Breast feeding and complimentary feeding are two best practices which reduce infant mortality and morbidity.this presentation will be helpful in understanding the art and science of both interventions.

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2. FAQs
• I do not know how to feed ?
• No milk production?
• Milk is not enough/ sufficient?
• Asking milk every half to one hr.?
• Frequent motions?
• No motion for 3-5 days?
• Why should I breast feed?
• How long should I breast feed
09/05/14 DR HARIVANSH CHOPRA

3. Objectives
1. To study the composition of breast milk and its
advantages to the infant and mother.
2. To study exclusive breast feeding and
complimentary feeding.
3. To study the baby friendly hospital initiative.
09/05/14 DR HARIVANSH CHOPRA

4. Breast Milk – The best milk for Infant
Under any circumstances, “Breast Milk” is the
ideal food for infant. No other food is required till
6 months of age.
09/05/14 DR HARIVANSH CHOPRA

5. Breast Milk
1. Average volume of secretion (Indian Mothers)
= 450 – 600 ml per day.
2. Constituents (per 100 gm):
1. Fat 3.4 gm.
2. Protein 1.1 gm.
3. Lactose 7.4 gm.
09/05/14 DR HARIVANSH CHOPRA

6. Breast Milk
2. Constituents (per 100 gm):
5. Calcium 28 mg.
6. Vitamin C 3 mg.
7. Minerals 0.1 gm.
8. Water 88 gm
9. Energy 65 Kcal.
09/05/14 DR HARIVANSH CHOPRA

7. Colostrum
1. Colostrum is thick yellow to orange
colour milk produced in late pregnancy
and 1st week of lactation in low
volumes.
2. Colostrum is low in fat, and high in
carbohydrates, protein, and antibodies.
09/05/14 DR HARIVANSH CHOPRA

8. Colostrum
3. Benefits of colostrum feeding:
1. Perfect food for infants in initial days.
2. Laxative effect – clears infant’s intestines
of initial stools; prevents jaundice.
3. Contains leukocytes which prevent
infection.
4. Contains IgA which also provides
immunity.
09/05/14 DR HARIVANSH CHOPRA

9. When mothers hear that colostrum is
measurable in teaspoons rather than
ounces, they often wonder if that can
really be enough for their babies. The
short answer is that colostrum is the
only food healthy, full-term babies
need. The following is an explanation:
09/05/14 DR HARIVANSH CHOPRA

10. A 1 day old baby's stomach capacity is
about 5-7 ml, or about the size of a
marble. Interestingly, researchers have
found that the day-old newborn's
stomach does not stretch to hold more.
Since the walls of the newborn's
stomach stays firm, extra milk is most
often expelled (spit up). Your
colostrum is just the right amount for
your baby's first feedings 09/05/14 DR HARIVANSH CHOPRA

11. By day 3, the newborn's
stomach capacity has grown to
about 0.75-1 oz, or about the
size of a "shooter" marble.
Small, frequent feedings
assure that your baby takes in
all the milk he needs
09/05/14 DR HARIVANSH CHOPRA

12. Around day 7, the newborn's
stomach capacity is now about
1.5-2 oz, or about the size of a
ping-pong ball. Continued
frequent feeding will assure that
your baby takes in all the milk he
needs, and your milk production
meets his demands. 09/05/14 DR HARIVANSH CHOPRA

13. 09/05/14 DR HARIVANSH CHOPRA

14. Timing of breast feeding
1. Breast feeding should be started as early as
possible after delivery:
1. Within half hour of normal delivery.
2. Within three hours of Caeserian Section delivery.
2. Infant feeding must be “Feeding on Demand”.
09/05/14 DR HARIVANSH CHOPRA

15. 09/05/14 DR HARIVANSH CHOPRA

16. Care of lactating woman
1. Good health.
2. Proper balance of rest and exercise.
3. Freedom from worry.
4. Early & sufficient treatment of any incurrent
disease.
09/05/14 DR HARIVANSH CHOPRA

17. Care of lactating woman
5. Adequate nutrition:
1. +600 to +520 Kcal/day.
2. +19 to +13 gm protein/day.
3. About 30 gm fat per day.
4. Other foods rich in minerals and vitamins.
09/05/14 DR HARIVANSH CHOPRA

18. Exclusive Breast Feeding
The infant only receives breast milk without any
additional food or drink, not even water.
WHO has recommended that the duration of
exclusive breast feeding should be 6 months.
09/05/14 DR HARIVANSH CHOPRA

19. Technique of breastfeeding –
Prerequisites
Infant should be:
1. Hungry.
2. Dry.
3. At comfortable
temperature.
4. Supported in semi-sitting
position.
09/05/14 DR HARIVANSH CHOPRA

20. Helping mother to attach infant
1. Touch her infant’s lips with her nipple.
2. Wait until her infant’s mouth is opening
wide.
3. Move her infant quickly onto her breast,
aiming the infant’s lower lip well below
the nipple.
09/05/14 DR HARIVANSH CHOPRA

21. Positioning of Infant
1. Infant’s neck is straight
or bent slightly back.
2. Infant’s body is turned
towards the mother.
3. Infant’s body is close to
the mother.
4. Infant’s whole body is
supported.
09/05/14 DR HARIVANSH CHOPRA

22. Signs of Proper Attachment
1. Infant’s mouth is wide
open.
2. Infant’s chin is touching
the breast.
3. Infant’s lower lip is
turned outwards.
4. More of areola is visible
on the Upper side.
09/05/14 DR HARIVANSH CHOPRA

23. One Breast or Both Breasts
1. Infants must empty at least one breast at a time.
2. During initial weeks of lactation, both breasts
must be offered.
3. During later months of lactation, one breast at a
time, and alternated in the successive cycle.
09/05/14 DR HARIVANSH CHOPRA

24. Foremilk and Hindmilk
Foremilk, the thinner milk the baby gets first,
which has a lower fat content; and Hindmilk, the
high-fat, creamier milk that follows.
09/05/14 DR HARIVANSH CHOPRA

25. Foremilk and Hindmilk
Baby starts feeding
Foremilk Low fat,
High Lactose milk
MILK EJECTION REFLEX
Milk & sticking fat
on ducts squeezed
09/05/14 DR HHARiInVAdNmSH CilHkOPRA High fat milk

26. Breast Feeding
1. The best stimulus to refill breast is “Empty
Breast”. That is why, alternative breast must be
offered to the infant.
2. Infant must suckle the breast at least for 10
minutes to empty it completely.
09/05/14 DR HARIVANSH CHOPRA

27. Common problems of breast feeding
1. The newborn is a very rapid sucker and will
normally sleep within 2 – 3 minutes of sucking
the breast, so the mother has to wake up the
newborn by gently tickling at the sole of the
newborn, and force the child to suckle at least
for 10 minutes.
09/05/14 DR HARIVANSH CHOPRA

28. Common problems of breast feeding
2. While feeding the
newborn, every
precaution must be taken
not to touch the cheek of
other side because this
will distract the newborn
from the breast of the
mother due to rooting
reflex.
09/05/14 DR HARIVANSH CHOPRA

29. Common problems of breast feeding
3. Gastrocolic reflex:
Normally the child will pass motion after taking the
breast milk, and there is a great variation in the
defecation habits of the newborn children – the child
may pass 10-14 motions a day or may pass 1
motion in five days while on breast feeding.
09/05/14 DR HARIVANSH CHOPRA

30. Post-breastfeeding
Infant should be held erect
over mother’s shoulder or in
lap, and patted in back for
expelling swallowed air
(burping).
09/05/14 DR HARIVANSH CHOPRA

31. Adequate feeding
1. Infants suckle breast for 5 – 20
minutes.
2. With the exception of sore nipple,
infants must be allowed to suckle till
satisfied.
09/05/14 DR HARIVANSH CHOPRA

32. Adequate feeding
3. Signs of adequate feeding:
1. Infant satisfied after feeds.
2. Sleeps 3 – 4 hrs after feeds.
3. Adequate urination.
4. Adequate weight gain.
09/05/14 DR HARIVANSH CHOPRA

33. Expressed Milk
1. Breast milk may be expressed manually, or
through use of a breast pump.
2. Useful in cases of engorged breasts, working
mothers, or sore nipples.
3. Expressed milk must be brought to adequate
temperature 09/05/14 befoDrRe H AfReIVeAdNSiHn CgHO iPRnAfant.

34. Advantages of Breast Feeding
1. The breast milk:
1. Always available – No preparation time.
2. Proper temperature.
3. Clean & Fresh.
4. Free of contaminating agents.
5. Cheap.
09/05/14 DR HARIVANSH CHOPRA

35. Advantages of Breast Feeding
2. To the infant:
1. Meets the full nutritional requirement of infant.
2. Less incidence of allergy & intolerance.
3. Contains antimicrobials factors against various
diseases.
09/05/14 DR HARIVANSH CHOPRA

36. Advantages of Breast Feeding
2. To the infant:
4. Suckling helps in development of jaws and teeth.
5. Protects against obesity.
09/05/14 DR HARIVANSH CHOPRA

37. Advantages of Breast Feeding
3. To the mother:
1. Helps building of a bond with her child.
2. Helps spacing of children by prolonging
period of infertility.
09/05/14 DR HARIVANSH CHOPRA

38. Baby Friendly Hospital Initiative
1. BFHI created and promoted by WHO and
UNICEF.
2. Lists ten steps for hospitals to fulfill.
3. Correct breast feeding practices alone can
prevent 1 million deaths world wide.
09/05/14 DR HARIVANSH CHOPRA

39. 10 steps of BFHI
1. Have a written
breastfeeding policy
that is routinely
communicated to all
health care staff.
09/05/14 DR HARIVANSH CHOPRA

40. 10 steps of BFHI
2. Train all health care
staff in skills necessary
to implement this
policy.
09/05/14 DR HARIVANSH CHOPRA

41. 10 steps of BFHI
3. Inform all pregnant
women about the
benefits and
management of
breastfeeding.
09/05/14 DR HARIVANSH CHOPRA

42. 10 steps of BFHI
4. Help mothers initiate
breastfeeding within
half-hour of birth.
09/05/14 DR HARIVANSH CHOPRA

43. 10 steps of BFHI
5. Show mothers how to
breastfeed and maintain
lactation, even if they
should be separated
from their infants.
09/05/14 DR HARIVANSH CHOPRA

44. 10 steps of BFHI
6. Give newborn infants no
food or drink other than
breast milk, unless
medically indicated.
09/05/14 DR HARIVANSH CHOPRA

45. 10 steps of BFHI
7. Practice rooming in -
that is, allow mothers
and infants to remain
together 24 hours a day.
09/05/14 DR HARIVANSH CHOPRA

46. 10 steps of BFHI
8. Encourage breastfeeding
on demand.
09/05/14 DR HARIVANSH CHOPRA

47. 10 steps of or pacifiers (also called
dummies or soothers) to
X BFHI
breastfeeding infants. 09/05/14 DR HARIVANSH CHOPRA
9. Give no artificial teats

48. 10 steps of BFHI
10. Foster the
establishment of
breastfeeding support
groups and refer
mothers to them on
discharge from the
hospital or clinic.
09/05/14 DR HARIVANSH CHOPRA

49. Solution –
Storing breast milk
1. Breast milk may be stored
in hard sided plastic/glass
containers with tight lid, or
specially designed bags.
2. About 2 – 4 oz stored at a
time to minimize wastage.
09/05/14 DR HARIVANSH CHOPRA

50. Solution –
Storing breast milk
3. Maximum storage time:
1. Room temperature Up to 10 hrs.
2. Refrigerator (2 – 8 oC) Up to 8 days.
3. Freezer 2 weeks to 3 months.
4. Deep freezer (0 – -19oC) Up to 6 months.
3. Milk must not be heated for reuse. The container
should be held under running tap water.
09/05/14 DR HARIVANSH CHOPRA

51. MCQs
1. According to the WHO, Exclusive breast
feeding should be practiced till the age of:
1. 2 months.
2. 4 months.
3. 6 months.
4. 1 year.
Ans. – 3
09/05/14 DR HARIVANSH CHOPRA

52. MCQs
2. Colostrum, in comparison to normal breast milk,
has:
1. More fats.
2. More proteins.
3. Is lighter in colour.
4. More constipating effect on neonate.
Ans. – 2
09/05/14 DR HARIVANSH CHOPRA

53. MCQs
4. Which of the following is not a component of
WHO’s BFHI:
1. Early initiation of breast feeding.
2. Foster establishment of breastfeeding support groups.
3. Breastfeeding on demand.
4. Establishment of human milk-banks.
Ans. – 4
09/05/14 DR HARIVANSH CHOPRA

54. MCQs
5. Expressed breast milk can be stored in deep
freezer at -19oC for:
1. Up to 24 hours.
2. Up to 10 days.
3. Up to 1 month.
4. Up to 6 months.
Ans. – 4
09/05/14 DR HARIVANSH CHOPRA

55. Contraindications to Breast feeding
1. Markedly inverted or
cracked nipples.
09/05/14 DR HARIVANSH CHOPRA

56. Maternal infection contraindication to
breast feeding
Contraindications
Mastitis / Staphylococcus aureus When breast abscess is present
Active Mycobacterium Tuberculosis Because of aerosol spread
HIV In developed countries
HTLV-1 In developed countries
HTLV-2 In developed countries
Herpes simplex virus When breast vesicles are present
09/05/14 DR HARIVANSH CHOPRA

57. Drugs contraindicated during breast
feeding
• Amphetamines
• Antineoplastic agents
• Bromocriptine
• Chloramphenicol
• Cimetidine
• Cocaine
• Cyclophosphamide
• Cyclosporine
• Diethylstilbestrol
• Doxorubicin , Ergots
• Gold salts, Heroin
• Immunosuppressants
• Iodides, Lithium
• Methimazole
• Methylamphetamine
• Nicotine (smoking)
• Radiopharmaceuticals
• Tetracycline
09/05/14 DR HARIVANSH CHOPRA

58. Contraindications to Breast feeding
2. Mothers with any active
infection with the infant
having no infection:
1. HIV +ve mothers.
2. Mothers with septicemia,
active tuberculosis,
typhoid fever, breast
cancer, or malaria.
09/05/14 DR HARIVANSH CHOPRA

59. Contraindications to Breast feeding
3. Substance abuse by mother.
09/05/14 DR HARIVANSH CHOPRA

60. Contraindications to Breast feeding
4. Severe neurosis or
psychosis in mother.
09/05/14 DR HARIVANSH CHOPRA

61. Solution –
Inverted or Flat nipples
1. Use of breast shells in
the brassiere, massaging
exercises (Hoffman
Technique), breast
pumps, or nipple shields
may be one.
09/05/14 DR HARIVANSH CHOPRA

62. Solution –
Inverted or Flat nipples
2. Use of a cut syringe inverted to draw out
nipple or milk may be done.
09/05/14 DR HARIVANSH CHOPRA

63. Solution –
Sore nipple
1. Proper positioning of infant while
breast feeding.
2. Offer baby short, frequent feeds for
less vigorous suck.
3. Feed on other side, if possible.
09/05/14 DR HARIVANSH CHOPRA

64. Solution –
Sore nipple
4. Pull baby’s chin or corner of mouth to
break suction before removing him from
breast.
09/05/14 DR HARIVANSH CHOPRA

65. Solution –
Sore nipple
5. Keep nipples moist (lanolin, etc) as moist
healing is better for them. Nipple shields
may be used.
09/05/14 DR HARIVANSH CHOPRA

66. Solution –
Leaking breasts
1. Mothers leaking with one breast while feeding
on other should use towel, or cotton diaper to
catch the flow.
2. Disposable, or washable cotton pads may be
used in brassiere; avoid ones with plastic lining.
09/05/14 DR HARIVANSH CHOPRA

67. Solution –
Leaking breasts
3. Not to miss the feeds or going longer between
feeds solves problem.
4. Slight pressure against breasts stops sudden
leaking or let down.
09/05/14 DR HARIVANSH CHOPRA

68. Solution –
Twin feeding
1. Think positive. Negative thoughts hinder milk
production.
2. Babies may be fed at the same time positioned
like X in front of the mother, or held on sides.
09/05/14 DR HARIVANSH CHOPRA

69. Solution –
Twin feeding
3. Adequate diet, rest &
exercise for the mother.
4. If supplements required,
feed with cup, finger,
dropper, or syringe –
Avoid bottle feeding.
09/05/14 DR HARIVANSH CHOPRA

70. Solution –
Breast feeding an adopted child
1. Most mothers may
produce enough milk
for an adopted child,
whether they have
ever been pregnant
or not.
09/05/14 DR HARIVANSH CHOPRA

71. Solution –
Breast feeding an adopted child
2. The key to lactation is
breast stimulation by:
1. Breast pump before the
arrival of baby.
2. Continued suckling by
child.
3. Use of pump while baby
is suckling.
09/05/14 DR HARIVANSH CHOPRA

72. Complimentary Feeding
When breast milk alone is unable to
suffice the needs of the infant,
transition from exclusive breast
feeding to family foods is known as
complimentary feeding.
09/05/14 DR HARIVANSH CHOPRA

73. Complimentary Feeding
1. It is both “science” and “art”.
2. Only home available foods should be used.
3. Market preparations are best to be avoided.
4. Home available foods help in the development
of taste buds of the child.
5. Thus, it helps to prevent the occurrence of
feeding problems later in childhood.
09/05/14 DR HARIVANSH CHOPRA

74. Supplementary feeding
1. Feeding formula feeds to a previously
exclusively breastfed child.
2. Useful for working mothers.
09/05/14 DR HARIVANSH CHOPRA

75. Complimentary Feeding during 6-12
months of age – What should be given?
1. Breastfeed as often as child wants.
2. Offer banana/ biscuit/ cheeko/ mango/ papaya.
09/05/14 DR HARIVANSH CHOPRA

76. Complimentary Feeding during 6-12
months of age – What should be given?
3. Give at least “one katorie” at a time of:
1. Mashed roti/ rice/ bread/ biscuit mixed in sweetened
undiluted milk, OR
2. Mashed roti/ rice/ bread mixed in thick dal with
added ghee/ oil. Add cooked vegetables also in the
servings, OR
3. Sevian/ dalia/ halwa/ kheer prepared in milk or any
cereal porridge cooked in milk, OR
4. Mashed boiled/ fried potatoes.
09/05/14 DR HARIVANSH CHOPRA

77. Complimentary Feeding during 6-12
months of age – When and How?
• 3 times per day if breastfed;
5
times per day if not
breastfed.
• Remember:
• Keep the child in your lap and
feed with your own hands.
• Wash your own and child’s
hands with soap and water
09/05/1e4very time beforeDR f HeAeRdIViAnNgSH. CHOPRA

78. Complimentary Feeding during 12 mths-
2 yrs of age – What should be given?
1. Breastfeed as often as child wants.
2. Offer food from the family pot.
3. Offer banana/ biscuit/ cheeko/ mango/ papaya.
09/05/14 DR HARIVANSH CHOPRA

79. Complimentary Feeding during 12 mths-
2 yrs of age – What should be given?
4. Give at least “1 ½ katorie” at a time of:
1. Mashed roti/ rice/ bread/ biscuit mixed in sweetened
undiluted milk, OR
2. Mashed roti/ rice/ bread mixed in thick dal with
added ghee/ oil. Add cooked vegetables also in the
servings, OR
3. Sevian/ dalia/ halwa/ kheer prepared in milk or any
cereal porridge cooked in milk, OR
4. Mashed boiled/ fried potatoes.
09/05/14 DR HARIVANSH CHOPRA

80. Complimentary Feeding during 12 mths-
2 yrs of age – When and How?
• 5 times per day if not
breastfed.
• Remember:
• Sit by the side of child and
help him to finish the
serving.
• Wash your child’s hands
with soap and water every
time before feeding.
09/05/14 DR HARIVANSH CHOPRA

81. Complimentary Feeding –
Timing
1. The complimentary feeding
should be started at least half an
hour before the scheduled time
of feeding.
2. If this fact is not kept in mind,
and if one starts feeding
complimentary feeding when
the child is hungry, then the
child is not going to accept and
will start crying.
09/05/14 DR HARIVANSH CHOPRA

82. Complimentary Feeding –
Timing
3. Thus it will result in non-acceptance of the
complimentary feeds.
4. The reason behind starting complimentary
feeding earlier than the scheduled time is that the
child is a rapid sucker. While on breast feeding,
the child is able to suckle 50% of the breast feed
in the first 2 minutes, and this rate cannot be
matched by spoon or any other method.
09/05/14 DR HARIVANSH CHOPRA

83. Complimentary Feeding –
Timing and Amount
1. The mother should fix one time in the morning
or evening in the beginning.
2. Initially, a very small amount of liquids should
be offered to the infant.
3. Every day there should be an increment of 2 – 3
tsf.
4. Initially, the breast feeding is to be offered at the
scheduled time.
09/05/14 DR HARIVANSH CHOPRA

84. Complimentary Feeding –
Timing and Amount
4. In 10 – 15 days time the
amount will be adequate
so that the mother can
miss the scheduled
breast feeding.
5. Then another time is
fixed and the same
process is repeated.
09/05/14 DR HARIVANSH CHOPRA

85. Complimentary Feeding –
Type of Feeds
1. Initially only liquids in the form of fruit juices
and soups and milk preparations should be
offered to the child.
2. Then semi-solids like mashed banana, boiled
and mashed potato, etc should be offered to the
child.
3. Later on, the young toddler must learn to eat
from the “Family Pot”.
09/05/14 DR HARIVANSH CHOPRA

86. Complimentary Feeding –
Hygiene
1. Mother should prepare the complimentary feeds
herself in proper hygienic conditions.
2. Before giving feeding to the child, she must
wash her hands, and clean the utensils after
feeding the child to minimize the risk of
weaning induced diarrhea.
09/05/14 DR HARIVANSH CHOPRA

87. Complimentary Feeding
1. This way the child will learn to eat the home
cooked food, as well as will be able to fulfill
his/her nutritional requirements except iron.
2. For this the child needs to be given either food
fortified with iron or iron supplementation under
the supervision of a doctor.
09/05/14 DR HARIVANSH CHOPRA

88. Requisites of Complimentary Feeding
1. Timely – started at 6 months.
2. Adequate – good nutritive value.
3. Safe – free from contamination.
4. Appropriate – in sufficient amount.
09/05/14 DR HARIVANSH CHOPRA

89. MCQs
3. Which of the following is a contraindication for
breast feeding:
1. Elderly gravida.
2. Preterm delivery.
3. Mother with active tubercuosis.
4. Nulliparous mother of adopted child.
Ans. – 3
09/05/14 DR HARIVANSH CHOPRA

90. Conclusion
1. Breast milk is the best food for the infant up to 6
months of age.
2. After 6 months complimentary feeding should
be started.
3. These two are the best practices for the
attainment of normal growth in children.
09/05/14 DR HARIVANSH CHOPRA

91. 09/05/14 DR HARIVANSH CHOPRA