Feeding of healthy

newborn babies
 Learning objectives - 1
 To list the benefits of breast feeding
 Benefits to baby
 Benefits to mother
 To explain the physiology of lactation
 Prolactinreflex
 Oxytocin reflex

Teaching Aids: ENC NF- 2

 Exclusive breastfeeding
 All healthy infants should be breastfed exclusively
for the first six months of life
 Exclusive breastfeeding is defined as "an infant's
consumption of human milk with no supplementation
of any type (no water, no juice, no nonhuman milk,
and no foods) except for vitamins, minerals, and
medications."

Teaching Aids: ENC NF- 3

 Benefits of breast milk to the baby
 Breast milk and human colostrum are made for babies
and is the best first food
 Easily digested and well absorbed
 Contains essential amino acids
 Rich in essential fatty acids
 Better bioavailability of iron and calcium

Teaching Aids: ENC NF- 4

 Benefits of breast milk (contd.)
 Prevents under five child deaths
 Protects against infections
 Prevents allergies
 Better intelligence
 Promotes emotional bonding
 Less heart disease, diabetes and lymphoma

Teaching Aids: ENC NF- 5

 Protection against infection
2. WBC in
1. Mother
infected
mother’s
body
make
antibodies
to protect
mother

3. Some
WBCs go
4. Antibody to to breast
mother’s and make
infection antibodies
secreted in milk there
to protect baby
Teaching Aids: ENC NF- 6
 Benefits to mother
 Helps in involution of uterus
 Delays pregnancy
 Decreases mother’s workload, saves time and
energy
 Lowers risk of breast and ovarian cancer
 Helps reduce weight faster

Teaching Aids: ENC NF- 7

 Benefits to family and society
 Contributes to child survival
 Saves money
 Promotes family planning
 Environment friendly

Teaching Aids: ENC NF- 8

 Anatomy of breast
Myoepithelial cells

Epithelial cells

ducts

Lactiferous sinus

Nipple

Areola

Montgomery gland
Alveoli
Supporting tissue
and fat

Teaching Aids: ENC NF- 9

 Physiology of lactation
 Hormonal secretions in the mother
 Prolactin helps in production of milk
 Oxytocin causes ejection of milk
 Reflexes in the baby – rooting, sucking &
swallowing

Teaching Aids: ENC NF-10

 Prolactin “milk secretion” reflex
Enhancing factors Hindering factors

Early initiation
of breastfeeds

Delay in initiation
Good attachment of breastfeeds,
& effective suckling Pre-lacteal feeds,
Bottle feeding,
Incorrect positioning,
Frequent feeds Painful breast
including night
feeds

Emptying
of breast
Prolactin in Sensory impulse
blood from nipple

Teaching Aids: ENC NF- 11

 Oxytocin “milk ejection” reflex

Oxytocin contracts
myoepithelial cells

Sensory impulse from

nipple to brain

Baby sucking

Teaching Aids: ENC NF-12

 Oxytocin reflex
Stimulated by Inhibited by

• Thinks lovingly of baby • Worry

• Sound of the baby • Stress

• Sight of the baby • Pain

• CONFIDENCE • Doubt

Teaching Aids: ENC NF-13

 Feeding reflexes in the baby
Rooting reflex

Sucking reflex

Swallowing reflex

Teaching Aids: ENC NF-14

 Learning objectives - 2
 Ensuring good start
 To be able to describe how breastfeeding works
 To recognise good and poor attachment and
positioning of a baby feeding at the breast
 Overcoming difficulties
 Tohelp a mother breastfeed her newborn baby
 Help a mother prevent common problems

Teaching Aids: ENC NF-15

 For successful breastfeeding
 A willing and motivated mother
 An active and sucking newborn
 A motivator who can bring both mother and newborn
together (health professional or relative)

Teaching Aids: ENC NF-16

 Key points of positioning
Mother:
 Make the mother sit in a comfortable and convenient
position (she can feed in lying down position)
 Ensure that she is relaxed and comfortable
Baby:
 Baby’s head and body are in a straight line
 Baby’s whole body is supported
 Baby’s face is opposite the nipple and the breast
 Baby’s abdomen touches mother’s abdomen

Teaching Aids: ENC NF-17

 Good positioning

Teaching Aids: ENC NF-18

 Key points of good attachment

1. Baby’s mouth is wide open

2. Baby’s chin touches the breast
3. Baby’s lower lip is curled outward
4. Usually the lower portion of the areola is
not visible

Teaching Aids: ENC NF-19

 Good attachment
lower lip is curled outward baby’s mouth is wide open

chin touches lower portion

the breast of the areola is
not visible

Teaching Aids: ENC NF-20

 Good and poor attachment

Teaching Aids: ENC NF-21

 Effective suckling

For an infant who shows signs of good attachment, the

next step would be to assess suckling:
 If the infant takes several slow deep sucks followed
by swallowing and then pauses, then he/she is
sucking effectively

Teaching Aids: ENC NF-22

Problems in breastfeeding: Inverted nipple
Treatment should begin after
birth
 Manually stretch and roll the
nipple between the thumb and
finger several times a day
 Teach the mother to grasp the
breast tissue so that areola
forms a teat, and allows the
baby to feed
 Syringe suction method

Teaching Aids: ENC NF-23

 Inverted nipple: treatment by syringe method
Before feeds 5-8
STEP 1
times a day
Use 10 or 20cc syringe
Cut along this
line with blade
STEP 2
Insert the plunger
from cut end

STEP 3
Mother gently pulls
the plunger

STEP 4 Press at the edge and

allow air to enter before
removing the syringe
Teaching Aids: ENC NF-24
 Problems in breastfeeding: Sore nipple

Look for a cause:

 Check the baby’s attachment at
the breast
 Check the baby’s position if
attachment is poor
 Examine the breasts –
engorgement, fissures, candida
 Ask if mother washes the
breasts after each feed (frequent
washing leads to sore nipple)
 If the problem persists, check the
baby’s oral cavity for candida

Teaching Aids: ENC NF-25

 Sore nipple: management
Give appropriate treatment:
 Build mother’s confidence
 Improve the baby’s
attachment and continue
breastfeeding
 Reduce engorgement, feed
frequently, express breast
milk
 Treat candida
Teaching Aids: ENC
Advise the mother to:
 Wash breasts only once a
day; avoid using soap
 Avoid medicated lotions
and ointments
 Gently apply hind milk
onto nipple and areola
after each feed
NF-26
 Problems in breastfeeding: Breast
engorgement
Causes
 Delayed and infrequent breastfeeds
 Incorrect latching of the baby
Treatment
 Give analgesics to relieve pain
 Apply warm packs locally
 Gently express milk prior to feed
 Put the baby frequently to the breast

Teaching Aids: ENC NF-27

 Full vs. engorged breasts

Engorged breasts =
Full breasts = NORMAL
ABNORMAL

Teaching Aids: ENC NF-28

 Full vs. engorged breasts
Full breasts: Engorged breasts:
 36/72 hours after  can occur at any time
birth. during breastfeeding
 Painful; edematous
 Hot, heavy, may be
 Tight, especially nipple
hard area
 Milk flowing  Shiny
 Fever uncommon  May look red
 Milk NOT flowing
 Fever may occur
 May cause a decrease in
Teaching Aids: ENC milk supply if it happens
NF-29
 “Not enough milk”: causes

 Not breastfeeding often enough

 Too short or hurried breastfeeding
 Night feeds stopped early
 Poor suckling position
 Poor oxytocin reflex (anxiety, lack of confidence)
 Engorgement or mastitis

Teaching Aids: ENC NF-30

 “Not enough milk”: management

 Put baby to breast frequently

 Baby to be correctly attached to breast
 Build mother’s confidence
 Back massage and relaxation can help
 Use galactogogues (metaclopropamide) judiciously

Adequate weight gain and urine frequency 5-6 times a day are
reliable signs of enough milk intake

Teaching Aids: ENC NF-31

 Adequacy of breastfeeding

 Breastfeeding is considered adequate if the

baby
 Goes to sleep for 2-3 hrs after each feed
 Passes urine 6-8 times in 24 hrs
 Gains weight at 10-15 gm/kg/day
 Crosses birth weight by 2 weeks

Teaching Aids: ENC NF-32

 Expressed breast milk
Indications
 Sick mother, local breast problems
 Preterm / sick baby
 Working mother
Storage
 Clean wide-mouthed container with tight lid
 At room temperature: 6 hrs
 Refrigerator: 24 hours; Freezer (20°C): for 3 months

Teaching Aids: ENC NF-33

 EXPRESSING
BREAST MILK

W a sh y ou r h a n d s w e ll w it h soa p a n d
w ater

Pla ce a cle a n con t a in e r b e low y ou r b r e a st t o

colle ct m ilk

M a ssa g e t h e br e a st s g e n t ly
t ow a r d t h e n ip ple s

Pla ce y ou r t h u m b a n d in de x f in g e r oppo sit e e a ch ot h e r j u st

ou t side t h e da r k cir cle a r ou n d t h e n ip p le

N ow pr e ss b a ck t ow a r d y ou r ch e st , t h e n ge n t ly sq u e e z e t o
r e le a se m ilk

Re p e a t st e p 5 a t d if f e r e n t p osit ion s a r ou n d t h e
a r e ola

Teaching Aids: ENC NF-34

Ten steps to successful breastfeeding
Every facility providing maternity services and care for
newborn infants should

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

Teaching Aids: ENC NF-35

Ten steps to successful breastfeeding
(contd….)
4. Help mothers initiate breastfeeding within half
hour of birth
5. Show mothers how to breastfeed, and how to
maintain lactation even if they are separated from
their infants
6. Give no food or drink, unless medically indicated
7. Practice rooming-in : allow mothers and infants to
remain together 24 hrs a day
Teaching Aids: ENC NF-36
 Ten steps to successful breastfeeding
(contd….)
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.

Teaching Aids: ENC NF-37