Download MBBS Pediatric PPT 2 Breast Feeding Lecture Notes

Introduction

Breastfeeding is the optimal source of nutrition. The

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Human Milk is species specific and it provides all the

essential nutrients necessary for the growth and

development of the newborn infant.

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Breast Anatomy Structure

fat
Prolactin Reflex

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Secretion continues

AFTER feed to

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produce NEXT

feed

To increase milk productions

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Pituitary releases

prolactin and oxytocin.

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Stimulation of

rmones travel

nerve endings

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a bloodstream

in mother's

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mammary gland

nipple/areola

stimulate milk

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sends signal

oduction and

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to mother's

lk ejection

hypothalamus/

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flex (le down).

pituitary.

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Infant suckles

at the breast.
Oxytocin Reflex

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For milk ejection

Helping and Hindering the

Oxytocin Reflex

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For milk ejection
Inhibitor in Breastmilk

Attachment at Breast

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Mechanism of

`Suckling Cycle'

What Differences Do You See?

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Picture 1

Picture 2

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GOOD

ATTACHMENT

POOR

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ATTACHMENT
What Differences Do You See?

Picture 1

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Picture 2

ATTACHMENT, OUTSIDE

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APPEARENCE

Consequences of Poor

Attachment

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u

Pain and damage to nipples

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Sore nipples

Fissures

u

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Breast milk not removed effectively

Engorgement

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Baby unsatisfied,

wants to feed a lot

Apparent poor milk supply

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Baby frustrated,

refuses to suckle

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Breasts make less milk

Baby fails to gain

weight

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Causes of Poor Attachment

Use of feeding bottle

before breastfeeding established

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for later supplements

Inexperienced mother

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first baby

previous bottle feeder

Functional difficulty

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small or weak baby

nipple poorly protractile

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engorgement

late start

Lack of skilled support

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less traditional help and community

support

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doctors, midwives, nurses not trained

to help

Feeding Reflexes

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Rooting reflex
When something

touches lips,

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baby opens mouth

puts tongue down

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Sucking reflex

and forward

When something touches

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palate baby sucks

Skill

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Mother learns to position baby

Baby learns to take breast

Swal owing reflex

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Gag reflex

When mouth fills with milk,

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When something touches

baby swal ows

anterior part of the tongue,

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baby pushes it out.
Types and Composition of

Human Breast Milk

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Types of Breast Milk:

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Colostrum or Early Milk



Transitional Milk

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Mature Milk

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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

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to Colostrum.

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

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the termination of the breastfeeding.

Nutrients in Human & Animal Milk 1/4

What are the differences between these milks?

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Differences in the Quality of the

1/5

Proteins in Different Milks

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Differences in the Fats of

Different Milks

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HUMAN

COW`S

Contains

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Contains

Essential Fatty Acids,

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No Essential Fatty Acids

Enzyme Lipase

No Enzyme Lipase

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Vitamins in Different Milks

1/7

1/8

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Iron in Milk
Types and Composition of Human Breast

Milk (Cont'd)

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

triglycerides phospholipids and essential fatty acids.

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Protein ? Whey ; lactoferrin, lysozymes, immunoglobulin A ,

lactalbumin, Casein; lower concentration in human milk.

Carbohydrate ? Include lactose and oligosaccharides.

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Leukocytes - Include neutrophils, marcrophages ,

lymphocytes.

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Non protein nitrogen ? urea, uric acid

Other constituents : steroid hormones, peptides, insulins,

growth factors, minerals, vitamins, lipase.

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Mechanism of Protection Against

1/9

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Infection

When

White cells in

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Mother

mother's body

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infected

make

antibodies to

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protect her

These

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antibodies are

Some white

secreted in

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cel s go

breastmilk to

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to her breast

protect baby

and make

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antibodies there
Storage of Breast Milk

Human milk can be stored at room temperature for 4

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hours.

Expressed milk can be stored in refrigerator for

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24hours.

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

about 3 months

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Achieving Optimal Breastfeeding

Activities, attitudes and procedures during the

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delivery and post partum period have an impact on

breastfeeding

There is well documented evidence soon after

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delivery starting breast feeding provides skin to skin

contact between infant and mother, helps to

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maintain the body temperatures, reduce risk of

hypoglycemia, enhance oxytocin release and

beneficial nutrition with intake of colostrum

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

after delivery. Procedures after delivery like

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weighing, administration of vitamin K, eye

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

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Breastfeeding should be started and fully

established before discharge from the hospital

Physicians and health care professionals should

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observe at least one feeding and ensure this is

done properly and breast milk is produced

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Lactation specialist should also work with

parents that are having difficulty with breast

feeding.

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Early follow up after leaving the hospital is

required.

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Signs of Effective Breastfeeding

Frequent feedings 8-12 times daily.

Intermittent episodes of rhythmic sucking with audible swallows should

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be heard while the infant is nursing.

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

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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

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yellow after day 3.

Average daily weight gain of 15 -30g.

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

The baby should be properly positioned to achieve effective latching

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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

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a neutral position.

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

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breast.

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

the mouth.

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

reservoir.

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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

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Cradle Hold

This is the most common

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position used by

mothers.

Infant's head is

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supported in the elbow,

the back and buttock is

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supported by the arm

and lifted to the breast.
Breastfeeding Positions

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Football Hold Position
The infant's is placed under

the arm, like holding a

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football

Baby's body is supported

with the forearm and the

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head is supported with the

hand.

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Many mothers are not

comfortable with this

position

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Good position after

operative procedures

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Breastfeeding Positions

Side Lying Position

The mother lies on her side

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propping up her head and

shoulder with pillows.

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The infant is also lying down

facing the mother.

Good position after Caesarean

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section.

Allows the new mother some rest.

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Most mothers are scared of

crushing the baby.
Breastfeeding Positions

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Cross Cradle Hold Position

Ideal for early breastfeeding.

Mother holds the baby

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crosswise in the crook of the

arm opposite the breast the

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infant is to be fed.

The baby's trunk and head are

supported with the forearm

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and palm.

The other hand is placed

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beneath the breast in a U-

shaped to guide the baby's

mouth to your breast.

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Breastfeeding Positions

Australian Hold Position

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This is also called the

saddle hold

Usually used for older

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infants

Not commonly used by

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mothers.

Best used in older

infants with runny nose,

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

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Infants

Helps in Gastrointestinal development and function

Helps in development of the immune system

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Helps in cognitive development of the infant

Infants who are breastfed have reduced risk of infection compared to

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formula fed infants.

Benefits of Breastfeeding

to Infants

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Breastfed infants have reduced risk of obesity

later in life compared to formula fed infants.

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Reduced risk of sudden infant death

syndrome, Hodgkin's lymphoma, Leukemia

and non insulin dependent Diabetes.

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Lower risk of infections e.g. otitis media,

Lower respiratory tract infection, Diarrheal

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diseases, Allergies , eczema, Meningitis and

inflammatory bowel diseases.
Benefits of Breastfeeding

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to Mothers

Enhance early maternal ? infant bond.

Aids involution of the uterus.

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Long term breastfeeding helps in loss of the excess weight acquired

during pregnancy.

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Prolonged Breastfeeding prolongs anovulation.

Documented long term effect of breastfeeding include reduced risk of

breast, ovarian and endometrial cancers.

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Socio-economic Benefits of

Breastfeeding

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Income savings

Reduced risk of infections and diseases hence

reduced hospital visits and attendant medical cost.

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Mothers are more economically productive since they

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

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(contd.)

Mother

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Society

Family

Reduces post

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Eco-friendly

delivery bleeding

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Low cost

and anemia

Human

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involved

resource

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Delays next

developmen

pregnancy

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Less illnesses

t

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Protects breast and

ovarian cancer

Family

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Economy

developmen

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Protects obesity and

bonding

shapes body

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t

Convenient

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Barriers To Effective
Breastfeeding
Lack of confidence in mother

Belief that breast milk is not sufficient

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Lack of adequate support system

History of previous breast surgery

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Breast engorgement, cracked and sore nipples

Retractile nipples
Barriers To Effective Breastfeeding

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Embarrassment by mother

Jealousy by siblings

Chronic illness in mother;

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psychosis, Cancer.

Contraindication to Breastfeeding

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Neonatal conditions-Inborn error of

metabolism; galactosemia, phenylketonuria.

Maternal conditions-

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Mothers on certain medications ; anticancer

therapy, radioactive isotope, antithyroid

drugs, MAO inhibitors, lithium, gold

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salt,ergotamine etc.

Psychosis(untreated)
Role of the Nurse

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Provide education about breastfeeding at first

prenatal visit

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Physical exam should include breast exam

Ensure rooming-in after delivery

Ensure breastfeeding is started and established

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before discharge after delivery.

Observe at least a session of breastfeeding to

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ensure it is done correctly
RECOMMENDATIONS

Exclusive breast feeding until 6

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months of age

Introduce complimentary foods

with continued breastfeeding

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Optimum to breastfeed for 2

years or longer

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HARMFUL EFFECTS OF

FORMULA MILK
Why some mothers choose

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

problems.

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Convenience issues

Pressures of employment/school

Worries that breast shape will change

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Formula manufacturers manipulate people

through ads

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Doctors and nurses need more lactation training

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Why some mothers choose

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formula vs. breast milk

Moms given very little time to adjust to changes of

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postpartum

Family demands

Non-supportive family/health professionals

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Embarrassment

Lack of confidence in self

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Feeling that one cannot produce enough milk

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Mother's milk vs. formula milk

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Formula milk for 3 days old

babies is no different than

formula milk for 3 months

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old infants.

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Breast milk is ingeniously

different every single day;

adapted to the changing

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needs of the baby.

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Mother's milk vs. formula milk

Human milk is designed to

support the development of

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large brains, capable of

processing and storing lots of

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information.

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Cows milk is designed to

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support functions, like

constant grazing.

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Illness Relative risk

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

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5.5 times

Inflammatory bowel disease

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1.5 to 1.9 times

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

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times

Otitis media 2.4 times
Haemophilus influenzae

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meningitis 3.8 times

Necrotizing enterocolitis 6 to

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10 times

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Illness Relative risk

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Pneumonia/lower

respiratory tract

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infection 4 times

Respiratory syncytial

virus infection 3.9 times

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Sepsis 2.1 times

Sudden infant death

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syndrome 2.0 times

Industrialized-world

hospitalization 3 times

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Barriers to Bonding

* A Bottle places a physical

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barrier between mom and

baby

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*Less skin to skin contact

*Less eye contact

* The hormonal connection

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between the breastfeeding

mother and baby cannot be

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experienced by the bottle

feeding mother

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Other Options If

Breastfeeding is Not Possible

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Mom can still use her milk, even if

she decides not to breastfeed:

Use a breast pump (electric/manual)

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Cup or bowl feeding

Spoon feeding

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Get milk from donation bank

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There is no freedom of choice for humans

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if it has been taken away from them

at the beginning.

Breast-feeding is not a choice,

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but an obligation to the choice,

Give your child the freedom of choice.

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Kangaroo Mother

Care

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Kangaroo Mother Care

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

of low birth weight babies

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It fosters their health and well being by promoting

effective thermal control, breastfeeding, infection

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prevention and bonding

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

contact by the mother and breastfed exclusively to the

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utmost extent

KMC is initiated in the hospital and continued at home.

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Components of Kangaroo

Mother Care

Skin to skin contact

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Exclusive breast feeding
Pre-requisite for KMC

Support to the mother in hospital and at home

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Post discharge follow up

Requirement for KMC

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implementation

Training of nurses, physicians and other staff

? Educational material

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? If possible, reclining chairs in the nursery and postnatal

wards

Mother can provide KMC sitting on an ordinary chair or

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

pillows
Preparing for KMC

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Arrange a time

Demonstrate her KMC procedure

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Encourage her to bring her family members

KMC procedure

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

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an upright position

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

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extended position

This slightly extended head position keeps the airway open

and allows eye to eye contact between the mother and her

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baby.

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

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position; the arms should also be flexed.

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

epigastrium.

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Mother's breathing stimulates the baby, thus reducing the

occurrence of apnea.

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

Start kangaroo position as soon as possible after delivery!

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01/06/2017


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

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per the local culture

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

A suitable apparel that can retain the baby for

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extended period of time can be adapted locally

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

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sleeveless shirt or 'jhabala'.

Time of initiation

KMC can be started as soon as the baby is stable

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Babies with severe illnesses or requiring special

treatment should be managed according to the unit

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protocol

Short KMC sessions can be initiated during recovery with

ongoing medical treatment (IV fluids, oxygen therapy)

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KMC can be provided while the baby is being fed via

oro-gastric tube or on oxygen therapy
Duration of KMC

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Skin-to-skin contact should start gradually in the

nursery, with a smooth transition from conventional

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care to continuous KMC

Sessions that last less than one hour should be avoided

because frequent handling may be stressful for the

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baby.

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

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increased up to 24 hours a day, interrupted only for

changing diapers.

When the baby does not require intensive care, she

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should be transferred to the post-natal ward where KMC

should be continued.

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Criteria to transfer the baby

from nursery to the ward

Stable baby

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Mother confident to look after the baby

Gaining weight
Discharge criteria

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Baby's general health is good and no evidence of

infection

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Feeding well, and receiving exclusively or

predominantly breast milk.

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

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three consecutive days)

Maintaining body temperature satisfactorily for at least

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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

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for follow-up visits regularly.

When should KMC be

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discontinued ?

When the mother and baby are comfortable, KMC is

continued for as long as possible, at the institution &

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then at home

Often this is desirable until the baby's gestation reaches

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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

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mother tries to put her back skin to skin.

This is the time to wean the baby from KMC

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Mothers can provide skin to skin contact occasionally

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

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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

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

enough till 3 months of post-conceptional age

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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

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

10 gm/kg/ day subsequently)

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