As a Certified Breastfeeding Counselor (CBC) you might encounter families managing a NICU stay. Babies are in the NICU for a variety of reasons, prematurity being most common. Many NICU babies have difficulty feeding, making breastfeeding a challenge.
Babies with extenuating feeding challenges often need to work with an IBCLC to overcome these issues. Some may also work with speech and occupational therapists. However, upon discharge, in support groups, months down the road, you could find yourself supporting NICU families.
A CBC can be part of a feeding team for any baby. You can help encourage and support any feeding plans set forth by the appropriate providers. You can provide education and support to families with common feeding questions.
You are equipped to help initiate typical breastfeeding while also being a source of support and help to those working with other professionals.
Here are things to know about supporting NICU families:
Many NICU Families Will Be Pumping
Every NICU baby is admitted for a unique reason. However, many will be unable to latch in the early days and weeks. Babies requiring higher levels of oxygen, some forms of CPAP, and ventilator support are not able to safely latch. Some levels of oxygen do allow for feeding.
If a baby is less than 34 weeks gestation, they may not yet have a safe suck, swallow, breath reflex. Any baby under 37 weeks might struggle to complete all feeds at the breast. Some late preterm babies can latch well.
As a CBC, it is important that you not make recommendations which are not possible. Be sure to stay within your scope of practice if you have questions from a NICU family. What will be important for you to know is that when a baby cannot latch a breastfeeding parent should:
- Pump approximately 8 times in 24 hours
- Double electric pumps, preferably hospital grade rentals, are often needed when baby cannot latch
- Be familiar with breast milk storage guidelines
- When possible, skin-to-skin before pumping can help
- Pictures, items which smell like baby, sound of baby’s cry, etc. might aid in letdown
- While breastfeeding can be done on-demand, pumping output is often better on a schedule
Babies Leave The NICU Feeding in a Variety of Ways
Most babies are discharged without any feeding accessories. However, some will be discharged with an NG tube, or even a G-tube. Sometimes it is safe for baby to try to latch, in other cases feeds need to be thickened due to aspiration risks.
As a CBC, you do not need knowledge to help with those scenarios. However, you need to know the importance of not advising families to latch if a healthcare provider has said otherwise.
Some NICU babies require fortifier or supplements depending on their gestation, weight, or another medical concerns. There is evidence which supports exclusively breastfeeding preemies of different gestations even from birth. However, it is outside our scope as CBCs to make any recommendations about fortifier or supplementations.
What we can do is send information, studies, and recommend questions they can ask their baby’s doctor.
For babies with feeding tubes and such, you can support clients with maintaining milk supply tips, pumping support, and general support.
Babies Can Leave The NICU Exclusively Breastfeeding
Some babies are physically able to latch and have adequate efficiency in transferring milk. For those babies, it is possible to leave the NICU exclusively breastfeeding. If a client has the okay from her provider to do so, you can provide typical breastfeeding initiation support and education.
That said, while some babies can leave exclusively breastfeeding, as mentioned above, some cannot. Be sure you provide realistic and empathetic support to NICU families transitioning home and desiring to breastfeed.
Most importantly, if their needs are outside your scope of generalized education and support, you must refer to the appropriate provider. An IBCLC, gastroenterologist, pediatric nutritionist, occupational therapist, and speech therapists are all frequent parts of a NICU baby’s feeding team.
Patience, Education and Support Are Key
The NICU journey is a challenging one. Feeding is just one component of the stress and trauma parents may deal with. As a professional, it is important to support parents with patience and empathy. Provide education about infant feeding as well as reminders to follow their doctor’s recommendations.
As a CBC, your primary role in supporting NICU families is simply education and support. Be sure to become familiar with the professionals in your area to refer to for more complicated infant feeding issues.