Download MBBS Pediatric PPT 2 Breast Feeding Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Pediatric PPT 2 Breast Feeding Lecture Notes


Breastfeeding is the optimal source of nutrition. The

Human Milk is species specific and it provides all the

essential nutrients necessary for the growth and

development of the newborn infant.

Breast Anatomy Structure

Prolactin Reflex

Secretion continues

AFTER feed to

produce NEXT


To increase milk productions

Pituitary releases

prolactin and oxytocin.

Stimulation of

rmones travel

nerve endings

a bloodstream

in mother's

mammary gland


stimulate milk

sends signal

oduction and

to mother's

lk ejection


flex (le down).


Infant suckles

at the breast.
Oxytocin Reflex

For milk ejection

Helping and Hindering the

Oxytocin Reflex

For milk ejection
Inhibitor in Breastmilk

Attachment at Breast
Mechanism of

`Suckling Cycle'

What Differences Do You See?

Picture 1

Picture 2




What Differences Do You See?

Picture 1

Picture 2



Consequences of Poor



Pain and damage to nipples

Sore nipples



Breast milk not removed effectively


Baby unsatisfied,

wants to feed a lot

Apparent poor milk supply

Baby frustrated,

refuses to suckle

Breasts make less milk

Baby fails to gain

Causes of Poor Attachment

Use of feeding bottle

before breastfeeding established

for later supplements

Inexperienced mother

first baby

previous bottle feeder

Functional difficulty

small or weak baby

nipple poorly protractile


late start

Lack of skilled support

less traditional help and community


doctors, midwives, nurses not trained

to help

Feeding Reflexes

Rooting reflex
When something

touches lips,

baby opens mouth

puts tongue down

Sucking reflex

and forward

When something touches

palate baby sucks


Mother learns to position baby

Baby learns to take breast

Swal owing reflex

Gag reflex

When mouth fills with milk,

When something touches

baby swal ows

anterior part of the tongue,

baby pushes it out.
Types and Composition of

Human Breast Milk

Types of Breast Milk:

Colostrum or Early Milk

Transitional Milk

Mature Milk

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

to Colostrum.

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

the termination of the breastfeeding.

Nutrients in Human & Animal Milk 1/4

What are the differences between these milks?
Differences in the Quality of the


Proteins in Different Milks

Differences in the Fats of

Different Milks





Essential Fatty Acids,

No Essential Fatty Acids

Enzyme Lipase

No Enzyme Lipase
Vitamins in Different Milks



Iron in Milk
Types and Composition of Human Breast

Milk (Cont'd)

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

triglycerides phospholipids and essential fatty acids.

Protein ? Whey ; lactoferrin, lysozymes, immunoglobulin A ,

lactalbumin, Casein; lower concentration in human milk.

Carbohydrate ? Include lactose and oligosaccharides.

Leukocytes - Include neutrophils, marcrophages ,


Non protein nitrogen ? urea, uric acid

Other constituents : steroid hormones, peptides, insulins,

growth factors, minerals, vitamins, lipase.

Mechanism of Protection Against




White cells in


mother's body



antibodies to

protect her


antibodies are

Some white

secreted in

cel s go

breastmilk to

to her breast

protect baby

and make

antibodies there
Storage of Breast Milk

Human milk can be stored at room temperature for 4


Expressed milk can be stored in refrigerator for


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

about 3 months

Achieving Optimal Breastfeeding

Activities, attitudes and procedures during the

delivery and post partum period have an impact on


There is well documented evidence soon after

delivery starting breast feeding provides skin to skin

contact between infant and mother, helps to

maintain the body temperatures, reduce risk of

hypoglycemia, enhance oxytocin release and

beneficial nutrition with intake of colostrum

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

after delivery. Procedures after delivery like

weighing, administration of vitamin K, eye

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

Breastfeeding should be started and fully

established before discharge from the hospital

Physicians and health care professionals should

observe at least one feeding and ensure this is

done properly and breast milk is produced

Lactation specialist should also work with

parents that are having difficulty with breast


Early follow up after leaving the hospital is


Signs of Effective Breastfeeding

Frequent feedings 8-12 times daily.

Intermittent episodes of rhythmic sucking with audible swallows should

be heard while the infant is nursing.

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

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

yellow after day 3.

Average daily weight gain of 15 -30g.

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

The baby should be properly positioned to achieve effective latching

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

a neutral position.

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


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

the mouth.

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


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

Cradle Hold

This is the most common

position used by


Infant's head is

supported in the elbow,

the back and buttock is

supported by the arm

and lifted to the breast.
Breastfeeding Positions

Football Hold Position
The infant's is placed under

the arm, like holding a


Baby's body is supported

with the forearm and the

head is supported with the


Many mothers are not

comfortable with this


Good position after

operative procedures

Breastfeeding Positions

Side Lying Position

The mother lies on her side

propping up her head and

shoulder with pillows.

The infant is also lying down

facing the mother.

Good position after Caesarean


Allows the new mother some rest.

Most mothers are scared of

crushing the baby.
Breastfeeding Positions

Cross Cradle Hold Position

Ideal for early breastfeeding.

Mother holds the baby

crosswise in the crook of the

arm opposite the breast the

infant is to be fed.

The baby's trunk and head are

supported with the forearm

and palm.

The other hand is placed

beneath the breast in a U-

shaped to guide the baby's

mouth to your breast.

Breastfeeding Positions

Australian Hold Position

This is also called the

saddle hold

Usually used for older


Not commonly used by


Best used in older

infants with runny nose,

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


Helps in Gastrointestinal development and function

Helps in development of the immune system

Helps in cognitive development of the infant

Infants who are breastfed have reduced risk of infection compared to

formula fed infants.

Benefits of Breastfeeding

to Infants

Breastfed infants have reduced risk of obesity

later in life compared to formula fed infants.

Reduced risk of sudden infant death

syndrome, Hodgkin's lymphoma, Leukemia

and non insulin dependent Diabetes.

Lower risk of infections e.g. otitis media,

Lower respiratory tract infection, Diarrheal

diseases, Allergies , eczema, Meningitis and

inflammatory bowel diseases.
Benefits of Breastfeeding

to Mothers

Enhance early maternal ? infant bond.

Aids involution of the uterus.

Long term breastfeeding helps in loss of the excess weight acquired

during pregnancy.

Prolonged Breastfeeding prolongs anovulation.

Documented long term effect of breastfeeding include reduced risk of

breast, ovarian and endometrial cancers.

Socio-economic Benefits of


Income savings

Reduced risk of infections and diseases hence

reduced hospital visits and attendant medical cost.

Mothers are more economically productive since they

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





Reduces post


delivery bleeding

Low cost

and anemia




Delays next



Less illnesses


Protects breast and

ovarian cancer




Protects obesity and


shapes body



Barriers To Effective
Lack of confidence in mother

Belief that breast milk is not sufficient

Lack of adequate support system

History of previous breast surgery

Breast engorgement, cracked and sore nipples

Retractile nipples
Barriers To Effective Breastfeeding

Embarrassment by mother

Jealousy by siblings

Chronic illness in mother;

psychosis, Cancer.

Contraindication to Breastfeeding

Neonatal conditions-Inborn error of

metabolism; galactosemia, phenylketonuria.

Maternal conditions-
Mothers on certain medications ; anticancer

therapy, radioactive isotope, antithyroid

drugs, MAO inhibitors, lithium, gold

salt,ergotamine etc.

Role of the Nurse

Provide education about breastfeeding at first

prenatal visit

Physical exam should include breast exam

Ensure rooming-in after delivery

Ensure breastfeeding is started and established

before discharge after delivery.

Observe at least a session of breastfeeding to

ensure it is done correctly

Exclusive breast feeding until 6

months of age

Introduce complimentary foods

with continued breastfeeding

Optimum to breastfeed for 2

years or longer


Why some mothers choose

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


Convenience issues

Pressures of employment/school

Worries that breast shape will change

Formula manufacturers manipulate people

through ads

Doctors and nurses need more lactation training ../baby_crying.gif

Why some mothers choose

formula vs. breast milk

Moms given very little time to adjust to changes of


Family demands

Non-supportive family/health professionals


Lack of confidence in self

Feeling that one cannot produce enough milk thumb_27/11304631444pJ47D.jpg
Mother's milk vs. formula milk

Formula milk for 3 days old

babies is no different than

formula milk for 3 months

old infants. media/pr_prosobee_lipil.jpg

Breast milk is ingeniously

different every single day;

adapted to the changing

needs of the baby. Resources/breastfeeding.jpeg

Mother's milk vs. formula milk

Human milk is designed to

support the development of

large brains, capable of

processing and storing lots of


www.babymal images/readingroomcartoon.gif

Cows milk is designed to

support functions, like

constant grazing. quiz/cow_picture.png
Illness Relative risk

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

5.5 times

Inflammatory bowel disease

1.5 to 1.9 times

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


Otitis media 2.4 times
Haemophilus influenzae

meningitis 3.8 times

Necrotizing enterocolitis 6 to

10 times Canopy/4116/stalk.gif

Illness Relative risk


respiratory tract

infection 4 times

Respiratory syncytial

virus infection 3.9 times

Sepsis 2.1 times

Sudden infant death

syndrome 2.0 times


hospitalization 3 times images/lungs1.gif
Barriers to Bonding

* A Bottle places a physical

barrier between mom and


*Less skin to skin contact

*Less eye contact

* The hormonal connection

between the breastfeeding

mother and baby cannot be

experienced by the bottle

feeding mother mom-and-baby-1a.jpg

Other Options If

Breastfeeding is Not Possible

Mom can still use her milk, even if

she decides not to breastfeed:

Use a breast pump (electric/manual)

Cup or bowl feeding

Spoon feeding

Get milk from donation bank ../womanpumping.jpg
There is no freedom of choice for humans

if it has been taken away from them

at the beginning.

Breast-feeding is not a choice,

but an obligation to the choice,

Give your child the freedom of choice. image006.jpg

Kangaroo Mother

Kangaroo Mother Care

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

of low birth weight babies

It fosters their health and well being by promoting

effective thermal control, breastfeeding, infection

prevention and bonding

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

contact by the mother and breastfed exclusively to the

utmost extent

KMC is initiated in the hospital and continued at home.

Components of Kangaroo

Mother Care

Skin to skin contact

Exclusive breast feeding
Pre-requisite for KMC

Support to the mother in hospital and at home

Post discharge follow up

Requirement for KMC


Training of nurses, physicians and other staff

? Educational material
? If possible, reclining chairs in the nursery and postnatal


Mother can provide KMC sitting on an ordinary chair or

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

Preparing for KMC

Arrange a time

Demonstrate her KMC procedure

Encourage her to bring her family members

KMC procedure

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

an upright position

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

extended position

This slightly extended head position keeps the airway open

and allows eye to eye contact between the mother and her


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

position; the arms should also be flexed.

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


Mother's breathing stimulates the baby, thus reducing the

occurrence of apnea.

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

Start kangaroo position as soon as possible after delivery!


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

per the local culture

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

A suitable apparel that can retain the baby for

extended period of time can be adapted locally

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

sleeveless shirt or 'jhabala'.

Time of initiation

KMC can be started as soon as the baby is stable

Babies with severe illnesses or requiring special

treatment should be managed according to the unit


Short KMC sessions can be initiated during recovery with

ongoing medical treatment (IV fluids, oxygen therapy)

KMC can be provided while the baby is being fed via

oro-gastric tube or on oxygen therapy
Duration of KMC

Skin-to-skin contact should start gradually in the

nursery, with a smooth transition from conventional

care to continuous KMC

Sessions that last less than one hour should be avoided

because frequent handling may be stressful for the


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

increased up to 24 hours a day, interrupted only for

changing diapers.

When the baby does not require intensive care, she

should be transferred to the post-natal ward where KMC

should be continued.

Criteria to transfer the baby

from nursery to the ward

Stable baby

Mother confident to look after the baby

Gaining weight
Discharge criteria

Baby's general health is good and no evidence of


Feeding well, and receiving exclusively or

predominantly breast milk.

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

three consecutive days)

Maintaining body temperature satisfactorily for at least

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

for follow-up visits regularly.

When should KMC be

discontinued ?

When the mother and baby are comfortable, KMC is

continued for as long as possible, at the institution &

then at home

Often this is desirable until the baby's gestation reaches

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

mother tries to put her back skin to skin.

This is the time to wean the baby from KMC

Mothers can provide skin to skin contact occasionally

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

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

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

enough till 3 months of post-conceptional age

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

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

10 gm/kg/ day subsequently)

This post was last modified on 07 April 2022