Several positioning techniques are recommended
for ill or preterm infants. Head and
neck support are very important and in
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general the cross-cradle and football holds are
most effective because the mother can support
her breast and have good control of the
infant’s head at the same time. The mother
should ensure that the infant is pulled in close
to the breast. She should support her breast
during the entire feeding so that the infant is
less likely to fall away from the breast.
The nipple shield is a critical temporary device
for improving milk intake at the breast.
The nipple shield helps to compensate for
poor suckling from the infant by concentrating
negative pressures in the tip of the
shield.61 The shield is effective in increasing
milk intake from the breast and extending the
duration of breastfeeding.61 The shield is most
effective when utilized early in the breastfeeding
process, not as a last resort, and should be
used for all breastfeeding sessions. The nurse
should allow the infant to attempt breastfeeding
first without the shield, and if after a few
attempts no milk transfer is noted, the shield
should be utilized. If the mother has flat or inverted
nipples, the shield should be used from
the outset. The mother should use the nipple
shield until the infant is able to take all feeds
from the breast with the shield. Once the infant
is fully breastfed at the breast with the
shield, the mother can begin to wean the infant
from the shield. This weaning process is
likely to occur in the postdischarge period.
Nurses are paramount in providing mothers
with maximal breastfeeding attempts. Nurses
control feedings in nurseries and can positively
or negatively influence a mother’s
breastfeeding success. The nurse should always
maintain positive verbal and nonverbal
communication when assisting a mother with
transitioning to breastfeeding. Breastfeeding
is more work for nursing staff and does require
more nursing time; however, provision
of breastfeeding care and evidence-based support
leads to improved outcomes for the infant
and the mother.