feeding.
Follow-up status (Anthropometry)
Category
Admission
Discharge
Follow-up
Date
14/09/2011
21/09/2011
06/10/2011
Age
4.5 Months
4.5 Months
5 months
Weight
3.5 Kg
4.12 Kg
4.5 Kg
height
58 cm
58 cm
59 cm
Z score
<-4SD
<-3SD
<-2 SD
Diagnosis
Dysentery, dehydration, fever,
presented in semiconscious
state
Complications settled,
baby interactive
Nil complications
Nutritional
status
Severely wasted, lethargic,
feeble to suckle, refusing
breast milk due to bottle
feeding
Suckling re-established,
600 gm of weight gain.
Ascending weight
continuously, 1000gm
weight gain in 23 days.
12.4gm /Kg/day wt gain
Mothers
nutritional
status
Anemic and complaining of
insufficient milk production.
Patient is the ninth child and
mother gives history of
insufficient milk syndrome for
all deliveries.
Breast fullness, mother
and baby satisfied, mother
misconception cleared by
re-establishment of Breast
feeding.
Feeling healthy and
confident about breast
feeding by learning and
teaching to others.
Shahsawar with parents on follow-up visit
Mother Comments
Packing her bag and eager to reach home, delighted Zakia begum shared her
feelings with the female nutritionist and staff nurse reflecting mixed emotions of
contentment with her child’s recovery and regrets on past negligence that
deprived her 8 previous babies from exclusive and appropriate breastfeeding
practices.
Her Husband Abdul Rehman, a daily wage laborer supported his wife during the
treatment period and is working as Merlin’s activist promoting the approaches
that recovered his child and wife from malnutrition and lactation failure. The
detailed discussion with the couple revealed multiple contributing factors
preventing breastfeeding to their babies, including misconceptions related to
culture, religion and elders.
Zakia shared that she has been disposing off her colostrum for all her newborns
on advice of elders whom considered it to be toxic and useless. This has been
practiced in her family since generations. She thanked the SC staff for
counseling her on the real value of mother’s milk that helped her dispel the false
beliefs and taboos to bring a positive change in her behavior.
Making it possible!
On Arrival
After treatment