BREAST FEEDING

BY
DR AHMEDULLAH
ASSOCIATE PROFESSOR
DEPARTMENT OF PAEDIATRICS, DCMS
The more we know
about human breast
milk the more we
discover about its
value in human
nutrition and
development
 INTRODUCTION
• Breastfeeding is feeding of an infant or young child with
breast milk directly from female human breast via lactation
rather than using infant formula from a baby bottle or
container
• Ideal food for Neonates
• Best gift of Mother to her baby
• Exclusive breastfeeding – the most effective intervention to
 Reduce infant mortality
Prevent 13% of under-5 mortality in low income countries
CULTURAL BELIEFS AND PRACTICES
• A common practise in various parts of INDIA –
discard the first yellowish coloured milk “colostrum”
• Pre-lacteal feeds – honey, cow’s milk, butter(ghee)
• Discard few drops before every feed, for purifying the
tubules

These beliefs and practises should be strictly avoided

 ANATOMY of BREAST
• Glandular tissue + supportive tissue and fat
• Areaola and nipples – extremely sensitive with rich
network of nerve endings
• Glandular tissue includes clusters of sac-like spaces
that produce milk
• Alveoli(milk sac) Lactiferous ducts
Lactiferous sinuses Areola of Nipple
 PHYSIOLOGY of BREAST FEEDING

1. Preparation of breast (Mammogenesis)

2. Synthesis and secretion from the breast alveoli (Lactogenesis)
3. Ejection of milk (Galactokinesis)
4. Maintenance of lactation (Galactopoiesis)
 LACTOGENESIS
PROLACTIN REFLEX (milk secretion) OXYTOCIN REFLEX(milk
• prolactin production by Anterior ejection)
Pituitary • oxytocin production by Posterior
• Milk secretion by alveolar epithelial cells Pituitary
• When baby starts to suck – nerve • Ejection of milk from glands into
impulses carried to ANTERIOR lactiferous sinuses
PITUITARY
• In turn , release of PROLACTIN • When baby starts to suck – nerve
impulses to POSTERIOR
PITUITARY
MORE THE BABY SUCKS, GREATER
IS THE MILK PRODUUCTION • OXYTOCIN production is
stimulated by suckling and thought,
sight, or sound of the baby
PROLACTIN REFLEX
OXYTOCIN REFLEX
 REFLEXES IN THE BABY
A baby is born with certain reflexes which help the baby
to feed.
1. Rooting reflex
2. Suckling reflex
3. Swallowing reflex

SUCKLE- SWALLOW- BREATHE CYCLE

 COMPOSITION of BREAST MILK
• Composition of breast milk varies at different time points to suit the needs
of the baby
• Milk of preterm delivered mother is different from milk of a mother
delivered a term baby.

COLUSTRUM : Secreted during initial 3-4 days post delivery; small

quantity , yellow and thick ; rich in antibodies and immunocompetent cells
and vitamin A,D,E,K
TRANSITIONAL MILK: After 3-4 days until 2 weeks ; immunoglobulin
and protein content reduces while sugar and fat content increases
MATURE MILK: thinner and watery ; has all nutrients for optimal
growth
PRETERM MILK: Mother’s milk who delivered before 37 weeks. Has
more proteins, sodium, iron, immunoglobulins and calories
 FOREMILK v/s HINDMILK
FOREMILK : secreted at start of a feed. Watery, rich in proteins,
sugars, minerals and water that quenches thirst
HINDMILK: secreted later towards end of feed and is richer in fat
and energy

FOREMILK FOR THIRST ; HINDMILK FOR SATIETY

COW’S MILK v/s BREAST MILK
 ADVANTAGES of BREAST FEEDING
• Nutritional superiority : contains all nutrients that baby needs for
normal growth and development
• Carbohydrates : lactose is in high concentration. Galactose is needed
for formation of galctocerebrosides
• Proteins : protein content of breast milk is low compared to animal
milk. Major protein – lactalbumin, lactoglobulin
• Fats : rich in PUFA , necessary for myelination of nervous system
• Vitamins and minerals : quantity and bioavailability of vitamins and
minerals is as per needs of the baby in first 6 months
• Water and electrolytes : 88% water content and hence baby
doesn’t need any additional water
• Immunological superiority : includes secretory IgA,
macrophages, lymphocytes, lactoferrin, bifidus factor.
 A breastfed baby is 14 times less likely to die of diarrhea and
almost 4 times less likely to die of respiratory infection
• Epidermal growth factor in breast milk enhance intestinal
maturation and reduces risk of allergy in later life.
• Benefits to mother : uterine involution, reduced chance of
PPH, lactational amenorrhea, reduced risk of breast and
ovary cancer.
 BABY FRIENDLY HOSPITAL
INITIATIVE
• Launched in 1991 by UNICEF and WHO
• To ensure that all hospitals, maternity facilities and communities
become CENTERS OF BREASTFEEDING SUPPORT
• Ten steps to successful breast feeding
BABY
FRIENDLY
HOSPITAL
INITIATIV
E
BABY FRIENDLY HOSPITAL INITIATIVE
Critical management procedures
1a. Comply fully with the International Code of Marketing of Breast-milk Substitutes
and relevant World Health Assembly resolutions.
1b. Have a written infant feeding policy that is routinely communicated to staff and
parents.
1c. Establish ongoing monitoring and data-management systems.
2. Ensure that staff have sufficient knowledge, competence and skills to support
breastfeeding.
Key clinical practices
3. Discuss the importance and management of breastfeeding with pregnant women and
their families.
4. Facilitate immediate and uninterrupted skin-to-skin contact and support mothers to
initiate breastfeeding as soon as possible after birth.
5. Support mothers to initiate and maintain breastfeeding and manage
common difficulties.
6. Do not provide breastfed newborns any food or fluids other than breast
milk, unless medically indicated.
7. Enable mothers and their infants to remain together and to practise
rooming-in 24 hours a day. BABY FRIENDLY HOSPITA
8. Support mothers to recognize and respond to their infants’ cues for feeding.
9. Counsel mothers on the use and risks of feeding bottles, teats and pacifiers.
10. Coordinate discharge so that parents and their infants have timely access
to ongoing support and care.
 THANK YOU

THANK YOU