notes

1. BREASTFEEDING

2. BREASTFEEDING
• Breastfeeding is the feeding of an infant or
young child with breast milk directly from
female human breasts (i.e., via lactation) not
from a baby bottle or other container.

3. POSITIONING OF BREASTFEEDING
• Side lying position
• Football hold position
• Cradle hold position
• Cross cradle hold position
• Saddle Hold
• Twin Football Hold

4. Benefits of breastfeeding for the infant
• Provides superior nutrition for
optimum growth.
• Provides adequate water for
hydration.
• Protects against infection and
allergies.
• Promotes bonding and
development.
Transparency 2.4

5. Advantages for Infants
• Fewer ear infections
• Less incidence of Sudden Infant Death
Syndrome (SIDS)
• Fewer respiratory infections
• Reduces the risk of developing insulin
dependent diabetes mellitus

6. Advantages for Infants
• Lower incidence of allergies and asthma
• Lower incidence of childhood lymphoma
• Decreases the risk of gastrointestinal
infections
• Decreases the risk of Necrotizing Enterocolitis
(NEC)
• Decreases the risk of urinary tract infections

7. Advantages
• Increased IQ scores later in childhood
• Enhanced neurodevelopmental performance

8. SIGNS THAT THE BABY IS GETTING
ENOUGH BREAST MILK
• 1. He is contented for 1-2 hours after a feed
• 2. He passes clear dilute urine 5-6 times a day
• 3. He passes bright yellow watery stools 6-8
times a day
• 4. He regains birth weight after 2weeks

9. COMPLICATION
• Breast Pain
• Biting
• Too much milk
• Mastitis
• Breast abscess
• Breast engorgement
• Sore nipple

10. Summary of differences between
milks
Human milk Animal milks Infant formula
Protein
correct amount, easy
to digest
too much, difficult to
digest
partly corrected
Fat
enough essential fatty
acids, lipase to digest
lacks essential fatty
acids, no lipase
no lipase
Water enough extra needed may need extra
Anti-infective
properties
present absent absent
Adapted from: Breastfeeding counselling: A training course. Geneva, World Health
Organization, 1993 (WHO/CDR/93.6).
Transparency 2.10

11. Breast milk composition differences
(dynamic)
• Gestational age at birth
(preterm and full term)
• Stage of lactation
(colustrum and mature milk)
• During a feed
(foremilk and hindmilk)
Transparency 2.11

12. Colostrum
Property
• Antibody-rich
• Many white cells
• Purgative
• Growth factors
• Vitamin-A rich
Importance
• protects against infection and
allergy
• protects against infection
• clears meconium; helps prevent
jaundice
• helps intestine mature;
prevents allergy, intolerance
• reduces severity of some
infection (such as measles and
diarrhoea); prevents vitamin A-
related eye diseases
Transparency 2.12

13. NUTRITION WHILE BREASTFEEDING
• Eat a well-balanced, varied diet
• Breastfeeding mothers burn 500+ calories daily
• Check with doctor about taking a multivitamin with
iron
• Drink eight glasses of fluid (eight ounces each) daily
• Avoid or limit caffeinated drinks to one to two cups
daily
• Avoid alcohol or limit to one serving (six ounces of
wine or 12 ounces of beer) on a special occasion

14. Benefits of breastfeeding for the
mother
• Protects mother’s health
– helps reduces risk of uterine bleeding and
helps the uterus to return to its previous size
– reduces risk of breast and
ovarian cancer
• Helps delay a new pregnancy
• Helps a mother return to pre-pregnancy weight
Transparency 2.14

15. Risks of artificial feeding
 Interferes with bonding
 More diarrhoea and
respiratory infections
 Persistent diarrhoea
 Malnutrition
Vitamin A deficiency
 More likely to die
 More allergy and
milk intolerance
 Increased risk of
some
chronic diseases
 Overweight
 Lower scores on
intelligence tests
 May become
pregnant sooner
 Increased risk of anaemia,
ovarian and breast cancer
Mother
Adapted from: Breastfeeding counselling: A training course. Geneva,
World Health Organization, 1993 (WHO/CDR/93.6). Slide 2.15

16. Benefits of breastfeeding for the family
• Better health, nutrition, and well-being
• Economic benefits
–breastfeeding costs less than artificial
feeding
–breastfeeding results in lower medical care
costs
Transparency 2.16

17. Benefits of breastfeeding for the
hospital
• Warmer and calmer emotional environment
• No nurseries, more hospital space
• Fewer neonatal infections
• Less staff time needed
• Improved hospital image and prestige
• Fewer abandoned children
• Safer in emergencies
Transparency 2.17

18. Steps to Successful Breastfeeding1
• A written breastfeeding policy that is communicated
to all health care staff
• Staff training in the skills needed to implement the
policy
• Education of pregnant women about the benefits
and management of breastfeeding
• Early initiation of breastfeeding
• Education of mothers on how to breastfeed and
maintain lactation

19. Steps to Successful Breastfeeding1
• Limited use of any food or drink other than
human breast milk
• Rooming-in
• Breastfeeding on demand
• Limited use of pacifiers and artificial nipples
• Fostering of breastfeeding support groups and
services

20. CONTRAINDICATION TO
BREASTFEEDING
• Active /untreated TB
• Mom takes radioactive compound(cancer for
chemo)
• Mom take illegal drug
• HIV infection

21. Artificial feeding
• This is the feeding of infant when he gets
cow’s or buffalo’s milk or formula from first
days till 4th to 6th month of his life.

22. • Formula milks are humanized, i.e., they come
very close to the composition of breast milk.
• However, they are more expensive, so cow’s
or buffalo’s milk are quite often used.

23. Composition of cow’s milk versus
breast milk.
(in 100 ml)
Human milk Cow’s milk
Calories 67 67
Water 87 % 87 %
Carbohydrate 7.4 % 4.4 %
Lactose
isomer
β-lactose α-lactose
Fat 3.5 % 3.5 %

24. Human milk Cow’s milk
Protein 1.5 % 3.5 %
Lactalbumin:Casein
ratio
60 : 40 20 : 80
Sodium 15 mg
60 mg
(4 times)
Phosphorus 15 mg
90 mg
(6 times)
Calcium 30 mg
120 mg
(4 times)
Iron 0.5 mg 0.1 mg

25. Other advantages of breast milk versus
cow’s milk:
• Breast milk is available all the time and is practically
free from pathogenic bacteria.
• It needs no time for preparation
• It is available at the optimum temperature.
• It contains antibodies as IgG and IgA and protects
against certain infections such as E.Coli, cholera,
polio, tetanus, measles etc. IgA antibodies prevent
the microorganisms to adhere the intestinal mucosa
and provide local GIT immunity.

26. • β-lactose is called Bifidus factor, which promotes the
growth of lactobacillus and helps to lower the gut pH,
thus inhibiting the growth of E.Coli and yeasts.
• Breast milk contains lactoferrin (an iron-binding whey
protein), which inhibits bacterial growth by depriving
them of iron, which is necessary for growth.
• Breast milk contains cystine and tyrosine, which are
not synthesized by infants but they are essential for
proper growth and development.
• Breast milk contains taurine that is synthesized in
inadequate amounts in infants. It is important for
normal differentiation of CNS.

27. • Breast milk contains nonspecific factors of
immune difence: lisozyme, macrofagocytes,
neutrofiles, lymphocytes, complement system.
• There are 5 times more essential fatty acids
(polyunsaturated: arachidonic, docosahexacnoic,
linoleic, and α-linolenic) in breasts milk than in
cow’s milk.
• Breast milk contains ferments (lipase, lactase)
and mothers hormones.
• Breast milk is ‘species specific’ and therefore
allergy to breast milk is rare.

28. Dilution of Cow’s Milk:
Child’s Age Cow’s Milk Water
First 10 days 1 part 2 parts
10 to 20 days 1 part 1 part
Up to 2 mo 2 parts 1 part
• If dilution of cow’s milk is required, add 1 TSF
of sugar to each ounce of water (5 %) –
isocaloric formula)

29. Supplementary Feeding:
• The distribution of food to supplement energy
and other nutrients missing from the diet of
those who have special nutritional
requirements (WHO 1997).

30. Supplementary feed:
• where a breastfed infant has been given one
or more fluid feeds, including infant formula.
Expressed breast milk is considered a
supplementary feed.

31. Use of formula as a supplementary
feed may occur in the following
situations:
• Baby is unwell eg. Signs of dehydration
• Mother is unwell and/or unable to provide
breast milk
• Weight loss > 10%
• Jaundice / Phototherapy
• Hypoglycaemia

32. Initiation of supplementary feeds
• Supplementary feeding may be initiated for
medical reasons. The mother should be provided
with appropriate support to commence/continue
with breastfeeding. A proper assessment of
breastfeeding should be undertaken.
• On occasions supplementary feeding may be
initiated for non-medical reasons at the parents’
request. Non-medically indicated supplementary
feeds should not be instigated until a proper
assessment of breastfeeding has been
undertaken and other options considered.

33. Weaning
• Weaning is the process of switching a baby
from breastfeeding to bottle-feeding, from
breast- or bottle-feeding to a cup, or breast-
or bottle-feeding to solid foods.