Breastfeeding

Surg Cdr RW Thergaonkar

The Importance

The Importance
Ideal food for a normal neonate
Needs to be exclusive in the first six
months
NFHS3:
only babies started B/F in 1st 30 min
of life
57% gave additional feeds
Exclusive B/F only 28% at 4-5 mths age

ADVANTAGES OF HUMAN
MILK

Advantages of
breastfeeding
Physiological human milk for
human baby, cows milk for calf

High lactose content

Easily digestible protein Whey 80%
LCPUFAs
Enzymes

Immunologically / Microbiologically
Lactoferrin protects from E. coli
Bifidus factor promotes growth of lactobacilli
PABA protects against malaria

Advantages of
breastfeeding
Physical
Optimum fluidity
Optimum temperature

Economical
Convenient
No carrying / sterlising utensils

Psychological
Mother infant bond

Maternal Benefits
Involution of uterus
Decreases the incidence of ovarian & breast CA

Advantages of
breastfeeding
Epidemiologically : significant
decrease in mortality
B/F babies are 14 times less likely to die
from diarrhea
B/F babies are 4 times less likely to die
from respiratory illnesses
B/F babies are 2.5 times less likely to die
from any other infection

Adverse effects of artificial feeding

Infections due to contamination

Malnutrition due to dilution
Increased risk of allergies
Early onset of hypertension / diabetes
Iron deficiency anemia
Learning disabilities : dyslexia etc
Lower IQ
Cow Milk Protein Intolerance
Necrotising Entero-Colitis

Fact of The Matter

IN THE FIRST SIX MONTHS, THE RISK
OF
MORBIDITY
&
DEATH
FROM
DIARRHOEA IS RESPECTIVELY 15 AND 25
TIMES HIGHER FOR CHILDREN NOT
RECEIVING BREASTMILK COMPARED TO
THOSE WHO HAVE THE IMMUNOGICAL
PROTECTION OF AN EXCLUSIVELY
BREASTMILK DIET.
UNICEF ANNUAL REPORT, 1988.

Maternal Infant Bonding

In the FIRST HOUR

Maternal Infant Bonding

The bonding process has tremendous implications for both
mother and child.
High incidence in those not breast-fed of
1. Behavioral problems
2. Conduct disorders
3. Developmental delays & learning problems
4. Personality disturbances in adulthood
a. Aggression
b. Depression
c. Emotional detachment
d. Destructive or cruel behavior
e. Impulsive behavior

Physiology of
Lactation
Know the Hormones
Mammogenesis -

Oestrogen & Progesterone

Lactogenesis

Prolactin

Galactopoiesis

Prolactin, TSH, GH

Milk let down reflex -

Oxytocin

Lactogenesis

The earlier a baby is put to breast after birth,

earlier the milk production.
Simplest, oldest and most natural way to
increase milk production is to let the baby suck
more often.

Milk let down reflex

1. Popular belief Infant sucks its mother milk.
2. Fact is - Mother herself pushes the milk towards the infant.

Milk let down reflex

(Very strong Reflex)

Milk Let Down Reflex

Milk let down reflex - highly sensitive reflex.

NEWTONS STUDY
Situation
No Maternal
Disturbance

Amount of Milk output

168 gm

DistractionI.V.

99 gm

fluids
DistractionPinching

80 gm

Bite Toe
DistractionMaths

40 gm

Question
DistractionMother-

k let down reflex - highly sensitive r

Mother should feed her baby in a calm

environment.

BABY REFLEXES

Rooting Reflex
Sucking Reflex
Swallowing Reflex

Rooting
Reflex

Sucking Reflex

First Feed
Normal Baby

Contradictions

From breast
Apgar <6,
Preterm baby
Baby of heavily
medicated mother
Hydramnios (TOF)

PRELACTEAL FEEDS

Except: Baby of diabetic mother LBW baby

MECHANISM OF
SUCKING

MECHANISM OF
SUCKING

Initiating Breastfeeding
The main prerequisite for successful breast feeding is
confidence that one can do it
Inexperienced mothers have to develop it
With nuclear families, the tradition whereby the old
taught the young about practical matters of life is lost

Stimulus of sucking of the newborn starts the secretion

of milk
To reach full milk production may take from 2 to 13 days.
During this period, baby and the breast are not yet in
equilibrium the lady needs support, encouragement
and supervision so as not to give up

Initiating Breastfeeding
Within 30 min of a normal delivery
Within 4 hrs of a caesarean
Colostrum is rich in proteins and immunoglobulins
The small amounts that it is produced in, in the initial
days is sufficient to meet the babies requirements
If you have too little milk - Put him to breast, put
him to breast

Initiating Breastfeeding
Sucking in the first few days is essential to get the milk
flowing
The small amount of milk produced is usually enough for
the babys needs
Early feeds are to learn how to suck and not for taking in
large amounts of milk
The quality of milk is always good
Bottle feeding is dangerous

Signs of Good Attachment

Chin touching breast

Mouth wide open
Lower lip turned outward
More areola visible above than below
the mouth
No pain while breastfeeding

Good Positioning for Breastfeeding

Infants neck is straight or bent slightly
back
Infants body is turned towards the mother
Infants body is close to the mother
Infants whole body is supported
Most importantly: mother must be relaxed
in her position

BEST METHOD TO
IMPROVE
MILK PRODUCTION

Put the baby to breast more frequently & for longer duration

How often to breastfeed?

Varies from baby to baby, depending on:
Stomach capacity
Sucking habits
Milk production

ON DEMAND FEEDING
In the 1st week they may need anything from 4 to 16 feeds
a day

Average duration of a feed in traditionally

breastfeeding societies e.g. rural Kenya is 13 min

Burping after feeding?

For 10 15 min
Continue even after the baby burps
Various positions:

Signs of adequate breastfeeding

Baby sleeps/ rests for 1 2 hrs
following feed
Urine > 5 times / day
Stools > 1-2 times / day
Mother can feel milk being drained
from the breast and the breast feels
lighter following the feed
Mother can hear baby swallowing
milk
Regular weight gain

Ideal duration of breast

feeding
Exclusive
breastfeeding till age 6
months
Continued breastfeeding till age 2
years

NUTRIENTS IN DIFFERENT
MILK gm/ 100 ml

DIFFERENCES IN QUALITY OF
PROTEINS IN HUMAN AND COWS MILK
WHEY PROTEINS
Easy to digest
Well absorbed
Anti infective properties
Aminoacids for CNS
development

CASEIN
Less easy to digest

Common problems during breastfeeding

Flat or inverted nipples
Nipple protractility test during pregnancy
Suckling improves it
Inverted syringe method

Common problems during breastfeeding

Fullness / engorgement of breasts

Accumulation in the breast of increased amounts

of blood, milk & ECF
Breast becomes very full, tender and lumpy
Cause
Delayed initiation of feeding
Artificial feeding
Any restriction of breast feeding
Treatment
Heat and massage
Express prior to feeding
Frequent feeding
Pain relief

Common problems during breastfeeding

Sore nipples and cracked nipples

Painful / cracked nipples severe pain while

feeding
Rarely bleeding from nipples
Cause
POOR ATTACHMENT
Frequent washing of nipples with soap & water
Treatment
Correct positioning
Bathing nipples in breast milk & allow to air dry
Do not apply soap
Lanolin may be applied
If severe nipple shield may be required

Common problems during breastfeeding

Blocked / plugged ducts
Isolated tender lumps in an otherwise well
mother

Treatment
Heat and massage
Position the infants jaw towards the blocked
duct
Frequent feeding / milk removal

Common problems during breastfeeding

Mastitis
Red, painful and hard area in the breast
Fever
Treatment
Antibiotics
Continue frequent breastfeeding

Breast abscess
Pus forms in the breast
Treatment
Antibiotics
I&D

TO SUM UP
Breastfeeding a natural reflex
Exclusive BF 1st 6 months, continued
BF till 2 years
Best nutritional choice for the young
infant
Anti-infective properties
Facts and correct technique need to be
taught
Troubleshoot common problems

Thank You