Breast feeding

notes

1. BREASTFEEDING

2. BREASTFEEDING Breastfeeding is the feeding of an infant or young child with breast milk directly from female human breasts (i.e., via lactation) not from a baby bottle or other container.

3. POSITIONING OF BREASTFEEDING Side lying position Football hold position Cradle hold position Cross cradle hold position Saddle Hold Twin Football Hold

4. Benefits of breastfeeding for the infant Provides superior nutrition for optimum growth. Provides adequate water for hydration. Protects against infection and allergies. Promotes bonding and development. Transparency 2. 4

5. Advantages for Infants Fewer ear infections Less incidence of Sudden Infant Death Syndrome (SIDS) Fewer respiratory infections Reduces the risk of developing insulin dependent diabetes mellitus

6. Advantages for Infants Lower incidence of allergies and asthma Lower incidence of childhood lymphoma Decreases the risk of gastrointestinal infections Decreases the risk of Necrotizing Enterocolitis (NEC) Decreases the risk of urinary tract infections

7. Advantages Increased IQ scores later in childhood Enhanced neurodevelopmental performance

8. SIGNS THAT THE BABY IS GETTING ENOUGH BREAST MILK 1 . He is contented for 1-2 hours after a feed 2 . He passes clear dilute urine 5-6 times a day 3 . He passes bright yellow watery stools 6-8 times a day 4 . He regains birth weight after 2weeks

9. COMPLICATION Breast Pain Biting Too much milk Mastitis Breast abscess Breast engorgement Sore nipple

10. Summary of differences between milks Adapted from: Breastfeeding counselling: A training course. Geneva, World Health Organization, 1993 (WHO/CDR/93.6). Transparency 2. 10

11. 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) Transparency 2. 11

12. Colostrum Property Antibody-rich Many white cells Purgative Growth factors Vitamin-A rich Importance protects against infection and allergy protects against infection clears meconium; helps prevent jaundice helps intestine mature; prevents allergy, intolerance reduces severity of some infection (such as measles and diarrhoea); prevents vitamin A-related eye diseases Transparency 2. 12

13. NUTRITION WHILE BREASTFEEDING Eat a well-balanced, varied diet Breastfeeding mothers burn 500+ calories daily Check with doctor about taking a multivitamin with iron Drink eight glasses of fluid (eight ounces each) daily Avoid or limit caffeinated drinks to one to two cups daily Avoid alcohol or limit to one serving (six ounces of wine or 12 ounces of beer) on a special occasion

14. 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 Transparency 2. 14

15. Risks of artificial feeding  Interferes with bonding  More diarrhoea and respiratory infections  Persistent diarrhoea  Malnutrition Vitamin A deficiency  More likely to die  More allergy and milk intolerance  Increased risk of some chronic diseases  Overweight  Lower scores on intelligence tests  May become pregnant sooner  Increased risk of anaemia, ovarian and breast cancer Mother Adapted from: Breastfeeding counselling: A training course. Geneva, World Health Organization, 1993 (WHO/CDR/93.6). Slide 2. 15

16. Benefits of breastfeeding for the family Better health, nutrition, and well-being Economic benefits breastfeeding costs less than artificial feeding breastfeeding results in lower medical care costs Transparency 2. 16

17. Benefits of breastfeeding for the hospital Warmer and calmer emotional environment No nurseries, more hospital space Fewer neonatal infections Less staff time needed Improved hospital image and prestige Fewer abandoned children Safer in emergencies Transparency 2. 17

18. Steps to Successful Breastfeeding1 A written breastfeeding policy that is communicated to all health care staff Staff training in the skills needed to implement the policy Education of pregnant women about the benefits and management of breastfeeding Early initiation of breastfeeding Education of mothers on how to breastfeed and maintain lactation

19. Steps to Successful Breastfeeding1 Limited use of any food or drink other than human breast milk Rooming-in Breastfeeding on demand Limited use of pacifiers and artificial nipples Fostering of breastfeeding support groups and services

20. CONTRAINDICATION TO BREASTFEEDING Active /untreated TB Mom takes radioactive compound(cancer for chemo) Mom take illegal drug HIV infection

21. Artificial feeding This is the feeding of infant when he gets cow’s or buffalo’s milk or formula from first days till 4 th to 6 th month of his life.

22. Formula milks are humanized, i.e., they come very close to the composition of breast milk. However, they are more expensive, so cow’s or buffalo’s milk are quite often used.

23. Composition of cow’s milk versus breast milk. (in 100 ml) Human milk Cow’s milk Calories 67 67 Water 87 % 87 % Carbohydrate 7.4 % 4.4 % Lactose isomer β -lactose α -lactose Fat 3.5 % 3.5 %

24. Human milk Cow’s milk Protein 1.5 % 3.5 % Lactalbumin:Casein ratio 60 : 40 20 : 80 Sodium 15 mg 60 mg (4 times) Phosphorus 15 mg 90 mg (6 times) Calcium 30 mg 120 mg (4 times) Iron 0.5 mg 0.1 mg

25. Other advantages of breast milk versus cow’s milk: Breast milk is available all the time and is practically free from pathogenic bacteria. It needs no time for preparation It is available at the optimum temperature. It contains antibodies as IgG and IgA and protects against certain infections such as E.Coli , cholera, polio, tetanus, measles etc. IgA antibodies prevent the microorganisms to adhere the intestinal mucosa and provide local GIT immunity.

26. β -lactose is called Bifidus factor, which promotes the growth of lactobacillus and helps to lower the gut pH, thus inhibiting the growth of E.Coli and yeasts. Breast milk contains lactoferrin (an iron-binding whey protein), which inhibits bacterial growth by depriving them of iron, which is necessary for growth. Breast milk contains cystine and tyrosine, which are not synthesized by infants but they are essential for proper growth and development. Breast milk contains taurine that is synthesized in inadequate amounts in infants. It is important for normal differentiation of CNS.

27. Breast milk contains nonspecific factors of immune difence: lisozyme, macrofagocytes, neutrofiles, lymphocytes, complement system. There are 5 times more essential fatty acids (polyunsaturated: arachidonic, docosahexacnoic, linoleic, and α-linolenic) in breasts milk than in cow’s milk. Breast milk contains ferments (lipase, lactase) and mothers hormones. Breast milk is ‘species specific’ and therefore allergy to breast milk is rare.

28. Dilution of Cow’s Milk: Child’s Age Cow’s Milk Water First 10 days 1 part 2 parts 10 to 20 days 1 part 1 part Up to 2 mo 2 parts 1 part If dilution of cow’s milk is required, add 1 TSF of sugar to each ounce of water (5 %) – isocaloric formula)

29. Supplementary Feeding: T he distribution of food to supplement energy and other nutrients missing from the diet of those who have special nutritional requirements (WHO 1997).

30. Supplementary feed: where a breastfed infant has been given one or more fluid feeds, including infant formula. Expressed breast milk is considered a supplementary feed.

31. Use of formula as a supplementary feed may occur in the following situations : Baby is unwell eg . Signs of dehydration Mother is unwell and/or unable to provide breast milk Weight loss > 10% Jaundice / Phototherapy Hypoglycaemia

32. Initiation of supplementary feeds Supplementary feeding may be initiated for medical reasons. The mother should be provided with appropriate support to commence/continue with breastfeeding. A proper assessment of breastfeeding should be undertaken. On occasions supplementary feeding may be initiated for non-medical reasons at the parents’ request. Non-medically indicated supplementary feeds should not be instigated until a proper assessment of breastfeeding has been undertaken and other options considered.

33. Weaning Weaning is the process of switching a baby from breastfeeding to bottle-feeding, from breast- or bottle-feeding to a cup, or breast- or bottle-feeding to solid foods.