بسم الله الرحمن الرحيم اقدامات دهگانه در بيمارستانهای دوستدار کودک برای نيل به تغذيه موفقيت آميز کودک با شير مادر دکتر محمدرضا مدبر مدیر گروه سلامت خانواده و جمعیت مرکز بهداشت استان قزوین

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 Global Strategy for Infant and Young Child Feeding The aim of the Global Strategy is to improve – through optimal feeding – the nutritional status, growth and development, health, and thus the survival of infants and young children. It supports exclusive breastfeeding for 6 months, with timely, adequate, safe and appropriate complementary feeding, while continuing breastfeeding for two years and beyond. It also supports maternal nutrition, and social and community support. 1/1

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 The aim of the Baby Friendly Hospital Initiative To implement the Ten Steps to Successful Breastfeeding and to end the distribution of free and low-cost supplies of breastmilk substitutes to health facilities. 1/2

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 Course Aims The aim of this course is that every staff member will confidently support mothers with early and exclusive breastfeeding, and that this facility moves towards achieving Baby-friendly designation. 1/3

اقدامات دهگانه در بیمارستانهای دوستدار کودک UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

اقدام اول: سیاست مدون ترویج تغذیه با شیر مادر در معرض دید کلیه کارکنان نصب شده باشدو برای اطمینان از ارتقاءکیفیت خدمات به طور مستمر توسط کمیته بیمارستانی ترویج تغذیه با شیر مادر پایش شود. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

اقدام دوم: کلیه کارکنان به منظور کسب مهارت های لازم برای اجرای این سیاست قبل از خدمت وحین خدمت آموزش های مکرر ببینند. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

اقدام سوم: مادران بارداردر زمینه مزایای تغذیه با شیر مادر، چگونگی شیر دهی وتداوم آن، عوارض تغذیه مصنوعی وبطری وگول زنک آموزش ببینند. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

3/1 Original illustration by Jenny Corkery

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course /1 Original illustration by Jenny Corkery

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

اقدام چهارم: به مادران کمک کنند تا تماس پوست باپوست را از لحظه تولد وتغذیه نوزاد با شیر مادر را در ساعت اول شروع کنند و در بخش های اطفال برنامه تجویز دارو وانجام آزمایشات واعمال جراحی به گونه ای طراحی گردد که در تغذیه از پستان مادراختلال ایجاد نکند. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

First Skin to Skin Contact 5/3 Dr Nils Bergman, Cape Town, South Africa

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 Skin to Skin Contact and Early Breastfeeding 5/2 UNICEF/HQ / Roger Lemoyne, Thailand

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

اقدام پنجم : به مادران روش تغذیه با شیر مادر و چگونگی حفظ و تداوم شیر دهی را در هنگام بیماری مادر یا شیر خوار و اشتغال مادرآموزش دهند وبرای حل مشکلات شیر دهی کمک وحمایت کنند. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Kangaroo Mother Care 10/1 Dr Nils Bergman, Cape Town, South Africa

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 Kangaroo Mother Care Dr Nils Bergman, Cape Town, South Africa 10/2

اقدام ششم: به شیر خواران سالم در 6 ماهه اول عمر به جز شیر مادر، غذا یا مایعات دیگر ندهند. ( مگر در ضرورتهای پزشکی ) UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

اقدام هفتم: برنامه هم اتاقی مادر و شیر خوار را در طول شبانه روز اجرا و بخش های اطفال تسهیلات لازم را برای اقامت شبانه روزی و تامین ونیازهای فیزیکی وعاطفی مادران تهیه نمایند. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

8/1 9/1 Original illustration by Jenny Corkery

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

اقدام هشتم: مادران را به تغذیه بر حسب میل وتقاضای شیر خوار با شیر مادر تشویق، کمک و حمایت کنندودر مواقع لزوم امکان دوشیدن مکرر شیر وذخیره آن وجود داشته باشد.

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

اقدام نهم: مطلقا از شیشه و پستانک (گول زنک ) استفاده نکنند.

اقدام دهم: تشکیل گروه های حمایت از مادران شیر ده را پیگیری نمایند و اطلاعاتی در مورد گروههای حامی و مراکز مشاوره شیر دهی در اختیار والدین قرار دهند.

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

BREASTFEED OBSERVATION AID Mother's name _______________________________Date ___________________ Baby's name _________________________________Baby's age ______________ Signs that breastfeeding is going well: Signs of possible difficulty: GENERALMother:  Mother looks healthy  Mother looks ill or depressed  Mother relaxed and comfortable  Mother looks tense and uncomfortable  Signs of bonding between mother and baby  No mother/baby eye contactBaby:  Baby looks healthy  Baby looks sleepy or ill  Baby calm and relaxed  Baby is restless or crying  Baby reaches or roots for breast if hungry  Baby does not reach or root BREASTS  Breasts look healthy  Breasts look red, swollen, or sore  No pain or discomfort  Breast or nipple painful Breast well supported with fingers away from nipple  Breasts held with fingers on areola BABY’S POSITION  Baby’s head and body in line  Baby’s neck and head twisted to feed  Baby held close to mother’s body  Baby not held close  Baby’s whole body supported  Baby supported by head and neck only  Baby approaches breast, nose to nipple  Baby approaches breast, lower lip/chin to nipple BABY’S ATTACHMENT  More areola seen above baby’s top lip  More areola seen below bottom lip  Baby’s mouth open wide  Baby’s mouth not open wide  Lower lip turned outwards  Lips pointing forward or turned in  Baby’s chin touches breast  Baby’s chin not touching breast SUCKLING  Slow, deep sucks with pauses  Rapid shallow sucks  Cheeks round when suckling  Cheeks pulled in when suckling  Baby releases breast when finished  Mother takes baby off the breast Mother notices signs of oxytocin reflex  No signs of oxytocin reflex noticed Notes: 7/2

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 Positioning a preterm infant 10/3 UNICEF/HQ / Roger Lemoyne, China

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 Twins Grow Well on Breastmilk UNICEF/HQ / Lauren Goodsmith, Mauritania 10/4

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 Chin Support 10/6 Kay Hoover and Barbara Wilson-Clay, from The Breastfeeding Atlas

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 Syringe method for inverted nipples 12/7 Breastfeeding Counselling: a training course, WHO/CHD/93.4, UNICEF/NUT/93.2

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 چگونه یک برنامه مدون عملیاتی تهیه کنیم؟

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 Where are we now? Developing a Plan: Step One 15/2

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Where do we want to be? 15/3 Developing a Plan: Step Two

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 Developing a Plan: Step Three 15/4 How will we get there?

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 How will we know if we are there? Developing a Plan: Step Four 15/5

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 How will we sustain it? 15/6 Developing a Plan: Step Five

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

روش ارتقاي فرايند : بر اساس نتايج اقدام كنيد ACT براي ارتقا برنامه ريزي كنيد PLAN برنامه را اجرا كنيد DODO نتايج را ارزيابي كنيد CHECK فرايندي را براي ارتقا پيدا كنيد. FIND تيمي كه فرايند را مي شناسد سازماندهي كنيد. ORGANIZE روشن كنيد فرايند چگونه عمل مي كند. CLARIFY علل تغييرات عملكرد فرايند را درك كنيد. UNDERSTAND قسمتي از فرايند را كه نياز به ارتقا دارد انتخاب كنيد. SELECT FOCUS – PDCA

از توجه شما متشکرم UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006