Infant feeding

Infant feeding or breast feeding intoduction, its advantages and disadvantages and breast feeding problems

1. Infant feeding

2. Introduction Feeding the baby with that of mother breast milk is commonly known as breast-feeding . Milk is the unique food adapted to the nutritional needs of the offspring in mammals. Breast milk from the mother is the ideal food for human infants. It meets the nutritional needs of infants up to 6 months of age. Breast-feeding contributes to infant nutrition and health through a number of important mechanisms. It provides a complete source of nutrition for the first six months of life, half of all requirements in the second six months of life, and one-third of requirements in the second year of life (WHO1998).

3. ADVANTAGE OF BREASTFEEDING Always fresh and free from contamination. Contains easily digestible protein. Sugar content is one and half times more than that in cow milk. Easily digestible fat and contains more essential unsaturated fatty acid. Contains water soluble vitamin 'D' and contain more vitamin. A, vitamin. B, vitamin. C and iron in better absorbable form.

4. For mother Breastfeeding immediately after delivery encourage the contraction of uterus which helps the mother to regain her figure quickly. Decrease depression and risk of osteoporosis Has some contraceptives effects i.e. Lactational Amenorrhoea Method. This also helps in spacing of children. Leads to closure bond between mother and baby. It is cheaper and easily available

5. For baby: Colostrum contain large amount of antibodies which helps a baby to prevent from infection. Helps in elimination of baby It is a complete food and provides all nutrients needed to infants

6. Colostrum feeding

7. Benefits of Colostrum Feeding Antibodies against polio, mumps and measles. Cellular anti-infective substances like macrophages and lymphocytes and enzymes like lysozymes are present in high concentration in the colostrum. Bifidus factors is essential for the growth of Lacto bacillus. Bifidus stop the pathogenic organism growth in the gut of the infant. Lectoferrin , an unsaturated iron binding protein inhibits the growth of E. coli, a common pathogen for GI infection. The pH of the stool of breast fed baby i.e. low acidic pH, inhibit the growth of pathogens in their gut.

8. Exclusive Breastfeeding Exclusive breast feeding is that infant only receives breast milk without any additional food or drink, not even water. That should be done for 6 months thereafter infants should receive complementary food with continued breastfeeding up to 2 years of age.

9. Benefits of Exclusive Breastfeeding Prevent risk of infection from artificial feeding Prevents nutritional imbalance Greater chance of survival than artificial feeding e.g. mortality rate in developing country is 5-10 times higher who have not been exclusively breast fed for below six months.

10. Recommendation regarding frequency and duration of breastfeeding Breast feeding is the first fundamental right of the children. The child should be put to the breast as soon as possible after birth. Newborn babies want to feed on demand, usually 8 to 12 times in a 24 hour period for the first two to four weeks. During the newborn period, most breastfeeding sessions take 20 to 45 minutes .   By 1 to 2 months of age, a breastfed baby will probably nurse 7-9 times a day. The practice of giving prelacteal feeds like glucose water or cow's milk should be absolutely discouraged.

11. Recommendation Regarding Frequency And Duration Of Breastfeeding It is not necessary to train mothers to feed by the clocks but the intervals between feeds are important for mother and baby both which may vary between one to four hour, according to the babies needs, size, length of sucking and the mother's milk supply. The baby should be allowed to breast feed whenever it wants. Feeding the baby on demand helps the baby to gain weight. Prolonged breast-feeding does protect the infant from early malnutrition and some infections. Exclusive breast-feeding is recommended for the baby for the first 4 to 6 months of life.

12. Common Problem Related to Breastfeeding Cracked nipples Retracted nipples Large nipples Regurgitation Twins Cleft palate babies Baby unable to suck Sick mother Mastitis and breast engorgement

13. Cracked nipple Cracked nipple is defined as the condition with fissure, abrasion of nipple caused by unclean hygiene, formation of crust over the nipple, retracted nipple etc. And it is characterized by painful infant sucks, mastitis etc .

14. Cracked nipple Causes : Loss of surface epithelium with the formation of a raw area on the nipple. Unclean hygiene resulting in formation of a crust over the nipples. Inadequate milk flow. Retracted nipple. Signs and symptoms: The condition may remain asymptomatic but become painful when the infant sucks. Hard tip of the nipple .

15. Management: Manual expression of milk if possible but is very painful. Squeezing a few drops of orange or lemon on the cracks. It speeds up healing. Antiseptics can be applied to prevent infections. Educate mother to clean nipple gently during pregnancy and in the puerperium before and after each breast- feeding to prevent from crust formation over the nipple. Educate mother about the proper technique of breast- feeding such as well fixation of nipple into the baby mouth .

16. Management: The nipple is to be kept clean, dry and exposed to air but don’t use soap on the nipple. If the nipple do not heal properly, the nipple should be protected by a nipple shield during each feeding for a few days. Provided rest to the affected nipple for 24 hours and breast should be strapped with a tight bandage. Don’t stop breastfeeding. The baby can suck from a nipple that is bleeding, unless the mother is HIV positive. Apply antibiotic ointment after the night feeding and the fissure is likely to be healed within 8-12 hours .

17. Breast engorgement: This condition occurs around the 3 rd or 4 th days of postpartum. The breast are hard (edematous), painful and sometimes flushed. The condition occurs when the baby is unable to feed efficiently because he is not correctly attached to the breast .

18. Breast engorgement: Causes Breast engorgement is due to exaggerated normal venous and lymphatic engorgement of the breast which precedes lactation. This in turn prevents escape of milk from the lacteal system. The primiparae patient and the patient with inelastic breast are likely to be involved. Signs and symptoms Considerable pain and feeling of tenderness or heaviness in both the breasts, Generalized malaise or even transient rise in temperature. Painful breastfeeding

19. Breast engorgement: Management Explain the mother how to reduce breast engorgement. Advice mother to do the following things:

20. a . Apply warmth to the breasts prior to each breast feeding to promote milk flow for about 5-10 minutes.

21. b . Warm Shower

22. c . Breastfeed the baby at least every 2-3 hours without using any supplements.

23. d. Express the milk manually or by breast pump to empty breasts after baby has nursed.

24. Breast engorgement: Management Before each breastfeed manually express a small amount of milk before putting the baby on the breast. This softens the area around the nipple (the areola) and helps milk flow, making it easier for the baby to attach. At each feed, empty the first breast before offering the other breast to the baby. Advice to avoid tight fitting brassier. Apply cold compress to the breasts between feeding to help reduce swelling and pain.

25. Mastitis Infection of breast tissue is known as mastitis. Causes Infection due to engorged breasts, plugged milk duct, wearing very tight brassier. Weak immune system of the mother as poor maternal health, malnourished mother, under stress, having immune suppressed medicines. Signs and symptoms Generalized malaise and headache. Fever i.e. 102*f or more with chills. Severe pain and tender swelling in one quadrant of the breast .

26. Mastitis Management Give the mother one of the following medicines for 10 days by mouth. Cloxacillin is the first choice. Other are Erythromycin, Amoxicillin, Ampicillin. Advice the mother to put hot wet clean clothes over the infected area for 5-10 days. Breastfeed often (every 2 hours) starting with the infected breast. Feed the baby longer from the infected breast. Drink lots of water(at least four liters a day) Give paracetamol 500 mg every 4-6 hours to control pain.

27. Aerophagy and Posseting (regurgitation ) Aerophagy is a more common problem in bottle fed baby. In posseting, a baby often brings up some milk when he has a full stomach or if he has swallowed air with his feed. A young mother may be worried by it. Regurgitated milk is never ejected forcefully. It just flows out of the stomach soon after feeding. Management The mother should be advised to hold baby upright with his abdomen against mother's shoulder and hit baby's back gently for a few minutes. After then let him sleep with his face down.

28. Retracted nipple It is commonly seen in primigravidae and usually acquired. If fail uncorrected may lead to difficulty in breastfeeding and predispose to cracked nipple. Manual lifting of retracted nipple or wearing a nipple shield during the last two month of pregnancy is very useful to rectify the defect. After delivery, use of a nipple shield during breastfeeding may be helpful .

29. Large nipple If the baby is small, his mouth may not be able to get beyond the nipple and on to the breast. Lactation could be initiated by expressing although pumps may not be of any use because the nipple may not fit into the breast cup. As the baby grows and the breast and nipple become more protractile, breastfeeding may become possible .

30. Twins If trend of weight gain is not satisfactory, alternative of breast milk has to be given to each after breast-feeding.

31. Cleft lip and cleft palate babies Cleft lip and cleft palate are the openings or splits in the upper lip, the roof of the mouth (palate) or both.

32. Cleft lip and cleft palate babies Management : Provide emotional support to the mother. Explain about the importance of feeding to ensure adequate weight gain for surgery. If the baby has cleft lip, allow the baby to attempt breastfeed. If the baby has cleft palate, give expressed breast milk by spoon. Give small feeding slowly. Frequently break the wind or burp up to remove the swallowed air. Counsel parents for alternate feeding methods. Follow up the baby as needed.

33. Baby unable to suck

34. Baby unable to suck A baby's ability to suck and remove milk may be affected in different ways. Here are some of the reasons due to which baby may find difficult to suck milk from breast: Cleft Palate or Lip  Incorrect Feeding Position  Oral Thrush (It is also called oral candidiasis — is a condition in which the fungus Candida albicans accumulates on the lining of the mouth) Drowsiness in Infant 

35. Baby unable to suck Management : Treat or remove the cause if possible. Keep baby close to the mother all the time. Offer breastmilk whenever a baby is willing to suckle. Make sure that the baby is latched on correctly. Use breast compression to increase milk transfer. Extra stimulation may help. For e.g. Pat the baby on the outer edges of his/her lips before feeding, make the nipple firm and cold (with a cold compress) just before nursing. Nipple shields can sometime help a baby latch on, especially if the baby has low muscle tone.

36. Sick mother There are very few illnesses that require a mother to stop nursing. Since most illnesses are caused by viruses that are most contagious before a mother even realize she is sick, her baby has already been exposed before she even develop symptoms (such as fever, diarrhea, vomiting, rash, runny nose, cough, etc ). Continuing to breastfeed will help protect her baby from the infection, because her body produces antibodies to the specific bug that is causing the infection, and she pass them on to the baby through her breast milk. 

37. Any questions ???