Breast feed ppt gcg 42

Breast feed –Natural Healthy & LovingJust get it Right

Dr.Mahesh Hiranandani

M.D(PGI)

“Feeding of breast milk to a

Child directly from

mouth to breast contact”

Breast feeding

Egyptian & Romans* Women fed their own children.* Royalty utilised wet nurses.

India* Mothers fed only after 5th day.

Japan* Breast fed with help of massage.* Weaning as late as adolescence.

History of Breastfeeding

1970’s

Universal breast feeding , Formulas unheard.

1980’s & 1990’s

Foren mem….. Angrezi doodh Trendy feeders…

21st century !!!!

Widespread education Internet revolution

Mirror imaging western mothers but but …..

Villian is within the house…..

Our times…………..

PERFECT FOOD FOR BABIES

• Just the right amount of nutrients in the right proportions

• Over 200 components in human milk

• Composition of breast milk:

-Live cells, fat, carbohydrates, proteins, vitamins, minerals

-Less fat than most other mammals

-More lactose than other mammals

BREAST MILK COMPOSITION

• Fat (4% concentration provides up to 50% of caloric needs, cholesterol levels constant, lipolytic enzymes aid in fat digestion)

• Carbohydrates (lactose = milk sugar predominantly in human milk, 7% concentration provides up to 40% caloric needs, essential for development of CNS, enhances calcium & iron absorption)

Colostrum Breast milk Cows milk

• Calories 58 70 65

• Protein 3.7gm 1.3gm 3.4gm

• Carbohy 5.3gm 7.4gm 4.8gm

• Fats 2.9gms 4.2gms 3.7gm

• Colostrum-> Thin , yellow , Low on fat & carbs.

• Breast milk -> White,thin,watery & sweet.

• Foremilk-> Watery, low fat & high carbs.

• Hindmilk-> Creamier, thick, high fat

Basic nutritional info on Breast milk

Other key constituents in Breast milk(100ml)

Iron 76mg

Calcium 35mg

Sodium 16mg

Cholesterol 16mg

DHA Unknown

Phosphorus 15mg

Vitamin C 3.8mg

Magnesium 2.8mg

Zinc,Iodine, Copper, Vitamin A D E K B-complex

Hormones Growth factors & Anti-infective factors

Nutrients & calories in Breast milk

Varies according to :

* How many days mother has been lactating.

* The time of the day.

* The mothers diet.

* Frequency between feeding.

* Antenatal priming of mother.

Nutrients in Breast milk

All this is panjiri ka asar

Many of the things we need today can wait

a child cannot,to Him we cannot answer Tomorrow

“ His name is Today ”

World Breastfeeding week 2007

Breastfeeding 1st Hour save ONE MillionBabies

Irresistible baby charm

Nature makes them that way to ensure the survival of the species

Animal babies

Adorable

Human babies

Human babies need a longer time span to develop and be socialized and it is therefore important for them to be loved by their mums and dads or other adults around them. Being so cute works in their favour.

Beginning Breastfeeding within ONE hour :Beginning life with “life”

Objectives

• To draw the world’s attention to save ONEmillion babies with just ONE action, just ONEhour support and just ONE message….

• To encourage establishing breastfeeding within ONE hour as key indicator of health progress by all communities locally and globally.

Slide 4h

BREAST MILK COMPOSITION

• Carbohydrates (Bifidus factor = growth factor present only in human milk required for establishing an acidic environment in the gut to inhibit growth of bacteria, fungi and parasites)

• Protein

-Lactoferin => Isolates external iron

-Secretory IGA => Most important immunoglobulin, breast milk = only source for first 6 weeks

BENEFITS OF BREASTFEEDING

• Ecological:

-Saves resources

-Less waste

-No refrigeration

-No manufacturing

-No bottles, cans

-No trucking

-No handling

BENEFITS OF BREASTFEEDING

• For Society

-Smarter

-Healthier

-Less cost to healthcare system

-Stronger families

BENEFITS OF BREASTFEEDING

• To Families

-Less trips to doctors, hospitals

-Less prescriptions

-Less stress

-Less illness

-More bonding

-Inexpensive

BENEFITS OF BREASTFEEDING

• Benefits to baby:

-Better dental health

-Increased visual acuity

-Decreased duration and intensity of illnesses

-Less allergies

-Better health & less risk of illnesses

BENEFITS OF BREASTFEEDING

• Benefits to mother:-Psychological (Attachment, bonding, security, skin to skin, fulfillment of

basic needs, relationship)-Easier weight loss-Decreased risk of illness (breast cancer, osteoperosis, hemmorhage,

ovarian cancer)-Birth control-Pride, empowerment, fulfillment

BENEFITS OF BREASTFEEDING

• Benefits to baby:

-Better dental health

-Increased visual acuity

-Decreased duration and intensity of illnesses

-Less allergies

-Better health & less risk of illnesses

HARMFUL EFFECTS OF FORMULA MILK

Why some mothers choose formula vs. breast milk

• Distressed by physical discomfort of early breastfeeding problems.

• Convenience issues

• Pressures of employment/school

• Worries that breast shape will change

• Formula manufacturers manipulate people through their ads

• Doctors and nurses need more lactation training

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Why some mothers choose formula vs. breast milk

• Moms given very little time to adjust to changes of postpartum

• Family demands

• Non-supportive family/health professionals

• Embarrassment

• Lack of confidence in self

• Feeling that one cannot produce enough milk

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Mother’s milk vs. formula milk

• Formula milk for 3 days old babies is no different than formula milk for 3 months old infants.

• Breast milk is ingeniously different every single day; adapted to the changing needs of the baby.

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Mother’s milk vs. formula milk

• Human milk is designed to support the development of large brains, capable of processing and storing lots of information.

• Cows milk is designed to support functions, like constant grazing.

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Illness Relative risk

• Allergies, eczema 2 to 7 times

• Urinary tract infections 2.6 to 5.5 times

• Inflammatory bowel disease 1.5 to 1.9 times

• Diabetes, type 1 2.4 times

• Gastroenteritis 3 times

• Hodgkin's lymphoma 1.8 to 6.7 times

• Otitis media 2.4 times

• Haemophilus influenzae meningitis 3.8 times

• Necrotizing enterocolitis 6 to 10 times

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Illness Relative risk

• Pneumonia/lower respiratory tract infection 1.7 to 5 times

• Respiratory syncytial virus infection 3.9 times

• Sepsis 2.1 times

• Sudden infant death syndrome 2.0 times

• Industrialized-world hospitalization 3 times

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Barriers to Bonding

* A Bottle places a physical barrier between mom and baby

*Less skin to skin contact

*Less eye contact

* The hormonal connection between the breastfeeding mother and baby cannot be experienced by the bottle feeding mother

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THE END

There is no freedom of choice for humansif it has been taken away from themat the beginning.

Breast-feeding is not a choice,but an obligation to the choice,

Give your child the freedom of choice.

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OBJECTIVE

• To increase awareness about breast feeding.

• To educate about the benefits of breast feeding.

• To educate about the basics of breast feeding.

• To educate about the harms associated with formula feeding.

• To advocate for breast feeding and empower parents to make an informed choice.

Distribution of 10 million deaths in under 5 children of all developing

countries

* Adequate nutrition determines newborn baby’s

Growth & development.

* Exclusive breast feeding prevents many adult diseases in later life.

* 2/3rd of under five child deaths in the world are

due to inappropriate feeding practices and occur

during first year of life.

* Yes …. Only 1/3rd of worlds infants are optimally fed.

Under 5 mortality

Breast feeding alone can save up to 13% babies

“Exclusive breast feeding from birth to

Six months of age and there after

continued breast feeding for 2 years or

beyond with adequate , safe & age

appropriate additional foods and liquids

to meet the nutritional demands of a young

growing child.”

WHO 2002

Guidelines for feeding

It rocks man…

Rooting reflexWhen something touches the baby’s lips , baby opens the mouth & pushesits tongue down & forward.

Sucking reflexWhen something touches the palatethe baby starts sucking.

Swallowing ReflexWhen the mouth fills with milk, baby swallows.

Gag reflexWhen something touches the anteriortongue, baby pushes it out.

SkillMother learns to position the baby baby learns to take breast.

Initiation of Breast feeding

* Initiate breast feed within the first hour.

* Baby needs mothers help initially to

take the breast into her mouth.

* Keeping the baby & mother together is vital.

* More suckling makes more milk.

* For sustained milk secretion it is essential

to breast feed frequently at short intervals.

Which mother will need extra support…..?

* Primiparas.

* Problem while BF Prev baby.

* LSCS

* Birth weight < 2.5 kg.

* Mother reporting painful engorged/cracked breasts.

* Any baby sick & separated from mother.

* If the baby is feeding less

than 8 times a day.

* Mother feeling the need

to give extra top ups .

* Mother reports pain or difficulty.

* Child not gaining weight adequately.

Which mother-baby unit needs your support…..?

Observe Breast feedingMake her comfortable.

Ask her to put the child to breast

if the child is awake & ready to suck.

Watch the mother-baby pair for

* Interaction.

* Signs of attachment.

* Signs of effective sucking.

* Correct positioning.

* Any sign of discomfort.

Infant well attachedChin touching the breast .

Yes……..

Mouth wide open…

Yes…….

Lower lip turned outward..

Yes..

More areola visible above

than below..

Yes…

Infant not well attached

Chin touching the breast

No……

Mouth wide open……

Yes…

Lower lip turned outward…

Yes..

More areola visible above..

No…….

•

Correct latch on technique

Is my baby getting enough milk ??

Is baby getting enough milk…????* Weight gain

Regain birth weight at 2 weeks, 200gm/week.

* Wet diapers

5-6 sopping wet diaper /day. Urine pale & smell.

* Dirty diapers

3-4 dirty diapers , stools yellow & watery.

Active alert baby who goes to sleep for 2-3hrs after

the feeds. Mothers breast soft after the feeds .

Breast babies & schedulesBreast milk Formula milk

Easily digestible Strains the digestionLaxative effect Constipating effectPoor sleep Sleeps longer

Rigid feeding schedule may be detrimental.Breast milk is produced on a supply-demand basisFrequent unrestricted feeds establishes good flow.

“Cluster feed” “Stack feed” “Bunch feed”Babies suck when lonely , insecure or overwhelmed

Babys age Average weight gain

0 to 4 mths 600 to 1000gm/month

4 to 6 mths 400 to 600gm/month

6 to 12 mths 200 to 400gm/month

* An average breast fed baby doubles by 4 months.

* At one year most babies are 3 times birth wt.

Normal Growth of Breast fed babies

Growth Spurts

Period of frequent feeding & fussy behavior.

Coincides with spurt in growth & development.

Frequency : Every few weeks in the first year.

Less often in later years.

Duaration : Lasts only a few days to a week.

How to handle : Follow your child’s lead.

Baby will extract more & mother has to comply.

Message for mothers: Eat healthy & eat more.

Simple Do’s for better weight gain

* Sleep with your baby( Prolactin & Frequency ).

* Nurse often at least every 2 hrs.

* Allow to finish the milk on one side Switch.

* Use breast massage to improve the quality ..

* Decrease solid foods in babies less 6 months.

Are breast fed babies likely to be obese ?

* Breast fed babies gain weight rapidly in Q1 .

* ??Large breast fed baby will be a large adult….

No ! in fact they slim down on being mobile .

* Fats laid during infancy pulls them through.

Unusual weight gain in breast feds

• Genetics : Are parents ,siblings & others as big.

• Over abundant supply .

• CHF, Renal or Endocrinal problems.

Low weight gain in Breast fed babies

Look at the growth Curve ….. Is it genuine ???..

* Poor Breast feeding Management

* Latching well * Supply adequate * Intake

* Nursing pattern * Switching sides * Quality

* Medical problems affecting weight gain

* Sick infant * Reflux * Anemia * Allergies

* UTI

How to improve the quality of breast milk

* Breast feed on demand.

* Don’t skip on dietary proteins.

* Limit saturated fats.

* Increase DHA intake. ( Fish /Supplements)

* Daily vitamin supplements.

* Let the baby take time at each breast.

Don’t worry…. We will look after the baby feeds!

Sisterji…. Do ghante baad test feed de dena !!!

Arree isnu dudh de do Raula pa rakhiya hai!!!

Maam mujhe bahut dard hai isko please feed de do…..

Doctor we would like to give just one bottle feed atnight….habit dalni hai…..

Scenario at a Maternity home

* A BF mother needs 550 extra calories.

* She needs to eat & drink almost every 2 hrly.

DIET

More Cereal, pulses & green veggies.

Seasonal fruit & other veggies.

Egg, meat & fish beneficial.

Milk ,curd, Paneer & butter milk.

Ghee Panjiri et al Not at all.

Gallons of water ???? Other healthy liquids..

Alcohol Caffeine Tobacco

Diet of Lactating mother

Role of Antenatal priming• Much desired but sadly lacking.

TargetPrimiparasThose who faced problems

TimeEvery possible visit… repeat…

Via Media

One to one/Group interactionPictures more than wordExamination of breast/nipples.

Treating feeding ProblemsIf the child is not feeding properly

* Ask the mother to feed

more frequently

* > 8 times & to exclusively

breast feed at night.

“Baby has to learn to suck &

Mother to let the baby suckle.”

Feeding Problems

If not well attached or sucking effectively.

* Teach correct positioning & again look for

Signs of attachment & effective sucking.

* Look for oral thrush or signs of infection.

* Always check for nose block.

Breast & Nipple problems

Breast feeding should not hurt

If mothers reports pain or difficulty while feeding

Examine the breast & nipple

Look for

* Cracked or sore nipple.

* Retracted nipple.

* Engorged breasts

Not enough milk !!!! Causes

• Infrequent feeding.

• Mother restricting the length of feed.

• Poor positioning & attachment.

• Starting other supplements.

• Medications like OCP’s.

• Breast & nipple problems.

Breast feeding—The challengesPersonal comfort

Latch on pain should not last.

Cracked nipples seek help

Time & frequency of feeding

Mom in demand every 2-3 hrs.

Commitment & patience is the key.

Diet

Food sanyaas for a year.

If there is no breast milk at all..

1. Death of mother.

2. Baby being adopted.

3. Serious illness in mother.

HIV T.B Cancer Psychosis

4. Ingestion of drugs

Anticancer RA drugs Antipsychotics

5. As a supplement to BF in VLBW babies.

6. 9 to 9 corporate jobs.

Cows milk

* Perfect food ……….

* One of the four basic food groups.

* A child needs a liter of milk/day.

* Lactating mother must consume

at least 1-2 lit/day.

* Provides all essential nutrients

* Helps to build a stronger body.

* Your may be in jeopardy if you

do not drink milk.

Enough !! I just cant wait to bash this….

What is next best……

Cows milk is the perfect food for baby calves

*Cross species feeding of milk

is a gross dietary error.

* Nourishment & immunity

provided is species specific.

* Diseases attributable to Cm

Diarrhea Allergies GI bleeds

URTI’s DM CHD Arthritis

Anemia Osteoporosis NHL

Harmful constituents

Proteins Fats Minerals Hormones

Pesticides Pollutants Drugs

Lets deflate the dairy……* High milk consumption predisposes

to Osteoporosis.

* Excessive mucus created by dairy

produces RTI’s,constipation & fatigue

* Culprit in Infantile colic has been

nailed to be Cm.

* Fats in Cm are Atherogenic from D1.

* Iron def anemia is universal amongst

Cm consumers.

* Cows milk is the culprit in 60%

being evaluated for Food allergies.

Does the dairy deserve a coveted place in the food pyramid ?????

“ Infant formula is a special food manufactured to support the growth of

Infants under 6 months of age .”Composition is based on mothers milk at

3 months of age.

Protein Purified cows milk whey & caesin

Fats Blend of vegetable oils

Carbo Lactose

Vitamins –Mineral mix

Infant milk formula

??? Formula milk – Next only toBreast milk

Breast milk

Formula milk

Pasteurized milk

Untreated milkNutritionally acceptable to Doctors

Modified & fortified to match BM

Nutritionally adequate & safe complimentary food

Boon for working mothers

Place of storage Temp Max time

In a room 25C 6-8 hrs

In refrigerator 4C 24 hrs

Freezer -15C 2 weeks

Deep freezer -20C 6-12 mths

Human milk banking is yet to come

Storage of Expressed breast milk

Breast feeding Practices in India

• Insight into traditional practices – Eye opener.

“Other culture”, “Alternative belief”

• TPNC based on common sense & scientific logic .

• Unacceptable in its current distorted form.

• Influences the Neonatal morbidity & mortality.

*Beneficial TPNC worth promoting

*Harmful practices worth discontinuing

*Innocuous practices that may be allowed

Prelacteal feeds Origin

Honey/Ghee/Butter given by the eldermost .Given with finger, coton wick or a spoon.

SupportBreast milk output presumed poor.Colstrum considered dirty , harmful & heavy.Known to improve strength & Logevity.???? Role in IUGR & IDM.

Objection Delays the initiation of breast feeding process.Poor hygiene predisposes to infection.

RecommendationsNot required at all . Start breast feed as soon as possible.

Colostrum & Breast feeding

OriginColostrum is heavy & harmful hence discarded .Mother unable to feed – Baby cant suck.Delay the breast feed till ……..

ObjectionsRobs away proven nutritional & immunological benefits.Delay in BF causes breast engorgement & lactation .

RecommendationsColostrum is the first & the most effective Immunization.Early sucking promotes good lactation.Breast feeding should be initiated as soon as possible.

Lactogogues & Postpartum Diet restrictionsOrigin

Ajwain Saunf Jeera Dry fruits Panjiri !!!!

Post partum diet restriction --2days to 2 months.

Support

Lactogogues are known to improve lactation.

Emotional & nutritional support.

Objection

Cant be substitute for normal diet.

A monentary load on the family……no body minds it

Institutional promotion of BF

1 Written breast feeding policy.2 Train all health care staff.3 Inform benefits & management of BF.4 Initiate breast feeding within an hour.5 Show mothers how to breast feed. 6 Offer newborn no other liquid .7 Practise rooming in.8 Give no teats or pacifiers.9 Establish breast feeding support group.

Breast feed –Stay in shape

Don’t ever suggest an alternative to BF

Lucky humans … just have to feed one at a time

A junkie baby in the year 2050

Breast feeding is healthy

Thanks for your attention

Breast feeding the twins

Formula feeding –The Challenges

Organization & preparationEnough formula Sterile waterSterilized bottles Warming device

Lack of anti-infective factorsAntibodies Live lymphocytes

ExpenseCan cost as much as

Possibility of colic & constipationCant match the complexity of breast milk

Doc! Is there any thing in my diet that will improve quality of my breast milk

Moms diet does not affect the fat or calories .

Can alter the milk by changing the dietary fat.

Full breast = Lower fat & slower milk output.

Empty breast = Higher fat & faster milk output.

Volume of milk is the only growth determinant.

Breast feeding & IQ and Brain development

“Just do anything to make his brain sharp”

How does Breast feeding benefit the brain??

* Ideal ratio of Fats ,amino acids & other nutrients.

* Taurine : High in breast milk – Good for brain.

* DHA & ARA are essential components of brain

Plentiful in mothers feed .

* Cholestrol : Must for brain & nervous tissue.

Cows milk In Infant feeding

Milk builds strong bones

Prevents osteoporosis

Cows milk

High calcium ----Deficient in Mg & others

High phosphate & protein----Ca Unavailable

Growth of breast fed v/s formula babies

• Both grow at the same rate in first 4 months .

• 4-6 months formula fed lead the breast fed peers.

• 6-12 months breast fed babies become leaner.

• Water retention & different fat composition.

Variation in Normal pattern of Infant weight gain

Body habitus

Banana babies v/s Pear babies

Temprament

Mellow down v/s Motor driven

• Cows milk has pervaded every dietary item.

• Height of intrusion is its passage to baby through

mothers feed.

Harmful contents of bovine milk

Proteins Lactose Fats Hormones Pollutants Metals

But don’t we need this milk to build strong bones

No other animal suffers from Osteoporosis than man

Is Cows milk perfect food for human babies ??

Breast milk composition

• 1800 AD

Women forced by law to nurse their children.

High mortality attributed to wet nursing ????

Breast milk Curative & imparts wisdom.

• 1900 AD

Mothers milk viewed as the best.

“Unfit to have a child if not fit to nurse it”

Good diet, exercise & mental balance crucial.

18th & 19th century

• Babies breast fed within 1 hr of birth 24%

• Children 0-6months exclusively breast fed 46%

• Breast feeding beyond 6 months 57%

• Children aged 6-9 months receiving 57%

Solid or semisolid food & breast milk

• Children under 3 years who are underweight 46%

Facts & figuresNutritional status of children

Breast feeding benefits

• Good for all body parts from Brain to diaper area.

• Brain: Higher IQ .

• Eyes : Higher visual acuity.

• Ears : Fewer ear infections.

• Mouth : Lower need for orthodontic Rx.

• Throat : Less likely to require tonsillectomy.

• Respiratory : Fewer URTI & LRTI.

• Heart : Lower cholestrol & lower risk of IHD.

• GIT : Less diarrhea , Ulcerative colitis & Crohns .

Immunity : Better response to vaccines

stronger immunity & reduced cancer risk.

• Endocrine : Reduced risk of diabetes .

• Kidneys : Low salt & protein Easy on kidneys .

• Joints/Muscles : JRA less common .

• Skin : Lower incidence of Atopic dermatitis.

• Growth : Leaner at 1 year & rarely obese .

• Bowels : Less constipation .

Breast milk the best milk……. • Good for every body part : Brain to diaper area

• Breast milk is the best natural food for babies.

• Breast milk is always clean.

• Breast milk protects the babies from diseases.

• Breast milk builds brighter brains.

• Breast milk is available 24x7x365…..

• Breast milk builds beautiful bond with mother.

• Breast feed helps to space children.

• Breast milk beautifies the mothers from 8 ) (