Brest Feeding.final

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Benefits for the infant

Superior nutrition

Breast milk contains the ideal ratio of the amino acids cystine, methionine, and taurine to supportdevelopment of the central and peripheral nervous system. Children aged seven and eight years oldwho were of low birthweight who were breastfed for more than eight months demonstratedsignificantly higher intelligence quotient scores than comparable children breastfed for less time.

Less Diarrhea

Breastfeeding protects infants against diarrhea as compared to formula-fed peers and alsocompared to formula-fed peers, death rates due to diarrhea in breastfed infants are lower irrespective of the development level of the country.

Greater immune health

Breast milk include several anti-infective factors such as bile salt stimulated lipase (protectingagainst amoebic infections), lactoferrin (which binds to iron and inhibits the growth of intestinal

bacteria) and immunoglobulin A protecting factor against microorganisms.

High levels of certain polyunsaturated fatty acids in breast milk (including eicosadienoic,arachidonic and gamma-Linolenic acids) are associated with a reduced risk of child infection wheneven nursed by HIV-positive mothers. Arachidonic acid and gamma-linolenic acid may alsoreduce viral shedding of the HIV virus in Breast milk.

Higher IntelligenceBabies with a specific variant of the FADS2 gene (approximately 90% of all babies) demonstratean IQ an average of 7 points higher if breastfed

Long Term Health Effects

Infants exclusively breastfed have less chance of developing diabetes mellitus type 1 than peerswith a shorter duration of breastfeeding and an earlier exposure to cow milk and solid foods.Breastfeeding also appears to protect against diabetes mellitus type 2 , at least in part due to itseffects on the child's weight.

Breastfeeding appears to reduce the risk of extreme obesity in children aged 39 to 42 months.The protective effect of breastfeeding against obesity is consistent, and appears to increase with theduration of breastfeeding.

A review of the association between breastfeeding and celiac disease (CD) concluded that breastfeeding while introducing gluten to the diet reduced the risk of CD .

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Fewer InfectionsBreastfeeding reduced the risk of acquiring urinary tract infections in infants up to seven months

post-partum. Breastfeeding appears to reduce symptoms of upper respiratory tract infections in premature infants up to seven months after release from hospital. Increased duration of certaintypes of middle ear infections (otitis media with effusion, OME) in the first two years of life is

associated with a shorter period of breastfeeding. A reduced proportion and duration of any otitismedia infection was associated with breastfeeding rather than formula feeding for the first twelvemonths of life.

Less AtopyIn children who are at risk for atopy (defined as at least one parent or sibling having atopy), atopicsyndrome can be prevented or delayed through exclusive breastfeeding for four months.Atopic dermatitis, the most common form of eczema, can be reduced through exclusive

breastfeeding beyond 12 weeks in individuals with a family history of atopy.

Less necrotizing enterocolitis

Necrotizing enterocolitis (NC), found mainly in premature births, is six to ten times more commonin infants fed formula exclusively, and three times more common in infants fed a mixture of breastmilk and formula, as compared to exclusive breastfeeding.

Possible protection from sudden infant death syndrome

Breastfed babies have improved arousal from sleep, which may reduce the risk of sudden infantdeath syndrome

Benefits for mothers

Breastfeeding is a cost effective way of feeding an infant, and provides the best nourishment for achild at a small nutrient cost to the mother. Frequent and exclusive breastfeeding can delay thereturn of fertility through lactational amenorrhea.

CancerBreastfeeding mothers have less risk of endometrial, and ovarian cancer, and osteoporosis.Womenwho were breast fed in infancy may have a lower risk of developing breast cancer than those whowere not breast fed.

Other health benefitsMothers who breastfeed longer than eight months also benefit from bone re-mineralization and

breastfeeding diabetic mothers require less insulin. Breastfeeding helps stabilize maternalendometriosis, reduces the risk of post-partum bleeding and benefits the insulin levels for motherswith polycystic ovary syndrome.

Arthritis

Women who breast feed for longer have a smaller chance of getting rheumatoid arthritis.

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Bonding

The hormones released during breastfeeding strengthen the maternal bond.

Hormone release

Breastfeeding releases the hormones oxytocin and prolactin which relax the mother and make her feel more nurturing toward her baby. Breastfeeding soon after giving birth increases themother's oxytocin levels, making her uterus contract more quickly and reducing bleeding.

Weight loss

As fat accumulated during pregnancy is used to produce milk, extended breastfeedingat least 6monthscan help mothers lose weight.

Methods and considerations

Early breastfeeding

In the half hour after birth, the baby's suckling reflex is strongest, and the baby is more alert, so itis the ideal time to start breastfeeding.

Time and place for breastfeeding

Breastfeeding at least every two to three hours helps to maintain milk production. For mostwomen, eight breastfeeding or pumping sessions every 24 hours keeps their milk production high.Newborn babies may feed more often than this: 10 to 12 breastfeeding sessions every 24 hours iscommon, and some may even feed 18 times a day. Feeding a baby "on demand" (sometimesreferred to as "on cue"), means feeding when the baby shows signs of hunger; feeding thisway rather than by the clock helps to maintain milk production and ensure the baby's needs for milk and comfort are being met.

The sucking patterns and needs of babies vary. Babies may also nurse when they are lonely,frightened or in pain.

The "rooting reflex" is the baby's natural tendency to turn towards the breast with the mouthopen wide; mothers sometimes make use of this by gently stroking the baby's cheek or lips with their nipple in order to induce the baby to move into position for a breastfeedingsession, then quickly moving baby onto the breast while baby's mouth is wide open.

Exclusive breastfeeding

Exclusive breastfeeding is when an infant receives no other food or drink besides breastmilk. National and international guidelines recommend that all infants be breastfedexclusively for the first six months of life. Breastfeeding may continue with the addition of appropriate foods, for two years or more. Exclusive breastfeeding has dramatically reduced infantdeaths in developing countries by reducing diarrhea and infectious diseases.

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Exclusively breastfed infants feed anywhere from 6 to 14 times a day. Newborns consume from30 to 90 ml .After the age of four weeks, babies consume about 120ml per feed. Each baby isdifferent, but as it grows the amount will increase.

It is important to recognize the baby's hunger signs. It is assumed that the baby knows how muchmilk it needs and it is therefore advised that the baby should dictate the number, frequency, andlength of each feed. The supply of milk from the breast is determined by the number and length of these feeds or the amount of milk expressed.

Babies that fail to eat enough may exhibit symptoms of failure to thrive. If necessary , it ispossible to estimate feeding from wet and soiled nappies (diapers): 8 wet cloth or 56 wetdisposable, and 25 soiled per 24 hours suggests an acceptable amount of input for newbornsolder than 56 days old. After 23 months, stool frequency is a less accurate measure of adequate input as some normal infants may go up to 10 days between stools. Babies can also beweighed before and after feeds.

Assessment of Breast feeding

ASK, CHECK RECORDAsk the mother,How is the breast feeding going?

Has your baby fed on the previous hour?

Is there any difficulty?

Is your baby satisfied with the feed?

Have you fed your baby any other foods or drinks?

How do your breasts feel?

Do you have any concerns?

If baby more than one day old:How many times has your baby fed in 24 hours?

LOOK, LISTEN, FEEL

Observe a breastfeed

If the baby has not fed in previous hour, ask mother to put the baby on her breasts &observe for about 5 minutes.

LOOK

Is the baby able to attach correctly?

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Is the baby well positioned?

Is the baby sucking effectively?

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If mother has fed in last one hour, ask her to tell you when her baby is wiling to feed again.

SIGNS CLASSIFY TREAT & ADVISE

Sucking effectivelyBreast feeding 8times in 24 hours ondemand

FEEDINGWELL Encourage the mother to continuefeeding on demand

Not yet breastfed(firsthour of life)Not well attachedNot sucking effectivelyB.F. less than 8 timesper 24 hour Receiving other foods or drinksSeveral days old &inadequate wt.gain

FEEDINGDIFFICULTY

Support exclusive B.F.Help the mother to initiate B.F.Teach correct positioning &attachmentAdvise to feed more frequently, day& nightAdvise mother to stop other foods &drinksReassess at next feed or follow-upvisit in 2 days.

Not sucking(after 6hours of age)Stopped feeding

NOT ABLE TOFEED

Refer baby urgently to hospital

Support exclusive breast feedingKeep the mother & baby together, Do not separate them

Encourage B.F. on demand, day & night, As long as the baby wants.

A baby needs to feed day & night, 8 or more times in 24 hours from birth.

A small baby should be encouraged to feed, day & night, at least 8 times in 24 hours frombirth.

DO NOT FORCE THE BABY TO TAKE BREAST.

DO NOT INTERRUPT BABY BEFORE BABY WANTS.

DO NOT GIVE ANY OTHER FEEDS OR WATER.

DO NOT USE ARTIFICIAL TEATS OR PACIFIERS.

Teach correct positioning & attachmentShow the mother how to hold her baby, she should;

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Make sure babys head & body are in a straight line

Make sure baby is facing the breast; the nose is opposite to nipple

Hold babys body close to her body

Support babys whole body, not just head & shoulder

Show the mother how to help baby to attach, she should;

Touch her babys lips with her nipple

Wait until babys mouth is opened wide

Move baby quickly on to breast, aiming infants lower lip well below nipple.

Look for signs of good attachment;

More of areola visible above babys mouth

Mouth wide open

Lower lip turned outwards

Babys chin touching breast

Look for signs of effective sucking(i.e. slow, deep sucks)

If the attachment or sucking is not good, try again. Then reassess.

If breast engorgement, express a small amount of breast milk before starting to softennipple area so that to make attachment easier.

Expressing breast milk

Manual breast pump

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When direct breastfeeding is not possible, a mother can express (artificially remove and store) her milk. With manual massage or using a breast pump, a woman can express her milk and keep it infreezer storage bags, a supplemental nursing system, or a bottle ready for use.

"Exclusively Expressing", "Exclusively pumping" and "EPing" are terms for a mother whofeeds her baby exclusively on her breastmilk while not physically breastfeeding.

It is generally advised to delay using a bottle to feed expressed breast milk until the baby is 4-6weeks old and is good at sucking directly from the breast. Because it takes less effort to suck froma bottle, a baby might lose its desire to suck from the breast. This is called nursing strike or nipple confusion . To avoid this when feeding expressed breast milk (EBM) before 4-6 weeks of age, it is recommended that breast milk be given by other means such as feeding spoons or feeding cups.

Express breast milk

Need clean container to collect & store milk, with a well fitting lid to cover.

INDICATION: - To provide milk when she is away.

-To feed if baby is small & weak to suckle.

-To relieve engorgement.

-To drain when severe mastitis or abscess.

How to express;

Wash hands thoroughly.

Sit comfortably & hold a clean container underneath breast.

Put first finger & thumb on either side of areola, behind the nipple.

Press slightly inwards toward breast between finger & thumb.

Express one side until milk flow slows. Then express other side.

Continue alternate side for at least 20-30 min.

If milk does not flow well:

Apply warm compresses.

Do massage on back & neck before next expression.

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Teach mother breast & nipple massage.

Feed baby by cup immediately. If not store properly.

Hand express breast milk directly in to babys mouth.

Teach mother how to express.

Hold baby in skin to skin contact, mouth close to nipple.

Wait until baby is alert & opens mouth or stimulate baby lightly to awaken.

Let the baby smell, lick the nipple & attempt to suck.

Let some milk fall in to babys mouth.

Wait until baby swallows before expressing more milk.

When baby has had enough milk he will close mouth & take no more.

Repeat this process every 1-2 hour if baby is very small.

ASSESS REPLACEMENT FEEDINGSIGNS CLASSIFY TREAT & ADVISE

Sucking & swallowing

adequate amount of milk,spilling littleFeeding 8 times in 24 hours ondemand day & night

FEEDINGWELL

Encourage mother to continue feeding by

cup on demand.

Not yet fed(first 6 hours of life)Not fed by cupNot sucking & swallowingeffectively, spilling moreNot feeding adequate amountper dayFeeding < 8 times per dayReceiving other foods & drinksSeveral days old & inadequatewt.gain

FEEDINGDIFFICULTY

Teach mother replacement feedingTeach mother cup feedingAdvice to feed more frequently, ondemand, day & nightAdvise to stop feeding other foods or drinksReassess at next feed or follow-up visit in2 days

Not sucking(after 6 hours of age)Stopped feeding

NOT ABLETO FEED

Refer baby urgently to hospital

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Mixed feeding

Expressed breast milk (EBM) or infant formula can be fed to an infant by bottle

Predominant or mixed breastfeeding means feeding breast milk along with infant formula,

baby food and even water, depending on the age of the child. Babies feed differently withartificial teats than from a breast. When feeding from the breast, the tongue massages the milkout rather than sucking, and the nipple does not go as far into the mouth; when feeding from abottle, an infant will suck harder and the milk may come in more rapidly. Therefore, mixingbreastfeeding and bottle-feeding (or using a pacifier) before the baby is used to feeding from itsmother can induce the infant to prefer the bottle to the breast

Tandem breastfeeding

Feeding two children at the same time is called tandem breastfeeding . The most commonreason for tandem breastfeeding is the birth of twins, although women with closely spacedchildren can and do continue to nurse the older as well as the younger. As the appetite and

feeding habits of each baby may not be the same, this could mean feeding each according to their own individual needs, and can also include breastfeeding them together, one on each breast.

Give special support to breastfeed twins

Explain mother, she has enough supply for two.

Twins may take longer to establish B.F., as they are frequently born preterm withlow birth wt.

Start feeding one baby at a time until B.F. is well established.

If one baby is weaker, make sure that weaker gets enough milk.

Shared breastfeeding

It used to be common worldwide, and still is in developing nations such as those in Africa, for more than one woman to breastfeed a child. Shared breastfeeding is a risk factor for HIV infectionin infants . A woman who is engaged to breastfeed another's baby is known as a wet nurse

Weaning

Weaning is the process of introducing the infant to other food and reducing the supply of breast milk. The infant is fully weaned once it relies on other food for all its nutrition and it nolonger receives any breast milk. In the past, bromocriptine was sometimes used to reduce theengorgement experienced by many women during weaning. But this medication posed serioushealth risks such as stroke so not used nowadays.

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Sociological factors with breastfeeding

There are several social factors that correlate with differences in initiation, frequency, and durationof breastfeeding practices of mothers. Race, ethnic differences and socioeconomic status andother factors have been shown to affect a mothers choice whether or not to breastfeed and howlong she breastfeeds her child.Race and culture ; African American women are less likely than white women of similar socioeconomic status to breastfeed and Hispanic women are more likely to breastfeed. This maybe evidence that breastfeeding acceptability is based on cultural acceptance, and that acceptanceis related to socioeconomic status in the mothers culture.

Income ; income level can also contribute to women discontinuing breastfeeding early. Morehighly educated women are more likely to have access to information regarding difficulties withbreastfeeding, allowing them to continue breastfeeding through difficulty rather than weaning

early. Women in higher status jobs are more likely to have access to a lactation room and suffer less social stigma from having to breastfeed or express breastmilk at work. In addition, womenwho are unable to take an extended leave from work following the birth of their child are less likelyto continue breastfeeding when they return to work.

Other factors found to have an effect on breastfeeding are household composition,metropolitan/non-metropolitan residence, parental education, household income or poverty status,neighborhood safety, familial support, maternal physical activity, and household smoking status.

Economic factors of breastfeeding

Women who are less likely to breastfeed, their babies lack the protection that breast milkprovides. In the case of poor mothers this combined with the extra cost of artificial feeding couldresult in more debt, and even worse poverty.

The birth of a child puts an economic strain on parents, but this is exacerbated if the baby is notbreastfed. This is also linked to Michael Marmots theory of status syndrome , in which statuslevel, determined by education, wealth, occupation, and social prestige, determines how healthypeople are.

Higher breastfeeding rates will not reduce the socioeconomic disparity, but it might help toincrease the health of those who are poor and disadvantaged.

Breastfeeding difficultiesMany breastfeeding difficulties can be resolved with proper hospital procedures, properly trainedmidwives, doctors and hospital staff, and lactation consultants. There are some situations in whichbreastfeeding may be harmful to the infant, including infection with tuberculosis or HIV, somemedications and some drugs.

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Breastfeeding Difficulties Mother

ASSESS THE MOTHERS BREAST IF COMPLAINING OF NIPPLE OR BREAST PAIN

Sore Nipples

Probably it is the most common difficulty, Caused by different factors.

If nipples feel painfully sore or the nipples or areola feel bruised, it is mainly due to an improper latch-on process or ineffective sucking. Suspect a difficulty with baby's latch or sucking if nipplesbecome very red, raw, blistered, or cracked. A latch or sucking difficulty or a structural variation inthe baby's mouth might result in nipples that look creased or blanched (turn white) at the end of feedings. Certain creams or dressings may promote healing, but others can actually cause moredamage. Also, avoid any treatment that might result in drying the nipple tissue, which may lead tocracking of the skin.

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SIGNS CLASSIFY TREAT & ADVISENo

swelling,redness,tendernessNormal body temp.Nipple not sore & no fissure

seenBaby well attached

BREASTHEALTHY

Reassure the mother

Nipple sore or fissuredBabe not well attached

NIPPLESORENESS

ORFISSURE

Encourage mother to continue B.F.Teach correct position & attachmentReassess after 2 feed(or 1 day).If not

better, teach mother how to expressmilk from affected breast &feed bycup, continue B.F. on healthy side

Both breast are swollen,shiny & patchy red

Temp.38 CFeels ill

MASTITIS

Encourage mother to continue B.F.Teach correct position & attachmentGive cloxacillin for 10 daysReassess in 2 days, if worse or no

improvement refer to hospitalIf severe pain, give paracetemol


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When nipples become red and burn, or feel extremely sore after weeks or months of pain-freebreastfeeding, it may be due to a yeast infection such as thrush, appear as white patches in thebaby's mouth or it may show up as a bright red diaper rash. Specific medications are needed totreat yeast infections.

Insufficient or Delayed Milk Production

A delay in the time when milk "comes in" sometimes occurs in mothers dealing with certain healthconditions.

Infrequent or insufficient breastfeeding (milk removal) is the most common reason for a delay inthe time when the milk "comes in," for insufficient milk production, or for any drop in production.

First thing to do is a review of the number and length of breast feedings.

Occasionally, a mother has a health condition that may temporarily delay the large increase inmilk production usually seen between three to five days following birth (postpartum). These

mothers do not begin to obtain large amounts of milk until seven to 14 days after giving birth. Thecause for a delay in increased milk production may be due to:

severe stress cesarean (surgical) delivery postpartum hemorrhage retained placenta fragments infection or illness with fever diabetes - juvenile, adult-onset and gestational thyroid conditions strict or prolonged bed rest during pregnancy

Low Milk Production

Sometimes, a delay in the time when milk "comes in" turns into an ongoing problem with low milkproduction. Sometimes, a mother has been producing sufficient amounts of milk, and then milkproduction slowly, or quite suddenly, decreases. Some of the conditions associated with a delaymay also have an ongoing effect on milk production, including the following:

severe postpartum hemorrhage (excessive bleeding) retained placental fragments thyroid conditions

Mothers with previous breast surgery that cut some of the nerves, milk-making tissue, or milk

ducts, may have difficulty producing enough milk to fully feed a baby.

Other factors can also lead to insufficient milk production. Maternal smoking has been shown toresult in less milk. Some medications and herbal preparations have a negative effect on theamount of milk produced. Hormonal forms of birth control , especially any containing estrogen,have been found to have a big impact on milk production. However, some mothers report a dropin milk production after receiving/taking a progestin-only contraceptive during the first four to eightweeks after delivery (postpartum). Milk production may also decrease if mother becomepregnant again.

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If insufficient milk production seems to be a problem, yet the baby seems to be suckingeffectively, physician may recommend the following:

(1) Increase the number of breastfeeding to 10 to 12 in 24 hours.(2) Increase the period of skin-to-skin contact with baby.(3) A review of health history of mother to discover if there may be a health condition,

treatment, or medication interfering with milk production.(4) Pump breasts for several minutes after breastfeeding, using a hospital-grade electric

breast pump.(5)Consider a galactogogue, which is a medication or an herbal preparation found to have a

positive effect on milk production.

Flat or Inverted Nipples

Techniques for flat or inverted nipples:

Usually there is little trouble in breastfeeding even if mother's nipples appear to be flatter. Thebenefit of using hard plastic breast shells is not conclusive. Breast shells exert a small amount of traction to help draw the nipple outward. Using a breast pump to draw the nipple out just prior tobreastfeeding may also help.

If nipples invert, or "dent" inward, with stimulation, Nipple eversion devices are available.Occasionally, a mother has one or more severely inverted nipples. If one breast is less affected,babies can breastfeed on only one breast.

The management of flat nipples (much engorgement contributes to the problem):

Try to manipulate the nipple a little, to make it more erect and easy to grasp.

It is often helpful to remove some of the milk so that the breast becomes a little softer either express by hand, or use a breast pump.

Gently and patiently, put the infant to the breast for another try. One drop of milk left at thetip of the nipple may act as an appetizer.

Remember that the nipple and the areola must both be put well into the babys mouth.Sometime to do these press the baby rather firmly on to the breast. Dont be afraid to dothis if you think the breast is going to block the babys nose, use a finger to hold thebreast clear of the nose dont pull the babys head away!

If the baby still does not succeed, let it suck through a nipple shield for a few days, until

engorgement subsides and the nipple has stretched.

Plugged Milk Ducts

A plugged duct feels like a tender lump in the breast. Usually they occur when a mother goes toolong without emptying her breasts, or if insufficient milk is removed during feedings. Reviewbaby's feeding routine and see if the time between one or more feedings has recently changed for any reason. Ineffective sucking may contribute to plugged ducts.

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Management ; be sure to breastfeed/remove milk often and alternate different feeding positions. Itoften helps to apply warm compresses to the area or soak the breast with warm water. Massageabove and then over the affected area when breastfeeding and after application of warmcompresses .

Mastitis

Mastitis is often due to breast infection or due to an inflammation. Often a reddened area is notedon the breast. Reasons are similar to those for plugged duct development, and the sameinterventions usually are helpful.

Management ; It is especially important to keep the affected breast "empty" through frequentbreastfeeding. If there are flu-like symptoms or the temperature increases to 100.4 F or higher,patient should be prescribed an antibiotic probably for 10 to 14 days.

Breastfeeding Difficulties Baby

Ineffective Latch-On or Sucking

A baby must be able to effectively remove milk from the breast to gain weight .Therefore;ineffective milk removal can result in poor weight gain which is then followed by a drop in theamount of milk being produced for the baby.

A baby's ability to suck and remove milk may be affected by Prematurity, labour and deliverymedication , and conditions such as Down syndrome , may initially make it difficult for a baby'scentral nervous system to remain alert or coordinate suck-swallow-breathe actions.

Acute health conditions (jaundice or infections) and chronic conditions , such as cardiacdefects may also influence a baby's level of alertness or the ability to suck.

A "mechanical" issue , such as tongue-tie or a cleft lip or palate might directly interfere with ababy's ability to use the structures in the mouth for effective sucking.

Signs of ineffective sucking may include the following:The baby who consistently :

1. Does not wake on his/her own to cue for feedings eight or more times in 24 hours.2. Cues to feed 14 or more times in 24 hours.3. Latches on and then lets go of the breast repeatedly.4. Pushes away or resists latch-on.5. falls asleep within five minutes of latch-on or after sucking for only two or three minutes.6. Does not suck almost continuously for the first seven to 10 minutes of a feeding.7. Continues to feed without self-detaching at the first breast after 30 to 40 minutes.8. Feeds for more than 45 minutes without acting satisfied or full after a meal.9. Produces less than 3 stools in 24 hours by the end of the first week (for the first 4 to 8 weeks).10. seems "gassy" and produces green, frothy stools after the first week.11. Produces fewer than six soaking wet diapers in 24 hours by the end of the first week.12. Has difficulty taking milk by other alternative feeding methods.

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The mother who:

1. Have persistent sore or bruised nipples or areola.2. Develops red, scraped or cracked nipples.3. Frequently observes misshapen nipples after feedings (i.e., creasing or flattening).4. Rarely or never notices fullness prior to, and a softening of the breasts after, a feeding,

especially if there are several hours between feedings.5. Experiences more than one episode of plugged ducts or mastitis.

How you can help with the breastfeeding process:

1. Wake the baby to breastfeed every two to three hours if he/she is "sleepy" and still has notmastered feeding cues.

2. Your baby probably will do better for some feedings. Do not be discouraged if he/she is toosleepy or seems to "forget" from feeding to feeding.

3. Some feedings will last longer than others, and your baby may need time to "get going" atthe breast for some feeds.

4. Massage your breast with downward and inward strokes to deliver milk into the baby'smouth when he/she begins to fall asleep at the breast too soon after starting to feed.

5. Chart the number, amount, and color of urine and stools for wet and dirty diapers on a dailyrecord.

6. Use a hospital-grade, electric breast pump to ensure milk removal. Express milk for several

minutes after breastfeeding. How long you will need to continue to pump depends on howquickly your baby learns to breastfeed effectively.

7. Weigh the baby regularly or record a test-weight before and after one or more dailyfeedings.

8. Offer additional calories by giving baby any expressed breast milk available first or aprescribed infant formula based on his/her progress at breast. The amount used and thealternative feeding method used should change as your baby's sucking ability improves.

Certain breastfeeding devices or alternative feeding methods may encourage effectivesucking during the "learning to breastfeed" process. Devices that may be helpful in certainsituations include the following:

o Nipple shieldA thin silicone or latex nipple shield, which is centered over the nipple and areola, has beenshown to encourage a better latch, more effective sucking pattern, and better milk intakeduring breastfeeding for certain babies.

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o Feeding tube systema feeding-tube system may be taped to the breast or your finger so that a baby receivesadditional milk through the tube when the baby sucks. When a thin feeding tube is attachedto a syringe and taped it to the breast or your finger (finger-feeding), you or a helper cangently press the plunger to deliver a few drops of milk in the baby's mouth if the baby"forgets" to suck. Commercial feeding-tube systems are also available.

o Alternative feeding methodsIn addition to a feeding-tube system, there are other alternative feeding methods that willensure that your baby gets enough food, yet are less likely to interfere with long-termbreastfeeding. These include cup-feeding, syringe-feeding, spoon-feeding, or (eye) dropper-feeding. If using a bottle, bottle nipples (teats) with a slower rate of flow usually arepreferred.

If any structural variation in the baby's mouth is found, work with the proper healthcareprofessionals to correct or treat it.

Slow or Poor Infant Weight Gain

Determining slow or poor infant weight gain:

Weight gain is one of many signs of good health in the breastfeeding baby. Sometimes, aperfectly healthy baby simply gains weight slowly because it is just his/her own unique growthpattern. If a baby is not gaining weight according to certain patterns, the baby and the mother should be checked.

Distinguishing the "natural" slow gainer from a slow-weight-gain problem:

A baby that is a "natural" slow-gainer still gains weight steadily, albeit slowly:

Maintains a particular growth curve.

Increases in length and head circumference increase according to typical rates of growth.

Wakes on his/her own and are alert and cues to breastfeed about 8 to 12 times in 24hours.

Produces wet and dirty diaper counts similar to a faster-growing baby.

Does not gain at least one-half an ounce (15 g) a day by the fourth or fifth day after birth.

Does not regain birth weight by two to three weeks after birth. Does not gain at least one pound (454 g) a month for the first four months (from lowest

weight after birth versus birth weight).

Exhibits a dramatic drop in rate of growth (weight, length, or head circumference) fromher/his previous curve.

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Mismanaged Breastfeeding

Managing mismanaged breastfeeding:

Perhaps the most common cause of slow weight gain is related to mismanaged breastfeeding.The following are some ways to help your baby gain weight if breastfeeding management is thereason for the slow weight-gain pattern.

Watch for signs from baby that he/she wants to feed. baby should wake and "cue" tobreastfeed about eight to 12 times in 24 hours by rooting, making licking or suckingmotions, bobbing his/her head against the mattress, mothers neck or a shoulder, or bringing his/her hand to the face or mouth. Put him/her to breast right then.

Crying is a late feeding cue. Usually a baby latches and breastfeeds better if he/she doesnot have to wait until he/she is crying, frustrated, or too tired to feed. Putting a baby off totry to get the baby to go longer between feedings and frequently offering a pacifier insteadof the breast when a baby demonstrates feeding cues are often linked to poor weight gain.

If your baby is a "sleepy" baby who does not cue to feed at least eight times in 24 hours,you will have to wake the baby to feed frequently - about every two hours during thedaytime and evening hours and at least every three to four hours at night until weight gainimproves.

Be sure baby is mainly uncovered during breastfeeding. A baby that is bundled papoose-style seems to get much too warm and comfy, and he/she is more likely to doze off tooquickly during feedings. If there is a chill in the air, drape a sheet or light blanket over youand the baby, as needed.

If the baby falls asleep within minutes of latching on, massage the breast as youbreastfeed to re-trigger sucking by stroking downward and inward on the breast.

Make sure the baby is latching on correctly and sucking effectively.

In general, avoid "switch nursing." That is, breastfeeding at one breast for a few minutes,then the other, and then back again. This may interfere with your baby getting enough of the calorie-rich hindmilk, which your baby gets more of as a feeding continues on onebreast. However, the "switch" strategy sometimes stimulates the "sleepy" baby so he/shewakes up and begins sucking again.

Offer a supplement during, or after, breastfeeding (when prescribed) to provide additional

calories. Use mothers own expressed milk first for any alternative feedings if anysupplementary feedings are recommended.

Use an alternative feeding method recommended , Alternative feeding methods include:

o cup feedingo a tube system with a special feeding tube taped to the breast or a finger o syringe feedingo an eyedropper

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o spoon feedingo bottle-feeding

Baby should be weighed on a frequent and regular basis until he/she is gaining weight ata satisfactory rate. Digital scales are available to get precise pre- and post-feeding weightsin order to measure how much milk a baby takes in during a particular breastfeeding.Although this can be helpful, babies take in different amounts at different feedingsthroughout a 24-hour period. They also may suggest recording only a daily or weeklyweight, depending on the situation.

If breastfeeding is properly managed, yet the baby still is not gaining adequate weight, it is likelythat some other factor is affecting milk production or the baby's ability to breastfeed effectively.Always consult your physician in this case.

Over-Active Let-DownAlthough most babies with breastfeeding difficulties have problems related to getting enough milk,a few have the opposite problem - handling too much milk. Some mothers have such a strong let-

down that the baby cannot handle the volume of milk.

If your baby chokes, gags, pushes off of the breast a minute or two after beginning to feed, anover-active let-down may be the cause.

Most babies do learn to handle let-down as they mature, but until then you might take the baby off the breast until the milk flow slows. Try using only one breast each feeding. Some mothers find ithelps to position the baby so that the back of her throat is higher than the nipple, so that the milkhas to "travel" uphill during a let-down, which slows the flow. Another option is to try pumpingthrough the let-down immediately before a feeding.

Contraception while breast-feedingDuring breastfeeding, many types of contraceptives are safe. Suitable methods for breastfeedingwomen are:AbstinenceCondomsDiaphragmCervical capMini-PillDepo ProveraImplanonIUD: copper and Mirena

Mirena

Breastfeeding your premature babyWhen a baby arrives prematurely, there are many good reasons for supplying baby withbreastmilk. The breastmilk of mothers who deliver prematurely is ideally suited to the specialneeds of the premature baby.

Help a premature baby to resist infection. Improve the neurological development of premature infants.

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.Give special support to small baby (preterm and/or LBW)Reassurance

Explain she can breast feed & she has enough milk

Explain How the appearance of milk changes

A small baby will not feed as well as normal baby in first days;

May tire easily & suck weakly at first

May Suckle for shorter periods

Long pause between sucking

Does not always wake up for feeds.

Encourage skin to skin contact since it makes B.F. easier.

HELP THE MOTHER

Initiate B.F. within 1 hour.

Feed baby every 2-3 hours, wake baby for feeding,2 hours after last feed.

Always start with B.F. before offering a cup.

Keep the baby long at breast. Allow long pause or slow feed. Do not interrupt feed if babyis still trying.

If baby is not yet sucking well and long enough,

Let the mother express breast milk in babys mouth.

Let the mother express breast milk and feed by cup.

Teach mother to observe swallowing if giving expressed milk.

Weight baby daily, record & assess weight gain.

Infant weight gain Pattern

Breastfed infants generally gain weight according to the following guidelines:

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04 months: 170 grams per week 46 months: 113142 grams per week612 months: 57113 grams per week It is acceptable for some babies to gain 113142 grams (45 ounces) per week. Thisaverage is taken from the lowest weight, not the birth weight.

The average breastfed baby doubles birth weight in 56 months. By one year, the typicalbreastfed baby will weigh about 2 times birth weight. At one year, breastfed babies tend to beleaner than bottle fed babies. By two years, differences in weight gain and growth betweenbreastfed and formula-fed babies are no longer evident.

What is the best way to store and freeze/thaw milk?General guidelines ;

Containers used for collection or storage of breastmilk should be clean and sterile. Small plasticbags or disposable bottle liners (double bag) can be used to freeze milk which are commerciallyavailable.

Label each collection with name and date, as the oldest milk will be used first. It is safest torefrigerate or freeze milk promptly after pumping. Fresh milk can be refrigerated and transportedon ice to the NICU

Storage times: Recommendations provided by WHO

Fresh milk(6 hours at room temperature),refrigerator (3-4 days, at the back of the fridge where it is coldest),freezer compartment of your refrigerator (2 weeks),if the refrigerator has a separate door (3 months),deep freezer (6-12 months).Frozen milk: if thawed in the fridge but not warmed (4 hours or less at room

temperature),thawed in the fridge (24 hours but don't refreeze),thawed in warm water (only for the duration of the feed, or back inthe fridge for a maximum of 4 hours).

To defrost: Thaw under warm running water or in a tepid water bath. Do not use hotwater, as this can destroy some of the milk's benefits. Do not thaw by leaving on thecounter for a long period of time (the refrigerator is O.K. though). Do not microwavebreast milk to heat it or thaw it. Breast milk also separates, so gently swirl to remix

What is the WBW?

The World Breastfeeding Week (WBW)is the greatest outreach vehicle for the

breastfeeding movement, beingcelebrated in over 120 countries.

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2007: Breastfeeding: The 1st Hour - Save ONE million babies!2006: Code Watch: 25 Years of Protecting Breastfeeding2005: Breastfeeding and Family Foods: LOVING &HEALTHY2004: Exclusive Breastfeeding: the Gold Standard Safe, Sound,Sustainable2003: Breastfeeding in a Globalised World for Peace andJustice2002: Breastfeeding: Healthy Mothers and Healthy Babies2001: Breastfeeding in the Information Age2000: Breastfeeding It's Your Right!

1999: Breastfeeding - Education for Life1998: Breastfeeding - The Best Investment1997: Breastfeeding - Nature's Way
http://www.waba.org.my/whatwedo/wbw/wbw00/wbw2000.htmhttp://www.waba.org.my/whatwedo/wbw/wbw00/wbw2000.htm


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Officially it is celebrated from 17 August. However, groups may choose other dates to make it a moresuccessful event in their countries.

The World Alliance for Breastfeeding Action (WABA) was formed in 1991 to act on the InnocentiDeclaration (1990) to protect, promote and support breastfeeding. As part of its action plan tofacilitate and strengthen social mobilisation for breastfeeding, WABA envision a global unifying

breastfeeding promotion strategy. A day dedicated to breastfeeding was suggested to be marked inthe calendar of international events. The idea of a day's celebration was later turned into a week.

This has become to be known as World Breastfeeding Week (WBW) celebrated every 1-7 Augustto commemorate the Innocenti Declaration. World Breastfeeding Week was first celebrated in1992. Now it involves over 120 countries and is endorsed by UNICEF, WHO and FAO.

Overall coordination of World Breastfeeding Week is done at the WABA Secretariat in Penang,

Malaysia, which includes the selection of the theme and slogan, identifying resource persons for aspecific theme and the preparation and dissemination of World Breastfeeding Week materials suchas the calendar announcement, posters, action folders and banners. These advocacy materials serveto stimulate action among local groups, governments, UN and other agencies and other issueorganisations for their own World Breastfeeding Week activities in their area/country.

World Breastfeeding Week 2008 Mother Support: Going for the Gold

Breastfeeding results from a reproductive health continuum for the mother to the child with no beginningor end, from generation to generation. When a practice is disrupted, it must be restored. However,

restoration of the breastfeeding culture demands more resources and mobilization.

In conjunction with the Olympics next August, WBW 2008 calls for greater support for mothers inachieving the gold standard of infant feeding: breastfeeding exclusively for six months, and

providing appropriate complementary foods with continued breastfeeding for up to two years or beyond.

As every country sends its best athletes to compete at these global games, it is important to remindourselves that, in a similar fashion, a healthy young athlete can only emerge from a healthy start onlife. There is no question that optimal infant and young child feeding is essential for optimalgrowth and development.

Supporting Mother = Supporting Her to Provide the Golden Start For Every Child!

Baby-friendly hospital

Baby-friendly hospital is a designation awarded by the World Health Organization and theUnited Nations Children's Fund to hospitals worldwide that foster evidence based strategiesconcerning infant feeding. These strategies have as an outcome an increased likelihood of

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WBW themes over the years


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informed decision making regarding infant feeding and greater skills for mothers to initiate andsustain breastfeeding. It is termed baby friendly because it is a global strategy inclusive of andbeneficial to all mothers regardless of how they decide to feed their infants. The designation isawarded according to stringent criteria. The award recognizes facilities that offer mothers theinformation, confidence and skills needed to successfully initiate and continue breastfeeding their

babies.

The initiative was launched in 1991 as part of an effort to promote nursing over formula feeding.In developing countries, formula feeding is associated with higher infant mortality and higher social and economic costs. Even in developed countries, breastfeeding offers nutritional,developmental, immunologic, and psychological advantages.

The criteria for designation as Baby-Friendly include:

1. Have a written breastfeeding policy that is routinely communicated to all health care staff.2. Train all health care staff in skills necessary to implement this policy.

3. Inform all pregnant women about the benefits and management of breastfeeding.4. Help mothers initiate breastfeeding within one half-hour of birth.5. Show mothers how to breastfeed and maintain lactation, even if they should be separated

from their infants.6. Give newborn infants no food or drink other than breast milk, not even sips of water, unless

medically indicated.7. Practice rooming in - that is, allow mothers and infants to remain together 24 hours a day.8. Encourage breastfeeding on demand.9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding

infants.10. Foster the establishment of breastfeeding support groups and refer mothers to them on

discharge from the hospital or clinicThe program also restricts use by the hospital of free formula or other infant care aids provided byformula companies.

Between 1991 and 2005, approximately 15,000 facilities worldwide have been inspected andaccredited as "Baby-Friendly."

The concept of "rooming in" is rapidly being converted to the concept of bedding in, where theneonate is transferred to the mother within 30 minutes after a normal vaginal delivery andmaximum of 4 hours following a caesarean section.

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Documents

Brest Feeding.final