1. BABY FRIENDLY HOSPITAL INITIATIVE(BFHI)

2. Goals of baby friendly hospital initiative

3. To transform hospitals and maternity facilities through implementation of the ten steps
To end the practice of distribution of free and low cost supplies of breast milk substitutes to maternity wards and hospitals

4. Definition:
The Baby Friendly Hospital Initiative was introduced in 1991 by the World Health Organization/United Nations Children's Fund (WHO/UNICEF) to promote, protect and support breastfeeding in the hospital or birth setting. A key element in this promotion and support is outlined in their

5. Ten Steps to Successful Breastfeeding

6. Ten steps to successful breastfeeding
Have a written breastfeeding policy that is routinely communicated to all health care staff
Train all health care staff in skills necessary to implement this policy
Inform all pregnant women about the benefits and management of breastfeeding
Help mothers initiate breastfeeding within half n hour of birth

7. Show mothers how to breastfeed and maitain lactation,even if they should be separated fromtheir infants
Give new born infants no food or drink other than breastfeed,unless medically indicated
Practice rooming-in- that is allow mothers and infants to remain together 24 hours aday
Encourage breastfeeding on demand

8. Give no artificial teats or pacifiers to breastfeed infants
Foster the establishment of breastfeeding support groups and refer mothers on discharge from the hospital or clinic

10. Key dates in the history of breastfeeding and BFHI

12. What our religion says
Islam has known this fact(importance of breastfeeding)for some 1400 years
We have enjoined on man kindness to his parents:in paindid his mother bear him,and in pain did she gave him birth……….O my Lord!Grant me that I may be grateful for Thy favor
(Holy Quran 46;15)

13. According to certain witnesses, the Prophet (PBUH)even indicated, in one of his Hadiths
“those mothers who can breastfeed
their babies and yet do not do so will
be called to account”

14. TEN STEPS TO SUCCESSFUL BREASTFEEDING ALONGWITH EXPLANATION

15. Step 1
Have a written breastfeeding policy that is routinely communicated to all health care staff

16. Why need a policy??? Requires a course of action and provides guidance
Helps establish consistent care for mothers and babies
Provides a standard that can be evaluated

17. Policy should includes
At a minimum, it should include:
The 10 steps to successful breastfeeding
An institutional ban on acceptance of free or low cost supplies of breast-milk substitutes, bottles, and teats and its distribution to mothers
A framework for assisting HIV positive mothers to make informed infant feeding decisions that meet their individual circumstances and then support for this decision
Other points can be added

18. It should be:
Written in the most common languages understood by patients and staff
Available to all staff caring for mothers and babies
Posted or displayed in areas where mothers and babies are cared for

20. Step 2. Train all health-care staff in skills necessary to implement this policy.

22. Areas of knowledge Advantages of breastfeeding
Risks of artificial feeding
Mechanisms of lactation and suckling
How to help mothers initiate and sustain breastfeeding

23. How to resolve breastfeeding difficulties
How to assess a breastfeed
Hospital breastfeeding policies and practices
Focus on changing negative attitudes which set up barriers

24. Step 3. Inform all pregnant women about the benefits of breastfeeding.

25. It includes Benefits of breastfeeding Early initiation
Importance of rooming-in (if new concept)
Importance of feeding on demand
Importance of exclusive breastfeeding
How to assure enough breastmilk
Risks of artificial feeding and use of bottles and pacifiers (soothers, teats, nipples, etc.)

26. Step. 4. Help. mothers initiate breastfeeding within. a
Step 4. Help mothers initiate breastfeeding within a half-hour of birth.

27. Why early initiation Increases duration of breastfeeding
Allows skin-to-skin contact for warmth and colonization of baby with maternal organisms
Provides colostrum as the baby’s first immunization
Takes advantage of the first hour of alertness
Babies learn to suckle more effectively
Improved developmental outcomes

28. Keep mother and baby together
Place baby on mother’s chest
Let baby start suckling when ready
Do not hurry or interrupt the process
Delay non-urgent medical routines for at least one hour

30. Step 5. Show mothers how to breastfeed and how to maintain lactation, even if they should be separated from their infants

31. Step. 6. Give newborn infants no food
Step 6. Give newborn infants no food or drink other than breast milk unless medically indicated

34. Acceptable medical reasons for supplementation or replacement
Infant conditions:
Infants who cannot be BF but can receive BM include those who are very weak, have sucking difficulties or oral abnormalities or are separated from their mothers.
Infants who may need other nutrition in addition to BM include very low birth weight or preterm infants, infants at risk of hypoglycaemia, or those who are dehydrated or malnourished, when BM alone is not enough.
Infants with galactosemia should not receive BM or the usual BMS. They will need a galactose free formula.
Infants with phenylketonuria may be BF and receive some phenylalanine free formula. • • •

35. Maternal conditions: •
BF should stop during therapy if a mother is taking anti-metabolites, radioactive iodine, or some anti-thyroid medications.
Some medications may cause drowsiness or other side effects in infants and should be substituted during BF.
BF remains the feeding choice for the majority of infants even with tobacco, alcohol and drug use. If the mother is an intravenous drug user BF is not indicated.
Avoidance of all BF by HIV+ mothers is recommended when replacement feeding is acceptable, feasible, affordable, sustainable and safe. Otherwise EBF is recommended during the first months, with BF discontinued when conditions are met. Mixed feeding is not recommended. • • •

36. Maternal conditions (continued):•
If a mother is weak, she may be assisted to position her baby so she can BF.
BF is not recommended when a mother has a breast abscess, but BM should be expressed and BF resumed once the breast is drained and antibiotics have commenced. BF can continue on the unaffected breast.
Mothers with herpes lesions on their breasts should refrain from BF until active lesions have been resolved.
BF is not encouraged for mothers with Human T-cell leukaemia virus, if safe and feasible options are available.
BF can be continued when mothers have hepatitis B, TB and mastitis, with appropriate treatments undertaken. • • • •

37. Step. 7. Practice rooming-in — allow mothers and infants to remain
Step 7. Practice rooming-in — allow mothers and infants to remain together —
24 hours a day.

38. Rooming-in
A hospital arrangement where a mother/baby pair stay in the same room day and night, allowing unlimited contact between mother and infant

40. Why rooming-in is important
Reduces costs
Requires minimal equipment
Requires no additional personnel
Reduces infection
Helps establish and maintain breastfeeding
Facilitates the bonding process

41. Step 8. Encourage breastfeeding on demand.

42. Breastfeeding on demand:
Breastfeeding whenever the baby or mother wants, with no restrictions on the length or frequency of feeds

43. Step 9. Give no artificial teats or pacifiers also called dummies and soothers to breastfeeding infants.

45. Alternatives to artificial teats
cup
spoon
dropper
Syringe

46. Step 10.Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

47. Support can include Early postnatal or clinic checkup Home visits
Telephone calls
Community services
Outpatient breastfeeding clinics
Peer counselling programmes

48. Mother support groups Family support system Help set up new groups
Establish working relationships with those already in existence
Family support system

49. What is exclusive breastfeeding

50. Definition:
The feeding of an infant or young child with breast milk directly from female human breasts rather than from a baby bottle or other container.

51. Benefits to the Baby Perfect nutrition Higher IQ
Complete food for the first six months
Emotional bonding Prevents infections Prevents chronic diseases Easily digested

52. Benefits to the Mother Reduces post delivery bleeding and anemia
Helps delay next pregnancy Protective effect against breast and ovarian cancer Helps to loose weight Emotional bonding
Needs no preparation

53. Breastfeeding in the Correct Position
Milk producing glands Lactiferous canaliculi Lactiferous sinuses Myoepithelial tissue Adipose tissue

54. Signs of Correct Attachment
Mouth wide open
Lower lip is turned outside Chin touching the breast Black part of the breast not visible below the lower lip Large black portion of breast and nipple including milk collecting ducts are inside baby’s mouth
Tongue under the teat

55. Incorrect Sucking Position
Mouth is not wide open
Chin is away from the breast Baby is sucking only nipple Most black portion of the breast is outside the baby’s mouth
Tongue away from the teat

56. Causes of Incorrect Attachment
Use of feeding bottles. Leads to nipple confusion
Inexperienced mother
Functional difficulty with the mother or the baby
Lack of skilled support

57. Breastmilk Production
The Prolactin reflex
Sensory Impulses from nipple
Prolactin in blood
More prolactin secreted at night
Secreted after feed to produce next feed Suppresses ovulation
Baby sucking

58. Let-down reflex
A let down reflex is a conditional reflex ejecting milk from the alveoli through the ducts to the sinuses of the breast and the nipples
This reflex makes it easier to breastfeed the baby

59. Feeling of not enough milk
Not true
Reinforce mothers: Self confidence is must
Ensure frequent suckling Ensure effective suckling

60. 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) •

61. 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

62. BENEFITS OF BREASTFEEDING
Ecological:
-Saves resources
-Less waste
-No refrigeration
-No manufacturing
-No bottles, cans
-No trucking
-No handling

63. BENEFITS OF BREASTFEEDING
For Society
-Smarter
-Healthier
-Less cost to healthcare system
-Stronger families

64. BENEFITS OF BREASTFEEDING
To Families
-Less trips to doctors, hospitals
-Less prescriptions
-Less stress
-Less illness
-More bonding
-Inexpensive

65. 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

66. 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

67. Importance of breastfeeding
Early breast milk is a liquid gold
Breast milk changes as baby grows
Breast milk is easier to digest
Breast milk fights disease
Breastfeeding can be good for mother’s health too
Breastfeeding can save money

68. Learning to breastfeed
Breastfeed as soon as possible after birth
Ask for an on-site lactation consultant to come and help
Ask the staff not to give your baby other food or formula
Try to avoid giving any pacifier or artificial nipple to baby

69. HARMFUL EFFECTS OF FORMULA MILK

70. Breast milk VS Formula 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 •

71. 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

72. 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.

73. IMPLEMENTATION OF BREASTFEEDING IN PAKISTAN
The Pakistan pediatric association(PPA)has been asking for stricter implementation of the breastfeeding laws to protect children from malnutrition
Owing to lax government attitudes, bottle feeding rate in Pakistan is above 40 percent, as per Unicef estimates
(published in the Express Tribune,March 16th ,2018)

74. Breastfeeding rates in pakistan

75. Monthly income and breastfeeding in Pakistan

76. As a Public health Student what should be done in my community to implement breastfeeding

77. Encourage a breastfeeding policy in hospitals based on the principles of BFHI
Train health care professionals in the promtion and managenent of breastfeeding
Develop strategies for the promotion of breastfeeding in the community

78. Social media can also be used to promote and support breastfeeding
We can develop appropriate facilities in workplace for breastfeeding
To increase general population awareness about the benefits of breastfeeding including the role of the husband and other family members in supporting the lactating mother

79. World breastfeeding week

80. References
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Brooks WA, Santosham M, Naheed A, et al. Effect of weekly zinc supplements on incidence of pneumonia and diarrhoea in children younger than 2 years in an urban, low-income population in Bangladesh: randomised controlled trial. Lancet 2005; 366: 999–1004.
Kraemer K, Zimmermann MB, eds. Nutritional anemias (accessed May 30, 2007).
Rastogi R, Mathers CD. Global burden of iron deficiency anaemia in the year irondeficiencyanaemia.pdf (accessed May 17, 2007).
Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL. Global Burden of Disease and Risk Factors. New York: Oxford University Press, 2006.
United Nations Children’s Fund and World Health Organization. Low birthweight: Country, regional and global estimates. New York: UNICEF,