Breast feeding 2015
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Transcript of Breast feeding 2015
Dr.S.Preethi (MD) Community medicineYenepoya medical College
Celebrated 1 to 7 August , > 170 countries
2015 marks the 25th Anniversary of Innocenti Declaration
WHO & UNICEF August 1990 protect, promote & support
Galvanize Promote Inform
Strengthen Engage
Every fifth young child in world lives in India
Every second child in India is malnourished
Three out of four young children in India is anemic
Every second newborn in India is at risk of reduced learning capacity
due to iodine deficiency
Exclusive breastfeeding -nursing -baby indicates desire- 6 months
Continued breastfeeding - nursing beyond six months- 2yrs
Mixed breastfeeding -breast milk & supplements before 6 months
Formula feeding - fed with a bottle and receives only formula, cow’s milk
to specialty formulas
1981 - The Int Code of Marketing Breast-milk Substitutes
1990 - Innocenti Declaration on the Protection, Promotion and
Support of Breastfeeding
1991 - Baby-friendly Hospital Initiative
1992 - Infant Milk Substitutes Feeding Bottles, and Infant Foods
(Regulation of Production, Supply and Distribution) Act (IMS Act)
which was further amended in 2003
National Guidelines on Infant and Young Child Feeding in 2006
However , India has failed to implement both of these effectively
Health benefits of Breast milk on Infants
Lowers rate of type-2 diabetes.
Intelligence level high
Benefits for mothers
reduces risks of breast and ovarian cancer
return to their pre-pregnancy weight faster
lowers rates of obesity.
Infant formula does not contain the antibodies -linked water-borne
diseases that arise from mixing powdered formula with unsafe water
Malnutrition can result from over-diluting formula to "stretch" supplies.
'The Earth - Our Mother - is in crisis!' and 'Over 20 years of evidence has shown how infant formula production, packaging and use are adding to this crisis!'
Colostrums feeding
Exclusive breast feeding
Complementary feeding
16% to 50% 55% to 80%
34% to 75%
In India, the NFHS-3 (2005-2006 )
Only 24 % children under three years are breastfed within 1hr of birth
Only 46 percent children in the age group 0-6 months are exclusively breastfed
DLHS - 3 (District level household and facility survey) Fact Sheets 2007-
2008
Initiation of breastfeeding within one hour of birth – 40.2%
Complementary feeding along with continued breastfeeding
in 6-9 months- 23.9%.
MDG-4 (Under 5 mortality target RATE- 55/1000 LB)
Reduce by 2/3rd between 1990 and 2015
12th Five year plan IMR 40 – 25 by 2017
Assam – 83 per 1,000 live births highest under-five mortality rate
Kerala recorded lowest under-five mortality rate of – 15/1000 LB
Tamil Nadu – 27/1000 LB
Ghutti (a mixture of herbs, extracts and flavorings) Pakistan 2- 3 days
In Ethiopia, infants -boiled water and butter-protect against infection
Chinese babies are given herbal tea for the first 2-3 days.
In Mysore, India, babies are bottle-fed sugar water
In peninsular Malaysia a paste of corn flour and water is given
Certain facts Powdered milk not completely sterile, and to be mixed with hot water
Modified animal milk no longer considered adequate for milk feeds for
a baby less than 6 months old
Exclusive breastfeeding stands out as a single most effective
intervention for child survival
Ref: Arun Gupta et al (Breastfeeding and Complementary Feeding as a Public Health Intervention for Child Survival in India) Indian journal of paediatrics
Exclusive breastfeeding can cut down HIV transmission rates from
HIV positive women to their offspring by half in comparison with
those who practice mixed feeding.
Evidence-based ways to universalize optimal infant and young
child feeding (IYCF) practices
Ref: Arun Gupta et al (Breastfeeding and Complementary Feeding as a Public Health Intervention for Child Survival in India) Indian
journal of paediatrics
WHO AND UNICEF Recommends Initiation of breastfeeding within the first hour of life
Exclusive breastfeeding for the first six months of life
Breastfeeding on demand
No use of bottles, teats or pacifiers
At six months, other foods should complement breastfeeding for up
to two years or more.
Timely -need for energy and nutrients exceeds
Adequate –provide sufficient energy growing child
Safe –hygienically stored and prepared
Implemented in about 16.000 hospitals in 171 countries
1. Written breast feeding policy
2. Train all health care staff
3. Inform all pregnant women about the benefits and management
4. Help mothers initiate breast feeding within half-an-hour of birth.
5. Show mothers how to breast feed and maintain lactation – separation
6. Give newborn infants no food or drink other than breast milk
7. Practice rooming in - 24 hours a day.
8. Encourage breast feeding on demand.
9. Give no artificial teats or dummies to breast feeding infants.
10. Foster the establishment of breast feeding support groups
The signs of poor attachment are:
More of the areola is visible below the
baby’s bottom lip than above the top lip –
or the amounts above and below are equal;
the baby’s mouth is not wide open;
the baby’s lower lip points forward or is
turned inwards;
the baby’s chin is away from the breast.
The signs of good attachment are:
more of the areola is visible above the
baby’s top lip than below the lower lip;
the baby’s mouth is wide open;
the baby’s lower lip is curled outwards;
the baby’s chin is touching or almost
touching the breast.
Cradle-hold Cross-cradle hold
Lying on your side
Football hold Laid back
150 ml per kg body weight per day, divided into 8 feeds in 24 hours
Each 100 ml of mature breast milk
• 70 calories
• 89.97 g water
• 7.4 g carbohydrates (primarily lactose)
• 4.2 g fat
• 1.3 g protein
Ref :ttp://www.parentingscience.com/calories-in-breast-milk.html#sthash.QPdQMVB6.dpuf
• Breast changes: The breasts feel fuller or firmer, or milk leaks or can be expressed
•Less supplement consumed
•Stool changes: The infant’s stools become softer, more like those of a breastfed infant
Lactogogues
Drugs used are metoclopramide (given 10 mg 3 times a day for 7–14 days) or
domperidone (given 20–40 mg 3 times a day for 7–10 days).
However, drugs help only if the woman also receives adequate help and her breasts are
fully stimulated by the infant suckling.
International code regulate marketing of breast-milk substitutes -1981
All formula labels must state benefits & breastfeeding risk substitutes
No promotion of breast-milk substitutes
No free samples of substitutes given to pregnant women
No distribution of free or subsidized substitutes to health workers
Infant conditions
Galactosemia Maple syrup urine disease Phenylketonuria <1.5 kg <32 week
Maternal conditions
HIV (AAFSS) HSV-1 Anti-epileptic drugs Topical iodine Cytotoxic drugs
Possible reasons for suboptimal breastfeeding
1.Lack of proper information to mothers
2. Lack of by the commercial industries
3. Inadequate health care support
4. Inability of the health care providers to help mothers experiencing
breastfeeding difficulty
5. No mention of BFHI in NRHM document
6. Inadequate mechanism to enforce “The Infant Milk Substitutes,
Feeding Bottles and Infant Foods (Regulation of Production,
Supply and Distribution) Act, 1992”, as amended in 2003(IMS
Act)
7. Inadequate counseling to HIV positive women regarding infant
feeding options
WHO recommends at least 16 wks of absence from work after delivery
Mothers abandon EBF before six months – no sufficient time, place to
breastfeed or express and store their milk at work.
Mothers need access to a safe, clean and private place in or near their
workplaces to continue the practice.
Express your breast milk before you go to work, and leave it for the carer to give to your baby:
Express in a relaxed way and express as much breast milk as you can
Cover the cups of expressed breast milk with a clean cloth or plate
Leave the milk in the coolest place refrigerator or freezer
You do not need to boil or reheat your breast milk
Germs do not start growing in EBM for at least 6-8 hours, even in a hot
climate, and outside the refrigerator
14 weeks of maternity leave
Paid leave (at least 2/3 of salary) and medical benefits
both paid by social security or social/health insurance
One or more breastfeeding breaks as part of working time
Health protection for pregnant and breastfeeding workers
Job protection against dismissal if pregnant or breastfeeding
Non-discrimination against hiring women of childbearing age
Inclusion of working women from the non-formal sector
Breaks can be combined at beginning or end of the working day
Where practicable, establishment of facilities for nursing under
adequate hygienic conditions at or near the workplace
Maternal absentee rates due to infant illness in two US companies
- 25% if breastfed
- 75% if artificially fed
Reduced absenteeism leads to cost savings
Providing breastfeeding support to employees results in cost
benefit
Less turnover of employees and training of new ones
Goal: To reduce IMR 44 – 25 (2017)
Objective: To Increase the EBF rate by educating and enabling lactating
mothers to breast feed at their workplace
Strategies:
1. Paid maternity and breast feeding breaks
2. Shorter working days and flexible working hours
3. Crèches at workplace
4. Home caregivers brings baby to work for feeds
5. In all these cases, regular communication between mother,
employer and trade union
Pilot study: FGD among working women to get inputs on how to
make the working place atmosphere friendly to breast feed their
babies.
1. Neonatal Integrated comprehensive approach ( Neonatal care
and breast feeding education)
2. Intersectorial Co-ordination of existing infrastructures
3. Political commitment
4. Implementation of 2003 IMS Act strictly by making the
existing laws more stringent
5. Baby Friendly Hospital Initiative
6. Operational research for evidence based interventions
7. Infant during emergencies
8. Health and nutrition care
9. Develop a network of support at work
10. A realistic timeline for their achievement,
and measurable process and output indicators that will permit an
accurate monitoring and evaluation
Accessibility Indicators:
No: of crèches in different Govt and private sectors in the city
No: of breastfeeding supporting groups in the city
Percentage of breast feeding clinics in the city
Quality Indicators:
Rate of EBF under 6-months
Rate of complementary feeding at one yr of age
Rate of early initiation of breastfeeding in the last 24 months
Rate of lactating women getting absent at workplace
Impact indicators:
Prevalence of IMR, Under-5 MR
Breastfeed exclusively and frequently for the whole maternity leave
Learn to express your breast milk soon after your baby is born
Avoid starting other ways of feeding before you really need to
Continue to breastfeed at night, in the early morning, and at any
other time that you are at home.
Breastfeed your baby after you have expressed
use the formula within 2 hours, and then throw away any left
over or feed it to an older child.
Teach the carer properly and carefully
While you are at work express your breast milk 2-3 times each
workday (about 3 hourly)
8-hour work period
8:00 a.m. Begin work
9:45-10:00 Use break to express milk
12:00 noon Take allowed lunch period to express milk
2:30-2:45 Use break to express milk
5:00 p.m. Leave work
Bhalwar R. Text Book of Public Health and Community Medicine. 1st ed. Pune: Dept of Community Medicine, AFMC. 2009. Pp 750-60.
Park.K. Text Book of Preventive and Social Medicine.22nd ed. Jabalpur: M/S. Banarasidas Bhonot Publishers;2013.Pp 480-523.
Women and work manual. Availabe from: http://uhs.berkeley.edu/Facstaff/pdf/healthmatters/Breastfeeding%20and%20Working%20from%20WomensHealth.pdf. Last retrieved on 22nd July 2015.