1.
.
AMRITA A.S
ASSISTANT PROFESSOR

2.
Breastfeeding is the feeding of an infant or young
child with breast milk directly from female breasts (i.e.
via lactation).
It is the normal way of providing young infants with
the nutrients they need for healthy growth and
development.
INTRODUCTION

3.
“Breast fed Infants… are Healthy Infants”

4.
Breasts consists of gland tissues
(consisting lactiferous sinuses) that
make milk, which goes along milk ducts
towards the nipple.
• Suckling stimulates nerve endings,
• Message is carried to anterior pituitary
which synthesizes prolactin.
• Prolactin stimulates gland cells to
stimulate milk production.
• Oxytocin is released from posterior
pituitary, which helps in contracting the
muscle cells around the alveoli, resulting
in milk ejection from nipple.
ANATOMY AND PHYSIOLOGY OF BREAST
FEEDING

5.
TYPES OF BREAST MILK
Colostrum
Transitional milk
Mature milk
Preterm milk
Fore milk
Hind milk

6.
COLOSTRUM
• Is milk secreted during
first week after delivery
• Yellow, thick, has more
antibodies and WBC
• Secreted in small quantity
• High protein
• NEVER BE DISCARDED
TRANSITIONAL MILK
• Milk secreted during two
weeks
• Contain immunoglobulin
and low protein content
• Increase fat and sugar
content

7.
MATURE MILK
• Follows transitional milk
• More thinner and watery
• Contains all essential
nutrients for growth of the
baby
PRETERM MILK
• Is breast milk of a mother
who delivers prematurely
• High quantity proteins,
sodium, iron and
immunoglobulins

8.
FORE MILK
• Milk secreted at the start
of a feed
• Watery, rich in proteins,
sugar, vitamins, minerals,
water
• Satisfied the baby’s thirst
HIND MILK
• Comes later towards the
end of a feed
• Richer in fat content
• Provides more energy,
satisfies baby’s hunger
• For optimal growth baby
needs both fore and hind
milk
• Baby be allowed to empty
one breast fully first
• Baby receives only
foremilk cry excessively

9.
 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.
STORAGE OF BREAST MILK

10.
Caution mother in advance about engorgement
Do not wash nipple before and after every feed
Continue each feed as long as baby wants
Recommended demand feeding
Help baby suckle in a Good position
Give colostrum and avoid prelacteal feeds
Initiate Breastfeeding soon after delivery
Avoid unnecessary use of drugs prior to delivery
Select Right place for the delivery
Motivate mother before Birth
PREPARATION FOR SUCCESSFUL
BREASTFEEDING

11.
HELPING A MOTHER TO
BREASTFEED
PREPARING THE INFANT AND MOTHER
 ensure infant is clinically stable & alert
 ensure mother comfortable and relaxed
Make her sit down in comfortable and
convenient position

12.
FOUR KEY POINTS IN POSITION
• BABY’S HEAD IN LINE WITH THE BODY
• WHOLE BODY WELL SUPPORTED
• BABY’S TURNED TOWARDS THE
MOTHER
• BABY’S ABDOMEN TOUCHING
MOTHER’S ABDOMEN

13.
HOW TO SUPPORT HER BREAST
WITH THE OTHER HAND
• PUT HER FINGERS BELOW HER
BREAST
• USE HER FIRST FINGER TO SUPPORT
THE BREAST
• PUT HER THUMB ABOVE THE AREOLA
HELPING TO SHAPE THE BREAST
• NOT TO KEEP HER FINGERS NEAR
THE NIPPLE

14.
HOW TO HELP THE BABY TO
ATTACH
• EXPRESS A LITTLE MILK ON TO HER NIPPLE
• TOUCH THE BABY’S LIPS WITH HER NIPPLE
• WAIT UNTIL THE BABY’S MOUTH IS
OPENING WIDE, AND THE TONGUE IS DOWN
AND FORWARD
• MOVE THE BABY QUICKLY ONTO HER
BREAST, AIMING THE NIPPLE TOWARDS
THE BABY’S PALATE AND HIS LOWER LIP
WELL BELOW THE NIPPLE

15.
SIGNS OF GOOD ATTACHMENT
• MORE AREOLA IS VISIBLE ABOVE THE
BABY’S MOUTH THAN BELOW IT
• BABY’S MOUTH IS WIDE OPEN
• BABY’S LOWER LIP IS TURNED
OUTWARDS
• BABY’S CHIN IS TOUCHING THE
BREAST

16.
EFFECTIVE SUCKING
• Infant takes several slow
deep sucks followed by
swallowing and then
pauses
INEFFECTIVE SUCKING
• Infant suckles for a short
time but tires out and is
unable to continue for
long enough

17.
• Frequent feedings 8-12 times daily.
• Intermittent episodes of rhythmic suckling with audible
swallows should be heard while the infant is nursing.
• Infant should have about 6-8 wet diapers in a 24 hour
period once breast feeding is established.
• Infant should have minimum of 3-4 bowel movements every
24 hours.
• Stools should be soft and yellow after day 3.
• Average daily weight gain of 15-30g.
• Infant has regained birth weight by 10th day of life.
SIGNS OF EFFECTIVE BREAST FEEDING

18.
1. Complete nutrition-
• contains most suitable protein and fat
rich in essential fatty acids- linoleic
acid and linolenic acid
• More lactose than other milk
• Offers enough vitamins, iron and water
and has correct proportion of salt,
calcium and phosphate.
• Special enzyme ‘lipase’- helps in
proper digestion of fat
ADVANTAGES OF BREASTFEEDING TO
CHILD

19.
2. Cover Against Infection-
Has anti-infective factors-
• Immunoglobulins (IgA)
• Lactoferrin
• Lysosymes
• Cells (T & B lymphocytes)
• Antiviral factor
ADVANTAGES OF BREASTFEEDING TO
CHILD

20.
1. Convenient
2. Cheaper than artificial milk
3. Helps in expulsion of placenta & minimizes risk of PPH
4. Calming effect
5. Contour of body come back to normal
ADVANTAGES OF BREASTFEEDING TO
MOTHER

21.
1. Develop a close loving bond
2. Child spacing
3. Cost benefits
ADVANTAGES TO BOTH MOTHER
AND CHILD

22.
 Lack of confidence in mother
 Belief that breast milk is not sufficient
 Lack of adequate support system
 History of previous breast surgery
 Breast engorgement, crackled and sore nipples.
 Embarrassment by mother
 Chronic illness in mother; psychosis, cancer
BARRIERS TO EFFECTIVE BREAST FEEDING

23.
• HIV infection
• Active Tuberculosis
• Herpes lesions on mother’s breast
• Infant with inborn error of metabolism, phenylketouria
should not be breastfed.
• Mothers on certain medications; anticancer therapy,
radioactive isotope, etc.- Feeding is withheld for the
period the mother is on the drug. She can express and
discard the feed. After cessation of the medication.
CONTRAINDICATIONS TO BREAST
FEEDING

24.
ISSUES IN BREASTFEEDING
• INVERTED/FLAT NIPPLES
• SORE NIPPLES
• BREAST ENGORGEMENT
• BREAST ABSCESS
• NOT ENOUGH MILK

25.
INVERTED/FLAT NIPPLES
• Flat or short nipples which
protract(become prominent or pull out
easily) do not cause difficulty in
breastfeeding
• Inverted or retract nipples make
attachment to breast difficult
• Should be diagnosed in antenatal period

26.
• Treatment is started after the birth
• Nipple is manually stretched and rolled out
several times a day
• Stimulate nipple before feeding and
shaping breast by supporting underneath
with the fingers and pressing above with
the thumb
• A plastic syringe is used to draw out the
nipple before putting the baby to breast

27.
FLAT / INVERTED NIPPLES

28.
SORE NIPPLES
• caused by incorrect attachment of the
baby to the breast
• A baby who sucks only at nipples does not
enough milk so he sucks more vigorously
resulting in sore nipple
• Pain during feeding and fissures or cracks
on nipple

29.
• Frequent washing with soap and water
and pulling the baby off the breast while
he is still sucking
• Fungal infection after few weeks causes
sore nipples
TREATMENT
 Correct positioning
Correct attachment
Hind milk applied to the nipple after feed
Nipples should be allowed to heal between
feeds

30.
BREAST ENGORGEMENT
• if feeding delayed, infrequent or the baby
is not well positioned at the breast, the
milk accumulates in the alveoli
• As milk production increases, the amount
of milk in the breast exceeds the capacity
of the alveoli to store it
• Breast becomes swollen, hard, warm and
painful

31.
TREATMENT
 Early and frequent
feeding
Correct attachment
Local warm water packs
for not more than 15
minutes
 PCM to relieve pain
Gently express milk to
soften the breast

32.
BREAST ABSCESS
• If conditions like engorged breast, cracked
nipples, blocked duct or mastitis are not
treated breast abscess develops
• High grade fever and tenderness in breast
TREATMENT
 analgesic , antiboitics
Abscess must be incised & drained
Breastfeeding continued on other breast

33.
BREAST ABSCESS

34.
NOT ENOUGH MILK
• Mothers often complains
• Reassurance and psychological support
only if baby is gaining weight and passing
adequate amount of urine
• CAUSES- not breastfeeding frequently,
too short or hurried breastfeeds, poor
position, breast engorgement or mastitis

35.
TREATMENT
 Proper attachment
Treat painful condition
Increase fluid intake
Massage breast
Back massage stimulate lactation
(15-30 minutes, 3-4 times a day)
Metoclopramide or Domperidone may be
useful