Breast Feeding: Initiation & Maintenance

When to start
Priming of mother during antenatal period Ante-natal breast examination Early rooming in with mother
As soon as possible after normal delivery On return from OT in LSCS case

Successful Breastfeeding
Exclusive breastfeeding for the first six months

Successful Breastfeeding
Initiate Breastfeeding Within half an Hour of Birth

Successful Breastfeeding
No Prelacteal Feeds

Replace colostrum Reduce babys desire for

breastfeeding Greater risk of infection Risk of intolerance, allergy

Successful Breastfeeding
No Bottles, Artificial Teats or Pacifiers for Breastfeeding Infants It leads to nipple confusion

Successful Breastfeeding
Breastfeed on demand 8-10 times or more in 24 hours Breastfeed at night No restrictions on length of breastfeeds No restrictions on frequency of breastfeeds
MORE SUCKLING MORE MILK

INITIATE FEEDING
BABYS MOUTH MUST BE NEAR THE NIPPLE

TOUCH THE LOWER LIP OF BABY WITH YOUR BREAST NIPPLE IT STIMULATES ROOTING REFLEX HAVE PATIENCE

ART OF FEEDING :attachment

AS THE BABY OPENS MOUTH LIFT BREAST UPWARD
PULL THE BABY CLOSE

HEAD OF BABY SHOULD BE STRAIGHT PUT NIPPLE & AS MUCH AREOLA INSIDE

Latch
Mouth wide open Chin touches breast Lower lip curled outward Lower portion of areola not visible Suck, swallow, breathe cycle Audible swallow Baby calm & relaxed No pain in breast

Incorrect Sucking Position

Mouth is not wide open Chin is away from the breast Baby is sucking only nipple Most black portion of the breast is outside the babys mouth Tongue away from the teat

Causes Of Incorrect Attachment

Use of feeding bottles. Leads to nipple confusion Inexperienced mother Functional difficulty with the mother or the baby Lack of skilled support

Infant suckling milk flow Active removal from milk ducts

SWALLOWING REFLEX

Duration of feeding

Feed her as long as She wants

Come off on her own

Release suction - insert your finger Into corner of babys mouth

Art of feeding

Feed on alternate sides

Involve other mothers

The pleasant experience

Warmth, tender,
Comfort, trust

Dont get tired!

Position for feeding

Any position
Comfortable to the mother Close contact with the baby Support head and neck of the baby

Position of baby in relation to the mother

Indian Method
The baby`s whole body should face the mother and be close to her The babys head and neck should be supported , in a straight line with his body , and face the breast Baby`s abdomen should touch mother`s abdomen to be as close as possible to his mother

Cradle position

 Sitting on a chair Babys stomach touching your stomach

Modified cradle position

Football hold

Side lying

Twins

Ten steps for successful breast feeding

Step One : Policies

Routine communication to all health personnel

Step two : training

Important necessity For effective guidance and counselling Need to be introduced in basic curriculum of doctors, nurses & midwives

Step three : antenatal preparation

Creating

awareness of
breast feeding

Education on benefits

Training mothers

Step four : early contact

Normal deliveries 1/2 hr

Lscs

Lscs mother
Mother pain control Within four hours / responsive mother Extra support by health worker Side lying position

Supervision

Step five : guidance

To mother in skill of feeding

Manual expression

Care of babies in special care nursery

Step six : supplements

Avoid free samples of breast milk substitutes

Provide skilled help to prevent &

overcome difficulties in lactation

Step seven : rooming in

Facilitates demand

feeding

Mother & infant must

remain together 24 hrs

Step eight : demand feeding

Promotes weight loss in post partum period

Duration of breast feeding is increased

Step nine : teats & pacifiers

Associated with early cessation of breast feeding

Avoid pacifiers to breast feeding infant

Step ten: support groups

Key family member to be sensitized Nutritious diet

Commmon feeding problems

Major hurdles

Lack of family support Lack of support by health professionals Commercial influence

Primigravida mother problems

Anxiety

Lack of confidence

Breast & Nipple Problems

Contents
Inverted nipples Sore nipples Breast engorgement Blocked duct Mastitis Breast abscess

Inverted nipples
Short /flat nipple does not cause problem Inverted nipple - difficult attachment

How to treat inverted nipple

Manual stretch & roll Grasping breast tissue to make teat from areola Breast pump Suction device

Suction device

Sore nipple
Tender painful nipple Causes Incorrect attachment Use of soap & water Pulling off baby from breast Candidial infection

Sucking only at nipple

Good latching

How to treat sore nipple

Do not stop breast feeding Change position Begin on less affected breast Apply hind milk Expose nipple to air Avoid brassiere, Wear loose clothes Treat oral thrush , affected nipple

How to prevent sore nipples

Attach baby well No frequent washing of nipples Do not take baby off when sucking Treat candiasis

Candidial infection of nipple

Signs- pain despite correct attachment - normal or red nipple - vaginal infection Signs of thrush -white patches -baby suckles but leaves due to discomfort

How to treat candidiasis

Antifungal mouth paint Continue breastfeeding Milk expression & feeding using katori & spoon

Breast engorgement
Excess amount of milk in breast Causes - Incorrect feeding practices -Incorrect attachment -Inability of baby to suckle & empty breast

How to treat breast engorgement

Analgesics Warm packs Put baby to breast Express milk before feeding Proper breast attachment

How to prevent breast engorgement

Exclusive , demand , unrestricted feeding Proper attachment No prelacteal feeds Frequent expression if premature , sick baby

A blocked duct
Blocked duct - segment unable to empty - painful lump

How to treat

Continue feeding

Adopt different positions for feeding Massage the lump Warm packs

 Mastitis - untreated blocked duct , larger

part of breast becomes tender & swollen

Breast abscess- Infection of blocked

segment

How to treat
- Analgesics & antibiotics

-Apply warm packs Continue breastfeeding - Frequent manual expression of milk - Incision & drainage of abscess - Start breastfeeding as soon as possible

How to prevent
Exclusive , demand & unrestricted breastfeeding , correct positioning , milk expression in special circumstances Prompt treatment of blocked duct & infected sore nipple

Feeding in special situations

Special situations in reference to baby
Twins Pre term baby Sick baby

Special situations in reference to mother

Working mothers Maternal illness - Decreased milk production

Feeding twins
More emptying breast prolactin

Double breast emptying

prolactin

Hence feed both at the same time Need not be all the time If one baby is feeding & second baby Starts crying - dont stop

Pick up the second

And feed

Different positions to simultaneously feed the twin babies

Preterm & low birth weight babies

Feed with preterm milk Begin expression 8 10 times Feed immediately after birth Mother to visit nicu If sucking good encourage Alternate katori / tube feed + Non nutritive sucking

Working mother
EXCLUSIVE BREAST FEEDING at least till 4 months of age MATERNITY LEAVE 3-6 months Apply for leave as much as close to six months Breast feed before going to work/after returning/at night more often on holidays Teach expression of breast milk Express after feeding baby/at night/ before going to work Start at one - two months before joining office Feed with cup & spoon Teach care giver to feed the baby STORAGE UPTO 8-10 hrs. if facility /privacy exist express and store milk while at work for comfort and maintaining production Consider starting complementary foods if child 4 months of age or more

Milk banking
Store EBM obtained from mothers in glass containers Drip milk can be collected Mannual expression

Expression of breast milk

MASSAGE BREAST

PLACE THUMBS

PRESS THUMB & FINGERS INWARDS TOWARDS CHEST PRESS & RELEASE

ON AREOLA ABOVE FROM CHEST TO NIPPLE NIPPLE REST OF FINGERS BELOW NIPPLE

Ebm in washed container can be stored For eight hours at room temperature For twenty four hours in referigerator

Never feed ebm by using a bottle It leads to nipple confusion

Hiv positive & feeding

Human milk - antiviral properties Colostrum is safe Exclusive breast feeding three Transmission rates of hiv at 3 months exclusive breast fed never breast fed mixed feeding 14.6% 18.8% 24.1%

months

cout soudis et al lancet 1999

Decreased milk production

Assess wt gain, urine output, exclusive breast feeding Reassure mother Provide psychological support Treat if any underlying feeding problem in baby/mother Teach correct method of feeding Increase feed frequency and for sufficient length of time Stop using pacifiers/bottle

Galactogogues
Chlorpromazine metochlopramide

Lactation suppressants
Estrogens Bromocriptine Thiazides

Pyridoxines

WEANING
5- 6 MONTHS CULTURALLY ACCEPTABLE BALANCED :MIXTURES CHEAP EASILY AVAILABLE PHYSIOLOGICALLY SUITABLE, EASILY DIGESTIBLE BLAND & NOURISHING

THANKS