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Breastfeeding and weaning

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Community medicine notes on Breastfeeding and weaning

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Breastfeeding and weaning

  1. 1. •Naulo Pokhrel •LMC, Palpa,Nepal
  2. 2.  Breastfeeding is the first fundamental right of child. It greatly improves the quality of life by providing unique nutritional, immunological , economic, ecological, psychological and child spacing benefits.  Breastfeeding also enhances maternal health.  Exclusive breastfeeding for first six months of life is the most effective child survival intervention in developing countries.  WHO and UNICEF launched the Baby-friendly Hospital Initiative (BFHI) in 1992 as a primary intervention strategy for promoting breast feeding and strengthening national health services.
  3. 3. EXCLUSIVE BREASTFEEDING  Only breast milk, no other food or drink even water PREDOMINANT BREAST FEEDING  Main source of nutrition is breastmilk but child is also receiving other fluids like water or water based drinks such as juices PARTIAL BREASTFEEDING  Giving a child non human formula or cereal based foods in addition to breast milk.
  4. 4. ADVANTAGESOF BREASTFEEDING BENEFITS TO BABY NUTRITIONAL SUPERIORITY :  It contains the right kind of proteins, fats, lactose, vitamins, Iron, minerals , water and enzymes in the amount necessary for the baby. It meets all the nutritional needs of the baby for the first six month.  Iron in breast milk is better absorbed thus protecting against iron deficiency anaemia .  Breast milk contain plenty of vit-a and c and can largely fulfill their needs even in the second year of life.
  5. 5. ADVANTAGE OF BREASTFEEDING Immunological superiority  Breast milk contains a no. of protective factors such as immunoglobin, mainly secretory IgA , macrophages , lymphocytes , lactoferrins, lysozymes and interferons.  Breastfed babies are less likely to develop infection.  A breast fed babies is 14 times less likely to die of diarrhoea and almost 4 times less likely of respiratory infections.
  6. 6.  Breast milk contain no of growth factors, enzymes, and hormones. It promotes growth and development of baby.  Breastfeeding enhances brain development and breastfed babies have been shown to have a higher intelligence quotient(IQ).  It is clean,free from pathogenic bacteria and has no chances of contamination.  It is easily digested and assimilated. Breastfed babies do not suffer from constipation.  It enhances the emotional bond between the child and the mother and provides warmth,love and affection to the baby.
  7. 7. ADVANTAGE OF BREASTFEEDING BENEFITS TO THE MOTHER  It reduces anaemia due to reduction in postpartum bleeding and reduced blood loss because of delayed menstruation.  It is convenient,needs no preparation and is readily available at the right temperature.  Ithelps the mother to regain her normal figure.  It promotes early uterine involution.  It has a protective effect against breast and ovarian cancers.  Breastfeeding helps in delaying another pregnancy.
  8. 8. ADVANTAGE OF BREASTFEEDING BENEFITS TO THE SOCIETY  Breastfeeding is economical and hardly costs the family anything extra.  Breastfeeding lowers healthcare costs to the society by reducing illness among children.  BF is eco-friendly and does not cause any environmental pollution.
  9. 9. Breastfeeding recommendations  Initiate BF immediately after birth.  The first feed should always be mother’s milk.  Give breast feed on demand.  Baby should exclusively be breast feed for six months.  Complementary feeding should begin in all babies at six months of age.  Continued BF along with complementary feeding should be done till at least 2 years of age.  Mothers and family should be motivated, educated and supported regarding healthy feeding practices for maintaining and sustaining healthy infant feeding practices.
  10. 10. Composition of breast milk Colostrum  Milk secreted during the initial 3-4 days after delivery, small in quantity,yellow and thick, contains large amount of antibodies and immune competent cells and vitamins A,D,E,K. Transitional milk  Milk secreted after 3-4 days until 2 weeks.  Immunoglobulin and protein content decreases while fat and sugar content increases. Mature milk  Follows transitional milk, thinner and watery but contains all the nutrients . Preterm milk  Milk delivered before 37 weeks, contains more proteins, sodium, iron, Immunoglobulins and calorie.
  11. 11. FOREMILK  Secreted at the start of feed  Is watery and rich in protein, sugars ,vitamins , minerals and water  Quenches baby’s thirst HINDMILK  Comes later towards the end  Rich in fat that provides more energy and a sense of satiety
  12. 12. Attachment Signs of good attachment-  Baby’s mouth is wide open  Most of the nipple and areola in the mouth, only upper areola is visible not the lower one.  The baby’s chin touches the breast  The baby’s lower lip is everted Effective suckling  Baby suckles slowly and pauses in between to swallow ( suck, suck, and swallow)  Baby’s cheek are full and not hollow or retracting during suckling.
  13. 13. Contraindications of breastfeeding  Infants with Special Dietary Requirements  Galactosemia  Phenylketonuria – may be partially breastfed  Maternal Infectious Disease  Cytomegalovirus – may or may not breastfeed depending on individual circumstances  Herpes – if active on breast, may use other breast if not affected  HIV – may or may not breastfeed depending on individual circumstances  Human T-Lymphotropic Virus type 1 or 2 infection  Tuberculosis – if not contagious or may resume feeding after two weeks of treatment  Maternal Drugs –  Chemotherapy agents – certain agents, discontinue breastfeeding for as long as they remain in the milk  Drugs of abuse – discontinue breastfeeding until drugs are out of maternal system  Primaquine and Quinine – contraindicated if either infant or mother has G6PD  Metronidazole – discontinue breastfeeding until at least 12-24 hours after medication  Sulfa drugs – may be a problem in infants with jaundice or G6PD, stressed or premature  Radioactive isotope – discontinue breastfeeding for as long as the radioactivity is in the milk
  14. 14. Weaning
  15. 15. weaning  Weaning is not sudden withdrawl of child from the breast. It is a gradual process of starting around the age of 6 months of age, because the mother’s milk alone is not sufficient to sustain the growth beyond 6 months.  It should be supplemented with other foods rich in proteins and other nutrients. Complementary foods- at one serving  mashed roti / bread/ biscuit mixed in sweetned undiluted milk or  Mashed roti/rice/bread mixed in thich dal with added ghee/oil or  Khir or any cereal porridge cooked in milk plus ADD cooked vegetables or mashed boiled or fried potatoes to these servings
  16. 16. Age Food Frequency Up to 6 months Only breast milk As often as child wants, days and night, at least 8 times in 24 hours 6 to 12 months Breast milk + one katori serving with snacks banana ,biscuit mango , papaya in between 3 times if breast feed , 5 times if not 12 mo to 2 yr Breastmilk on demand + 1 and ½ katori serving with snacks banana ,biscuit mango , papaya in between. 5 times a day 2 yrs and older Give family meals + snacks 3 meals each day + snacks twice

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