BREASTFEEDING

DEFINITION Breastfeeding is the normal way of providing young infants with the nutrients they need for healthy growth and development. Virtually all mothers can breastfeed, provided they have accurate information, and the support of their family, the health care system and society at large. Colostrum, the yellowish, sticky breast milk produced at the end of pregnancy, is recommended by WHO as the perfect food for the newborn, and feeding should be initiated within the first hour after birth. Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond. WHO Breastfeeding Definitions Exclusive Breastfeeding Requires that the infant receive breast milk (including milk expressed or from wet nurse) Allows the infant to receive drops, syrups (vitamins, minerals, medicines) Does not allow the infant to receive anything else Predominant Breastfeeding Requires that the infant receive breast milk (including milk expressed or from wet nurse) as the predominant source of nourishment Allows the infant to receive liquids (water, and water-based drinks, fruit, juice, oral rehydration solution), ritual fluids and drops or syrups (vitamins, minerals, medicines) Does not allow the infant to receive anything else (in particular non-human milk, food-based fluids) Complementary Feeding Requires that the infant receive breast milk and solid or semi-solid foods Allows the infant to receive any food or liquid including non-human milk Breastfeeding Requires that the infant receive breast milk Allows the infant to receive any food or liquid including non-human milk Bottle-Feeding Requires that the infant receive any liquid or semi-solid food from a bottle with nipple/teat Allows the infant to receive breast milk by bottle\ Exclusive and predominant breastfeeding categories together constitue "full breastfeeding."

THE IMPORTANCE OF BREASTFEEDING y y y y y Breastfeeding protects babies Mothers benefit from breastfeeding Breastfeeding benefits society Breastfeeding during an emergency More information on why breastfeeding is important

Breastfeeding protects babies 1. Early breast milk is liquid gold Known as liquid gold, colostrum (coh-LOSS-trum) is the thick yellow first breast milk that you make during pregnancy and just after birth. This milk is very rich in nutrients and antibodies to protect your baby. Although your baby only gets a small amount of colostrum at each feeding, it matches the amount his or her tiny stomach can hold. (Visit How to know your baby is getting enough milk to see just how small your newborns tummy is!) 2. Your breast milk changes as your baby grows Colostrum changes into what is called mature milk. By the third to fifth day after birth, this mature breast milk has just the right amount of fat, sugar, water, and protein to help your baby continue to grow. It is a thinner type of milk than colostrum, but it provides all of the nutrients and antibodies your baby needs. 3. Breast milk is easier to digest For most babies especially premature babies breast milk is easier to digest than formula. The proteins in formula are made from cows milk and it takes time for babies stomachs to adjust to digesting them. 4. Breast milk fights disease The cells, hormones, and antibodies in breast milk protect babies from illness. This protection is unique; formula cannot match the chemical makeup of human breast milk. In fact, among formula-fed babies, ear infections and diarrhea are more common. Formula-fed babies also have higher risks of: o Necrotizing (nek-roh-TEYE-zing) enterocolitis thegastrointestinal tract in preterm infants. Lower respiratory infections Asthma Obesity Type 2 diabetes (en-TUR-oh-coh-lyt-iss), a disease that affects

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Some research shows that breastfeeding can also reduce the risk of Type 1 diabetes, childhood leukemia, and atopic dermatitis (a type of skin rash) in babies. Breastfeeding has also been shown to lower the risk of SIDS(sudden infant death syndrome).

Mothers benefit from breastfeeding 1. Life can be easier when you breastfeed Breastfeeding may take a little more effort than formula feeding at first. But it can make life easier once you and your baby settle into a good routine. Plus, when you breastfeed, there are no bottles and nipples to sterilize. You do not have to buy, measure, and mix formula. And there are no bottles to warm in the middle of the night! You can satisfy your babys hunger right away when breastfeeding. 2. Breastfeeding can save money Formula and feeding supplies can cost well over $1,500 each year, depending on how much your baby eats. Breastfed babies are also sick less often, which can lower health care costs. 3. Breastfeeding can feel great Physical contact is important to newborns. It can help them feel more secure, warm, and comforted. Mothers can benefit from this closeness, as well. Breastfeeding requires a mother to take some quiet relaxed time to bond. The skin-to-skin contact can boost the mothers oxytocin (OKS-ee-TOH-suhn) levels. Oxytocin is a hormone that helps milk flow and can calm the mother. 4. Breastfeeding can be good for the mothers health, too Breastfeeding is linked to a lower risk of these health problems in women: 1. Type 2 diabetes 2. Breast cancer 3. Ovarian cancer 4. Postpartum depression 5. Mothers miss less work Breastfeeding mothers miss fewer days from work because their infants are sick less often.

Breastfeeding benefits society The nation benefits overall when mothers breastfeed. Recent research shows that if 90 percent of families breastfed exclusively for 6 months, nearly 1,000 deaths among infants could be prevented. The United States would also save $13 billion per year medical care costs are lower for fully breastfed infants than never-breastfed infants. Breastfed infants typically need fewer sick care visits, prescriptions, and hospitalizations. Breastfeeding also contributes to a more productive workforce since mothers miss less work to care for sick infants. Employer medical costs are also lower. Breastfeeding is also better for the environment. There is less trash and plastic waste compared to that produced by formula cans and bottle supplies.

Breastfeeding during an emergency When an emergency occurs, breastfeeding can save lives: y y Breastfeeding protects babies from the risks of a contaminated water supply. Breastfeeding can help protect against respiratory illnesses and diarrhea. These diseases can be fatal in populations displaced by disaster. Breast milk is the right temperature for babies and helps to prevent hypothermia, when the body temperature drops too low. Breast milk is readily available without needing other supplies.

THE ADVANTAGES OF BREASTFEEDING FOR BABY 1. Due to the anti-infective properties of breastmilk, breastfed babies tend to have less incidence of or less pronounced symptoms of ear infections, respiratory illness, allergies, diarrhea, and vomiting. 2. Due to the digestibility of breastmilk, breastfed babies are rarely constipated. 3. The stools of breastfed babies are mild-smelling. 4. SIDS (Sudden Infant Death Syndrome) is less common in breastfed babies. 5. Breastmilk is constantly changing in its composition to meet the changing needs of the baby. It has the exact combination of protein, fats, vitamins, minerals, enzymes, and sugars needed for the human infant at various stages of his growth. 6. Breastfed babies are constantly exposed to a variety of tastes through their mother's milk. 7. Breastfed children are at less risk for chrohn's disease and juvenile diabetes. 8. Children who were breastfed are less likely to need orthodontic work such as braces due to the unique sucking action required with breastfeeding. They also seem to have better overall dental health than formula-fed children. Children who were breastfed need speech therapy less often than those who were bottle-fed. 9. IQ levels are an average of 8 points higher in children who were breastfed. 10. Adult daughters who were breastfed are at less risk for breast cancer. 11. Adults who were breastfed have a lower risk for high cholesterol and asthma. 12. The bond between mother and child seems to be enhanced with breastfeeding.

FOR MOTHER 1. Nursing immediately following delivery causes the uterus to contract lessening the risk of postpartum hemorrhage. 2. The uterus of a breastfeeding mother shrinks to its pre-pregnancy size more quickly. 3. Calories are burned while breastfeeding. It takes approximately 20 calories to produce an ounce of milk. 4. Women who nurse their babies for at least 6 months lessen their chances of pre-menopausal breast cancer. 5. Osteoporosis and cervical cancer are less common in women who breastfed. 6. The return of fertility is delayed with breastfeeding. 7. Breastfeeding is more economical than formula feeding. 8. Breastmilk is always available, clean, and the right temperature. 9. Many mothers feel a special satisfaction in knowing that they alone are meeting the nutritional needs of their babies.

THE DISADVANTAGES OF BREASTFEEDING FOR BABY AND MOTHER Feeding your babies can prove to be easy when a mother uses her natural milk, but there are disadvantages of breastfeeding that every mother should be aware of. It is often recommended to breastfeed babies up to two years, as benefits of breastfeeding for baby and mother are often considered to allow for less costs as well as more nutritional content in the milk. Because of such, most mothers have undertaken to breastfeeding their children. However, some mothers still think the opposite. Here are a few reasons why some mothers prefer not to breastfeed their children. Disadvantages of Breastfeeding Diet Watching - Mothers are often instructed to be mindful of what they eat, as most of what they consume would go into their breast milk. This makes for one of the disadvantages of breastfeeding, as it can limit mothers from eating what they feel like doing so. While it makes for a healthy diet, it will appear inconvenient and costly for some to have to spend for healthy and nutritious food when regular varieties are already available. Public Feeding Mothers who breastfeed their babies may find it difficult to do so in public. As one of the disadvantages of breastfeeding, it can lead to frustration, especially since most mothers start lactating the moment their baby cries. It can be embarrassing to leak milk at inconvenient times, much less having to feed your baby while you are out in public. Pain and Discomfort - These two go hand in hand as one of the disadvantages of breastfeeding, especially when the baby starts to grow teeth. Sore nipples often occur not only in mothers who are just starting to breastfeed, but for those who have done so for a long time. Most mothers also feel that their nipples, as well as their breasts, end up getting misshapen in time from breastfeeding their babies.

WHY IS IT THAT THE DOH IS STILL PROMOTING BREASTFEEDING INSTEAD OF BOTTLE FEEDING? Nutrition Month is an annual event held every July in accordance with Presidential Decree No. 491 known as the Nutrition Act of the Philippines which created the National Nutrition Council (NNC). The NNC coordinates the nationwide celebration. Each year the NNC comes up with a theme to call the nation's attention and action on a particular issue. What is the theme for the 2011 Nutrition Month? The theme for the 2011 Nutrition Month is "Isulong ang BREASTFEEDING Tama, Sapat, at EKsklusibo". The theme focuses on key messages to ensure successful breastfeeding practices. The theme supports the Department of Health's campaign on Communication for Behavioral Impact on breastfeeding which is "Breastfeeding TSEK (Tama. Sapat. EKsklusibo)." The objective of this year's Nutrition Month celebration is to encourage all sectors of society to help promote, protect and support correct breastfeeding practices.

What does BREASTFEEDING TSEK means? TSEK or Tama, Sapat at EKsklusibo means: o baby o o after birth, and initiation of "Tama" by immediate skin-to-skin contact between mother and the first hour of life.

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"Sapat" by encouraging and assuring mothers that little breastmilk is enough for the first week and that frequent breastfeeding ensures continuous breastmilk supply to respond to the increasing needs of the baby. "EKsklusibo" by giving only breastmilk and no other liquid to the baby for the first six months. Breastmilk has all

the other and nutrients that the baby needs for the first six months after which the baby should be given appropriate complementary foods while continuing breastfeeding. What is the importance of BREASTFEEDING TSEK? The protection, promotion, and support of breastfeeding rank among the most effective interventions to improve child's survival. According to the World Health Organization (WHO), it is estimated that high coverage of optimal breastfeeding practices could avert 13% of the 10.6 million yearly deaths of children five years old and below. Evidence on the importance of exclusive breastfeeding and early initiation includes: y y y y y Babies who were not breastfed in the first 6 months of their lives are 25 times more likely to die than those who experienced exclusive breastfeeding from the time they were born. The timing of initiation of breastfeeding is important as there is a higher risk of death among infants with longer delay in the initiation of breastfeeding. Hospitalized low birth weight Infants who were fed with formula milk had 4 times the incidence of serious illness compared to those infants who were breastfed. There is a 2-4 fold increase in neonatal mortality rate (NMR) in not receiving colostrum. There is a 5-13% decrease in NMR with exclusive breastfeeding. Breastfeeding not only saves babies from death, but also provides long-term benefits. Breastfed babies do better in school cognitive tests by as much as 4.9 points. There is a positive association of breastfeeding with educational attainment.

Why is early initiation of breastfeeding very important? Some babies die after birth because they were not breastfed immediately. Breastfeeding should be initiated at once about 30 minutes after normal delivery and about 3 - 4 hours after delivery by caesarian section. Providing breastmilk within the first hour after delivery can save up to 22% of infants from death and about 16% when they are breastfed within the first day thus, decreasing the rate of infant mortality significantly. Infants who were given early breastfeeding will have the opportunity to be more successful and sustain exclusive breastfeeding. In addition, babies who are breastfed immediately can help avoid the risk of hypothermia as the warmth of the mother's breast helps regulate the baby's body temperature and avoiding the risk of death due to cold. Also, babies that were placed on the mother's chest will be calmer as it reduces stress and stabilizes the heartbeat and breathing. On the other hand, the baby's touch and suckle can help stimulate the production of oxytocin by the mother which causes uterine contractions that help reduce bleeding; stimulates other hormones, which makes the mother calm and relaxed and stimulates the production of breastmilk. y y y Early initiation of breastfeeding is part of the Essential Newborn Care Protocol adopted by the Department of Health. The four key elements of the protocol are: Immediate and thorough drying up of the newborn for 30 seconds to one minute warms the newborn and stimulates breathing. Early skin-to-skin contact between newborn and mother and delayed washing for at least 6 hours prevents hypothermia, infection and hypoglycemia.

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Properly timed cord clamping and cutting prevents the newborn from having anemia and protects against brain hemorrhage in premature newborns. Continuous non-separation of newborn and mother for early breastfeeding protects newborns from dying due to infections.

What are the advantages of exclusive breastfeeding for the mother? a. y y Physiological benefits Breastfeeding promotes uterine involution, decreases risk of postpartum hemorrhage and increases period of postpartum anovulation (having periods without ovulating). Mothers can also practice natural child spacing since breastfeeding delays ovulation. This is called Lactation Amenorrhea Method (LAM). A lactating woman has at least 98% protection from pregnancy for six (6) months when she remains without her period (ammenorrheic) and fully or nearly fully breastfeeds. Breastfeeding also decreases the risk of breast cancer, ovarian cancer and hip and bone fractures. Breastfeeding also makes it easier for night feeds. Psychological Benefit y Breastfeeding promotes attachment between the mother and child, increases self-esteem to mothers and allows daily rests for mothers. It is important for the optimal health and development of the baby. Breastmilk provides every single essential nutrient in the development of the baby, and the bonding element (mother's thoughts, emotions and vibrations) that helps mother and baby to bond for life.

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Financial Benefits y y y Breastfeeding can save as much as P2000 a month when compared to using other milks. Reduces time lost from work. Mothers do not have to absent themselves from work because breastfed babies are less likely to get sick. Reduces cost for medicines for sick baby because breastfed infants do not get sick easily.

What are the advantages of exclusive breastfeeding for the baby? The human milk is naturally designed for human consumption. It is nutritionally superior to any alternatives, bacteriologically safe and always fresh. Breastfeeding promotes proper jaw, teeth, and speech development. Suckling at the breast is comforting to fussy, overtired, ill, or hurt baby. It also promotes bonding. Some of the other benefits of breastfeeding to babies are: a. Provides protection against infection. Breastmilk reduces the risk of acute infections such as diarrhea, pneumonia, ear infection, influenza, meningitis and urinary tract infections. b. Protects against illnesses. It protects against chronic disease in children such as allergies, diabetes, ulcerative colitis and Chron's disease. Breastfeeding promotes child development and is associated with lower risk factors for cardiovascular diseases including high blood pressure and obesity in later life. c. Protects from allergies. Breastfed babies are exposed to fewer allergens in the first hour of life and the first feedings of colostrum literally 'seal the gut' (the porous lining of the intestine), providing a barrier to the absorption of allergyproducing agents. Both colostrum and mother's mature milk are rich in antibodies, providing the baby the benefit of being immune for about 6 months of age. d. Enhances intelligence. Human breast milk enhances brain development and improves cognitive development. According to the study by the American Academy of Pediatricians among the extremely low birth weight infants that a 10/ml per day increase in breast milk intake of infants increased the mental developmental index by 0.59 points, the psychomotor developmental index by 0.56 pts and total behavior percentile score by 0.99 points using the Bayley Mental Developmental Score. The risk of rehospitalization of babies from discharge to 30 months decreased by 5%. World Alliance for Breastfeeding Action (WABA) says that the average I.Q. of 7 and 8 year old children who were breastfed as infants was 10 points higher than their bottle-fed counterparts. BREASTFEEDING TECHNIQUES CRADLE HOLD For the cradle hold, the mother positions the infants head at or near the antecubital level with her nipples, with her arm supporting the infants body. Her other hand is free to hold the breast. Once the infant is position, pillows or blankets can be use to support the mothers arm, which may tire from holding the baby. FOOTBALL HOLD This method allows the mother to see the position of the infants mouth on the breast, helps her control the infants head, and is especially helpful for mothers with heavy breast. This hold also avoids pressure against the abdominal incision. CROSS CRADLE OR MODIFIED CRADLE HOLD The cross cradle or modified cradle hold is helpful for infants who are preterm or have a fracture clavicle.

The mother holds the infants head on the hand opposite from the side on which the infant will feed, with the arm supporting the body across the mothers lap. The other hand holds the breast. SIDE LYING POSITION The side lying position avoids pressure on episiotomy or abdominal incisions and allows the mother to rest while feeding. C-POSITION OF HAND C position of hand on breast. The hand is positioned so that the thumb is on top of the breast while the fingers support the breast from below. Note the flaring of the infants lips. TEACHING BREASTFEEDING TECHNIQUES 1. Position of the mother and the infant. 2. position of mothers hands 3. Teach the client/mother of latch on techniques. 4. position the mouth of the infant 5. Teach the mother of the infants sucking pattern. 6. removal from the breast BURPING TECHNIQUES Some infants seem to swallow large amount of air when they breastfeed, so as a major rule, it is helpful to bubble (burp) newborns after they have emptied the first breast and again the after the total feeding. Placing the baby against one shoulder and patting the back is an acceptable position. However, the position is not very satisfactory for an infant who has poor head control. Holding a baby in a sitting position on the lap: This position provides head support and leaves the other hand free to pat the babys back. Laying the baby prone against the lap is another alternative position. SUPPLEMENTAL FEEDING 1. A breastfeeding woman may leave her child in the care of a baby-sitter, just as bottle-feeding woman may. She can express breast milk manually and leave it in a bottle in the refrigerator or prepare a single bottle of formula by the time she is away. 2. Bottles used for storage should be sterilized in a dishwasher. Breast milk may then be sterilized for 24hrs, frozen for 30 days, or placed in deep freezer for 6mos. 3. Use of commercially prepared formula or powder formula is appropriate and convenient to replace a single feeding because one bottle at a time can be prepared. 4. Once breast-feeding has been established, missing one feeding will not affect milk production. WEANING 1. Women breast feed for varying lengths of time. Some do it for 1-3 months, and then wean their children from breast to bottle. Others continue until their children are 6-12 mos. of age and then wean directly a small cup or glass. Some continue to breast feed until the child reaches preschool / toddler years. Lengthy breast feeding may lead to nutritional deficiencies if the child is taking in a large quantity of milk at the expense of other foods. 2. At any age, breast feeding should be discontinued gradually to prevent engorgement and pain of mothers breast while still providing satisfaction for the infant. To do this, a woman should first omit breastfeeding a day, substituting a bottle feeding or milk cup or glass. Then she should omit 2 breast feedings and so on, until the child is feeding entirely on a glass or cup. If breasts are not emptied by regular feedings, the resulting pressure leads to milk suppression and natural, gradual discontinuance milk secretion. 3. If weaned before 12 mos., infants should be weaned to formula, not whole milk, so that they continue to receive added vitamins and low solute load of commercial formulas.

THE COMPOSITION OF BREAST MILK: Breast milk, which is 90% water, consists of:nutrient proteins, non-protein nitrogen compounds, lipids, oligosaccharides, vitamins,minerals, hormones, enzymes, growth factors andprotective agents. It has 10% solids for energy and growth. Typical Milk Volume: y y y y y From birth to 24 hours, colostrum averages about 37 ml From 24 to 96 hours, there is a slow rise in volume Day 5: approximately 500 ml/day 3 to 5 months: 750 ml/day 6 months: 800 ml/day

Breastmilk has various advantages, one of which is that it contains well-balanced nutrients, including fat, lactose and protein, which are the main ingredients. The proportions of these ingredients are automatically adjusted at different times to match the growth of baby. This makes breastmilk the best food for your baby. Breastmilk components and their functions Fat, lactose and protein, the main components of breastmilk, have the characteristics below. Lactose is a source of energy and is contained the largest proportion (among fat, lactose and protein) in breastmilk. Fat is an important ingredient in the development of your baby's brain and in the maintenance of the body structure.

Protein is broken down into amino acids when it is absorbed into your baby's body, and becomes a source for building muscles. It also contains important immunoproteins such as lactoferrin and IgA. Other components have the functions explained below. They reduce the risk of allergies developing Breastmilk has a substance that forms a protective coating on the intestinal wall, and promotes the development of the intestinal epidermis. Thus it prevents allergens from invading through the baby's intestines, which have numerous openings. They help breastmilk be easily digested and absorbed Breastmilk contains enzymes such as lipase and amylase that help with digestion, so it is easily digested and absorbed by babies with fragile intestinal systems. Change in breastmilk components The components of breastmilk change according to different factors, including the number of days postpartum, the season and the mothers diet. The composition of breastmilk changes each time your baby nurses, and even changes as your baby is nursing. Here is how the components change according to the number of days postpartum and with each breastfeeding. Change of components in one breastfeeding The breastmilk released each time your baby begins breastfeeding is called fore milk, and this is followed by hind milk. As breastfeeding continues, the fat content, which is a source of energy and is important for the development of the brain and the maintenance of the body structure, increases. Change in breastmilk components according to postpartum date. Breastmilk is separated into two main groups, colostrum and mature milk. Colostrum is the breastmilk secreted until the fifth postpartum day. It is characterized by the large content of immunoproteins, such as lactoferrin and IgA. This breastmilk looks yellow because it contains -carotene, which is also found in carrots and other vegetables. Mature milk is the breastmilk that is secreted 10 days postpartum. It is characterized by a lower protein content and higher content of lactose and fat as compared to the colostrum, making it higher in calories. Breastmilk at this time looks milky white.