Breast Feeding
Specific objectives:At the end of this lecture you will be able to 1.Identify hormones play a role in milk production. 2.State variations in breast milk composition. 3.Have a look on the composition of breast milk. 4.List reflexes played a role in Breast Feeding (BF) process. 5.Describe various steps that determine correct positioning in BF.
.6. Enumerate disadvantages of Bottle Feeding 7. Enumerate benefits of BF. 8. List contraindications to BF. 9. List conditions in which BF is not contraindicated. 10. Enumerate ten steps to successful BF. 11. List common problems associated with BF, causes, prevention and treatment.
12. Indicate the time of introduction of .Complementary food 13. Define weaning and weaning period. 14. List causes of diarrhea and malnutrition associated with weaning. 15. State time of starting weaning and for how long. 16. Describe the process of weaning and type of food given.
Breast Feeding Milk production is under control of the hormone prolactine which is secreted from the anterior part of the pituitary gland. Oxytocin is hormone produced by the posterior part of the pituitary gland which is responsible for milk ejection.
Breast Feeding The composition changes according to the need of the child & mother factors. It varies according to the following Stage of lactation : 1st week colustrum. 2nd week transitional milk. there after mature milk. Fore milk Water content is more at the beginning of the feed. Hind milk Fat content is more at the end of the feed.
Breast Feeding
Composition of milk2)Time of the dayFat content is highest in the mid – day.Breast Feeding Composition of milk 3) Maternal nutrition The quality of milk will be affected by maternal under-nutrition only in its severe forms. 4) ClimateHot climate more water is needed, mother doesn’t have to give extra-water.Cold climate there will be an increase in fat content which will lead to higher energy production. Individual variation.
Breast feeding process; Reflexes
Rooting Reflex If the cheeks or lips of the infant are stimulated (touched) he opens his mouth and turns his face to the nipple. Suckling Reflex The infant suckles anything that enters his mouth and touch the roof of the mouth (palate). This reflex is very vigorous at birth.Breast feeding process; Reflexes
Swallowing Reflex The infant swallows the milk, and coordinates this reflex with the suckling reflex. If the reflexes are not well developed (as in a preterm baby), the breast milk can be given by a Naso-Gastric tube.Breast feeding process; Reflexes
Swallowing Reflex If the baby opens his mouth widely, he will take the areola with the nipple & press on the milk lakes so the milk is expelled. If the mouth is not opened widely, he will take only the nipple & bite on it & no milk will be expelled. This will result in nipple cracks, which are very painful.Positioning in breast feeding
Correct positioning will determine the success of breast feeding. There are various steps to correct positioning:Positioning of the mother She must breast feed in a comfortable & relaxed position because if not, she will feel tired & end the feed quickly. The mother should sit with a straight back supported with a pillow, or if she can’t sit straight then she can feed the baby while lying down on her back, or on her side and the baby beside her.Positioning in breast feeding
2. Positioning of the infant Head and body are in one line with a straight neck. Infant is facing the mother. Infant is well supported (when he is still small one hand is enough for support but later on both hands are used). Infant is close to the mother.Positioning in breast feeding
Attachment to the breast Mouth should be opened widely Chin touching the breast. Lower lip turned outward. The lower part of the areola should not be seen & the upper part should be partly visible. Effective suckling Slow deep sucks, pauses from time to time, swallowing can be seen, the mother feels no pain.Wrong position
This baby is not in the right position. He is nipple feeding ,not breast feeding. If he is allowed to continue to do so ,his mother will develop nipple cracks.Right position
This baby is just in a right position, the mouth is widely opened. Chin is touching the breast. Lower lip turned outward. The lower part of the areola is not seen & the upper part is partly visible.Disadvantages of bottle feeding Contamination diarrhea malnutrition. Lack of BF increases the risk of death from diarrhea to 6.1 times and from pneumonia to 2.4 times. High cost the mother will give diluted feed malnutrition. Low level of vitamins , iron anemia.
Disadvantages of bottle feeding
Hypernatremia acidosis (in LBW infants), kidney diseases & diarrhea.Hypercalcemia due to the high content of Ca in cow milk.
Disadvantages of bottle feedingHigher content of saturated fatty acids in cow’s milk. Infants need unsaturated fatty acids for brain development. Cow milk is deficient in lenolenic acid and cholesterol which are needed for brain growth.
Disadvantages of bottle feeding
High casein content leads to indigestion which results in constipation. Allergic conditions.Nipple confusion & refusal of breast milk. The mechanism of suckling the breast is different from that of sucking the bottle. The child will be confused & will abandon the suckling mechanism preferring the sucking which is easier.
Disadvantages of bottle feeding
Non exclusive BF for the 1st 4months increases the risk of death from diarrhea to 3.1 times and from pneumonia to 2.4 times.Benefits of breast feeding High nutritional value. Provides immunological protection. Has anti allergic properties. Provides close emotional relationship. Avoids dental caries. Promotes normal facial development.
Benefits of breast feeding
7. Protects against different diseases. 8. Improves speech development. 9. Promotes greater intellectual ability. 10. Provides fertility control. 11. It is cheep ,convenient, has right temp, and sterile.Contra –indications to BFActive phase to Breast Ca.Inborn errors of metabolism (PKU), (glactosemia ).Breast milk Jaundice which starts after 2 weeks of life, while physiological jaundice starts after few days. Sever bilateral mistitis.Beta-Streptococcal infection of the infant throat.Puerperal psychosis.
There are certain conditions in which BF is not contra – indicatedViral infection as HBV & HIV.TB when the infant receives BCG. Neonatal Jaundice.Prematurity & LBW.New pregnancy.Congenital anomalies as in cleft palate.Fetal distress & hypoxia.Multiple birth.
Ten steps to successful breast feeding Every facility providing maternity & new born care services should have the following Written BF policy that is routinely communicated to all health care staff. Training of all health care staff in skills necessary to implement this policy. Inform all pregnants about benefits & management of BF. Helping mothers to initiate BF within half an hour after delivery. Showing mothers how to BF & maintain lactation even if they should be separated from her baby.
Ten steps to successful breast feeding Give new born no food or drink other then breast milk unless otherwise medically indicated. The practice of rooming in i.e. allow mothers & infants to remain together 24 hrs. Encourage breast feeding on demands. No artificial teats or pacifiers should be used. Foster the establishment of BF support groups & refer mothers to them on discharge from hospitals.
Problems associated with breast feeding Engorged & congested breast. Causes infant is not in correct position imperfect emptying, leads to sustained milk and congestion. Treatment & prevention Early initiation of BF. Manual evacuation. Massage & cold sponging. Breast emptying.
Problems during breast feeding
2.Milk fever This happens when the breast is filled milk is pumped back into the circulation immune reaction. It is self-limiting.
Problems during breast feeding 3.Nipple pain & cracks Causes Only nipple is sucked. Incorrect positioning. Treatment & prevention Correct position. Do not use Antibiotic & creams.
Problems during breast feeding
Suckle refusal Causes Sick infant. Premature (<2000gm) where reflexes are not developed yet. Nipple confusion. Separation of infant from his mother for several days (psychological refusal).Problems during breast feeding 5. Mastitis Causes blocked duct & bacterial growth leads to abscess formation Treatment Early treatment (i.e.) before pus accumulation: Massage. Express milk. Antibiotics. Bed rest. Open obstructed duct.
Problems during breast feeding
5. Mastitis Late treatment (i.e. after pus accumulation ) Surgical. Antibiotics. Note: Don't stop breast feeding use the healthy breast.When to start complementary food
When energy and nutrients are no longer sufficient i.e. age 4-6 month. At this age the child has a better control of his tongue moves jaws up and down, starts teething, likes to put things in his mouth, interested in new tests, has more mature digestive system.Delayed initiation of complementary food
Does not adequately fill the energy gap. Child stop growing or grows slowly. Increase risk of malnutrition and micronutrients deficiency.Weaning period It is the transitional stage when a young child’s diet gradually changes from one of milk alone to a diet based on what the family eats .
Weaning period
Weaning begins when the child is introduced to food other than milk & is completed when the child is full accustomed to the regular family diet & this period differs from one child to another.
Weaning period
During weaning the child should continue breast feeding, since breast milk is an important source of nutrition during this period.During this period the child may be exposed to : Diarrhea Causes Wrong food Contaminated food. Bad hygiene particularly during food preparation. Bad storage of food. Contaminated water.
Malnutrition Causes Type of food i.e. not giving the infant enough proteins and energy in the diet. Repeated attacks of diarrhea.
Weaning period
When to start weaning and for how long ? Start at 6 months of age. Weaning can be completed at any time. between12-24 months. note: Early weaning (2 months) is wrong. It leads to diarrhea. Late weaning (>6 months) is also wrong. It leads to malnutrition.Weaning period How to wean ? Gradually by using tea spoon one time and use mashed food. Initially give one meal /day & watch adaptation of the child. If there is no vomiting or diarrhea give another meal & so on.
Weaning period
How to wean? 3.Then increase the quantity & frequency. 4. Give about 2-4 additional meals two months later. 5. Add solid food at the age of 7 months & the meals should reach 5-6 /day.What to give to the baby? This depends on The traditional food usually given to the child. What is available. Time available to mother (preparations feeding).
Note :Start with fruit juices, rice soup, vegetable soup up to the age of 6 month then add white meat (chicken) then red meat when the child is adapting so ending up with multimix. Eggs should not be given before the end of the first year (sensitivity ,contamination).Honey shouldn’t be given before the end of the first year (contamination).
Conclusion Breast feeding is important strategy for health promotion and protection of children under fives. Since, it has many advantages against many disadvantages of bottle feeding.