Breast feeding

1. Breast feeding

2. INTRODUCTION
The nature has designed the provision that
infants be fed upon their mother’s milk.
They find their feed and mother at the same
time. It is a complete nourishment for them
both for their body and soul.
RABINDARANATH TAGORE

3. Breastfeeding is the physiologic norm for
mammalian mothers and babies

4. MILK PRODUCING
STRUCTURES IN THE
BREAST

5. PHYSIOLOGY OF MILK PRODUCTION
& SECRETION
• Breast milk is produced as a result of
interaction between hormones and
reflexes
• Hormones secreted by mother
Prolactin helps in the production and
secretion
Oxytocin causes ejection of milk (‘let-
down reflex’)
• Reflexes in the baby
Rooting, sucking and swallowing

6. PROLACTIN REFLEX – FOR
MILK PRODUCTION

7. OXYTOCIN REFLEX – FOR
MILK EJECTION

8. FEEDNG REFLEXES IN THE
BABY

9. TYPES OF BREAST MILK
• Colostrum
• Transitional milk
• Mature milk
• Preterm milk
• Foremilk
• Hind milk

10. NUTRITIONAL
REQUIREMENTS DURING
INFANCY
Water - 150 -200 ml/ kg
(10
-20% of body wt)
 Protein - 3.5 – 2.5 gms/kg
 Fats - 5-6 gms/kg
Calorie Requirement per kg
0-3 months - 140 – 130
3- 12 months- 120 – 110

12. COM PARISON BETWEEN
HUMAN MILK & COW MILK
(Per 100 ml)

13. Factors Human milk Cow milk
Protein 1.1gm 3.5 gm
Casein 30 - 40 80
Lactose 6.5 gm 4.5 gm
Fat 3.5 gm (Poly unsaturated) 3.5 gm (More saturated)
Enzymes Lipase + Lacks digestive enzymes
Ash 0.2 gm 0.7 gm
Ca:P ratio 34: 15 120 : 102
Hematenic
factors
More Less
Contaminant
s
DDT? Pesticides, antibiotics, adulterants
Related
diseases
HDD (< Vit K) Tetany, milk allergy, Fe & Cu
deficiency,
metabolic
acidosis, glucose intolerance,Calories 67 Varied

14. The anti-infective properties of
breast milk are manifold-
• No bacterial contamination
• Immunoglobulins IgA,IgG, IgM
• Has cellular elements – Macrophages,
lymphocytes, lymphoid cells
• Has complement system C3 & C4
• Bifidus factor

15. • Decreases diarrheal/ resp infection
episodes
• Decreased allergy/atopy /infl dis/DM
• Specific inhibitors – antiviral, anti
streptococcal factors
• PABA – protection against Malaria

16. PREPARATION FOR BREAST
FEEDING
During Ante natal visits
Motivation & education
Diet – Adequate Calories & fluids
Preparation of breast –Treat inverted/ retracted/
cracked nipple
Teach – Technique of feeding, factors relating to
let-down reflex
Breast examination at least twice during
pregnancy
Give advice on breast feeding

17. ESTABLISHMENT OF
LACTATION

18. The first 24hrs
• Mothers produce 30-100 ml of colostrum in
the first 24 hours, with only 2-10 ml per
feeding on day 1
• So how will that fill the infant?
International Lactation Consultant Association, 2005

19. Infant Stomachs
are Very Small!
Day 1
Size of marble
Capacity 5-7ml
Day 3
Size of ping pong ball
Capacity 22-27ml
Day 10
Size of extra large chicken egg
Capacity 22-27ml
http://www.ameda.com/breastfeeding/started/stomach.aspx

20. ART OF BREAST FEEDING

21. POSITIONS/ HOLDS USED
FOR BREAST FEEDING

23. CRADLE HOLD

25. SIDE LYING

26. FOOT BALL HOLD

27. FOUR SIGNS OF GOOD
ATTACHMENT
1. Baby’s mouth wide open
2. Lower lip turned outwards
3. Baby’s chin touches mother’s breast
4. Most of areola inside baby’s mouth

28. LATCHING

29. BURPING THE BABY

30. MEASURES TO INCREASE
BREAST MILK
• Self confidence
• Plenty of fluids, milk
• Good sleep & rest. Rest before feeds
• Treat breast engorgement, cracked nipples
• Shorten the time between feeds
• Feed on both sides
• Galactogogues (culturally popular) – Garlic,
ginger, coconut, jaggery, ghee, pepper, bajra,
sonth, khuskhus.
• Drugs - Chloropromazine, etachlorpromide

31. SIGNS THAT A BABY IS FEEDING
CORRECTLY AND ADEQUATELY
• Gains weight appropriately.
• Regains birth weight by 7-10 days after
birth
• Has at least 3 to 4 loose, seedy bowel
movements each day.
• After 3-4 weeks, the baby may have
bowel movements less often.
• Sleeps between feedings.

32. • Has at least 6 wet diapers every
day.
• Is fed 8-12 times every 24 hours
• Slow rhythmic sucking
• Audible swallowing
• Feels let down reflex
• Appears satisfied after nursing.

33. PROBLEMS RELATED TO
BREAST FEEDING
• Baby
–Under feeding, over feeding, aerophagy,
regurgitation
–Poor latching on, Nipple confusion
–Preterm/ SFD, twin babies, thrush, Cong
anomalies (CLP, TEF, Macroglossia)

34. Mother
»Flat/Retracted/ cracked nipples,
breast abscess/ engorgement,
anxiety, poor confidence
»Inadequate milk
»Septicemia, nephritis, eclampsia,
active TB, Typhoid fever, Br
abscess, Psych problems

35. »Mother on drugs - Anti
thyroid, Lithium, anti
cancer, chloramphenicol,
metronidazole,
sulphonamides
»Working mothers - Lack of
time & privacy to feed
»Poor inclination to breast
feed

36. Inverted nipples
• Make attachment to the breast difficult
• Should be diagnosed antenatally
• Mother needs additional support to feed
• Treatment –
• Stretch nipple manually/ by plastic
syringe and roll out several times/day
before feeding

37. Using plastic syringe -

38. Nipple shield

39. BREAST ENGORGEMENT
• Milk production is normally ­
increased by 2nd and 3rd day of
delivery
• Delayed or infrequent feeding
leads to accumulation of milk
• Breasts become hard, painful,
warm and swollen

40. Engorged breast

41. Treatment of breast
engorgement
• Gently express the milk to soften the breast
• Help the mother to correctly latch the baby to
breasts
• Warm compress can relieve pain and make
breast soft
• Massage the breasts before and after feeding to
stimulate “let down reflex” so that baby can
feed easily
• Wear well fitting bra for support
• Empty the breast every 2 hourly

42. SORE/ CRACKED NIPPLE
• Caused by incorrect attachment of baby to
the breast
• Frequent washing with soap and water

43. • Treatment
• Continue breast feeding with correct
attachment
• Apply hind milk to the nipple after
breast feeding
• Do not use soap as it removes the
protective oil and cause drying
• Expose the breasts to air between feeds
• Some oils can be applied specially
coconut oil

44. • ‘NOT ENOUGH MILK’
• Mother may complain of ‘not enough milk’
• Make sure that her perception about
inadequate milk is true
• Reassure if baby is gaining weight and has
other signs of adequate feeding
• If the baby is not gaining weight, ask
mother to feed more frequently, add night
feeds
• Encourage mother to take plenty of fluids
• Back massage useful for stimulating
lactation

46. EXPRESSION OF BREAST
MILK
Massage breast from chest to
nipple
Place thumb on areola above nipple,
and the fingers encircling below nipple
Press thumb and fingers inwards
towards chest…….and release

47. METHODS OF EXPRESSION
OF BREAST MILK
­ Hand expression
–Breast pumps
–Hand pumps
–Mechanical cylindrical pumps
–Electric pumps

50. STORAGE OF EBM
• EBM in washed container can be stored:
• For 8 hours at room temperature
• For 24 hours in refrigerator
• For 3 months at –20 deg in deep freezer

51. • Never feed EBM (Expressed Breast Milk)
with bottle. It leads to nipple confusion.
Instead use spoon or palada

52. MEASURES TO STOP BREAST
MILK PRODUCTION
• Oestrogens – Bromocriptine
• Inj Mixogen - Has testosterone and
oestrogen
• Reduce fluid intake
• Tight binder over breast

53. Obstacles to Breastfeeding
Initiation and Continuation

54. OBSTACLES TO EFFECTIVE
BREAST FEEDING
• ‘Poor & conflicting advice’
• ‘Limited milk expression equipment’
• ‘Lack of privacy’
• ‘Too rigid feeding schedules’
• ‘Lactation failure’
• ‘Minimal encouragement & support’

55. BARRIERS TO EXCLUSIVE
BREAST FEEDING
• Personal
• Reluctance to continue breast feeding
• Figure conscious
• Women and their sexuality
• Carrier oriented
• Inability to feed due to other commitments-Family
• Pressure to conceive again
• Cultural norms and traditions-Social
• Cultural practices
• Lack of support in the work place

57. ROLE OF HEALTH PROFESSIONALS
IN SUPPORTING AND PROTECTING
BREAST FEEDING
• General
–Promote, support and protect breast
feeding enthusiastically
–Promote breast feeding as a cultural
norm and encourage family and
societal support
–Recognize the effect of cultural
diversity on breast feeding attitudes
and practices

58. • Education
–Become knowledgeable and
skilled in management of breast
feeding
–Encourage development of
formal training in curriculum
–Use every opportunity to provide
age appropriate breast feeding
education to children and adults
in schools & colleges

59. • Clinical practices
–Work colloraboratively with
obstetrician so that women receive
accurate and sufficient information.
–Promote hospital policies and
procedures that facilitate breast
feeding
–Encourage time to time training in
breast feeding for all health care staff
–Provide breast pumps and private
feeding areas

60. •Society
–Encourage the media to portray breast
feeding as positive and normative
–Encourage employer’s to provide
appropriate facilities and adequate time
in the work place for breast feeding
and/or milk expression
–Build crèche facilities at the work place
–Adjustment of working hours so that
breast feeding can be continued
–Encourage to have EBM for working
mothers

61. • Research
–Promote research on
breast feeding with the
help of professional
agencies