Family Medicine

Team 438

BREAST
FEEDING Editing file

This lecture is based on male’s slides

Lecture Objectives:
➤ To be aware of WHO recommendation
➤ To increase awareness about the benefits of breastfeeding.
➤ To know about the properties of breastfeeding.
➤ To educate about the basics of breastfeeding and empower
parents to make an informed choice.
➤ To educate about the harms associated with formula feeding.
➤ To know how can you deal with Breast Engorgement
➤ To know about the contraindication of breastfeeding

❏ Important
❏ Original content
❏ Only in girls slides
❏ Only in boys slides
❏ Doctor’s notes
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THE BABY-FRIENDLY HOSPITAL INITIATIVE

● Provides guidance on the implementation, training, monitoring, assessment and

re-assessment of the Ten Steps to Successful Breastfeeding and the International
Code of Marketing of Breast-milk Substitutes, a set of recommendations to
regulate the marketing of breast-milk substitutes, feeding bottles and teats
adopted by the 34th World Health Assembly (WHA).

IMPORTANT SKIN-TO-SKIN CONTACT

● Is when the infant is placed prone on the mother’s abdomen or chest in direct
ventral-to-ventral skin-to-skin contact.
● Immediate skin-to-skin contact is done immediately after delivery, less than 10
minutes after birth.
● Early skin-to-skin contact was defined as beginning any time from delivery to 23
hours after birth.
● Skin-to skin contact should be uninterrupted for at least 60 minutes. The infant is
thoroughly dried and kept warm (for instance by being covered across the back
with a warmed blanket).

EARLY INITIATION OF BREASTFEEDING

● Involves a breastfeeding initiation time of within 1 hour after birth.

● Delayed breastfeeding initiation means initiating breastfeeding after the first hour
after birth (2–23 hours after birth or a day or more after birth).
● Timing of breastfeeding initiation:
○ Early breastfeeding: if initiated to baby within the first one hour of birth.
○ Delayed breastfeeding: if the time of the first breastfeeding initiation is
more than one hour after birth).
 Showing Mothers how to Breastfeed:
● Is a supportive interventions that enable mothers to breastfeed
successfully.
● This support usually involves showing mothers how to hold and position
their infant to attach to the breast.

IMPORTANT A GOOD BREASTFEEDING LATCH

● The ideal latch encompasses both the nipple and the surrounding areola.
● A proper latch if the baby's chin and tip of nose are touching breast.
● Clamping down just on the nipple is not only inefficient for drawing out milk but
can also cause nipple damage and pain.
● Why a good breastfeeding latch is important?
○ A good latch is the foundation of successful breastfeeding. It allows your
baby to feed freely, and stop when satisfied.
○ It's also the only way to make breasts are stimulated to produce more milk.

SHOWING MOTHERS HOW TO EXPRESS BREAST

MILK

● To reassure mothers that milk is being produced by their breasts (particularly in the
first few days after birth).
● To enable a mother to provide breast milk in the event, that she will need to be
separated from her infant.
● Expression of breast milk is primarily done or taught through hand expression, by
placing the thumb and fingers around the areola.
● The use of a mechanical pump only when necessary.
 ROOMING-IN

● Involves keeping mothers and infants together in the same room, immediately
after leaving the labour room after a normal facility birth or from the time when
the mother is able to respond to the infant, until discharge.
● This means that the mother and infant are together throughout the day and night,
apart from short intervals when the mother has a specific need, for instance, to
use the bathroom.

IMPORTANT DEMAND FEEDING

● Involves recognizing and responding to the infant’s display of hunger and feeding
cues and readiness to feed.
● Demand, or baby-led feeding puts no restrictions on the frequency or length of
the infants’ feeds, or the use of one or both breasts at a feed.
● Mothers are advised to breastfeed whenever the infant shows signs of hunger, or
as often as the infant wants.

AVOIDANCE OF PACIFIERS OR DUMMIES

● Involves advising mothers to avoid offering pacifiers or dummies and may, in

addition, involve teaching mothers alternative methods to calm and soothe their
infants.
● Unrestricted pacifier use means that pacifiers or dummies can be offered liberally
to infants to suck on during their stay at the facility providing maternity and
newborn services.

AVOIDANCE OF FEEDING BOTTLE AND TEATS

● Involves offering oral feeds (of expressed breast milk or, when medically indicated,
a combination of expressed breast milk and other fluids) without using feeding
bottles and teats, but instead feeding by cup, dropper, or spoon when the infant is
not on the breast.
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CREATING AND ENABLING ENVIRONMENT

● Breastfeeding policies in facilities providing maternity and newborn services

need to cover all established standards of practice and be fully implemented and
publicly and regularly communicated to staff.
● Training of health workers enables them to build on existing knowledge and
develop effective skills, give consistent messages and implement policy standards
according to their roles.
● Antenatal breastfeeding education for mothers can encourage discussion,
help prepare mothers practically and promote initiation of breastfeeding after
delivery. It may include counselling and information given in a variety of ways.
● Discharge planning and linkage to continuing support before discharge
from the facility providing maternity and newborn services, it is necessary to plan
for breastfeeding after discharge and to provide linkage to continuing and
consistent support outside the facility, to help mothers to sustain breastfeeding.

IMPORTANT
TEN STEPS TO SUCCESSFUL BREASTFEEDING

WHO/UNICEF Ten Steps to Successful Breastfeeding

1 Have a written breastfeeding policy communicated to all health care staff.
2 Train all health care staff to implement this policy.
3 Inform all pregnant women about benefits of breastfeeding.
4 Initiate the breastfeeding within the first hour.
5 Show mothers how to breastfeed and how to maintain lactation.
Give newborn infants no food or drink other than breast milk, unless medically
6
indicated.
7 Allow mothers and infants to remain together 24 hour a day.
8 Encourage breast feeding on demand.
9 Give no artificial nipples or pacifiers to breastfeeding infants.
Foster the establishment of breastfeeding support groups and refer mothers to them
10
on discharge from hospital.
IMPORTANT RECOMMENDATIONS OF WHO

breastfeeding should begin within one hour

Exclusive breastfeeding until 6 of birth
months of age
breastfeeding should be "on demand", as
Introduce complementary foods with often as the child wants day and night
continued
breastfeeding up to 2 years. In
addition:
bottles or pacifiers should be avoided.

breastfeeding should not be decreased

when starting on solids.

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It is estimated that sub-optimal

Around 32% of children breastfeeding, especially non
less than 5 years of age in SUB-OPTIMAL
exclusive breastfeeding in the
developing countries are BREASTFEEDING: first 6 months of life, results in
stunted and 10% are 1.4 million deaths and 10% of
wasted. the disease burden in children
younger than 5 years.
 HOW OFTEN SHOULD I BREASTFEED AND HOW
LONG SHOULD A FEEDING LAST?

● A woman should breastfeed when her baby shows signs of being hungry
● A baby can show that he or she is hungry by:
○ Waking up from sleep.
○ Moving the head around as if he or she is looking for the breast.
○ Sucking on his or her hands, lips, or tongue.

HOW DO I KNOW IF MY BABY IS GETTING ENOUGH BREAST MILK?

● You can tell if your baby is getting enough breast milk by:
1) Checking his or her diapers. 2) Checking his or her bowel movements 3) Having your doctor or
By day 4 or 5 after birth, – By day 4 after birth, babies should nurse check to see if
babies should have at least have 4 or more bowel movements a your baby is gaining
6 wet diapers a day. day. By day 5, their bowel movements weight.
should be yellow.

PROPERTIES, COMPOSITION & VOLUME OF BREAST MILK

PROPERTIES COMPOSITION MILK VOLUME

1. Biologic specificity => Proteins ● Healthy exclusively
Long-chain omega-3 breastfeeding women
Fatty Acids produce approximately
The concentration of protein in breast milk (0.9 g per 100 ml) is
2. Important for brain and 750 to 800 mL per day of
lower than in animal milks.
retinal development milk when lactation is fully
3. Higher Iqs established.
(a meta-analysis of 20 studies Fat ● However, milk volume
showed scores of cognitive varies among individuals
function on average 3.2 points (3.5 g per 100ml) provides up to 50% of caloric needs, cholesterol and can range from 450 to
higher among children who
levels constant, lipolytic enzymes aid in fat digestion) 1200 mL per day.
were breastfed compared with
those who were formula fed) ● Milk volume is low on the
Carbohydrates first two days postpartum,
increases markedly on
days three and four, then
(lactose = milk sugar) predominantly in human milk (7 g per 100 gradually increases to
ml) provides up to 40% caloric needs, essential for development levels seen in full lactation.
of CNS, enhances calcium & iron absorption)

Vitamins and minerals

● Breast milk normally contains sufficient vitamins for an infant,

unless the mother herself is deficient. The exception is vitamin D.
The infant needs exposure to sunlight to generate endogenous
vitamin D or, if this is not possible, a supplement.
● The minerals iron and zinc are present in relatively low
concentration, but their bioavailability and absorption is high.
 IMMUNOLOGIC SPECIFICITY
Colostrum = Baby’s first vaccination
● Is the special milk that is secreted in the first 2–3 days after delivery.
● It is produced in small amounts, about 40–50 ml on the first day, but is all that an infant
normally needs at this time.
● Colostrum is rich in white cells and antibodies, especially IgA, and it contains a larger
percentage of protein, minerals and fat-soluble vitamins (A, E and K) than later milk

ANTI-MICROBIAL ACTIVITY of BREAST MILK

Breast milk contains many factors that help to protect

an infant against infection including:

White blood cells Oligosaccharides Whey proteins (lysozyme

Which can kill which prevent bacteria and lactoferrin)
microorganisms from attaching to which can kill bacteria,
mucosal surfaces. viruses and fungi

Immunoglobulin Carbohydrates (Bifidus factor)

principally (IgA), which coats the growth factor present only in human milk
intestinal mucosa and prevents required for establishing an acidic
bacteria from entering the cells. environment in the gut to inhibit growth of
bacteria, fungi and parasites)

HORMONAL CONTROL OF MILK PRODUCTION

● There are two hormones that directly affect breastfeeding are prolactin and oxytocin.
● The prolactin level is highest about 30 minutes after the beginning of the feed, so its
most important effect is to make milk for the next Feed.
● More prolactin is produced at night, so breastfeeding at night is especially helpful for
keeping up the milk supply.
 BENEFITS OF BREASTFEEDING

1 To Mother
● Psychological (attachment, bonding, security)
● Decreased postpartum bleeding, depression, T2DM.
● More rapid uterine involution due to increased of oxytocin.
● Decreased menstrual blood loss.
● Method of birth control (98% protection in the first six months after birth)
● Earlier return to pregnancy weight.
● Decreased risk of breast cancer.
● Decreased risk of ovarian cancer.
● Decreased risk of hip fractures and osteoporosis in the postmenopausal
period.

2 To Baby
● Better dental health
● Increased visual acuity
● Decreased duration and intensity of illnesses
● Less allergies
● Better health & less risk of illnesses

BREASTFEEDING AND UTI

● The risk of UTI was 2-3 times higher in non-breastfed children when compared with
exclusively breastfed children
● The protective effect of breastfeeding was dependent on the duration of breastfeeding as
well as the gender of the child or infant.
● A longer duration of breastfeeding was associated with a lower risk of infection after
weaning and the effect was stronger in girls.
 Why some mothers choose formula vs breast milk?
● Distressed by physical discomfort of early breastfeeding problems.
● Convenience issues.
● Pressures of employment/school.
● Worries that breast shape will change.
● Formula manufacturers manipulate people through their advantages.
● Doctors and nurses need more lactation training.
● Moms given very little time to adjust to changes of postpartum.
● Family demands.
● Non-supportive family/health professionals.
● Embarrassment.
● Lack of confidence in self.
● Feeling that one cannot produce enough milk.

NUMBERS ARE NOT IMP

FORMULA MILK ILLNESS “RELATIVE RISK” BY TIMES

2-7 2.4 3 2.4

2.6- 1.5- 1.8-
Allergies, Diabetes Gastroenteritis
5.5 1.9 6.7 Otitis media
eczema type 1
Urinary tract Inflammatory Hodgkin's
infections bowel disease lymphoma
6-10 3.8 1.7-5 3.9 2.1 3 2
Necrotizing Haemophilus Pneumonia Respiratory syncytial Sepsis Industrialized-world Sudden infant
enterocolitis influenzae meningitis virus infection hospitalization death syndrome
 RISK REDUCTION OF BREAST MILK

● Diabetes:
○ Up to a 30% reduction in the incidence of type 1 DM is reported for infants
who exclusively breastfed for at least 3 months.

● Childhood leukaemia:
○ A reduction of 20% in the risk of acute lymphocytic leukaemia and 15% in the
risk of acute myeloid leukaemia in infants breastfed for 6 months or longer.

● Sudden Infant Death Syndrome (SIDS):

○ A 36% reduction in risk of SIDS

BREAST ENGORGEMENT

● Engorgement refers to swelling within the breast tissue, which can be painful. In
some women with engorgement, the breasts become firm, flushed, warm to the
touch, and feel as if they are throbbing. Some women develop a slight fever

● The best treatment for engorgement is to:

1 2
Empty the breasts Expressing milk by hand
or breast pump can help
frequently and
to soften the areola and
completely by allow the baby to latch on
breastfeeding. more easily.

3 4
Use of a cold compress
or ice pack can be Pain medications :
helpful in relieving the Paracetamol / Ibuprofen
discomfort of are safe.
engorgement.
 HIV AND BREASTFEEDING

● An HIV-infected mother can pass the infection to her infant during pregnancy,
delivery and through breastfeeding.
● However, antiretroviral (ARV) drugs given to either the mother or HIV-exposed
infant reduces the risk of transmission.
● WHO recommends that when HIV-infected mothers breastfeed, they should
receive ARVs and follow WHO guidance for infant feeding:

The 2016 WHO recommendation on HIV and infant feeding

Strength of the Quality of the
Recommendations
recommendation evidence

For how long should a mother living with HIV breastfeed if she is receiving ART and there is
no evidence of clinical, immune or viral failure?

Mothers living with HIV should breastfeed for at

least 12 months and may continue breastfeeding
for up to 24 months or beyond (similar to the 12 months: low
general population) while being fully supported Strong
for ART adherence. (See the WHO consolidated 24 months: very low
guidelines on ARV drugs for interventions to
optimize adherence)

Guiding practice statements

If a mother living with HIV does not exclusively breastfeed, is mixed feeding with ART
better than no breastfeeding at all?

Mothers living with HIV and health-care workers can be reassured that ARV treatment
reduces the risk of postnatal HIV transmission in the context of mixed feeding. Although
exclusive breastfeeding is recommended, practising mixed feeding is not a reason to stop
breastfeeding in the presence of ARV drugs.
 CONTRAINDICATION OF BREASTFEEDING

Untreated brucellosis Active or untreated tuberculosis

01 02 (use expressed milk)

Infant with Active herpes simplex

galactosaemia 06 03 on her breast (use
expressed milk)

Mothers with H1N1 influenza,

Mothers who are receiving
diagnostic or therapeutic 05 04 temporarily be isolated until
radioactive isotopes. become afebrile

Conditions that are not contraindications to breastfeeding:

● Mothers with:
○ Hepatitis B.
○ Hepatitis C.

OPTIONS if BREASTFEEDING is NOT POSSIBLE

Mom can still use her milk, even if she decides not to breastfeed:
● Use a breast pump (electric), efficient to produce milk.
● Cup or bowl feeding.
● Spoon feeding.
● Eyedropper or feeding syringe.
● Nursing supplementer.
THE END
● There is no freedom of choice for humans if it has been taken away from
them at the beginning.
● Breastfeeding is not a choice, but an obligation to the choice, Give your child
the freedom of choice.
 QUIZ!
1) Which one of the following if a benefit for breastfeeding
mothers?
A. Decrease risk of cancers B. Slower uterine involution
C. Increase chance for pregnancy early

2) Which of the following is a component of mother’s milk?

A. Vitamin D B. Fructose C. Lactose

3) Which one of the following will be reduced if we use breast

milk for the baby?
A. Sudden Infant Death Syndrome (SIDS) B. Type 2 DM
C. Ovarian cancer

4) Which one of the following conditions is contraindicated for

break milk?
A. Hepatitis B. B. Mother with H1N1 C. Hepatitis C

5) Why some moms choose formula milk Instead of Breast milk?

A. Embarrassment B. Family demands C. A+B

Answers
1. A, 2. C, 3. A, 4. B, 5. C
 Team Leaders
Abdulrahman Bedaiwi & Jude Alotaibi

Team Members
● Alhanouf Alhaluli
● Ajeed Alrashoud
● Jehad Alorainy
● Mashal Abaalkhail
● Mohannad Alqarni
● Naif Alsolais
● Rahaf Alshabri
● Rawan Alzayed
● Rema Almutawa

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