BREASTFEEDINGPEDIATRIC DEPARTMENTUNIVERSITAS ISLAM BANDUNG

IntroductionBreastfeeding is the optimal source of nutrition. The Human Milk is specie specific and it provides all the essential nutrients necessary for the growth and development of the newborn infant

The AAP, AAFP and WHO recommend exclusive breastfeeding for the first six months of life , and continuous breastfeeding for at least 12 months of life

The Target of USDHHS Healthy People 2010 initiative is to achieve breastfeeding at birth of 75%, 50% at 6 month and 25% at 12 months of life

2008 data published by the CDC shows that 77% of mothers in the US initiate breastfeeding at birth. Only about 30% of women continue with breastfeeding of the infant to 6 months of age

Protection against infection

Why breastmilk is a perfect food ?(continue)

ComponentBreastmilkCow milkIron0,5 (absorp >>)0,5 (absorp

Anatomy of breast (1)

Anatomy of the breast (2)

ProlactinSecreted during and after feed to produce next feed

Prolactin, enhancing and hindering factors

More suckling makes more milkOther effects of prolactin :supress the activity of the ovaries delays the return of fertility and menstruation

Engorgement

DIFFERENCES BETWEEN FULL AND ENGORGED BREASTSFull BreastsEngorged BreastsHotPainfulHeavyOedematousTight, especially nippleShinyMay look redMilk flowingMilk NOT flowingNo feverMay be fever for 24 hours

Oxytocin reflexWorks before or during feed to make milk flow

Oxytocin, enhancing and hindering factors

To help a mothers milk ejection :Be kind and supportive.Help her not to worryReassure her that she can breastfed.Other effects of oxytocin :make the uterus contract which helps to deliver placenta.

SIGNS & SENSATIONS OF ACTIVE OXYTOCIN REFLEXA mother may notice:A squeezing or tingling sensation in her breasts just before she feeds her baby, or during a feed.Milk flowing from her breasts when she thinks of her baby, or hears him crying.Milk dripping from her other breast, when her baby is suckling.Pain from uterine contractions, sometimes with a rush of blood, during feeds in the first week.

HOW TO STIMULATE THE OXYTOCIN REFLEX

Help the mother psychologically: Build her confidence Try to reduce any sources of pain or anxiety Help her to have good thoughts and feelings about the baby

Help the mother practically: Sit quietly and privately or with a supportive friendHold her baby with skin-to-skin contact if possibleTake a warm soothing drin warm her breastsStimulate her nipplesMassage or stroke the breasts lightlyAsk a helper to rub her back

A helper rubbing a mother's back to stimulate the oxytocin reflex

COLOSTRUMPROPERTY IMPORTANCEAntibody rich- protects against infection and allergyMany white cells- Protect against infectionPurgative- Clears meconium helps to prevent jaundiceGrowth factors- Help intestine to mature prevents allergy, intoleranceVitamin A rich- Reduces severity of infection, prevents eye disease

Variation of composition of breastmilkColostrum- produce in the first few days after delivery- thick and yellowish or clear colourFore milk- produce early in a feed, large amounts- looks bluer than hindmilk, plenty of protein, lactose and other nutrientsHind milk- looks whiter, contains more fat.

Differences between colostrum and mature milk

GOOD ATTACHMENT a. The baby's chin touches the breast. b. His mouth is wide open. c. His lower lip is turned outwards. d. You can see more of the areola above his mouth and less below.

RESULTS OF POOR ATTACHMENTPain and damage to nipplesSore nipples

Breastmilk not removed EngorgementeffectivelyBaby unsatisfiedApparent poor milk supply wants to feed a lot

Baby frustated,refused to suckleBreasts make less milkBaby fails to gainweight

CAUSES OF POOR ATTACHMENTUse of feeding bottle - before breastfeeding established - for later suplementsInexperienced mother - first baby - previous bottle feederFunctional difficulty - small or weak baby - breast poorly protactile - engorgement - late startLack of skilled support - less traditional help and community support - doctors, midwives, nurses, not trained to help

How the baby suckle

Signs that a baby is suckling in a good position

The babys whole body is facing his mother & close to her, the babys head and body should be in a straight lineIf her baby is newborn, she should support his buttom, and not just his head and shouldersThe babys face is close up the breast, with his nose opposite the nippleThe babys chin is touching the breastThe babys mouth is wide openThe babys lower lip is curled outwardsThere is more areola showing above the babys upper lip and less areola showing below the lipYou can see the baby taking slow, deep sucksThe baby is relaxed and happy and is satisfied at the end of the feedThe mother doesnt feel nipple painYou may be able to hear the baby swallowing

Breastfeeding Positions Cradle Hold

This is the most common position used by mothers.

Infants head is supported in the elbow, the back and buttock is supported by the arm and lifted to the breast.Adapted from AAFP Journal September 2001

Football Hold PositionThe infants is placed under the arm, like holding a football

Babys body is supported with the forearm and the head is supported with the hand.

Many mothers are not comfortable with this position

Good position after operative proceduresAdapted from AAFP Journal September 2001Breastfeeding Positions

Side Lying Position

The mother lies on her side propping up her head and shoulder with pillows The infant is also lying down facing the mother.

Good position after Caesarean section.

Allows the new mother some rest.

Most mothers are scared of crushing the babyBreastfeeding PositionsAdapted from AAFP Journal September 2001

Cross Cradle Hold Position

Ideal for early breastfeeding

Mother holds the baby crosswise in the crook of the arm opposite the breast the infant is to be fed

The baby's trunk and head are supported with the forearm and palm

The other hand is placed beneath the breast in a U-shaped to guide the baby's mouth to your breast Breastfeeding PositionsAdapted from AAFP Journal September 2001

Australian Hold Position

This is also called the saddle hold

Usually used for older infants

Not commonly used by mothers

Best used in older infants with runny nose, ear infectionBreastfeeding PositionsAdapted from AAFP Journal September 2001

Is breastmilk enough ?Subjective signObjective sign- Urinary > 6 times / day- Growth chart : - Dancis curve for neonates Birth Weight should be regained by two weeks of life - Normal growth

HOW TO EXPRESS BREASTMILK BY HAND

Wash her hands thoroughly.Sit or stand comfortably, and hold the container near her breast.Put her thumb on her breast ABOVE the nipple and areola, and her first finger on the breast BELOW the nipple and areola, opposite the thumb. She supports the breast with her other fingers.Press her thumb and first finger slightly inwards towards the chest wall. She should avoid pressing too far, because that can block the milk ducts.

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Press her breast behind the nipple and areola between her finger and thumb. She must press on the lactiferous sinuses beneath the areola. Sometimes in a lactating breast it is possible to feel the sinuses. They are like pods, or peanuts. If she can feel them, she can press on them.

Press and release, press and release. This should not hurt - if it hurts, the technique is wrong.

At first no milk may come, but after pressing a few times, milk starts to drip out. It may flow in streams if the oxytocin reflex is active.

Press the areola in the same way from the SIDES, to make sure that milk is expressed from all segments of the breast.

Storage of Breast MilkHuman milk can be stored at room temperature for 6-8 hours

Expressed milk can be stored in an insulated cooler bag with icepacks for 24 hours

Breast milk can be stored in the refrigerator for about 5 days at about 40 F

It can also be kept in a freezer compartment of a fridge for up to two weeks at 0 - 5F

It can be stored in a deep freezer for about 3-12 months

Breast milk should be stored in BPA (Bisphenol A) free containers

RECOMMENDATIONStart breastfeeding within hour of birthBreastfeed exclusively from 0-6 months of ageGive complementary foods to all children from 6 months of ageContinue breastfeeding up to 2 years of age beyond

BREASTFEED OBSERVATION FORM

GENERALSign that breastfeeding is going well Sign of possible difficultyMother: Mother: Mother looks healthy Mother looks ill or depressed Mother relaxed and comfortable Mother looks tense and uncomfortable Signs of bonding between mother & baby No mother/baby eye contactBaby:Baby: Baby looks healthy Baby looks sleepy or ill Baby calm and relaxed Baby is restless or crying Baby reaches or roots for breast if hungry Baby does not reach or rootBREASTS Breasts look healthy Breasts look red, swollen, or sore No pain or discomfort Breast or nipple painful Breast well supported with fingers away from nipple Breast held with fingers on areola BABYS POSITION Babys head and body in line Babys neck and head twisted to feed Baby held close to mothers body Baby not held close Babys whole body supported Baby supported by head and neck only Baby approaches breast, nose to nipple Baby approaches breast, lower lip/chin to nippleBABYS ATTACHMENT More areola seen above babys top lip More areola seen below bottom lip Babys mouth open wide Babys mouth not open wide Lower lip turned outwards Lips pointing forward or turned in Babys chin touches breast Babys chin not touching breastSUCKLING Slow, deep sucks with pauses Rapid shallow sucks Cheeks round when suckling Cheeks pulled in when suckling Baby releases breast when finished Mother takes baby off the breast Mother notices signs of oxytocin reflex No signs of oxytocin reflex noticed

HOW TO HELP A MOTHER TO POSITION HER BABY Greet the mother and ask how breastfeeding is going Assess a breastfeed Explain what might help, and ask if she would like you to show her Make sure that she is comfortable and relaxed Explain how to hold her baby, and show her if necessary Show her how to support her breast Explain or show her how to help the baby to attach Look for signs of good attachment. If the attachment is not good, try again Notice how she responds and ask her how her baby's suckling feels

The mother sit in a comfortable and relaxed position A low seat is usually best, if possible one that supports the mother's back If the seat is rather high, find a stool for her to put her feet onto. However, be areful not to make her knees so high that her baby is too high for her breast If she is sitting on the floor, make sure that her back is supported If she supports her baby on her knee, help her to hold the baby high enough so that she does not lean forward to put him onto her breast

How to hold her babyBabys head and body in lineBaby held close to mothers body. The baby's whole body should almost face his mother's bodyBaby supported. Babys whole body supported with the mothers arm along the babys back. For older babies, support of the upper part of the body is usually enough Baby approaches breast, nose to nipple

How to support her breastIf she has small and high breasts, she may not need to support them.She should place her fingers flat on her chest wall under her breast, so that her first finger forms a support at the base of the breast.She can use her thumb to press the top of her breast slightly. This can improve the shape of the breast so that it is easier for her baby to attach well.

She should not hold her breast too near to the nipple.Holding the breast too near the nipple makes it difficult for a baby to attach and suckle effectively. Such as:- holding the breast with the fingers and thumb close to the areola pinching up the nipple or areola between your thumb and fingers, and trying to push the nipple into a babys mouth holding the breast in the scissor hold index finger above and middle finger below the nipple

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