Dr Shivu P. MBBS, DCH.

Consultant in Pediatrics, GGSVMH, Mysuru.

No. 757, Vinayamarga, 11th cross, Siddarthanagar, Mysore 11. PIN: 570011.Mobile number: 9448477380, Land phone: 0821 2561277, 0821 4000778Mail: shivup.183@gmail.comVisit: www.slideshare.net/drshivu

India: National Family Health Survey. 2015-16NFHS 4

2005 – 06 NFHS 3

Children under the age of 3 years breast fed within one hour of birth (%)

41.6 23.4

42.8 Urban

41.1 Rural

Children under the age of 6 months exclusively breast fed (%)

54.9 46.4

52.1Urban

56.0Rural

Karnataka: National Family Health Survey. 2015-16NFHS 4

2005 – 06 NFHS 3

Children under the age of 3 years breast fed within one hour of birth (%)

56.4 35.6

53.7 Urban

58.2Rural

Children under the age of 6 months exclusively breast fed (%)

54.4 58.6

46.9Urban

58.2Rural

Mysuru: National Family Health Survey. 2015-16NFHS 4

2005 – 06 NFHS 3

Children under the age of 3 years breast fed within one hour of birth (%)

51.6 NA

34.1 Urban

63.6 Rural

Children under the age of 6 months exclusively breast fed (%)

NA NA

• Sustaining for how long?

• Who has to sustain?

• Who are all responsible for sustaining?

• Breast feeding?

• Feeding the child with

the breast milk directly

from the breast.

• No contamination, • No adulteration,• At correct temperature,• Hygienic,• Nutritious,• Species specific,• Gestation specific,• Contains protecting cells – no one can

manufacture this.• Economic,• Mother friendly,• Baby friendly,• Less disturbance to the family / neighbors /

society,• Environmental friendly – less waste generation.• Nation friendly: saves lakhs of rupees to the

family, crore of rupees to the nation.• Creates Positive health for the mother,• Creates Positive health for the baby,

Feeding the child with the breast milk directly from the breast – why?

• Mother,• Baby, • Family members,• Community,• Employer,• Education,• Media,• Mindset of the people,• Health personnel.• Indigenous people.• Nation,

Together means?

• Sustaining for how long?

• Six months - exclusive

breast feeding.

• Continue till the age of

twenty four months.

• Weaning six months

onwards.

Who has to sustain?

The primary person involved in this

process is the mother,

She has to get the support from all the

people like the husband, parents,

family members, neighbors,

community, employer, nation.

• What are the needs from the

mother side to sustain the breast

feeding.

• Normal anatomy of the breast,

• Normal physiology,

• Good secretion,

• Gained knowledge / skill of

feeding the baby.

Normal physiology

• Lactiferous glands (Milk secreting glands);

the exocrine gland which secretes the milk

by extracting the nutrients from the

interstitial space and from the blood. The

muscle cells which surrounds the gland helps

the gland to contract and make the milk to

flow towards the ducts.

Note: the secretion of milk from the gland and

its contents depends on the nutrition of the

mother. Good nutrition is vital in secreting

good quality and quantity of milk.

Good nutrition is vital both in pregnancy

and lactation as the body gains about 12

kgs in pregnancy in which the breast is

going to gain 1 to 2 kgs of weight.

Who influences all these things:

Mothers own knowledge on diet,

family knowledge on diet and cooking,

family economy / income,

the nation and the policy which influences

their income directly and indirectly.

• Love and affection, is the physiological process

through which the blood vessels relax and

maintain the normal pressure under

physiological condition, make the blood

supply to the breast optimum and facilitates

the milk secretion, not only in the feeding

breast, but even from the opposite breast.

• Mother child bondage, relations and

affections among the family members /

relatives / community are the determinants of

love and affection.

Gained knowledge / skill of feeding the baby

– Good feeding technique is the key to the

successful feeding establishment.

Seniors, education, health personnel's,

mothers own knowledge on breast feeding ,

her courage to face the ill guiding people are

some of the determinants .

Breast feeding and Physics - Pressure.

Breast feeding and Physics-Circumferential pressure.

Breast feeding and Physics-

Suction Pressure.

Breast feeding and physics.Circumferential pressure and suction

pressure.

Good position in breast feedingBaby’s body is well supported.

Baby is held close to the mother.

The entire body of the baby is turned

towards the mother (But not only the

head).

Baby’s head is in close contact with the

mother with good attachment to the nipple

and areola.

Baby’s abdomen is in close contact with

the abdomen of the mother.

With this the baby ‘s mouth, chin and the

umbilicus will come in straight line (i.e. the

head, neck, and the body of the baby are

kept in the same plain).

Good position in breast feeding

Chin of the baby is in close contact with the breast , that is there is no gap between the

breast and the chin of the baby.

Most of the areola of the breast is inside the mouth of the baby.

Baby’s mouth is wide open.

Tongue of the baby latches the nipple and areola.

Lips are everted out (turned out) and grasping the areola well.

Lips and gums are fitted firmly and circumferentially like a purse string, over the areola in

air tight fashion.

Bad position in breast feeding

Poor attachment.

Poor attachment.

Good attachment.

Good attachment.

Good attachment.

If the baby breast feeds with good

attachment then only the milk will be filled

inside the stomach and there is no collection

of air.

Even then it is better to burp for about 20

minutes after each feed because, even a

minute amount of air can also cause problem.

Poor attachment.

If there is poor attachment then some amount of air will enter in to the mouth through the

gap between the mouth of the baby and the breast, that will enter in to the stomach as the

baby swallows the milk mixed with the bubbles of air.

Later they may enter in to the intestine where they form the air columns or the child may

vomit the milk as the air bubbles comes out through the esophagus and then through the nose

and mouth.

What are the needs from the baby side to sustain the breast feeding.

Healthy baby.

Baby who is able to feed.

If the Baby is unable to sustain breast feeding.

Then, Who is going to take care of such neonates?

Who is going to look after the neonates at the time of its

entry to this world in a condition where breast feeding

is going to be sustainable.

Who is going to train the people who make the entry of the

neonate to this world in a condition where breast

feeding is going to be sustainable in an affordable way

even in the small villages.

Where you are going to take care? NICU /Ward – Public /

Private.

What are the prerequisites for the sustainability of breast feeding?

Good ANC care,

Good fetal monitoring,

Good nutrition to the mother,

Delivering the baby in a condition where the baby is able to establish breast feed immediately and sustain in long run,

Good care of the new born till they are able sustain breast feeding.

Economic influence on these issues both in public and private sector.

Generation of required qualified skilled work personnel for the same in a economical way and making them to serve even in the peripheries meeting all their requirement to serve the people without any compromise.

How family members can involve in the process of sustaining breast feeding?

Unit family issues, Combined family issues,

Showing love and affection to the mother and the baby,

Helping the mother in the process of feeding, burping, caring the mother and newborn.

Providing adequate rest to the mother by sharing house hold works.

Burping after the feed.

As the air is lighter than fluid (that is the milk) all the air bubbles will fuse at the top of

the stomach (that is at the fundus of the stomach) when the baby is kept in erect

posture either over the shoulder or over the lap. This fused air bubble (that is only the

air) will come out through the mouth of the baby leaving only the milk which is settled

at the bottom (Body and the Pylorus) of the stomach . Thus only milk will enter in the

intestine.

Poor burping – Short burping – No burping.

• Will lead to vomiting, as the air tries to come out of the

stomach which is mixed with milk.

• Air mixed milk may come out both through the mouth and

nostrils.

• When the milk sticks to the nose, they may get discomfort

in the nose or blocked nose and the baby does not know

how to clear the nose and it will not be able breath

through the nose, so it will continuously cry to breath

himself through the mouth.

• Baby may be hungry, but it will not be able to feed as the

mouth is going to be covered with breast during the breast

feeding and the nose is already blocked and it gets

suffocated if it tries to feed.

Poor burping – Short burping – No burping.

• The air which enters the small intestine makes the

intestine to bloat up and thus the baby gets the

pain in the abdomen, and the baby will cry with

this pain disturbing the entire family and the

neighbors, till the air gets out of the intestine from

the bottom as flatus.

The air columns which are formed between the milk in the lumen of the intestine and the

wall of the intestine will interfere with the digestion and absorption of the milk and thus

poor weight gain by the baby.

Lack of sleep by the baby make it irritable child with poor growth and poor performance in

the life.

Sleepless night by the members of the family may interfere with the earning by the family

members.

Burping after the feed Any one in the family can involve in this lovely job of burping and enjoying with the baby.

• Community:

• Breast feeding support group.

• Neighbors helping in the care of the mother

/ baby,

• Tolerating the baby’s cry,

• Showering love and affection to the mother

and the baby,

• Giving good and useful advises,

• Guiding the mother with their experiences.

• Employer,

• Providing suitable working hours to

the pregnant and feeding mothers,

• Infant caring centers at working

place,

• Feeding places,

• Maternity / Paternity leave,

• Toilets,

• Education,

• How the mother is going to get the knowledge

about the breast feeding,

• When she is going to get this knowledge,

• How mistakes in breast feeding can be

avoided,

• Who is going to identify the mistakes

• Who is going to identify the problems with

the breast and breast feeding and manage the

same?

• Education.

• Should we hide all these knowledge and make

both the mother and the baby to suffer later?

• If we are educating in these issues which is the

right time - degree courses / high school ?

• Do all the girls go to school, if so till what class

– thus how many mothers we are going to miss

in the process of educating in breast feeding

skills?

• Media.

• How to reach the unreached?

• How often the media needs to address

these issues?

• If it is not commercialized, then whether

that media is going to sustain or not?

• If so who is going to support them

economically?

Mindset of the people:

Should we talk these things openly or behind the

screen?

What are the problems which can arise if it

becomes an open discussions?

What are the mistakes which can happen if these

aspects remains behind the screen?

Do our people need to change to save this

environment?

• Health personnel:

• ?SBA

• LHW’

• Staff nurses’

• Doctors,

• Super specialists,

• Their generation cost,

• Their stay,

• Their sustainability in service at different geographical

places,

• Updates in the field for the same people.

• Indigenous people.

• Easy availability,

• Their perceptions,

• Their cultural influences,

• Taboos and superstitions they follow.

• Faith on them by the elders and family

members.

• Nation.

• Its understanding capabilities on these issues and

if the nations understands these issues then the

next is how fast it understands and creates policies

for the same e. g. maternity leave.

• The money spent on these issues for promotion,

manpower / generation of skilled personnel,

infrastructure, implementation, incorporating

these issues in education all these needs to be

done by the nation.

• Sustaining for how long?

• Who has to sustain?

• Who are all responsible for

sustaining?

• It is every ones responsibility

starting from the baby to the leaders

of the nation and all together

working makes the breast feeding

sustainable in long run.