Breast feeding an important aspect of child growth and development.

2. MS..JAYA SHARMA
KGMU COLLEGE OF nursing

3.  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.

4.  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."

5.  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

6.  Prevents under five child
deaths
 Protects against infections
 Prevents allergies
 Better intelligence
 Promotes emotional
bonding
 Less heart disease, diabetes
and lymphoma

7.  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

8.  Contributes to child survival
 Saves money, time and energy.
 Promotes family planning
 Environment friendly
 Community expenditure on health care
contraception are reduced.

9. Myoepithelial
cells
Epithelial cells
ducts
Lactiferous sinus
Areola
Montgomery
gland
Alveoli
Supporting
tissue and fat
Nipple

10.  Hormonal secretions in the mother
◦ Prolactin helps in production of milk
◦ Oxytocin causes ejection of milk
 Reflexes in the baby – rooting, sucking &
swallowing

11. Enhancing factors Hindering
factors
Emptying
of breast
Good attachment
& effective suckling
Early initiation
of breastfeeds
Frequent feeds
including night
feeds
Delay in initiation
of breastfeeds,
Pre-lacteal feeds,
Bottle feeding,
Incorrect positioning,
Painful breast
Sensory impulse
from nipple
Prolactin in
blood

12. Baby sucking
Sensory impulse from
nipple to brain
Oxytocin contracts
myoepithelial cells
Oxytocin “milk ejection” reflex

13. •Thinks lovingly of baby
•Sound of the baby
•Sight of the baby
•Confidence
•Worry
•Stress
•Pain
•Doubt
Stimulated by Inhibited by

14. Rooting reflex
Swallowing reflex
Sucking reflex

15.  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.

16.  Educate about prevention of micronutrients
deficiency, proper rest, regular exercise and
hygienic measures.
 Mother should psychologically prepare to fed
her baby immediate after birth.

17.  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.

18.  COLOSTRUM- it is secreted during first 3 days after
delivery.it 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.

19.  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.

20.  A willing and motivated mother
 An active and sucking newborn
 A motivator who can bring both mother and
newborn together (health professional or
relative)

21. 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

23. 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
Key points of good attachment

24. Good attachment
baby’s mouth is wide open
lower lip is curled outward
lower portion
of the areola is
not visible
chin touches
the breast

26. Teaching Aids: ENC
NF- 26

29. 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

30. 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

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

32. 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

33. 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

34. 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

35. Full breasts = NORMAL
Engorged breasts =
ABNORMAL

36. 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; oedematous
◦ 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
Full vs. engorged breasts

37.  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

38.  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

39.  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.

40. 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

41. EXPRESSING
BREAST MILK
Place a clean container below your breast to
collect m ilk
Massage the breasts gently
tow ard the nipples
W ash your hands w ell w ith soap and
w ater
Now press back tow ard your chest, then gently squeeze to
release m ilk
Place your thum b and index finger opposite each other just
outside the dark circle around the nipple
Repeat step 5 at different positions around the
areola
EXPRESSING
BREAST MILK
Place a clean container below your breast to
collect m ilk
Place a clean container below your breast to
collect m ilk
Massage the breasts gently
tow ard the nipples
Massage the breasts gently
tow ard the nipples
W ash your hands w ell w ith soap and
w ater
W ash your hands w ell w ith soap and
w ater
W ash your hands w ell w ith soap and
w ater
Now press back tow ard your chest, then gently squeeze to
release m ilk
Now press back tow ard your chest, then gently squeeze to
release m ilk
Now press back tow ard your chest, then gently squeeze to
release m ilk
Place your thum b and index finger opposite each other just
outside the dark circle around the nipple
Place your thum b and index finger opposite each other just
outside the dark circle around the nipple
Repeat step 5 at different positions around the
areola
Repeat step 5 at different positions around the
areola

42. 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

43. 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

44. 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.
Ten steps to successful breastfeeding
(cont.….)

45.  1. How many calories should a lactating
woman increase above her non-pregnant
baseline calorie consumption?

46.  500 calories

48.  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

49.  1. Parul Dutta ,Pediatric Nursing ,Jaypee Brothers,
Medical Publishers Pvt.Limited ,Third Edition ,2014.
 2. Rimple Sharma ,Essential Pediatric Nursing ,Second
Edition , 2017.
 3.Piyush Gupta ,Essential Pediatric Nursing Fourth
Edition ,2019.
 4.Ghai ,Essential Pediatrics ,Ninth Edition 2019.
Teaching Aids: ENC
NF- 49

50. THANK
YOU