Breast Feeding

Breast feedingBreast feeding

Dr Rania HusseinDr Rania Hussein

Preparation for breast feeding should start Preparation for breast feeding should start during pregnancyduring pregnancy . .


Parts of the breastParts of the breast


RootingRooting is a natural reflex for babies. is a natural reflex for babies. The baby’s The baby’s mouth opens mouth opens wide and its wide and its head moves quickly from side to side, head moves quickly from side to side, searchingsearching for the nipple. To start a baby for the nipple. To start a baby rooting, the mother must lightly touch her rooting, the mother must lightly touch her nipple to the baby’s lower lip.nipple to the baby’s lower lip.


Latching on”Latching on” is the expression used to is the expression used to describe how a baby describe how a baby graspsgrasps the mother’s the mother’s nipple with his/her mouth. It is a skill that nipple with his/her mouth. It is a skill that baby must learn with a little help from baby must learn with a little help from mother.mother.


To start breast feeding, mother has to lightly To start breast feeding, mother has to lightly touch her nipple to the baby’s lower lip → baby touch her nipple to the baby’s lower lip → baby will “will “rootroot” for breast → rapidly lift her breast to ” for breast → rapidly lift her breast to its mouth + pull the baby close → baby can its mouth + pull the baby close → baby can latch onto the nipple.latch onto the nipple.


Once the baby is latched on and sucking, Once the baby is latched on and sucking, receptors of the nipple and areola send a receptors of the nipple and areola send a message to the hypothalamus, which message to the hypothalamus, which stimulates prolactin and oxytocin release from stimulates prolactin and oxytocin release from the pituitary.the pituitary.

Prolactin reflex= milk – secreting reflexProlactin reflex= milk – secreting reflex: : prolactin makes the breast prolactin makes the breast produceproduce milk milk

Oxytocin reflex= milk – ejection reflex= let- Oxytocin reflex= milk – ejection reflex= let- downdown reflex:reflex: oxytocin makes the milk oxytocin makes the milk movemove from alveoli through duct system to the nipplefrom alveoli through duct system to the nipple

Oxytocin also produces uterine contractionOxytocin also produces uterine contraction


How breast milk variesHow breast milk varies??


11 . .ColostrumColostrum : :

Yellowish milk secreted in the first few days Yellowish milk secreted in the first few days after labor:after labor:

1.1. rich in antibodies and growth factorsrich in antibodies and growth factors2.2. laxativelaxative3.3.prepares the baby’s gut for digestion and prepares the baby’s gut for digestion and

absorptionabsorption


2. Mature breast milk2. Mature breast milk Foremilk: Foremilk: lower fat milk released at the lower fat milk released at the

beginning of a feedingbeginning of a feeding Hindmilk: Hindmilk: Higher fat milk released toward Higher fat milk released toward

the end of a feedingthe end of a feeding


WHOWHO’’s infant and young s infant and young child feeding child feeding recommendationsrecommendations Initiate breastfeeding within one hour of Initiate breastfeeding within one hour of

birth.birth. Breastfeed exclusively for the first six Breastfeed exclusively for the first six

months of age (180 days).months of age (180 days). Thereafter give nutritionally adequate and Thereafter give nutritionally adequate and

safe complementary foods to all children.safe complementary foods to all children. Continue breastfeeding for up to two years Continue breastfeeding for up to two years

of age or beyond.of age or beyond.

Adapted from the Adapted from the Global Strategy.Global Strategy.


Breastfeeding and Breastfeeding and complementary feeding terms complementary feeding terms and definitionsand definitions

EXCLUSIVE BREASTFEEDING:EXCLUSIVE BREASTFEEDING: the infant takes the infant takes only breast milk only breast milk and no additional food, water, or and no additional food, water, or other fluids with the exception of medicines and other fluids with the exception of medicines and vitamin or mineral drops.vitamin or mineral drops.

Predominant BREASTFEEDING :Predominant BREASTFEEDING : the infant is the infant is given predominantly breast milk ,with some artificial given predominantly breast milk ,with some artificial feeds, either milk or cereal, or other food or water.feeds, either milk or cereal, or other food or water.

BOTTLE-FEEDING:BOTTLE-FEEDING: the infant is feeding from a the infant is feeding from a bottle, regardless of its contents, including bottle, regardless of its contents, including expressed breast milk.expressed breast milk.


Breastfeeding and Breastfeeding and complementary feeding complementary feeding terms and definitionsterms and definitions

COMPLEMENTARY FEEDING:COMPLEMENTARY FEEDING: the process of the process of giving an infantgiving an infant food food in addition to breast milk or in addition to breast milk or infant formula, when either becomes insufficient infant formula, when either becomes insufficient to satisfy the infant's nutritional requirements.to satisfy the infant's nutritional requirements.

ARTIFICIAL FEEDING:ARTIFICIAL FEEDING: the infant is the infant is given breast-milk given breast-milk substitutes substitutes and not and not breastfeeding at all.breastfeeding at all.


Benefits of breastfeeding Benefits of breastfeeding for the infantfor the infant

1.1. It is a unique food, and It is a unique food, and nutritionally superior to any nutritionally superior to any alternativealternative

2.2. Bacteriologically safe and always Bacteriologically safe and always freshfresh

3.3. Contains many anti infectious Contains many anti infectious factorsfactors

4.4. Is the least allergenic of any infant Is the least allergenic of any infant foodfood

Slide 2.1Dr Rania HusseinDr Rania Hussein

5. Breast fed babies are less likely to be 5. Breast fed babies are less likely to be overfed, and less likely to become overfed, and less likely to become obese, or develop IDDMobese, or develop IDDM

6. Promotes bonding and development.6. Promotes bonding and development.7. Optimizes infant intelligence7. Optimizes infant intelligence


Nutritious values of Nutritious values of breast milkbreast milk

Human milk Animal milks Infant formula

Protein correct amount, easy to digest

too much, difficult to digest

partly corrected

Fatenough essential

fatty acids, lipase to digest

lacks essential fatty acids, no lipase no lipase

Water enough extra needed may need extra

Nutrient bioavailability

Higher bioavailability of Fe , Zn, and Ca

Lower bioavailability

Adapted from: Breastfeeding counselling: A training course. Geneva, World Health Organization, 1993 (WHO/CDR/93.6).


Nutrients in human and Nutrients in human and animal milksanimal milks

Fat

Protein

Lactose

Human Cow Goat

Differences in the quality Differences in the quality of proteins in different of proteins in different milksmilks

Cow’s milkHuman milk

Whey protein

Curds

Easy to digest Difficult to digest

Whey protein Whey protein is the protein remaining in the is the protein remaining in the watery fraction of milk after the curd and cream watery fraction of milk after the curd and cream have been removed. Contains have been removed. Contains lactalbuminlactalbumin (an (an easy to digest protein).easy to digest protein).

Casein: Casein: the principle protein in Cow milk.the principle protein in Cow milk.


Nutrients in human and Nutrients in human and formula milksformula milks


Anti infective factors Anti infective factors (protective factors in human (protective factors in human milk)milk)

Antistaphylococcus factorAntistaphylococcus factor Bifidus factor: fights enteropathogensBifidus factor: fights enteropathogens Immnunoglobulins: secretory Immnunoglobulins: secretory Ig A which protects Ig A which protects

the immature infant gut from bacterial infections the immature infant gut from bacterial infections and foreign protein moleculesand foreign protein molecules

Interferon (antiviral)Interferon (antiviral) Lysozyme ( enzyme which breaks cell wall of Lysozyme ( enzyme which breaks cell wall of

bacteria)bacteria) Macrophages: phagocytes that kill bacteria and Macrophages: phagocytes that kill bacteria and

fungifungi Lactoferrin (iron binding proteinLactoferrin (iron binding protein


Benefits of breastfeeding Benefits of breastfeeding for the motherfor the mother

1. Helps reduce risk of uterine bleeding and 1. Helps reduce risk of uterine bleeding and helps the uterus to return to its previous size helps the uterus to return to its previous size

2. Reduces risk of breast and ovarian cancer2. Reduces risk of breast and ovarian cancer

3. Helps delay a new pregnancy3. Helps delay a new pregnancy

4. Helps a mother return to pre-pregnancy 4. Helps a mother return to pre-pregnancy weightweight

5. Conserves iron stores by prolonging 5. Conserves iron stores by prolonging amenorrheaamenorrhea


Benefits of breastfeeding Benefits of breastfeeding for the familyfor the family

1.1. Better health, nutrition, and well-beingBetter health, nutrition, and well-being2.2. Economic benefitsEconomic benefits

breastfeeding costs less than artificial breastfeeding costs less than artificial feedingfeeding

breastfeeding results in lower medical breastfeeding results in lower medical care costscare costs


Benefits of breastfeeding Benefits of breastfeeding for the hospitalfor the hospital

Warmer and calmer emotional environmentWarmer and calmer emotional environmentNo nurseries, more hospital spaceNo nurseries, more hospital spaceFewer neonatal infectionsFewer neonatal infectionsLess staff time neededLess staff time neededImproved hospital image and prestigeImproved hospital image and prestigeFewer abandoned childrenFewer abandoned childrenSafer in emergenciesSafer in emergencies


Ten steps to successful Ten steps to successful breast feedingbreast feeding

1.1. Have a written breast feeding Have a written breast feeding policypolicy that is that is routinely communicated to all health care staffroutinely communicated to all health care staff

2.2. TrainTrain all health care staff in the skills all health care staff in the skills necessary to implement this policynecessary to implement this policy

3.3. Inform all Inform all pregnant females pregnant females about the about the benefits and management of breast feedingbenefits and management of breast feeding


4. Help the mother initiate breast feeding within 4. Help the mother initiate breast feeding within a half a half hour of birthhour of birth

5. Practice 5. Practice rooming-inrooming-in : allow mothers and infants to : allow mothers and infants to remain together 24 hours a dayremain together 24 hours a day

6. Encourage breast feeding 6. Encourage breast feeding on demandon demand7. Give 7. Give NO artificial teats or pacifiers NO artificial teats or pacifiers to breast feeding to breast feeding

infantsinfants8. Give newborn infants 8. Give newborn infants NO food or drink NO food or drink other than other than

breast milk unless medically indicated breast milk unless medically indicated


9. Show 9. Show mothersmothers how to breast feed and how to breast feed and how to how to maintainmaintain lactation, even if they are lactation, even if they are separated from their infants separated from their infants

10. Foster he establishment of 10. Foster he establishment of breast-breast-feeding support groupsfeeding support groups, and refer , and refer mothers to them on discharge from the mothers to them on discharge from the hospitalhospital


How to know that breast feeding How to know that breast feeding is going well?is going well?


Signs of successful breastfeedingSigns of successful breastfeeding: :

1. GENERAL1. GENERAL Mother relaxed and comfortableMother relaxed and comfortable Breasts look healthy, no redness, Breasts look healthy, no redness,

no swellingno swelling Baby calm and relaxedBaby calm and relaxed Baby reaches or roots for breast if Baby reaches or roots for breast if

hungryhungry


Signs of successful breastfeedingSigns of successful breastfeeding: :

2. BABY’S POSITION2. BABY’S POSITION Baby’s head and body in line. Baby’s head and body in line.

Neck and head not twisted to Neck and head not twisted to feedfeed

Baby held close to mother’s Baby held close to mother’s bodybody

Baby’s whole body supported, Baby’s whole body supported, not supported by head and neck not supported by head and neck onlyonly


Signs of successful Signs of successful breastfeedingbreastfeeding: : 3. 3. BABY’S ATTACHMENTBABY’S ATTACHMENT More areola seen More areola seen aboveabove (than below) the (than below) the

baby’s top lipbaby’s top lip Baby’s mouth open wide Baby’s mouth open wide Lower lip Lower lip turned outwards turned outwards Baby’s Baby’s chin touches chin touches breastbreast


Good attachment- Poor attachmentGood attachment- Poor attachment

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Good attachment Poor attachmentGood attachment Poor attachment


Wide open mouthWide open mouth


Signs of successful Signs of successful breastfeedingbreastfeeding: : 4. SUCKING4. SUCKING Slow, deep sucks with pausesSlow, deep sucks with pauses Cheeks round when sucklingCheeks round when suckling We can see or hear the baby swallowingWe can see or hear the baby swallowing Baby finishes sucking after 10 minutesBaby finishes sucking after 10 minutes Mother notices signs of oxytocin reflexMother notices signs of oxytocin reflex


Signs of successful Signs of successful breastfeedingbreastfeeding: : 5. If the baby 5. If the baby has 6- 8 wet diapers a day, has 6- 8 wet diapers a day, passes normal soft stools, passes normal soft stools, seems contended seems contended is gaining weight, is gaining weight, you can be sure that baby is being well you can be sure that baby is being well

fedfedDr Rania HusseinDr Rania Hussein

Difficulties with breast feedingDifficulties with breast feeding


Engorged breasts: Engorged breasts: can be reduced by can be reduced by frequent nursing or little milk expressionfrequent nursing or little milk expression


Sore nipples: Sore nipples: treated by correcting feeding treated by correcting feeding positions, leaving milk drops to dry on the nipple after positions, leaving milk drops to dry on the nipple after feedingfeeding


MastitisMastitis


Leaking milkLeaking milk::

Treated by gentle pressure on the Treated by gentle pressure on the nipples, or wearing soft disposable nipples, or wearing soft disposable

bra pads bra pads


Can you store breast milkCan you store breast milk??

Breast emptying stimulates Breast emptying stimulates milk production. When an milk production. When an infant is unable to nurse, infant is unable to nurse, manual expression or manual expression or using a breast pump can using a breast pump can be used to maintain milk be used to maintain milk productionproduction


Store milk in a sterile containerStore milk in a sterile container Up to 48 hours in refrigeratorUp to 48 hours in refrigerator CAUTION: Never heat on stove or put in CAUTION: Never heat on stove or put in

microwave.microwave.


Practices incompatible with lactationPractices incompatible with lactation


11 . .Intense ExertionIntense Exertion::

Intense physical activity → ↑ lactic acid in Intense physical activity → ↑ lactic acid in breast milk→ altered milk taste breast milk→ altered milk taste

So better to breast feed the baby before So better to breast feed the baby before exertionexertion


2. Alcohol intake2. Alcohol intake

1.1. Alteration of milk tasteAlteration of milk taste2.2. ↓ ↓ oxytocin secretion→ ↓ milk ejectionoxytocin secretion→ ↓ milk ejection3.3. Sleepy babySleepy baby



33 . .Caffeine intakeCaffeine intake Caffeine Caffeine in coffee and cola can accumulate in in coffee and cola can accumulate in

the infant causing irritability and wakefulnessthe infant causing irritability and wakefulness Caffeine interferes with bioavailability of Caffeine interferes with bioavailability of

iron in breast milkiron in breast milk

4. Smoking:4. Smoking:

1.1. ↓ ↓ milk volume.milk volume.2.2. Nicotine alters smell and taste of milk Nicotine alters smell and taste of milk


55 . .Particular foodsParticular foods::

1.1. May alter the smell and taste of milk. May alter the smell and taste of milk. 2.2. May cause colics (especially vegetables and May cause colics (especially vegetables and

fruits, as garlic, onion, apricots, prunes).fruits, as garlic, onion, apricots, prunes).3.3. In infants who develop food allergy, In infants who develop food allergy,

offenders in mother’s diet may be eggs, fish, offenders in mother’s diet may be eggs, fish, peanutspeanuts


Contraindications of Contraindications of breast feedingbreast feeding

1- Newborn with inborn error of metabolisms 1- Newborn with inborn error of metabolisms as galactosemia, or primary lactase as galactosemia, or primary lactase deficiencydeficiency

2-Infected mother with AIDS2-Infected mother with AIDS3- Mothers taking drugs as aspirin, sedatives, 3- Mothers taking drugs as aspirin, sedatives,

antiepileptics, radioactive isotopes, cancer antiepileptics, radioactive isotopes, cancer chemotherapeutic agentschemotherapeutic agents


Breast healthBreast health::

To prevent breast sagging, a nursing To prevent breast sagging, a nursing mother must give proper support, have mother must give proper support, have regular exercise , and take adequate diet.regular exercise , and take adequate diet.


FinallyFinally

-Nurse your newborn baby 8 to 10 times in a 24-hour period.

-Offer one breast and then the other at each feeding.

-A baby will usually get most of the milk from a breast in the first five to tenminutes of sucking.


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Breast Feeding