This document discusses breastfeeding and breast milk. It provides information on the anatomy and physiology of lactation, the nutritional composition and benefits of breast milk, positions for breastfeeding, establishing and maintaining milk supply, and methods for increasing or decreasing milk production. The key points covered include that breast milk provides optimal nutrition for infants, its composition varies to meet baby's needs, and breastfeeding has benefits for both infant health and mother-child bonding.

1. C o m p l i m e n t a r y f e e d i n g
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4.  Breast milk usually refers to the milk produced
by a human female which is usually fed to
infants, toddlers, and young children by
breastfeeding.
 It provides the primary source of nutrition for
newborns before they are able to eat solid food
and digest a wider variety of food.
 Breast milk is fed to the infant by a variety of
methods: breastfeeding, baby bottle, cup and/or
spoon, supplementation drip system, and
nasogastric tube.
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5. ANATOMY OF BREAST
 Alveoli are the glandular tissue where milk is
produced and stored till it is released by baby’s
suckling.
 Milk travels from the alveoli, through milk ducts,
into the milk sinuses (reservoirs that lie under
the areola.)
 There are 15 – 20 milk ducts in each breast, and
milk flows from these through the openings in
the nipple.
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6. The areola is the darkened area around
the nipple.
It’s very important that babies latch on to
the areola, not just the nipple, because
that will mean that their mouth is
compressing the milk sinuses.
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7. CROSS SECTION OF ALVEOLI
ANATOMY OF BREAST
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8. PHYSIOLOGY OF LACTION
During pregnancy, the body increases its
production of a hormone called prolactin, which
stimulates the breast to make milk.
Suckling by the infant stimulates the release of
prolactin. The size of the breasts is not a factor
in milk production.
Oxytocin, another hormone, allows the breast
tissue to "let down" or release milk from the milk
ducts to the nipples (LET DOWN REFLEX).
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9. . This let-down takes place after the baby
has nursed for about 40 seconds
Some women feel a tingling, itching,
or warmth in their breasts when they
have “let-down” and the milk flow
increases.
Others only notice that baby’s
suckling slows down, and baby begins
to swallow rhythmically
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11. .
 They may also see milk in baby’s mouth.
In the early weeks, let-down may take
several minutes.
 Later on, it will take only a few seconds.
Milk let-down happens best when mothers
are relaxed, and feeling comfortable..
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12. BREAST HYGIENE::
o The breast should be kept clean.
o The nipples and areole should also
be care fully washed before &after each
feed with a gauge pad dipped in boiled
water or normal saline.
o It is advisable not to use alcohol or
glycerin.
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13. TYPES OF BREAST MILK :
 The composition of breast milk varies at
different stages of lactation to suite the
needs of the baby.
 Milk of a mother who has delivered a
preterm baby is different from milk of a
mother who has delivered a full term baby.
 Therefore, “THE MILK IS NOT ONLY SPECIES
SPECIFIC, IT IS BABY SPECIFIC”.
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14. a) COLOSTRUM:
 Is the milk secreted during the first 3
days after delivery.
 It is thick & yellow & contains more
antibodies and white blood cells.
 Though secreted in small quantities, it
has higher protein content & is most
suited for the needs of the baby.
 It should never be discarded.
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15. B)TRANSITIONAL MILK:
Is the milk secreted during the
following two weeks.
C)MATURE MILK:
Follows transitional milk.
It Is thinner & watery but contains all the
nutrients essential for optimal growth of
the baby.
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16. D) FORE MILK:
Is the milk secreted at the start of a feed.
It is rich in proteins, sugar, vitamins,
minerals & water.
E) HIND MILK:
Comes later towards the end of a feed and
is richer in fat content & provides more energy
and satiety.
For optimum growth, the body needs the
both fore & hind milk.
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17. D) PRE TERM MILK:
The milk of a mother who delivers pre
maturely contains more calories, higher
concentration of fat, protein & sodium which are
needed by her preterm baby.
The concentrations of lactose, calcium &
phosphorus, are lower as compared to milk
produced by mothers of term infants.
The composition of milk also varies
during the phase of feeding.
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18. Nutritional Needs of the Mother
Milk production requires about 800 calories a
day. The Recommended Dietary Allowances
for calories during breastfeeding is 500 more
calories a day than is required by a nonpregnant
woman.
Nutritional requirements do not change
significantly from pregnancy, with the exception
of decreases in folate and iron, and increases
in vitamin A, vitamin C, niacin, and zinc.
The diet can be the same as during pregnancy,
plus an additional glass of milk.
Women who are on medication should check
with their physicians, since most drugs are
absorbed in breast milk.
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19. NUTRITIONAL CONTENTS
NUTRIENT CONTENT/100ml
MACRONUTRIENTS:
Calories 67k cal
Proteins 1.1g
Fat 3.5g
Lactose 7.0g
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20. Micronutrients/minerals:
Sodium 0.9mEq
Potassium 1.4mEq
Calcium 35mg
Phosphorus 30-50µg
Zinc 120µg
Vitamins:
Vitamin A 60µg
Vitamin C 5.2mg
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21. Mature milk contains on average:
Energy (750 kcal / liter)
Lipids (38 g / liter) - The main lipids found
in human breast milk are the triacyl-
glycerols, phospholipids, and fatty acids
including essential fatty acids.
 Maternal diet does not affect the amount
of fat in milk but does affect the types of
fat.
Cholesterol is present in breast milk .
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22.  Casein (2.5 g / liter) - protein - Casein or
curds are proteins with low solubility
which complex with calcium.
 These are present in breast milk in
much lower concentration than in cow's
milk.
 Whey (6.4 g / liter) - protein - the whey
proteins are located in the clear liquid left
behind when clotted milk stands.
 The largest components are alpha-
lactalbumen, lactoferrin, lysozyme,
albumen and immunoglobulins.
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23.  Nonprotein Nitrogen is used in amino
acid synthesis and includes the nitrogen
in urea, creatine, creatinine, uric acid and
ammonia.
 Peptides, such as epidermal growth
factor, somatomedin - C and insulin are
also present in this fraction.
 Nucleotides such as cytidine
monophosphate are derived from nucleic
acids and play an important role in the
immune system and protein synthesis.
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24. Lactose (70 g / liter) carbohydrate -
Lactose is the major carbohydrate in
breast milk.
It is composed of galactose and glucose.
Lactose concentration in breast milk
increases over the duration of
breastfeeding.
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25. ANTI INFECTIVE AGENTS in human milk
1.Immunoglobulins:Secretory IgA, IgM, IgG.
2. Cellular elements: Lymphoid
cells,polymorphs,macrophages,plasma
cells.
3. Opsonic & chemo tactic actives of C3,C4
compliment system.
4. Unsaturated lacto ferrin& trans ferrin.
5. Lysozyme.
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26. 6.Lactoperoxidase.
7.Oligo saccharides.
8.Specific inhibitors: Anti viral,Anti-
stephylococcal factors.
9. Growth factors for lacto bacillus bifidus.
10.Para amino benzoic acid may afford
same protection against Malaria.
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27. Immunobiology of breast milk
Breast milk contains IgA ,IgM anti-bodies which are
not available to newborn baby because they do not
cross the placenta.
The highest concentration of surface or secretory
IgA in any body fluid are found in colostrum.
Sec IgA can also lyse certain bacteria .
Sec IgA binds M O & prevent their penetration in
to interstitial mucosa, respiratory tract.
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28. Non-specific humoral factors such as
lysozymes, oligosaccharides,lactoferrin,
lacto peridoxidase.
Oligosaccharides provide protection
against infection because of their
structural similarity with bacterial antigen
receptors.
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29. Macrophages makes up to 90% of white
cells,10% lymphocytes with equal
distribution of B and T-cells.
Macrophages offers primary line of
defense against many pathogens.
Human milk contains live cells to extent
1.2x 106 leucocytes/ml..
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30. lactoferrin the iron binding whey protein has an
inhibitarory effect on the growth of e.coli, which
is commonest pathogen for diarrhoeal episodes.
this way gastro-enteritis less common in breast
feed babies.
High concentration of para-amino benzoic acid
(PABA) in milk may protect the child getting
from malaria.
The bile salt stimulated lipase, kills giardia
lambia & entamoeba histolytica.
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31. Benefits of Breastfeeding
Human milk contains the right balance of
nutrients for human growth and development.
It is low in total protein and high in
carbohydrates, making it more digestible and
less stressful on the immature kidneys.
A significant benefit of human milk is that it
contains many immunologic agents that protect
the infant against bacteria, viruses, and
parasites.
Breastfeeding also provides many benefits for
the mother
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32. Benefits for Infant Benefits for Mother
• Perfect food for infant • Promotes faster shrinking of the
uterus
• Guarantees safe, fresh milk • Promotes less postpartum
bleeding
• Enhances immune system • Promotes faster return to pre-
pregnancy weight
• Protects against infectious and
noninfectious diseases
• Eliminates the need for preparing
and mixing formula
• Protects against food allergies
and intolerances
• Saves money not spent on
formula milk
• Decreases risk of diarrhea and
respiratory infections
• Decreases risk of breast and
ovarian cancer
• Promotes correct development of
jaw, teeth, and speech patterns
• Increases bonding with infant
• Decreases risk of childhood
obesity
• Enhances self-esteem in the
maternal role
• Increases cognitive function • Delays the menstrual cycle
• Increases bonding with mother
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33. POSITIONS OF BREAST FEEDING
Cradle position: Place
baby's head in the crook
of mothers arm. Support
baby's back and bottom
with arm and hand.
Baby will be lying
sideways facing mother.
breast should be right in
front of baby's face
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34. Football position: Tuck
baby under mothers arm like
a football with his or her
head resting on hand.
Support baby's body with
mothers forearm. This may
be a good position if
recovering from a cesarean
section.
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35.  Lying down position: In
this position lie on mothers
side with baby facing
mother. Mother can use
pillows to prop up head and
shoulders. This is also a
good position if mother
recovering from a cesarean
section or episiotomies
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36. PROPER LACT ON POSITION
Baby is facing mother, so that he does not have to turn
his head.
Baby has taken an inch or more of the areola in his
mouth (mom's nipple is actually at the roof of baby's
mouth).
Baby is pulled in so close that his chin and the tip of his
nose are touching the breast.
Baby's tongue is cupped beneath the mother's breast.
once baby is latched on, his lips are flanged out and
relaxed.
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38. SUPPLY AND DEMAND
The amount of milk mother make depends on
how often baby nurses and how effectively milk
is removed from breasts.
The more often baby suckles at breast, the
more stimulates the production of prolactin and
oxytocin, and the more milk will make.
To establish a good milk supply, it is important to
feed frequently: watch the baby for hunger cues
and feed on demand.
Also, let baby feed until full each time. There is
no need to limit feedings, or restrict the amount
of time spent feeding.
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39. .
 Mother notice that if she go three hours
between feedings, mother breasts may feel full
and hard. At the end of a feeding, mother
breasts may feel “emptied” and soft.
 Remember that always have milk available to
feed the baby. Mother don’t have to wait till
breasts are hard to feed baby… even if it’s only
been a short while since last feeding and
breasts feel soft, will produce plenty of milk to
feed baby as soon as put him to breast and
baby begins suckling.
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40. ADEQUACY OF BREAST FEEDING:
A satisfactory gain in weight.
A satisfaction evidenced by the baby, it
sleeps well & does not cry.
The type of stool.
The stool of the breast fed baby is bright
yellow in colour , soft & has a peculiar
aromatic odour.
The stains are difficult to remove.
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41. Breastfeeding women experience sore nipples
Sensitive skin and nipples
Incorrect latch on and positioning
to breast
Baby feeds too often
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42. METHODS OF INCREASING BREAST MILK
The importance of adequate fluid intake.
A glass of milk ,grape juice or other fluids intake
before each feed may help.
The breast should be emptied completely after
sucking, by gentle massage with the flat of hand
towards the nipple.
Alternate cleaning of breast with cold &hot
flannels of 4-5 min before feed.
A period of rest and relaxation before a feed
helps in the flow of milk.
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43. METHODS OF DRYING UP BREAST MILK
Normally breast milk diminishes gradually by
the time the baby 9 or 10 months old .
If any necessary to hasten this process, the
following methods may be use:
 a)Oestrogens,taken in a dose of 0.5 mg twice
daily.
 b) An injection of mixogen containing
testoteron.
 c)Drinking smaller quantities of water,
complete emptying of the breast after feeds, a
tight binder & taking Epsom salts for few days.
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44. Breastfed babies have:
fewer illnesses and hospitalizations
faster recovery when ill
fewer allergies
reduced chance of obesity
fewer tummy aches from overfeeding
less diaper rash or eczema
fewer ear infections
significantly higher IQ
reduced risk of childhood cancers such as
lymphoma and Hodgkin's Disease
less likely to develop Diabetes
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