1. Feeding of healthy newborn babies

2. Learning objectives - 1 To list the benefits of breast feeding
Benefits to baby
Benefits to mother
To explain the physiology of lactation
Prolactin reflex
Oxytocin reflex
Teaching Aids: ENC
NF-

3. Exclusive breastfeeding
All healthy infants should be breastfed exclusively for the first six months of life
Exclusive breastfeeding is defined as "an infant's consumption of human milk with no supplementation of any type (no water, no juice, no nonhuman milk, and no foods) except for vitamins, minerals, and medications."
Teaching Aids: ENC
NF-

4. Benefits of breast milk to the baby
Breast milk and human colostrum are made for babies and is the best first food
Easily digested and well absorbed
Contains essential amino acids
Rich in essential fatty acids
Better bioavailability of iron and calcium
Teaching Aids: ENC
NF-

5. Benefits of breast milk (contd.)
Prevents under five child deaths
Protects against infections
Prevents allergies
Better intelligence
Promotes emotional bonding
Less heart disease, diabetes and lymphoma
Teaching Aids: ENC
NF-

6. Protection against infection
Mother infected
Antibody to mother’s infection secreted in milk to protect baby
WBC in mother’s body make antibodies to protect mother
Some WBCs go to breast and make antibodies there
Teaching Aids: ENC
NF-

7. Benefits to mother Helps in involution of uterus Delays pregnancy
Decreases mother’s workload, saves time and energy
Lowers risk of breast and ovarian cancer
Helps reduce weight faster
Teaching Aids: ENC
NF-

8. Benefits to family and society
Contributes to child survival
Saves money
Promotes family planning
Environment friendly
Teaching Aids: ENC
NF-

9. Anatomy of breast Myoepithelial cells Epithelial cells ducts
Lactiferous sinus
Areola
Montgomery gland
Alveoli
Supporting tissue and fat
Nipple
Teaching Aids: ENC
NF-

10. Physiology of lactation
Hormonal secretions in the mother
Prolactin helps in production of milk
Oxytocin causes ejection of milk
Reflexes in the baby – rooting, sucking & swallowing
Teaching Aids: ENC
NF-

11. Prolactin “milk secretion” reflex
Enhancing factors
Hindering factors
Early initiation
of breastfeeds
Delay in initiation
of breastfeeds,
Pre-lacteal feeds,
Bottle feeding,
Incorrect positioning,
Painful breast
Good attachment
& effective suckling
Frequent feeds
including night
feeds
Emptying
of breast
Sensory impulse from nipple
Prolactin in blood
Teaching Aids: ENC
NF-

12. Oxytocin “milk ejection” reflex
Oxytocin contracts myoepithelial cells
Sensory impulse from nipple to brain
Baby sucking
Teaching Aids: ENC
NF-

13. Oxytocin reflex Inhibited by Stimulated by Thinks lovingly of baby
Sound of the baby
Sight of the baby
CONFIDENCE
Worry
Stress
Pain
Doubt
Teaching Aids: ENC
NF-

14. Feeding reflexes in the baby
Rooting reflex
Sucking reflex
Swallowing reflex
Teaching Aids: ENC
NF-

15. Learning objectives - 2 Ensuring good start Overcoming difficulties
To be able to describe how breastfeeding works
To recognise good and poor attachment and positioning of a baby feeding at the breast
Overcoming difficulties
To help a mother breastfeed her newborn baby
Help a mother prevent common problems
Teaching Aids: ENC
NF-

16. For successful breastfeeding
A willing and motivated mother
An active and sucking newborn
A motivator who can bring both mother and newborn together (health professional or relative)
Teaching Aids: ENC
NF-

17. Key points of positioning
Mother:
Make the mother sit in a comfortable and convenient position (she can feed in lying down position)
Ensure that she is relaxed and comfortable
Baby:
Baby’s head and body are in a straight line
Baby’s whole body is supported
Baby’s face is opposite the nipple and the breast
Baby’s abdomen touches mother’s abdomen
Teaching Aids: ENC
NF-

18. Good positioning
Teaching Aids: ENC
NF-

19. Key points of good attachment
Baby’s mouth is wide open
Baby’s chin touches the breast
Baby’s lower lip is curled outward
Usually the lower portion of the areola is not visible
Teaching Aids: ENC
NF-

20. Good attachment lower lip is curled outward baby’s mouth is wide open
chin touches the breast
lower portion of the areola is not visible
Teaching Aids: ENC
NF-

21. Good and poor attachment
Teaching Aids: ENC
NF-

22. Effective suckling
For an infant who shows signs of good attachment, the next step would be to assess suckling:
If the infant takes several slow deep sucks followed by swallowing and then pauses, then he/she is sucking effectively
Teaching Aids: ENC
NF-

23. Problems in breastfeeding: Inverted nipple
Treatment should begin after birth
Manually stretch and roll the nipple between the thumb and finger several times a day
Teach the mother to grasp the breast tissue so that areola forms a teat, and allows the baby to feed
Syringe suction method
Teaching Aids: ENC
NF-

24. Inverted nipple: treatment by syringe method
Before feeds 5-8 times a day
STEP 1
Use 10 or 20cc syringe
Cut along this line with blade
STEP 2
Insert the plunger from cut end
STEP 3
Mother gently pulls the plunger
STEP 4
Press at the edge and allow air to enter before removing the syringe
Teaching Aids: ENC
NF-

25. Problems in breastfeeding: Sore nipple
Look for a cause:
Check the baby’s attachment at the breast
Check the baby’s position if attachment is poor
Examine the breasts – engorgement, fissures, candida
Ask if mother washes the
breasts after each feed (frequent washing leads to sore nipple)
If the problem persists, check the baby’s oral cavity for candida
Teaching Aids: ENC
NF-

26. Sore nipple: management
Give appropriate treatment:
Build mother’s confidence
Improve the baby’s attachment and continue breastfeeding
Reduce engorgement, feed frequently, express breast milk
Treat candida
Advise the mother to:
Wash breasts only once a day; avoid using soap
Avoid medicated lotions and ointments
Gently apply hind milk onto nipple and areola after each feed
Teaching Aids: ENC
NF-

27. Problems in breastfeeding: Breast engorgement
Causes
Delayed and infrequent breastfeeds
Incorrect latching of the baby
Treatment
Give analgesics to relieve pain
Apply warm packs locally
Gently express milk prior to feed
Put the baby frequently to the breast
Teaching Aids: ENC
NF-

28. Full vs. engorged breasts
Full breasts = NORMAL
Engorged breasts = ABNORMAL
Teaching Aids: ENC
NF-

29. Full vs. engorged breasts
Full breasts:
36/72 hours after birth.
Hot, heavy, may be hard
Milk flowing
Fever uncommon
Engorged breasts:
can occur at any time during breastfeeding
Painful; edematous
Tight, especially nipple area
Shiny
May look red
Milk NOT flowing
Fever may occur
May cause a decrease in milk supply if it happens often
Teaching Aids: ENC
NF-

30. “Not enough milk”: causes
Not breastfeeding often enough
Too short or hurried breastfeeding
Night feeds stopped early
Poor suckling position
Poor oxytocin reflex (anxiety, lack of confidence)
Engorgement or mastitis
Teaching Aids: ENC
NF-

31. “Not enough milk”: management
Put baby to breast frequently
Baby to be correctly attached to breast
Build mother’s confidence
Back massage and relaxation can help
Use galactogogues (metaclopropamide) judiciously
Adequate weight gain and urine frequency 5-6 times a day are reliable signs of enough milk intake
Teaching Aids: ENC
NF-

32. Adequacy of breastfeeding
Breastfeeding is considered adequate if the baby
Goes to sleep for 2-3 hrs after each feed
Passes urine 6-8 times in 24 hrs
Gains weight at gm/kg/day
Crosses birth weight by 2 weeks
Teaching Aids: ENC
NF-

33. Expressed breast milk Indications Storage
Sick mother, local breast problems
Preterm / sick baby
Working mother
Storage
Clean wide-mouthed container with tight lid
At room temperature: 6 hrs
Refrigerator: 24 hours; Freezer (20°C): for 3 months
Teaching Aids: ENC
NF-

34. Teaching Aids: ENC
NF-

35. Ten steps to successful breastfeeding
Every facility providing maternity services and care for newborn infants should
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
Teaching Aids: ENC
NF-

36. Ten steps to successful breastfeeding (contd….)
Help mothers initiate breastfeeding within half hour of birth
Show mothers how to breastfeed, and how to maintain lactation even if they are separated from their infants
Give no food or drink, unless medically indicated
Practice rooming-in : allow mothers and infants to remain together 24 hrs a day
Teaching Aids: ENC
NF-

37. Ten steps to successful breastfeeding (contd….)
Encourage breastfeeding on demand
Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants
Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital.
Teaching Aids: ENC
NF-