UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 ابتکار عمل بیمارستان های دوستدار کودک: اصلاح،به روزرسانی،گسترش برای مراقبت های جامع “Maternity”, 1963, © 2003 Estate of Pablo Picasso/Artists Rights Society (ARS), New York

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 استراتژي جهاني تغذيه شيرخواران وكودكان خردسال هدف استراتژي جهاني عبارتست از: ارتقا وضعيت تغذيه،رشد وتكامل،سلامت و درنتيجه بقاءشيرخواران و كودكان.خردسال از طريق خورانش مطلوب اين استراتژي از تغذيه انحصاري باشيرمادر در 6ماه اول عمر، شروع غذاهاي كمكي بموقع،كافي،سالم و مناسب همراه با تداوم تغذيه باشيرمادر براي مدت 2 سال و بيشتر حمايت مي كند. همچنين از تغذيه مطلوب مادر و حمايت اجتماع و جامعه از او پشتيباني مي كند. 1/1

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 هدف راه اندازي بيمارستانهاي دوستداركودك: اجراي اقدامات دهگانه براي موفقيت شيردهي و خاتمه دادن به توزيع رايگان و ارزان قيمت جانشين شونده هاي شيرمادر در بيمارستانها 1/2

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 هدف اين دوره آموزشي: هدف اين دوره آموزشي عبارتست از اينكه: كاركنان بهداشتي درماني با اعتماد بنفس براي تغذيه زودرس و انحصاري شيرخواران باشيرمادر از مادران حمايت كنند و بيمارستان در راستاي معيارهاي بيمارستان دوستدار كودك حركت كند. 1/3

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 فقط وقتي جايگزين شيرمادربراي تغذيه شيرخوارشرايط زير را داشته باشد، تغذيه باشيرمادرمنع مي شود: ” قابل قبول،عملي،دردسترس،مستمروايمن“ (AFASS): Acceptable, Feasible, Affordable, Sustainable and Safe, يا : تغذيه انحصاري باشيرمادربراي ماه هاي اول ، وسپس قطع آن به محض دسترسي به تغذيه جايگزين كه شرايط فوق را داشته باشد،توصيه مي شود. توصيه هاي تغذيه اي براي مادران مثبت:HIV 3/2

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 هدف كلي آئين نامه بين المللي بازاريابي جانشين شونده هاي شيرمادر عبارتست از: تغذيه ايمن و كافي تمام شيرخواران 4/2

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 Skin to Skin Contact and Early Breastfeeding 5/1 ©UNICEF C107-2

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 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 Parts of the Breast 6/1 Adapted from 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 Helping the Oxytocin Reflex 6/2 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 What can you see? Good attachmentPoor attachment 6/3 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 What can you see? Good attachmentPoor attachment 6/4 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 Breastfeeding Positions 7/1 In line Close Supported Facing 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 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 Assess a Breastfeed ارزیابی تغذیه با سینه 7/3 ©UNICEF C107-5

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 ©UNICEF C107-7 Wide Open Mouth 7/4

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 Assess a Breastfeed 7/5 ©UNICEF C107-9

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course /1 9/1 Original illustration by Jenny Corkery

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 Case study 9/2 UNICEF/HQ / Betty Press, Kenya “Sleeping all the time” “Refusing” the breast 3 stools in week 12% under birth weight Bottle with honey and water twice yesterday 2 weeks old Healthy at birth Discharged Day 2 Case study 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 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

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 DANCER Hand Position 10/5 ©UNICEF C107-21

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 Hand Expression 11/1 ©UNICEF F

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 Cup Feeding 11/2 Promoting breastfeeding in health facilities: A short course for administrators and policy makers WHO/NUT/96.3, Wellstart International

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 Supplementer 11/3 Dr Ruskhana Haider, Dhaka, Bangladesh

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 Size and Shape There are many different shapes and sizes of breast and nipple. Babies can breastfeed from almost all of them. 12/1 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 Full Breast UNICEF C /2

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 Engorged Breast © UNICEF C /3

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 Mastitis 12/4 ©UNICEF C107-39

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 Sore Nipple 12/5 ©UNICEF C107-31

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 Sore Nipple 12/6 ©UNICEF C107-32

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 Candida on the nipple 12/8 ©UNICEF C107-34

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 Candida on the nipple 12/9 ©UNICEF C

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 Tongue-tie 12/10 ©UNICEF C107-35

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 Lactational Amenorrhea Method (LAM) 13/1 Institute for Reproductive Health, Georgetown, Washington, DC 1. Have your menses returned? 2. Are you giving supplements or are there long periods without breastfeeding either day or night? 3. Is your baby more than six months old? Ask the mother or advise her to ask herself these three questions: There is only a 1-2% chance of pregnancy at this time. YES NO YES When the answer to ANY one of these questions becomes YES The mother’s chance of pregnancy is increased. For continued protection, and to achieve child spacing, a complementary family planning method needs to be used, and breastfeeding continue.

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 Course Aims The aim of this course is that every staff member will confidently support mothers to succeed with early and exclusive breastfeeding, and that this facility moves towards achieving Baby-Friendly designation. 15/1

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