BREASFEEDING

Dr.p.natarajan
 Why breastfeeding is crucial?
1. Breast feeding provides optimal nutrition for
the normal infant during the early months of
life
2. Provide protection against GI and upper
respiratory infections which are killer
diseases in infancy
3. Provides factors for myelinization
4. Mother infant bonding provides a source of
security and comfort to the infant
5. There are many benefits to mother also
 Withhold breastfeeding in:
a. Perinatal asphyxia.
b. Mechanical ventilation.
c. Hemodynamic instability (use of pressors).
d. Sepsis.
e. Frequent episodes of apnea and bradycardia.
f. Presence of umbilical catheters (controversial).
g. Feeding in the presence of patent ductus arteriosus
and indomethacin therapy
 Criteria for initiating infant feeding
A. No history of excessive oral secretions,
vomiting, or
B. No bilious-stained gastric aspirate.
C. Nondistended, soft abdomen,
D. Respiratory rate: Tachypnea increases the
risk of aspiration.
E. Prematurity. it is now believed that feedings
should be initiated as soon as clinically
possible.
 Protein Fat Carbohydrate
0.9 gm 3.5 g 7 g lactose
• less casein • Progressive increase in • more than in
• higher protein hindmilk most other
(3.2gm) in animal milks • Contains long chain milks, 4.8 gm in
can overload kidneys polyunsaturated fatty cow milk
• more alpha- acids • oligosaccharides,
lactalbumin; (docosahexaenoic acid or provide
• cow milk contains DHA, and arachidonic acid protection against
beta - lactoglobulin or ARA) infection
which produce allergy • important for the
neurological development
 Vitamins/minerals
• Less of iron, Vit D and Zinc
• Iron compensated by clamping after cord
pulsation (3 mts )
• Anti-infective factors:
1. immunoglobulin A, coats the intestinal mucosa and
prevents bacteria from entering the cells;
2. White blood cells kill micro-organisms;
3. Whey proteins (lysozyme and lactoferrin) can kill
bacteria, viruses and fungi;
4. Oligosacccharides prevent bacteria from attaching
to mucosal surfaces.
 Other bioactive factors

1. Bile-salt stimulated lipase facilitates the

complete digestion of fat

2. Epidermal growth factor stimulates maturation

of the lining of the infant’s intestine
 Intelligence
• on average 3.2 points higher among children who
were breastfed
• Increased duration of breastfeeding has been
associated with greater intelligence in late
childhood and adulthood, which may affect the
individual’s ability to contribute to society.
 Colostrum and mature milk
1. Colostrum is the special milk that is secreted in the
first 2–3 days after delivery. about 40–50 ml on the
first day
2. Colostrum is rich in:
1. white cells and
2. antibodies, especially Ig A,
3. larger percentage of protein, minerals and fat-
soluble vitamins (A, E and K)
3. Colostrum is a baby's first immunization against many
bacteria and viruses
4. Colostrum is laxative, and helps the baby to pass
meconium
 Mature milk

• On the third day, an infant is normally taking

about 300–400 ml per 24 hours, and on the
fifth day 500–800 ml .

• From day 7 to 14, the milk is called transitional,

and after 2 weeks it is called mature milk.
• Foremilk is the milk that is produced early in a
feed. It provides:
– plenty of protein,
– lactose, other nutrients and
– water.
• Hindmilk is the milk that is produced later in a
feed.
– contains more fat.
– provides much of the energy
– Satiety
– sleep
 Preterm milk

• Preterm breast milk, has more protein,

• Higher levels of some minerals including iron,

• More immune properties than mature milk,

making it more suited for the needs of a
premature baby.
 Hormonal control of milk production
• Oestrogen is involved indirectly in lactation
• Prolactin: secretion of milk by the cells of the alveoli;
• More prolactin is produced at night, so breastfeeding at
night keeps up the milk supply
• Oxytocin makes the myoepithelial cells around the
alveoli contract – “let down” reflex
• The reflex gets actvated by touching, smelling or
seeing her baby, or hearing her baby cry, or thinking
about the baby.
• Rooming in is thus very important !
Prolactin Oxytocin
 Feedback inhibitor of lactation
• Milk production is also controlled in the breast
by a substance called the feedback inhibitor of
lactation, or FIL (a polypeptide), which is
present in breast milk
• If milk is not removed, the inhibitor collects
and stops the cells from secreting any more,
helping to protect the breast from the harmful
effects of being too full
1. Baby’ chin touching the breast
2. Nipple and lower areola inside the mouth
3. some upper areola visible
4. Lowe lip turned outside
 Four key points for good position

1. The baby’s head and body should be in a straight line

2. His face should face the breast, with his nose opposite
the nipple
3. His mother should hold his body close to hers
4. Mother should support his bottom, and not shoulders
and head
Good position Bad position
 “NOT ENOUGH MILK” Reliable Signs

1. Poor weight gain (<500gm/month)

2. Passing small amount of urine
(<6times/day)
3. Concentrated urine
4. Hard stools
5. Frequent crying?
 Reasons for not enough milk
1. Delayed initiation of breastfeeding
2. Poor attachment
3. Infrequent feeds-8 upto 8 weeks; 6 upto 6 months
4. Short feeds
5. Using bottles or pacifiers
6. Giving other foods or drinks
7. Stressed mother
8. Sick mother
9. Oral pill ; pregnancy
10. Sick baby
 Lactation management
Help the mother practically
1. Sit quietly and privately or with a
supportive friend.
2. Hold her baby with skin –to – skin contact if
possible
3. Take a warm soothing drink
4. Stimulate her nipples
5. Massage or stroke the breasts lightly
6. Ask a helper to rub her back
Rubbing the back
 Breastfeeding &Working Mother
1. If working mother she should take
maternity leave
2. xpress milk before leaving for work
and somebody can feed using paladai
3. Reverse the feeding pattern
 Maternal Nutrition During
Breastfeeding
1. The average increase in calories to support
breastfeeding is 750 calories/day
2. Recommendations are to eat an additional
500 calories/day and let fat reserves
accumulated during pregnancy provide
the rest
 Maternal Nutrition During
Breastfeeding

Fluid

1. Fluid needs increase with breastfeeding

2. Women need to drink 8 to 12 cups of

fluid/day to prevent dehydration and
milk production
 Carry home message
• Exclusive breastfeeding for 6
months
• Continue breastfeeding for 2 years
with supplementary feeding (home
food)
 Exclusive breastfeeding
Definition:
1. Exclusive breastfeeding means that an infant
receives only breast milk from his or her mother
or a wet nurse, or expressed breast milk,
2. and no other liquids or solids, not even water,
3. with the exception of oral rehydration solution,
prescribed drops or syrups consisting of vitamins,
minerals supplements or medicines
 Advantages of breast milk for baby:
1. Natural food
2. Always available at the proper temperature and
requires no preparation time.
3. Fresh and free of contaminating bacteria,
4. The protective effects against enteric and other
pathogens
6. Contains bacterial and viral antibodies,
including secretory ig.A
7. It also inhibits growth of many common
viruses.
8. No allergy
8. Lower incidence of diarrhea , otitis media, pneumonia,
bacteremia, and meningitis during the 1st yr of life
9. Macrophages in human milk may synthesize complement,
lysozyme, and lactoferrin.
10. Lactoferrin, an iron-binding whey protein has an inhibitory
effect on the growth of escherichia coli in the intestine.
11. The lower ph contributes to the favorable intestinal flora
(i.E.,More bifidobacteria and lactobacilli; fewer E. Coli),
12. Contains bile salt-stimulated lipase, which kills giardia lamblia
and entamoeba histolytica.
13. Transfer of tuberculin responsiveness by breast milk suggests
passive transfer of t-cell immunity.
14. Artificially-fed children have an increased risk of asthma, atopic
dermatitis, type 1 diabetes, celiac disease, ulcerative colitis and
Crohn disease.
15. Artificial feeding is also associated with a greater risk of
childhood leukaemia.
16. Obesity in later childhood and adolescence is less common
among breastfed children
17. Risks to cardiovascular health, including increased blood
pressure, altered blood cholesterol levels and atherosclerosis in
later adulthood.
18. Increased duration of breastfeeding has been associated with
greater intelligence in late childhood and adulthood, which may
affect the individual’s ability to contribute to society.
Artificially-fed children have an increased risk of
1. Asthma and other atopic conditions,
2. Type 1 diabetes,
3. obescity
4. Celiac disease,
5. Ulcerative colitis and crohn disease.
6. Childhood leukaemia
7. cardiovascular health, including increased blood
pressure, altered blood cholesterol levels and
atherosclerosis
 Benefits for the mother
1. The psychologic advantages for both mother and
infant
2. A feeling of being essential and a sense of
accomplishment for the mother
3. Less risk of postpartum haemorrhage
4. Les risk of breast and ovarian cancer
5. less obesity and accelerated recovery of pre-
pregnancy weight
6. lactation amenorrhea
• assists the uterus return to its pre-pregnant
state faster
• can help women to lose weight after baby’s
birth
• reduces the risk of ovarian cancer and pre-
menopausal breast cancer
• reduces the risk of osteoporosis
• reduces the risk of mothers with gestational
diabetes developing Type 2 diabetes
 Benefits to the family
1. The cost of rearing a child by buying formula
or cow’s milk is reduced
2. The cost of frequent visits to hospital is
substantially low in breastfed infants as they
have less incidence of illnesses
3. Lactation amenorrhea helps planning the
family size in the first year
4. Infanticide is unknown if mother starts
breastfeeding and develops bonding
 Benefits to State
• More intelligent citizen
• Low IMR
• Less health budget burden
• Less population explossion
 The Baby-friendly Hospital Initiative (BFHI)
• launched by WHO and UNICEF in 1991, following
the Innocenti Declaration of 1990.
• The initiative is a global effort to implement
practices:
1. To protect, promote and support breastfeeding
2. To achieve the goal of promoting breastfeeding
practices in the hospitals both in government and
private sectors.
3. This is one of the key interventions towards
achieving the goal of reducing infant mortality
rates.
 Baby friendly hospital initiative-BFHI
Concepts:
1.Breastfeeding is important for mother and baby.
2.Most mothers and babies can breastfeed.
3.Mothers and babies who are not breastfeeding
need extra care to be healthy.
4.Hospital practices can help (or hinder) baby and
mother friendly practices.
5.Implementing the Baby-friendly Hospital Initiative
helps good practices to happen.
 Objectives of BFHI
1. To enable mothers to make an informed choice
about how to feed their newborns;
2. To support early initiation of breastfeeding;
3. To promote exclusive breastfeeding for the first 6
months;
4. To ensure the cessation of free and low cost
infant formula supply to hospitals;
5. To include, possibly at a later stage and where
needed, other mother and infant health care
issues.
 BFHI Guidelines
1. Hospital should display the feeding policy
2. Baby should breast feed within ½ hour after birth
or at the earliest in Caesarian section
3. Rooming in arrangement should be available
4. No prelacteal feeds are recommended for babies
5. No bottle feeds are given
6. Teach mothers about techniques of breast feed
and about expressing breast milk
7. Advice exclusive breastfeed for 6 months and
continued with other feedings upto 2 years
 Ten steps to successful breast feeding in
health facilities:
1. Have a written breastfeeding policy that is routinely
communicated to all health care staff.
2. Train all health care staff in skills necessary to implement
this policy.
3. Inform all pregnant women about the benefits and
management of breastfeeding.
4. Help mothers initiate breastfeeding within one half-hour
of birth.
5. Show mothers how to breastfeed and maintain lactation,
even if they should be separated from their infants.
6. Give newborn infants no food or drink other than
breast milk, unless medically indicated.
7. Practice rooming in - that is, allow mothers and
infants to remain together 24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no artificial teats or pacifiers (also called
dummies or soothers) to breastfeeding infants.
10. Foster the establishment of breastfeeding support
groups and refer mothers to them on discharge from
the hospital or clinic.