Dr GAURAV TANWAR

M.D PAEDIATRICS
DEPT OF PAEDIATRICS
NIMS JAIPUR
 Globally about 38% of babies are just
breastfed during their first 6 months of life.
 Malnutrition is responsible for 1/3 of death
and above 2/3 of death often associated
with inappropriate feeding practice.
 Unicef provided a statistical data, In
India(2012) about 40.5% mothers initiate
early breastfeeding and 46.4% babies are
breastfed during their 6 months of life.
 In infancy, no gift is more precious than
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."
 Breast milk contain all the nutrients in the
right proportion.
 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
 Prevents under five child
deaths
 Protects against infections
 Prevents allergies
 Better intelligence
 Promotes emotional
bonding
 Less heart disease, diabetes

and lymphoma
 Helps in involution of uterus.
 It promotes close physical and

emotional bondage with baby.

 Delays pregnancy

 Decreases mother’s workload, saves time

and energy
 Lowers risk of breast and ovarian cancer

 Helps reduce weight faster

 Contributes to child survival
 Saves money, time and energy.

 Promotes family planning

 Environment friendly
 Community expenditure on health care
contraception are reduced.
 Myoepithelial
cells
Epithelial cells

ducts

Lactiferous sinus

Nipple

Areola

Montgomery
gland
Alveoli
Supporting
tissue and fat
 Hormonal secretions in the mother
◦ Prolactin helps in production of milk
◦ Oxytocin causes ejection of milk
 Reflexes in the baby – rooting, sucking &
swallowing
 Enhancing factors Hindering
factors
Early initiation
of breastfeeds

Delay in initiation
Good attachment of breastfeeds,
& effective suckling Pre-lacteal feeds,
Bottle feeding,
Incorrect positioning,
Frequent feeds Painful breast
including night
feeds

Emptying
of breast
Prolactin in Sensory impulse
blood from nipple
 Oxytocin “milk ejection” reflex

Oxytocin contracts
myoepithelial cells

Sensory impulse from

nipple to brain

Baby sucking
 Stimulated by Inhibited by

•Thinks lovingly of baby •Worry

•Sound of the baby •Stress

•Sight of the baby •Pain

•Confidence •Doubt
Rooting reflex

Sucking reflex

Swallowing reflex
 Preparation must begins in the antenatal
period.
 In this period , breast examination and
identification of problems like retracted
nipple, should be done with necessary advice
for intervention.
 Educate about prevention of micronutrients
deficiency, proper rest, regular exercise and
hygienic measures.
 Mother should psychologically prepare to fed
her baby immediate after birth.
 Breastfeeding should initiated first
half an hours to one hours of birth
or as soon as possible.
 “Colostrum” the baby’s first
immunization.
 Mothers should demonstrated about
the techniques of breast feeding.
 Rooming-in or bedding-in should be
done with infant and mother
 In case of preterm babies, they
should fed with expressed breast
milk.
 COLOSTRUM- it is secreted during first 3 days after
[Link] contain more antibodies and high
protein.

 TRANSITIONAL MILK-it follow colostrum and

secretes during first two weeks in postnatal period.
It has increased sugar and fat content.

 MATURE MILK-it is secreted usually from10-12

days after delivery.
 PRETERM MILK- the breast milk secreted by
mothers who has deliver a preterm baby. This milk
contain protein, sodium, iron etc.

 FORE MILK- it is secreted at the starting of the

regular breastfeeding. It is more watery to satisfy
the baby’s thirst.

 HIND MILK-it is secreted towards the end of

regular breastfeeding and contain more fat and
energy.
 A willing and motivated mother
 An active and sucking newborn
 A motivator who can bring both mother and
newborn together (health professional or
relative)
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
 Key points of good attachment

1. Baby’s mouth is wide open

2. Baby’s chin touches the breast
3. Baby’s lower lip is curled outward
4. Usually the lower portion of the areola is
not visible
 Good attachment
lower lip is curled outward baby’s mouth is wide open

chin touches lower portion

the breast of the areola is
not visible
NF- Teaching Aids: ENC 26
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
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
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
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
Give appropriate treatment: Advise the mother to:
◦ Build mother’s ◦ Wash breasts only
confidence once a day; avoid
◦ Improve the baby’s using soap
attachment and ◦ Avoid medicated
continue breastfeeding lotions and ointments
◦ Reduce engorgement, ◦ Gently apply hind milk
feed frequently, express onto nipple and areola
breast milk after each feed
◦ Treat candida
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
 Engorged breasts =
Full breasts = NORMAL
ABNORMAL
 Full vs. engorged breasts

Full breasts: Engorged breasts:

◦ 36/72 hours after ◦ can occur at any time
birth. during breastfeeding
◦ Painful; oedematous
◦ Hot, heavy, may be ◦ Tight, especially nipple
hard area
◦ Milk flowing ◦ Shiny
◦ May look red
◦ Fever uncommon ◦ Milk NOT flowing
◦ Fever may occur
◦ May cause a decrease in
milk supply if it happens
often
 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
 Put baby to breast frequently
 Baby to be correctly attached to breast
 Build mother’s confidence
 Back massage and relaxation can help

Adequate weight gain and urine frequency 5-6 times

a day are reliable signs of enough milk intake
 Breastfeeding is considered adequate by
following -

◦ Audible swallowing sound during the feed.

◦ Let down sensation in mother’s breast.
◦ Breast is full before feed and softer afterward.
◦ Goes to sleep for 2-3 hours after each feed
◦ Passes urine 6-8 times in 24 hours
◦ Gains weight at 15-30 gram/kg/day
◦ Do not cry frequently.
Indications
◦ 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
 EXPRESSING
BREAST MILK

W a sh y ou r h a n ds w e ll w it h soa p a n d
w ater

Pla ce a cle a n con t a in e r be low y ou r b r e a st t o

colle ct m ilk

M a ssa g e t h e br e a st s g e n t ly
t ow a r d t h e n ip ple s

Pla ce y ou r t h u m b a n d in de x f in g e r opposit e e a ch ot h e r j u st
ou t side t h e da r k cir cle a r ou n d t h e n ipple

N ow pr e ss ba ck t ow a r d y ou r ch e st , t h e n ge n t ly sq u e e z e t o
r e le a se m ilk

Re pe a t st e p 5 a t dif f e r e n t p osit ion s a r ou n d t h e

a r e ola
Every facility providing maternity services and care
for newborn infants should

1. Have a written breastfeeding policy that is

routinely communicated to all health care staff
2. Train all health care staff in skills necessary to
implement this policy
3. Inform all pregnant women about the benefits
and management of breastfeeding
4. Help mothers initiate breastfeeding within
half hour of birth
5. Show mothers how to breastfeed, and how
to maintain lactation even if they are
separated from their infants
6. Give no food or drink, unless medically
indicated
7. Practice rooming-in : allow mothers and
infants to remain together 24 hrs a day
 Ten steps to successful breastfeeding
(cont.….)
8. Encourage breastfeeding on demand
9. Give no artificial teats or pacifiers (also
called dummies or soothers) to
breastfeeding infants
10. Foster the establishment of
breastfeeding support groups and refer
mothers to them on discharge from the
hospital.
 1. How many calories should a lactating
woman increase above her non-pregnant
baseline calorie consumption?
 500 calories
✓ Breastfeeding is desirable and achievable.
✓ Professional help and community support
are available.
✓ Breastfeeding should be comfortable.

✓ Breastfeeding promotes close physical and

emotional bondage with baby
✓ Exclusive breastfeeding is important.
✓ In infancy, no gift is more precious than
breastfeeding
THANK
YOU