Lecture on breast feeding infant and newbornpptx

Pediatric nutrition

1. BREAST FEEDING Dr : Eman Khammas Alsadi paediatrition

2. Breastfeeding is the normal way of providing young infants with the nutrients they need for healthy growth and development. Virtually all mothers can breastfeed, provided they have accurate information, and the support of their family, the health care system and society at large.

3. The nutrient composition of human milk Outstanding characteristics include the relatively low but highly bioavailable protein content. A generous quantity of essential fatty acids. A relatively low sodium and solute load, and low but highly bioavailable concentrations of calcium, iron, and zinc, which provide adequate quantities of these nutrients to a normal breastfed infant for approximately 6 months. From a practical point of view, breast milk does not need to be warmed, does not require a clean water supply, and is generally free of microorganisms .

4. Why breast is best ? Provides the ideal nutrition for infants during the first 4-6 months of life Is life-saving in developing countries Reduces the risk of gastrointestinal infection, and, in preterm infants, of necrotizing enterocolitis Enhances mother-baby relationship Reduces risk of insulin-dependent diabetes, hypertension and obesity and asthma in later life. Advantages for the mother are that it: • promotes close attachment between mother and baby •Increases the time interval between children, which is important in reducing birth rate in developing countries •Helps with A possible reduction in premenopausal breast cancer and cervical cancer (uterine cervix)

5. ADVANTAGES OF BREAST-FEEDING. Breast milk is the natural food for full-term infants during the first months of life. It is always available at the proper temperature and requires no preparation time. It is fresh and free of contaminating bacteria, thereby reducing the chances of gastrointestinal disturbances. Breast-feeding is associated with fewer feeding difficulties ,incident to allergy and/or intolerance to bovine milk. These include diarrhea, intestinal bleeding, occult melena, "spitting up," colic, and atopic eczema. Breast-fed infants also appear to have a lower frequency of certain allergic and chronic diseases in later life than formula-fed infants.

6. Human milk contains bacterial and viral antibodies, including relatively high concentrations of secretory IgA that prevents microorganisms from adhering to the intestinal mucosa Macrophages in human milk may synthesize complement, lysozyme, and lactoferrin. Human milk also contains bile salt-stimulated lipase, which kills Giardia lamblia and Entamoeba histolytica. Milk from the mother whose diet is sufficient and properly balanced will supply all the necessary nutrients except, perhaps, fluoride and, after several months, vitamin D

7. If the water supply is not adequately fluoridated (≤0.3 ppm), the breast-fed infant should receive at least 10 μg of fluoride daily for the first 6 mo of life; thereafter, the fluoride intake should approximate the adequate intake. The iron content of human milk is somewhat low. However, most normal infants have sufficient iron stores for the first 6 mo of life.Moreover , human milk iron is well absorbed. Nonetheless, by 4-6 mo of age, the breast-fed infant's diet should be supplemented with iron-fortified complementary foods or a ferrous iron preparation . The psychologic advantages of breast-feeding for both mother and infant are well recognized. The mother is personally involved in the nurturing of her infant, resulting both in a feeling of being essential and a sense of accomplishment while the infant is provided with a close and comfortable physical relationship with the mother

8. The vitamin K content of human milk also is low and may contribute to hemorrhagic disease of the newborn. Parenteral administration of 1 mg of vitamin K1 at birth is recommended for all infants, and this is especially important for those who will be breast-fed

9. Exclusive Breastfeeding Breastfeeding is the recommended method for feeding normal infants during approximately the first 6 months of life.

10. Colostrum, a high-protein, low-fat fluid, is produced in small amounts during the first few postpartum days. It has some nutritional value but primarily has important immunologic and maturational properties. colostrum

11. Adequacy of milk intake can be assessed by voiding and stooling patterns of the infant. A well-hydrated infant voids six to eight times a day. Each voiding should soak, not merely moisten, a diaper. urine should be colorless. By 5 to 7 days, loose yellow stools should be passed at least four times a day. Rate of weight gain provides the most objective indicator of adequate milk intake. Total weight loss after birth should not exceed 7%, and birth weight should be regained by 10 days. An infant may be adequately hydrated while not receiving enough milk to achieve adequate energy and nutrient intake.

12. relation of breast feeding and jaundice: In the newborn period, elevated concentrations of serum bilirubin are present more often in breastfed infants than in formula-fed infants. frequent feedings stimulate meconium passage and excretion of bilirubin in the stool. Infants who have insufficient milk intake and poor weight gain may have an increase in unconjugated bilirubin secondary to an exaggerated enteropathic circulation of bilirubin. This is known as breastfeeding jaundice. The use of water supplements in breastfed infants has no effect on bilirubin levels and is not recommended. Exclusively breastfed infants should be supplemented with vitamin D (200 IU/day starting at 2 months of age), and possibly fluoride after 6 months.

13. Common Breast feeding Problems Breast tenderness, engorgement, and cracked nipples are the most common problems encountered by breast-feeding mothers. Engorgement: one of the most common causes of lactation failure, should receive prompt attention because milk supply can decrease quickly if the breasts are not adequately emptied. Applying warm or cold compresses to the breasts before nursing and hand expression or pumping of some milk can provide relief to the mother and make the areola easier to grasp by the baby . Pay attention to proper latch-on and positioning of the infant. Supportive measures include nursing for shorter periods, beginning feedings on the less sore side, air drying the nipples well after nursing, and applying lanolin cream after each nursing session.

14. mastitis : If a lactating woman reports fever, chills, and malaise, mastitis should be considered. Treatment includes frequent and complete emptying of the breast manually or by using a pump antibiotics. Breastfeeding usually should not be stopped because it has no adverse effects on the breastfed infant, and abrupt weaning may increase the risk of development of a breast abscess Nursing from the contralateral breast can be continued with the healthy infant. If maternal comfort allows, nursing also can continue on the affected side.

15. Maternal infection with HIV is considered a contraindication for breastfeeding in developed countries. When the mother has active tuberculosis, syphilis, or varicella, restarting breastfeeding may be considered after therapy is initiated. If a woman has herpetic lesions on her breast , nursing and contact with the infant on that breast should be avoided. Women with genital herpes can breastfeed. Proper hand-washing procedures should be stressed. Galactosemia in the infant also is a contraindication to breastfeeding . contraindication

16. Herpetic lesion

17. Maternal Drug Use Any drug prescribed therapeutically to newborns usually can be consumed via breast milk without ill effect. The factors that determine the effects of maternal drug therapy on the nursing infant include the route of administration Dosage. molecular weight. pH. protein binding. Few therapeutic drugs are absolutely contraindicated; these include radioactive compounds, antimetabolites, lithium, and certain antithyroid drugs. The mother should be advised against the use of prescribed drugs, including alcohol, nicotine, caffeine, or "street drugs. "

18. WEANING FROM BREAST-FEEDING. Most infants gradually reduce the volume and the frequency of breast-feedings between 6 and 12 mo of age after they become accustomed to solid foods and liquids by bottle and/or cup. As they demand less milk, the mother's supply gradually diminishes without causing discomfort from engorgement. Weaning can be initiated by substituting formula or bovine milk by bottle or cup for part and, subsequently, for all of a breast-feeding. The breast-feedings are eventually replaced with formula, usually over several days, and the infant is weaned completely.. Praise, loving attention, and cuddling are vital to successful weaning. When cessation of nursing is necessary at an earlier age, use of a tight breast binder and application of ice bags may help decrease milk production. Restriction of the mother's fluid intake is also helpful. Small doses of estrogen for 1-2 days also may help decrease milk production at the termination of nursing .

19. WHO/UNICEF were determined tens steps for increasing breastfeeding success. This steps are: Determining a written breastfeeding policy, Training all health care staff for implementing this policy, Informing all pregnant women about the benefits and management of breastfeeding, Helping mothers initiate breastfeeding, Showing mothers how to breastfeed and how to maintain lactation, Giving infants only breast milk, Practicing rooming-in, Encouraging breastfeeding on demand, Giving no pacifiers or artificial nipples, Supporting mother with foster breastfeeding groups before discharge