Mengapa menyusui penting?

 Manfaat menyusui secara eksklusif

 Daftar kerugian menggunakan artificial feeding
 Menjelaskan perbedaan antara ASI dengan formula buatan
Manfaat Menyusui untuk Bayi
 Provides superior nutrition for optimum growth.
 Provides adequate water for hydration.
 Protects against infection and allergies.
 Promotes bonding and development.
Ringkasan perbedaan antar Susu
Human milk Animal milks Infant formula
Jumlah cukup, mudah terlalu banyak, sulit
Protein sebagian disesuaikan
dicerna dicerna
ada asam lemak kurang asam lemak
Fat essensial, lipase essensial, tidak ada tidak ada lipase
untuk mencerna lipase

Water cukup kelebihan mungkin butuh lebih

Anti-infective
ada tidak ada tidak ada
properties

Adapted from: Breastfeeding counselling: A training course. Geneva, World Health

Organization, 1993 (WHO/CDR/93.6).
Breast milk composition differences
(dynamic)
 Gestational age at birth
(preterm and full term)
 Stage of lactation
(colustrum and mature milk)
 During a feed
(foremilk and hindmilk)
Colostrum
Property Importance
 Antibody-rich  protects against infection and
allergy
 Many white cells  protects against infection
 Purgative  clears meconium; helps prevent
jaundice
 Growth factors  helps intestine mature; prevents
allergy, intolerance
 Vitamin-A rich  reduces severity of some infection
(such as measles and diarrhoea);
prevents vitamin A-related eye
diseases
Air Susu pada tahun kedua
100%
%
daily 80%
needs
provided 60%

by
40%
500 ml 95%
breast 20% 45%
milk
0%
Vitamin A Vitamin C
From: Breastfeeding counselling: A training course. Geneva, World Health Organization, 1993
(WHO/CDR/93.6).
Transparency 2.7
 2/11

Air Susu pada tahun kedua

100% Gap
Percentage of daily needs

75%

50%
Provided by
550 ml breast
milk
25%

0%
Energy Protein Iron Vitamin A
Nutrient
PROTECTIVE EFFECT OF
BREASTFEEDING
ON INFANT MORBIDITY
 Resiko diare dari metode pemberian
makan untuk bayi umur 0-2 bulan, Filipina
20
17,3

15 13,3

10

5 3,2
1,0
0
Breast milk only Breast milk & Breast milk & No breast milk
non-nutritious nutritious
liquids supplements

Adapted from: Popkin BM, Adair L, Akin JS, Black R, et al. Breastfeeding and diarrheal
morbidity. Pediatrics, 1990, 86(6): 874-882.
Percentage of babies bottle-fed and breastfed for the first 13 weeks
that had diarrhoeal illness at various weeks of age during the first
year, Scotland

25 22,3 22,4
Percent with diarrhoea

19,5 19,1
20
15 12,9 11,9
10 7,1
5 3,6

0
0-13 14-26 27-39 40-52
Incidence of diarrhoeal illness by age in weeks

Bottle-fed Breastfed
Adapted from: Howie PW, Forsyth JS, Ogston SA, Clark A, Florey CV. Protective effect
of breastfeeding against infection. Br Med J, 1990, 300: 11-15.
Percentage of infants 2-7 months of age reported as experiencing
diarrhoea, by feeding category
in the preceding month in the U.S.
12 11,4

10
8,5
8
6,4
Percent 6 5,4 Diarrhea
4,8
4

0
Breast milk High mixed Middle Low mixed Formula
only (89-99) Mixed (1-57) only (0)
(100) (58-88)

Adapted from: Scariati PD, Grummer-Strawn LM, Fein SB. A longitudinal analysis of infant
morbidity and the extent of breastfeeding in the United States. Pediatrics, 1997, 99(6).
Percentage of babies bottle-fed and breastfed for the first 13 weeks
that had respiratory illness at various weeks of age during the first
year, Scotland
60 54,1
Percent with respiratory

50 47,1 45,5
42,4 40
38,9 36,2
40
illness

30 23,1
20
10
0
0-13 14-26 27-39 40-52
Incidence of respiratory illness by age in weeks

Bottle-fed Breastfed
Adapted from: Howie PW, Forsyth JS, Ogston SA, Clark A, Florey CV. Protective effect of
breastfeeding against infection. Br Med J, 1990, 300: 11-15.
 Frequency of acute otitis media in relation
to feeding pattern and age, Sweden
20 20
Percent with acute otitis

14
15 13
media

10 7
6
5 4
5
1
0
1-3 4-7 8-12
months

breastfed mixed fed weaned

Adapted from: Aniansson G, Alm B, Andersson B, Hakansson A et al. A prospective coherent

study on breast-feeding and otitis media in Swedish infants. Pediat Infect Dis J, 1994, 13: 183-
188.
 Percentage of infants 2-7 months of age reported as experiencing
ear infections, by feeding category in the preceding month in the
U.S.
14 13,2

12 11,1

10 9,4

8
6,6 6,6
Percent Ear Infection
6

0
Breast High Middle Low mixed Formula
milk only mixed mixed (1-57) only (0)
(100) (89-99) (58-88)

Adapted from: Scariati PD, Grummer-Strawn LM, Fein SB. A longitudinal analysis of infant
morbidity and the extent of breastfeeding in the United States. Pediatrics, 1997, 99(6).
 2/5

Protection against infection

1. Mother infected 2. White cells in

mother’s body make
antibodies to protect
mother

4. Antibodies to 3. Some white cells go

mother’s infection to breast and make
secreted in milk to antibodies there
protect baby
PROTECTIVE EFFECT OF
BREASTFEEDING
ON INFANT MORTALITY
 Relative risks of death from diarrhoeal disease
by age and breastfeeding category in Latin America

16 15,1
14
12 exclusive
10 breastfeeding
partial
8
breastfeeding
6 no breastfeeding
4,1
4
2,2
2 1 1
0
Diarrhoea 0-3 mo Diarrhoea 4-11 mo

Adapted from: Betran AP, de Onis M, Lauer JA, Villar J. Ecological study of effect of
breast feeding on infant mortality in Latin America. BMJ, 2001, 323: 1-5.
Relative risks of death from acute respiratory infections by age
and breastfeeding category
in Latin America
4,5
4
4
3,5
2,9 exclusive
3 breastfeeding
2,5 2,1 partial
2 breastfeeding
1,5 no breastfeeding
1 1
1
0,5
0
ARI 0-3 mo 4-11 mo

Adapted from: Betran AP, de Onis M, Lauer JA, Villar J. Ecological study of effect of
breast feeding on infant mortality in Latin America. BMJ, 2001, 323: 1-5.
BREASTFEEDING REDUCES THE
RISK OF CHRONIC DISEASE
 Breastfeeding decreases the risk of allergic disorders
– a prospective birth cohort study

Type of feeding Asthma Atopic Allergic

dermatitis rhinitis
Children exclusively 7.7% 24% 6.5%
breastfed 4 months or
more
Children breastfed for 12% 27% 9%
a shorter period

Adapted from Kull I. et al. Breastfeeding and allergic diseases in infants - a prospective birth
cohort study. Archives of Disease in Childhood 2002: 87:478-481.
 Atopic
dermatitis
 Breastfeeding decreases the prevalence
of obesity in childhood at age five and six years, Germany
5 4,5
4,5
4 3,8
Prevalence (%)

3,5
0 months
3
2,3 2 months
2,5
2 1,7 3-5 months
1,5 6-12 months
1
0,5
0
months breastfeeding
Adapted from: von Kries R, Koletzko B, Sauerwald T et al. Breast feeding and obesity:
cross sectional study. BMJ, 1999, 319:147-150.
 BREASTFEEDING HAS
PSYCHOSOCIAL
AND DEVELOPMENTAL BENEFITS
 Intelligence quotient by type of feeding
BF 12.9 points
BF 2 points higher than FF
higher than FF Study in 9.5
year-olds
Study in 3-7
1996
year-olds
1982
BF 8.3 points
higher than FF
Study in 7.5-8
BF 2.1 points year-olds
higher than FF 1992
Study in 6 months
to 2 year- olds References:
1988 BM 7.5 points •Fergusson DM et al. Soc
higher than no BM SciMed 1982
•Morrow-Tlucak M et al.
Study in 7.5-8 SocSciMed 1988
BF = breastfed year-olds •Lucas A et al. Lancet 1992
FF = formula fed •Riva Eet al. Acta Paediatr 1996
BM = breast milk 1992
 Duration of breastfeeding associated with higher IQ
scores in young adults, Denmark
108
106
106
104 < 1 months
104
102,3 2-3 months
101,7
102 4-6 months
99,4 7-9 months
100
> 9 months
98

96
Duration of breastfeeding in months
Adapted from: Mortensen EL, Michaelsen KF, Sanders SA, Reinisch JM. The association
between duration of breastfeeding and adult intelligence. JAMA, 2002, 287: 2365-2371.
Benefits of breastfeeding for the mother

 Protects mother’s health

 helps reduces risk of uterine bleeding and helps the
uterus to return to its previous size
 reduces risk of breast and
ovarian cancer
 Helps delay a new pregnancy
 Helps a mother return to pre-pregnancy weight
 Breast cancer and breastfeeding:
Analysis of data from 47 epidemiological studies in 30
countries
R e la tiv e ris k o f b re a s t c a n c e r

1,2

0,8

0,6

0,4

0,2

Lifetime duration of breastfeeding(years)

0 1 2 3 4 5 6

Adapted from: Beral V et al. (Collaborative group on hormonal factors in breast cancer). Breast
cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological
studies in 30 countries… Lancet 2002; 360: 187-95.
 Relationship between duration of breastfeeding and
postpartum amenorrhoea (in months)

Adapted from: Saadeh R, Benbouzid D. Breast-feeding and child spacing: importance of

information collection to public health policy. Bulletin of the WHO, 1990, 68(5) 625-631.
Risks of artificial feeding
 Interferes with bonding

 More diarrhoea and  More allergy and

respiratory infections milk intolerance

 Persistent diarrhoea  Increased risk of some

chronic diseases
 Malnutrition
Vitamin A deficiency  Overweight

 More likely to die  Lower scores on

intelligence tests
Mother
 May become  Increased risk of anaemia,
pregnant sooner ovarian and breast cancer
Adapted from: Breastfeeding counselling: A training course. Geneva, World
Health Organization, 1993 (WHO/CDR/93.6).
Manfaat Menyusui bagi keluarga
 Kesehatan, gizi dan kesejahteraan yang lebih baik
 Manfaat ekonomis
 Membutuhkan biaya lebih sedikit dari
pemberian makan artifisial
 Menyusui menghasilkan biaya perawatan medis
yang lebih rendah
Manfaat Menyusui untuk Rumah Sakit
 Lingkungan emosi yang lebih hangat dan tenang
 Tidak membutuhkan pendampingan, lebih banyak
ruang kosong di RS
 Lebih sedikit kejadian infeksi neonatal
 Lebih sedikit waktu kerja staf
 Memperbaiki citra RS
 Lebih sedikit anak yang terasingkan
Zat gizi pada susu ibu dan susu hamil

Human Cow Goat

Fat

Protein

Lactose
Perbedaan kualitas protein pada susu yang
berbeda
Human milk Cow’s milk

Whey protein

Curds

Easy to digest Difficult to digest

Perbedaan antara Kolustrum dengan ASI

Foremilk Hindmilk

Fat

Protein

Lactose

Colostrum Mature milk

 Kolostrum
Property Importance
 Antibody rich - protects against allergy & infection
 Many white cells - protects against infection
 Purgative - clears meconium
- helps to prevent jaundice
 Growth factors - helps intestine to mature
- prevents allergy, intolerance
 Rich in Vitamin A - reduces severity of infection
Manfaat Psikologis dari Menyusui
Emotional bonding
 close, loving relationship between mother and baby

 mother more emotionally satisfied

 baby cries less

 baby may be more emotionally secure

Development
 children perform better on intelligence tests
Kerugian Pemberian Makan Buatan
 Interferes with bonding
 More diarrhoea and persistent diarrhoea
 More frequent respiratory infections
 Malnutrition; Vitamin A deficiency
 More allergy and milk intolerance
 Increased risk of some chronic diseases
 Obesity
 Lower scores on intelligence tests
 Mother may become pregnant sooner
 Increased risk of anaemia, ovarian cancer, and breast cancer in
mother