BREAST FEEDING

J.DASARATHAI/C DIVISION OF NEONATALOGY

RDT CHILDREN’S HOSPITAL, BATHALAPALLI

Why to breastfeed?Breastmilk:• Is the most appropiate and

natural food for the baby.• It adapts to the baby’s needs.

Even if baby is premature. Protects the baby against

infections : diarrhoea, bronchitis, pneumonia & immunological problems: allergies,diabetes..

• Favours utrine involution

and reduces the risk of PPH

• Reduces of uterine, ovarian & breast cancer

• Lactational amenorrhea helps in family planning

• Saves money and decreases the need for medical consultancies and drugs

Anatomy of breast

Physiology of Lactation

Murru Palu Bangaram

Colostrum• Contains a large

amount of proteins and vitamins, apart of many more inmmunoglobulins

• Even in small amounts it is enough to feed the newborn baby

Transitional milk: 3rd and 10th day post-partum

Mature milk: It’s composition changes during the course of the same feeding:

Fore milk: more proteins, lactose, water and

vitamins Hind milk: more creamy rich in fats and calories

Breastmilk contains:Anti infective factors Minerals

Anti-cancer Probiotics

Growth factors Prebiotics

Enzymes Fats

Hormones DHA/ARA

Anti-viruses Protein

Anti-allergies Water

Anti-parasites Vitamins

When ? AS SOON AS POSSIBLE.

• Strongly recomended during 1st hour after delivery

Skin to skin promotes a close bond between mother & baby

• Skin to skin in the 1st hour increases the production of Oxytocin

• Oxytocin is also called the love hormone

• This hormone promotes bonding & affection

How often do it?:

• Breastfeeding must be on demand

• Atleast 8 times a day

• Babies feed with different frequencies and take different amounts of milk at each feed

• No timetable for breastfeeding

Baby’s hunger signs

• Allow suckling until he/she spontaneously releases the nipple.

How to take the baby off

• Insert a finger into the edge of the baby’s mouth until the suction is broken

Warning signs:

• Staying on breast more than one half hour for every feed

• Wanting to feed more often than every 1–1½ hours each time

Poor attachment should be suspected

How to know if your baby is getting enough Breast milk

• You feel : your breast being pulled with NO PAIN• You hear : your baby swallowing• You see : a wide open mouth curled out lips chin pressed into your breast sucking and swallowing

Weight gain

• The new born may lose 7 % in the first 3 days• Should return to their birth weight by 10 days

of age• Should gain at least 20-35 grs a day in the first

3-4 months of age

Wet diapers

1 day At least 1 diaper 2 day At least 2 wet diapers

3 day Atleast 3 heavy diapers 4 day At least 4 heavy diapers

5-6 days At least 6 heavy wet diapers and older

For how long ?

WHO recommendations :

Breastfeed exclusively up to 6 months and with complementary foods up to 2 years of years or beyond

How to breastfeed?:

Skilled assistance

Wash hands,Be comfortableRelaxe your shoulders

• Head and body in straight line

• Whole body supported

• Nose to nipple• Tummy to tummy• Support your breast.

Thumb is on top and fingers are below the breast

How to achieve a good latch?:

• Nose to nipple so he has to open wide his mouth

• Draw the baby closer to the breast

• Covering the entire areola

Good latch-on

• Wide open mouth• Lower lip turned

outward• Chin to breast• More areola visible

above than below • No pain

Good latch-on

Usual positions:

• Changing positions help in prevention of mastitis.

Special situations:

• TWINS: Foot ball position

Premature Infant: Cross Cradle Hold

All infants > 34 weeks to be breastfed• Less than 34 weeks– Give colostrum– Initiate NNS– Lactation aid (Drip method)– Few minutes of breast feeding

Hypotonic Baby

A baby with low muscle tone usually sucks better when the head and bottomare level, or close to it. Support your baby using pillows on your lap

Hypertonic Baby

•Non Rhythmic sucking : Use Rocking chair & • Breast in quiet atmosphere•Cuddle and chat with the baby

extra chin support

Cleft Lip and Palate

• Cleft lip– Complete breastfeeding possible– Defect closed with a finger to create seal

• Cleft palate– Upright position, straddle position or modified

football position– Feed with a Palade expressed milk

Sitting

Maternal Illness

• HIV : Promote Exclusive breastfeeding unless AFASS criteria is met

• Hepatitis B : Breastfeed after Vaccine and or HepaB IV IG• Active Tuberculosis: Breastfeed along with

Chemo and BCG after stopping Chemo to baby

Expressing breast milk• Wash your hands• Use a clean glass or palada• Place your thumb and first

2 fingers outside the areola

• Push your fingers straight back towards your chest

• Gently compress your breast and roll fingers towards your nipple

Caring for your breast

• After breast feeding express some breast milk onto nipples & areola to protect the skin

Dificulties during breast-feeding

FLAT AND INVERTED NIPPLES

Solution

• Stimulate your nipple by rolling it between 2 fingers

• You can also use a syringe to pull it out

CRACKS

• In the first weeks

• Can be an sign of

poor latch on

• Pain

Solutions

• Reasses the latch – on & correct

• Spread a drop of hind milk on the nipple

• If still painful, EBM should be given

ENGORGEMENT

• Breast become hard, swollen , sensitive and tight, dry and red skin

• Breastfeed more frequently and change positions

• Warm and massage the breast before breastfeeding

After breastfeeding: Apply cold pads or clean cabbage leaves avoiding the nipples

Solutions

MASTITIS

• Bacterial infection of lactiferous glands

• RED, HOT and PAIN

• Sometimes fever and chills

Solutions• Breastfeed more

frequently and change positions

• Warm and massage the breast before breastfeeding

• Antibiotics treatment

• No reason for giving up breast feeding

Fungus

• Can affect your breast and baby’s mouth during breast feeding

• Your nipples are extremely itchy, burning, sore & wet

• The usual remedies for sore nipples aren’t working.

• Baby has oral thrush (white, cottage-cheese-like patches on the tongue and sides of the mouth)

Solutions

• Improve hygienic conditions

• Reasses latch-on• Apply an antifungical

cream • Analgesic if needed

THANK YOU

L atch on

A s soon as possible

T ummy to tummy

C olostrum is gold

H is/her Right

O n demand

N o to bottle