Breast feeding

Dr Nimesha Gamhewage
MBBS (Col), MD, DCH
Consultant Neonatologist
Senior Lectuter in Paediatrics
Learning outcomes
• Exclusive breast feeding
• Constituents of breast milk
• Advantages of breast feeding
• Physiological basis
• Establishing breast feeding
• Alternative methods of feeding
Introduction
• Breastfeeding is one of the most effective ways to ensure infant
survival
• Breastmilk provides all the energy and nutrients in first 6 months
• Provide 50% of nutritional needs during the next 6 months
• Benefits both baby and mother
Exclusive breast feeding- WHO
EBF is the situation in which an infant receives only breast milk

for the first 6 months

and no other solids or liquids

with the exception of drops or syrups consisting of vitamins, minerals,

supplements, or medicines
Fore milk Hind milk
Secreted at the start of a feed Towards the end
Rich in proteins, carbohydrates, vitamins, water Higher fat content
Satisfies thirst Satisfies hunger
Advantages of breast feeding
Advantages
• Nutritional properties
• Easy to digest as whey : casein ratio = 60:40
• Breastmilk lipase facilitates lipolysis
• Ideal ca: phosphorus ratio
• Increased bioavailability of iron
• Low renal solute load
• Presence of LPUFA
• Adequate vitamins
• Anti infective
• Secretory IgA
• Prebiotics: bifidus factor
• Lactoferrin
• Macrophages and lymphocytes
• Lysozymes
• Oligosacccharides which prevent bacteria from attaching to mucosal surfaces.
Other advantanges
• Epidermal growth factor stimulates maturation of intestinal
epithelium
• Promotes bonding between mother and baby
• Reduces diseases: DM, Obesity, IBD
• To mother
• Contraceptive effect
• Reduces breast and ovarian cancer
• Reduce weight
Physiological basis of breast feeding
2 hormones
• Prolactin
• Oxytocin
Prolactin
• Necessary for the production of
milk by the cells of the alveoli
• Prolactin levels increase during
pregnancy  stimulates the growth
and development of the mammary
tissue
( However, milk is not secreted during
pregnancy because of progesterone
and oestrogen)
Oxytocin :
let down reflex=
milk ejection reflex
• Stimulates the myoepithelial
cells around the alveoli to
contract
• This makes the milk, which
has collected in the alveoli,
flow along and fill the ducts
• The reflex becomes
conditioned to the mother's
sensations and feelings
Signs of an active oxytocin reflex

• Tingling sensation in the breast before or during a feed

• Milk flowing from her breasts when she thinks of the baby or hears
him crying
• Milk flowing from the other breast when the baby is suckling
• Slow deep sucks and swallowing by the baby, which show that milk is
flowing into his mouth
Reflexes of the baby
• Rooting
• When something touches a baby's lips or cheek, the baby turns to
find the stimulus, and opens the mouth, putting the tongue down and
forward.
• Present from about the 32 POA
• Sucking reflex
• When something touches a baby's palate, he or she starts to suck it.
• Present from 32 POA

• Swallowing reflex
• When the baby's mouth fills with milk, he or she swallows

• Coordination of suckling, swallowing and breathing appears between

32 and 35 POA
Establishing breastfeeding
• Positioning
• Attachment
Positioning
• Positioning of the mother
• Seated
• Lying down
• Back supported
Positioning of the baby: 4 rules
• Baby's body should be straight
• Baby should be facing the breast
• Baby's body should be close to the mother
• Whole body should be supported.
Atachment
4 signs of good attachment
• More of the areola is visible above the baby's top lip than below the
lower lip;
• The baby's mouth is wide open;
• The baby's lower lip is curled outwards;
• The baby's chin is touching or almost touching the breast.
Twins can be succesfully breastfed
• Practice on demand breast feeding
• Begin soon after birth
• Both day and night
• Preterm babies too ……….
Assessment of breast feeding
• Observe the feeding technique
• Weight
• Urine output
• Behaviour of the baby
Alternative methods
Contraindications of breastfeeding
• Metabolic problems of the baby
• Some maternal medications
• Gastrointestinal pathologies of the baby
Eg: NEC, Perforation, congenital gut abnormalities
What if BF is not established properly?
• Baby
• Poor growth
• Dehydration fever
• Hypernatremia

• Mother
• Cracked nipples
• Breast abscess
• Reduced milk flow
Support for the mother
• Antenatal classes
• Post natal ward
• Mid wife
• Lactation management center
Re lactation
Relactation is the process by which a parent reestablishes lactation
after having stopped for some time (weeks or months)
Indications
• Separation due to an illness or medical procedure led to earlier than
desired weaning.
• A parent who lactated for a previous child wants to nurse an adopted
infant
• Desire to have a safe way to feed an infant during uncertain times,
such as emergencies from natural disasters or disease outbreaks