BREAST FEEDING
Human milk is the ideal and uniquely superior food for infants for the
first year of life and as the sole source of nutrition for the first 6
months. This recommendation stems from the compelling advantages
that breast-feeding offers infants, mothers, and society.
Human milk feeding decreases the incidence or severity of diarrhea,
respiratory illnesses, otitis media, bacteremia, bacterial meningitis, and
necrotizing enterocolitis.
Breastfeeding advantages to mothers include decreased risk for
postpartum hemorrhage, longer period of amenorrhea, reduced risk of
ovarian and premenopausal breast cancers, and possibly a reduced risk
of osteoporosis.
Advantages to society include reduced health care costs owing to lower
incidence of illness in breastfed infants. Human milk may reduce the
incidence of food allergies and eczema. It also contains protective
bacterial and viral antibodies (secretory IgA) and nonspecific immune
factors, including macrophages, which also help limit infections
.
breast feeding intiation
The mother should be comfortable and the infant positioned so that
nothing interferes with mouth-to-breast contact. The breast from
which the infant nurses should be supported with the opposite hand,
with the thumb and index finger above the nipple to allow the infant
easy access to the nipple. The rooting reflex should be explained to the
parents to make initiation of breast-feeding easier. The nipple is
stroked against the infant's cheek nearest the nipple. The infant turns
toward the nipple (rooting reflex) and open the mouth, allowing the
introduction of the nipple and areola. The entire nipple and most of
the areola should be placed in the infant's mouth. The infant "latches
on" by compressing the lips. The mechanics of normal suckling include
suction of 4 to 6 cm of the areola, compression of the nipple against
the palate, stimulation of milk ejection by initial rapid non-nutritive
sucking, and extraction of milk from the lactiferous sinuses by a slower
suck-swallow rhythm of approximately one per second. The infant may
be removed from the breast by placing a clean finger between the
infant's gums and the areola to release suction. The mean feeding
frequency during the early weeks postpartum is 8 to 12 times per day.
E
xclusive Breastfeeding
Breastfeeding is the recommended method for feeding normal infants
during approximately the first 6 months of life. Colostrum, a high-
protein, low-fat fluid, is produced in small amounts during the first few
postpartum days. It has some nutritional value but primarily has
important immunologic and maturational properties. Primiparous
women often experience breast engorgement as the milk comes in
around the third postpartum day; the breasts become hard and are
painful, the nipples become nonprotractile, and the mother's
temperature may increase slightly. Enhancement of milk flow is the
best management. If severe engorgement occurs, areolar rigidity may
prevent the infant from grasping the nipple and areola. Attention to
proper latch-on and hand expression of milk assist in drainage.
Adequacy of milk intake
can be assessed by voiding and stooling
patterns of the infant. A well-hydrated infant voids six to eight times a
day. Each voiding should soak, not merely moisten, a diaper, and urine
should be colorless. By 5 to 7 days, loose yellow stools should be
passed at least four times a day. Rate of weight gain provides the most
objective indicator of adequate milk intake. Total weight loss after birth
should not exceed 7%, and birth weight should be regained by 10 days.
The characteristics of the stools of breastfed infants often alarm
parents. Stools are unformed, yellow, and seedy in appearance. Parents
commonly think their breastfed infant has diarrhea. Stool frequencies
vary; during the first 4 to 6 weeks, breastfed infants tend to produce
stool more frequently than formula-fed infants. After 6 to 8 weeks,
breastfed infants may go several days without passing a stool.
In the newborn period, elevated concentrations of serum bilirubin are
present more often in breastfed infants than in formula-fed infants.
Feeding frequency during the first 3 days of life of breastfed infants is
inversely related to the level of bilirubin; frequent feedings stimulate
meconium passage and excretion of bilirubin in the stool.
Infants who have insufficient milk intake and poor weight gain may
have an increase in unconjugated bilirubin secondary to an exaggerated
as breastfeeding
tion of bilirubin. This is known
enterohepatic circula
. Attention should be directed toward improved milk
jaundice
production and intake. The use of water supplements in breastfed
infants has no effect on bilirubin levels and is not recommended
, which is a diagnosis of exclusion and should be
jaundice
milk
breast
made only if an infant is otherwise thriving, with normal growth and
no evidence of hemolysis, infection, or metabolic disease ; Which is
due to some sorts of fatty acids in breast milk that interfere
mainly
with bilirubin conjugation
Exclusively breastfed infants should be supplemented with vitamin D
(200 IU/day starting at 2 months of age), and possibly fluoride after 6
months
Common Breastfeeding Problems
Breast tenderness, engorgement, and cracked nipples are the most
common problems encountered by breast-feeding mothers.
Engorgement, one of the most common causes of lactation failure,
should receive prompt attention because milk supply can decrease
quickly if the breasts are not adequately emptied. Applying warm or cold
compresses to the breasts before nursing and hand expression or
pumping of some milk can provide relief to the mother
Supportive measures include nursing for shorter periods, beginning
feedings on the less sore side, air drying the nipples well after nursing,.
Severe nipple pain and cracking usually indicate improper latch-on.
Temporary pumping, which is well tolerated, may be needed.
If a lactating woman reports fever, chills, and malaise,
mastitis
should
be considered. Treatment includes frequent and complete emptying of
be stopped
should not
the breast and antibiotics. Breastfeeding usually
because the mother's mastitis commonly has no adverse effects on the
breastfed infant, and abrupt weaning may increase the risk of
development of a breast abscess. Untreated mastitis also may progress
to a breast abscess. If an abscess is diagnosed, treatment includes
incision and drainage, antibiotics, and regular emptying of the breast.
Nursing from the contralateral breast can be continued with the
healthy infant. If maternal comfort allows, nursing also can continue on
the affected side
contraindication of breastfeeding
Maternal infection with
HIV
is considered a contraindication for
breastfeeding in developed countries. When the mother has
active
tuberculosis, syphilis, or varicella
, restarting breastfeeding may be
considered after therapy is initiated. If a woman has
herpetic lesions on
her breast
, nursing and contact with the infant on that breast should be
avoided. Women with genital herpes can breastfeed. Proper hand-
washing procedures should be stressed.
Galactosemia
in the infant also
is a contraindication to breastfeeding.