Exclusive breastfeeding means babies are given only breast milk and nothing else for the first 6 months. Breast milk provides optimal nutrition for growth and immunity. The WHO recommends initiating breastfeeding within the first hour of birth and exclusive breastfeeding for the first 6 months. Weaning is the gradual introduction of complementary foods between 5-6 months while continuing breastfeeding. Appropriate weaning foods are introduced one at a time and increase in amount and complexity as the baby ages.
2. STATISTICS OF EXCLUSIVE BREAST FEEDING
• According to WHO statistics globally 3 in 5 not breastfeed in the first hour of life
• WHO says 820000 children could be saved yearly if all children were optimally
breastfed
• Only 41% of infants 0 – 6 months of age are exclusively breastfed.
3.
4. INTRODUCTION
According to the WHO& AAP breastfeeding is the normal way of providing
young infants with the nutrients that they need for healthy growth and development.
Breastfeeding helps against a number of infections, prevent allergies, and protect
against a number of chronic conditions.
5. BREAST FEEDING
DEFINITION
Breastfeeding is the feeding of an infant or young child with
breast milk directly from female human breast (i.e ,via lactation) not
from a baby bottle or other container
-WHO
6. EXCLUSIVE BREAST FEEDING
Exclusive breast feeding means babies are given only breast milk
and nothing other than breast milk such as cow’s milk, food, drinks and
not even water.
During the first 6 month exclusive breast feeding is followed.
7. Meaning of Breastfeeding
• B- Best for baby
• R- Reduces incidence of
allergies
• E- Economical - no waste
• A- Antibodies greater
immunity against infections
• S- Stool inoffensive - never
constipated
• T- Temperature always correct
and constant
• F- Fresh milk - never goes sour
in the breast
• E- Emotional bonding
• E- Easy once established
• D- Digested easily within two
to three hours
• I- Immediately available
• N- Nutritionally balanced
• G- Gastroenteritis greatly
reduced
8. HORMONES IN BREASTFEEDING
• PROLACTIN – helps in milk production ( Anterior pituitary)
• OXYTOCIN - helps in ejection. ( Posterior pituitary)
9. EXPRESSION OF LATCH
• L= lacth on
• A= audible swallowing
• T= type of nipple
• C= comfort
• H= hold positioning
10. PHYSIOLOGY OF LACTATION
Milk producing reflex
When the baby cries
The sensory nerve ending in breast is stimulated
The impulse is carried to hypothalamus by
vagus nerve
In hypothalamus, anterior pituitary release
prolactin into the blood
Prolactin in blood , acts on milk producing cells
in breast.
Thus , milk produced.
“ the more the baby sucks, the more the milk is
secreated”
11. PHYSIOLOGY OF LACTATION
• Mammogenesis (preparation of breasts): In this, basically there is
growth of ductal system and lobulo-alveolar system.
• Lactogenesis (synthesis and secretion from breast alveoli): Actual
milk secretion starts on the 3rd or 4th postpartum day. The breasts
become engorged, tense, tender and feel warm. Secretory activity is
enhanced by Prolactin.
• It is also enhanced directly by growth hormone thyroxine,
glucocorticoids and insulin. During pregnancy, the level of prolactin is
high but there is no lactation because of steroids, estrogen and
progesterone. These hormones makes the breast tissue unresponsive to
prolactin.
12. • Galactokinesis (ejection of milk): Ejection of milk depends upon:
• Sucking of baby
• Contractile mechanism which expresses the milk from the alveoli
into the ducts.
• Galactopoiesis (maintenance of lactation):
• Prolactin appears to be the most important galactopoietic hormone.
• For maintenance of effective and continuous lactation, sucking is
essential. It helps to remove milk from the glands, and also causes
release of prolactin.
17. • 1. Colostrum:
• Colostrum is the fluid secreted by the breasts in the last few weeks of
pregnancy
• It secretes during first 3 to 4 days after delivery until lactation begins.
• It is a deep yellow serous fluid
• It is alkaline in reaction.
• It has high specific gravity.
• It contains vitamins A, D, E, K, white blood cells and antibodies
(IgA). The immunoglobulin coats the lining of the babies immature
intestines helping to prevent pathogens from invading the baby's
system.
• It has low carbohydrates, fat and potassium
18. 2.Transitional milk:
• Transitional milk is lower protein breast milk.
• It replaces the colostrum.
• It is secreted about 3 to 6 days after delivery,
• Breast milk increases in quantity and changes in appearance and composition.4.
3. Mature milk:
• After two weeks, mature milk is secreted.
• It is thin and watery in texture.
• It is high in fat content and lactose.
• It is high in linoleic acid and cholesterol content.
• It is good for brain development.
19. 4. Fore milk:
• Fore milk is secreted at the start of a feed.
• It is watery, rich in protein, sugar, vitamins, minerals and water.
• It helps to satisfy baby's thirst.
5. Hind milk:
• It comes later towards the end of a feed.
• It is richer in fat content.
• It provides more energy and satisfy baby's hunger.
• For optional growth baby needs fore and hind
• milk.
21. COMPOSITION
MACRO NUTIRIENT
high quality of milk and lower concentration of fat & protein but
higher concentration of lactose.
PROTIEN
- mature milk 0.9 – 1.2 g/dl
- more abondent protein are casein, a – lactoalbumin, lactoferrin, IGA ,
lysozyme and serum albumin.
22. FAT
• term mature milk – 3.2 – 3.6 gm/dl
• High concentration of palmitic and oleic acid
• Fatty acid profile varies in relation to maternal diet
23. CARBOHYDRATE
• Predominant sugar lactose 6.7 – 7.8 mg/dl
• Oligo saccrides 1gm/ dl bioactive factors
MICRONUTRIENTS
• vary depending on maternal diet and body stores including vit A, B1,
B6, B12, and iodine
• vit K and vit D is low quantity in human milk.
24. Composition of different stages of human milk & cow’s milk
Colostrum Transitional Mature Cows milk
Energy, kcal 58 74 71 69
Total solids, g 12.8 13.6 12.4 12.7
Fat, g 2.9 3.6 3.8 3.7
Lactose, g 5.3 6.6 7.0 4.8
Protien, g 2.7 1.6 1.2 3.3
Caesin , g 1.2 0.7 0.4 2.8
Calcium 31 34 33 125
Magnesium, mg 4 4 4 12
Potassium, mg 74 64 55 138
Sodium, mg 48 29 15 58
Iron , mg 0.09 0.04 0.15 0.10
26. • B. Advantages for Mother
• 1. Lactation suppresses ovulation in mothers who give exclusive breast
feeding to their infants and serves as a natural contraceptive.
• 2. Breastfeeding lowers the risk of ovarian and breast cancer.
• 3. Breastfeeding is convenient for the mother as she is not required to
clean the bottle and prepare milk whenever she feeds the baby.
• 4. Breastfeeding the baby helps mother lose extra weight that she had
put during pregnancy.
• 5. Breastfeeding promotes involution of uterus, thus brings back the
mother in shape after delivery.
27. INITIATION OF BREASTFEEDING
WHO recommendations regarding initiation of
breastfeeding are
• Early and uninterrupted skin-to-skin contact
between mothers and infants should be facilitated
and encouraged as soon as possible after birth.
• All mothers should be supported to initiate
breastfeeding as soon as possible after birth or
within the first hour after delivery.
• Mother should receive practical support to enable
them to initiate and establish
28. TECHNIQUES
POSITION OF MOTHER AND BABY
• The baby should be properly positioned to achieve effective latching.
• The mother should wear comfortable apparel, with the breast well exposed for
the infant to be able to latch.
• The infant’s mouth, chin and umbilicus should be lined up with the head in a
neutral position.
• The infant is brought to the breast, with the nose touching or close to the breast.
29. • The gum line should overlap the areola, and the nipple straight back into
the mouth.
• The tongue moves forward beyond the lower gum, cupped and forming a
reservoir.
• Milk is removed for the lactiferous sinuses, the jaw moves down creating
a negative pressure gradient that helped transfer milk to the pharynx.
34. RESULT OF BAD ATTACHMENT
• Painful nipples
• Damaged nipples
• Engorgement
• Baby unsatisfied and cries a lot
• Baby feeds frequently and for a long time
• Decreased milk production
• Baby fails to gain weight
35. PATTERNS OF BREAST FEEDING
FRIST FEED: normal delivery – ½ hour
caeserian – 1 hour
Demand feed : whenever baby cries
Duration of feeding : one breast completely than the other
Interval : 6 – 8 times a day
36. BURPING
Burp the baby after feeding at each breast and at the
end of the feeding
When burping the baby, remember to apply some
gentle but firm pressure on the abdomen.
Helpful positions to burp include:
1. Propped up with baby's tummy against the shoulder.
2. Lying tummy-down across the lap.
3. Sitting up, leaning over with the supportive hand
under baby's arm.
37. CONTRA INDICATION FOR BREAST
FEEDING
For infants
• The baby is diagnosed with galactosemia, or other inborn errors of
metabolism
• Gross prematurity of baby or other conditions in which the newborn
cannot suckle.
38. For mothers
• Mothers Infected with the human immunodeficiency virus (HIV)
• human T-cell lymphotropic virus Herpetic lesions localized to the breast
• Untreated active pulmonary tuberculosis
• If taking prescribed cancer chemotherapy agents, such as antimetabolites
• Mothers addicted to alcohol or heavy doses of some drugs.
• Psychosis
• Local condition like breast abscess, cracked nipples
39. BARRIERS TO EFFECTIVE BREAST
FEEDING
• Lack of confidence in mother.
• Belief that breast milk is not sufficient.
• Lack of adequate support system.
• History of previous breast surgery.
• Breast engorgement, cracked and sore nipples.
• Retractile nipples.
Infrequent suckling/failure to empty breast
• Embarrassment by mother
Premature infants
• Chronic illness in mother; psychosis, Cancer.
40. SORE NIPPLE
Causes
• Improper latching
• Frequent washing with soap & water
• Pulling of while sucking
Treatment
• Proper positioning & latching
• Local hygiene
• Expose to air, application of breast milk or lanolin, use nipple shield
41. Breast engorgement
Cause
• Delayed or infrequent feeding
• Improper latching 7 positioning
• Engorge breast, swollen, hard, warm & painfull
Treatment
• Milk expressed to soften breast
• Breast massage, warm compresses
• analgesics
42. INVERTED NIPPLE
• Make difficult in attachment
• Improper suckling may cause
sore and excoriated nipple
Treatment
• Manual eversion
• Plastic syringe
• Nipple shield
46. STORAGE OF BREAST MILK
• Human milk can be stored at room temperature
for 6-8 hours.
• Expressed milk can be stored in an insulated
cooler bag with ice packs for 24hours.
• Breast milk can be stored in the refrigerator for
about 5 days at about 40°F.
• It can also be kept in a freezer compartment of a
fridge for up to 2 weeks at 0-5°F.
• It can be stored in a deep freezer for about 3-12
months.
47. PRESENT STATE OF BREAST FEEDING
PATTERN
• The government of India has always been promoting at national and
International for an exclusive breastfeeding for the first 6 month and
introduction of complementary for after 6 month and then after with
continued with the Indian tradition of prolonged breastfeeding and
introduction of complementary foods from 6 month of age through
ceremony
• India now has one of the strongest legislation to protect from
commercial influence.
49. WEANING
Meaning of weaning
Weaning means- to free from a habit
Process of gradual and progressive transfer of the baby from the
breastfeeding to the usual family diet
Weaning does not mean discontinuity of breast feeding. Weaning foods are
given in addition of breast feed when the amount of breastfeeding is
inadequate.
50. DEFINITION
• Weaning is defined as ‘the systematic process of introduction of
suitable food at the right time in addition to mother’s milk in order to
provide needed nutrients to the baby’
- (UNICEF, 1984).
51. Qualities of complementary foods
1.Liquid at
starting then
semisolid
and solid
2.Clean
and Fresh
4. Hygenic
3.Easily
digestible
52. 5.Easy to
prepare
6. High in
energy
7. Based on
cultural
practice and
traditional
beliefs
8.Well
balanced
53. Principles of introduction of weaning food
1. Weaning foods should provide extra requirement as per need of the
baby
2. Initially small amount should be given then increase gradually in
course of a week
3.New food to be placed over the tongue of the baby to get the taste of
food and to feel the consistency.
4. A single weaning food is added at a time.
5. Weaning should be started between 5 to 6 months of age but
breastfeeding to be continued up to 2 years of age.
54. 6. Additional food can be given in the day time. Initially it can be given
once, then twice or thrice.
7. New foods should be given when the infant is hungry, but never
force the child to take the feeds.
8. Delayed weaning result in malnutrition and growth failure.
9. Observe the problems related to weaning process. The infant may
have:- - indigestion - pain in abdomen - weaning diarrhea - skin rashes -
psychological upset
55. Preparing and storing the weaning foods
1.Hands-carefully washed with soap and water before preparing food
2.Utensils – washed and scrubed thoroughly
3. Clean cooking place and chopping board
4.Foods should be-
-Fresh for weaning
-prepared immediately
-cooked and boiled well
-mashed with clean pestle, fork or spoon
-use clean water for washing and making weaning food
-not store for more then 2 hours
56. WEANING FOOD ACCORDING TO AGE
AGE FOOD ITEM AMOUNT FREQUENCY
AT 5 – 6 MONTH initiated with fruit juice 1-2 teaspoon at fruit 4-6 times a day
AT 6-7 MONTH • soft mixture of rice
and dal
• khichei,pulses
• mashed and boiled
potatoes
• bread as roti socked
in metlc
• mashed fruits like
banana mango
• egg yolk
• cured or khir
• enjoy bite of biscurt
• then 3-4 teaspoon
• increased gradually
4-6 times a day
57. 9-12 month • more variety of
household food can
be added
• can eat everything
cooked at home
• spices and
condiments
• no need to mash
food but shoulb be
soft
• 5-6 teaspoon
increased gradually
4-5 times a day
12-18 month • all food cooked in
family
• breastfeed to be
continued especially
at night
• according to child
need
4-5 tomes or according
the child needs
58. PROBLEMS DURING WEANING
• If on starting weaning, breast feeding is stopped suddenly, it
can have adverse psychological effect on the child.
• Weaning food, if prepared unhygienically or not digested
properly can cause diarrhoea.
• If weaning food are not nutrient rich, the child can develop
malnutrition.
• Children may develop indigestion, abdominal pain, diarrhea
or rashes if they are allergic to certain foods.
60. INTRODUCTION
BFHI is a global movement, spearheaded by WHO and UNICEF that aims to
give every baby the best start in life by creating a health care environment where
breastfeeding is the norm. Maternity wards and hospitals applying the principles in
the joint statement are being designated baby friendly to call public attention to
their support for sound environment.
61. GOALS
1. To transform hospitals and maternity facilities through
implementation of the “ten steps”.
2. To end the practice of distribution of free and low - cost supplies of
breast milk substitutes to maternity wards and hospitals.
62. 10 STEPS FOR SUCESSFUL
BREASTFEEDING
• Critical management procedures
• 1a. Comply fully with the International Code of Marketing of Breast-milk
Substitutes and relevant World Health Assembly resolutions.
• 1b. Have a written infant feeding policy that is routinely communicated to staff
and parents.
• 1c. Establish ongoing monitoring and data-management systems.
• 2. Ensure that staff have sufficient knowledge, competence and skills to support
breastfeeding.
63. key clinical practices
• 3. Discuss the importance and management of breastfeeding with pregnant women
and their families.
• 4. Facilitate immediate and uninterrupted skin-to-skin contact and support mothers
to initiate breastfeeding as soon as possible after birth.
• 5. Support mothers to initiate and maintain breastfeeding and manage common
difficulties.
• 6. Do not provide breastfed newborns any food or fluids other than breast milk,
unless medically indicated.
• 7. Enable mothers and their infants to remain together and to practise rooming-in
24 hours a day.
• 8. Support mothers to recognize and respond to their infants’ cues for feeding.
• 9. Counsel mothers on the use and risks of feeding bottles, teats and pacifiers.
• 10. Coordinate discharge so that parents and their infants have timely access to
ongoing support and care.
65. MALNUTITION AND CHILD
According to WHO and UNICEF estimates 60% of
child death are malnutrition associated
• Asia has the largest number of malnourished
children
• India account for 40% of malnourished in the
world
• UNICEF estimates that malnutrition affects
physical mental function of 2 billion children
“1 in 3 malnourished children lives in india”
66. INTRODUCTION
Nutrition is the science that interprets the interaction of nutrients
and other substances in food in relation to maintenance , growth ,
reproduction , health and illness of an organism .A poor diet may have
an injurious impact on health causing deficiency diseases
DEFINITION
• Nutrition is defined as the process of providing or obtaining the food
necessary for health and growth
_ OXFORD DICTIONARY
67. NUTRIENTS
Nutrients are of two types :
MACRONUTRIENTS , which are needed in larger amounts ( CHO ,
Fats , protein and water).
MICRONUTRIENTS , which are needed in smaller amounts (
minerals and vitamins )
68. NUTRIENT & ITS PRIMARY FUNCTION
NUTRIENT PRIMARY FUNCTIONS
water Dissolves and carry nutrient, remove, waste and regulates body
temperature
Protien Builds new tissue, antibodies, enzyme hormones and other
components
CHO Provides energy
Fat Provides long term energy, insulation and protection
Vitamins Facilitate use of other nutrition involved in regulating growth
and manufacturing hormones
Minerals Helps in growth of bone & teeth aid in muscle function and
nervous system activity
69. Well balance diet
• The well balanced diet is achieved by eating variety of food. There is
no single food with correct amount of all external nutrients.
• The basic composition of balanced diet is highly variable as it differ
from country to country depending on the availability of food
70. Importance of well balanced diet
• Body’s organ and tissue need proper nutrient to work
effectively.
• Without good nutrition, body is more prone to
disease, infections, fatigue and poor performance
• It helps in growth and development
• Children with poor diet run the risk of growth and
development but eating habits can continue for the
result of their lives
71. Improper Diet May Result
In:
• Failure to flourish
• Poor growth
• Poor development
• Poor physical and mental
health
• Infection disease
• Even death
over diet may result in:
• Weight gain
• Insulin resistance
• Diabeties
• Heart condition
• And even death
72. DEFICIENCY OF NUTRIENTS AND
DEVELOPMENT:
NUTRIENT DIFICIENCY MANIFESTATION
PROTIEN KWASHIORKAR MARASMUS
IODINE GOITRE
IRON ANEMIA
CALCIUM BONE AND TOOTH DECAY
VITAMIN A LOSS OF VISION
VITAMIN B1 BERIBERI
VITAMIN C SURVEY (EMPAIRED INFLAMMATORY
VESPONSE)
VITAMIN D RICKETS
ZINC c
SELENCIUM IMPAIRED ANTIBODY PRODUCTION
DHA SHORTMEMORY SPAN, POOR ABILITY FOR
DISRIMINATION
73. CONCLUSION:
Adequate knowledge, attitude and features application of
nutrition and requirements must be basis of infant feeding. the health
and nutritional status of an infant and subsequent growth and
development through childhood depends upon successful feeding
pediatrics. Nutritional counselling is the important responsibility of the
nurse to promote the nutritional status the children and to prevent
nutritional deficiency disease.
74. JOURNAL ABSTRACT
KNOWLEDGE EFFECT ON POSTNATAL MOTHERS REGARDING BFHI.
Breastfeeding is the “Gold standard” for infant feeding. There are several areas of
biological superiority of breastfeeding and breast milk over artificial (formula) milk. The
present study aims to assess knowledge effect on postnatal mothers regarding baby
friendly hospital initiative. A one group pretest posttest research design was conducted
among 60 postnatal mothers. Convenient sampling technique was used to select samples.
Structured knowledge questionnaire was used to assess the effectiveness of information
booklet regarding BFHI among postnatal mothers. The present study attempted to
evaluate the effectiveness of information booklet on BFHI among postnatal mothers of
SMCH and found that 6(10%) had adequate, 9(15%) had moderate adequate knowledge
and also 45(75%) had inadequate knowledge in pretest and 42(70%) had adequate,
12(20%) had moderate adequate knowledge and 6(10%) had inadequate knowledge in
posttest and concluded that there was a significant improvement after administration of
information booklet. Thus, information booklet was effective in improving the
knowledge on Baby Friendly Hospital initiative among postnatal mothers.
75. • BREASTFEEDING PRACTICE & NEWBORN CARE IN RURAL AREA
Breastfeeding practices play an important role in reducing child mortality and morbidity. This
study was aimed to describe the breastfeeding practices prevalent in rural areas. Objectives: The
primary objective of this study was to describe the breastfeeding and newborn care practices in rural
areas and the secondary objective was to describe the factors affecting the initiation and duration of
breastfeeding. Settings and Design: The study was conducted in primary health care center (PHC) that
is attached to a medical college in Kengeri, rural Bangalore, Karnataka. Materials and
Methods: Mothers with children who were 9 months old who came to the PHC for measles vaccination
were included in the study and data was collected using the pre-tested questionnaire on breastfeeding
and newborn practices. Results: Our study shows 97% of the mothers initiated breastfeeding, 19%
used pre lacteal feeds, 90% had hospital deliveries and 10% had home deliveries, and 50% used a
house knife to cut the umbilical cord among home deliveries. Conclusions: This study emphasizes the
need for breastfeeding intervention programs especially for the mother during antenatal and postnatal
check-ups and practices like discarding the colostrum and early/late weaning are still widely prevalent
and need to be addressed.
76. BIBLIOGRAPHY
The short textbook of pediatric by suraj gupta, 13th edition, jaype publication pvt
ltd,pg no 22 – 48
Pediatric clinical method by meharben singh, CBS publication & distribution pvt
ltd, pg no 544 - 576
Pediatric nursing by parul dUtta; 3rd edition; jaypee brother medical publishers
pvt ltd; pg no 229-232.
Wongs essential of paediatric nursing 8th edition by marilyn J. hocken berry,
david Wilson
Child health nursing 2 nd edition by Padmaja, jaypee publisher pvt lid.
