Feeding of healthy newborn babies. NF-2 Teaching Aids: ENC Learning objectives - 1 To list the benefits of breast feeding Benefits to baby Benefits

Feeding of healthy newborn babies

NF- 2Teaching Aids: ENC

Learning objectives - 1

To list the benefits of breast feeding Benefits to baby Benefits to mother

To explain the physiology of lactation Prolactin reflex Oxytocin reflex

Exclusive breastfeeding

All healthy infants should be breastfed exclusively for the first six months of life

Exclusive breastfeeding is defined as "an infant's consumption of human milk with no supplementation of any type (no water, no juice, no nonhuman milk, and no foods) except for vitamins, minerals, and medications."



Benefits of breast milk to the baby

Breast milk and human colostrum are made for babies and is the best first food

Easily digested and well absorbed Contains essential amino acids Rich in essential fatty acids Better bioavailability of iron and calcium


Benefits of breast milk (contd.)

Prevents under five child deaths Protects against infections Prevents allergies Better intelligence Promotes emotional bonding Less heart disease, diabetes and lymphoma


1. Mother infected

4. Antibody to mother’s infection secreted in milk to protect baby

2. WBC in mother’s body make antibodies to protect mother

3. Some WBCs go to breast and make antibodies there

Protection against infection


Benefits to mother Helps in involution of uterus Delays pregnancy Decreases mother’s workload, saves time and

energy Lowers risk of breast and ovarian cancer Helps reduce weight faster


Benefits to family and society

Contributes to child survival

Saves money

Promotes family planning

Environment friendly


Anatomy of breastMyoepithelial cells

Epithelial cells

ducts

Lactiferous sinus

Areola

Montgomery gland

AlveoliSupporting tissue and fat

Nipple

NF-10Teaching Aids: ENC

Physiology of lactation

Hormonal secretions in the mother

Prolactin helps in production of milk

Oxytocin causes ejection of milk

Reflexes in the baby – rooting, sucking &

swallowing


Enhancing factors Hindering factors

Emptying of breast

Good attachment & effective suckling

Early initiation of breastfeeds

Frequent feeds including night

feeds

Delay in initiation of breastfeeds,

Pre-lacteal feeds,Bottle feeding,

Incorrect positioning,Painful breast

Sensory impulse from nipple

Prolactin in blood

Prolactin “milk secretion” reflex


Baby sucking

Sensory impulse from nipple to brain

Oxytocin contracts myoepithelial cells

Oxytocin “milk ejection” reflex


•Thinks lovingly of baby

•Sound of the baby

•Sight of the baby

•CONFIDENCE

•Worry

•Stress

•Pain

•Doubt

Stimulated by Inhibited by

Oxytocin reflex


Rooting reflexRooting reflex

Swallowing reflexSwallowing reflex

Sucking reflexSucking reflex

Feeding reflexes in the baby


Learning objectives - 2

Ensuring good startTo be able to describe how breastfeeding worksTo recognise good and poor attachment and

positioning of a baby feeding at the breast Overcoming difficulties

To help a mother breastfeed her newborn babyHelp a mother prevent common problems


For successful breastfeeding

A willing and motivated mother

An active and sucking newborn

A motivator who can bring both mother and newborn

together (health professional or relative)


Key points of positioning

Mother:

Make the mother sit in a comfortable and convenient

position (she can feed in lying down position)

Ensure that she is relaxed and comfortable

Baby:

Baby’s head and body are in a straight line

Baby’s whole body is supported

Baby’s face is opposite the nipple and the breast

Baby’s abdomen touches mother’s abdomen


Good positioning


1. Baby’s mouth is wide open

2. Baby’s chin touches the breast

3. Baby’s lower lip is curled outward

4. Usually the lower portion of the areola is not visible

Key points of good attachment


Good attachmentbaby’s mouth is wide openlower lip is curled outward

lower portion of the areola is not visible

chin touches the breast


Good and poor attachment

Effective suckling

For an infant who shows signs of good attachment, the next step would be to assess suckling:

If the infant takes several slow deep sucks followed by swallowing and then pauses, then he/she is sucking effectively



Problems in breastfeeding: Inverted nipple

Treatment should begin after birth

Manually stretch and roll the nipple between the thumb and finger several times a day

Teach the mother to grasp the breast tissue so that areola forms a teat, and allows the baby to feed

Syringe suction method


Inverted nipple: treatment by syringe method

STEP 1

STEP 3

STEP 2

Cut along this line with blade

Mother gently pulls the plunger

Insert the plunger from cut end

Use 10 or 20cc syringe

Before feeds 5-8 times a day

STEP 4 Press at the edge and allow air to enter before removing the syringe


Problems in breastfeeding: Sore nipple

Look for a cause: Check the baby’s attachment

at the breast Check the baby’s position if

attachment is poor Examine the breasts –

engorgement, fissures, candida Ask if mother washes the breasts after each feed

(frequent washing leads to sore nipple)

If the problem persists, check the baby’s oral cavity for candida


Sore nipple: management

Give appropriate treatment: Build mother’s confidence Improve the baby’s

attachment and continue breastfeeding

Reduce engorgement, feed frequently, express breast milk

Treat candida

Advise the mother to: Wash breasts only once a

day; avoid using soap Avoid medicated lotions

and ointments Gently apply hind milk

onto nipple and areola after each feed


Problems in breastfeeding: Breast engorgement

Causes

Delayed and infrequent breastfeeds

Incorrect latching of the baby

Treatment

Give analgesics to relieve pain

Apply warm packs locally

Gently express milk prior to feed

Put the baby frequently to the breast


Full vs. engorged breasts

Full breasts = NORMALEngorged breasts =

ABNORMAL


Full breasts: 36/72 hours after birth. Hot, heavy, may be hard Milk flowing Fever uncommon

Engorged breasts: can occur at any time during

breastfeeding Painful; edematous Tight, especially nipple area Shiny May look red Milk NOT flowing Fever may occur May cause a decrease in milk

supply if it happens often

Full vs. engorged breasts


“Not enough milk”: causes

Not breastfeeding often enough Too short or hurried breastfeeding Night feeds stopped early Poor suckling position Poor oxytocin reflex (anxiety, lack of confidence) Engorgement or mastitis


“Not enough milk”: management

Put baby to breast frequently Baby to be correctly attached to breast Build mother’s confidence Back massage and relaxation can help Use galactogogues (metaclopropamide) judiciously

Adequate weight gain and urine frequency 5-6 times a day are reliable signs of enough milk intake

Adequacy of breastfeeding

Breastfeeding is considered adequate if the babyGoes to sleep for 2-3 hrs after each feedPasses urine 6-8 times in 24 hrsGains weight at 10-15 gm/kg/dayCrosses birth weight by 2 weeks



Expressed breast milk

Indications Sick mother, local breast problems Preterm / sick baby Working mother

Storage Clean wide-mouthed container with tight lid At room temperature: 6 hrs Refrigerator: 24 hours; Freezer (20°C): for 3 months


EXPRESSING BREAST MILK

Place a clean container below your breast to collect m ilk

Massage the breasts gent lytow ard the nipples

W ash your hands w ell w ith soap and w ater

Now press back tow ard your chest , then gent ly squeeze to release m ilk

Place your thum b and index finger opposite each other just outside the dark circle around the nipple

Repeat step 5 at different posit ions around the areola

EXPRESSING BREAST MILK
















Ten steps to successful breastfeeding

Every facility providing maternity services and care for newborn infants should

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



(contd….) 4. Help mothers initiate breastfeeding within half

hour of birth

5. Show mothers how to breastfeed, and how to

maintain lactation even if they are separated from

their infants

6. Give no food or drink, unless medically indicated

7. Practice rooming-in : allow mothers and infants to

remain together 24 hrs 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.


(contd….)

Documents

Feeding of healthy newborn babies. NF-2 Teaching Aids: ENC Learning objectives - 1 To list the benefits of breast feeding Benefits to baby Benefits