Breastfeeding

1. BREAST & BOTTLE
FEEDING OF INFANT
Lecture for 2-d year
students
Gostishcheva E.V.

2. Plan of the lecture:
 BREAST FEEDING of 1-st year life children.
 The advantages of breast feeding.
 Medical and psychological benefits of breast feeding
for mother’s and baby’s health.
 The composition and properties of breast milk.
 It’s immune and biological factors.
 Contraindications to breast feeding
 Classification and characteristics of milk formulas for
mixed and bottle feeding.
 Feed ups and additional feeding in breast & bottle
feeding.

3. Terminology
 Breastfeeding is a type of feeding when the main source
of nutrition for a baby in the first year of life is mother's
milk.
 WHO recommends exclusive breastfeeding starting within
one hour after birth until a baby is 6 months old. Nutritious
complementary foods should then be added while
continuing to breastfeed for up to 2 years or beyond.

4. Breast milk contains everything the baby needs for the
first six months of life, in all the right proportions. Its
composition even changes according to the baby's
changing needs, especially during the first month of life.
 Breast milk helps to lower the risk of or protect against:
1. Diabetes
 2. Gastroenteritis
 3. Diarrhoea
 4. Asthma
 5. Allergies
 6. Urinary tract infection
 7. Chest infection and wheezing
 8. Ear infection
 9. Obesity

5. The program on promotion, protection
and support of breast-feeding by WHO and
UNISEF (Ten steps to successful breast-feeding)
 l1. Have a written breast-feeding policy that is
routinely communicated to all health care staff.
 2.Train all care staff in skills necessary to implement
this policy.
 3. Inform all pregnant women about the benefits and
management of breast-feeding.
 4.Help mothers initiate breast-feeding within a half-
hour of birth.
 5. Show mothers how to breast-feeding, and how to
maintain lactation even if they should be separated
from their infants.

6. The program on promotion, protection
and support of breast-feeding by WHO and
UNISEF (Ten steps to successful breast-feeding)
 6. Give newborn infants no food or drink other than breast
milk, unless medically indicated.
 7. Practice rooming-in. Allow mothers and infants to remain
together 24 hours a day.
 8. Encourage breast-feeding on demand.
 9. Give no artificial teats or pacifiers (also called dummies
or soothers) to breast-feeding infants.
 10. Foster the establishment of breast-feeding support
groups and refer mothers to them on discharge from the
hospital.

7. TYPES OF BREAST MILK PRODUCED
There are three types of breast milk depending on the
term after delivery.
 During the last weeks of pregnancy and the first
few days after delivery the colostrum is
excreated from the breast.
 Then from 6 to 15 days the transitional milk is
produced;
 and from the 15th day after delivery the mature
milk is generated.

8. TYPES OF BREAST MILK PRODUCED
Colostrum Transitional Mature
When
produced
1-5-6 days postpartum 6-15 days
postpartum
From the 15th
onward
Color Yellowish,
transparent
More milky but still
watery looking
Skim milk
appearance
Composition
/per 100 ml
More protein
(7-5 g )
Less carbohydrate
(4-5g )
Less fat
(2,0g )
High protein
(2,5g )
More carbohydr
(5,5-6,6 g )
More fat
(3,2 g )
Lower protein
(0,9-1,8g )
More carbohydr.
(7-7,5g )
More fat
(3,3-3,9g)
Energy
kcal/100 ml
150 60-80 65-70

9. Breast milk composition
 During the first days after birth, the breasts produce a thick
and yellowish fluid called colostrum. It's high in protein, low
in sugar and loaded with beneficial compounds.
 Colostrum is the ideal first milk and helps the newborn's
immature digestive tract develop.
 The colostrum contains higher amounts of white blood cells and
antibodies than mature milk, and is especially high in immunoglobulin A
(IgA), which coats the lining of babies' immature intestines, helping to
prevent germs from invading baby's system. Secretory IgA also works to
help prevent food allergies. After a baby has been nursing for 5-6 days,
the colostrum in the breast slowly begins the process of changing into
mature breast milk over the next two weeks.

10. Feeding a child during the first year with
milk from the mother’s breast is called
natural or breast-feeding.
 Breast milk is the perfect food for a newborn.
 It is the best gift a mother can give her baby.
 The composition of human milk is ideal for most
infants.
 Breast-feeding has been encouraged mainly for its
psychologic advantages, economy, and asepsis.
 It contains all the nutrients for normal growth and
development of a baby from the time of birth to
the first four to six months of life.

11. breast-feeding.


12. Protein. Quantity (0,9-1,3 g100ml). The ratio of albumin,
globulin and casein in breast milk is 80:20, and in cow's
milk the opposite is, therefore, a looser clot is formed when
milk is curdled in the stomach, easier digestion and
absorption, faster evacuation from the stomach.
a-lactalbumin predominates, which is absorbed
unchanged, which makes it easier for their absorption
and digestion.
The content of amino acids is less than in cow's milk, but
they are in an optimal ratio. The taurine content is
higher than in cow. Taurine stimulates the growth and
differentiation of the retina, nervous tissue, adrenal
glands, pineal gland, pituitary gland, stimulates
phagocytic activity of neutrophils, antioxidant,
membrane stabilizing effect. Participates in the
conjugation of bile acids

13. Fats. Quantity (3,9-4,5 g100ml). The main components
are triglycerides, phospholipids, fatty acids. The content of
polyunsaturated fatty acids (PUFA) reaches 50% - ω3
and ω6
Higher phospholipid content/
Linoleic acid regulates the vascular permeability
Galactosides and cerebrosides are involved in the
myelination of nerve fibers.
Higher activity of the lipase enzyme than in cow's milk/
In some women, the concentration of fat in milk at the
end of the feed is 4-5 times higher than at the
beginning.

14. Carbohydrates. Quantity (6,8-7,2 g100ml).
Carbohydrates in breast milk are represented
by ß-lactose (90%) - bifidus factor - is slowly
broken down in the large intestine, part of it is
hydrolyzed into glucose and galactose reaches
the large intestine.
HMO - human milk oligosaccharides -
carbohydrates, with prebiotic properties, which
are necessary for the nutrition of bifidobacteria
and lactobacilli.

15. HMO - human milk oligosaccharides enhance the
barrier function of the intestines, providing a protective
effect on the mucous membranes, protecting them
from the attacks of possible viruses and bacteria. Due
to the fact that there are different types of
oligosaccharides, they are able to "catch" different
bacteria. The microbe does not attach to a cell of the
body, but to HMO, and cannot cause disease.
Breast milk oligosaccharides help the proper
development of immunity by interacting with cells
involved in the formation of the immune defense of the
child's body. They train and develop the baby's
immune system, protecting against diseases, and in
case of their occurrence, help the body to fight them
on its own.

16. Breast milk contains 15 minerals, their content is 3.5
times lower than in cow's milk.
Na is 4 times less than in cow. - Low osmolarity and,
consequently, a decrease in the load on the excretory
system of the newborn and in the future, the
prevention of hypertension in adolescents.
Mineral substances are in proportions that are
optimal for the absorption and mineralization of
bone tissue. - The ratio of Ca and P is 2: 1, in this
connection, the coefficient of absorption of Ca is
50-70%.
The higher content of trace elements: copper, zinc.
Iron is characterized by greater digestibility, due
to the presence of the protein lactoferrin.

17. Fat-soluble vitamins A, E, D are presented in
sufficient quantities. - They serve as
membrane stabilizers, vit. D regulates the
absorption of calcium and phosphorus.
Less water-soluble B vitamins,
Vit C 5 times more.
Carnitine is present. - Prevents cholestasis
and jaundice.
The contents of hormones, enzymes and
retinol, α-tocopherol.

18. IMMUNOBIOLOGICAL FACTORS OF MOTHER’S MILK.
1) High content of Ig A (the most in colostrum).
2) There’s a high content of lactoferrin.
3) There’s enzyme – lactoperoxydase destroys
streptococcus, enterococcus, Escherichia coli.
4) The human milk contains antistaphylococcal
factor, which suppresses enzyme systems of
staphylococcus.
5) High concentration of bifidus factor in human milk
(40-100 times bigger than in cow’s milk).

19. IMMUNOBIOLOGICAL FACTORS OF MOTHER’S MILK.
6) The role of cellular factor in forming the
antibacterial immunity is of great importance:
 B- lymphocytes synthesize immunoglobulins;
 T- lymphocytes implement the cellular immunity;
 Macrophages produce complement, lisozyme,
lactoferrine.
7) Para-amino-benzoic acid (PABA) provides
protection against malaria.
8) BF protects against neonatal hypocalcemia and
tetany, deficiencies of minerals (Fe, I, Zn, P) and
celiac diseases.

20. Breast milk composition.
Breast Milk Contains Important Antibodies
Breast milk is loaded with antibodies that help baby fight
off viruses and bacteria.
This particularly applies to colostrum, the first milk.
Colostrum provides high amounts of immunoglobulin A
(IgA), as well as several other antibodies.
When the mother is exposed to viruses or bacteria, she
starts producing antibodies.
These antibodies are then secreted into the breast milk
and passed to the baby during feeding.
IgA protects the baby from getting sick by forming a
protective layer in the baby's nose, throat and digestive
system.

21. Breast milk composition.
Breast Milk Contains Important Antibodies
 For this reason, breastfeeding mothers with the flu may
actually provide their babies with antibodies that help them
fight the pathogen that is causing the sickness.
 Nonetheless, if mothers ill, she should always practice strict
hygiene. (wash hands often and try to avoid infecting baby).
 Formula doesn't provide antibody protection for babies.
Numerous studies show that babies who are not breastfed
are more vulnerable to health issues like pneumonia,
diarrhea and infection.

22. The advantages of breast feeding [BF]
 The earlier begins of Bf is the better for mother’s
and baby’s health.
 Sucking makes mother’s organism product
oxytocin. It makes the womb contract and so
prevents uterus bleeding after delivery.
 Besides lactation sets up earlier and for a longer
period and hardening of mammary glands is less
painful.
 Lactation suppresses ovulation, and serves as an
effective contraceptive.

23. The advantages of breast feeding
(continuation)
 BF promotes close physical and emotional
bonds between the mother and the baby.
 Sucking reflex settles faster and normal
intestinal microflora formed if a child is BF soon
after the birth.
 There is lower risk of infection of child.
 The sterility and adequate temperature of Breast
milk.
 Physiological adaptation of Breast milk to the
need of her baby.
 BF protects from allergy of newborn.

24. There are also many health benefits for mothers
because breastfeeding does the following:
 Burns more calories and helps to get back to
prepregnancy weight quicker.
 Reduces the risk of ovarial cancer and, breast
cancer in premenopausal women.
 Builds bone strength to protect against bone
fractures in older age.
 Helps the uterus to return to its regular size
more quickly.

25. Medical benefits of breast feeding
for mother’s and baby’s health.
 Delays the return of menstrual period, which
may help to extend the time between
pregnancies. (Keep in mind that breastfeeding
alone will not prevent pregnancy.)
 Adults who were BF turned out to have better
sexual potency and fertility.
 BF prevents the development of
atherosclerosis and hypertension when a child
reaches middle or elderly age.

26. Psychological benefits of breastfeeding
 BF may have psychological benefits for the infant
as well, creating an early attachment between
mother and child.
 Tender mother`s look, her kind voice and words,
her smells, touch of her hands contribute to
correct behavioral feelings in baby.
 Numerous investigations in this field show that
breastfed infants usually are more kind and more
humane in future.
 BF becomes more than a way to feed a baby; it's
a source of warmth and comfort.

27. There are several reasons why a mother
may not breastfeed her baby:
 1. Medical or other health reasons may prevent a mother
from breastfeeding.
 2. The baby with special requirements may not tolerate
breast milk.
 3. Some social or psychological reasons can make it more
difficult to breastfeed exclusively.

28. Medical contraindications to breast-feeding
connected with mother
 1. Decompensated chronic diseases like blood circulation
insufficiency, kidney or liver problems, respiratory insufficiency
of III grade, HIV-infection, etc.
 2. Psychical disorders as epilepsy, schizophrenia, depressive
phychosis, postpartum psychosis.
 3. Taking certain medications
 4. Substanceabuse (drugs, alcohol, marijuana, cocaine, heroin, ets)

29. Relative contraindications to breast feeding:
 active forms of mother’s tuberculosis (the child is isolated
from birth till1,5-2months and fed with processed milk)
 syphilis if infected after 6th-7th month of pregnancy and the
newborn is symptom free
 epidemic typhus and relapsing fever – stop breast feeding
in rough cases, in light – continuing is possible provided
that disinfection
 typhoid fever paratyphoid and dysentery: rough cases –
temporally stop, light – feed with processed and boiled milk
 purulent mastitis

30. Other reasons why a mother may not
breastfeed her baby:
 Working outside the home makes it more difficult to
breastfeed exclusively, especially if there is no support at
her workplace for her to either bring her baby or to express
and store her milk.
 Choosing not to breastfeed for personal reasons, either from
the birth of the baby or after breastfeeding for a short while,
is a mother's prerogative.

31. How to assess effectiveness of breastfeeding?
Signs of a Well-Fed Newborn
At least 8 breastfeeds every 24 hours (10-12 in newborns)
Obviously swallowing during the feeds
Seems happily satisfied after the feeds
No merconium faeces by Day-5.
No constipation.
Adequate diuresis: Six (6) to eight (8) wet cloth diapers in 24
hours.
Baby should regain his weight birth by the second week. Gain
at least 110-200 g per week after the fourth day of life.
Thereafter gaining 100g-200g per week, 600-800 g per first
month.
The average breastfed baby doubles birth weight in 5-6 months.

32. Signs of an Underfed Baby
Continues to lose weight after day-5
Below birth weight at day-14
Gaining less than 500-600g per first month.
Less than six wet nappies daily – oliguria
Urine that is yellow and strong smelling
Infrequent dry, hard, green stools or constipation
Worried-looking face
Unusually lethargic and sleepy
Weak cry

49. Products of weanings and feeding
correction
6 month 7 month 8 month 9 month 10-12 month
Juice, ml
(fruit, berry, vegetable)
30-50 50-70 50-70 80 100
Fruit puree, ml 40-50 50-70 50-70 80 90-100
Vegetable puree, gr 50-100 150 170 180 200
Milk and barley porridge,
gr
100-150 150 180 200
Milky cereal porridge, gr 150 180 200
Sour-milk products, ml 50-100 100-150 150-200
Cottage cheese, gr with 5-25 10-30 30 30 50
Yolk with 1/8-1/4 ¼-1/2 1/2 ½-1
Meat puree, gr with 5-30 30 50 50 50-60
Fish puree, gr 10-20 30-50 50-60
Oil, a teaspoon 1/2 1/2 1 1 1
Butter, a teaspoon 1/2 1/2 1 1 1
White bread, gr with 5 5 10

53. METHODS OF COUNTING THE DAILY
VOLUME OF FEEDING
First 10 days of life a necessary amount of food
 Zaitseva's formula:
 V = 2% of body weight at birth × n,
 n - day of life.

54. calorie method
 For 1 kg of weight, the child should receive:
 from birth to 6 months, 115 kcal / kg / day,
 from 6 to 12 months - 110 kcal / kg / day
 Meaning that 1 liter of breast milk contains
approx. 700 Kcal, count the necessary feeding
volume:
 V = A*B*1000
 700
 (A-Kcal/kg, B-weight in kg)

55. Volume method Gabner-Cherni
age and weight is taken into consideration:
 2weeks-1.5 month -1/5 weight
 1.5month-4months - 1/6 weight
 4-6 months - 1/7 weight
 older than 6 months - 1/8 weight
 (or MAX=1000ml/24hrs)

56. Child’s necessity of nutrients
Proteins, g/kg| day
the 1st-3rd month 2,2
the 4th-6th month 2,6
the 7th-12th month 2,9
Lipids, g/kg|day
the 1st-3rd month 6,5
the 4th-6th month 6,0
the 7th-12th month 5,5
Carbohydrates, g/kg|day
the 1st-12th months 13

57. Feeding frequency regime:
from birth -2 months – 7 times (3hrs
brake)
2-4 months – 6 times (3,5 hrs brake)
5-12 months – 5 times (4 hrs brake)
The 1st feeding – 6.00 a.m.

58. An example of making a menu for a child at 4 months.
with a birth weight of 3 kg
1.calculate body weight
3kg + 4x0.8rg= 6.2 kg
2.calculate the daily volume by two methods
1|7 x 6,2kg= 0.9kg- 900ml
A (115Kcal)xB (6,2 kg) x1000ml : 700Kcal= 1000ml
3. Find a one-time volume
950ml : 6 (times)=160 ml
4. Making the menu

59. Sample menu for a 4 month old baby weight 6.200kg
1. 6.00 - 160 ml- breast milk
2. 9.30 - 160 ml – BM
3. 13.00 – 160 ml – BM
4. 16.30 – 160 ml – BM
5. 20.00 – 160 ml BM
6. 23.30 – 160 ml BM

60. Sample menu for a 6 month old baby weight 7.00kg
1. 6.00 - 200 ml- breast milk
2. 10.00 – 200 gr– VP
3. 14.00 – 200 ml – BM
4. 18.00 – 200 ml – BM
5. 22.00 – 200 ml - BM

61. Thanks for attention