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= let-
down 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 terms
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
terms 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 infant
1. It is a unique food, and
nutritionally superior to any
alternative
2. Bacteriologically safe and always
fresh
3. Contains many anti infectious
factors
4. 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 Cow Goat

Fat

Protein

Lactose
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)
 Antistaphylococcus factor
 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 mother
1. Helps reduce risk of uterine bleeding and
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

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 breast-
feeding support 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 supported,
not supported 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
Good attachment- Poor attachment

Breastfeeding Counselling: a training course,

WHO/CHD/93.4, UNICEF/NUT/93.2
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,
 passes 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. Alteration of milk taste

2. ↓ oxytocin secretion→ ↓ milk ejection
3. 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 support, 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