Benefits of breastfeeding, CME for junior doctors

Benefits of breastfeeding for junior doctors

1. Breastfeeding & Nutrition in Children HO Teaching

2. Outline First 1000 Days National Breastfeeding Policy Breastfeeding Friendly Hospital Initiative Benefits of breastfeeding Composition of breastmilk Breastfeeding techniques

3. First 1000 Days

4. National Breastfeeding Policy

5. All mothers are encouraged to breastfeed their children with breast milk from birth until six months old continuing until two years of age. Complementary foods should be given from 6 months old.

6. Exclusive Breastfeeding Infants are fed only breast milk either from the mother or mother's milk, including extracted breast milk. Babies are not given other food or drink except Oral Rehydration Salt (ORS), vitamins, minerals and medication in the form of drops or syrup.

7. Breastfeeding Friendly Hospital Initiative (BFHI)

8. Launched by WHO and UNICEF in 1991. Malaysia has implemented this initiative since 1993.  In 1998, Malaysia was recognised by the World Health Organization as the third country in the world with 100% government hospitals accredited as Baby Friendly Hospitals.

9. 1. All health staff must be aware of the written Hospital Breastfeeding Policy and be able to inform the public on its implementation. 2. Train all hospital staff involved in the care of mothers and infants to be skilled in implementing the policies. 3. Antenatal education to all mothers on the benefits and management of breastfeeding.

10. 4. In accordance with the National Breastfeeding Policy, all mothers are encouraged to exclusively breastfeed their infants for the first six months of life and to continue breastfeeding until the age of 2. Complementary diet to commence at 6 months old. 5. Practise skin-to-skin contact with mothers immediately following birth for at least 30 minutes, although the recommended duration is up to 1 hour. Staff to also help mothers recognise when babies are ready to breastfeed, offering help if necessary.

11. 6. Staff to show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants due to medical reasons. 7. No other food or drinks other than breast milk are to be given to newborns in wards unless medically-indicated. Promotion of breast milk substitutes are not allowed in this hospital. The latest Malaysian Code of Ethics for “The Marketing of Infant Foods and Related Products” shall be adhered by all staff.

12. 8. Provide rooming-in facilities to allow mothers and infants to remain together 24 hours a day and avoid interrupting breastfeeding. 9. To encourage all mothers to breastfeed on demand in order to maintain breastmilk production.

13. 10. Artificial teats or pacifiers are strictly not allowed to avoid nipple confusion. 11. Mothers who are being discharged should be provided with written information on breastfeeding support. They should also be encouraged to seek help from local health clinics.

14. 12. Providing mother-friendly care to help all women to feel competent, in control and supported. 13. Mothers with HIV will be given the appropriate advice, counselling, support and care to reduce mother-to-child transmission, which shall include appropriate advice on infant feeding if necessary.

15. Benefits of breastfeeding Benefits to the family and socioeconomic stability Benefits to the baby Benefits to the mother

16. Benefit to family and socioeconomic stability Economic Readily available Simple with no equipment or preparation needed

17. Benefits to baby Provides ideal nutrition Protective against many infections - source of antibody Prevents infant death Reduces risk of allergies Reduces risk of condition such as juvenile-onset of DM May assist in blood pressure regulation Reduce obesity in later life

18. Children who do not breastfeed or receive breastmilk may be at risk of: Infection such as diarrhoea and GI infections Respiratory infections Eczema and other atopic conditions Obesity in childhood Heart disease later on in life Mortality below 5 years old

19. Benefits to mother Reduces risks of: Breast cancer, and some forms of ovarian cancer Hip fractures in older age Retention of fat deposited during pregnancy which may result in later obesity Anaemia due to low contraction of the uterus and early return of menses Frequent pregnancies due to lack of child-spacing effect of breastfeeding Fewer opportunities to be close to their baby.

20. How is breastmilk unique?

21. Superiority of breastmilk A mother's milk has just the right amount of Fat Carbohydrate Protein  Minerals Vitamins Water     for baby’s growth and     development Human milk is the "gold standard" for preterm and term infants Most complete form of nutrition for infants. Protects against bacteria. All breastmilk are not alike, contents changes in different situations.

22. Composition of breastmilk Breastmilk Formula milk Contaminants   Absent/minimal High risk Anti-infective factors Present Absent   Growth factors Present Absent Protein 1 % - low quality 1.5 % -  poor quality Casein Low High Fat Adequate   (4%) - good quality, has enzymes Inadequate, no enzymes Iron Adequate Adequate Vitamin Adequate Adequate Water   Adequate Adequate

23. Protein in breastmilk Perfect for infant growth and brain development Easy to digest

24. Protein in breastmilk 32

25. Fat in breastmilk Main source of energy Enzymes ( lipase ) help in digestion of fat to make it quickly available to baby for energy Very long-chain fatty acids for brain growth and eye development  cholesterol and vitamins High level of cholesterol may help the infant to develop  body systems to handle cholesterol throughout life

26. Fat in breastmilk Foremilk - low level of  fat (quench thirst) Hindmilk - higher level of fat (satiety)

27. Fat in breastmilk Fat content may vary from feed to feed.

28. Water in breastmilk Breastmilk is very rich in water (88%) No need for supplemental water

29. Stages of breastmilk The content of breastmilk changes over the course of baby's development.  There  are essentially 3 stages of breastmilk: colostrum transitional milk mature milk 1 2 3

30. Colostrum 38 Acts like “paint coating” Protect baby’s gut from infections Acts as first immunisation against many bacteria Helps establish good bacteria in baby’s gut Laxative and helps the baby to pass meconium

31. The volume is approximately 100ml Over a 24-hour period

32. Preterm breastmilk Milk from mother who give birth before 37 weeks gestation has MORE protein, IgA, lactoferrin than mature milk More suited for the needs of a premature baby A mother’s milk can even be used before the baby is able to breastfeed She can express her milk, and fed her baby by cup or spoon

33. Transitional milk Produced from 3 to 5 days after birth until the mature milk come in (2 -3 weeks) It is intermediate in composition in between colostrum and mature milk The immunoglobulins  and protein contents decrease whereas fat and sugar contents increase

34. Mature Milk Contains ALL major nutrients: Protein, carbohydrate, fat Vitamins and minerals Water Changes in relation to: the time of day Length of breastfeeding Needs of the babies Diseases with  which the mother has had contact    

35. Composition: Colostrum vs Mature Milk

36. Right Breastfeeding Technique

37. Mother’s position Positions that a mother may use: sitting on the floor/ground  sitting on a chair lying down standing up walking  45

38. /1 Lying down side position Football hold (Underarm position) Cradle Hold Cross cradle (Cross arm) Breastfeeding Positions

39. Baby’s position The baby can also be in different positions: Along the mother’s arm Under the mother’s arm Along her side 47

40. 4 key points to help ensure baby is comfortable:  In line Head, shoulder and body straight  Close To mother’s body, baby brought to breast, not breast to baby  Supported At head, shoulders If prem/newborn - whole body  4. Facing Baby’s nose to the nipple

41. Special considerations

42. Maternal reasons Active TB Untreated brucellosis Active herpes simplex lesions on the berast Active varicella infection HIV Only applies to developed countries with safe alternative forms of infant nutrition Certain maternal drugs Catergories  (+) or (-) or CI

43. Maternal substance abuse Can be considered in infants with in utero exposure to illicit substances if mother enrolled an compliant in treatment programs Abstinent from illicit drug use for 90 days before delivery Negative toxicology screen at delivery Methadone treatment alone is not a contraindication for breastfeeding

44. Infant reasons Galactossaemia Often a combination of human imlk and other metabolic formulas can be used

45. Take Home Message National and hospital policies on breastfeeding Benefits and importance of breastfeeding Special considerations Breastfeeding may not come naturally to all mothers - we need to provide help and support