Breastfeeding Tips For Moms and Health Workers
Transcript of Breastfeeding Tips For Moms and Health Workers
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BREASTFEEDING
Best Food For the NewbornJosephine T.R. Holgado,M.D.,D.P.P.S.
October 31, 2012Calamba Medical Center
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INTRODUCTION
W.H.O. strongly recommends
exclusive breastfeeding
for the first six months of life.
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INTRODUCTION
Ten Steps To Successful Breastfeeding*
Every facility providing maternity services and care for newborn infants should:1. Have a written breastfeeding policy that is routinely communicated to all health care staff.2. Train all health care staff in skills necessary to implement this policy.3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within a half-hour of birth.5. Show mothers how to breastfeed, and how to maintain lactation even if they are separatedfrom their infants.6. Give newborn infants no food or drink other than breastmilk, unless medically indicated.7. Practise rooming-in - allow mothers and infants to remain together - 24 hours a day.8. Encourage breastfeeding on demand.9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them ondischarge from the hospital or clinic.
* A summary of the main recommendations of the Joint WHO/UNICEF Statement (1989) called"Protecting, Promoting and Supporting Breastfeeding: The Special Role of Maternity Services"
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INTRODUCTION
Summary of the International Code of Marketing of Breastmilk Substitutes*The Code includes these 10 important provisions:
1. No advertising of all breastmilk substitutes** to the public.2. No free samples to mothers.3. No promotion of products in health care facilities, including no free or low-cost formula.4. No company representatives to contact mothers.5. No gifts or personal samples to health workers. Health workers should never pass products
on to mothers.6. No words or pictures idealizing artificial feeding, including pictures of infants, on the labels.7. Information to health workers must be scientific and factual.8. All information on artificial infant feeding must explain the benefits and superiority ofbreastfeeding, and the costs and hazards associated with artificial feeding.9. Unsuitable products, such as sweetened condensed milk should not be promotedfor babies.10. Manufacturers and distributors should comply with the Code's provisions even if countrieshave not acted to implement the Code.
* The International Code of Marketing of Breastmilk Substitutes was adopted by the WorldHealth Assembly in 1981 as a tool to protect breastfeeding.** Breastmilk Substitutes include: infant formula, follow-up formula, feeding bottles, teats, babyfood and beverages etc.
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INTRODUCTION
Republic Act No. 7600
AN ACT PROVIDING INCENTIVES TO
ALL GOVERNMENT AND PRIVATEHEALTH INSTITUTIONS WITHROOMING-IN AND BREAST-FEEDING
PRACTICES AND FOR OTHERPURPOSES.
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OBJECTIVES
General Objective
To acquire a general knowledge on theimportance and practice of breastfeeding
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OBJECTIVES
Specific Objectives1. To determine the benefits of breastfeeding2. To find out the different positions to breastfeed3. To know the steps on correct latching4. To enumerate the absolute and temporary
contraindications to breastfeeding5. To know how to express and store breastmilk
6. To differentiate full breasts from engorgedbreasts7. To find out the management of sore nipples
and mastitis
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BENEFITS OF BREASTFEEDING
Health benefits for infants
1. gives infants all the nutrients they need forhealthy development.
2. safe and contains antibodies that help protectinfants from common childhood illnesses - suchas diarrhoea and pneumonia, the two primarycauses of child mortality worldwide.
3. readily available and affordable, which helps toensure that infants get adequate sustenance
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BENEFITS OF BREASTFEEDING
Health benefits for mothers
1. associated with a natural (though not fail-safe)method of birth control (98% of protection in the
first 6 months after birth) if done exclusively2. reduces risks of breast and ovarian cancer later
in life,
3. helps women return to their pre-pregnancyweight faster,
4. lowers rates of obesity.
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POSITIONS
1. Cross-cradle Hold
2. Cradle Hold
3. Football Hold4. Side-lying Hold
5. Football Hold for twins
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Good and poor attachment
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Key points to good attachment
The mouth is widely open
The lower lip is turned outwards
The chin is touching the breast
More areola is visible above the babys mouththan below it
The tongue is forward in the mouth, and maybeseen over the bottom gum
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CORRECT LATCHING/SUCKLING
VIDEOS
GOOD ATTACHMENT
POSITIONING
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CONTRAINDICATIONS
ABSOLUTE
Mental Disorder
Mental Retardation
Seizure Disorder
Cardiac Disease
Advanced Nephritis
Open Tuberculosis
Thyrotoxicosis
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CONTRAINDICATIONS
TEMPORARY
intake of drugs like anticoagulants,antibiotics,
toxic substances like mercury andbenzene
mechanical problems like retracted andoversized nipples.
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Drugs of Abuse for Which Adverse Effects on theInfant During Breastfeeding Have Been Reported*
Drug Reported Effect or Reasons for Concern
Amphetamine Irritability, poor sleeping pattern
Cocaine Cocaine intoxication: irritability,vomiting, diarrhea, tremulousness, seizures
Heroin Tremors, restlessness, vomiting, poor feedingMarijuana Only 1 report in literature; no effect mentioned;
very long half-life for some componentsPhencyclidine Potent hallucinogen
* The Committee on Drugs strongly believes that nursing mothers should notingest drugs of abuse, because they are hazardous to thenursing infant and to the health of the mother. Drug is concentrated in human milk.
The Transfer of Drugs and Other Chemicals Into Human MilkAmerican Academy of Pediatrics Committee on Drugs
Pediatrics2001;108;776
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Drugs for Which the Effect on Nursing Infants Is Unknownbut May Be of Concern*
Drug Reported or Possible Effect
AntidepressantsFluoxetine Colic, irritability, feeding and sleep
disorders, slow weight gain
AntipsychoticChlorpromazine Galactorrhea in mother; drowsiness and
lethargy in infant; decline in developmentalscores
Haloperidol Decline in developmental scores
The Transfer of Drugs and Other Chemicals Into Human Milk
AAP Committee on Drugs
Pediatrics2001;108;776
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Drugs for Which the Effect on Nursing Infants Is Unknownbut May Be of Concern*
OTHERSDrug Reported or Possible EffectAmiodarone Possible hypothyroidismChloramphenicol Possible idiosyncratic bone marrow
suppressionClofazimine Potential for transfer of high percentage of
maternal dose; possible increase in skinpigmentation
Lamotrigine Potential therapeutic serum concentrationsin infant
Metoclopramide None described;dopaminergic blocking agent
Metronidazole In vitro mutagen; may discontinuebreastfeeding for 1224 h to allowexcretion of dose when single-dosetherapy given to mother
Tinidazole See metronidazole
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Drugs That Have Been Associated With Significant Effectson Some Nursing Infants and Should Be Given to Nursing
Mothers With Caution*
Drug Reported EffectAcebutolol Hypotension; bradycardia; tachypnea5-Aminosalicylic acid Diarrhea (1 case)
Atenolol Cyanosis; bradycardiaBromocriptine Suppresses lactation; may be hazardous to the mother
Aspirin (salicylates) Metabolic acidosis (1 case)Clemastine Drowsiness, irritability, refusal to feed, high-pitched cry,
neck stiffness (1 case)Ergotamine Vomiting, diarrhea, convulsions (doses used in migrainemedications)
Lithium One-third to one-half therapeutic blood concentration ininfants
Phenindione Anticoagulant: increased prothrombin and partialthromboplastin time in 1 infant; not used in United States
Phenobarbital Sedation; infantile spasms after weaning from milkcontaining phenobarbital, methemoglobinemia (1 case)
Primidone Sedation, feeding problemsSulfasalazine(salicylazosulfapyridine) Bloody diarrhea (1 case)* Blood concentration in the infant may be of clinical importance.
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Maternal Medication Usually Compatible WithBreastfeeding
Drug Reported Sign or Symptom in Infant or
Effect on Lactation
Alcohol (ethanol) With large amounts, drowsiness, diaphoresis, deep sleep,weakness, decrease in linear growth, abnormal weightgain; maternal ingestion of 1 g/kg daily decreases
milk ejection reflexCaffeine Irritability, poor sleeping pattern, excreted slowly; no
effect with moderate intake of caffeinated beverages(23 cups per day)
Carbimazole GoiterChloral hydrate SleepinessContraceptive pillwith estrogen/progesterone Rare breast enlargement; decrease in milk production
and protein content (not confirmed in several studies)Indomethacin Seizure (1 case)Iodides May affect thyroid activity; see iodineIodine GoiterIodine (povidone-iodine, eg, in a vaginal douche) Elevated iodine levels in breast milk, odor of
iodine on infants skinIsoniazid None; acetyl (hepatotoxic) metabolite secreted but no hepatotoxicity
reported in infants
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Maternal Medication Usually Compatible WithBreastfeeding
Drug Reported Sign or Symptom in Infant or
Effect on LactationMorphine None; infant may have measurable blood concentration
Nalidixic acid Hemolysis in infant with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency
Nitrofurantoin Hemolysis in infant with G-6-PD deficiencyPhenytoin Methemoglobinemia (1 case)
Sulfapyridine Caution in infant with jaundice or G-6-PD deficiency and ill, stressed, orpremature infant; appears in infants milk
Sulfisoxazole Caution in infant with jaundice or G-6-PD deficiency and ill, stressed, orpremature infant; appears in infants milk
Tetracycline None; negligible absorption by infant
Tolbutamide Possible jaundice
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Food and Environmental Agents:Effects on Breastfeeding
Agent Reported Sign or Symptom in Infant orEffect on Lactation
Aspartame Caution if mother or infant has phenylketonuriaBromide (photographic laboratory) Potential absorption and bromide transfer into milk;Chocolate (theobromine) Irritability or increased bowel activity if excess amounts
($16 oz/d) consumed by mother
Fava beans Hemolysis in patient with G-6-PD deficiency FluoridesHexachlorobenzene Skin rash, diarrhea, vomiting, dark urine, neurotoxicity,death
Hexachlorophene None; possible contamination of milk from nipple washingLead Possible neurotoxicityMercury, methylmercury May affect neurodevelopmentPolychlorinated biphenyls and
polybrominated biphenyls Lack of endurance, hypotonia, sullen, expressionlessfaciesSilicone Esophageal dysmotilityTetrachloroethylene cleaning fluid
(perchloroethylene) Obstructive jaundice, dark urineVegetarian diet Signs of B12 deficiency
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EXPRESS BREASTMILK
VIDEO ON HAND EXPRESSION
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BREASTMILK STORAGE
Breastmilk Hospital Use Home Use
Fresh, room temperature 4 hours 8 hoursFresh, refrigerated 72 hours 8 days
Thawed, after freezing 24 hours 24 hours
Frozen (-20 to 0 F) 12 months 12 monthsFrozen in home freezer
(5 - 15 F) 6 months 6 months
Frozen in small interior freezer 2 weeks 2 weeks
*Do not store milk in the door compartments of therefrigerator or freezer
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CHARACTERISTICS OF FULL BREASTS
NORMAL
36/72 hours after birth.
Hot, heavy, may be hard
Milk flowing or dripping
Fever uncommon
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CHARACTERISTICS OF ENGORGEDBREASTS
ABNORMAL can occur at any time duringbreastfeeding
Painful. edematous
Tight, especially nipple area
Shiny May look red
Milk NOT flowing
Fever may occur
Engorgement may causea decrease in milk supply
if it happens often
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Management of Sore Nipples
Look for a cause:Check the babys position at the breast
Check the babys attachment at the breast.Examine the breasts engorgement, fissures, candida. Check the baby for candida.
Give appropriate treatment: Build the mothers confidence Improve the babys attachment and continue breastfeeding Reduce engorgement, feed frequently, express breast milk Treat candida.
Advise the mother to: Wash breasts only once a day, avoid using soap Avoid medicated lotions and ointments Gently smooth hindmilk into nipple and areola after a breastfeed.
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MASTITIS
Manifestations:
fever with temp > 38 C or with flu-like symptoms
affects only one part of the breast
Well-defined, red, sore, and swollen area
Pathophysiology: a blocked duct so
milk does not flow from that part of the breast.
Complication: If no treatment is given and milk is
not removed by feeding or expressionthe mother may develop an abscess
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Causes of Mastitis
Fissured nipples
Not feeding often enough
Tight clothesHolding the breast during a feed
Baby poorly attached and not removing
the milk properly from all parts (lobes) ofthe breast
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Management of Mastitis
Breastfeed frequently at least every 3 hours.Using different feeding position may help clearthe blockage
If mother cannot breastfeed from affectedbreast, express milk every 3 hours untilimproved
If no change within 24 hours or if mother lives farfrom the health facility, she should beginantibiotics immediately
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Management of Mastitis
Give Cloxacillin 500 mg q 6 hours for 10days.
If severe pain, give paracetamol.
Reassess in 2 days. If no improvement or
worse, refer to a hospital.
Do not give sugar water, formula or otherprelacteals
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SUMMARY
It is BEST for babies up to 2 years and beyond.
B - Bonds the mother and the child;
E Economical in terms of time, money and
convenience,S Safe for it prevents diarrhea and otherdiseases, allergies and provides antibodies
against infection and necessary nutrients in theproper quality and quantity and
T Tried and Tested for years since it is alwaysat the right Temperature and with contraceptive
effect, especially with exclusive breastfeeding.
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THANK YOU!