Breastfeeding provides significant health benefits to both infants and mothers by reducing the risk of various illnesses. The document discusses the physiology of lactation, including the roles of prolactin and oxytocin in milk production and ejection. It also covers common breastfeeding problems like low milk supply, mastitis, and breast abscess, providing diagnostic criteria and treatment recommendations. Maintaining proper latching, frequent feeding to stimulate supply, and emptying the breast are emphasized as ways to support breastfeeding success and maternal recovery from issues.
BREAST CARE (PRECEDURE)
PRESENTED BY – M. MANJOT KAUR GILL
DEFINITION
Breast care is the process of cleaning the breast of mother that helps in maintaining hygiene and prevent from cross infection during feeding .
PURPOSES
To clean the breast.
To detect any abnormalities.
To stimulate milk ejection .
To prevent local infection.
To prevent breast complications.
INDICATIONS
Postnatal mothers.
Before and after breastfeeding.
Cracked nipple.
Pt. who are not able to take self care.
Nipple with unhygienic conditions.
PREPRATION OF ARTICLES
Screen
Mackintosh with towel.
A bowel with 2-3 cottons.
A bowel with boiled and cool cotton swabs.(12-15)
A bowel with dry gauze pieces.(12-15)
Kidney tray/Paper bag
Nursing records.
STEPS OF PROCEDURES.
Arrange all articles .
Explain the procedure to the mother about benefit of breast care.
Provide screen for privacy.
Provide comfortable position to the mother preferable sitting position.
Spread the mackintosh with towel over the lap of the mother.
Wash hand
Stand on the right side of the mother whole giving care.
Expose both the Brest firth and check symmetry.
Inspect the Breast for size and any abnormality.
-Inverted nipple
-Cracked nipple.
-Retracted nipples
-Any sign of infection
Palpate the breast from superficial to deep for tenderness, pain, tumors, exaggerated lymph nodes, etc
Squeeze the breast and observe the secretions.
Clean the secretion with the pad and throw In paper bag.
Take the cotton swab and squeeze excess water holding the tail and keeping above the hand.
Clean the breast in the following order—nipple-primary areola-secondary areola- total breast –lower crease-axilla.
Dry the breast with gauze pieces following the same order.
Cover the further breast exposing the near one.
Inspect, palpate and squeeze in the previous manner.
Assist the mother to do hand wash for return demonstration.
Assist the mother to clean the breast in same manner.
Put the baby on to the breast.
Make the mother and baby comfortable after care.
Record any abnormal findings.
SUMMARIZATION
Definition
Purposes
Indications
Articles
Steps of procedure
BIBLIOGRAPHY
Ghai, sandhya .(2018) clinical nursing procedures. New Delhi: satish kumar. Pp.613-616.
Dharitri, swain.(2017) obstetrics nursing procedure manual. New Delhi: jappee brothers. Pp. 158--159.
THANKS
Postnatal care (PNC) for the mother should respond to her special needs, starting within an hour after the delivery of the placenta and extending through the following six weeks. The care includes the prevention, early detection and treatment of complications, and the provision of counselling on breastfeeding, birth spacing, immunization and maternal nutrition. To standardise the PNC service, you are advised to use the screening, counselling and postnatal care cards. These cards ensure that you have covered all the essential steps in every home visit.
this ppt is beneficial for nursing and obstetric and gynaecology students.
When it comes to good positions to use while breastfeeding, your comfort as well as the ease with which your baby will be able to feed is the first and foremost concern. Finding a position that you are most comfortable and happy with will make it easier for your baby to latch on to your breasts and feed with ease. Here are some of the best breast-feeding positions that you might use when you are breastfeeding.
Babies should be breastfed and/or receive expressed human milk exclusively for the first six months of life. Breastfeeding should continue with the addition of complementary foods throughout the second half of the first year.
BREAST CARE (PRECEDURE)
PRESENTED BY – M. MANJOT KAUR GILL
DEFINITION
Breast care is the process of cleaning the breast of mother that helps in maintaining hygiene and prevent from cross infection during feeding .
PURPOSES
To clean the breast.
To detect any abnormalities.
To stimulate milk ejection .
To prevent local infection.
To prevent breast complications.
INDICATIONS
Postnatal mothers.
Before and after breastfeeding.
Cracked nipple.
Pt. who are not able to take self care.
Nipple with unhygienic conditions.
PREPRATION OF ARTICLES
Screen
Mackintosh with towel.
A bowel with 2-3 cottons.
A bowel with boiled and cool cotton swabs.(12-15)
A bowel with dry gauze pieces.(12-15)
Kidney tray/Paper bag
Nursing records.
STEPS OF PROCEDURES.
Arrange all articles .
Explain the procedure to the mother about benefit of breast care.
Provide screen for privacy.
Provide comfortable position to the mother preferable sitting position.
Spread the mackintosh with towel over the lap of the mother.
Wash hand
Stand on the right side of the mother whole giving care.
Expose both the Brest firth and check symmetry.
Inspect the Breast for size and any abnormality.
-Inverted nipple
-Cracked nipple.
-Retracted nipples
-Any sign of infection
Palpate the breast from superficial to deep for tenderness, pain, tumors, exaggerated lymph nodes, etc
Squeeze the breast and observe the secretions.
Clean the secretion with the pad and throw In paper bag.
Take the cotton swab and squeeze excess water holding the tail and keeping above the hand.
Clean the breast in the following order—nipple-primary areola-secondary areola- total breast –lower crease-axilla.
Dry the breast with gauze pieces following the same order.
Cover the further breast exposing the near one.
Inspect, palpate and squeeze in the previous manner.
Assist the mother to do hand wash for return demonstration.
Assist the mother to clean the breast in same manner.
Put the baby on to the breast.
Make the mother and baby comfortable after care.
Record any abnormal findings.
SUMMARIZATION
Definition
Purposes
Indications
Articles
Steps of procedure
BIBLIOGRAPHY
Ghai, sandhya .(2018) clinical nursing procedures. New Delhi: satish kumar. Pp.613-616.
Dharitri, swain.(2017) obstetrics nursing procedure manual. New Delhi: jappee brothers. Pp. 158--159.
THANKS
Postnatal care (PNC) for the mother should respond to her special needs, starting within an hour after the delivery of the placenta and extending through the following six weeks. The care includes the prevention, early detection and treatment of complications, and the provision of counselling on breastfeeding, birth spacing, immunization and maternal nutrition. To standardise the PNC service, you are advised to use the screening, counselling and postnatal care cards. These cards ensure that you have covered all the essential steps in every home visit.
this ppt is beneficial for nursing and obstetric and gynaecology students.
When it comes to good positions to use while breastfeeding, your comfort as well as the ease with which your baby will be able to feed is the first and foremost concern. Finding a position that you are most comfortable and happy with will make it easier for your baby to latch on to your breasts and feed with ease. Here are some of the best breast-feeding positions that you might use when you are breastfeeding.
Babies should be breastfed and/or receive expressed human milk exclusively for the first six months of life. Breastfeeding should continue with the addition of complementary foods throughout the second half of the first year.
As part of the Strong Start for Mothers and Newborns effort, the CMS Innovation Center hosted a webinar to discuss why it is important to reduce early elective deliveries and share best practices on how reducing early elective deliveries improves the health of mothers and newborns across the country. Individuals representing the American College of Obstetricians and Gynecologists, the March of Dimes, providers and payers conveyed examples of successes and how reducing early elective deliveries can be accomplished. All interested parties were invited to attend this event.
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http://innovations.cms.gov
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. ObjectivesObjectives
• Review public health impact of
breastfeeding
• Understand physiology of lactation
• Identify the differential diagnosis and
treatment for common breastfeeding
problems
» Low milk supply
» Mastitis
» Breast abscess
3. Health Impact ofHealth Impact of
Not BreastfeedingNot Breastfeeding
INFANTINFANT MOTHERMOTHER
IllnessIllness OROR IllnessIllness OROR
DiarrheaDiarrhea 2.82.8
PremenopausalPremenopausal
breast cancerbreast cancer
1.41.4
Otitis mediaOtitis media 2.02.0 Ovarian cancerOvarian cancer 1.31.3
PneumoniaPneumonia 3.63.6 Type 2 DiabetesType 2 Diabetes 1.21.2
SIDSSIDS 1.61.6
AsthmaAsthma 1.41.4
LeukemiaLeukemia 1.21.2
Formula-feeding vs. breast-feeding: risk of adverse outcomes.
Breastfeeding and Maternal and Infant Health Outcomes in
Developed Countries. AHRQ Evidence Report Number 153. April 2007.
4. AAP RecommendationsAAP Recommendations
• Exclusive
breastfeeding for
the first six months
of life
• Continued
breastfeeding for
at least one year,
‘As long as is
mutually desired
by mother and
child’
American Academy of Pediatrics (2005). "Breastfeeding and the Use of
Human Milk." Pediatrics 115(2): 496-506.
5. ContraindicationsContraindications
• HTLV-1 and HTLV-2
• HSV with lesion on
the breast
• Active tuberculosis
• Medications that
contraindicate
breastfeeding
• Newborn with
galactosemia
• Maternal HIV
» US: not recommended
» UNICEF: When
replacement feeding is
acceptable, feasible,
affordable, sustainable
and safe, avoidance of
all breastfeeding is
recommended;
otherwise, exclusive
breastfeeding is
recommended during
the first months of life.
8. OxytocinOxytocin
• Moves milk from
lobules to sinuses,
so baby can eat
• Inhibited by stress,
pain, anxiety
• Triggered by sound,
smell, sight of infant
Let Down: Ejection, not suction,
moves milk to the areola.
9. Stress and Milk VolumeStress and Milk Volume
J. Pediatr 1948; 33:698-704.
10. Milk TransferMilk Transfer
• Infant grasps most
of the areola in his
mouth
• Tongue “milks”
milk to the back of
the mouth prior to
swallowing.
Latch: The baby’s tongue moves
milk from areola to nipple.
11. Negative feedbackNegative feedback
• Milk in lobules contains
whey protein called
Feedback Inhibitor of
Lactation (FIL)
• If milk is not removed,
and lumen is full,
production will decrease
• Goal: 10-12 feeds in 24
hours, until baby is done.
Moving Milk:
Demand drives supply.
13. Low Milk SupplyLow Milk Supply
• Primary lactation failure
» Anatomic abnormality
» Sheehan’s syndrome
• Disruption of normal physiology
» Infrequent or inadequate milk removal
» Postpartum depression
• First line therapy:
» Lactation consultation
» Mechanical expression after breastfeeding
• If needed:
» Supplement after breastfeeding as indicated
» Continue pumping during supplementation
» Consider metoclopramide
14. MastitisMastitis
• Definition: tender, swollen, wedge-shaped
area of breast, usually unilateral, with fever,
malaise, chills, and systemic symptoms
• Incidence: 3 to 20%
• Treatment
» Rest, fluids
» Antibiotics – Dicloxicllin 500mg QID x 10-14d
» Empty the breast
• Evaluate latch
• Continue frequent breast feeding
• Milk is not harmful to healthy, term infant
• Abrupt weaning slows maternal recovery
• Poor response requires further evaluation
Academy of Breastfeeding Medicine. ABM Clinical Protocol #4: Mastitis.
Breastfeeding Medicine 3(3); 2008.
15. Breast abscessBreast abscess
• 3% of women with mastitis
• Diagnosis
» Hard, red, tender mass after appropriate
treatment
» Diagnostic ultrasound
• Treatment
» Needle aspiration for culture / treatment
» Surgical drainage for large or multiple
abscesses
• Follow-up care
» Antibiotics
» Continue breastfeeding
16. For more informationFor more information
• American Academy of Pediatrics (2005).
Breastfeeding and the Use of Human Milk.
Pediatrics 115(2): 496-506.
• American Academy of Family Physicians.
(2001, 2/26/2007). Breastfeeding (Position
Paper).
• American College of Obstetrics and
Gynecology (2007). Breastfeeding: Maternal
and Infant Aspects. Special Report from
ACOG. ACOG Clinical Review 12(1
(supplement)): 1S-16S.
• Academy of Breastfeeding Medicine
www.bfmed.org
Editor's Notes
Breast tissue differentiates during gestation At delivery, loss of placental hormones allows milk production to begin Infant suckling at the breast causes contraction of myoepithelial cells and release of milk
Milk produced in mammary epithelium within lobules With nursing, oxytocin triggers contraction of myoepithelial cells and transfer to sinuses
Study: 1 woman, monitored during morning feed at 7 months. 8 control days, 12 distraction days; given saline or pitocin injection prior to nursing. Pitocin returned milk supply to near-normal. Ice water - immersed feet for 10 of 30 sec; math - difficult verbal problems w/ shock if incorrect answer; toe pull - interemittent pulling of big toe, causing pain
A shallow latch, or sucking on the nipple, stimulates let down but doesn’t empty the breast. It also leads to sore, cracked nipples, engorged breasts, and hungry, frustrated babies.
Don’t distribute formula company materials in your office or hospital Ensure pediatric follow-up in the first 3-5 days Skin-to-skin at birth, nurse in the first hour Room in Feed on demand No pacifiers or formula, unless medically necessary
