ENTATION ON

EASTFEEDING
itted to. Resp.mrs harjot kaur (msc nursing
TED BY. Prabhjot kaur
msc 1ST year
TED ON . 28/72020
 INTRODUCTION
• Breastfeeding is the best natural feeding & breast
milk is best milk.
• Breastfeeding is most effective way to provide a
baby with a caring environment & complete food.
• It meets the nutritional as well as emotional &
psychological needs of the infant.
• UNICEF & WHO recommends exclusive
breastfeeding to babies until 6 months of age.
 DEFINITION
• Breastfeeding is the process of a woman
feeding an infant or young child with milk
from her breasts, usually directly from the
nipples ,a process called lactation.
• Baby should receive only breastmilk for first 6
months & no other fluids such as water ,tea ,
juice.
• Breastfeeding should be continued atleast 2
years of age.
 CONTD…..
• B-Best for baby.
• R-Reduce incidence of allergies.
• E-Economical - no waste.
• A-Antibiotics - greater immunity against
infections.
• S-Stool inoffensive – never constipated.
• T-Temperature always correct & constant.
 CONTD….
• F-Fresh milk - never goes sour in the breast.
• E-Emotionally bonding.
• E-Easy once established.
• D-Digested easily within 2 to 3 hours.
• I-Immediately available.
• N-Nutritionally balanced.
• G-Gastroenteritis greatly reduced.
 PHYSIOLOGY OF LACTATION
• Human milk is produced due interaction
b/w hormones & reflexes .During
pregnancy, the glandular tissue of breast
is stimulated to produce milk due to
hormones-prolactin & oxytocin. The
reflexes mediated by these hormones are:
 CONTD….
1) Milk secretion reflex (prolactin reflex):-Prolactin
produced by anterior pituitary gland is responsible
for milk secretion with alveolar cells of breast.
2) Milk ejection reflex (oxytocin reflex):- Oxytocin
produced by posterior pituitary is responsible for
contraction of breast tissue leading to ejection of
milk from the gland into the lactiferous sinuses &
ducts.
 DIFFERENT COMPOSITION OF
BREASTMILK
 The composition of breastmilk varies at different
stages in the postnatal period to fulfill the needs of
the baby.
• Colostrum: It is secreted during first 3 days after
delivery.It is a thick ,yellow & small in quantities.It
contains more antibodies & cells with higher
amount of proteins & fat soluble vitamins
(A,D,E,K) .It is sufficient & protective for the baby
& should not be discarded.
 CONTD….
• Transitional milk:It follows the colostrums &
secretes during first 2 weeks of postnatal
period.It has increased fat & sugar content &
decreased protein & immunoglobulin content.
• Mature milk:It is secreted usually from 10-12
days after delivery.It is watery but contains all
nutrients for optimal growth of the baby.
 CONTD….
• Preterm milk :The breastmilk secreted by mother
who has delivered a preterm baby is different from
milk of a mother who has delivered a full term
baby.This milk contains more proteins, sodium,
iron,immunoglobulins & calories appropriate for the
requirements of preterm neonates.
• Foremilk :It is secreted at the starting of the regular
breastfeeding.It is more watery to satisfy the baby’s
thirst & contains more proteins, sugar, vitamins,
minerals.
 CONTD….
• Hind milk :It is secreted towards the end of regular
breastfeeding & contains more fat & energy.The
mother should feed the baby allowing one breast to
empty to provide both foremilk & hind milk,before
offering other breast.
 PROTECTION FROM DISEASES
PEDIATRIC DISEASES AGAINST WHICH
HUMAN MILK MAY PROTECT:-
• ACUTE DISORDERS:-
Diarrhea.
Otitis media.
 CONTD….
 Recurrent otitis media.
 UTI.
 Necrotizing
enterocolitis.
 Septicemia.
 Infant botulism.
 Hospitalizations.
 Infant mortality.
 CONTD….
CHRONIC DISORDERS:-
• Insulin-dependent diabetes mellitus.
• Celiac disease.
• Crohn disease.
• Childhood cancer-lymphoma, leukemia.
• Allergy,
• Obesity & overweight.
 ADVANTAGES OF BREASTFEEDING

• Breastfeeding is the cheapest,safest & best

protective food for infants.It is preferred food for
infants .FOR CHILD:-
1)Nutritive value:-
• Breast milk contains all the nutrients in the right
proportion which are needed for optimum growth &
development of the baby upto 6 months.
• It is essential for brain growth of the infant bcz of
high %age of lactose & galactose.
 CONTD…
• It facilitates absorption of calcium which helps in
bony growth.
• It contains aminoacids like taurine & cysteine which
are important as neurotransmitters .
• Breast milk fats are polyunsaturated fatty acids
which are necessary for the myelination of the
nervous system.
CONTD…
 CONTD…
• It has vitamins ,minerals, electrolytes & water in the right
proportion for the infant which are necessary for the
maturation of the intestinal tract.
• It provides specific nutrition for preterm baby in preterm
delivery.
 CONTD…
2)DIGESTIBILITY:-Breast milk is easily
digestable .The protein of breastmilk are
mostly lactoalbumin & lactoglobulin which
form a soft curds that is easy to digest.The
enzyme lipase in the breastmilk helps in the
digestion of fats & provides free fatty acids.
 CONTD….
3)PROTECTIVE VALUE:-Breastmilk contains
IgA,IgM, macrophages, lymphocytes, lysozyme
,complement & interferon.Thus breastfeed baby less
likely to develop infections specially GI & RTI e.g
diarrhea, ARI.
• It also provides protection against malaria & various
viral & bacterial infections like skin
infections,septicemia.
• It also protects from allergy & bronchial asthma.
 CONTD….
• It also protects against neonatal hypocalcemia ,
tetany,deficiencies of vit.E & zinc, neonatal
convulsions & sudden infant death syndrome.
• Exclusive breastfeeding baby has less chance of
developing malnutrition, hypertension,DM,
coronary artery disease ,arteriosclerosis,ulcerative
colitis,appendicitis ,childhood lymphoma,liver
disease,celiac disease,dental caries.
 CONTD….
4)PSYCHOLOGICAL BENEFITS:-
• Breastfeeding promotes close physical & emotional
bondage with the mother by frequent skin to skin
contact,attention & interaction.It stimulates
psychomotor & social development.It leads to
better parent child adjustment,fewer behavioural
disorders in children & less risk of child abuse &
neglect.
• Breastfeeding promotes development of higher
intelligence & feeling of security in infant.
 CONTD….

MATERNAL BENEFITS:-
• Breastfeeding reduces the chances of postpartum
hemorrhage & helps in better uterine involution.Lactation
amenorrhea promotes in recovery of iron stores.
• It protect from pregnancy for first 6 months if exclusive
breastfeeding is carried out.
• Breastfeeding improves metabolic efficiency & satisfaction
with sense of fulfillment of the mother.
• It reduce the risk of breast & ovarian cancer of the
mother.
 CONTD…
• It improves slimming of the mother by
consuming extra fat which accumulated
during pregnancy.
• It is more convenient & time saving for the
mother.Mother feels comfortable to feed the
baby especially at night.
 CONTD…
6)FAMILY & COMMUNITY BENEFITS:-
• Breastfeeding is economical in terms of saving money,time
& energy.
• Family has to spend less on milk , health care & illness.
• Community expenditure on health care & contraception are
reduced.It is economical for the families, hospitals,
communities & for countries.
 STEPS OF SUCCESSFUL BREASTFEEDING

There are 10 steps of successful breastfeeding:-

• STEP1:Have a written breastfeeding policy that is
routinely communicated to all health care staff.
• STEP2:Train all health care professionals in skills
necessary to implement this policy.
• STEP3:Inform all pregnant women about the
benefits & management of breast feeding.
• STEP4:Help mothers initiate breastfeeding within
half an hour of birth.
 CONTD….
• STEP5:Show mothers how to breastfeed & how to maintain
lactation even if they should be separated from their infants.
• STEP6:Give newborn infants no or drink other than human
milk,unless medically indicated.
• STEP7:Practice rooming-in allow mothers & infants to remain
together 24 hours a day.
• STEP8:Encourage breastfeeding on demand.
• STEP9:Give no artificial teats or pacifiers to breastfeeding
infants.
• STEP10:Foster the establishment of breastfeeding support
groups & refer mothers to them on discharge from the
hospital or clinic.
 PREPARATION FOR BREASTFEEDING

Preparation for breastfeeding must begin in the

antenatal period.In the antenatal
period,examination of breasts should be done.
• Mother should be psychologically prepare to feed
her baby immediate after birth.
• Immediately before feeding,the mother should be
made as comfortable as possible.
• Mother may prefer to breastfeed sitting up with a
pillow on her back & in the lap & infant resting on
the pillow.
 CONTD….
• The woman who had cesarean birth needs support.She
may be more comfortable lying on her side with a pillow
behind her back.
• For the sleepy baby, a period of playful activity such as
gently rubbing the feet & hands so that when the feeding is
initiated,the infant is ready & sucks eagerly.
• If the breast is firm & full ,it should be pressed with the first
finger to prevent pressing of baby’s nose.
 CONTD…
• If mother does not have prominent nipple,she
should stretch the nipple by pressing in & outward
around the nipple prior to feeding.
• Encourage the mother to allow her breast to air dry
after feeding to prevent sore nipples.
• After feeding the baby must be positioned on right
side.
 INITIATION OF BREASTFEEDING

• Breastfeeding should be initiated within first half an

hour to one hour of birth.
• It should be initiated within 4 hours after cesarean
section delivery.
• Mothers should be demonstrated about the
techniques of breastfeeding.
• In case of preterm babies or sick babies ,being in
special care unit,they should be fed with expressed
breast milk(EBM).
 POSITIONS FOR BREASTEEDING
Getting off to a good start begins with positioning the baby at
the breast in a way that is comfortable for both the mother
& the baby & that allows for good latch –on.The three most
common positions are the cradle,side-lying,football hold.
 CONTD…
1)Cradle position:-The cradle position begins with
mother sitting upright .The infant is held with the
mouth at nipple height,& the mother & infant are in
tummy to tummy arrangement.This position often
works well for premature babies bcz it provide extra
support to head & trunk.
2)Side lying position:-The mother lies on her
side,cradles her infant in her elbow,& supports the
infant back & nipples.
 CONTD…
3)Football hold:-This position is used by a
mother who had cesarean delivery.The baby is
in side lying position & flexed at the hips,with
the buttocks back.
 POSITION OF CORRECT FEEDING
Several principles are common to all positions for
breastfeeding,includes the following:
• Both the mother & the baby should be comfortable.
• The infant should be positioned “face on” at nipple
height so that no head turning or tilting is required.
• The infant should be lying on the side,not the back.
• The infant body should be in good alignment ,with a
straight line from ear to the shoulder to the hips.
• The infant tongue should extend forward over the
lower gumline & cup around the nipple & areola.
 CONTD…
• BURPING AFTER FEEDING:-This is very
important step to be followed each time
the baby is fed.It is essential to burp the
baby after each feed.
 TECHNIQUES OF BREASTFEEDING
Initially the mother need help in breast feeding.
A)Position of mother & baby :
1)Help the mother to get into a comfortable & relaxed
position –sitting or lying down.
2)Explain the mother to hold the baby ,keeping in mind the 4
key points-
• Head & body of baby should be straight.
• The baby’s nose should be opposite to the nipples.
 CONTD….
• Baby’s body should be close to her body.
• Whole body of baby must be supported.
3)Mother should then support her breast with her
fingers flat against her chest wall under her breast.
B)Latching or attachment of baby to the breast:-After
proper positioning ,the baby’s cheek is touched with
the nipples .Due to rooting reflex,baby quickly turns
his face towards the breasts & starts sucking. The
baby sucks,pauses & suckles again.
 SIGNS OF GOOD ATTACHMENT
• Baby’s mouth is wide open.
• Baby’s chin touches the breast.
• Much of the areola is not visible as it is in the
baby’s mouth.
• Baby’s cheeks are full & not hollow.
 SIGNS OF POOR ATTACHMENT

• Only the nipple is in the baby’s mouth not the

areola.
• The baby’s tongue is back inside his mouth &
cannot reach the ducts to press on them.
• Suckling with poor attachment may be
uncomfortable or painful for the mother.
 INDICATORS FOR ADEQUACY OF FEEDING

Adequacy of breastfeeding is indicated &

established by the following:-
• Audible swallowing sound during the feed.
• Let down sensation in mother’s breast.
• Breast is full before feed & softer afterward.
• Wet nappies 6 or more in 24 hours.
 CONTD….
• Frequent soft bowel to 8 times in 24 hours,
3movements.
• Average weight gain of 18 to 30g/day.
• Baby sleeps well & does not cry frequently.
• Baby has good muscle tone & healthy skin.
• Passage of urine 6 to 8 times/day .
 EXCLUSIVE BREASTFEEDING
EBF means feeding the baby with breast milk
soon after birth & continuing it until 6 months
without giving baby any other food.
• The baby is given only breast milk & nothing
else whenever the baby is hungry.
 CONTRAINDICATIONS

• REAL –Radiotherapy,Ergot therapy,Antimetabolites

therapy , Lithium therapy.
• Nipple or breast lesion.
• Maternal illness.
• If the mother becomes pregnant, the milk will usually start
to dry up.
• HIV.
• Infections.
 PROBLEMS OF BREASTFEEDING
The measures to be taken to overcome the problems
are as follows:
The baby who does not suckle:
• No unneeded drugs to be given to breastfeeding
mothers .
• No artificial food or water to be given to the baby.
• Breastfeeding to be given when the baby is alert &
dry.
• Milk to be expressed into nipples just prior to feed
the baby.
 CONTD….
• Nipple should be placed slightly upward towards the roof
of the baby’s mouth.
• Keeping the baby’s nose free during breastfeeding .
The baby who refused on breast:-
• Baby should be hold in comfortable position with good
attachment to the breast & should be kept dry & warm.
• Avoiding pressure on potentially painful areas during
feeding.
• Express breastmilk to maintain lactation in both breast.
• Allowing the baby to feed only one breast.
MEDICATIONS FOR BREASTFEEDING MOTHERS

General guidelines for maternal drug recommendations

include the following:
• Give drugs that are normally safe for infants .
• Avoid long acting form of a drug.
• Schedule feeding at times when the drug level is lowest.
• Consider all appropriate options & select the drug with the
lowest level in breast milk.
 CONTD….
• Be cautious about the use of herbal preparations.

• Avoid drugs that inhibit prolactin release, such as

estrogen ,antihistamines , ergot compounds.
 
 DYNAMICS OF BREASTFEEDING
1.Early feedings: The first breastfeeding should take
place as soon after birth as possible.
2.Frequency & duration of feedings:After first 24 hrs the
infant should go to the breast 8 to 12 times in 24 hrs
for approx. 20 to 45 mins at each feeding.
3.Urine:In first 2 days of life as the volume of breastmilk
increases , the infant may urinate only 1 to 3 times in
24 hrs. By day 3, the infant should have 4 or more wet
diapers in 24 hrs & then by day 4, 4 to 6 wet diapers
per 24 hrs.Overtime ,the infant should have maximum
of 6 to 8 diapers in 24 hour period.
 CONTD….
4.Stool:In first 24 hrs after delivery the baby should
have atleast one meconium stool followed by
another on the second dayof life.By day 3 stools are
beginning to make transition to the characteristic
loose,yellow ,seedy stools of breastfeeding & infant
should begin having 2 or 3 stools in 24 hrs.
 SUCCESSFUL BREASTFEEDING

• She /he is nursing atleast 8 times in 24 hrs.

• The mothers breast appear to soften after nursing.
• The no. of wet diapers increases by 4th or 5th day after
birth.
• There may be at least 8-10 wet diapers in 24 hrs after
5th day.
• The baby’s stool are yellow or the stools are beginning
to lighter in color by fourth or fifth day of age.
• There is appropriate weight gain after 10th day of birth.
COMMON BREASTFEEDING PROBLEMS

1)Inverted nipples:-
• Treatment should be started after birth of the baby.
• The nipple is manually stretched & rolled out several times
a day.
• A pump or a plastic syringe is used to drawout the nipple &
the baby is then put to the breasts.
2)Sore nipples:-
• Correct positioning & latching of the baby to the breast.
• Frequent washing with soap & water should be avoided.
• Baby should not be pull off the breast while still sucking.
 CONTD….
• Hind milk to be applied to the nipple after a feeding.
• Nipples should be aired & allowed to heal in b/w feeds.
3.Breast engorgement:-
• Frequent feeding & correct attachment of the baby to
the breast during feeding to be done to prevent
engorgement.
• Treatment of this condition to be done with local warm
packs & analgesics to the mother to relieve pain .
• Milk should be expressed gently to soften the breast &
then baby to be put to the breast with the good
latching.
 CONTD….
4.Breast abscess:-
• Treatment to be done with analgesics & antibiotics .
• Abscess may need incision & drainage.
• Breastfeeding must be continued.
5.Mastitis:It is an infection of the breast that can
occur at any time during lactation.
• Use analgesic as necessary.
6.Duct obstruction:This can be due to tight fitting
clothes exerting local pressure which can be
relieved by frequent nursing, moist heat & massage.
 SUMMARIZATION
• Introduction.
• Definition.
• Composition of breastfeeding.
• Advantages.
• Steps.
• Preparation .
• Initiation.
• Positions.
• Signs.
• Indicators.
• Problems.
 BIBLIOGRAPHY
• Sharma R Textbook of essentials nursing.1st Ed.
Published by Jaypee publishers.
• Yadav M. Textbook of child health nursing. 1st Ed.
Published by Peevee publishers.
• Datta P .Textbook of pediatric nursing .2nd Ed
.Published by Jaypee publishers.