INTRODUCTION

• Breastfeeding is the feeding of an infant or young child with

breast milk directly from female human breast via lactation
rather then using infant formula from a baby bottle or container
• Babies have sucking reflex that enables them to suck and
swallow milk
• Experts recommend that children be breastfed within one hour
of birth, exclusively breastfed for the first 6 months, and the
breast until age two.
• Under normal condition, around 600 ml of milk is secreted by a
mother per day
• The energy value of human milk is 70Kcal/100ml.
• Prolonged breasprotect infant from malnutrition and infections
FACTORS WHICH LESSEN MILK
PRODUCTION

• Dummies, pacifiers, bottles-even one or two feeds.

• Making the baby wait for feeds.
• Giving feeds like sugar water gripe water, honey, breast milk
substitutes or formula, either as pre-lacteal feeds or at anytime.
• Certain medications for mothers like oral contraceptives or
methergine.
• Painful breast conditions like sore or cracked nipples &
congested breast.
DIFFERENCES

• DIFFERENCES BETWEEN COW'S MILK AND BREAST MILK

• Both contain equal amounts of water.
• The energy contents are equal approximately 20Kcal/kg/oz ,as
10z=30 ml of milk
• Protein: Cow milk contains higher protein approximately 3 folds, its contents of
casein is about 6 folds, while the human milk protein is mainly whey protein
(lactalbumin & lactglobulin) but 30% casein .
• Carbohydrates: Human milk 7% which is lactose while cow milk is
4.5%.
• Fat: Contents are almost equal but there is qualitative differences ,as both
containing triglycerides (olein ,palmitin & stearin) but human milk contain twice of
the more absorbable olein .
DRUGS TO IMPROVE MILK
PRODUCTION
• Metclopramide (10 mg thrice daily)
• Increases the blood volume by increasing prolactin level.
Intranasal oxytocin contracts myoepithelial cells and causes
milk let down
COMPOSITION

• COLOSTRUM :
• Is the secretion of breast during the later part of pregnancy & for
2-4 days after delivery
• It has deep lemon yellow colour as it contain several times the
protein of mature breast milk but less fat & more minerals.
• It has important immunological factors (antibodies - IgA)
• It's alkaline in nature
COMPOSITION

• TRANSITIONAL MILK
• During the next two weeks, the milk increases in quantity and
changes in appearance and composition and this is called
transitional milk.
• The immunoglobin and protein content decreases while the fat
and sugar content increases.
• MATURE MILK
• The milk which replaces the transitional milk after 2 weeks of
lactation
DIFFERENCE
BREAST MILK COW MILK FORMULA MILK

WATER Enough Extra needed May need extra

ENERGY Equal Equal Equal
PROTEIN Correct amount easy to digest Too much difficult to digest Partially corrected

CARBOHYDRATE Lactose - plenty Lactose - less oligosaccharides Lactose + Sucrose

oligosaccharides Lacks lipase
FAT EFAs present No EFAS Some EFAs added
Lipase to digest No lipase No lipase
VITAMINS Adequate depending on Low vitamin A, C and Vitamin / mineral added -
mom's nutritional adequacy Iron usually enough

ANTI-INFECTIVE IgA, Lactoferrin, Lysozeme, etc None None

FACTORS
GROWTH FACTORS Present None none
DIFFERENCE
Nutrient
Water(g)
Human milk
88
Cow's milk
87.5
Energy (kcal) 65 67
Protein(g) 1.1 3.2
Carbohydrate(g) 4.4

Fat(g) 3.4 4.1

Calcium (mg) 28 120
Phosphorus(mg) 11 90
Iron(mg) - 0.2
Carotene (meg) 137 174
Thiamine(meg) 0.02 0.05
Riboflavin(meg) 0.02 0.19
Vitamin C(mg) 2

Caseinogen/ Lactalbumin 1:2 3:1

ratio Source: National Institute of
Nutrition ICMR Hvders
INITIATION

• Breast feeding should be started within half an hour of birth as

soon as possible after normal delivery where as in case of
caesarian section delivery, within 1 hours.
• Rooming in and bedding should be done with mother and baby
to prevent separation and promote breast feeding.
POSITION

• Baby's head & body straight.

• Baby's body turned towards the mother, nose opposite the
nipple.
• Baby's body touching mother's abdomen.
• Baby's whole body well supported not just neck or shoulders.
• Mother should than support her breast with her finger flat
against her chest wall under her breast.
• Cradle hold is the most common position used by mothers
• Lying position is good after c-section
MATERNAL FETAL

Reduces the risk of breast cancer, ovarian cancer, Meets the full nutritional requirement of infant
diabetes, hypertension and heart disease

Promotes post partum weight loss and emotional health Reduces the risk of infectious disease and illness

Emotional support and bonding Lowers the risk of developing allergies

Prevents post partum hemorrhage and delays ovulation Lowers the rate of sudden infant death syndrome (SIDS),
cancer, gastrointestinal disrupt
IMMUNITY
• During breast feeding approximately 0.25-0.5grams per day of
secretory IgA antibodies is passed to the baby via the milk. This
is one of the most important feature of breast feeding.
• The main target of these antibodies is the microorganism in the
fetal intestine.
• Breast milk also contains several substances such as bile salt
stimulated lipase which protects against amoebic infection,
lactoferrin which binds to iron and inhibits growth of intestinal
bacteria.
MENTAL HEALTH

• Breastfeeding for more than 6 months is an independent

predictor of better mental health through childhood and
adolescent.
• The more months the child has been breastfeed they less likely
suffer from depression, dequilent behavior, attention issues and
physiological issues
• Breastfeeding can also improve cognitive function
HORMONE RELEASE

• Breastfeeding releases oxytocin and prolactin, hormones that relax

the mother and make her feel more nurturing toward her baby.
• This hormone release can help to enable sleep even where a
mother may otherwise be having difficulty sleeping.
• Breastfeeding soon after giving birth increases the mother's
oxytocin levels, making her uterus contract more quickly and
reducing bleeding.
• Pitocin, a synthetic hormone used to make the uterus contract
during and after labor, is structurally modeled on oxytocin.
WEIGHT LOSS

• As the fat accumulated during pregnancy is used to produce milk,

extended breastfeeding as least 6 months can help mothers lose
weight.
• However, weight loss is highly variable among lactating women
monitoring the diet and increasing the amount of intensity of
exercise are more reliable ways of losing weight.
• The 2007 review for the AHRQ found "The effect of weight
breastfeeding in mothers on return-to-pre-pregnancy weight" was
negligible, and the effect of breastfeeding on postpartum weight loss
was unclear.
LONG TERM HEALTH

• For breastfeeding women, long-term health benefits incudes:

• Less risk of breast cancer, ovarian cancer, and endometrial cancer.
• Breastfeeding diabetic mothers requires less insulin.
• Reduced risk of metabolic syndrome.
• Reduce risk of post-partum bleeding.
• Women who breast fed for a longer duration have a lower risk for
contracting rheumatoid arthritis than women who breast fed for a
short duration or who had never breast fed.
• Breastfeeding a s a family planning method works only if:
• The baby is less than 6 months old
• The woman breastfeeds the baby every 6 hours and the baby eats no
other food
• Her monthly bleeding cycle hasn't started yet
IN MOTHER

• Chronic disease such as active TB, leprosy, AIDS etc.

• Mothers addicted to alcohol or heavy doses of some drugs.
• Mothers taking any of the following medications: radioactive
isotopes, cancer chemotherapy agents, such as antimetabolites,
and thyrotoxic agents.
• Psychosis
• Local condition like breast abscess, cracked nipples
• The mother should give adequate attention to her diet, personal
hygiene and health and should have sufficient rest.
INFANTS

• Gross prematurity of baby or other conditions in which the

newborn cannot suckle.
• Inborn errors such as phenylketonuria, lactose intolerance,
galactosemia
CONTRAINDICATIONS

• 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 take medications: Most medications can be taken while
breastfeeding.
• Commonly mistaken as contraindication are the following:
• 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.
• Women who have pierced nipples: Remove nipple accessories before feeding to
avoid the risk of infant choking.
PROBLEMS

• Blood stained nipple discharge

• Painful nipple
• Breast engorgement
• Plugged duct
• Mastitis
BLOOD STAINED NIPPLE DISCHARGE

• Typically bilateral
• Due to epithelial proliferation
• 2nd and 3rd of pregnancy and < 3 months of postpartum
• Self limiting, no treatment needed.
BREAST ENGORGEMENT CAUSES:
• Delayed or infrequent feeding
• Improper latching and positioning
• Symptoms: swollen, hard, warm and painful
• Prevention :
• Early and frequent feeds
• Correct the positioning and attachment
• Express your milk when feedings are missed
• Treatment:
• Applying and ice bag, breast massage, analgesics
• Hand express some milk to allow for easier latching.
 MASTITIS :CAUSES

• Bacteria enter the breast through the nipple.

• Blocked duct obstructs the flow of the milk & distends the alveoli
• cracked or sore nipple.
• Symptoms:

• Painful, red and swollen

• Flu like symptoms
• Tachycardia
• Pyrexia, rigors
• Intense, localized pain
• Red, hot and swollen breast Treatment:
• Isolation of the mother and baby
• Ceasing the breastfeeding from the affected part
• Express the milk manually or electric pump
• Antibiotic such as flucloxacillin
BABY FRIENDLY HOSPITAL
INITIATIVE-BFHI

• WHO's and UNICEF effort since 1991

• Global effort
• To promote breastfeedingBABY FRIENDLY