breast.pptx

Baby friendly hospital

1. EXCLUSIVE BREAST FEEDING

2. STATISTICS OF EXCLUSIVE BREAST FEEDING According to WHO statistics globally 3 in 5 not breastfeed in the first hour of life WHO says 820000 children could be saved yearly if all children were optimally breastfed Only 41% of infants 0 – 6 months of age are exclusively breastfed.

3. INTRODUCTION According to the WHO& AAP breastfeeding is the normal way of providing young infants with the nutrients that they need for healthy growth and development. Breastfeeding helps against a number of infections, prevent allergies, and protect against a number of chronic conditions.

4. BREAST FEEDING DEFINITION Breastfeeding is the feeding of an infant or young child with breast milk directly from female human breast ( i.e ,via lactation) not from a baby bottle or other container - WHO

5. EXCLUSIVE BREAST FEEDING Exclusive breast feeding means babies are given only breast milk and nothing other than breast milk such as cow’s milk, food, drinks and not even water. During the first 6 month exclusive breast feeding is followed.  

6. Meaning of Breastfeeding B - Best for baby R - Reduces incidence of allergies E - Economical - no waste A - Antibodies greater immunity against infections S - Stool inoffensive - never constipated T - Temperature always correct and constant F - Fresh milk - never goes sour in the breast E - Emotional bonding E - Easy once established D - Digested easily within two to three hours I - Immediately available N - Nutritionally balanced G - Gastroenteritis greatly reduced

7. HORMONES IN BREASTFEEDING PROLACTIN – helps in milk production ( Anterior pituitary ) OXYTOCIN - helps in ejection. ( Posterior pituitary)

8. EXPRESSION OF LATCH L = lacth on A = audible swallowing T = type of nipple C = comfort H = hold positioning

9. PHYSIOLOGY OF LACTATION Milk producing reflex When the baby cries The sensory nerve ending in breast is stimulated The impulse is carried to hypothalamus by vagus nerve In hypothalamus, anterior pituitary release prolactin into the blood Prolactin in blood , acts on milk producing cells in breast. Thus , milk produced. “ the more the baby sucks, the more the milk is secreated ”

10. PHYSIOLOGY OF LACTATION Mammogenesis (preparation of breasts): In this, basically there is growth of ductal system and lobulo -alveolar system. Lactogenesis (synthesis and secretion from breast alveoli): Actual milk secretion starts on the 3rd or 4th postpartum day. The breasts become engorged, tense, tender and feel warm. Secretory activity is enhanced by Prolactin . It is also enhanced directly by growth hormone thyroxine , glucocorticoids and insulin. During pregnancy, the level of prolactin is high but there is no lactation because of steroids, estrogen and progesterone. These hormones makes the breast tissue unresponsive to prolactin .

11. Galactokinesis (ejection of milk): Ejection of milk depends upon: Sucking of baby Contractile mechanism which expresses the milk from the alveoli into the ducts. Galactopoiesis (maintenance of lactation): Prolactin appears to be the most important galactopoietic hormone. For maintenance of effective and continuous lactation, sucking is essential. It helps to remove milk from the glands, and also causes release of prolactin .

12. Types of Breast Milk

13. 1. Colostrum : Colostrum is the fluid secreted by the breasts in the last few weeks of pregnancy It secretes during first 3 to 4 days after delivery until lactation begins. It is a deep yellow serous fluid It is alkaline in reaction. It has high specific gravity. It contains vitamins A, D, E, K, white blood cells and antibodies ( IgA ). The immunoglobulin coats the lining of the babies immature intestines helping to prevent pathogens from invading the baby's system. It has low carbohydrates, fat and potassium

14. 2 .Transitional milk: Transitional milk is lower protein breast milk. It replaces the colostrum . It is secreted about 3 to 6 days after delivery, Breast milk increases in quantity and changes in appearance and composition.4. 3. Mature milk: After two weeks, mature milk is secreted. It is thin and watery in texture. It is high in fat content and lactose. It is high in linoleic acid and cholesterol content. It is good for brain development.

15. 4. Fore milk: Fore milk is secreted at the start of a feed. It is watery, rich in protein, sugar, vitamins, minerals and water. It helps to satisfy baby's thirst. 5. Hind milk: It comes later towards the end of a feed. It is richer in fat content. It provides more energy and satisfy baby's hunger. For optional growth baby needs fore and hind milk.

16. COMPOSITION MACRO NUTIRIENT high quality of milk and lower concentration of fat & protein but higher concentration of lactose. PROTIEN - mature milk 0.9 – 1.2 g/dl - more abondent protein are casein, a – lactoalbumin , lactoferrin, IGA , lysozyme and serum albumin.

17. FAT term mature milk – 3.2 – 3.6 gm/dl High concentration of palmitic and oleic acid Fatty acid profile varies in relation to maternal diet

18. CARBOHYDRATE Predominant sugar lactose 6.7 – 7.8 mg/dl Oligo saccrides 1gm/ dl bioactive factors MICRONUTRIENTS vary depending on maternal diet and body stores including vit A, B1, B6, B12, and iodine vit K and vit D is low quantity in human milk.

19. Composition of different stages of human milk & cow’s milk Colostrum Transitional Mature Cows milk Energy, kcal 58 74 71 69 Total solids, g 12.8 13.6 12.4 12.7 Fat, g 2.9 3.6 3.8 3.7 Lactose, g 5.3 6.6 7.0 4.8 Protien , g 2.7 1.6 1.2 3.3 Caesin , g 1.2 0.7 0.4 2.8 Calcium 31 34 33 125 Magnesium, mg 4 4 4 12 Potassium, mg 74 64 55 138 Sodium, mg 48 29 15 58 Iron , mg 0.09 0.04 0.15 0.10

20. ADVANTAGE OF BREASTFEEDING

21. B. Advantages for Mother 1. Lactation suppresses ovulation in mothers who give exclusive breast feeding to their infants and serves as a natural contraceptive. 2. Breastfeeding lowers the risk of ovarian and breast cancer. 3. Breastfeeding is convenient for the mother as she is not required to clean the bottle and prepare milk whenever she feeds the baby. 4. Breastfeeding the baby helps mother lose extra weight that she had put during pregnancy. 5. Breastfeeding promotes involution of uterus, thus brings back the mother in shape after delivery.

22. INITIATION OF BREASTFEEDING WHO recommendations regarding initiation of breastfeeding are Early and uninterrupted skin-to-skin contact between mothers and infants should be facilitated and encouraged as soon as possible after birth. All mothers should be supported to initiate breastfeeding as soon as possible after birth or within the first hour after delivery. Mother should receive practical support to enable them to initiate and establish

23. TECHNIQUES POSITION OF MOTHER AND BABY The baby should be properly positioned to achieve effective latching. The mother should wear comfortable apparel, with the breast well exposed for the infant to be able to latch. The infant’s mouth, chin and umbilicus should be lined up with the head in a neutral position. The infant is brought to the breast, with the nose touching or close to the breast.

24. The gum line should overlap the areola, and the nipple straight back into the mouth. The tongue moves forward beyond the lower gum, cupped and forming a reservoir. Milk is removed for the lactiferous sinuses, the jaw moves down creating a negative pressure gradient that helped transfer milk to the pharynx.

25. TYPES OF POSITION CRADLE HOLD FOOT BALL METHOD

26. SIDE – LYING POSITION CROSS CRADLE HOLD

27. Signs of good attachment

28. RESULT OF BAD ATTACHMENT • Painful nipples • Damaged nipples • Engorgement • Baby unsatisfied and cries a lot • Baby feeds frequently and for a long time • Decreased milk production • Baby fails to gain weight

29. PATTERNS OF BREAST FEEDING FRIST FEED: normal delivery – ½ hour caeserian – 1 hour Demand feed : whenever baby cries Duration of feeding : one breast completely than the other Interval : 6 – 8 times a day

30. BURPING Burp the baby after feeding at each breast and at the end of the feeding When burping the baby, remember to apply some gentle but firm pressure on the abdomen. Helpful positions to burp include: Propped up with baby's tummy against the shoulder. Lying tummy-down across the lap. 3. Sitting up, leaning over with the supportive hand under baby's arm.

31. CONTRA INDICATION FOR BREAST FEEDING For infants The baby is diagnosed with galactosemia, or other inborn errors of metabolism Gross prematurity of baby or other conditions in which the newborn cannot suckle.

32. For mothers Mothers Infected with the human immunodeficiency virus (HIV) human T-cell lymphotropic virus Herpetic lesions localized to the breast Untreated active pulmonary tuberculosis If taking prescribed cancer chemotherapy agents, such as antimetabolites Mothers addicted to alcohol or heavy doses of some drugs. Psychosis Local condition like breast abscess, cracked nipples

33. BARRIERS TO EFFECTIVE BREAST FEEDING • Lack of confidence in mother. • Belief that breast milk is not sufficient. • Lack of adequate support system. • History of previous breast surgery. • Breast engorgement, cracked and sore nipples. • Retractile nipples. Infrequent suckling/failure to empty breast • Embarrassment by mother Premature infants • Chronic illness in mother; psychosis, Cancer.

34. SORE NIPPLE Causes Improper latching Frequent washing with soap & water Pulling of while sucking Treatment Proper positioning & latching Local hygiene Expose to air, application of breast milk or lanolin, use nipple shield

35. Breast engorgement Cause Delayed or infrequent feeding Improper latching 7 positioning Engorge breast, swollen, hard, warm & painfull Treatment Milk expressed to soften breast Breast massage, warm compresses analgesics

36. INVERTED NIPPLE Make difficult in attachment Improper suckling may cause sore and excoriated nipple Treatment Manual eversion Plastic syringe Nipple shield

37. Syringe technique

38. Mastities and breast abcess Cause Engorged breast Cracked nipple Treatment Analgesics, Antibiotic Incision and drainage

39. Medications that increase lactation metoclopramide domperidone phenothiazine neuroleptics -chlorpromazine Risperine Hypoglycemics H2 antagonists-cimetidine Antihypertensives-methyl dopa, b blockers 31

40. STORAGE OF BREAST MILK Human milk can be stored at room temperature for 6-8 hours. Expressed milk can be stored in an insulated cooler bag with ice packs for 24hours. Breast milk can be stored in the refrigerator for about 5 days at about 40°F. It can also be kept in a freezer compartment of a fridge for up to 2 weeks at 0-5°F. It can be stored in a deep freezer for about 3-12 months.

41. PRESENT STATE OF BREAST FEEDING PATTERN The government of India has always been promoting at national and International for an exclusive breastfeeding for the first 6 month and introduction of complementary for after 6 month and then after with continued with the Indian tradition of prolonged breastfeeding and introduction of complementary foods from 6 month of age through ceremony India now has one of the strongest legislation to protect from commercial influence.

42. WEANING

43. WEANING Meaning of weaning Weaning means- to free from a habit Process of gradual and progressive transfer of the baby from the breastfeeding to the usual family diet Weaning does not mean discontinuity of breast feeding. Weaning foods are given in addition of breast feed when the amount of breastfeeding is inadequate.

44. DEFINITION Weaning is defined as ‘the systematic process of introduction of suitable food at the right time in addition to mother’s milk in order to provide needed nutrients to the baby’ - (UNICEF, 1984).

45. Qualities of complementary foods

46. Principles of introduction of weaning food Weaning foods should provide extra requirement as per need of the baby Initially small amount should be given then increase gradually in course of a week 3.New food to be placed over the tongue of the baby to get the taste of food and to feel the consistency. 4. A single weaning food is added at a time. 5. Weaning should be started between 5 to 6 months of age but breastfeeding to be continued up to 2 years of age.

47. 6. Additional food can be given in the day time. Initially it can be given once, then twice or thrice. 7. New foods should be given when the infant is hungry, but never force the child to take the feeds. 8. Delayed weaning result in malnutrition and growth failure. 9. Observe the problems related to weaning process. The infant may have:- - indigestion - pain in abdomen - weaning diarrhea - skin rashes - psychological upset

48. Preparing and storing the weaning foods 1.Hands-carefully washed with soap and water before preparing food 2.Utensils – washed and scrubed thoroughly 3. Clean cooking place and chopping board 4.Foods should be- -Fresh for weaning -prepared immediately -cooked and boiled well -mashed with clean pestle, fork or spoon -use clean water for washing and making weaning food -not store for more then 2 hours

49. WEANING FOOD ACCORDING TO AGE AGE FOOD ITEM AMOUNT FREQUENCY AT 5 – 6 MONTH initiated with fruit juice 1-2 teaspoon at fruit 4-6 times a day AT 6-7 MONTH soft mixture of rice and dal khichei,pulses mashed and boiled potatoes bread as roti socked in metlc mashed fruits like banana mango egg yolk cured or khir enjoy bite of biscurt then 3-4 teaspoon increased gradually 4-6 times a day

50. 9-12 month more variety of household food can be added can eat everything cooked at home spices and condiments no need to mash food but shoulb be soft 5-6 teaspoon increased gradually 4-5 times a day 12-18 month all food cooked in family breastfeed to be continued especially at night according to child need 4-5 tomes or according the child needs

51. PROBLEMS DURING WEANING If on starting weaning, breast feeding is stopped suddenly, it can have adverse psychological effect on the child. Weaning food, if prepared unhygienically or not digested properly can cause diarrhoea . If weaning food are not nutrient rich, the child can develop malnutrition. Children may develop indigestion, abdominal pain, diarrhea or rashes if they are allergic to certain foods.

52. BABY FRIENDLY HOSPITAL INITIATIVE

53. INTRODUCTION BFHI is a global movement, spearheaded by WHO and UNICEF that aims to give every baby the best start in life by creating a health care environment where breastfeeding is the norm. Maternity wards and hospitals applying the principles in the joint statement are being designated baby friendly to call public attention to their support for sound environment.

54. GOALS To transform hospitals and maternity facilities through implementation of the “ten steps”. To end the practice of distribution of free and low - cost supplies of breast milk substitutes to maternity wards and hospitals.

55. 10 STEPS FOR SUCESSFUL BREASTFEEDING   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.

56. 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. 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.

57. NUTRITION & NUTRITIONAL REQUIREMENT OF CHILDREN

58. MALNUTITION AND CHILD According to WHO and UNICEF estimates 60% of child death are malnutrition associated Asia has the largest number of malnourished children India account for 40% of malnourished in the world UNICEF estimates that malnutrition affects physical mental function of 2 billion children “1 in 3 malnourished children lives in india ”

59. INTRODUCTION Nutrition is the science that interprets the interaction of nutrients and other substances in food in relation to maintenance , growth , reproduction , health and illness of an organism .A poor diet may have an injurious impact on health causing deficiency diseases DEFINITION Nutrition is defined as the process of providing or obtaining the food necessary for health and growth _ OXFORD DICTIONARY

60. NUTRIENTS Nutrients are of two types : MACRONUTRIENTS , which are needed in larger amounts ( CHO , Fats , protein and water). MICRONUTRIENTS , which are needed in smaller amounts ( minerals and vitamins )

61. NUTRIENT & ITS PRIMARY FUNCTION NUTRIENT PRIMARY FUNCTIONS water Dissolves and carry nutrient, remove, waste and regulates body temperature Protien Builds new tissue, antibodies, enzyme hormones and other components CHO Provides energy Fat Provides long term energy, insulation and protection Vitamins Facilitate use of other nutrition involved in regulating growth and manufacturing hormones Minerals Helps in growth of bone & teeth aid in muscle function and nervous system activity

62. Well balance diet The well balanced diet is achieved by eating variety of food. There is no single food with correct amount of all external nutrients. The basic composition of balanced diet is highly variable as it differ from country to country depending on the availability of food

63. Importance of well balanced diet Body’s organ and tissue need proper nutrient to work effectively. Without good nutrition, body is more prone to disease, infections, fatigue and poor performance It helps in growth and development Children with poor diet run the risk of growth and development but eating habits can continue for the result of their lives

64. Improper Diet May Result In: Failure to flourish Poor growth Poor development Poor physical and mental health Infection disease Even death over diet may result in: Weight gain Insulin resistance Diabeties Heart condition And even death

65. DEFICIENCY OF NUTRIENTS AND DEVELOPMENT: NUTRIENT DIFICIENCY MANIFESTATION PROTIEN KWASHIORKAR MARASMUS IODINE GOITRE IRON ANEMIA CALCIUM BONE AND TOOTH DECAY VITAMIN A LOSS OF VISION VITAMIN B1 BERIBERI VITAMIN C SURVEY (EMPAIRED INFLAMMATORY VESPONSE) VITAMIN D RICKETS ZINC c SELENCIUM IMPAIRED ANTIBODY PRODUCTION DHA SHORTMEMORY SPAN, POOR ABILITY FOR DISRIMINATION

66. CONCLUSION: Adequate knowledge, attitude and features application of nutrition and requirements must be basis of infant feeding. the health and nutritional status of an infant and subsequent growth and development through childhood depends upon successful feeding pediatrics. Nutritional counselling is the important responsibility of the nurse to promote the nutritional status the children and to prevent nutritional deficiency disease.

67. JOURNAL ABSTRACT KNOWLEDGE EFFECT ON POSTNATAL MOTHERS REGARDING BFHI. Breastfeeding is the “Gold standard” for infant feeding. There are several areas of biological superiority of breastfeeding and breast milk over artificial (formula) milk. The present study aims to assess knowledge effect on postnatal mothers regarding baby friendly hospital initiative. A one group pretest posttest research design was conducted among 60 postnatal mothers. Convenient sampling technique was used to select samples. Structured knowledge questionnaire was used to assess the effectiveness of information booklet regarding BFHI among postnatal mothers. The present study attempted to evaluate the effectiveness of information booklet on BFHI among postnatal mothers of SMCH and found that 6(10%) had adequate, 9(15%) had moderate adequate knowledge and also 45(75%) had inadequate knowledge in pretest and 42(70%) had adequate, 12(20%) had moderate adequate knowledge and 6(10%) had inadequate knowledge in posttest and concluded that there was a significant improvement after administration of information booklet. Thus, information booklet was effective in improving the knowledge on Baby Friendly Hospital initiative among postnatal mothers.

68. BREASTFEEDING PRACTICE & NEWBORN CARE IN RURAL AREA Breastfeeding practices play an important role in reducing child mortality and morbidity. This study was aimed to describe the breastfeeding practices prevalent in rural areas.  Objectives:  The primary objective of this study was to describe the breastfeeding and newborn care practices in rural areas and the secondary objective was to describe the factors affecting the initiation and duration of breastfeeding.  Settings and Design:  The study was conducted in primary health care center (PHC) that is attached to a medical college in Kengeri , rural Bangalore, Karnataka.  Materials and Methods:  Mothers with children who were 9 months old who came to the PHC for measles vaccination were included in the study and data was collected using the pre-tested questionnaire on breastfeeding and newborn practices.  Results:  Our study shows 97% of the mothers initiated breastfeeding, 19% used pre lacteal feeds, 90% had hospital deliveries and 10% had home deliveries, and 50% used a house knife to cut the umbilical cord among home deliveries.  Conclusions:  This study emphasizes the need for breastfeeding intervention programs especially for the mother during antenatal and postnatal check-ups and practices like discarding the colostrum and early/late weaning are still widely prevalent and need to be addressed.

69. BIBLIOGRAPHY The short textbook of pediatric by suraj gupta , 13 th edition, jaype publication pvt ltd,pg no 22 – 48 Pediatric clinical method by meharben singh , CBS publication & distribution pvt ltd, pg no 544 - 576 Pediatric nursing by parul dUtta ; 3rd edition; jaypee brother medical publishers pvt ltd; pg no 229-232. Wongs essential of paediatric nursing 8th edition by marilyn J. hocken berry, david Wilson Child health nursing 2 nd edition by Padmaja, jaypee publisher pvt lid.