ADAPTIVE NURSING APC

Add to Favourites
Post to:


Type: ppt

Discussion
Presentation Transcript Presentation Transcript

ADAPTIVE NURSING: Promoting Permanency, Healing Hearts, Nurturing Souls : ADAPTIVE NURSING : Promoting Permanency, Healing Hearts, Nurturing Souls Alla Gordina , MD, IBCLC, FAAP Global Pediatrics and Family Medicine Assistant Professor of Pediatrics Rutgers Robert Wood Johnson School of Medicine Drexel University Medical College

VALUE = (BENEFITS) – (COSTS) : VALUE = (BENEFITS) – (COSTS) 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 2

Value of adoptive breastfeeding (general) : Value of adoptive breastfeeding (general) Family bonding Nutritional support Immunologic support Developmental support 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 3

Value of adoptive breastfeeding (children) : Value of adoptive breastfeeding (children) promotes secure attachment and trust, augments their sensory and physical development, provides a therapeutic effect on the correction of oral deficits and/or aversions 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 4

Value of adoptive breastfeeding (mothers) : Value of adoptive breastfeeding (mothers) Fills the emotional void of failure to conceive, carry through, and/or to give birth . Provides multiple medical and psychological benefits 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 5

Value of adoptive breastfeeding (society) : Value of adoptive breastfeeding (society) justification a child's acceptance in the family (Russia). p rovides child’s acceptance as a blood/milk relative (Islam) 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 6

Dealing with trauma and disasters : Dealing with trauma and disasters Close body contact Not regression, but coping Stepping back is good Official recommendations on re-lactation during disasters Comfort foods 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 7

Russian Adoption Story : Russian Adoption Story “I successfully re-lactated 2 years ago. I had breastfed my 3 bio children but that was 18 years earlier! I bought an electric pump and pumped every two hours during the day for about a month. After this time, I took the drug Domperidone to help induce lactation. It worked and I was pumping about 6 oz a day. We were adopting a 12 month old severely malnourished baby boy. He weighed 12 lbs and had a lot of digestive problems . I really felt breast milk would be best for him”. EEAC APR (adoption list serve) 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 8

Russian Adoption Story : Russian Adoption Story “When I got to Russia, he would have NOTHING to do with breastfeeding. He was so hungry and took 8 oz bottles every 3 hours plus baby food. There was no way I could have kept up with his appetite. He did not want to nurse, even for comfort .” EEAC APR (adoption list serve) 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 9

Russian Adoption Story : Russian Adoption Story “I finally realized that I was doing this for ME instead of him since he didn't want to do it. It wasn't worth it. He had gone through so many changes. Why take away the comfort of sucking on a bottle that he loved so much. So we quit. Then I dealt with the hormonal changes that inducing caused. I had horrible depression and had to take medicine to get me through this. So my opinion is that it is not something that is worth the incredible time it takes to induce. Plus it is probably not going to be anything that your adopted child will want to participate in!” EEAC APR (adoption list serve) 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 10

Russian Adoption Story : Russian Adoption Story Mother was eager to breastfeed Mother was able to re-lactate Was the mother ready? Was the kid ready? Were the adoption professionals ready? 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 11

“Breastfeeding and use of human milk” (AAP, 2005) : “Breastfeeding and use of human milk” (AAP, 2005 ) Role of pediatricians and other health professionals in protecting, promoting, and supporting breastfeeding ... Provide counsel to adoptive mothers who decide to breastfeed through induced lactation , a process requiring professional support and encouragement 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 12

DEFINITIONS : DEFINITIONS LACTATION 1 . Secretion or formation of milk by the mammary glands. 2 . The period during which the mammary glands secrete milk. BREASTFEEDING Nourishing at the breast http://www.thefreedictionary.com 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 13

DEFINITIONS : DEFINITIONS LACTATION 1 . Secretion or formation of milk by the mammary glands. 2 . The period during which the mammary glands secrete milk. BREASTFEEDING Nourishing at the breast NURSING (See Synonyms at nurture.) To serve as a nurse for (nursed the patient back to health). To cause or allow to take milk from the breast (a mother nursing her baby). To feed at the breast of; suckle. To try to cure by special care or treatment (nurse a cough with various remedies). To treat carefully, especially in order to prevent pain (He nursed his injured knee by shifting his weight to the other leg). To manage or guide carefully; look after with care; foster (nursed her business through the depression). http://www.thefreedictionary.com 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 14

DEFINITIONS : DEFINITIONS ADOPTIVE Of or having to do with adoption . ADAPTIVE Relating to or exhibiting adaptation . Readily capable of adapting or of being adapted : an adaptive worker; adaptive clothing for children with special needs http://www.thefreedictionary.com 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 15

DEFINITIONS : DEFINITIONS ADOPTIVE BREASTFEEDING the breastfeeding of a child who the woman did not give birth to but who is caring for the child on a long term basis .” ( Karleen Gribble, 2013 ) INDUCED LACTATION ability to produce milk on demand without pregnancy (may or may not be a part of adoptive breastfeeding). 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 16

DEFINITIONS : DEFINITIONS ADAPTIVE NURSING™   – a continuum of attachment and development promoting interventions - ranging from encouraging holding and skin-to skin contact, to promoting healthy dependency, to the pinnacle of partial or exclusive breastfeeding . 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 17

STATISTICS : STATISTICS 100,000 to 135,000 children are adopted annually in the United States 59% adopted from the foster care domestically, 26% -adopted internationally and 15% are voluntarily relinquished domestic infant adoptions). At least 50% of international and foster care adoptions involve children less than 5 years of age. Congressional Coalition on Adoption Institute, 2011 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 18

Google AdWords Study : Google AdWords Study Keywords Related Keywords Monthly Searches Global USA Breastfeeding 4 090 000 1 830 000 Adoptive Breastfeeding 1300 880 Breastfeeding adopted baby 720 480 Adoptive mothers breastfeeding 320 210 Adoptive nursing 880 720 A. Gordina , 2012 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 19

Google AdWords Study : Google AdWords Study Keywords Related Keywords Monthly Searches Global USA Induced Lactation 12 100 8 100 … without pregnancy 880 590 … protocol 210 140 Breastfeeding… …adopted infant 720 480 …premature infant 720 480 …and cleft palate 590 320 …and Down Syndrome 320 170 A. Gordina , 2012 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 20

What do we know? : What do we know? Adoptive breastfeeding is possible b eneficial for both adoptive parents and adopted children r equired in some types of adoption practiced for millennia in all cultures Adoptive breastfeeding is NOT about ability to lactate and to latch about newborns and young infants s omething that does happen overnight 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 21

But… : But… Adoptive breastfeeding is e xtremely personal v ery controversial requiring significant time and effort expenditure Adoptive breastfeeding is NOT a well researched phenomenon a widely accepted phenomenon a n allowed phenomenon (i.e. foster care) supported by US FDA covered under any insurance (ACA or not) 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 22

They are so vulnerable and… : They are so vulnerable and… 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 23

…their Simple needs are so Similar : …their S imple needs are so S imilar S ecurity S tability S afety S atiety S ensory (Developmental) S uccess SURVIVAL 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 24

B.E.St. Protocol : B.E.St . Protocol B indung (bonding) E ntwicklung ( Development ) S t illen (Breastfeeding) Dr. Beatrix Schmidt (Germany) ® 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 25

B.E.St. Protocol : B.E.St . Protocol B indung (bonding) E ntwicklung ( Development ) S t illen (relief, satisfaction, quenching, nursing, breastfeeding ) Dr. Beatrix Schmidt (Germany) ® 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 26

Attachment parenting : Attachment parenting William Sears MD Sensitive and emotionally available parenting “Total motherhood” Co-sleeping Vague use of terms (“attachment therapy”, “RAD”) No formal research 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 27

Attachment parenting : Attachment parenting 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 28

Harlow Experiments : Harlow Experiments 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 29

Chinese Adoption Story : Chinese Adoption Story “..our 12 month old daughter…is the happiest little baby we've ever met. .. However, she will hardly eat anything at all. The orphanage told us she was a picky eater, but boy is that an understatement. …We were expecting a child who wouldn't stop eating. Never dreamed we'd be in this situation!” 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 30

Feeding problems in at-risk infants and children : Feeding problems in at-risk infants and children Any child can have problems eating if he/she is exposed to new Types of foods (meats, fresh vegetables, spices, etc ) Textures (dry foods like cheerios or teething biscuits, or if foods are not pureed enough) Smell (kids are used to the smell of the orphanage food and would not tolerate new and unusual sensations) Temperatures (children are usually not used to cold or very hot foods) Feeding techniques (kids can be bottle-fed through a nipple with a huge hole, and unable to eat from a spoon) Feeding position (frequently kids placed facing away from a caregiver so they don’t see the person who is feeding them) Feeding environment (anything rather then familiar room with the small tables and familiar caregivers or a car with the food in a brown bag) 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 31

Feeding problems in at-risk infants and children : Feeding problems in at-risk infants and children Other reasons for feeding difficulties Oral aversions and other sensory deficits will have difficulties with accepting foods, chewing and swallowing. Low muscle tone (generalized or of facial muscles only) will lead to early fatigue and poor feeding Painful lesions in the mouth (past or present) Abusive feeding techniques in the previous placements (family, foster care, orphanage) Medical conditions like ear infections, gastro-intestinal problems, asthma, colds and so on Behavioral and emotional problems including Developmental Trauma Disorder 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 32

Feeding problems: Be prepared! : Feeding problems: Be prepared! Anticipate this situation and to request caregivers to show you how exactly this particular child was fed and with what. Be flexible with the feeding routines and techniques – feeding a bottle, spoon-feeding, giving local formulas, feeding with the baby’s face away from you and so on Reduce over-stimulation as much as possible before and during feeding Make sure that your child gets enough rest and sleep Not to stare on your child, while he/she is eating unless you and he/she are ready to initiate the eye contact 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 33

Feeding problems: Be prepared! : Feeding problems: Be prepared! Offer your child warm formula/ milk / yogurt, sweetened enough for this child to take it willingly. You will be able to slowly reduce the sweetness later on. Warm/cool all foods (depending on your child’s preference) even if it does not make sense to you (i.e. warm milk ). Offer ethnic/regional - style foods even if that does mean making unhealthy choices Create as much routine as possible even while in transition – when the child is eating, with what, how, where and in what order 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 34

Feeding problems: Be prepared! : Feeding problems: Be prepared! Don’t be concern with the lack of food variety in your child’s diet in the first days and even weeks after adoption. Slowly introduce new foods/ textures/ temperatures if your child will tolerate them. Not to give such child a sippy cup; use a bottle with the hole as large as your child needs, slowly decreasing the opening; straw cup or a regular cup can be used too Spoon-feed your child if necessary, even with the fluids like milk and formula Promote dependency on you providing food for your child (hand/finger feeding by caregiver even for snacks, feeding/drinking in the breastfeeding position and/or on caregiver’s lap, bottle feeding, eye contact, etc ) 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 35

Feeding problems: Be prepared! : Feeding problems: Be prepared! Don’t expect for this particular child to get better on her own Have the full medical evaluation* , and Evaluation by a specialized pediatric feeding team* (usually present in speech departments of large hospitals) as soon as possible Early intervention program evaluation* may be scheduled as soon as possible Have a formal occupational therapy* evaluation * Unfortunately many health care providers are not familiar with the special needs of at-risk children 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 36

Feeding problems: Be prepared! : Feeding problems: Be prepared! Never ever accept “ ALL TODDLERS ARE PICKY EATERS” a nd/or “ ONE CAN NOT STARVE IN A CORNFIELD” as an answer regarding any feeding problems of a newly placed adopted/foster child 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 37

Be prepared… : Be prepared… … for your child at some point to exhibit “breastfeeding seeking” behaviors 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 38

Obstacles on the way: the process : Obstacles on the way: the process Uncertainties Unknown timing Unknown age/condition of the child Lack of support Lack of knowledge society, medical professionals, lactation professionals a uxiliary professionals Administrative/legal issues 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 39

Obstacles on the way: the dyad : Obstacles on the way: the dyad Medical conditions preventing lactation Ability to produce milk but failure to adopt Social, f amily, and financial obligations Sensory, medical and/or developmental problems affecting child’s ability to be held, to latch and/or to suck Breastfeeding seeking behaviors in at-risk children 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 40

Where to start : Where to start Read Ask questions Be open Look for solutions, not obstacles Find support – in person, on line, in print Start slow Treat your quest as a colorful journey, not as a back/white dogma Accept every step as a success 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 41

Feeding essentials : Feeding essentials 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 42

Feeding essentials : Feeding essentials Pumps Supplemental systems Lact -Aid Medela SMS 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 43

Feeding essentials : Feeding essentials Pumps Supplemental systems Medela SMS Lact -Aid Bottles P acifiers Bowls and spoons Brown bags* 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 44

GALACTAGOGUES : GALACTAGOGUES 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 45

Galactagogues : Galactagogues http:// www.bfmed.org/Media/Files/Protocols 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 46

Galactagogues : Galactagogues http://pediatrics.aappublications.org/content/132/3/e796.full#abstract-1 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 47

Galactagogues : Galactagogues Pharmaceuticals (not approved for induced lactation in US) Domperidone and other dopamine receptor antagonists Antipsychotics Hormones (oxytocin, growth hormone, and others) Supplements and herbs (not regulated by FDA) Fenugreek, fennel, milk thistle, etc “milk teas”, “milk cookies” Foods Grains (barley, oats, millet) Aromatics (garlic, celery, etc ) Bovine or other types of milk are NOT considered as galactagogues 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 48

American Adoption Story : American Adoption Story 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 49

American Adoption Story : American Adoption Story One day, I was running late taking our oldest son to school and forgot to make him breakfast so I ran to Starbucks and grabbed a bagel for everyone, even though I knew Zach wouldn’t eat it. As soon as I started passing back the bags to the kids, Zach started to grunt…I looked back and he had his hand out! He was interacting and wanted food! I handed back a bag with a bagel and he pulled it out of the bag and began eating with more gusto than I had ever seen anyone eat! After he finished his bagel, he put his hand out again and grunted, so I gave him mine…he ate that one too! “ 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 50

Canadian Adoption Story : Canadian Adoption Story "Our daughter was placed with us from foster care last summer just weeks before her 2nd birthday (actually foster to adopt). ... I introduced her to breastfeeding through books, friends who breastfeed, talking about nursing her baby dolls and giving her child sized slings for her babies. … about a month after placement …she latched (and) it seemed to please her…   " Personal correspondence 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 51

Canadian Adoption Story : Canadian Adoption Story “When my milk came in some she began refusing to latch and was quite put off by the milk and even became a little uncertain of our regular cuddle routine. After only a month I stopped the pumping and taking Domperidone knowing that for her and I the latching was far more important than the milk. If the milk was putting her off then we didn't need it."    Personal correspondence 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 52

Australian Adoption Story : Australian Adoption Story My daughter is nearly 11 and have been with us for nearly 5 years. I always cuddle her in bed before she goes to sleep for 30 mins or so and sometimes she is still awake when I come up to bed and she gets in with me for more cuddles. Her comment the other night when she did this was "I am like a battery and you are like a charger, you charge me with love" How sweet! And she continues to build on this idea as she comes and gets hugs through the day saying, "I need charging." Actually , I think that she is a lot like a sieve and that the love just pores out through all the holes she has as a result of too many years with terrible care....but she's getting there.   Personal correspondence 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 53

PowerPoint Presentation : 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 54

PowerPoint Presentation : 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 55

PowerPoint Presentation : 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 56

PowerPoint Presentation : 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 57

PowerPoint Presentation : 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 58

PowerPoint Presentation : 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 59

PowerPoint Presentation : 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 60

PowerPoint Presentation : 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 61

Resources (internet) : Resources (internet) http ://www.fourfriends.com/abrw / www.creatingafamily.org www.iamnotthebabysitter.com breast-feeding.adoption.com/ http://darillyn.tripod.com / 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 62

Resources (books) : Resources (books) Debra Peterson, Breastfeeding the Adopted Baby Elizabeth Hormann , Breastfeeding an Adopted Baby and Relactation Alyssa Schnell, Breastfeeding Without Birthing: A Breastfeeding Guide for Mothers through Adoption, Surrogacy, and Other Special Circumstances 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 63

Contact information : Contact information Alla Gordina , MD, IBCLC, FAAP Global Pediatrics and Family Medicine 7 Auer Court , East Brunswick, NJ 08816, 732-432-7777 www.globalppfm.com drgordina@globalpediatrics.net 11/24/2013 Alla Gordina, MD, IBCLC, FAAP © 64

8 Members Recommend
6 Followers

Your Facebook Friends on WizIQ