I have had lots of requests for a copy of our Supplementation Policy. I am
copying it here because I'm getting ready to leave for the weekend. If
anyone wants me to send it in Word, I will e-mail it on Monday when I
return.
Julia
Eden, NC

Policy Statement:

The American Academy of Pediatrics, in its 1997 policy, states that, "No
supplements (water, glucose water, formula, and so forth) should be given
to breastfeeding newborns unless a medical indication exists. With sound
brestfeeding knowledge and practices, supplements rarely are needed.
Supplements and pacifiers should be avoided whenever possible and, if used
at all, only after breastfeeding is well established".

Policy Interpretation and Implementation:

1. Initiate early breastfeeding in the first 1-2 hours after birth. If the
infant has a low body temperature, place the infant skin-to-skin with
mother during the feeding attempt.
2. Watch for infant to wake within 3 hours for the next feeding.
3. If infant wakes, encourage mother to feed on demand or attempt every 3
hours if infant is sleepy.
4. If infant does not wake, work with  mother on waking techniques and
attempt to breastfeed.
5. If infant does not awaken to nurse, assess for s/s of hypoglycemia
(jittery, agitated, low temp), sepsis (poor color/muscle tone, lethargy,
low temp), or dehydration.
6. If all other s/s above are absent, wait 1-2 hours.
7. Attempt next feeding
8. If feeding is ineffective or poor, reassess for all s/s.
9. At 12 hours, mother may be offered a breastpump to save her colostrum
in the event it is needed for supplementation at the 24-hour mark. She
should be encouraged to use breastpump every 3 hours until infant is
nursing well.
10. Continue this pattern for 24 hours. It is normal for some well babies
to take this resting /sleep phase. No supplementation is needed unless
medically indicated.
11. After 24 hours of ineffective or absent feeding, a 10-20 cc
supplemental feeding should be offered using mother's own pumped colostrum
if at all possible. If colostrum is not available, a formula of the
parent's choice should be used. ** For "at risk infants" the supplemental
feeding may take place at 12 hours - check with physician. Infants at risk
include: premature infants, SGA, small infants under 6 pounds which are
not nursing well, LGA, diabetic mother, insult during delivery, possible
sepsis.
12. Infants should be fed supplement at the breast with SNS if at all
possible, with a cup, or with a syringe. Bottles should be given as a last
resort and only after discussing with parents.
13. Continue attempting infant at breast every 1-2 hours, supplementing
PRN.
14. If infant continues to be supplemented at discharge and has not been
seen by the lactation consultant, contact the lactation consultant for
follow-up phone call and outpatient consult as needed.

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