pictorial description of anatomy, physiology of lactation, neonatal reflex of rooting,suckling,swallowing, good attachment, good position, special situations, problems while breastfeeding

1. BREAST
FEEDING
J.DASARATHA
I/C DIVISION OF NEONATALOGY
RDT CHILDREN’S HOSPITAL,
BATHALAPALLI

2. Why to breastfeed?
Breastmilk:
• Is the most appropiate and
natural food for the baby.
• It adapts to the baby’s needs.
Even if baby is premature.
Protects the baby against
infections : diarrhoea,
bronchitis, pneumonia &
immunological problems:
allergies,diabetes..

3. • Favours utrine involution
and reduces the risk of
PPH
• Reduces of uterine,
ovarian & breast cancer
• Lactational amenorrhea
helps in family planning
• Saves money and
decreases the need for
medical consultancies
and drugs

4. Anatomy of breast

5. Physiology of Lactation

9. Murru Palu Bangaram

10. Colostrum
• Contains a large
amount of proteins
and vitamins, apart of
many more
inmmunoglobulins
• Even in small amounts
it is enough to feed
the newborn baby

11. Transitional milk: 3rd and 10th day post-partum
Mature milk: It’s composition changes during the
course of the same feeding:
Fore milk: more proteins, lactose, water and
vitamins
Hind milk: more creamy rich in fats and calories

12. Breastmilk contains:
Anti infective factors Minerals
Anti-cancer Probiotics
Growth factors Prebiotics
Enzymes Fats
Hormones DHA/ARA
Anti-viruses Protein
Anti-allergies Water
Anti-parasites Vitamins

13. When ? AS SOON AS POSSIBLE.
• Strongly recomended
during 1st hour
after delivery

14. Skin to skin promotes a close bond
between mother & baby
• Skin to skin in the 1st
hour increases the
production of
Oxytocin
• Oxytocin is also called
the love hormone
• This hormone
promotes bonding &
affection

16. How often do it?:
• Breastfeeding must be on demand
• Atleast 8 times a day
• Babies feed with different frequencies and take
different amounts of milk at each feed
• No timetable for
breastfeeding

17. Baby’s hunger signs

18. • Allow suckling until he/she spontaneously
releases the nipple.

19. How to take the baby off
• Insert a finger into the edge of the baby’s
mouth until the suction is broken

20. Warning signs:
• Staying on breast more than one half hour for
every feed
• Wanting to feed more often than every 1–1½
hours each time
Poor attachment should be suspected

21. How to know if your baby is getting
enough Breast milk
• You feel : your breast being pulled with NO PAIN
• You hear : your baby swallowing
• You see : a wide open mouth
curled out lips
chin pressed into your breast
sucking and swallowing

22. Weight gain
• The new born may lose 7 % in the first 3 days
• Should return to their birth weight by 10 days
of age
• Should gain at least 20-35 grs a day in the first
3-4 months of age

23. Wet diapers
1 day At least 1 diaper
2 day At least 2 wet diapers
3 day Atleast 3 heavy diapers
4 day At least 4 heavy diapers
5-6 days At least 6 heavy wet diapers
and older

24. For how long ?
WHO recommendations :
Breastfeed exclusively up to 6 months and
with complementary foods up to 2 years of
years or beyond

25. How to breastfeed?:
Skilled assistance

26. Wash hands,Be comfortable
Relaxe your shoulders
• Head and body in
straight line
• Whole body
supported
• Nose to nipple
• Tummy to tummy
• Support your breast.
Thumb is on top and
fingers are below
the breast

27. How to achieve a good latch?:
• Nose to nipple so he
has to open wide his
mouth
• Draw the baby closer to
the breast
• Covering the entire
areola

28. Good latch-on
• Wide open mouth
• Lower lip turned
outward
• Chin to breast
• More areola visible
above than below
• No pain

29. Good latch-on

30. Usual positions:
• Changing positions help in prevention of
mastitis.

31. Special situations:
• TWINS:
Foot ball position

33. Premature Infant: Cross Cradle Hold

34. All infants > 34 weeks to be breastfed
• Less than 34 weeks
– Give colostrum
– Initiate NNS
– Lactation aid (Drip method)
– Few minutes of breast feeding

36. Hypotonic Baby
A baby with low muscle tone usually sucks better when the head and bottom
are level, or close to it. Support your baby using pillows on your lap

37. Hypertonic Baby
•Non Rhythmic sucking : Use Rocking chair &
• Breast in quiet atmosphere
•Cuddle and chat with the baby
extra chin support

38. Cleft Lip and Palate
• Cleft lip
– Complete breastfeeding possible
– Defect closed with a finger to create seal
• Cleft palate
– Upright position, straddle position or modified
football position
– Feed with a Palade expressed milk

39. Sitting

40. Maternal Illness
• HIV : Promote Exclusive breastfeeding unless
AFASS criteria is met
• Hepatitis B : Breastfeed after Vaccine and or
HepaB IV IG
• Active Tuberculosis: Breastfeed along with
Chemo and BCG after stopping Chemo to baby

41. Expressing breast milk
• Wash your hands
• Use a clean glass or
palada
• Place your thumb and
first 2 fingers outside the
areola
• Push your fingers straight
back towards your chest
• Gently compress your
breast and roll fingers
towards your nipple

43. Caring for your breast
• After breast feeding
express some breast
milk onto nipples &
areola to protect the
skin

44. Dificulties during breast-feeding

45. FLAT AND INVERTED NIPPLES

46. Solution
• Stimulate your nipple
by rolling it between 2
fingers
• You can also use a
syringe to pull it out

47. CRACKS
• In the first weeks
• Can be an sign of
poor latch on
• Pain

48. Solutions
• Reasses the latch – on
& correct
• Spread a drop of hind
milk on the nipple
• If still painful, EBM
should be given

49. ENGORGEMENT
• Breast become hard,
swollen , sensitive and
tight, dry and red skin

50. • Breastfeed more
frequently and change
positions
• Warm and massage the
breast before
breastfeeding
After breastfeeding:
Apply cold pads or clean
cabbage leaves avoiding
the nipples
Solutions

51. MASTITIS
• Bacterial infection of
lactiferous glands
• RED, HOT and PAIN
• Sometimes fever and
chills

52. Solutions
• Breastfeed more
frequently and change
positions
• Warm and massage
the breast before
breastfeeding
• Antibiotics
treatment
• No reason for giving
up breast feeding

53. Fungus
• Can affect your breast and
baby’s mouth during breast
feeding
• Your nipples are extremely
itchy, burning, sore & wet
• The usual remedies for sore
nipples aren’t working.
• Baby has oral thrush (white,
cottage-cheese-like patches
on the tongue and sides of
the mouth)

54. Solutions
• Improve hygienic
conditions
• Reasses latch-on
• Apply an antifungical
cream
• Analgesic if needed

55. THANK YOU
L atch on
A s soon as possible
T ummy to tummy
C olostrum is gold
H is/her Right
O n demand
N o to bottle