My choice

World Breastfeeding Week(1 – 7 August)

Breastfeeding - The foundation to

Sustainable Development

ADVANTAGES OF MOTHERS MILK Ideal ConstituentsImmune FactorsGrowth Promoting FactorsEnzymesHormonesCytokines

Types and Composition of Human Breast Milk• Types of Breast Milk:

• Colostrum or Early Milk• Transitional Milk• Mature Milk

• Colostrum or Early Milk: is produced in the late stage of pregnancy till 4 days after delivery; and is rich in antibodies.

• Transitional Milk: produced from day 4 – 10 is lower in protein in comparison to Colostrum.

• Mature milk: is produced from approximately ten days after delivery up until the termination of the breastfeeding.

Kind (In 100 ml)

Protein (g)

Fat (g)

Carbohydrate(g)

Calorie (Kcal)

Colostrum 7.5 2 4-5 150

Transitive 2.5 3.2 5.5 – 6.6 60-80

Mature 1.1-1.5 3.5-4.5 7 65-70

Nutrients in Human & Animal Milk

What are the differences between these milks?

Differences in the Quality of the Proteins in Different Milks

Differences in the Fats of Different Milks

HUMAN COW`S

Contains

Essential Fatty Acids,

Enzyme Lipase

Contains

No Essential Fatty Acids

No Enzyme Lipase

Vitamins in Different Milks

Iron in Milk

Mother’s MilkComposition Unmatched

BREAST MILK COMPOSITION

• Carbohydrates (Bifidus factor = growth factor present only in human milk required for establishing an acidic environment in the gut to inhibit growth of bacteria, fungi and parasites)

• Protein -Lactoferin => Isolates external iron -Secretory IGA => Most important

immunoglobulin, breast milk = only source for first 6 weeks

Mother’s milk vs. formula milk• Formula milk for 3 days

old babies is no different than formula milk for 3 months old infants.

• Breast milk is ingeniously different every single day; adapted to the changing needs of the baby.

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Mother’s milk vs. formula milk

• Human milk is designed to support the development of large brains, capable of processing and storing lots of information.

• Cows milk is designed to support functions, like constant grazing.

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Newborn’s Choice

Breast Feeding decreases Pneumonia Deaths

Breast Feeding decreases Diarrhoea episodes

Breast Feeding decreases Neonatal Jaundice

Breast feeding alone can save up to 13%

babies

BreastfeedingMother Health Benefits

• Breastfeeding could also prevent the death of 20,000 women a year from breast cancer.

• Breastfeeding could also improve birth spacing.

• Breastfeeding is associated with a reduction a woman’s risk of diabetes.

• Breastfeeding might reduce rates of ovarian cancer.

Breast feed –Stay in shape

• Scaling up breastfeeding could save the lives of more than 820,000 children under age 5.

• Breastfeeding is associated with an IQ increase of 3 to 4 points.

• Children who are breastfed for longer periods have lower infectious morbidity and mortality rates than children who are breastfed for shorter periods or who are not breastfed.

• Longer periods of breastfeeding are associated with a reduction in a child’s risk of overweight or obesity.

BreastfeedingInfant Health Benefits

BreastfeedingInfant Health Benefits

• Allergies, eczema • Urinary tract infections • Inflammatory bowel

disease • Diabetes, type 1 • Gastroenteritis • Hodgkin's lymphoma • Otitis media • Haemophilus influenzae

meningitis • Necrotizing enterocolitis.

• Pneumonia/lower respiratory tract infection

• Respiratory syncytial virus infection

• Sepsis • Sudden infant death syndrome .

• Provides immunologic protection while the infant’s immune system is maturing– Antimicrobial agents– Anti-inflammatory agents– Immunomodulating agents

Benefits to family and society

• Saves money

• Promotes family planning

• Decreases need for hospitalization

• Contributes to child survival

Rules of breast feedingExclusive breastfeeding for about 6 mo and To

continue for at least the second year.Complementary foods rich in iron and other

micronutrients should be introduced at about 6 mo of age.

Mother and infant should sleep in proximity to each other to facilitate breastfeeding

Initiation of breastfeeding should be encouraged as soon as possible after the birth, ideally within 1 hour.

Ensure 8 to 12 feedings every 24 h till 2 – 3 months then 6 feeding till 6 months then 5 feeding till one year.

At every feeding the infant is placed only on one breast and then during the next feeding on the other one, thus alternating them.

The duration of feeding is about 20-30 minutes. However, it is said that there is no exact time of every feeding of the infant. Every infant sucks the breast with different frequency and different duration of feedings with a day.

Rules of breast feeding

The amount of milk that the breasts produce depends partly on how much the baby suckles, and how much milk he removes. More suckling makes more milk.

Breastmilk flow depends partly on the mother's thoughts, feelings and sensations. It is important to keep mothers and babies together day and night, and to help mothers to feel good about breastfeeding.

Give no supplements (water, glucose water, commercial infant formula, or other fluids) to breastfeeding newborn infants .

Pacifier should be offered, while placing infant in back-to-sleep-position, no earlier than 3 to 4 wk of age and after breastfeeding has been established.

Rules of breast feeding

Indicators of good attachment and positioning:

• mouth wide open • less areola visible underneath the chin than

above the nipple • chin touching the breast, lower lip rolled

down, and nose free • no pain.

Rules of breast feeding

How Long to Breastfeed?• Exclusively for

the first 6 months of life• Continuing for

at least the first year of life, with addition of solids

• Thereafter, for as long as mutually desired by mother and child

Photo © Mary Boyd, MD, FAAP

AAP Pediatrics 2012;129;e827-41

Storage of Breast Milk

• Human milk can be stored at room temperature for 6-8 hours.

• Expressed milk can be stored in an insulated cooler bag with icepacks for 24hours.

• Breast milk can be stored in the refrigerator for about 5 days at about 40° F.

• It can also be kept in a freezer compartment of a fridge for up to two weeks at 0 - 5°F

• It can be stored in a deep freezer for about 3-12 months.

Storage of Breast Milk• Human milk can be stored at room

temperature for 6-8 hours. • Expressed milk can be stored in an insulated

cooler bag with icepacks for 24hours. • Breast milk can be stored in the refrigerator

for about 5 days at about 40° F.• It can also be kept in a freezer compartment

of a fridge for up to two weeks at 0 - 5°F • It can be stored in a deep freezer for about 3-

12 months.

Barriers to Breast Feeding

Barriers to Breastfeeding • Individual: Inadequate knowledge, embarrassment,

social , negative perceptions• Interpersonal: Lack of support from partner and

family, perceived threat to father-child bond• Institutional: Return to work or school, lack of

workplace facilities, unsupportive health care environments

• Community: discomfort about nursing in public• Policy: aggressive marketing by formula companies

Contraindications of breast feeding

Infants : galactosemia, phenylketoneureaMothers:Mothers infected with HIV ?Active untreated TBMothers taking any of the following medications:

radioactive isotopes, cancer chemotherapy agents, such as antimetabolites, and illegal drugs.

Breastfeeding mothers should avoid alcohol. An occasional drink is acceptable, but breastfeeding should be avoided for 2 hours after the drink.

Commonly Mistaken as contraindication are the following

• Women who have cesarean deliveries: Initiate breastfeeding immediately, using a semi recumbent position on the side or sitting up.

• Women received vaccinations or live with vaccinated children: Neither inactivated nor live vaccines administered to a lactating woman or other family members affect the safety of breastfeeding for the mother or infant.

• Women who had breast surgery: breastfeed frequently to maintain milk supply. If the surgical wound is painful, the other breast can be used but monitor infant growth because milk supply could be insufficient.

• Women who have hepatitis A: Initiate breastfeeding after infant receives immune serum globulin, and then vaccinate at 1 year of age.

• Women who have hepatitis B: Initiate breastfeeding after infant receives hepatitis B immune globulin and first dose of the 3-dose hepatitis B vaccine series.

• Women who have hepatitis C: Hepatitis C is not a contraindication for breastfeeding, but reconsider if nipples are cracked or bleeding.

PAKISTAN statistics

• Deaths in children < 5 yr age = 85 / 1000

• Malnutrition as a factor = 40 %

• Inadequate breastfeeding contributes to Malnutrition = 60 %

TAKE HOME MESSAGE

Mother’s milk is

the BestA. Prof. Dr. Allah Yar Malik.

Breastfeed Your Baby with Full of

Love, Pride & Joy!

BECAUSE EVERY DROP OF BREASTMILK IS PRECIOUS!

THANKS FOR YOUR ATTENTION

RISKS OF BREASTFEEDING

• Breastfeeding is not without potential nutritional risks. The best documented risks include:

• Iron deficiency • vitamin D deficiency • Breastfed exposed infant to environmental toxins

, legal and illegal drugs, and infectious pathogens that the mother may harbor (e.g., Human Immunodeficiency Virus HIV).

Mother’s milk vs. formula milkFormula milk for 3 days

old babies is no different than formula milk for 3 months old infants.

Breast milk is ingeniously different every single day; adapted to the changing needs of the baby.

أراد لمن كاملين حولين أوالدهن يرضعن والوالداتوكسوتهن رزقهن له المولود وعلى ضاعة الر يتم أن

والدة تضآر ال وسعها إال نفس ف تكل ال بالمعروفذلك مثل الوارث وعلى بولده ه ل مولود وال بولدهاجناح فال وتشاور منهما تراض عن فصاال أرادا فإنجناح فال أوالدكم تسترضعوا أن م أردت وإن عليهماالله قوا وات بالمعروف آتيتم مآ متم سل إذا عليكم

بصير تعملون بما الله أن واعلمواAnd the mothers should suckle their children for two whole years for

him who desires to make complete the time of suckling; and their maintenance and their clothing must be-- borne by the father

according to usage; no soul shall have imposed upon it a duty but to the extent of its capacity; neither shall a mother be made to suffer harm on account of her child, nor a father on account of his child,

and a similar duty (devolves) on the (father's) heir, but if both desire weaning by mutual consent and counsel, there is no blame on them, and if you wish to engage a wet-nurse for your children, there is no

blame on you so long as you pay what you promised for according to usage; and be careful of (your duty to) Allah and know that Allah

sees what you do.

• Positive media image of breastfeeding

• Breastfeeding education during medical training

• Family and societal support for breastfeeding

• Breastfeeding as cultural norm

AAP Policy Statement

Photo © La Leche League International

Role of Pediatricians and Other Health Care Professionals in Protecting, Promoting, and Supporting Breastfeeding

Opportunities to Promote Breastfeeding

Prenatal visits– Provide appropriate literature, resources.– Refer for prenatal and breastfeeding classes.– Refer to pediatrician for

prenatal visit.– Avoid formula coupons or products.

Summary• Breastfeeding is the preferred feeding for

almost all infants.• Mothers should be informed of the benefits

of breastfeeding.• Supplementation is rarely indicated and

interferes with successful lactation. • Breastfeeding should be actively

supported and promoted in the medical community and society.

• Women should feel comfortable continuing to breastfeed for as long as desired.

Mother’s milk is

the BestA. Prof. Dr. Allah Yar Malik.