BREASTFEEDING COUNSELLING

PEDIATRIC DEPARTMENT
HASAN SADIKIN HOSPITAL - UNIVERSITY OF PADJADJARAN
Objective
Importance of breastfeeding
Factors influence successful
breastfeeding
Help mother breastfeed her baby
successfully
The importance and ho to
suppress breastmilk
Advantages of breastfeeding
Breast milk Breastfeeding
• Perfect nutrients • Helps bonding
• Easily digested; and development
efficiently used • Helps delay a new
• Protects against pregnancy
infection • Protects mothers’
health


Costs less than artificial feeding
 Protection against
infection
1. Mother 2. White cells in
infected mother’s body
make
antibodies to
protect mother

4. Antibodies to 3. Some white

mother’s cells go to
infection breast and
secreted in milk make
to protect baby antibodies
there
 Disadvantages of artificial
feeding
Interferes with bonding
More diarrhoea and persistent diarrhoea
More frequent respiratory infections
Malnutrition; Vitamin A deficiency
More allergy and milk intolerance
Obesity
Mother may become pregnant sooner
etc
The Global Strategy for Infant and Young Child Feeding
recommends that:

Infants are exclusively breastfed for the first six

months of life.

After six months all babies require complementary

foods while breastfeeding continues for up to two
years of age or beyond
Anatomy of the breast
Oxytocin makes
Muscle cells them contract
Prolactin makes
Milk-secreting cells
them secrete milk

Ducts

Larger ducts

Nipple

Areola
Montgomery’s glands
Alveoli
Supporting
tissue and fat
 Prolactin
 Secreted during and after feed to produce next feed

Sensory impulses from

nipples

Prolactin in blood

Baby suckling
• More prolactin
secreted at night
• Suppresses ovulation
 Oxytocin reflex
 Works before or during feed to make milk
flow

Sensory impulses from

Oxytocin in blood nipples

Baby suckling
• Makes uterus contract
Helping and hindering of
oxytocin reflex
These help reflex These hinder reflex

• Thinks lovingly of baby •

• Sounds of baby Worry
• Sight of baby •
Stres
• Touches baby
s
• Confidence • Pain
•
Doubt
Inhibitor in breast milk

Inhibitor If breast remains

full of milk,
secretion stops
Attachment to the breast
Good and poor
attachment
What differences do you see?

1 2
Attachment (outside appearance)
What differences do you
see?

1 2
GOOD ATTACHMENT
a. The baby's chin touches the breast.
b. His mouth is wide open.
c. His lower lip is turned outwards.
d. You can see more of the areola above
his mouth and less below.
Results of poor attachment
 Painful nipples
 Damaged nipples
 Engorgement
 Baby unsatisfied and cries a lot
 Decreased milk production
 Baby fails to gain weight
 Reflexes in the baby
Rooting Reflex
When something touches lips,
baby opens mouth, puts tongue
down and forward
Sucking Reflex
When something touches
palate, baby sucks
Skill
Mother learns to
position baby
Baby learns to
take breast

Swallowing Reflex
When mouth fills with
milk, baby swallows
BREASTFEED OBSERVATION JOB
AID
- This form will help you to remember what
to look for when you assess a breastfeed.
 The form is arranged in 5 sections:

General,
Breasts,
Baby’s Position,
Baby’s Attachment,
Suckling.
 The signs on the left all show that
breastfeeding is going well. The signs on
the right indicate a possible difficulty.
GENERAL
Mother: Mother:
􀁆 Mother looks healthy 􀁆 Mother looks ill or depressed
􀁆 Mother relaxed and comfortable 􀁆 Mother looks tense and uncomfortable
􀁆 Signs of bonding between mother & baby 􀁆 No mother/baby eye contact
Baby: Baby:
􀁆 Baby looks healthy 􀁆 Baby looks sleepy or ill
􀁆 Baby calm and relaxed 􀁆 Baby is restless or crying
􀁆 Baby reaches or roots for breast if hungry 􀁆 Baby does not reach or root
BREASTS
􀁆 Breasts look healthy 􀁆 Breasts look red, swollen, or sore
􀁆 No pain or discomfort 􀁆 Breast or nipple painful
􀁆 Breast well supported with fingers away from nipple 􀁆 Breast held with fingers on areola
BABY’S POSITION
􀁆 Baby’s head and body in line 􀁆 Baby’s neck and head twisted to feed
􀁆 Baby held close to mother’s body 􀁆 Baby not held close
􀁆 Baby’s whole body supported 􀁆 Baby supported by head and neck only
􀁆 Baby approaches breast, nose to nipple 􀁆 Baby approaches breast, lower lip/chin to nipple
BABY’S ATTACHMENT
􀁆 More areola seen above baby’s top lip 􀁆 More areola seen below bottom lip
􀁆 Baby’s mouth open wide 􀁆 Baby’s mouth not open wide
􀁆 Lower lip turned outwards 􀁆 Lips pointing forward or turned in
􀁆 Baby’s chin touches breast 􀁆 Baby’s chin not touching breast
SUCKLING
􀁆 Slow, deep sucks with pauses 􀁆 Rapid shallow sucks
􀁆 Cheeks round when suckling 􀁆 Cheeks pulled in when suckling
􀁆 Baby releases breast when finished 􀁆 Mother takes baby off the breast
􀁆 Mother notices signs of oxytocin reflex 􀁆 No signs of oxytocin reflex noticed
HOW TO HELP A MOTHER TO POSITION HER BABY
􀂃 Greet the mother and ask how breastfeeding is going.
􀂃 Assess a breastfeed.
􀂃 Explain what might help, and ask if she would like you to

show her.
􀂃 Make sure that she is comfortable and relaxed.
􀂃 Explain how to hold her baby, and show her if necessary.
􀂃 Show her how to support her breast
􀂃 Explain or show her how to help the baby to attach
􀂃 Look for signs of good attachment. If the attachment is
not good, try again
􀂃 Notice how she responds and ask her how her baby's
suckling feels
How to hold her baby
Baby’s head and body in line
Baby held close to mother’s body. The baby's
whole body should almost face his mother's body.
Baby supported. Baby’s whole body supported
with the mother’s arm along the baby’s back. For
older babies, support of the upper part of the body
is usually enough.
Baby approaches breast, nose to nipple
EXPRESSING BREASTMILK
Express Breast Milk
Wash mother’s hand
Sit comfortably
Thumb above the nipple, first
finger below the nipple
Press slightly
Press - release
The most useful way for a mother to express milk is by hand. It needs
no appliance, so she can do it anywhere and at any time. With a good
technique, it can be very efficient.

Why is it helpful to stimulate a mother’s oxytocin reflex

before she expresses milk?
It is important that the oxytocin reflex works to make the milk
flow from her breasts.
The oxytocin reflex may not work as well when a mother
expresses as it does when a baby suckles. A mother needs
to know how to help her oxytocin reflex, or she may find it
difficult to express her milk.
A helper rubbing a mother's back to stimulate the oxytocin reflex
Terima kasih