A Dietitian's Role in Breastfeeding Promotion Through a Telephone “HELPLINE.”

Abstract

Dietitians have a vital role and responsibility to promote breastfeeding among all women to achieve the national health promotion and disease prevention objectives for breastfeeding by the year 2000. A telephone consultation service is one practical method for providing breastfeeding promotion and support to families and the health care professionals caring for them. Such a service was established more than 15 years ago in San Diego, as part of a non-profit pediatric practice specializing in lactation management and professional education. The phone counseling is provided by an interdisciplinary team of clinicians, including a dietitian, a nurse, a pediatrician, and two nurse practitioners. “Helpline” duty is scheduled on a monthly basis in four-hour time blocks, generally not overlapping with clinical appointment or teaching time. The dietitian and nurse answer the majority of the calls, triaging those regarding medications and complicated medical conditions to the pediatrician and nurse practitioners. The goals of the initial phone evaluation are to assess the reason for the call, and to determine whether home treatment or an office evaluation is necessary. When home treatment is chosen, appropriate guidance is provided. Indications for an office evaluation include: history indicates problem cannot be managed at home; clear history not obtainable; doubt about reliability or accuracy of history; referral from health care provider; parent request. For followup, legal, and evaluation reasons, a one-page form is completed and filed on each call. This form includes the names of both the patient and of the person who is making the call, the date and time of the call, a brief description of the history and symptoms given by the caller, a brief statement of the advice given and/or protocol followed, including any warning about the danger of non-compliance. During 1994 the “Helpline” answered more than 1900 calls, or nearly 40/week. The majority of calls were on infants 1–7 days of age, and the 6 most common questions were (in order of frequency) about (perceived) insufficient milk, pump rental/use, attachment, medications, weaning, and milk storage. The majority of the calls took 5–10 minutes on the phone, plus documentation time. Clinical appointments were recommended for 0%, and actually made for 7% of the calls. It should be emphasized that a telephone consultation service is not an activity to be delegated to non-perinatal health care professionals. Evaluating information gathered from a telephone interview requires skill and considerable experience.