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      <h1 id="top">3.5 Slowing of growth</h1>
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            <td class="body"><img src="images/key_icon.gif" class="icon" alt="" /><h3>Key Points - Case Study C</h3>
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			Joanne is discharged early on day three and comes to see you for a follow-up on day five. The day following discharge her breasts became painful and hard and Rosie is again having difficulty latching on to the breast. Is this normal? What would you suggest Joanne do?
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		<dl><dt><a href="topic_3-1.html"><cite>Topic 3.1: Early problems</cite></a></dt><dd class="topic-paragraph">There is a difference between breast fullness and engorgement. Early frequent feeding and good breast drainage helps prevent and manage engorgement.</dd></dl>
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			You see Joanne and Rosie again at 10 days. Joanne's breasts have settled and Rosie is feeding well. However, she has been feeding frequently at night and Joanne's husband, Tom, has suggested bringing the baby to bed with them. Joanne has heard that this increases the risk of SIDS. What would you tell her?
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		<dl><dt><a href="topic_3-2.html"><cite>Topic 3.2: Risk of SIDS</cite></a></dt><dd class="topic-paragraph">It is normal for breastfed infants to feed frequently and wake at night in the first few weeks of life. Some continue to wake for a longer period. Many parents will co-sleep (where the infant is in close physical and/or social relationship with another person) and/or bed-share (adults and infants sharing the same sleep surfaces) during this time. Safe sleeping guidelines should be followed to reduce the risk of SIDS.</dd></dl>
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			Joanne had been on the combined oral contraceptive pill before becoming pregnant. She intends to not use any contraception until she is six months postpartum. Is this a realistic option?
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		<dl><dt><a href="topic_3-3.html"><cite>Topic 3.3: Contraception</cite></a></dt><dd class="topic-paragraph">Lactational Amenorrhoea Method (LAM) of contraception is an effective method of contraception during the first six months postpartum. Non-hormonal forms of contraception are the methods of choice when another form of contraception is needed. Oestrogen containing contraceptive methods should preferably not be used during lactation.</dd></dl>
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			Joanne brings Rosie for immunization at four months. She is concerned about the composition of her milk. Although Rosie had been growing along the 50th percentile, her weight gain has started to slow.
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		<dl><dt><a href="topic_3-4.html"><cite>Topic 3.4: Milk composition</cite></a></dt><dd class="topic-paragraph">The composition of breast milk includes carbohydrates, proteins, fats, vitamins and minerals in unique combinations and concentrations ideally suited to the developing human infant. </dd></dl>
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			Is there any concern about a slowing of growth around this time?
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		<dl><dt><a href="topic_3-5.html"><cite>Topic 3.5: Slowing of growth</cite></a></dt><dd class="topic-paragraph">Infant growth is highest in the first few months postpartum and then begins to slow around four to six months. New WHO growth charts show how breastfed infants 'should' grow and may more accurately reflect normal growth than previously used charts.</dd></dl>
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			Is there any concern about a slowing of growth around this time?
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		Infant growth is highest in the first few months postpartum and then begins to slow so a decrease in the rate of growth at this age is normal. Additionally, after three months of age breastfed infants gain weight at a slower rate than formula-fed infants, so that by six months they are lighter<sup><a href="#note1">1</a></sup> and this is maintained until at least twelve months<sup><a href="#note2">2</a></sup>.
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		Most growth charts in use were developed in the United States from cross-sectional data of cohorts of infants who were mainly formula-fed, or contained a mixture of formula-fed and breastfed infants. On these charts, breastfed infants often began to deviate from a specific percentile after four to five months although they continued to thrive otherwise. In 2006 the <abbr title="World Health Organisation">WHO</abbr> released new growth standards based on longitudinal data of healthy breastfed infants and children from seven countries. These charts reflect how well-nourished breastfed infants 'should' grow rather than the actual growth in a given population. In comparison to the CDC charts commonly used, the mean weight in the <abbr title="World Health Organisation">WHO</abbr> standards is higher for the first six months but is lower from 6 to 32 months<sup><a href="#note3">3</a></sup>. <abbr title="World Health Organisation">WHO</abbr> standards for infant <abbr title="Body Mass Index">BMI</abbr> are also available to allow for difference in growth parameters between different racial groups.
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        <h3>Notes</h3>
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          <li id="note1"><a href="references.html#dewe92" title="See full details">#</a> Dewey KG et al. (1992) Growth of breast-fed and formula-fed infants from 0 to 18 months: The DARLING study</li>
          <li id="note2"><a href="references.html#dewe93a" title="See full details">#</a> Dewey KG et al. (1993) Breast-fed infants are leaner than formula-fed infants at 1 y of age: the DARLING study</li>
          <li id="note3"><a href="references.html#deon07" title="See full details">#</a> de Onis M et al. (2007) Comparison of the WHO Child Growth Standards and the CDC 2000 Growth Charts</li>
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      <h1>Breastfeeding Essentials</h1>
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        <li>0.1 <a href="topic_0-1.html">Introduction</a></li>
        <li>1.0 <a href="topic_1-0.html">Case Study A (Joanne)</a><ol><li>1.1 <a href="topic_1-1.html">Discussing breastfeeding</a></li><li>1.2 <a href="topic_1-2.html">What information to give</a></li><li>1.3 <a href="topic_1-3.html">Effects of Breastfeeding alternatives</a></li><li>1.4 <a href="topic_1-4.html">Common breastfeeding concerns</a></li><li>1.5 <a href="topic_1-5.html">Breast examination</a></li><li>1.6 <a href="topic_1-6.html">Contraindications to breastfeeding</a></li><li>1.7 <a href="topic_1-7.html">Conditions related to lactation outcomes</a></li><li>1.8 <a href="topic_1-8.html">Medications</a></li></ol></li>
        <li>2.0 <a href="topic_2-0.html">Case Study B (Joanne)</a><ol><li>2.1 <a href="topic_2-1.html">Preparation Before Birth</a></li><li>2.2 <a href="topic_2-2.html">Birthing Factors that Affect Breastfeeding</a></li><li>2.3 <a href="topic_2-3.html">Management After Birth</a></li><li>2.4 <a href="topic_2-4.html">Poor Attachment</a></li><li>2.5 <a href="topic_2-5.html">Hypoglycaemia</a></li><li>2.6 <a href="topic_2-6.html">Relationship between Jaundice and Breastfeeding</a></li></ol></li>
        <li>3.0 <a href="topic_3-0.html">Case Study C (Joanne)</a><ol><li>3.1 <a href="topic_3-1.html">Early problems</a></li><li>3.2 <a href="topic_3-2.html">Risk of SIDS</a></li><li>3.3 <a href="topic_3-3.html">Contraception</a></li><li>3.4 <a href="topic_3-4.html">Milk composition</a></li><li class="current">3.5 <img src="design/bullet_arrow_right.png" alt="*" title="You are here" /><a href="topic_3-5.html">Slowing of growth</a></li><li>3.6 <a href="topic_3-6.html">Introducing solids</a></li><li>3.7 <a href="topic_3-7.html">Weaning</a></li></ol></li>
        <li>4.0 <a href="topic_4-0.html">Case Study D (Sally)</a><ol><li>4.1 <a href="topic_4-1.html">Initial assessment</a></li><li>4.2 <a href="topic_4-2.html">Milk production</a></li><li>4.3 <a href="topic_4-3.html">Causes of inadequate infant growth</a></li><li>4.4 <a href="topic_4-4.html">Increasing milk supply</a></li></ol></li>
        <li>5.0 <a href="topic_5-0.html">Case Study E (Anna)</a><ol><li>5.1 <a href="topic_5-1.html">Sore nipples</a></li><li>5.2 <a href="topic_5-2.html">Factors causing nipple damage</a></li><li>5.3 <a href="topic_5-3.html">General treatment for sore nipples</a></li><li>5.4 <a href="topic_5-4.html">Further causes of nipple pain</a></li><li>5.5 <a href="topic_5-5.html">Mastitis – diagnosis</a></li><li>5.6 <a href="topic_5-6.html">Mastitis – treatment and complications</a></li></ol></li>
        <li>6.0 <a href="topic_6-0.html">In conclusion</a><hr /></li>
        <li class="appendix"> <a href="references.html">List of references</a></li>
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