1. BREAST FEEDING

2. WHAT IS BREAST FEEDING ?
Breastfeeding, also known as nursing, is the feeding of babies and young children with milk from a woman's breast
Health professionals recommend that breastfeeding begin within the first hour of a baby's life and continue as often and as much as the baby wants
During the first few weeks of life babies may nurse roughly every two to three hours
The duration of a feeding is usually ten to fifteen minutes on each breast
Older children feed less often
Mothers may pump milk so that it can be used later when breastfeeding is not possible
Breastfeeding has a number of benefits to both mother and baby, which infant formula lacks.

3. what is Breast milk ?
The milk produced by the mammary glands of the breasts is the primary source of nutrition for newborns before they are able to eat and digest other foods; older infants and toddlers may continue to be breastfed, either exclusively or in combination with other foods .
The World Health Organization recommends exclusive breastfeeding for the first six months of life, with solids gradually being introduced around this age when signs of readiness are shown. Supplemented breastfeeding is recommended until at least age two.
Breastfeeding offers health benefits to mother and child even after

4. Production
Under the influence of the hormones prolactin and oxytocin, women produce milk after childbirth to feed the baby
A number of other hormones, such as oestrogen, are involved indirectly in lactation. When a baby suckles at the breast, sensory impulses pass from the nipple to the brain. In response, the anterior lobe of the pituitary gland secretes prolactin and the posterior lobe secretes oxytocin
Prolactin : The level of prolactin in the blood increases markedly during pregnancy, and stimulates the growth and development of the mammary tissue, in preparation for the production of milk . However, milk is not secreted then, because progesterone and oestrogen, the hormones of pregnancy, block this action of prolactin. After delivery, levels of progesterone and oestrogen fall rapidly, prolactin is no longer blocked, and milk secretion begins.

6. Prolactin & OXYTOCIN HORMONES
More prolactin is produced at night, so breastfeeding at night is especially helpful for keeping up the milk supply. Prolactin seems to make a mother feel relaxed and sleepy, so she usually rests well even if she breastfeeds at night.
Oxytocin is produced more quickly than prolactin. It makes the milk that is already in the breast flow for the current feed, and helps the baby to get the milk easily.

7. The initial milk produced is referred to as colostrum, which is high in the immunoglobulin IgA, which coats the gastrointestinal tract. This helps to protect the newborn until its own immune system is functioning properly. It also creates a mild laxative effect, expelling meconium and helping to prevent the build-up of bilirubin
The amount of milk produced depends on how often the mother is nursing and/or pumping: the more the mother nurses her baby or pumps, the more milk is produced
It is beneficial to nurse when the baby wants to nurse rather than on a schedule.

9. Composition
Breast milk contains complex proteins, lipids, carbohydrates and other biologically active components. The level of Immunoglobulin A (IgA) in breast milk remains high from day 10 until at least 7.5 months post-partum .
Mature human milk contains :
Water 88%
3%--5% fat The fat fraction contains specific triglycerides of palmitic and oleic acid triglycerides
0.8%--0.9% protein
6.9%--7.2% carbohydrate calculated as lactose
0.2% mineral constituents expressed as ash
Its energy content is kcal/100 ml
Protein content is markedly higher and carbohydrate content lower in colostrum than in mature milk

10. Colostrum vs breast milk
During the first few days after delivery, the mother produces colostrum.
This is a thin yellowish fluid that is the same fluid that sometimes leaks from the breasts during pregnancy
It is rich in protein and antibodies that provide passive immunity to the baby
Colostrum also helps the newborn's digestive system to grow and function properly.
Colostrum will gradually change to become mature milk
In the first 3–4 days it will appear thin and watery and will taste very sweet; later, the milk will be thicker and creamier. Human milk provides the proteins, sugar, minerals, and antibodies that the baby needs.

11. Breast milk is the best for the baby, and the benefits of breastfeeding extend well beyond basic nutrition. In addition to containing all the vitamins and nutrients for the baby needs in the first six months of life, breast milk is packed with disease-fighting substances that protect the baby from illness.
That's one reason the American Academy of Pediatrics recommends exclusive breastfeeding for the first six months
Coordination of suckling, swallowing and breathing appears between 32 and 35 weeks of pregnancy. Infants can only suckle for a short time at that age
A majority of infants can breastfeed fully at a gestational age of 36 weeks

12. Breastfeeding protects the baby from a long list of illnesses
Numerous studies from around the world have shown that:
Stomach viruses
Lower respiratory illnesses
Ear infections
Meningitis
occur less often in breastfed babies and are less severe when they do happen. Exclusive breastfeeding (meaning no solid food, formula, or water) for at least six months seems to offer the most protection.

13. One large study by the National Institute of Environmental Health Sciences showed that children who are breastfed have 20 percent lower risk of dying between the ages of 28 days and 1 year than children who weren't breastfed, with longer breastfeeding associated with lower risk.
The main immune factor is a secretory immunoglobulin A (IgA) that's present in large amounts in colostrum, (the first milk produces for the baby.) (Secretory IgA is present in lower concentrations in mature breast milk.) The substance guards against invading germs by forming a protective layer on the mucous membranes of the baby's intestines, nose, and throat.

14. Breastfeeding's protection against illness lasts beyond baby's breastfeeding stage, too. Studies have shown that breastfeeding can reduce a child's risk of developing type 1 and type 2 diabetes, high cholesterol, and inflammatory bowel disease.
For babies who aren't breastfed, researchers have documented a link between lack of breastfeeding and later development of Crohn's disease and ulcerative colitis.

15. Breastfeeding can protect from developing allergies
Babies who are fed a formula based on cow's milk or soy tend to have more allergic reactions than breastfed babies.
The secretory IgA (only available in breast milk) help prevent allergic reactions to food by providing a layer of protection to a baby's intestinal tract. Without this protection the undigested proteins cross the gut where they can cause an allergic reaction and other health problems.
Babies who are fed formula rather than breast milk don't get this layer of protection, so they're more vulnerable to inflammation, allergies, and other eventual health issues.

16. Breastfeeding may boost child's intelligence : Various researchers have found a connection between breastfeeding and cognitive development.
Study of almost 4,000 children showed that babies who were breastfed had significantly higher scores on a vocabulary test at 5 years of age than children who were not breastfed. And the scores were higher the longer they had been nursed.
Preterm infants with extremely low birth weight who received breast milk shortly after birth improved their mental development scores at 18 months when compared with preterm infants who weren't given breast milk. These babies were also less likely to be hospitalized again because of respiratory infections.
Experts say that the emotional bonding that takes place during breastfeeding probably contributes to some of the brainpower benefits, & that the fatty acids in breast milk may play the biggest role.

17. Breastfeeding may protect THE child from obesity
The American Academy of Pediatrics recommends breastfeeding as a way to help reduce the child's risk of becoming overweight or obese.
Experts think that breastfeeding may affect later weight gain for several reasons:
Breastfed babies are better at eating until their hunger is satisfied, leading to healthier eating patterns as they grow
Breastfed babies have more leptin in their system, a hormone that researchers believe plays a role in regulating appetite and fat
Compared with breastfed babies, formula-fed infants gain weight more rapidly in the first weeks of life. This rapid weight gain is associated with later obesity.

18. sudden infant death syndrome (SIDS)
Large German study published in 2009 found that breastfeeding – either exclusively or partially – is associated with a lower risk of sudden infant death syndrome (SIDS). The researchers concluded that exclusive breastfeeding at 1 month of age cut the risk of SIDS in half.
Lower risk of childhood onset diabetes & eczema
Decreased dental problems
Decreased risk of developing psychological disorders

21. NUMBER OF FEEDINGS DAILY
The number of feedings requiered daily decreases throughout the first year from 8-12 to only 3-4 at one year of age .
Don't give solid foods before age 4 months because:
Breast milk or formula provides the baby all the nutrients that are needed for growth.
The baby isn't physically developed enough to eat solid food from a spoon.
Feeding the baby solid food too early may lead to overfeeding and being overweight.
Duration :
During the newborn period, most breastfeeding sessions take 20 to 45 minutes. However, because newborn babies are often sleepy, this length of time may require patience and persistence. Feed on the first side until baby stops suckling, and baby appears sleepy and relaxed. When these occur, break the suction, burp the baby and go to the other side. Continue feeding the baby until he/she stops the feeding at the second breast.

22. .
What to do when a baby is unable to breastfeed ?
Occasionally, there may be times where the baby is not able to breastfeed for a while. Electric breast pumps can provide the needed “suckling” stimulus for the milk production and are readily available
Continue pumping on a regular basis (every 1 to 3 hours, or 8 times in 24 hours, for 10 to 15 minutes). The milk supply will increase over time

24. Contraindications to breastfeeding
( To promote, protect and support breastfeeding, every effort must be made to minimize contraindications to breastfeeding, particularly unnecessary ones )
The baby has (galactosaemia )
Mother has active untreated tuberculosis
Mother is receiving diagnostic or therapeutic radioactive isotopes or has had exposure to radioactive materials
Mother is receiving chemotherapeutic agents
Mother is abusing drugs
Mother has herpes simplex lesions on a breast (the baby may feed from the other breast if free from lesions)
Mother is HIV positive
Maternal psychosis

25. Breastfeeding can reduce MOTHER’S stress level and THE risk of postpartum depression
The National Institutes of Health reviewed more than 9,000 study abstracts and concluded that women who didn't breastfeed or who stopped breastfeeding early on had a higher risk of postpartum depression.
Many women report feeling relaxed while breastfeeding. That's because nursing triggers the release of the hormone oxytocin. Numerous studies in animals and humans have found that oxytocin promotes relaxation. (Oxytocin released while nursing also helps the uterus contract after birth, resulting in less postpartum bleeding.)
One study found that women who had high amounts of oxytocin in their system had lower blood pressure after being asked to talk about a stressful personal problem.

26. Breastfeeding may reduce mother risk of some types of cancer
Numerous studies have found that the longer women breastfeed, the more they're protected against breast and ovarian cancer. For breast cancer, nursing for at least a year appears to have the most protective effect. It's not entirely clear how breastfeeding helps, but it may have to do with the structural changes in breast tissue caused by breastfeeding and the fact that lactation suppresses the amount of estrogen . Researchers think the effect on ovarian cancer may be related to estrogen suppression as well.

27. BREAST FEEDING PROBLEMS
Underfeeding:
The signs that the baby is getting enough milk
They seem calm and relaxed during feeds. Not crying
Gaining weight
No constipation
The baby comes off the breast on their own at the end of feeds
Overfeeding :
Regurgitation& Vomiting
Abdominal distention
Over weight
Colic

28. BREAST FEEDING PROBLEMS
Sore or cracked nipples :
It usually happens because the baby wasn't well positioned and attached at the breast.
Breast engorgement :
when breasts get too full of milk. They may feel hard, tight and painful. It can take a few days for milk supply to match baby's needs.
Mastitis (inflammation in the breast) :
Happens when a blocked duct is not relieved. It makes the breast feel painful and inflamed, mother is unwell with flu-like symptoms. Mastitis starts off as "non infective",. But if left it can then become "infective", and you'll need to start antibiotics.
Breastfeeding and thrush :
Thrush infections can sometimes happen when the nipples become cracked or damaged. The candida fungus can get into the nipple or breast.

29. Breastfeeding vs. Formula Feeding
Formula feeding is also a healthy choice for babies
Many moms choose formula for a variety of reasons:
It's convenient. Formula-fed babies can be fed by anyone at any time.
It's flexible. Mothers don't have to fit pumping into your work schedule. Instead, she can simply leave formula for her babysitter or day care center.
The father can help out with nighttime feedings and share that bonding experience with the baby.
Scheduling feedings may be easier. Formula isn't digested as quickly as breast milk, so formula- fed babies don't need to eat as often, especially in the first few months.
Mothers don't have to worry about what they eat. Moms who breastfeed may have to avoid certain foods that her baby can't tolerate.

32. Infant formula
Infant formula is a manufactured food designed and marketed for feeding to babies and infants under 12 months of age, usually prepared for bottle-feeding or cup-feeding from powder (mixed with water) .
Manufacturers state that the composition of infant formula is designed to be roughly based on a human mother's milk ; however, there are significant differences in the nutrient content of these products.
The most commonly used infant formulas contain purified cow's milk whey and casein as a protein source, a blend of vegetable oils as a fat source, lactose as a carbohydrate source, a vitamin-mineral mix, and other ingredients depending on the manufacturer
In addition, there are infant formulas using soybean as a protein source and formulas using protein hydrolysed into its component amino acids for infants who are allergic to other proteins.

34. Newborn babies need quite small amounts of formula to start with
Newborn babies need quite small amounts of formula to start with. By the end of their first week, most will need around 150 to 200ml per kilo of their weight per day until they are six months old
This amount will vary from baby to baby
Although most babies settle into a feeding pattern eventually, they vary in how often they want to feed and how much they want to drink.

35. Infant formulas come in a variety of types:
Infant formulas come in powder, liquid concentrate, and ready-to-feed forms. They are designed to be prepared by the parent or caregiver and fed to the infant, usually with either a cup or a baby bottle.
Infant formulas come in a variety of types:
Cow's milk formula is the most commonly used type. The milk has been altered to resemble breast milk.
Soy protein based formulas are frequently used for infants allergic to cow's milk or lactose. Soy-based formulas can also be useful if the parent wants to exclude animal proteins from the child's diet.
Protein hydrolysate formulas contain protein that's been broken down into smaller sizes than are those in cow's milk and soy- based formulas. Protein hydrolysate formulas are meant for babies who don't tolerate cow's milk or soy-based formulas.
Specialized formulas are also available for premature infants and those with specific medical conditions.

36. Manufacturers and health officials advise it is very important to measure powders or concentrates accurately to achieve the intended final product concentration; otherwise, the child will be malnourished. It is advisable that all equipment that comes into contact with the infant formula be cleaned and sterilized before each use. Proper refrigeration is essential for any infant formula which is prepared in advance.

37. Use of infant formula has increased health risks
Acute otitis media
Gastroenteritis
Severe lower respiratory tract infections
Atopic dermatitis
Asthma
Obesity
Type 1 and 2 diabetes
Sudden infant death syndrome (SIDS)
Eczema and necrotizing enterocolitis when compared to infants who are breastfed
Lower cognitive development

38. Nutritional content
Although cow's milk is the basis of almost all infant formula, plain cow's milk is unsuited for infants because of its high casein content and low whey content, and untreated cow's milk is not recommended before the age of 12 months
The infant intestine is not properly equipped to digest non-human milk, and this may often result in diarrhea, intestinal bleeding and malnutrition
To reduce the negative effect on the infant's digestive system, cow's milk used for formula undergoes processing to be made into infant formula. This includes steps to make protein more easily digestible and alter the whey-to-casein protein balance to one closer to human milk, the addition of several essential ingredients (often called "fortification"), the partial or total replacement of dairy fat with fats of vegetable or marine origin, etc.
Carbohydrates are an important source of energy for growing infants, as they account for 35 to 42% of their daily energy intake
Lactose is the main source of carbohydrates present, but lactose is not present in cow's milk- lactose-free formulas nor hydrolyzed protein formulas for infants with milk protein sensitivity
Lactose is also not present in soy-based formulas. Therefore, those formulas without lactose will use other sources of carbohydrates, such as sucrose and glucose
Lactose is not only a good source of energy, it also aids in the absorption of the minerals magnesium, calcium, zinc and iron.

39. Use of infant formula
Mother's health: The mother is infected with HIV or has active tuberculosis.
Baby is unable to breastfeed: The child has a birth defect or inborn error of metabolism such as galactosemia that makes breastfeeding difficult or impossible
Baby is considered at risk for malnutrition: In certain circumstances infants may be at risk for malnutrition, such as due to iron deficiency, vitamin deficiencies (e.g. vitamin D which may be less present in breastmilk than needed at high latitudes where there is less sun exposure), or inadequate nutrition during transition to solid foods
Absence of the mother: The child is adopted, orphaned, abandoned. The mother is separated from her child by being in prison or a mental hospital. The mother has left the child in the care of another person for an extended period of time, such as while traveling or working abroad

40. principles in weaning babies
Weaning is usually begun around six months old
Premature introduction of solids is inadvisable
A wide range of home-prepared and/or manufactured baby foods broadens the experience of taste and smell at a receptive age
Foods during weaning should be given without added salt or added
A low-fat diet is not appropriate for babies. Skimmed or semi-skimmed milk are not suitable
Fibre need not be excluded but should be given only in small amounts
Breast or complete formula milk should preferably be continued throughout the first year of life
The need for fluid increases with the intake of solids
Watch the sugar content in fruit juices and give well diluted
Children's vitamin drops should be given from six months up to two years, and preferably up to five years.

41. Thank you