Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Pediatric PPT 2 Breast Feeding Lecture Notes
Introduction
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
fat
Prolactin Reflex
Secretion continues
AFTER feed to
produce NEXT
feed
To increase milk productions
Pituitary releases
prolactin and oxytocin.
Stimulation of
rmones travel
nerve endings
a bloodstream
in mother's
mammary gland
nipple/areola
stimulate milk
sends signal
oduction and
to mother's
lk ejection
hypothalamus/
flex (le down).
pituitary.
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
GOOD
ATTACHMENT
POOR
ATTACHMENT
What Differences Do You See?
Picture 1
Picture 2
ATTACHMENT, OUTSIDE
APPEARENCE
Consequences of Poor
Attachment
u
Pain and damage to nipples
Sore nipples
Fissures
u
Breast milk not removed effectively
Engorgement
Baby unsatisfied,
wants to feed a lot
Apparent poor milk supply
Baby frustrated,
refuses to suckle
Breasts make less milk
Baby fails to gain
weight
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
engorgement
late start
Lack of skilled support
less traditional help and community
support
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
Skill
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
1/5
Proteins in Different Milks
Differences in the Fats of
Different Milks
HUMAN
COW`S
Contains
Contains
Essential Fatty Acids,
No Essential Fatty Acids
Enzyme Lipase
No Enzyme Lipase
Vitamins in Different Milks
1/7
1/8
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 ,
lymphocytes.
Non protein nitrogen ? urea, uric acid
Other constituents : steroid hormones, peptides, insulins,
growth factors, minerals, vitamins, lipase.
Mechanism of Protection Against
1/9
Infection
When
White cells in
Mother
mother's body
infected
make
antibodies to
protect her
These
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
hours.
Expressed milk can be stored in refrigerator for
24hours.
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
breastfeeding
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
feeding.
Early follow up after leaving the hospital is
required.
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
breast.
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
reservoir.
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
mothers.
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
football
Baby's body is supported
with the forearm and the
head is supported with the
hand.
Many mothers are not
comfortable with this
position
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
section.
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
infants
Not commonly used by
mothers.
Best used in older
infants with runny nose,
ear infection.
Can Yo u Identify the positions??
Benefits of Breastfeeding to
Infants
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
Breastfeeding
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
(contd.)
Mother
Society
Family
Reduces post
Eco-friendly
delivery bleeding
Low cost
and anemia
Human
involved
resource
Delays next
developmen
pregnancy
Less illnesses
t
Protects breast and
ovarian cancer
Family
Economy
developmen
Protects obesity and
bonding
shapes body
t
Convenient
Barriers To Effective
Breastfeeding
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.
Psychosis(untreated)
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
RECOMMENDATIONS
Exclusive breast feeding until 6
months of age
Introduce complimentary foods
with continued breastfeeding
Optimum to breastfeed for 2
years or longer
HARMFUL EFFECTS OF
FORMULA MILK
Why some mothers choose
formula vs. breast milk
Distressed by physical discomfort of early breastfeeding
problems.
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
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Why some mothers choose
formula vs. breast milk
Moms given very little time to adjust to changes of
postpartum
Family demands
Non-supportive family/health professionals
Embarrassment
Lack of confidence in self
Feeling that one cannot produce enough milk
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Mother's milk vs. formula milk
Formula milk for 3 days old
babies is no different than
formula milk for 3 months
old infants.
store.enfamil.com/ media/pr_prosobee_lipil.jpg
Breast milk is ingeniously
different every single day;
adapted to the changing
needs of the baby.
breastfeeding.8k.com/ 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
information.
www.babymal .com.au/ images/readingroomcartoon.gif
Cows milk is designed to
support functions, like
constant grazing.
myxo.css.msu.edu/danimal/ 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
times
Otitis media 2.4 times
Haemophilus influenzae
meningitis 3.8 times
Necrotizing enterocolitis 6 to
10 times
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Illness Relative risk
Pneumonia/lower
respiratory tract
infection 4 times
Respiratory syncytial
virus infection 3.9 times
Sepsis 2.1 times
Sudden infant death
syndrome 2.0 times
Industrialized-world
hospitalization 3 times
www.mamashealth.com/ images/lungs1.gif
Barriers to Bonding
* A Bottle places a physical
barrier between mom and
baby
*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
www.photohome.com/.../ 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
graphics.iparenting.com/. ../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.
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Kangaroo Mother
Care
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
implementation
Training of nurses, physicians and other staff
? Educational material
? If possible, reclining chairs in the nursery and postnatal
wards
Mother can provide KMC sitting on an ordinary chair or
in a semi-reclining posture on a bed with the help of
pillows
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
baby.
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
epigastrium.
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!
01/06/2017
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
protocol
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
baby.
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
infection
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