breastfeeding ppt made for 2018

1. Dr Ebin Roshan Paul

2. Why this class ???
 Exclusive breastfeeding prevents 13 % of under-five
deaths.
 Early initiation of breastfeeding can cut down 22% of
all neonatal mortality.
 As per National Survey (NFHS-4, 2015-16) India •
 Only 41.6% children under age 3 years breastfed within
one hour of birth
 Only •54.9% children under age 6 months exclusively
breast fed

3. Part I – Preparation for BF
 When to start ? Antenatal period.
 Mother should be motivated and prepared.
 Last trimester – inspect breast, retracted nipples ,
cracked nipples.
 Especially anticipate in primi mother / previous h/o
diff in breastfeeding.
 300 Kcal and 15 gm of protein.
 Plenty of green leafy vegetables, fruits , fluids.

4.  Do “Nipple Protractility test” for inverted nipple by
obstetrician.
 Tell the corrective steps to mother.

5. Part II – Initiation of BF
 Within ½ hour Normal delivery.
 Within 4 hours LSCS.

6. Pre lacteal feeds ???
 Gold , Water , Honey , Herbs, Glucose.
 Always say “NO”.
 Why ? NO......
 1. diarrhoea incidence increases
 2. infections chance more
 3. soon after birth baby is vigour to suck “Biologically
Active” > reduced effort > failure of lactation.

7. Part III- Advantages of BF
 Countless advantages
 1. Baby benefits
 2. Maternal benefits
 3. Socioeconomic factors

8. Baby benefits
 Immunity – Colostrum , S Ig A.
 Bonding with mother.
 Nutrition.
 Physiological fluid.
 Protection from jaundice.
 Brain / Gut / Growth and Development.
 Prevent hypothermia.

9. Maternal benefits
 Bonding with baby
 Post partum bleed decrease
 Excess weight gain in preg loss
 Uterus involution
 Lactation amenorrhea
 Protection from breast cancer , ovarian cancer ,
colorectal cancer.

10. Socioeconomic factors
 Free of cost
 “ Anytime anywhere”
 Less of infection and hospital admission.
 No need for utensils and sterilisation.

11. First learn Anatomy
fat

12. Part IV – Composition and types of
Breast milk.
 Colostrum
 Transition milk
 Fore milk
 Hind milk

13. Colostrum
 “ first milk” from mammary glands.
 Very less amount in first few days.
 10-40 ml – that's only needed for baby.
 Rich in proteins and Immunoglobulins.
 Reassure mother always.

14. Milk on day 2 and day 7

15. Transition milk
 First 2 weeks of life.
 Increases in amount.
 Decreases proteins and Ig content.
 Increases fat and sugar content.
 Composition of milk changes periodically for each
baby specifically.
 This is absent in formula fed babies.

16. Formula milk for 3 days old babies is
no different than formula milk for 3
months old infants.

Breast milk is ingeniously
different every single day;
adapted to the changing
needs of the baby.

17. Fore milk and Hind milk
20 min feed to finish one breast ideally.
Foremilk – thirst.
Hind milk – nutrition and more milk
production.

19. Reflexes in breastfeeding
 3 reflexes helps
 1)Rooting reflex
 2)Sucking reflex
 3)Swallowing reflex
“ Sucking and swallowing coordinated by 34 weeks”
Sucking by baby induces 2 reflexes – Prolactin reflex
and Oxytocin reflex....

21. Prolactin Reflex
 “milk production reflex”

22. Oxytocin reflex
 “ let down reflex”

23. When to feed ? “Response Feeding”
 What is “response feeding” ?
 Helping mothers know when their baby is hungry.
 Not limiting breastfeeding times.

25. Rooming-In & Bedding-In &
Mothering-In
 Rooming In = same room.
 Bedding In = same bed.
 Mothering In = baby on maternal abdomen.
Baby
Decreases Stress
Allows to breast
feed when hungry
 Safer
Mother
Learn feeding cues
Better quality sleep
 Good milk supply

26. Part V – Techniques and positions

27. Ideal Latching

28. Components of Latching
 Chin close to breast.
 Tongue under lactiferous sinus.
 Nile against palate.
 Mouth wide open.
 Lower lip out.
 More areola above.
 No pain.
 Cheeks full.
 Regular slow deep sucks.

29. LATCH SCORE
L Latch
A
Audible
swallowi
ng
T
Type of
nipple
C
Comfort
H
Hold
TOTAL
L Latch
0 1 2
Too sleepy
No
sustained
latch or
suck
Repeated
attempts for
latch or suck
Hold nipple
in mouth
Grasps breast
Tongue down
Lips flanged
Rhythmical
sucking
29

30. LATCH SCORE
IAP &NNF Kerala
L Latch
A
Audible
swallowi
ng
T
Type of
nipple
C
Comfort
H
Hold
TOTAL
A Audible swallowing
0 1 2
None
A few with
stimulation
Spontaneous
and
intermittent (<24
hrs )
30

31. LATCH SCORE
IAP &NNF Kerala
L Latch
A
Audible
swallowi
ng
T
Type of
nipple
C
Comfort
H
Hold
TOTAL
T Type of nipple
0 1 2
Inverted Flat
Everted
(after
stimulation)
31

32. LATCH SCORE
IAP &NNF Kerala
L Latch
A
Audible
swallowi
ng
T
Type of
nipple
C
Comfort
H
Hold
TOTAL
C Comfort
0 1 2
Engorged
Cracked,
bleeding,
large blisters,
or
bruises
Filling
Reddened,
small
blisters or
bruises
Soft
Non-
tender
32

33. LATCH SCORE
IAP &NNF Kerala
L Latch
A
Audible
swallowi
ng
T
Type of
nipple
C
Comfort
H
Hold
TOTAL
H Hold
0 1 2
Full assist
(staff holds
infant
at breast)
Minimal assist
(staff holds,
then
mother takes
over)
No assist from
staff
Mother able to
position
and hold infant
33

34. What Differences Do You See?
ATTACHMENT, OUTSIDE
APPEARENCE
Picture 1 Picture 2

35. What Differences Do You See?
GOOD
ATTACHMENT
POOR
ATTACHMENT
Picture 1 Picture 2

36. Breastfeeding Positions
Cradle Hold
 This is the most common
position used by mothers.
 Infant’s head is
supported in the elbow,
the back and buttock is
supported by the arm
and lifted to the breast.

37. Football Hold Position
 The infant’s is placed under
the arm, like holding a
football
 Baby’s body is supported with
the forearm and the head is
supported with the hand.
 Many mothers are not
comfortable with this position
 Good position after operative
procedures
Breastfeeding Positions

38. Side Lying Position
 The mother lies on her side
propping up her head and shoulder
with pillows.
 The infant is also lying down
facing the mother.
 Good position after Caesarean
section.
 Allows the new mother some rest.
 Most mothers are scared
of crushing the baby.
Breastfeeding Positions

39. Cross Cradle Hold Position
 Ideal for early breastfeeding.
 Mother holds the baby crosswise in
the crook of the arm opposite the
breast the infant is to be fed.
 The baby's trunk and head are
supported with the forearm
and palm.
 The other hand is placed beneath
the breast in a U-shaped to guide
the baby's mouth to your breast.
Breastfeeding Positions

40. Australian Hold Position
 This is also called the
saddle hold
 Usually used for older
infants
 Not commonly used by
mothers.
 Best used in older infants
with runny nose, ear
infection.
Breastfeeding Positions

41. Common Feeding
Positions
IAP &NNF Kerala
Cradle
Position
Cross
Cradle
Foot
Ball
Side
lying
For
Twins41

42. Can You Identify the positions??

44. Identify all positions ???

45. Burping / Winding
 Babies take in lot of air while feeding.
 Leads to colics , abdomen distension , regurgitation.
 Burping is must.
 Don't get surprise if baby didn't burp always after
burping.

46. How to Burp
 Keep baby in left shoulder.
 Hold head with left hand.
 Support buttocks with right arm
 Gently tap on back with right hand.
 Keep a cloth / towel if child
spit out feed.

48. Various positions

49. Positioning after feed
 Right lateral position – prevent aspiration.
 Prone position – “NO” , increased chances of SIDS.
( Sudden Infant Death Syndrome).

50. Upto 4 hours Upto 24 hours Upto 3- 6 m
Expressed Breast Milk - Storage

51. Recommendations- IYCN/IYCF
 Exclusive breast feeding until 6
months of age
 Introduce complimentary foods
at 6 months with continued
breastfeeding.
 Optimum to breastfeed for 2
years.

52. Ten Steps to Successful
Breastfeeding- WHO
 1. Written breastfeeding policy that is routinely
communicated to all health-care staff.
 2. Train all health-care staff in the skills necessary to
implement this policy.
 3. Inform all pregnant women about the benefits and
management of breastfeeding.
 4. Help mothers initiate breastfeeding within a half-
hour of birth.
 5. Show mothers how to breastfeed and how to
maintain lactation, even if they are separated from
their infants.

53.  6. Give newborn infants no food or drink other than
breast milk, unless medically indicated.
 7. Practise “rooming-in” allow mothers and infants to
remain together – 24 hours a day.
 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 or clinic.

54. Bottles, Teats & Pacifiers

55. 55
Feeding Areas in public places

56. Part VII- Troubleshoots in BF
 Not enough milk
 Flat nipples / Retracted nipples / Inverted nipples
 Fullness /Engorgement of breast
 Cracked nipples
 Duct block
 Mastitis / abscess

57. Not enough MILK !!!!!!

59. How to check adequacy ???
 Urine output 8-10/day ?
 Pale coloured urine ?
 Baby weight gain ?
 Stool output 1-6 liquid stools /day ?
 Sleep after feed comfortably ?
 Night feeds present/not ?
 “Milk let down” present/not ?
 Good latching and sucking ?

60. Flat/Retracted/Inverted nipples

61. “Inverted syringe technique”

62. Name this technique ???
Two 20 ml syringe, IV set rubber
connector

63. “Double syringe technique”

64.  Cracked nipples
 Fullness and engorgement of breast
 Duct block
 Mastitis and abscess

65. Quiz time ?

66. Question 1
 Breastfeeding prevents you from getting pregnant ?
 1)True
 2)False

67. Question 2
 On average, how many milk openings does a nipple
have?
 1)1
 2)5-10
 3)Hundreds of minuscule openings

68. Question 3
 Breast feeding should be initiated with in how many
hours after normal delivery?

69. Question 4
 The protein of breast milk mostly contains which
albumins?

70. Question 5
 Breast milk is produced with the action of which
hormone?

71. Question 6
 Breast feeding mother having less risk of developing
which cancer?

72. Question 7
 Expressed breast milk can be stored at room
temperature for how many hours?

73. Question 8
 What is NetCode ?

74.  Network for Global Monitoring and Support for
Implementation of the International Code of
Marketing of Breast-milk Substitutes and
Subsequent relevant World Health Assembly
Resolutions

75. Question 9
 Identify dish ???

76.  Molozyvo – a traditional dish of Ukranian cuisine. It
is a sweet cheese made of cow colostrum.

77. Question 10
 Who is she ?

78. Question 11
 Who is a Wet Nurse ?

79.  A wet nurse is a woman who breastfeeds and cares
for another's child.

80. Question 12
 Which chemical caused the notorious “2008 Chinese
Milk scandal” affecting 3,00,000 babies and making
54,000 babies hospitalised ?

81.  Melamine

82. Question 13
 Identify the person

83.  Henry Nestle