8/6/2019 Breast Feeding Recommendations
1/37
Breastfeeding Recommendations
Start breastfeeding within hour 1hr of birth
Breastfeed exclusively from 0 4month of age
Complementary foods can begin between 4-6mths
Give complementary foods to all children from
6mths
Continue breastfeeding up to 2 yrs of age or
beyond
Why must all mothers breastfeed their baby?
8/6/2019 Breast Feeding Recommendations
2/37
Protection from allergy
A mothers milk is especially suited for her
own baby.
Colostrum is the perfect first for baby food Is thick, sticky and yellowish in color.
Has laxative properties which helps baby pass
meconium therefore prevents jaundice. Contains immunonoglobulins which provide
an anti-infective protection to baby
8/6/2019 Breast Feeding Recommendations
3/37
Benefits of exclusive breastfeeding for 6
months
Protection against infection
Overall, there is less illness requiring health care
Provides the best infant nutrition and growth Protection against infection; bifidus factor helps
special bacteria to grow in babys intestine and
prevents other harmful bacteria from growing Has antibodies - protect baby against diseases
mother has been exposed to.
8/6/2019 Breast Feeding Recommendations
4/37
The amount of protein is perfect for growth andbrain development
The foremilk contains more protein whereas
the hindmilk contains more fat The GI tract develops more quickly when
breastfed preventing foreign proteins from
entering his system
Emotional bonding results in less child neglect
and abuse
8/6/2019 Breast Feeding Recommendations
5/37
Lower incidence of cot death and lower risk of
childhood diabetes, cancer and ear infection Better psychomotor, emotional and social
development
Mother oxytocin released during brestfeeding
contracts the uterus- helps stops the
bleeding after birth
- frequent feeding delays the return of
menses
8/6/2019 Breast Feeding Recommendations
6/37
- post partum depression is reduced
- safe, no preparation needed, and ??? What
else- Benefits to society - ???
8/6/2019 Breast Feeding Recommendations
7/37
Teach mothers how to keep prolactin
level high
Assist baby to attach effectively at the breast
never give dummies or teats
Baby breastfeed as frequently as he wants(every 1-3hrs) and as long as he wants
Offer night feeds
8/6/2019 Breast Feeding Recommendations
8/37
Release of oxytocin can be temporarily inhibited
by:
extreme pain
Stress hormones resulting from doubt,
embarrassment, anxiety
Nicotine and alcohol
8/6/2019 Breast Feeding Recommendations
9/37
Mother can reduce inhibition of oxytocin by:
Relaxing and getting comfortable for feeds
Avoid embarrassing or stressful situations
Express a little milk and gently stimulate the
nipple
Ask someone to massage her upper back
8/6/2019 Breast Feeding Recommendations
10/37
Identifying women at risk for
breastfeeding difficulties
* Previous feeding practices
Family difficulties
Age, social status or state of mind
Regular separation from their babies
8/6/2019 Breast Feeding Recommendations
11/37
Dealing with sleepy babies
Remove blankets and let the arms and legs
move
Breastfeed baby in a more upright position Gently massage the body and talk to him
Wait 1/2hr and try again
Allow baby to suckle until he releases the
breast.
8/6/2019 Breast Feeding Recommendations
12/37
Help mothers learn how to respond to
babys need
Keep baby and mother day and night
(rooming in)
Show them how to watch for feeding signs
rather than waiting for babys cry
Explain that frequent suckling and milk
removal keeps milk production high
8/6/2019 Breast Feeding Recommendations
13/37
Inform them to allow baby determine the
frequency and length of breastfeed
Relieve overfull or uncomfortable breasts bybreastfeeding or expressing milk
8/6/2019 Breast Feeding Recommendations
14/37
Suckling and Attachment
Hold the baby close and facing the mothers breast
The baby needs a large mouthful of breast in order to
remove milk effectively
The nipple, areola and breast tissue form a teat within the
babys mouth
The tongue cups along the sides of the teat, and a wave
of compression moves along the tongue towards the backof the mouth
The baby swallows when the back of his mouth is full
Artificial teats can cause sucking confusion
8/6/2019 Breast Feeding Recommendations
15/37
Positioning and Attachment
Positioning
Babys whole body to be turned towards
mother, with buttocks well supported
Attachment
Elicit the rooting reflex by touching babys lip
with the breast.
Wait until baby has a wide-open mouth
Bring baby to the breast, not the breast to the
breast
8/6/2019 Breast Feeding Recommendations
16/37
Move the whole of babys body to the breast;
do not push his head
Make sure baby gets a large mouthful of breast.
Support the breast during the feed to help with
attachment
Feed until baby releases the breast
spontaneously.
If baby is not attached well, or if mother feels
pain, she should break sucking, remove baby
from breast and start again.
8/6/2019 Breast Feeding Recommendations
17/37
Causes ofPoor Attachment
Use of feeding bottle before breastfeeding established- for later supplements
*Inexperienced mother first baby,
previous bottle feeder
Functional difficulty small or weak baby
- breast poorly protractile
- engorgement, late start
8/6/2019 Breast Feeding Recommendations
18/37
Signs of good attachment
Babys mouth is open wide
Chin is touching the breast
Lower lip is curled outward
Slow deep sucks
Mother may hear baby swallowing
8/6/2019 Breast Feeding Recommendations
19/37
Signs that a newborn is receiving
sufficient milk Breastfeed at least 8 times in 24hrs
During a feed swallowing and gulping may be
heard
Baby is alert, has good muscle tone and healthy
skin
8/6/2019 Breast Feeding Recommendations
20/37
Baby is contented between feeds
Uses 6 or more diapers in 24hrs
Has 3-8 bowel movements in 24hrs butbecomes less as they grow older
Consistent weight gain 18-30gm in 24hrs
8/6/2019 Breast Feeding Recommendations
21/37
Reasons why a baby may not get
enough breastmilk
These are Common Breastfeeding factors
Delayed start
Infrequent feeds
No night feeds
Short feeds
Poor attachment
Bottles pacifiers, complementary feeds
8/6/2019 Breast Feeding Recommendations
22/37
Common: Mother psychological factors
Lack of confidence
Worry, stress
Dislike of breastfeeding
Tiredness
Rejection of baby
8/6/2019 Breast Feeding Recommendations
23/37
These are not common
Mothers: physical condition eg
Contraceptive pills, diuretics
Pregnancy
Severe malnutrition
Alcohol, smoking, retained piece of
placenta(rare)
Babys condition
Illness
deformity
8/6/2019 Breast Feeding Recommendations
24/37
Premature babies can breastfeed:
When
* they are able to coordinate suckle and swallow
Putting their fist to their mouth
Feeding with only occasional disruptions in
breathing and heart rhythm
8/6/2019 Breast Feeding Recommendations
25/37
Skills for building confidence and
giving support
accept what a mother thinks and feels
Recognize and praise what a mother and baby
are doing right
Give practical help
Give a little, relevant information
Use simple language
Make 1 or 2 suggestions, not commands
8/6/2019 Breast Feeding Recommendations
26/37
Treating breast engorgement
Correct any problems with attachment Breastfeed more frequently
Gently express some milk to soften the areola,
help the babys attachment Apply cold compress to the breasts after a
breastfeed for comfort
8/6/2019 Breast Feeding Recommendations
27/37
Treating sore nipples
Check for poor attachment
Massage the breasts gently towards the
nipples. Express milk to stimulate milk flow
Begin each breastfeed on the least sore
breast
Avoid limitations on the frequency of feeds
Apply EBM to the nipples after a breast feed
Expose the breasts to air and sun
8/6/2019 Breast Feeding Recommendations
28/37
If the mother has thrush on her
nipples
Apply medication to the mothers nipple, babys
mouth and diaper area
Expose nipple to air and sunlight after feeds
Take special care in washing clothing
Check for vaginal infection and treat
8/6/2019 Breast Feeding Recommendations
29/37
Medication for breastfeeding mothers
Most medication pass through breastmilk invery small amounts.
For possible side effects; monitor the baby for
abnormal sleepiness, unwillingness to feed,jaundice
The following drugs may reduce milk supply;
oestrogen, thiazide diuretics (use alternative
drugs)
8/6/2019 Breast Feeding Recommendations
30/37
Preparation for discharge
Refer to a mother to mother support group
Give written or verbal advice for breastfeeding
at home
Identify where mothers can receive help andsupport
8/6/2019 Breast Feeding Recommendations
31/37
Roles of staff in upholding the
International Code
Breast-milk substitutes in the health facility
should be kept out of the sight of pregnant
women and mothers
Health facilities should not allow sample gift
packs with breast milk substitutes or relatedsupplies be distributed to pregnant women or
mothers
8/6/2019 Breast Feeding Recommendations
32/37
Financial or material inducements to promote
products within the scope of the Code should not be
accepted by health workers
Manufacturers and distributors of products within
the scope of the Code should disclose to the
institution any contributions made to health workers
such as fellowships, study tours, research grants
conference. Similar disclosures should be made by
the recipient
8/6/2019 Breast Feeding Recommendations
33/37
Ten steps to successful breastfeeding
Every facility providing maternity servicesand care for newborn infants should:
1. Have a written breastfeeding policy that is
routinely communicated to all health carestaff
2. Train all health care staff in skills necessary
to implement this policy
8/6/2019 Breast Feeding Recommendations
34/37
3. inform all pregnant women about thebenefits and management of breastfeeding
4. Help mothers initiate breastfeeding within a
half-hour of birth
5. Show mothers how to breastfeed, and how tomaintain lactation even if they should be
separated from their infants
8/6/2019 Breast Feeding Recommendations
35/37
6. Give newborn infants no food or drink otherthan breast milk unless medically indicated
7. Practice rooming in allow mothers and
infants to remain together 24hrs a day
8. Encourage breastfeeding on demand,
give no artificial teats or pacifiers to
breastfeeding infants
8/6/2019 Breast Feeding Recommendations
36/37
9. Give no artificial teats or pacifiers to
breastfeeding infants
10. Forster the establishment of breastfeedingsupport groups and refer mothers to them
on discharge from the hospital.
8/6/2019 Breast Feeding Recommendations
37/37
References
Palmer, G.(1998) The Politics of Breastfeeding. 3rd
ed. London. A Division of Harper Collins
Publishers.
Chetley, A. Allain, A. (1987) Protecting Infant
Health, a health workers guide to the
International Code of Marketing Breastmilk
Susbtitutes. 3rd ed. Penang
* Protecting, Promoting, and Supporting
Breastfeeding: the special role of maternityservices. A Joint WHO/UNICEF Statement,
Geneva: WHO/UNICEF, 1989.