Breast Feeding 126s

Breast feeding

Dr Rania Hussein

Preparation for breast feeding should start . during pregnancy

Dr Rania Hussein

Parts of the breast

Dr Rania Hussein

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

Dr Rania Hussein

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

Dr Rania Hussein

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

Dr Rania Hussein

 Once the baby is latched on and sucking, receptors of the nipple and areola send a message to the hypothalamus, which stimulates prolactin and oxytocin release from the pituitary.  Prolactin reflex= milk – secreting reflex: prolactin makes the breast produce milk  Oxytocin reflex= milk – ejection reflex= letdown reflex: oxytocin makes the milk move from alveoli through duct system to the nipple Oxytocin also produces uterine contraction Dr Rania Hussein

?How breast milk varies

Dr Rania Hussein

: Colostrum . 1 Yellowish milk secreted in the first few days after labor: 1. rich in antibodies and growth factors 2. laxative 3.prepares the baby’s gut for digestion and absorption

Dr Rania Hussein

2. Mature breast milk  Foremilk: lower fat milk released at the beginning of a feeding  Hindmilk: Higher fat milk released toward the end of a feeding

Dr Rania Hussein

WHO ’s infant and young child feeding recommendations Initiate breastfeeding within one hour of

birth.  Breastfeed exclusively for the first six months of age (180 days).  Thereafter give nutritionally adequate and safe complementary foods to all children.  Continue breastfeeding for up to two years of age or beyond. Adapted from the Global Strategy. Dr Rania Hussein

Breastfeeding and complementary feeding and definitions

 EXCLUSIVE BREASTFEEDING: the infant takes only breast milk and no additional food, water, or other fluids with the exception of medicines and vitamin or mineral drops.  Predominant BREASTFEEDING : the infant is given predominantly breast milk ,with some artificial feeds, either milk or cereal, or other food or water.  BOTTLE-FEEDING: the infant is feeding from a bottle, regardless of its contents, including expressed breast milk. Dr Rania Hussein

Breastfeeding and complementary feeding and definitions

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

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

Dr Rania Hussein

Benefits of breastfeeding for the 1. It is a unique food, and infantnutritionally superior to any 2. 3. 4.

alternative Bacteriologically safe and always fresh Contains many anti infectious factors Is the least allergenic of any infant food Dr Rania Hussein

Slide 2.1

5. Breast fed babies are less likely to be overfed, and less likely to become obese, or develop IDDM 6. Promotes bonding and development. 7. Optimizes infant intelligence

Dr Rania Hussein

Nutritious values of breast milk

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

Slide 2.2

Nutrients in human and animal milks Human Fat Protein

Lactose

Cow

Goat

Differences in the quality of proteins in different milks Human milk Cow’s milk Whey protein

Curds Easy to digest

Difficult to digest

 Whey protein is the protein remaining in the watery fraction of milk after the curd and cream have been removed. Contains lactalbumin (an easy to digest protein).  Casein: the principle protein in Cow milk.

Dr Rania Hussein

Nutrients in human and formula milks

Dr Rania Hussein

Anti infective factors (protective factors in human milk) factor  Antistaphylococcus  Bifidus factor: fights enteropathogens  Immnunoglobulins: secretory Ig A which protects the immature infant gut from bacterial infections and foreign protein molecules  Interferon (antiviral)  Lysozyme ( enzyme which breaks cell wall of bacteria)  Macrophages: phagocytes that kill bacteria and fungi  Lactoferrin (iron binding protein Dr Rania Hussein

Benefits of breastfeeding for the 1. Helps reduce risk of uterine bleeding and mother

helps the uterus to return to its previous size

2. Reduces risk of breast and ovarian cancer 3. Helps delay a new pregnancy 4. Helps a mother return to pre-pregnancy weight 5. Conserves iron stores by prolonging amenorrhea Dr Rania Hussein

Benefits of breastfeeding for the family 1. Better health, nutrition, and well-being 2. Economic benefits  breastfeeding costs less than artificial feeding  breastfeeding results in lower medical care costs

Dr Rania Hussein

Benefits of breastfeeding for the hospital Warmer and calmer emotional environment  No nurseries, more hospital space Fewer neonatal infections Less staff time needed Improved hospital image and prestige Fewer abandoned children Safer in emergencies Dr Rania Hussein

Slide 2.28

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Ten steps to successful breast feeding 1. Have a written breast feeding policy that is routinely communicated to all health care staff 2. Train all health care staff in the skills necessary to implement this policy 3. Inform all pregnant females about the benefits and management of breast feeding

Dr Rania Hussein

4. Help the mother initiate breast feeding within a half hour of birth 5. Practice rooming-in : allow mothers and infants to remain together 24 hours a day 6. Encourage breast feeding on demand 7. Give NO artificial teats or pacifiers to breast feeding infants 8. Give newborn infants NO food or drink other than breast milk unless medically indicated

Dr Rania Hussein

9. Show mothers how to breast feed and how to maintain lactation, even if they are separated from their infants 10. Foster he establishment of breastfeeding groups, and refer mothers to them on discharge from the hospital Dr Rania Hussein

How to know that breast feeding is going well?

Dr Rania Hussein

:Signs of successful breastfeeding 1. GENERAL  Mother relaxed and comfortable  Breasts look healthy, no redness, no swelling  Baby calm and relaxed  Baby reaches or roots for breast if hungry

Dr Rania Hussein

:Signs of successful breastfeeding 2. BABY’S POSITION  Baby’s head and body in line. Neck and head not twisted to feed  Baby held close to mother’s body  Baby’s whole body ed, not ed by head and neck only

Dr Rania Hussein

Signs of successful :breastfeeding 3. BABY’S ATTACHMENT  More areola seen above (than below) the baby’s top lip  Baby’s mouth open wide  Lower lip turned outwards  Baby’s chin touches breast

Dr Rania Hussein

Dr Rania Hussein WHO/CHD/93.4, UNICEF/NUT/93.2

Breastfeeding Counselling: a training course,

Good attachment- Poor attachment

Good attachment Poor attachment

Dr Rania Hussein

Wide open mouth

Dr Rania Hussein

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

Dr Rania Hussein

Signs of successful :breastfeeding 5. If the baby  has 6- 8 wet diapers a day,  es normal soft stools,  seems contended  is gaining weight, you can be sure that baby is being well fed Dr Rania Hussein

Difficulties with breast feeding

Dr Rania Hussein

Engorged breasts:

can be reduced by frequent nursing or little milk expression

Dr Rania Hussein

Sore nipples:

treated by correcting feeding positions, leaving milk drops to dry on the nipple after feeding

Dr Rania Hussein

Mastitis

Dr Rania Hussein

:Leaking milk Treated by gentle pressure on the nipples, or wearing soft disposable bra pads

Dr Rania Hussein

?Can you store breast milk Breast emptying stimulates milk production. When an infant is unable to nurse, manual expression or using a breast pump can be used to maintain milk production Dr Rania Hussein

Store milk in a sterile container  Up to 48 hours in refrigerator  CAUTION: Never heat on stove or put in microwave.

Dr Rania Hussein

Practices incompatible with lactation

Dr Rania Hussein

:Intense Exertion . 1 Intense physical activity → ↑ lactic acid in breast milk→ altered milk taste So better to breast feed the baby before exertion

Dr Rania Hussein

2. Alcohol intake 1. 2. 3.

Alteration of milk taste ↓ oxytocin secretion→ ↓ milk ejection Sleepy baby

Dr Rania Hussein

Caffeine intake . 3  Caffeine in coffee and cola can accumulate in the infant causing irritability and wakefulness  Caffeine interferes with bioavailability of iron in breast milk

Dr Rania Hussein

4. Smoking: 1. ↓ milk volume. 2. Nicotine alters smell and taste of milk

Dr Rania Hussein

:Particular foods. 5 1. May alter the smell and taste of milk. 2. May cause colics (especially vegetables and fruits, as garlic, onion, apricots, prunes). 3. In infants who develop food allergy, offenders in mother’s diet may be eggs, fish, peanuts

Dr Rania Hussein

Contraindications of breast feeding 1- Newborn with inborn error of metabolisms as galactosemia, or primary lactase deficiency 2-Infected mother with AIDS 3- Mothers taking drugs as aspirin, sedatives, antiepileptics, radioactive isotopes, cancer chemotherapeutic agents Dr Rania Hussein

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

Dr Rania Hussein

Finally -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 ten minutes of sucking.

Dr Rania Hussein