Assistant Professor Community Medicine Nishtar Medical College Multan Pakistan

1. My choice

4. World Breastfeeding Week
(1 – 7 August)
Breastfeeding -
The foundation to
Sustainable Development

18. ADVANTAGES OF MOTHERS MILK
Ideal Constituents
Immune Factors
Growth Promoting Factors
Enzymes
Hormones
Cytokines

19. Types and Composition of Human Breast Milk
• Types of Breast Milk:
• Colostrum or Early Milk
• Transitional Milk
• Mature Milk
• Colostrum or Early Milk: is produced in the late stage of
pregnancy till 4 days after delivery; and is rich in antibodies.
• Transitional Milk: produced from day 4 – 10 is lower in
protein in comparison to Colostrum.
• Mature milk: is produced from approximately ten days after
delivery up until the termination of the breastfeeding.
Kind
(In 100 ml)
Protein
(g)
Fat
(g)
Carbohydrate
(g)
Calorie
(Kcal)
Colostrum 7.5 2 4-5 150
Transitive 2.5 3.2 5.5 – 6.6 60-80
Mature 1.1-1.5 3.5-4.5 7 65-70

20. Nutrients in Human & Animal Milk
What are the differences between these milks?

21. Differences in the Quality of the
Proteins in Different Milks

22. Differences in the Fats of Different Milks
HUMAN COW`S
Contains
Essential Fatty Acids,
Enzyme Lipase
Contains
No Essential Fatty Acids
No Enzyme Lipase

23. Vitamins in Different Milks

24. Iron in Milk

25. Mother’s Milk
Composition Unmatched

26. 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

27. 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

28. 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

30. Newborn’s Choice

32. Breast Feeding decreases
Pneumonia Deaths

33. Breast Feeding decreases
Diarrhoea episodes

34. Breast Feeding decreases
Neonatal Jaundice

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

37. Breastfeeding
Mother Health Benefits
• Breastfeeding could also prevent the death of
20,000 women a year from breast cancer.
• Breastfeeding could also improve birth
spacing.
• Breastfeeding is associated with a reduction a
woman’s risk of diabetes.
• Breastfeeding might reduce rates of ovarian
cancer.

38. Breast feed –Stay in shape

41. • Scaling up breastfeeding could save the lives of more
than 820,000 children under age 5.
• Breastfeeding is associated with an IQ increase of 3
to 4 points.
• Children who are breastfed for longer periods have
lower infectious morbidity and mortality rates than
children who are breastfed for shorter periods or
who are not breastfed.
• Longer periods of breastfeeding are associated with
a reduction in a child’s risk of overweight or obesity.
Breastfeeding
Infant Health Benefits

42. Breastfeeding
Infant Health Benefits
• Allergies, eczema
• Urinary tract infections
• Inflammatory bowel
disease
• Diabetes, type 1
• Gastroenteritis
• Hodgkin's lymphoma
• Otitis media
• Haemophilus influenzae
meningitis
• Necrotizing enterocolitis.
• Pneumonia/lower respiratory
tract infection
• Respiratory syncytial virus
infection
• Sepsis
• Sudden infant death syndrome .
• Provides immunologic
protection while the
infant’s immune system is
maturing
– Antimicrobial agents
– Anti-inflammatory agents
– Immunomodulating agents

43. Benefits to family and society
• Saves money
• Promotes family planning
• Decreases need for hospitalization
• Contributes to child survival

45. Rules of breast feeding
Exclusive breastfeeding for about 6 mo and To
continue for at least the second year.
Complementary foods rich in iron and other
micronutrients should be introduced at about 6 mo of
age.
Mother and infant should sleep in proximity to each
other to facilitate breastfeeding
Initiation of breastfeeding should be encouraged as
soon as possible after the birth, ideally within 1 hour.
Ensure 8 to 12 feedings every 24 h till 2 – 3 months
then 6 feeding till 6 months then 5 feeding till one
year.

46. At every feeding the infant is placed only on
one breast and then during the next feeding
on the other one, thus alternating them.
The duration of feeding is about 20-30
minutes. However, it is said that there is no
exact time of every feeding of the infant. Every
infant sucks the breast with different
frequency and different duration of feedings
with a day.
Rules of breast feeding

47.  The amount of milk that the breasts produce depends
partly on how much the baby suckles, and how much milk
he removes. More suckling makes more milk.
 Breastmilk flow depends partly on the mother's thoughts,
feelings and sensations. It is important to keep mothers and
babies together day and night, and to help mothers to feel
good about breastfeeding.
 Give no supplements (water, glucose water, commercial
infant formula, or other fluids) to breastfeeding newborn
infants .
 Pacifier should be offered, while placing infant in back-to-
sleep-position, no earlier than 3 to 4 wk of age and after
breastfeeding has been established.
Rules of breast feeding

48. Indicators of good attachment and
positioning:
• mouth wide open
• less areola visible underneath the chin than
above the nipple
• chin touching the breast, lower lip rolled
down, and nose free
• no pain.
Rules of breast feeding

49. How Long to Breastfeed?
• Exclusively for
the first 6 months of life
• Continuing for
at least the first
year of life, with
addition of solids
• Thereafter, for as
long as mutually
desired by mother and child Photo © Mary Boyd, MD, FAAP
AAP Pediatrics 2012;129;e827-41

50. 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 icepacks 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 two weeks at 0 - 5°F
• It can be stored in a deep freezer for about 3-12 months.

51. 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 icepacks 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 two weeks at 0 - 5°F
• It can be stored in a deep freezer for about 3-
12 months.

52. Barriers to Breast Feeding

53. Barriers to Breastfeeding
• Individual: Inadequate knowledge, embarrassment,
social , negative perceptions
• Interpersonal: Lack of support from partner and
family, perceived threat to father-child bond
• Institutional: Return to work or school, lack of
workplace facilities, unsupportive health care
environments
• Community: discomfort about nursing in public
• Policy: aggressive marketing by formula companies

54. Contraindications of breast feeding
Infants : galactosemia, phenylketoneurea
Mothers:
Mothers infected with HIV ?
Active untreated TB
Mothers taking any of the following medications:
radioactive isotopes, cancer chemotherapy
agents, such as antimetabolites, and illegal drugs.
Breastfeeding mothers should avoid alcohol. An
occasional drink is acceptable, but breastfeeding
should be avoided for 2 hours after the drink.

55. Commonly Mistaken as
contraindication are the following
• Women who have cesarean deliveries: Initiate breastfeeding
immediately, using a semi recumbent position on the side or sitting up.
• Women received vaccinations or live with vaccinated children: Neither
inactivated nor live vaccines administered to a lactating woman or other
family members affect the safety of breastfeeding for the mother or
infant.
• Women who had breast surgery: breastfeed frequently to
maintain milk supply. If the surgical wound is painful, the other breast can
be used but monitor infant growth because milk supply could be
insufficient.
• Women who have hepatitis A: Initiate breastfeeding after infant receives
immune serum globulin, and then vaccinate at 1 year of age.
• Women who have hepatitis B: Initiate breastfeeding after infant receives
hepatitis B immune globulin and first dose of the 3-dose hepatitis B
vaccine series.
• Women who have hepatitis C: Hepatitis C is not a contraindication for
breastfeeding, but reconsider if nipples are cracked or bleeding.

57. PAKISTAN statistics
• Deaths in children < 5 yr age = 85 / 1000
• Malnutrition as a factor = 40 %
• Inadequate breastfeeding contributes to
Malnutrition = 60 %

58. TAKE HOME MESSAGE

59. Mother’s milk
is
the Best
A. Prof. Dr. Allah Yar Malik.

61. Breastfeed Your Baby with Full of
Love, Pride & Joy!
BECAUSE EVERY DROP OF BREASTMILK IS
PRECIOUS!

63. THANKS FOR YOUR ATTENTION

73. RISKS OF BREASTFEEDING
• Breastfeeding is not without potential
nutritional risks. The best documented risks
include:
• Iron deficiency
• vitamin D deficiency
• Breastfed exposed infant to environmental
toxins , legal and illegal drugs, and infectious
pathogens that the mother may harbor (e.g.,
Human Immunodeficiency Virus HIV).

74. 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.

77. ِ‫ْن‬‫ي‬َ‫ل‬ ْ‫و‬َ‫ح‬ َّ‫ن‬ُ‫ه‬َ‫د‬َ‫ال‬ ْ‫و‬َ‫أ‬ َ‫ن‬ْ‫ع‬ ِ‫ض‬ ْ‫ُر‬‫ي‬ ُ‫ات‬َ‫د‬ِ‫ل‬‫ا‬ َ‫و‬ْ‫ال‬ َ‫و‬ِ‫ت‬ُ‫ي‬ ‫ن‬َ‫أ‬ َ‫د‬‫ا‬َ‫ر‬َ‫أ‬ ْ‫ن‬َ‫م‬ِ‫ل‬ ِ‫ْن‬‫ي‬َ‫ل‬ِ‫ام‬َ‫ك‬َّ‫م‬
ِ‫ك‬ َ‫و‬ َّ‫ن‬ُ‫ه‬ُ‫ق‬ ْ‫ز‬ ِ‫ر‬ ُ‫ه‬َ‫ل‬ ِ‫د‬‫و‬ُ‫ل‬ ْ‫و‬َ‫م‬ْ‫ال‬ ‫ى‬َ‫ل‬‫ع‬ َ‫و‬ َ‫ة‬َ‫ع‬‫ا‬َ‫ض‬َّ‫الر‬ُ‫ت‬ َ‫ال‬ ِ‫وف‬ُ‫ر‬ْ‫ع‬َ‫م‬ْ‫ال‬ِ‫ب‬ َّ‫ن‬ُ‫ه‬ُ‫ت‬ َ‫ْو‬‫س‬ُ‫ف‬َّ‫ل‬َ‫ك‬
َ‫ل‬ َ‫و‬ِ‫ب‬ ٌ‫ة‬َ‫د‬ِ‫ل‬‫ا‬ َ‫و‬ َّ‫آر‬َ‫ض‬ُ‫ت‬ َ‫ال‬ ‫ا‬َ‫ه‬َ‫ع‬ْ‫س‬ ُ‫و‬ َّ‫ال‬ِ‫إ‬ ٌ‫س‬ْ‫ف‬َ‫ن‬ِ‫ه‬ِ‫د‬َ‫ل‬ َ‫و‬ِ‫ب‬ ُ‫ه‬َّ‫ل‬ ٌ‫د‬‫و‬ُ‫ل‬ ْ‫و‬َ‫م‬ َ‫ال‬ َ‫و‬ ‫َا‬‫ه‬ِ‫د‬‫ى‬َ‫ل‬َ‫ع‬ َ‫و‬
‫ن‬َ‫ع‬ ً‫ال‬‫ا‬َ‫ص‬ِ‫ف‬ ‫ا‬َ‫د‬‫ا‬َ‫ر‬َ‫أ‬ ْ‫ن‬ِ‫إ‬َ‫ف‬ َ‫ك‬ِ‫ل‬َ‫ذ‬ ُ‫ل‬ْ‫ث‬ِ‫م‬ ِ‫ث‬ ِ‫ار‬ َ‫و‬ْ‫ال‬َ‫ف‬ ٍ‫ر‬ ُ‫َاو‬‫ش‬َ‫ت‬ َ‫و‬ ‫ا‬َ‫م‬ُ‫ه‬ْ‫ن‬ِ‫م‬ ٍ‫اض‬َ‫ر‬َ‫ت‬َ‫ال‬
ِ‫ض‬ ْ‫ر‬َ‫ت‬ْ‫س‬َ‫ت‬ ‫ن‬َ‫أ‬ ْ‫م‬ُّ‫ت‬‫د‬َ‫ر‬َ‫أ‬ ْ‫ن‬ِ‫إ‬ َ‫و‬ ‫ا‬َ‫م‬ِ‫ه‬ْ‫ي‬َ‫ل‬َ‫ع‬ َ‫ح‬‫َا‬‫ن‬ُ‫ج‬َ‫ع‬ َ‫ح‬‫َا‬‫ن‬ُ‫ج‬ َ‫ال‬َ‫ف‬ ْ‫م‬ُ‫ك‬َ‫د‬َ‫ال‬ ْ‫و‬َ‫أ‬ ْ‫ا‬‫و‬ُ‫ع‬ْ‫م‬ُ‫ك‬ْ‫ي‬َ‫ل‬
َّ‫ت‬‫ا‬ َ‫و‬ ِ‫وف‬ُ‫ر‬ْ‫ع‬َ‫م‬ْ‫ال‬ِ‫ب‬ ‫م‬ُ‫ت‬ْ‫ي‬َ‫ت‬‫آ‬ ‫آ‬َّ‫م‬ ‫م‬ُ‫ت‬ْ‫م‬َّ‫ل‬َ‫س‬ ‫ا‬َ‫ذ‬ِ‫إ‬ِ‫ب‬ َ‫اّلل‬ َّ‫ن‬َ‫أ‬ ْ‫ا‬‫و‬ُ‫م‬َ‫ل‬ْ‫ع‬‫ا‬ َ‫و‬ َ‫اّلل‬ ْ‫ا‬‫و‬ُ‫ق‬َ‫ون‬ُ‫ل‬َ‫م‬ْ‫ع‬َ‫ت‬ ‫ا‬َ‫م‬
ٌ‫ير‬ ِ‫ص‬َ‫ب‬
And the mothers should suckle their children for two whole years
for him who desires to make complete the time of suckling; and
their maintenance and their clothing must be-- borne by the father
according to usage; no soul shall have imposed upon it a duty but
to the extent of its capacity; neither shall a mother be made to
suffer harm on account of her child, nor a father on account of his
child, and a similar duty (devolves) on the (father's) heir, but if
both desire weaning by mutual consent and counsel, there is no
blame on them, and if you wish to engage a wet-nurse for your
children, there is no blame on you so long as you pay what you
promised for according to usage; and be careful of (your duty to)
Allah and know that Allah sees what you do.

78. • Positive media image
of breastfeeding
• Breastfeeding education
during medical training
• Family and societal
support for breastfeeding
• Breastfeeding as
cultural norm
AAP Policy Statement
Photo © La Leche League International
Role of Pediatricians and Other Health Care
Professionals in Protecting, Promoting, and
Supporting Breastfeeding

79. Opportunities to
Promote Breastfeeding
Prenatal visits
– Provide appropriate literature, resources.
– Refer for prenatal and breastfeeding classes.
– Refer to pediatrician for
prenatal visit.
– Avoid formula coupons or products.

80. Summary
• Breastfeeding is the preferred feeding for
almost all infants.
• Mothers should be informed of the benefits
of breastfeeding.
• Supplementation is rarely indicated and
interferes with successful lactation.
• Breastfeeding should be actively supported
and promoted in the medical community and
society.
• Women should feel comfortable continuing
to breastfeed for as long as desired.

81. Mother’s milk
is
the Best
A. Prof. Dr. Allah Yar Malik.