Presentation for students teachers & lactation experts

1. Breast feed –Natural Healthy & Loving
Just get it Right
Dr.Mahesh Hiranandani
M.D(PGI)

2. “Feeding of breast milk to a
Child directly from
mouth to breast contact”
Breast feeding

3. Egyptian & Romans
* Women fed their own children.
* Royalty utilised wet nurses.
India
* Mothers fed only after 5th day.
Japan
* Breast fed with help of massage.
* Weaning as late as adolescence.
History of Breastfeeding

4. 1970’s
Universal breast feeding , Formulas unheard.
1980’s & 1990’s
Foren mem….. Angrezi doodh Trendy feeders…
21st century !!!!
Widespread education Internet revolution
Mirror imaging western mothers but but …..
Villian is within the house…..
Our times…………..

5. PERFECT FOOD FOR BABIES
• Just the right amount of nutrients in the right
proportions
• Over 200 components in human milk
• Composition of breast milk:
-Live cells, fat, carbohydrates, proteins,
vitamins, minerals
-Less fat than most other mammals
-More lactose than other mammals

6. BREAST MILK COMPOSITION
• Fat (4% concentration provides up to 50% of
caloric needs, cholesterol levels constant,
lipolytic enzymes aid in fat digestion)
• Carbohydrates (lactose = milk sugar
predominantly in human milk, 7%
concentration provides up to 40% caloric
needs, essential for development of CNS,
enhances calcium & iron absorption)

7. Colostrum Breast milk Cows milk
• Calories 58 70 65
• Protein 3.7gm 1.3gm 3.4gm
• Carbohy 5.3gm 7.4gm 4.8gm
• Fats 2.9gms 4.2gms 3.7gm
• Colostrum-> Thin , yellow , Low on fat & carbs.
• Breast milk -> White,thin,watery & sweet.
• Foremilk-> Watery, low fat & high carbs.
• Hindmilk-> Creamier, thick, high fat
Basic nutritional info on Breast milk

8. Other key constituents in Breast milk(100ml)
Iron 76mg
Calcium 35mg
Sodium 16mg
Cholesterol 16mg
DHA Unknown
Phosphorus 15mg
Vitamin C 3.8mg
Magnesium 2.8mg
Zinc,Iodine, Copper, Vitamin A D E K B-complex
Hormones Growth factors & Anti-infective factors

9. Nutrients & calories in Breast milk
Varies according to :
* How many days mother has been lactating.
* The time of the day.
* The mothers diet.
* Frequency between feeding.
* Antenatal priming of mother.

10. Nutrients in Breast milk
All this is panjiri ka asar

13. Many of the things we need today can wait
a child cannot,to Him we cannot answer Tomorrow
“ His name is Today ”

14. World Breastfeeding week 2007
Breastfeeding
1st Hour
save ONE Million
Babies

18. Irresistible baby charm
Nature makes them that way to
ensure the survival of the species

19. Animal babies
Adorable

20. Human babies
Human babies need a longer
time span to develop and be
socialized and it is therefore
important for them to be loved
by their mums and dads or
other adults around them.
Being so cute works in their
favour.

21. Beginning Breastfeeding within ONE hour
:Beginning life with “life”

22. Objectives
• To draw the world’s attention to save ONE
million babies with just ONE action, just ONE
hour support and just ONE message….
• To encourage establishing breastfeeding
within ONE hour as key indicator of health
progress by all communities locally and
globally.

23. Slide 4h

25. BREAST MILK COMPOSITION
• Carbohydrates (Bifidus factor = growth
factor present only in human milk
required for establishing an acidic
environment in the gut to inhibit growth
of bacteria, fungi and parasites)
• Protein
-Lactoferin => Isolates external iron
-Secretory IGA => Most important
immunoglobulin, breast milk = only source
for first 6 weeks

26. BENEFITS OF BREASTFEEDING
• Ecological:
-Saves resources
-Less waste
-No refrigeration
-No manufacturing
-No bottles, cans
-No trucking
-No handling

27. BENEFITS OF BREASTFEEDING
• For Society
-Smarter
-Healthier
-Less cost to healthcare system
-Stronger families

28. BENEFITS OF BREASTFEEDING
• To Families
-Less trips to
doctors, hospitals
-Less prescriptions
-Less stress
-Less illness
-More bonding
-Inexpensive

29. BENEFITS OF BREASTFEEDING
• Benefits to baby:
-Better dental health
-Increased visual acuity
-Decreased duration and
intensity of illnesses
-Less allergies
-Better health & less risk
of illnesses

30. BENEFITS OF BREASTFEEDING
• Benefits to mother:
-Psychological (Attachment, bonding, security, skin to skin, fulfillment of
basic needs, relationship)
-Easier weight loss
-Decreased risk of illness (breast cancer, osteoperosis, hemmorhage,
ovarian cancer)
-Birth control
-Pride, empowerment, fulfillment

31. BENEFITS OF BREASTFEEDING
• Benefits to baby:
-Better dental health
-Increased visual acuity
-Decreased duration and
intensity of illnesses
-Less allergies
-Better health & less risk
of illnesses

32. HARMFUL EFFECTS OF FORMULA
MILK

33. Why some mothers choose formula vs.
breast milk
• Distressed by physical discomfort of early breastfeeding
problems.
• Convenience issues
• Pressures of employment/school
• Worries that breast shape will change
• Formula manufacturers manipulate people through their ads
• Doctors and nurses need more lactation training
www.hasslefreeclipart.com/. ../baby_crying.gif

34. Why some mothers choose formula vs.
breast milk
• Moms given very little time to adjust to changes of postpartum
• Family demands
• Non-supportive family/health professionals
• Embarrassment
• Lack of confidence in self
• Feeling that one cannot produce enough milk
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35. Mother’s milk vs. formula milk
• 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.
store.enfamil.com/ media/pr_prosobee_lipil.jpg
breastfeeding.8k.com/ Resources/breastfeeding.jpeg

36. Mother’s milk vs. formula milk
• Human milk is designed to support
the development of large brains,
capable of processing and storing
lots of information.
• Cows milk is designed to support
functions, like constant grazing.
myxo.css.msu.edu/danimal/ quiz/cow_picture.png
www.babymall.com.au/ images/readingroomcartoon.gif

37. Illness Relative risk
• Allergies, eczema 2 to 7 times
• Urinary tract infections 2.6 to 5.5
times
• Inflammatory bowel disease 1.5
to 1.9 times
• Diabetes, type 1 2.4 times
• Gastroenteritis 3 times
• Hodgkin's lymphoma 1.8 to 6.7
times
• Otitis media 2.4 times
• Haemophilus influenzae
meningitis 3.8 times
• Necrotizing enterocolitis 6 to 10
times
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38. Illness Relative risk
• Pneumonia/lower
respiratory tract infection
1.7 to 5 times
• Respiratory syncytial virus
infection 3.9 times
• Sepsis 2.1 times
• Sudden infant death
syndrome 2.0 times
• Industrialized-world
hospitalization 3 times
www.mamashealth.com/ images/lungs1.gif

39. Barriers to Bonding
* A Bottle places a physical barrier
between mom and baby
*Less skin to skin contact
*Less eye contact
* The hormonal connection
between the breastfeeding
mother and baby cannot be
experienced by the bottle
feeding mother
www.photohome.com/.../ mom-and-baby-1a.jpg

40. THE END
There is no freedom of choice for humans
if it has been taken away from them
at the beginning.
Breast-feeding is not a choice,
but an obligation to the choice,
Give your child the freedom of choice.
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41. OBJECTIVE
• To increase awareness about breast feeding.
• To educate about the benefits of breast
feeding.
• To educate about the basics of breast feeding.
• To educate about the harms associated with
formula feeding.
• To advocate for breast feeding and empower
parents to make an informed choice.

42. Distribution of 10 million deaths in
under 5 children of all developing
countries

43. * Adequate nutrition determines newborn baby’s
Growth & development.
* Exclusive breast feeding prevents many adult
diseases in later life.
* 2/3rd of under five child deaths in the world are
due to inappropriate feeding practices and occur
during first year of life.
* Yes …. Only 1/3rd of worlds infants are optimally
fed.
Under 5 mortality

44. Breast feeding alone can save
up to 13% babies

45. “Exclusive breast feeding from birth to
Six months of age and there after
continued breast feeding for 2 years or
beyond with adequate , safe & age
appropriate additional foods and liquids
to meet the nutritional demands of a young
growing child.”
WHO 2002
Guidelines for feeding

46. It
rocks
man…

47. Rooting reflex
When something touches the baby’s
lips , baby opens the mouth & pushes
its tongue down & forward.
Sucking reflex
When something touches the palate
the baby starts sucking.
Swallowing Reflex
When the mouth fills with
milk, baby swallows.
Gag reflex
When something touches the anterior
tongue, baby pushes it out.
Skill
Mother learns to position the baby
baby learns to take breast.

48. Initiation of Breast feeding
* Initiate breast feed within the first hour.
* Baby needs mothers help initially to
take the breast into her mouth.
* Keeping the baby & mother together is vital.
* More suckling makes more milk.
* For sustained milk secretion it is essential
to breast feed frequently at short intervals.

49. Which mother will need extra support…..?
* Primiparas.
* Problem while BF Prev baby.
* LSCS
* Birth weight < 2.5 kg.
* Mother reporting painful
engorged/cracked breasts.
* Any baby sick & separated from
mother.

50. * If the baby is feeding less
than 8 times a day.
* Mother feeling the need
to give extra top ups .
* Mother reports pain or
difficulty.
* Child not gaining weight
adequately.
Which mother-baby unit needs your support…..?

51. Observe Breast feeding
Make her comfortable.
Ask her to put the child to breast
if the child is awake & ready to suck.
Watch the mother-baby pair for
* Interaction.
* Signs of attachment.
* Signs of effective sucking.
* Correct positioning.
* Any sign of discomfort.

52. Infant well attached
Chin touching the breast .
Yes……..
Mouth wide open…
Yes…….
Lower lip turned
outward..
Yes..
More areola visible above
than below..
Yes…

53. Infant not well attached
Chin touching the breast
No……
Mouth wide open……
Yes…
Lower lip turned outward…
Yes..
More areola visible above..
No…….
•

54. Correct latch on technique

55. Is my baby getting enough milk ??

56. Is baby getting enough milk…????
* Weight gain
Regain birth weight at 2 weeks, 200gm/week.
* Wet diapers
5-6 sopping wet diaper /day. Urine pale & smell.
* Dirty diapers
3-4 dirty diapers , stools yellow & watery.
Active alert baby who goes to sleep for 2-3hrs after
the feeds. Mothers breast soft after the feeds .

57. Breast babies & schedules
Breast milk Formula milk
Easily digestible Strains the digestion
Laxative effect Constipating effect
Poor sleep Sleeps longer
Rigid feeding schedule may be detrimental.
Breast milk is produced on a supply-demand basis
Frequent unrestricted feeds establishes good flow.
“Cluster feed” “Stack feed” “Bunch feed”
Babies suck when lonely , insecure or overwhelmed

58. Babys age Average weight gain
0 to 4 mths 600 to 1000gm/month
4 to 6 mths 400 to 600gm/month
6 to 12 mths 200 to 400gm/month
* An average breast fed baby doubles by 4 months.
* At one year most babies are 3 times birth wt.
Normal Growth of Breast fed babies

59. Growth Spurts
Period of frequent feeding & fussy behavior.
Coincides with spurt in growth & development.
Frequency : Every few weeks in the first year.
Less often in later years.
Duaration : Lasts only a few days to a week.
How to handle : Follow your child’s lead.
Baby will extract more & mother has to comply.
Message for mothers: Eat healthy & eat more.

60. Simple Do’s for better weight gain
* Sleep with your baby( Prolactin & Frequency ).
* Nurse often at least every 2 hrs.
* Allow to finish the milk on one side  Switch.
* Use breast massage to improve the quality ..
* Decrease solid foods in babies less 6 months.

61. Are breast fed babies likely to be obese ?
* Breast fed babies gain weight rapidly in Q1 .
* ??Large breast fed baby will be a large adult….
No ! in fact they slim down on being mobile .
* Fats laid during infancy pulls them through.
Unusual weight gain in breast feds
• Genetics : Are parents ,siblings & others as big.
• Over abundant supply .
• CHF, Renal or Endocrinal problems.

62. Low weight gain in Breast fed babies
Look at the growth Curve ….. Is it genuine ???..
* Poor Breast feeding Management
* Latching well * Supply adequate * Intake
* Nursing pattern * Switching sides * Quality
* Medical problems affecting weight gain
* Sick infant * Reflux * Anemia * Allergies
* UTI

63. How to improve the quality of breast milk
* Breast feed on demand.
* Don’t skip on dietary proteins.
* Limit saturated fats.
* Increase DHA intake. ( Fish /Supplements)
* Daily vitamin supplements.
* Let the baby take time at each breast.

64. Don’t worry…. We will look after the baby feeds!
Sisterji…. Do ghante baad test feed de dena !!!
Arree isnu dudh de do Raula pa rakhiya hai!!!
Maam mujhe bahut dard hai isko please feed de do…..
Doctor we would like to give just one bottle feed at
night….habit dalni hai…..
Scenario at a Maternity home

65. * A BF mother needs 550 extra calories.
* She needs to eat & drink almost every 2 hrly.
DIET
More Cereal, pulses & green veggies.
Seasonal fruit & other veggies.
Egg, meat & fish beneficial.
Milk ,curd, Paneer & butter milk.
Ghee Panjiri et al Not at all.
Gallons of water ???? Other healthy liquids..
Alcohol Caffeine Tobacco
Diet of Lactating mother

66. Role of Antenatal priming
• Much desired but sadly lacking.
Target
Primiparas
Those who faced problems
Time
Every possible visit… repeat…
Via Media
One to one/Group interaction
Pictures more than word
Examination of breast/nipples.

67. Treating feeding Problems
If the child is not feeding
properly
* Ask the mother to feed
more frequently
* > 8 times & to exclusively
breast feed at night.
“Baby has to learn to suck &
Mother to let the baby suckle.”

68. Feeding Problems
If not well attached or sucking effectively.
* Teach correct positioning & again look for
Signs of attachment & effective sucking.
* Look for oral thrush or signs of infection.
* Always check for nose block.

69. Breast & Nipple problems
Breast feeding should not hurt
If mothers reports pain or difficulty while feeding
Examine the breast & nipple
Look for
* Cracked or sore nipple.
* Retracted nipple.
* Engorged breasts

70. Not enough milk !!!! Causes
• Infrequent feeding.
• Mother restricting the length of feed.
• Poor positioning & attachment.
• Starting other supplements.
• Medications like OCP’s.
• Breast & nipple problems.

71. Breast feeding—The challenges
Personal comfort
Latch on pain should not last.
Cracked nipples seek help
Time & frequency of feeding
Mom in demand every 2-3 hrs.
Commitment & patience is the key.
Diet
Food sanyaas for a year.

72. If there is no breast milk at all..
1. Death of mother.
2. Baby being adopted.
3. Serious illness in mother.
HIV T.B Cancer Psychosis
4. Ingestion of drugs
Anticancer RA drugs Antipsychotics
5. As a supplement to BF in VLBW babies.
6. 9 to 9 corporate jobs.

73. Cows milk
* Perfect food ……….
* One of the four basic food groups.
* A child needs a liter of milk/day.
* Lactating mother must consume
at least 1-2 lit/day.
* Provides all essential nutrients
* Helps to build a stronger body.
* Your may be in jeopardy if you
do not drink milk.
Enough !! I just cant wait to bash this….
What is next best……

74. Cows milk is the perfect food for
baby calves
*Cross species feeding of milk
is a gross dietary error.
* Nourishment & immunity
provided is species specific.
* Diseases attributable to Cm
Diarrhea Allergies GI bleeds
URTI’s DM CHD Arthritis
Anemia Osteoporosis NHL
Harmful constituents
Proteins Fats Minerals Hormones
Pesticides Pollutants Drugs

75. Lets deflate the dairy……
* High milk consumption predisposes
to Osteoporosis.
* Excessive mucus created by dairy
produces RTI’s,constipation & fatigue
* Culprit in Infantile colic has been
nailed to be Cm.
* Fats in Cm are Atherogenic from D1.
* Iron def anemia is universal amongst
Cm consumers.
* Cows milk is the culprit in 60%
being evaluated for Food allergies.
Does the dairy deserve a coveted place in
the food pyramid ?????

76. “ Infant formula is a special food
manufactured to support the growth of
Infants under 6 months of age .”
Composition is based on mothers milk at
3 months of age.
Protein Purified cows milk whey & caesin
Fats Blend of vegetable oils
Carbo Lactose
Vitamins –Mineral mix
Infant milk formula

77. ??? Formula milk – Next only to
Breast milk
Breast milk
Formula milk
Pasteurized milk
Untreated milk
Nutritionally acceptable to Doctors
Modified & fortified to match BM
Nutritionally adequate & safe complimentary food

78. Boon for working mothers
Place of storage Temp Max time
In a room 25C 6-8 hrs
In refrigerator 4C 24 hrs
Freezer -15C 2 weeks
Deep freezer -20C 6-12 mths
Human milk banking is yet to come
Storage of Expressed breast milk

79. Breast feeding Practices in India
• Insight into traditional practices – Eye opener.
“Other culture”, “Alternative belief”
• TPNC based on common sense & scientific logic .
• Unacceptable in its current distorted form.
• Influences the Neonatal morbidity & mortality.
*Beneficial TPNC worth promoting
*Harmful practices worth discontinuing
*Innocuous practices that may be allowed

80. Prelacteal feeds
Origin
Honey/Ghee/Butter given by the eldermost .
Given with finger, coton wick or a spoon.
Support
Breast milk output presumed poor.
Colstrum considered dirty , harmful & heavy.
Known to improve strength & Logevity.
???? Role in IUGR & IDM.
Objection
Delays the initiation of breast feeding process.
Poor hygiene predisposes to infection.
Recommendations
Not required at all . Start breast feed as soon as possible.

81. Colostrum & Breast feeding
Origin
Colostrum is heavy & harmful hence discarded .
Mother unable to feed – Baby cant suck.
Delay the breast feed till ……..
Objections
Robs away proven nutritional & immunological benefits.
Delay in BF causes breast engorgement & lactation .
Recommendations
Colostrum is the first & the most effective Immunization.
Early sucking promotes good lactation.
Breast feeding should be initiated as soon as possible.

82. Lactogogues & Postpartum Diet restrictions
Origin
Ajwain Saunf Jeera Dry fruits Panjiri !!!!
Post partum diet restriction --2days to 2 months.
Support
Lactogogues are known to improve lactation.
Emotional & nutritional support.
Objection
Cant be substitute for normal diet.
A monentary load on the family……no body minds it

83. Institutional promotion of BF
1 Written breast feeding policy.
2 Train all health care staff.
3 Inform benefits & management of BF.
4 Initiate breast feeding within an hour.
5 Show mothers how to breast feed.
6 Offer newborn no other liquid .
7 Practise rooming in.
8 Give no teats or pacifiers.
9 Establish breast feeding support group.

86. Breast feed –Stay in shape

87. Don’t ever suggest
an alternative to BF

88. Lucky humans … just have to feed one at a time

89. A junkie baby in
the year 2050

90. Breast feeding is healthy
Thanks for your attention

91. Breast feeding the twins

94. Formula feeding –The Challenges
Organization & preparation
Enough formula Sterile water
Sterilized bottles Warming device
Lack of anti-infective factors
Antibodies Live lymphocytes
Expense
Can cost as much as
Possibility of colic & constipation
Cant match the complexity of breast milk

95. Doc! Is there any thing in my diet that
will improve quality of my breast milk
Moms diet does not affect the fat or calories .
Can alter the milk by changing the dietary fat.
Full breast = Lower fat & slower milk output.
Empty breast = Higher fat & faster milk output.
Volume of milk is the only growth determinant.

96. Breast feeding & IQ and Brain development
“Just do anything to make his brain sharp”
How does Breast feeding benefit the brain??
* Ideal ratio of Fats ,amino acids & other nutrients.
* Taurine : High in breast milk – Good for brain.
* DHA & ARA are essential components of brain
Plentiful in mothers feed .
* Cholestrol : Must for brain & nervous tissue.

97. Cows milk In Infant feeding
Milk builds strong bones
Prevents osteoporosis
Cows milk
High calcium ----Deficient in Mg & others
High phosphate & protein----Ca Unavailable

99. Growth of breast fed v/s formula babies
• Both grow at the same rate in first 4 months .
• 4-6 months formula fed lead the breast fed peers.
• 6-12 months breast fed babies become leaner.
• Water retention & different fat composition.
Variation in Normal pattern of Infant weight gain
Body habitus
Banana babies v/s Pear babies
Temprament
Mellow down v/s Motor driven

104. • Cows milk has pervaded every dietary item.
• Height of intrusion is its passage to baby through
mothers feed.
Harmful contents of bovine milk
Proteins Lactose Fats Hormones Pollutants Metals
But don’t we need this milk to build strong bones
No other animal suffers from Osteoporosis than man
Is Cows milk perfect food for human
babies ??

107. Breast milk composition

115. • 1800 AD
Women forced by law to nurse their children.
High mortality attributed to wet nursing ????
Breast milk  Curative & imparts wisdom.
• 1900 AD
Mothers milk viewed as the best.
“Unfit to have a child if not fit to nurse it”
Good diet, exercise & mental balance crucial.
18th & 19th century

116. • Babies breast fed within 1 hr of birth 24%
• Children 0-6months exclusively breast fed 46%
• Breast feeding beyond 6 months 57%
• Children aged 6-9 months receiving 57%
Solid or semisolid food & breast milk
• Children under 3 years who are underweight 46%
Facts & figures
Nutritional status of children

117. Breast feeding benefits
• Good for all body parts from Brain to diaper area.
• Brain: Higher IQ .
• Eyes : Higher visual acuity.
• Ears : Fewer ear infections.
• Mouth : Lower need for orthodontic Rx.
• Throat : Less likely to require tonsillectomy.
• Respiratory : Fewer URTI & LRTI.
• Heart : Lower cholestrol & lower risk of IHD.
• GIT : Less diarrhea , Ulcerative colitis & Crohns .

118. Immunity : Better response to vaccines
stronger immunity & reduced cancer risk.
• Endocrine : Reduced risk of diabetes .
• Kidneys : Low salt & protein Easy on kidneys .
• Joints/Muscles : JRA less common .
• Skin : Lower incidence of Atopic dermatitis.
• Growth : Leaner at 1 year & rarely obese .
• Bowels : Less constipation .

119. Breast milk the best milk…….
• Good for every body part : Brain to diaper area
• Breast milk is the best natural food for babies.
• Breast milk is always clean.
• Breast milk protects the babies from diseases.
• Breast milk builds brighter brains.
• Breast milk is available 24x7x365…..
• Breast milk builds beautiful bond with mother.
• Breast feed helps to space children.
• Breast milk beautifies the mothers from 8  ) (