Pediatrics

Dr. Haydar
1-Oct-06 Lec: -2-

Technique of Breast Feeding

The mother should be comfortable and the infant positioned so that nothing
interfere with mouth to breast contact . The breast from which the infant nurses
should be supported with opposite hand , with the thumb and index fingers above
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 entire nipple and most of the areola should be placed in the infant
mouth .
Breast feeding should begin as soon as after delivery as the condition of the
mother and baby is permits that .
Psychological condition of the mother is very important in giving successful
breast feeding , for example worry and unhappiness are the most effective means for
decreasing or abolishing breast secretions .
Encouragement of good hygiene and good diet of the mother are also important
for good breast feeding .

The infant should empty at least one breast at each feeding ; otherwise , it will not to
be stimulated to refill . Both breast should be used at each feeding in the early weeks
to encourage maximal production of milk ( by milk ejection reflex ) .
At the end of nursing period , the infant should be held erect over the mother
shoulder or on her lap with or without gently rubbing or patting the back to assist in
expelling the swallowed air .

Formula Feeding :-

The basis for most formulas are whole cows milk or its modified forms .Breast
milk are considered superior to formula feeding , in spite of that many infants
received formula feeding from birth , either they employed outside the home , or
many mothers are reluctant to nurse their infants , other believe that nursing will limit
their activities or they fear failure of nursing , and some consider breast feeding
socially unacceptable . The technique of formula feeding is similar to that of breast
feeding with the caregiver and the infant in comfortable position . The milk should be
warmed to a suitable temperature , and eructation of swallowed air during feeding is
very important to avoid regurgitation or abdominal discomfort .

Full term baby require 150-170 ml/kg/24 hr , this amount is very important for
maintain of haemostasis and in preventing hyperosmolarity and this amount of water
must be present in artificial formula .
Most of the artificial formulas now a day contain added vitamins and minerals .

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Differences between Breast Milk and Cow Milk :-

1) Colostrum :- it is found in breast milk and not found in cow milk . Colostrum
is the secretion of breast during the later part of the pregnancy and for the 2-4
days after delivery , it has deep lemon –yellow color , it is alkaline in reaction
. The total amount of secretion 20-40 ml per day , it contains several times
protein more than the usual breast milk and more minerals but less
carbohydrates and fat , also it contains unique immunologic factors .
2) Water :- the amount in each one is nearly same .

3) Calories :- the energy value may vary slightly ( about 20 kcal per oz or 0.67
per ml ) .
4) Protein :- cows milk contains 3 times protein more than breast milk ( cows
milk contains 3.3% protein ) . Other difference is that cows milk protein is
mainly of casein while breast milk protein mainly of whey protein .
5) Carbohydrate :- human milk contains 6.5-7% and cows milk 4.5% of lactose .
6) Fat :- the fat content of cows milk is about 3.5 , in human milk the fat varies
somewhat with maternal diet . The fat of each mainly of triglyceride , but
human milk contains more absorbable type ,olein
7) Minerals :- cows milk contains much more of all the minerals except iron and
copper than human milk . Breast milk iron although low , but it is better
absorbed through the infant G.I.T.
8) Vitamins :- cows milk is low in vitamin C and D . Breast milk contains
adequate amount of vitamin C if the mother eats appropriates foods . Also vit
D is adequate unless the mother is insufficiently exposed to sun light or has
darkly pigmented skin . Cows milk contains more vitamin K . Vit A and B are
same in both
9) Bacterial content :- human milk is usually not contaminated , but many
pathogenic microorganisms may enter breast milk through mastitis like TB ,
typhoid , herpes virus , rubella , HB , mumps and H.I.V. while cows milk is
usually contaminated by pathogenic and non-pathogenic bacteria .
10) Digestibility :- usually cows milk forms large curd than breast milk , and cows
milk is less digestible than breast milk . But curd in cows milk can be reduced
by boiling .

Milk used in formula :-

There are many types of milk used formula , like :-

Raw milk , pasteurized milk , homogenized milk , evaporated milk , prepared
milk , dried whole milk , dried skim milk , acid and fermented milk , goat milk , milk
protein , milk substitutes and hypoallergenic milk , elemental dietary substitutes for
milk .

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First year Feeding Problems :-

1) Underfeeding :- usually suggested by restlessness and crying and by failure to

gain weight adequately , also constipation , failure to sleep and irritability .
Treatment consist of increasing fluid and caloric intake .
2) Overfeeding :- it is either quantitative or qualitative , usually characterized by
regurgitation , vomiting , abdominal distention and discomfort with flatulence
and rapid gaining of weight . Treated by decreasing the caloric intake to
acceptable level and education of the parents about proper feeding of infant .
3) Regurgitation and vomiting :- regurgitation means retaining of small amount
of swallowed food and occur immediately after feeding while vomiting occur
some time after feeding . Regurgitation is a natural occurrence during the first
6 month of life or it may be due to over feeding , while vomiting may be due
to underlying pathology or disease .
4) Loose or diarrhea stool :- the stool of the breast milk infant is usually softer
and more frequent than cows milk fed infant .

Loose stool may be due to overfeeding . Actual diarrhea in breast fed infant is unusual
and should be considered infectious until proved otherwise .

5) Constipation :- the etiology of it in breast fed infant is usually unknown

especially in one who receiving adequate amount of milk , nearly the same in
cows milk fed infants . Whenever constipation or obstipation is present since
birth or shortly after that , so rectal examination should be performed .
Constipation in artificially fed infants may be caused by insufficient amount of
food or fluid , or may be due to diets containing too much fat or protein .
Treated by prune juice as temporary measure or add some bulk to food
( fibers) enemas and suppositories should never be more than temporary
measures .
6) Colic :- it is paroxysmal abdominal pain characterized by sever crying ,
flushing of face , circumoral pallor , abdominal distention and the legs are
draw up on the abdomen . The etiology usually not clear , but it may be
associated with hunger and with swallowed air that pass to the intestine . Or
may be due to over feeding or high carbohydrate diets . Careful physical
examination should be done to exclude intussusception or strangulated hernia ,
also hair in infant eye , otitis media , nephritis or other infections or
pathologies should be excluded .

Written By:
Rand Aras Najeeb

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