Download MBBS Pediatric PPT 2 Breast Feeding Lecture Notes

--- Content provided by FirstRanker.com ---

Human Milk is species specific and it provides all the

essential nutrients necessary for the growth and

development of the newborn infant.

--- Content provided by⁠ FirstRanker.com ---

Breast Anatomy Structure

fat
Prolactin Reflex

--- Content provided by‌ FirstRanker.com ---

Secretion continues

AFTER feed to

--- Content provided by​ FirstRanker.com ---

produce NEXT

feed

To increase milk productions

--- Content provided by‌ FirstRanker.com ---

Pituitary releases

prolactin and oxytocin.

--- Content provided by‍ FirstRanker.com ---

Stimulation of

rmones travel

nerve endings

--- Content provided by‍ FirstRanker.com ---

a bloodstream

in mother's

--- Content provided by⁠ FirstRanker.com ---

mammary gland

nipple/areola

stimulate milk

--- Content provided by⁠ FirstRanker.com ---

sends signal

oduction and

--- Content provided by FirstRanker.com ---

to mother's

lk ejection

hypothalamus/

--- Content provided by​ FirstRanker.com ---

flex (le down).

pituitary.

--- Content provided by FirstRanker.com ---

Infant suckles

at the breast.
Oxytocin Reflex

--- Content provided by⁠ FirstRanker.com ---

For milk ejection

Helping and Hindering the

Oxytocin Reflex

--- Content provided by⁠ FirstRanker.com ---

For milk ejection
Inhibitor in Breastmilk

Attachment at Breast

--- Content provided by‌ FirstRanker.com ---

Mechanism of

`Suckling Cycle'

What Differences Do You See?

--- Content provided by​ FirstRanker.com ---

Picture 1

Picture 2

--- Content provided by⁠ FirstRanker.com ---

GOOD

ATTACHMENT

POOR

--- Content provided by​ FirstRanker.com ---

ATTACHMENT
What Differences Do You See?

Picture 1

--- Content provided by‌ FirstRanker.com ---

Picture 2

ATTACHMENT, OUTSIDE

--- Content provided by​ FirstRanker.com ---

APPEARENCE

Consequences of Poor

Attachment

--- Content provided by​ FirstRanker.com ---

u

Pain and damage to nipples

--- Content provided by‍ FirstRanker.com ---

Sore nipples

Fissures

u

--- Content provided by FirstRanker.com ---

Breast milk not removed effectively

Engorgement

--- Content provided by‌ FirstRanker.com ---

Baby unsatisfied,

wants to feed a lot

Apparent poor milk supply

--- Content provided by FirstRanker.com ---

Baby frustrated,

refuses to suckle

--- Content provided by‌ FirstRanker.com ---

Breasts make less milk

Baby fails to gain

weight

--- Content provided by​ FirstRanker.com ---

Causes of Poor Attachment

Use of feeding bottle

before breastfeeding established

--- Content provided by‍ FirstRanker.com ---

for later supplements

Inexperienced mother

--- Content provided by‍ FirstRanker.com ---

first baby

previous bottle feeder

Functional difficulty

--- Content provided by⁠ FirstRanker.com ---

small or weak baby

nipple poorly protractile

--- Content provided by​ FirstRanker.com ---

engorgement

late start

Lack of skilled support

--- Content provided by‍ FirstRanker.com ---

less traditional help and community

support

--- Content provided by‌ FirstRanker.com ---

doctors, midwives, nurses not trained

to help

Feeding Reflexes

--- Content provided by‌ FirstRanker.com ---

Rooting reflex
When something

touches lips,

--- Content provided by FirstRanker.com ---

baby opens mouth

puts tongue down

--- Content provided by⁠ FirstRanker.com ---

Sucking reflex

and forward

When something touches

--- Content provided by‍ FirstRanker.com ---

palate baby sucks

Skill

--- Content provided by⁠ FirstRanker.com ---

Mother learns to position baby

Baby learns to take breast

Swal owing reflex

--- Content provided by‌ FirstRanker.com ---

Gag reflex

When mouth fills with milk,

--- Content provided by​ FirstRanker.com ---

When something touches

baby swal ows

anterior part of the tongue,

--- Content provided by⁠ FirstRanker.com ---

baby pushes it out.
Types and Composition of

Human Breast Milk

--- Content provided by‌ FirstRanker.com ---

Types of Breast Milk:

--- Content provided by‌ FirstRanker.com ---

Colostrum or Early Milk



Transitional Milk

--- Content provided by⁠ FirstRanker.com ---

Mature Milk

--- Content provided by FirstRanker.com ---

Colostrum or Early Milk is produced in the late stage of pregnancy till 4 days

after delivery; and is rich in antibodies.

Transitional Milk produced from day 4 ? 10 is lower in protein in comparison

--- Content provided by​ FirstRanker.com ---

to Colostrum.

Mature milk is produced from approximately ten days after delivery up until

--- Content provided by⁠ FirstRanker.com ---

the termination of the breastfeeding.

Nutrients in Human & Animal Milk 1/4

What are the differences between these milks?

--- Content provided by​ FirstRanker.com ---

Differences in the Quality of the

1/5

Proteins in Different Milks

--- Content provided by FirstRanker.com ---

Differences in the Fats of

Different Milks

--- Content provided by⁠ FirstRanker.com ---

HUMAN

COW`S

Contains

--- Content provided by‍ FirstRanker.com ---

Contains

Essential Fatty Acids,

--- Content provided by‌ FirstRanker.com ---

No Essential Fatty Acids

Enzyme Lipase

No Enzyme Lipase

--- Content provided by FirstRanker.com ---

Vitamins in Different Milks

1/7

1/8

--- Content provided by FirstRanker.com ---

Iron in Milk
Types and Composition of Human Breast

Milk (Cont'd)

--- Content provided by FirstRanker.com ---

Fa t - The main lipids found in human milk are the

triglycerides phospholipids and essential fatty acids.

--- Content provided by​ FirstRanker.com ---

Protein ? Whey ; lactoferrin, lysozymes, immunoglobulin A ,

lactalbumin, Casein; lower concentration in human milk.

Carbohydrate ? Include lactose and oligosaccharides.

--- Content provided by FirstRanker.com ---

Leukocytes - Include neutrophils, marcrophages ,

lymphocytes.

--- Content provided by​ FirstRanker.com ---

Non protein nitrogen ? urea, uric acid

Other constituents : steroid hormones, peptides, insulins,

growth factors, minerals, vitamins, lipase.

--- Content provided by​ FirstRanker.com ---

Mechanism of Protection Against

1/9

--- Content provided by FirstRanker.com ---

Infection

When

White cells in

--- Content provided by‍ FirstRanker.com ---

Mother

mother's body

--- Content provided by⁠ FirstRanker.com ---

infected

make

antibodies to

--- Content provided by‍ FirstRanker.com ---

protect her

These

--- Content provided by‍ FirstRanker.com ---

antibodies are

Some white

secreted in

--- Content provided by‌ FirstRanker.com ---

cel s go

breastmilk to

--- Content provided by‌ FirstRanker.com ---

to her breast

protect baby

and make

--- Content provided by​ FirstRanker.com ---

antibodies there
Storage of Breast Milk

Human milk can be stored at room temperature for 4

--- Content provided by‌ FirstRanker.com ---

hours.

Expressed milk can be stored in refrigerator for

--- Content provided by FirstRanker.com ---

24hours.

Breast milk can be stored in the freezer at -200C for

about 3 months

--- Content provided by FirstRanker.com ---

Achieving Optimal Breastfeeding

Activities, attitudes and procedures during the

--- Content provided by⁠ FirstRanker.com ---

delivery and post partum period have an impact on

breastfeeding

There is well documented evidence soon after

--- Content provided by FirstRanker.com ---

delivery starting breast feeding provides skin to skin

contact between infant and mother, helps to

--- Content provided by FirstRanker.com ---

maintain the body temperatures, reduce risk of

hypoglycemia, enhance oxytocin release and

beneficial nutrition with intake of colostrum

--- Content provided by⁠ FirstRanker.com ---

Skin to skin contact should occur for about 1-2 hours

after delivery. Procedures after delivery like

--- Content provided by‍ FirstRanker.com ---

weighing, administration of vitamin K, eye

prophylaxis and other procedures should be delayed
Achieving Optimal Breastfeeding (Cont'd)

--- Content provided by‌ FirstRanker.com ---

Breastfeeding should be started and fully

established before discharge from the hospital

Physicians and health care professionals should

--- Content provided by FirstRanker.com ---

observe at least one feeding and ensure this is

done properly and breast milk is produced

--- Content provided by⁠ FirstRanker.com ---

Lactation specialist should also work with

parents that are having difficulty with breast

feeding.

--- Content provided by‌ FirstRanker.com ---

Early follow up after leaving the hospital is

required.

--- Content provided by⁠ FirstRanker.com ---

Signs of Effective Breastfeeding

Frequent feedings 8-12 times daily.

Intermittent episodes of rhythmic sucking with audible swallows should

--- Content provided by FirstRanker.com ---

be heard while the infant is nursing.

Infant should have about 6-8 wet diapers in a 24 hour period once

--- Content provided by‍ FirstRanker.com ---

breast feeding is established.

Infant should have minimum of 3-4 bowel movements every 24 hours.

Stools should be about one tablespoon or larger and should be soft and

--- Content provided by‍ FirstRanker.com ---

yellow after day 3.

Average daily weight gain of 15 -30g.

--- Content provided by‌ FirstRanker.com ---

Infant has regained birth weight by day 10 of life.
Good Breastfeeding Techniques

The baby should be properly positioned to achieve effective latching

--- Content provided by​ FirstRanker.com ---

The mother should wear comfortable apparel, with the breast well exposed

for the infant to be able to latch.

The infant's mouth, chin and umbilicus should be lined up with the head in

--- Content provided by‌ FirstRanker.com ---

a neutral position.

The infant is brought to the breast, with the nose touching or close to the

--- Content provided by‍ FirstRanker.com ---

breast.

The gum line should overlap the areola, and the nipple straight back into

the mouth.

--- Content provided by‍ FirstRanker.com ---

The tongue moves forward beyond the lower gum, cupped and forming a

reservoir.

--- Content provided by‌ FirstRanker.com ---

Milk is removed for the lactiferous sinuses, the jaw moves down creating a

negative pressure gradient that helped transfer milk to the pharynx.

Breastfeeding Positions

--- Content provided by‍ FirstRanker.com ---

Cradle Hold

This is the most common

--- Content provided by⁠ FirstRanker.com ---

position used by

mothers.

Infant's head is

--- Content provided by FirstRanker.com ---

supported in the elbow,

the back and buttock is

--- Content provided by​ FirstRanker.com ---

supported by the arm

and lifted to the breast.
Breastfeeding Positions

--- Content provided by FirstRanker.com ---

Football Hold Position
The infant's is placed under

the arm, like holding a

--- Content provided by⁠ FirstRanker.com ---

football

Baby's body is supported

with the forearm and the

--- Content provided by‍ FirstRanker.com ---

head is supported with the

hand.

--- Content provided by FirstRanker.com ---

Many mothers are not

comfortable with this

position

--- Content provided by‍ FirstRanker.com ---

Good position after

operative procedures

--- Content provided by‌ FirstRanker.com ---

Breastfeeding Positions

Side Lying Position

The mother lies on her side

--- Content provided by‍ FirstRanker.com ---

propping up her head and

shoulder with pillows.

--- Content provided by‍ FirstRanker.com ---

The infant is also lying down

facing the mother.

Good position after Caesarean

--- Content provided by​ FirstRanker.com ---

section.

Allows the new mother some rest.

--- Content provided by FirstRanker.com ---

Most mothers are scared of

crushing the baby.
Breastfeeding Positions

--- Content provided by FirstRanker.com ---

Cross Cradle Hold Position

Ideal for early breastfeeding.

Mother holds the baby

--- Content provided by⁠ FirstRanker.com ---

crosswise in the crook of the

arm opposite the breast the

--- Content provided by‍ FirstRanker.com ---

infant is to be fed.

The baby's trunk and head are

supported with the forearm

--- Content provided by‍ FirstRanker.com ---

and palm.

The other hand is placed

--- Content provided by‌ FirstRanker.com ---

beneath the breast in a U-

shaped to guide the baby's

mouth to your breast.

--- Content provided by​ FirstRanker.com ---

Breastfeeding Positions

Australian Hold Position

--- Content provided by⁠ FirstRanker.com ---

This is also called the

saddle hold

Usually used for older

--- Content provided by​ FirstRanker.com ---

infants

Not commonly used by

--- Content provided by‍ FirstRanker.com ---

mothers.

Best used in older

infants with runny nose,

--- Content provided by​ FirstRanker.com ---

ear infection.
Can Yo u Identify the positions?
Benefits of Breastfeeding to

--- Content provided by⁠ FirstRanker.com ---

Infants

Helps in Gastrointestinal development and function

Helps in development of the immune system

--- Content provided by‌ FirstRanker.com ---

Helps in cognitive development of the infant

Infants who are breastfed have reduced risk of infection compared to

--- Content provided by‍ FirstRanker.com ---

formula fed infants.

Benefits of Breastfeeding

to Infants

--- Content provided by‌ FirstRanker.com ---

Breastfed infants have reduced risk of obesity

later in life compared to formula fed infants.

--- Content provided by FirstRanker.com ---

Reduced risk of sudden infant death

syndrome, Hodgkin's lymphoma, Leukemia

and non insulin dependent Diabetes.

--- Content provided by FirstRanker.com ---

Lower risk of infections e.g. otitis media,

Lower respiratory tract infection, Diarrheal

--- Content provided by‍ FirstRanker.com ---

diseases, Allergies , eczema, Meningitis and

inflammatory bowel diseases.
Benefits of Breastfeeding

--- Content provided by‌ FirstRanker.com ---

to Mothers

Enhance early maternal ? infant bond.

Aids involution of the uterus.

--- Content provided by‌ FirstRanker.com ---

Long term breastfeeding helps in loss of the excess weight acquired

during pregnancy.

--- Content provided by‍ FirstRanker.com ---

Prolonged Breastfeeding prolongs anovulation.

Documented long term effect of breastfeeding include reduced risk of

breast, ovarian and endometrial cancers.

--- Content provided by⁠ FirstRanker.com ---

Socio-economic Benefits of

Breastfeeding

--- Content provided by​ FirstRanker.com ---

Income savings

Reduced risk of infections and diseases hence

reduced hospital visits and attendant medical cost.

--- Content provided by FirstRanker.com ---

Mothers are more economically productive since they

will spend less time caring for a sick child.
Advantages of Breastfeeding

--- Content provided by FirstRanker.com ---

(contd.)

Mother

--- Content provided by​ FirstRanker.com ---

Society

Family

Reduces post

--- Content provided by‌ FirstRanker.com ---

Eco-friendly

delivery bleeding

--- Content provided by⁠ FirstRanker.com ---

Low cost

and anemia

Human

--- Content provided by⁠ FirstRanker.com ---

involved

resource

--- Content provided by‌ FirstRanker.com ---

Delays next

developmen

pregnancy

--- Content provided by FirstRanker.com ---

Less illnesses

t

--- Content provided by‍ FirstRanker.com ---

Protects breast and

ovarian cancer

Family

--- Content provided by⁠ FirstRanker.com ---

Economy

developmen

--- Content provided by⁠ FirstRanker.com ---

Protects obesity and

bonding

shapes body

--- Content provided by⁠ FirstRanker.com ---

t

Convenient

--- Content provided by​ FirstRanker.com ---

Barriers To Effective
Breastfeeding
Lack of confidence in mother

Belief that breast milk is not sufficient

--- Content provided by​ FirstRanker.com ---

Lack of adequate support system

History of previous breast surgery

--- Content provided by FirstRanker.com ---

Breast engorgement, cracked and sore nipples

Retractile nipples
Barriers To Effective Breastfeeding

--- Content provided by‍ FirstRanker.com ---

Embarrassment by mother

Jealousy by siblings

Chronic illness in mother;

--- Content provided by FirstRanker.com ---

psychosis, Cancer.

Contraindication to Breastfeeding

--- Content provided by​ FirstRanker.com ---

Neonatal conditions-Inborn error of

metabolism; galactosemia, phenylketonuria.

Maternal conditions-

--- Content provided by‍ FirstRanker.com ---

Mothers on certain medications ; anticancer

therapy, radioactive isotope, antithyroid

drugs, MAO inhibitors, lithium, gold

--- Content provided by⁠ FirstRanker.com ---

salt,ergotamine etc.

Psychosis(untreated)
Role of the Nurse

--- Content provided by‌ FirstRanker.com ---

Provide education about breastfeeding at first

prenatal visit

--- Content provided by‍ FirstRanker.com ---

Physical exam should include breast exam

Ensure rooming-in after delivery

Ensure breastfeeding is started and established

--- Content provided by‌ FirstRanker.com ---

before discharge after delivery.

Observe at least a session of breastfeeding to

--- Content provided by⁠ FirstRanker.com ---

ensure it is done correctly
RECOMMENDATIONS

Exclusive breast feeding until 6

--- Content provided by⁠ FirstRanker.com ---

months of age

Introduce complimentary foods

with continued breastfeeding

--- Content provided by⁠ FirstRanker.com ---

Optimum to breastfeed for 2

years or longer

--- Content provided by⁠ FirstRanker.com ---

HARMFUL EFFECTS OF

FORMULA MILK
Why some mothers choose

--- Content provided by⁠ FirstRanker.com ---

formula vs. breast milk
Distressed by physical discomfort of early breastfeeding

problems.

--- Content provided by‌ FirstRanker.com ---

Convenience issues

Pressures of employment/school

Worries that breast shape will change

--- Content provided by​ FirstRanker.com ---

Formula manufacturers manipulate people

through ads

--- Content provided by FirstRanker.com ---

Doctors and nurses need more lactation training

www.hasslefreeclipart.com/. ../baby_crying.gif

Why some mothers choose

--- Content provided by⁠ FirstRanker.com ---

formula vs. breast milk

Moms given very little time to adjust to changes of

--- Content provided by FirstRanker.com ---

postpartum

Family demands

Non-supportive family/health professionals

--- Content provided by‍ FirstRanker.com ---

Embarrassment

Lack of confidence in self

--- Content provided by‌ FirstRanker.com ---

Feeling that one cannot produce enough milk

www.dreamstime.com/ thumb_27/11304631444pJ47D.jpg
Mother's milk vs. formula milk

--- Content provided by‌ FirstRanker.com ---

Formula milk for 3 days old

babies is no different than

formula milk for 3 months

--- Content provided by FirstRanker.com ---

old infants.

store.enfamil.com/ media/pr_prosobee_lipil.jpg

--- Content provided by⁠ FirstRanker.com ---

Breast milk is ingeniously

different every single day;

adapted to the changing

--- Content provided by‌ FirstRanker.com ---

needs of the baby.

breastfeeding.8k.com/ Resources/breastfeeding.jpeg

--- Content provided by⁠ FirstRanker.com ---

Mother's milk vs. formula milk

Human milk is designed to

support the development of

--- Content provided by‍ FirstRanker.com ---

large brains, capable of

processing and storing lots of

--- Content provided by​ FirstRanker.com ---

information.

www.babymal .com.au/ images/readingroomcartoon.gif

Cows milk is designed to

--- Content provided by⁠ FirstRanker.com ---

support functions, like

constant grazing.

--- Content provided by⁠ FirstRanker.com ---

myxo.css.msu.edu/danimal/ quiz/cow_picture.png
Illness Relative risk

Allergies, eczema 2 to 7 times
Urinary tract infections 2.6 to

--- Content provided by​ FirstRanker.com ---

5.5 times

Inflammatory bowel disease

--- Content provided by​ FirstRanker.com ---

1.5 to 1.9 times

Diabetes2.4 times
Gastroenteritis 14 times
Hodgkin's lymphoma 1.8 to 6.7

--- Content provided by FirstRanker.com ---

times

Otitis media 2.4 times
Haemophilus influenzae

--- Content provided by⁠ FirstRanker.com ---

meningitis 3.8 times

Necrotizing enterocolitis 6 to

--- Content provided by‍ FirstRanker.com ---

10 times

www.geocities.com/.../ Canopy/4116/stalk.gif

Illness Relative risk

--- Content provided by‍ FirstRanker.com ---

Pneumonia/lower

respiratory tract

--- Content provided by​ FirstRanker.com ---

infection 4 times

Respiratory syncytial

virus infection 3.9 times

--- Content provided by⁠ FirstRanker.com ---

Sepsis 2.1 times

Sudden infant death

--- Content provided by​ FirstRanker.com ---

syndrome 2.0 times

Industrialized-world

hospitalization 3 times

--- Content provided by‌ FirstRanker.com ---

www.mamashealth.com/ images/lungs1.gif
Barriers to Bonding

* A Bottle places a physical

--- Content provided by FirstRanker.com ---

barrier between mom and

baby

--- Content provided by​ FirstRanker.com ---

*Less skin to skin contact

*Less eye contact

* The hormonal connection

--- Content provided by⁠ FirstRanker.com ---

between the breastfeeding

mother and baby cannot be

--- Content provided by‍ FirstRanker.com ---

experienced by the bottle

feeding mother

www.photohome.com/.../ mom-and-baby-1a.jpg

--- Content provided by⁠ FirstRanker.com ---

Other Options If

Breastfeeding is Not Possible

--- Content provided by‌ FirstRanker.com ---

Mom can still use her milk, even if

she decides not to breastfeed:

Use a breast pump (electric/manual)

--- Content provided by​ FirstRanker.com ---

Cup or bowl feeding

Spoon feeding

--- Content provided by FirstRanker.com ---

Get milk from donation bank

graphics.iparenting.com/. ../womanpumping.jpg
There is no freedom of choice for humans

--- Content provided by‌ FirstRanker.com ---

if it has been taken away from them

at the beginning.

Breast-feeding is not a choice,

--- Content provided by​ FirstRanker.com ---

but an obligation to the choice,

Give your child the freedom of choice.

--- Content provided by‍ FirstRanker.com ---

www.13.waisays.com/ image006.jpg

Kangaroo Mother

Care

--- Content provided by‌ FirstRanker.com ---

Kangaroo Mother Care

Kangaroo Mother Care (KMC) is a special way of caring

of low birth weight babies

--- Content provided by‍ FirstRanker.com ---

It fosters their health and well being by promoting

effective thermal control, breastfeeding, infection

--- Content provided by‍ FirstRanker.com ---

prevention and bonding

In KMC, the baby is continuously kept in skin-to-skin

contact by the mother and breastfed exclusively to the

--- Content provided by​ FirstRanker.com ---

utmost extent

KMC is initiated in the hospital and continued at home.

--- Content provided by​ FirstRanker.com ---

Components of Kangaroo

Mother Care

Skin to skin contact

--- Content provided by​ FirstRanker.com ---

Exclusive breast feeding
Pre-requisite for KMC

Support to the mother in hospital and at home

--- Content provided by‍ FirstRanker.com ---

Post discharge follow up

Requirement for KMC

--- Content provided by FirstRanker.com ---

implementation

Training of nurses, physicians and other staff

? Educational material

--- Content provided by‍ FirstRanker.com ---

? If possible, reclining chairs in the nursery and postnatal

wards

Mother can provide KMC sitting on an ordinary chair or

--- Content provided by FirstRanker.com ---

in a semi-reclining posture on a bed with the help of

pillows
Preparing for KMC

--- Content provided by⁠ FirstRanker.com ---

Arrange a time

Demonstrate her KMC procedure

--- Content provided by‍ FirstRanker.com ---

Encourage her to bring her family members

KMC procedure

The baby should be placed between the mother's breasts in

--- Content provided by​ FirstRanker.com ---

an upright position

The head should be turned to one side and in a slightly

--- Content provided by FirstRanker.com ---

extended position

This slightly extended head position keeps the airway open

and allows eye to eye contact between the mother and her

--- Content provided by‍ FirstRanker.com ---

baby.

The hips should be flexed and abducted in a "frog"

--- Content provided by​ FirstRanker.com ---

position; the arms should also be flexed.

Baby's abdomen should be at the level of the mother's

epigastrium.

--- Content provided by‍ FirstRanker.com ---

Mother's breathing stimulates the baby, thus reducing the

occurrence of apnea.

--- Content provided by​ FirstRanker.com ---

Support the baby's bottom with a sling/binder.
KMC ? positioning of the baby

Start kangaroo position as soon as possible after delivery!

--- Content provided by FirstRanker.com ---

01/06/2017


KMC can be provided using any front-open, light dress as

--- Content provided by‍ FirstRanker.com ---

per the local culture

KMC works well with blouse and sari, gown or shawl.

A suitable apparel that can retain the baby for

--- Content provided by‌ FirstRanker.com ---

extended period of time can be adapted locally

Baby is dressed with cap, socks, nappy, and front-open

--- Content provided by⁠ FirstRanker.com ---

sleeveless shirt or 'jhabala'.

Time of initiation

KMC can be started as soon as the baby is stable

--- Content provided by‍ FirstRanker.com ---

Babies with severe illnesses or requiring special

treatment should be managed according to the unit

--- Content provided by‌ FirstRanker.com ---

protocol

Short KMC sessions can be initiated during recovery with

ongoing medical treatment (IV fluids, oxygen therapy)

--- Content provided by FirstRanker.com ---

KMC can be provided while the baby is being fed via

oro-gastric tube or on oxygen therapy
Duration of KMC

--- Content provided by​ FirstRanker.com ---

Skin-to-skin contact should start gradually in the

nursery, with a smooth transition from conventional

--- Content provided by‍ FirstRanker.com ---

care to continuous KMC

Sessions that last less than one hour should be avoided

because frequent handling may be stressful for the

--- Content provided by FirstRanker.com ---

baby.

The length of skin-to-skin contacts should be gradually

--- Content provided by‌ FirstRanker.com ---

increased up to 24 hours a day, interrupted only for

changing diapers.

When the baby does not require intensive care, she

--- Content provided by⁠ FirstRanker.com ---

should be transferred to the post-natal ward where KMC

should be continued.

--- Content provided by‌ FirstRanker.com ---

Criteria to transfer the baby

from nursery to the ward

Stable baby

--- Content provided by⁠ FirstRanker.com ---

Mother confident to look after the baby

Gaining weight
Discharge criteria

--- Content provided by‌ FirstRanker.com ---

Baby's general health is good and no evidence of

infection

--- Content provided by‍ FirstRanker.com ---

Feeding well, and receiving exclusively or

predominantly breast milk.

Gaining weight (at least 15-20 gm/kg/day for at least

--- Content provided by⁠ FirstRanker.com ---

three consecutive days)

Maintaining body temperature satisfactorily for at least

--- Content provided by⁠ FirstRanker.com ---

three consecutive days in room temperature.

The mother and family members are confident to take

care of the baby in KMC and should be asked to come

--- Content provided by‌ FirstRanker.com ---

for follow-up visits regularly.

When should KMC be

--- Content provided by​ FirstRanker.com ---

discontinued ?

When the mother and baby are comfortable, KMC is

continued for as long as possible, at the institution &

--- Content provided by FirstRanker.com ---

then at home

Often this is desirable until the baby's gestation reaches

--- Content provided by‌ FirstRanker.com ---

term or the weight is around 2500 g

She starts wriggling to show that she is uncomfortable,

pulls her limbs out, cries and fusses every time the

--- Content provided by‌ FirstRanker.com ---

mother tries to put her back skin to skin.

This is the time to wean the baby from KMC

--- Content provided by⁠ FirstRanker.com ---

Mothers can provide skin to skin contact occasionally

after giving the baby a bath and during cold nights.
Post discharge follow up

--- Content provided by FirstRanker.com ---

In general, a baby is followed once or twice a week till

37-40 weeks of gestation or till the bay reaches 2.5-3 kg

of weight

--- Content provided by​ FirstRanker.com ---

Thereafter, a follow up once in 2-4 weeks may be

enough till 3 months of post-conceptional age

--- Content provided by⁠ FirstRanker.com ---

Later the baby should be seen at an interval of 1-2

months during first year of life

The baby should gain adequate weight (15-20

--- Content provided by‌ FirstRanker.com ---

gm/kg/day up to 40 weeks of post-conceptional age and

10 gm/kg/ day subsequently)

--- Content provided by‌ FirstRanker.com ---