Babies born with congenital anomalies, birth trauma complications, preterm and low birth weight can struggle to breastfeed. This new training guide aims to teach healthcare workers how to help mothers of special needs babies to breastfeed. Breastmilk can be vital for these more vulnerable babies but without extra support these babies too often miss out.

1. Introduction to the MAITS guide
on infant feeding difficulties
Himali de Silva & Maya Asir

2. MAITS: Multi Agency International
Training and Support
The remit of MAITS:
To provide training and resources for people supporting
individuals with disabilities and/or mental health
challenges in low-resource settings
The main ways in which MAITS provides support:
- Funding experienced professionals around the globe to
provide face-to-face training in their own country or
abroad
- Developing materials and resources that can be used
on the ground, such as MAITS Guides

3. Why Guide on working with
vulnerable infants
• Due to changes to neurology and anatomy
caused by prematurity, birth trauma and
congenital anomalies, infants with ‘additional
needs’ require more support to establish and
maintain breastfeeding.
• Practical support should be available to all
mothers to establish and maintain successful
breastfeeding.

4. • The Guide fills a gap in the existing training available
for people working in low resources settings, e.g. WHO
Breastfeeding, Essential Newborn Care.
• Existing training focuses on some vulnerable
populations, but no specific reference is given to the
diverse groups of children falling under the ‘ill’
category.
• Some of the generic advice in existing programmes
may not be effective, and can sometimes be harmful
for specific populations e.g. infants with birth
asphyxia.
MAITS Guide - How is it different?

5. • The Guide is also beneficial for infants <6 months
admitted with malnutrition without a known cause.
“In addition to causative factors such as low birth
weight, persistent diarrhoea and chronic underlying
diseases or disability, the development of severe acute
malnutrition in infants under 6 months of age
commonly reflects suboptimal feeding practices,
especially breastfeeding practices”
http://www.who.int/elena/titles/sam_infants/en
• MAITS Guide focuses on ‘how’ and not ‘why’.

6. Aim of the Guide
The guide is aimed at improving the knowledge
and skills of healthcare professionals to support
breastfeeding and nutrition in vulnerable
infants.

7. Scope of the Guide
• Train the trainer model
• Includes guidelines for specific populations: preterm,
hypertonic and hypotonic infants and cleft lip/palate
• Focuses on areas of difficulty specific to vulnerable
infants, e.g. readiness for feeding, muscle tone,
changes to suck patterns, swallow safety and after-
feeding care
• Includes practical sessions and video footage
• Encourages health workers to problem-solve
intervention strategies based on assessment findings

8. Sample page and video

9. Sample page from special populations

10. Who the Guide is for
This guide is designed to be delivered to healthcare
professionals who:
• have knowledge about infant feeding
• have preferably completed training through a
breastfeeding programme (e.g. WHO, UNICEF)
• are currently supporting vulnerable infants to
breastfeed in Neonatal Units / Special Care Units
Anyone delivering the guide needs to be specifically
trained to do so

11. How the Guide is organised
The training programme has two compulsory
components:
• classroom-based teaching
• practical sessions

12. Classroom-based teaching
There are 4 modules which need to be delivered in the
correct sequence. Each module will take 45 minutes–1½
hours (allowing for translation time).
Module 1: Lactation (optional module):
-importance of breastmilk
-breastmilk production
Module 2: Understanding infants with feeding difficulties:
-types of feeding difficulties
-assessment and breastfeeding checklist

13. Classroom-based teaching
Module 3: Intervention:
-breastfeeding positions
-intervention strategies
Module 4: Special populations:
-premature infants
-infants with high muscle tone
-infants with low muscle tone
-cleft lip/palate

14. Practical sessions
Practical sessions are delivered throughout the training,
in facilities that care for newborn infants who need
specialist support
Practical session 1: Observation only
Practical session 2: Carry out breastfeeding checklist
and assess infants feeding
Practical session 3: Observe interventional strategies
Practical session 4: Apply interventional strategies
Practical session 5: Consolidation of skills

15. Sample timetable
Day 1
9am-12pm: module 1 (optional) + module 2
12pm-1pm: practical 1
1pm-2pm: lunch break
2pm-3pm: module 3
3pm-4pm: practical 2
Day 2
9pm-10pm: practical 3
10pm-12pm: module 4
12pm-1pm: practical 4
1pm-3pm: lunch break
3pm-4pm: practical 5

16. Timeline and Next Steps
• Draft version of Guide written, based on trials in
Malawi and Uganda
• Draft completed with feedback from specialists
• Guide to be trialed in Sri Lanka in November 2016
• Guide to be finalised by February 2017
• Infant outcome data to be collected pre and post
training in Sri Lanka
• Aim to integrate into existing breastfeeding and
essential newborn care training
• Scope to form a platform for generating research
and evidence-base

17. Contact details
• MAITS: www.maits.org.uk
Mel Adams, MAITS director of operations:
mel@maits.org.uk
• Himali de Silva: desilva.himali@gmail.com
• Maya Asir: mayasir83@hotmail.com