Breastfeeding and Vitamin D Supplementation

Broadway Clinic QI Project

Rakhee Bowker, Michael Goldman, Stuart Holzer, Lisa Kurz, Lacy-Ann Landell, Robbie Majzner, Lindsay McGann, Lisa McReynolds,

Lisa Nowell, Anne Pierog, Gabe Rama, Corinna Rea, Daniel Stephens, Emily Whitesel, Kristal Woldu

Heidi Beutler, Renie Eis, Mariellen Lane, Pran Saha, Nan Salamon, John Rausch, Laura Robbins-Milne

Breastfeeding It is well demonstrated that breastfeeding provides benefits

for both mothers and infants, including: Infants-

Stimulate GI motility and growth, decrease risk of NEC Increased immune response due to transmission in breastmilk of

maternal antibodies Decrease risk of diseases such as asthma, obesity, and diabetes

Mothers- Stimulate oxytocin release and acceleration of recovery from

childbirth Increased weight loss Increased bonding with infant Prolonged annovulation postpartum Economic savings on formula Reduced risk of breast and ovarian cancer Decreased risk of cardiovascular disease

Vitamin DImportant in calcium

homeostasis

Transferred across the placenta from mother to fetus

Often low in infants if maternal levels low or infant premature

Amount of vitamin D in breastmilk is low, especially if mom is vitamin D deficient

AAP RecommendationsThe AAP recommends exclusively breastfeeding

infants until 6 months and then supplementing with breastmilk up to and beyond the first year of life

The AAP now recommends starting vitamin D supplementation within the first few days of life to any infant breastfeeding or taking less than 27oz of formula per day

Baseline Data For Broadway

Breastfeeding (exclusive and partial)2 months- 32%4 months- 16%

Vitamin D supplementation2 months- 57%4 months- 57% 

AIM StatementWe aim to improve collective breastfeeding

rates in the Washington Heights community, specifically to 30% at the 4 month well child visit in the Broadway Ambulatory Clinic pediatric population.

Within this patient population, we aim to increase vitamin D supplementation per current AAP guidelines to 90% in all nursing infants (including both fully and partially breastfed infants).

InterventionsBreastfeeding Resource Sheet in English &

Spanish created and distributed to mothers at the newborn visit

InterventionsBreastfeeding Resource Sheet in English & Spanish

created and distributed to mothers at the newborn visit

Didactic educating clinic providers regarding breastfeeding and vitamin D supplementation guidelines

InterventionsBreastfeeding Resource Sheet in English & Spanish

created and distributed to mothers at the newborn visit

Didactic educating clinic providers regarding breastfeeding and vitamin D supplementation guidelines

Breastfeeding checklist placed in all exam rooms with guidelines for providers regarding vitamin D supplementation

InterventionsBreastfeeding Resource Sheet in English & Spanish

created and distributed to mothers at the newborn visit

Didactic educating clinic providers regarding breastfeeding and vitamin D supplementation guidelines

Breastfeeding checklist placed in all exam rooms with guidelines for providers regarding vitamin D supplementation

Schedule breastfeeding newborns for a weight check/breastfeeding check at one month of age to troubleshoot and encourage continued breastfeeding

Other Interventions Also Happening At Broadway

Centering GroupPrenatal counseling at Broadway for teenage

expecting mothers

Residents developed a breastfeeding and Vitamin D supplementation presentation. Each month the outpatient resident gives the presentation to the expectant mothers in the group

Breastfeeding Your Baby: Healthy and Natural

Sitting comfortably with the baby at breast height using a pillow for

support (excellent options are My Breast Friend or Boppy pillows), tuck

the baby's tush in the crook of the opposite arm of the breast being fed.

The mother's forearm should be positioned up the length of the baby's back. The baby's head is supported by her thumb and forefinger, right behind the ears. The baby is held tummy-to-tummy with the mother

Cross Cradle Position

Breastfeeding Support Group

Meets every 1st and 3rd Wednesday morning

Mothers can walk-in

For expecting and new mothers of Broadway Clinic

Organized by Dr. Salamon and Alyssa Wynn

Percent of Infants Receiving Any Breastmilk

Percent of Breastfed Infants Receiving Vitamin D Supplementation

Lessons We LearnedWe were unable to improve our 4 month

breastfeeding rates. This reinforced that to positively Influence breastfeeding rates interventions need to reach mothers prior to the first outpatient office visit.

As shown in other studies, effective prenatal counseling and Baby Friendly Hospitals are important factors in educating mothers and families and improving breastfeeding rates.

Educational interventions and reminders in clinic aimed at providers were able to increase vitamin D prescription rates.

References Carol L. Wagner, MD, Frank R. Greer, MD and the Section on Breastfeeding and Committee on Nutrition.

Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents. Pediatrics Vol. 122 No. 5 November 2008, pp. 1142-1152.

Chua S, Arulkumaran S, Lim I, Selamat N, Ratnam SS. Influence of breastfeeding and nipple stimulation on postpartum uterine activity. Br J Obstet Gynaecol. 1994 Sep;101(9):804-5.

Dellifraine J, Langabeer J 2nd, Williams JF, Gong AK, Delgado RI, Gill SL. Cost comparison of baby friendly and non-baby friendly hospitals in the United States. Pediatrics. 2011 Apr;127(4):e989-94. Epub 2011 Mar 21.

Dewey KG, Heining MJ, Nommsen LA. Maternal weight-loss patterns during prolonged lactation. Am J Clin Nutr. 1993 Aug;58(2):162-6.

Gartner LM, Morton J, Lawrence RA, Naylor AJ, O’Hare D, Schanler RJ, Eidelman AI: American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2005 , Feb;115(2):496-506.

Office of the Surgeon General. Call to Action to Support Breastfeeding. http://www.surgeongeneral.gov/topics/breastfeeding/index.html. 2011.

Walter F. The Parathyroid and Vitamin D. Medical Physiology: A Cellular And Molecular Approach, 1300, Elsevier/Saunders, Boron. 2003, 1094.

Wang IV, Fraser IS. Reproductive function and contraception in the postpartum period. Obstet Gynecol Surv. 1994 Jan;49(1):56-63.