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Navajata Shishu Poshana
Vd. Miral Dobariya
Assistant Professor
Department of KB
MRIAS
Stana sampata
 नाति ऊर्ध्व नाति लम्बा् नाति कृ श नाति पीन युक्ि पपप्लकौ सुख प्रपनौ
(च.शा.8/५३)
 Not highly situated
 Not too long
 Not emaciated
 Not too fatty
 Should projected outwards, so baby can feed easily.
Su.sha.10
 ऊर्ध्वस्िनी- कराल क
ु यावि्
 लम्बस्िनी- नाससका-मुख- छादतयत््ा- मरण
आपादयति
 Can cause karal.
A.s.u.1
 पीनो अति- कन्धरा स्िम्भं क
ु यावि्, उर्ध्ावक्षम ऊर्ध्वगःउच्च्च्च्््ास रोध
 लम्बो अति- जीप्ि संशयम ्
 गसभवणी- पाररगसभवक
 Changing the milk frequently can cause adjustment problems in
baby in term of taste, tolerance, palatability, digestion &
metabolism.
 GIT upsets.
breast
 Large modified sebaceous gland.
 Assessory reproductive organ
 Shape- varies in women, in different
period of life. But size of base is
constant.
 2nd- 6th rib, in midclavical line
 Lies in subcutaneous tissue
over fascia covering, pactoralis
major, saradus anterior and
external oblique.
 Lateral projection of breast
towards axilla- axillary tail of
spence.
 Weight- 200- 300 gm at child
bearing age
Non lactating breast
 Areola- centrally, pigmented,
2.5 cm diameter
 Montgomery lands- assessory
glands around periphery of
areola. Can secret the milk.
 Nipple- muscular projection
covered by pigmented skin
 Covered by unstriated muscles which make it erectile
 Accommodates 15-20 lactiferous ducts and their opening
 Each duct dilate to form its opening in the nipple
 During feeding, by squeeze this, sinus opens in the mouth,
 Whole breast embedded in subcutaneous fat. It absent in nipples
and areola.
 Mature breast- 20%- glandular tissue, 80% fat connective tissue
 Each lobe has lactiferous duct
 Each lobe has 10-100 lobule
 Coopers ligament provide support to the breast
 Alveolus- lined by squmous columnar epithelium
 Alvioulus- alvioli- myoepithelium cells
 Capillaries- lobules- lobe- lacteferous ducts- L.F.sinus
 During pregnancy, hypertrophy and proliferation in alveoli,
connective tissue.
 Vascularity increase, bluish vein running under the skin.
 Axillary tails present
 Nipple- larger, erectile and deeply pigmented
 Montgomery tubercles- secretions keep nippal moist and healthy.
Stanya Sampata
नायाव िु मधुरम ् स्िन्यं कषाय अनुरसं हिमम |
नस्य आ्च्च्योिनयो: पथ्यं जी्नं लघु दीपनं ||
(सु. सू. ४५)
• Sweetish, astringent (second dominant taste), cold nature,
nutritive, easy to digest, improve digestion.
 बृिण
 सात्म्य
 स्नेिन
 िपवण
 अक्षक्षरोगजजि….etc
 प्रकृ ति ्णव गंध रस स्पशव
 पुजटिकरं, आरोग्यकरम (च.शा.८ )
Acc.To Kashyap Samhita
अव्यािि बल अंग आयु अरोगो ्धविे सुखम |
सशशु: धात्र्यो अनापपि: शुद्ध क्षीरस्य लक्षणं || (ka.su.19)
composition
 Varies genetic background, ethnic factor, age intake, parity, nutritional
status, and dietary intake, delivery timing, duration of lactation.
 Mainly…. Carbohydrate
 Protein
 Fat
 Immunoglobulin's
 Lysozome
 Antiviral inhibitors
Lactose highest- 7gm/dl •Sweeter thinner
•Lactose convert in to lactic
acid, which make baby
stomach more acidic,
prevent bacterial growth
Protein- lowest concentration
1.1 g/dl
Whey protein- 60:10- easy to
digest
Fat Lower
3.4g/dl
•Triglyceride and small amount
of di and monoglycerides,
phospho lipid
•Highest concentration of dha
docosahexaenoic acid
 Imunoglobuline- GAM
 Iga, Igm secrets through milk
 Iga highest concentration
 Lymphoid cell, polymorphs, microphages, plasma cells.
 Non protein nitrogen- urea, uric acid
 Other constituents- steroid hormones, peptide, insulins, growth
factors, minerals, vitamins, lipase.
Type of breast milk
 Colostrum
 Transitional Milk:
 Mature milk
 Preterm milk
 Foremilk
 Hind milk
 Breast milk is different in preterm and full term baby.
 Milk is not species specific, it is baby specific.
 Clolstrom
 Thin, golden yellow in nature.
 It secrets first 3 days after delivery.
 Secretes in small quantity.
 Carbohydrate and fat content is low
 Rich in protein, loaded with imunoglobins, beta carotene.
 Yellow color is due to beta-carotene
 High in Iga, which works as first vaccine shot
 Laxative effect prevent the billirubin build up.
 Transitional milk
 Two weeks before lactation established
 Mature milk
 After transitional milk
 Thinner, watery, and contains all nutrients
 Fore milk
 It secrets at starting of the feed
 Thin, watery, sweet in nature
 Rich in protein, sugar, vitamins, minerals and water
 Hind milk
 It secrets end of the feed
 Thicker, richer in fat and energy and satisfy the baby
 Baby needs both hind and fore milk, for satisfaction of the thirst
and hunger.
 For that, mother have to completely empty one breast and after
feed from other breast.
 Drip milk
 When feeding given from the one breast, drop of milk dripped
out from the other breast.
 Mainly secrets fore milk
स्तन्योत्पत्ति
रसप्रसादो मधुर: पक्् आिार तनसमिज: |
कृ त्स्नदेिाि स्िनौ प्राप्िः स्िन्यसमस्यसभधीयिे ||
(सु. तन. अ. १० )
ससराणाम िहदस्थानाम् प््ृित््ाि प्रसूतििः |
िृिीये अितन चिुथे ्ा स्रीणाम स्िन्यं प्र्िविे ||
(अ. ि. उ. १ )
 दशवनाि
 स्मरणाि
 शब्द श्र्णाि
 स्पशावि
 संिषाि
 सुप्रसन्न मन
 स्नेिो तनरंिर ( सु. तन. १० )
 यद अन्नपान प्रायेण गसभवणी स्री तनषे्िे- रसो- त्ररधा-
(का.सू.लेिार्धयाय)
एक अंश मािृ पुजटि िृिीयं स्िन पुजटि
द्प्तिय गभव पुजटि
 Existence of milk in female is compared with shukra in male.
 Both are like ghee in milk and guda in ikshu.
 Shukra sravana occurs by chesht yuvate darshan, smarana, shabda
samsravana, sparsh, samharsha, suprasana mana.
 Shukra and stanya forms earlier but functions only after hormonal
influence, puberty.
 Psycological factors- hypothalamic- pitutary, mammary axis
Physiology of lactation
 Depends on awareness, keenness and confidence- these are
important factor for successive lactation.
 Early bonding promotes it.
 Rooming in, bed in, mother in
 Early breast feeding
 Avoid pre and post lacteal feed
 Malnutrition does not significantly affect the adequacy of lactation
but milk may deficiate in fat, vitamin and minerals.
Physiology of lactation
 Interaction between hormones and reflexes
 Glandular tissue stimulation
Prolactine reflex (Milk Secretion reflex)
When baby sucks- nerve ending stimulates on nipple
Carrie massage to A.P.G
Release prolactine, milk produced according to demand
Prolactine secrete by A.P.G.
Stimulates glandular tissue of breast to produce milk
Let down reflex
 Ejection of the milk by…...
Nerve stimulate by sucking, love, sight, smell, cry,
touch
Oxitocine released by P.P.G
Contraction of myoepithelium
Leads to ejection of milk in
lactiferous sinus- ducts
Stanya paana vidhi
 First feeding given after 3 to 4 days after delivery. (su.shaa.10)
 After that, maghu+ghruta in panitala pramana 2 times in a day
1st day Ananta churna+ madhu sarpi 3
times in day with mantra siddha
2nd day Lakshmanaa sidhdha ghruta
3rd day Lakshmana sidhdha ghruta
 धारी स््ादु बिुल शुर्धध दुग्धा
 स्नाि अनुसलप्ि शुक्ल ्स्रं
 प्रजा स्थापन औषधध धारण
 क
ु मारं प्रांगमुखम
 प्रथम दक्षक्षणं स्िनं पाययेि (ch.sha.8)
 Prashasta tithi
 Shirah snaata, upavasa
 Dhaatri- praak mukhi, dakshina stana dhauta, ishata parisruta,
abhimantra
 नाना स्िन्य प्रयोग असात्म्याद व्याधध जन्म
 If milk is not parisruta, by atistabdha, stanyapurna stan paan, utsuhit
srotas- shishu becomes kaasa shwasamayi
 To prevents sudden gushing of milk while baby sucking vigorously.
By this chances of aspiration occurs. Sudden gushing can cause
aspiration of milk in trachea.
्जवतयत््ा
 जस्रयाः स्िन्यं आममे्, स्िन्य क्षीरे पाकतनषेध, अक््धथिे हििम
 न क्षुधधि- dehydration, thirst
 न शोकािव- psychologically depressed, , hypothalamo pitutary mammary axis
 श्रान्ि- energy deficit
 प्रदुटिधािु- illness
 गसभवणी- paarigarbhik, phaakk
 ज््र- risk of contamination
 अतिक्षीण- malnourished
 अतिस्थूल- obese
 प्दग्ध- hot, spicy food
 प्रुर्धधािार से्ी
 अजीणव औषध- secrets in the milk
Feeding problem
 Drashti dosha- attractive, well sized breast attracts attention of
people. They looked while mother feeds baby or other activity.
Cause pain and flow reduction.
 Stana kilaka- trun, kita, shuka, makshika are taken by the bhojana,
gose in to sira of stana, cause obstruction, cause abscess
 Virudhdhahar, khudhita, vichetasa- stanya roga kara
 Vitiated by graha, shakuni, putana
 Kshira alasaka- tridosha dushit dugdha.
Common feeding problems
 Prime gravid mother- anxiety, worry, lack of confidence
 Mechanical- cleft lip, palate, incorrect sucking and swallowing in
preterm.
 Retracted nipple
 Sore/ cracked nipple
 Enlarged breast
 Bottle feed
 Formula feed
 Sugar, honey, water, gripe water
 Supplementary food
 Painful condition like Breast engorgement, cracked nipples etc.
 Lack of night feeding, Inadequate emptying of breast
 Sick mother/ sick baby/ preterm baby
 Anxiety, stress, lack of love, anger, not enough sleep etc.
Breast feeding technique
 Position- any comfortable position
 Lie down or sitting
 Should not leaning on the baby.
 baby’s whole body supported. Not only neck or shoulder
 Head and body are in one lie
 Abdomen of baby and mother should touch
 Nose- at level of the nipple
 After birth baby should put on mothers abdomen.
 In case of LSCS, put between the breast within 4 hrs.
 Mother sit comfortably and keep head slightly raised and offer
alternate breast at each feed.
 Hollow of elbow- neck put comfortably, Back and buttocks
supported by forearm and hand.
 Touch baby cheek or side of mouth to her breast to stimulate
rooting reflex.
 For effective sucking, seal around nipple and areola should be
done.
 If sucks only nipple, milk is not ejected, and milk not properly
taken by baby- vigorously suck and cause nipple sour.
 During feed, if baby goes in to sleep, gentle tickling around the
ear or soles, avoid tv during this.
 Baby enjoys maternal warmth, cuddling
 One breast should completely empty first than other breast.
 After feeding should burp.
 Healthy baby do have enough stores of glycogen and not need any
complimentary feeds.
 Bottle feed can cause contamination and diarrhea, nipple
confusion, bottle teat is easy to suck.
Signs of attachment
 1. mouth widely open
 2. nipple, areola should cover in mouth
 3. chin should touches the breast
 4. lower lip is everted
Reflexes
 1. rooting-
 When cheeks/ side of mouth touch, baby opens the mouth.
 Reflex is search for the nipple
 Helps to find the nipple.
 Sucking-
 Palate is touched with nipple, baby starts suckling movement.
 It is very strong and starts immediately after birth.
 Sucking with bottle is passive process and baby has to control the flow of milk.
 Breast feeding requires active efforts, nipple confusion and refuses to feed.
 Swallowing reflex
 When mouth is field wit milk, baby reflex swallow the milk.
It requires couple of suckles to trigger swallowing reflex.
 It requires coordination with breathing.
 Suckle and swallow cycle lasts for one second.
Advantages of Breast milk
 Nutritive value – protein, fats, carbohydrates..
 Digestibility
 Lower risk of infection
 Protects from allergy
 Mental growth
 Emotional bonding
 Maternal advantages
 Economic factors
 Other
 Always available- no preparation time
 Proper temperature
 Clean and fresh
 Free of contaminating agents
 Cheap
Criteria for adequate feeding
 Weight gain (1% per day)
 Urine output (> 6 times/24 hours)
Relactation: for continue production of milk
 Emptying of milk 8-10 times/day
 Suckle like procedure by fingers at areola (nipple exercise)
 Night feeding (minimum 2 times)
Examination of breastmilk
 अप्सु परीक्षेि
 शंख अ्भास
 अप्सु नयस्िम एकीभा्ं गच्च्छति
 अफ
े तनलम, अिंिुम, न उत्प्ल्िे, न अ्सीदति
 क
ु मारस्य आरोग्यं, शरीर उपचय, बल ्ृजर्धध
(सु.तन.१० )
स्िन्याभा्े पथ्य व्य्स्था
स्िन्याभा्े पय्छागं गव्यं ्ा िद गुणं पपबेि् |
िस््ेन पञ्च मूलेन जस्थराभयां ्ा ससिा युिं ||
 Ajaa/cow has modified as close as possible to level and
constitution of human milk, given the strength to baby.
 Hasva panchmula- may decrease the solute load
 Sita- to componset less lactose.
 Dhaatri- baby specific and species specific.
स्तन्यनाश / स्तन्यक्षय
Causative factors:
शुकक्रोधलङ्घनआयासाः स्िन्य नाशस्य िेि्ः (अ.ि.उ.१)
 क्रोर्धध, शोक, अ्ात्सल्य
 लंघन, आयास
 रुक्ष अन्नपान, कशवन
 स्िन्य क्षये स्िन्योम्लावनिास्िन्य सम्भ्ो अल्पिा ्ा िर ्लेटम ्धवन द्रव्य
उपयोगः (सु.सू.१५/१६)
Treatment
 स्िन्यस्य ससधु्ज्यावतन मधान्यानुपजाः रसाः |
 क्षीरं क्षीररन्य औषधः शोकादवस्च प्पयवयः ||
 स्िन्यजनन गण कषाय
 क्षीरजनन मद्य ससधु ्ज्यव
 शाक ससर्धधाथवक ्ज्यव
 लसून प्लांडू से्न
 मधुर अम्ल ल्ण भूतयटठ आिार
 क्षीर पान
 भय शोक आयास ्जवन
 शयन सुख
स्िन्य जनन कषाय
 प्रण शाली षजटिक इक्षु्ासलका दभव क
ु श काश गुन्द्रा
इत्कि िृणमूलातन इति |
स्िन्य शोधन कषाय
 पाठा मिौषध सुरदारु मुस्िा मू्ाव गुडुधच ्त्सफ़ल ्
ककरातिक्ि किुरोहिनी सारर्ा
Medication to lactating mother
 All medicine secrets in breast milk.
 Minimize it by told to mother to take the drug after
immediate feeding.
 Anti cancer drug
Artificial feeding
 Infants formulas are food products designed to provide for the
nutritional needs of infants under 1 year old who are not
drinking breast milk.
 They include powders , concentrated liquids or ready-to-use
forms.
 Infants formulas vary in nutrients , calorie count , taste, ability
to be digested , and cost.
 Almost all babies and infants do well on these formulas. These
formulas are made with cow’s milk protein that has been
changed to be more like breast milk.
 Lactose and minerals from the cow’s milk ,as well as vegetable
oils, minerals and vitamins also in the formula milk.
Hypoallergic Formulas
(Protein hydrolyzed Formulas)
 This types of formula may be helpful for infants who cannot
digest cow milk protein and for those with skin rashes or wheezing
caused by allergies. It is more expensive than regular formulas.
 Lactose-free Formulas- These formulas are used for
galactosemia, lactose intolerance.
 Soy- Based Formula- These formulas are made using
soy protein. They do not contain lactose.
Disadvantages of formula feeds
 Chances of excess quantity feeding
 Variation in dilutions and preparation
 Not cost effective
 Bacterial contamination
Method of Feeding
<30 wks <1200gm IV Fluid
30-32wks 1200-1500gm Naso/Oro gastric feeding
32-34wks >1800gm Spoon/palady/breast
feeding
Methods of feeding
 Palade feeding
 Spoon feeding
 Bottle feeding
 Gavage feeding- Naso gastric feeding
Naso Jejuneal feednig
 1st need of baby after birth is feeding.
 Absence of mother, death, mechanical or pathological problems- alternative should
search.
 Human milk is species specific instead of animal milk.
 Wet nurse, step mother, upmaata
 Concept is not only for feeding, also for bathing, playing, caring.
 To hold, to protect, to give shelter
 One who protects and cares the baby in all its aspects.
 पुर शरीर रक्षाथव स््शरीर उपशोषण
 सिन्िे स्व दुखातन
 Word meaning is to hold, to protect and to give shelter. Like amalki..
धात्री
Examination of Dhatri
 समान ्णो
 यो्नस्था
 अनािुर अव्यंग अव्यसन
 क
ु लेजािा
 तनरोगी
 अप्रूप
 अजुगुजप्सि good mood, no psychological problems
 देश जाति ्णव प्रकृ ति सम
 अक्षुद्र कमव, न लोलुप no bed intention or behavior
 जीप्ि ्त्सा – पु ्त्सा
 बिु क्षीर, हिि आिार से्ी
 अनुच्च्चारशातयनी
 क
ु शल उपचारा
 शुधच, अशुधच द््ेषी
 स्िन संपियुक्ि
 ्यामा स्री प्रचुर क्षीरा भ्ति (दल्िण)
 २ धारी (अ. ि.)
 कृ शां च नटिपुटपां च बृियेिेन ससर्धयति
 क्षार प्रधान औषध not given. प्रजा नाश कर
 क्षारो धारीणां न शस्यिे
 धारी स्िन्य प््ृर्धयथे मुदगयुष ् रसाशतन
 स्िन्य शोधन and ्धवन गण
 बला िैल, ्योनाक िैल, कपपत्थ िैल, मत्स्य िैल,
सिकार िैल
 गुरुअन्न स्नेि मांसातन हद्ा स््ाप ् ्जवयेि
चिकित्सा (का.धच.१९)
 सुखम दुखम हि बालानाम धारीमूलम
 तनत्य संशोधनपरा, तनत्य प्रेचन
 अजीणव अपप न शस्यिे
 तिक्षनाजग्न-बृिणं
 मन्दाजग्न- दीपन
 प्षमाजग्न- पथ्यािार
 षट्पल & कल्याणक घृि use
 म्रक्षण, उद््िवन स्नान, शुक्लांबर, धमवरति- साजत््क आिारमेद्जस््नां
धारीणां ससराकमव प्रशस्यिे
 स्नेिन-स््ेदन् शोधन
Human Milk Banking
 Includes screening, collecting, processing, storing, and
distribution of donating milk.
 Who and unisef- biological mother – not possible to feed- used
human milk fro another sources.
 Banked/ pooled milk is best next option
 Most suitable for preterm, sick baby
 PDHM-pasturised donor human milk
Indication
 Inadequate lactation
 Flat/ inverted nipple
 Multiple baby
 Orphaned neonate
 Nicu
 Risk of breast milk
 Temporary interruption
 Formula intolerance
 Diarrhea
 Imuno deficiency
 hiv
1. screening
 Major issue is transmission of infection via milk.
 Detailed medical history of donor is taken
 Blood screening for hiv, hepatitis b and c, syphilis
 Consent taken by donor and doctor both, neither her or her infant
suffer from disease.
2. collection
 Strict aseptic precautions are taken
 Bacterial count before pasteurization - <103 colony forming unit
 Pasteurization- 560C for 30minutes
 By those, most of virus and bacteria killed without
compromisation in nutritional, immunological property
 Again check for microbial growth.
3. storage
40 C 72 hours
-200C 3-6 month
-370C frozen

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05 CLINICAL AUDIT-ORTHO done at a peripheral.pptx
 

Navajaat shishu poshana

  • 1. Navajata Shishu Poshana Vd. Miral Dobariya Assistant Professor Department of KB MRIAS
  • 2. Stana sampata  नाति ऊर्ध्व नाति लम्बा् नाति कृ श नाति पीन युक्ि पपप्लकौ सुख प्रपनौ (च.शा.8/५३)  Not highly situated  Not too long  Not emaciated  Not too fatty  Should projected outwards, so baby can feed easily.
  • 3. Su.sha.10  ऊर्ध्वस्िनी- कराल क ु यावि्  लम्बस्िनी- नाससका-मुख- छादतयत््ा- मरण आपादयति  Can cause karal.
  • 4. A.s.u.1  पीनो अति- कन्धरा स्िम्भं क ु यावि्, उर्ध्ावक्षम ऊर्ध्वगःउच्च्च्च्््ास रोध  लम्बो अति- जीप्ि संशयम ्  गसभवणी- पाररगसभवक  Changing the milk frequently can cause adjustment problems in baby in term of taste, tolerance, palatability, digestion & metabolism.  GIT upsets.
  • 5. breast  Large modified sebaceous gland.  Assessory reproductive organ  Shape- varies in women, in different period of life. But size of base is constant.  2nd- 6th rib, in midclavical line
  • 6.  Lies in subcutaneous tissue over fascia covering, pactoralis major, saradus anterior and external oblique.  Lateral projection of breast towards axilla- axillary tail of spence.  Weight- 200- 300 gm at child bearing age
  • 7. Non lactating breast  Areola- centrally, pigmented, 2.5 cm diameter  Montgomery lands- assessory glands around periphery of areola. Can secret the milk.  Nipple- muscular projection covered by pigmented skin
  • 8.  Covered by unstriated muscles which make it erectile  Accommodates 15-20 lactiferous ducts and their opening  Each duct dilate to form its opening in the nipple  During feeding, by squeeze this, sinus opens in the mouth,
  • 9.  Whole breast embedded in subcutaneous fat. It absent in nipples and areola.  Mature breast- 20%- glandular tissue, 80% fat connective tissue  Each lobe has lactiferous duct  Each lobe has 10-100 lobule  Coopers ligament provide support to the breast
  • 10.  Alveolus- lined by squmous columnar epithelium  Alvioulus- alvioli- myoepithelium cells  Capillaries- lobules- lobe- lacteferous ducts- L.F.sinus
  • 11.  During pregnancy, hypertrophy and proliferation in alveoli, connective tissue.  Vascularity increase, bluish vein running under the skin.  Axillary tails present  Nipple- larger, erectile and deeply pigmented  Montgomery tubercles- secretions keep nippal moist and healthy.
  • 12. Stanya Sampata नायाव िु मधुरम ् स्िन्यं कषाय अनुरसं हिमम | नस्य आ्च्च्योिनयो: पथ्यं जी्नं लघु दीपनं || (सु. सू. ४५) • Sweetish, astringent (second dominant taste), cold nature, nutritive, easy to digest, improve digestion.
  • 13.  बृिण  सात्म्य  स्नेिन  िपवण  अक्षक्षरोगजजि….etc  प्रकृ ति ्णव गंध रस स्पशव  पुजटिकरं, आरोग्यकरम (च.शा.८ )
  • 14. Acc.To Kashyap Samhita अव्यािि बल अंग आयु अरोगो ्धविे सुखम | सशशु: धात्र्यो अनापपि: शुद्ध क्षीरस्य लक्षणं || (ka.su.19)
  • 15. composition  Varies genetic background, ethnic factor, age intake, parity, nutritional status, and dietary intake, delivery timing, duration of lactation.  Mainly…. Carbohydrate  Protein  Fat  Immunoglobulin's  Lysozome  Antiviral inhibitors
  • 16. Lactose highest- 7gm/dl •Sweeter thinner •Lactose convert in to lactic acid, which make baby stomach more acidic, prevent bacterial growth Protein- lowest concentration 1.1 g/dl Whey protein- 60:10- easy to digest Fat Lower 3.4g/dl •Triglyceride and small amount of di and monoglycerides, phospho lipid •Highest concentration of dha docosahexaenoic acid
  • 17.  Imunoglobuline- GAM  Iga, Igm secrets through milk  Iga highest concentration  Lymphoid cell, polymorphs, microphages, plasma cells.  Non protein nitrogen- urea, uric acid  Other constituents- steroid hormones, peptide, insulins, growth factors, minerals, vitamins, lipase.
  • 18. Type of breast milk  Colostrum  Transitional Milk:  Mature milk  Preterm milk  Foremilk  Hind milk
  • 19.  Breast milk is different in preterm and full term baby.  Milk is not species specific, it is baby specific.  Clolstrom  Thin, golden yellow in nature.  It secrets first 3 days after delivery.  Secretes in small quantity.  Carbohydrate and fat content is low  Rich in protein, loaded with imunoglobins, beta carotene.  Yellow color is due to beta-carotene  High in Iga, which works as first vaccine shot  Laxative effect prevent the billirubin build up.
  • 20.  Transitional milk  Two weeks before lactation established  Mature milk  After transitional milk  Thinner, watery, and contains all nutrients  Fore milk  It secrets at starting of the feed  Thin, watery, sweet in nature  Rich in protein, sugar, vitamins, minerals and water
  • 21.  Hind milk  It secrets end of the feed  Thicker, richer in fat and energy and satisfy the baby  Baby needs both hind and fore milk, for satisfaction of the thirst and hunger.  For that, mother have to completely empty one breast and after feed from other breast.
  • 22.  Drip milk  When feeding given from the one breast, drop of milk dripped out from the other breast.  Mainly secrets fore milk
  • 23. स्तन्योत्पत्ति रसप्रसादो मधुर: पक्् आिार तनसमिज: | कृ त्स्नदेिाि स्िनौ प्राप्िः स्िन्यसमस्यसभधीयिे || (सु. तन. अ. १० ) ससराणाम िहदस्थानाम् प््ृित््ाि प्रसूतििः | िृिीये अितन चिुथे ्ा स्रीणाम स्िन्यं प्र्िविे || (अ. ि. उ. १ )  दशवनाि  स्मरणाि  शब्द श्र्णाि  स्पशावि  संिषाि  सुप्रसन्न मन  स्नेिो तनरंिर ( सु. तन. १० )
  • 24.  यद अन्नपान प्रायेण गसभवणी स्री तनषे्िे- रसो- त्ररधा- (का.सू.लेिार्धयाय) एक अंश मािृ पुजटि िृिीयं स्िन पुजटि द्प्तिय गभव पुजटि
  • 25.  Existence of milk in female is compared with shukra in male.  Both are like ghee in milk and guda in ikshu.  Shukra sravana occurs by chesht yuvate darshan, smarana, shabda samsravana, sparsh, samharsha, suprasana mana.  Shukra and stanya forms earlier but functions only after hormonal influence, puberty.  Psycological factors- hypothalamic- pitutary, mammary axis
  • 26. Physiology of lactation  Depends on awareness, keenness and confidence- these are important factor for successive lactation.  Early bonding promotes it.  Rooming in, bed in, mother in  Early breast feeding  Avoid pre and post lacteal feed  Malnutrition does not significantly affect the adequacy of lactation but milk may deficiate in fat, vitamin and minerals.
  • 27. Physiology of lactation  Interaction between hormones and reflexes  Glandular tissue stimulation
  • 28. Prolactine reflex (Milk Secretion reflex) When baby sucks- nerve ending stimulates on nipple Carrie massage to A.P.G Release prolactine, milk produced according to demand Prolactine secrete by A.P.G. Stimulates glandular tissue of breast to produce milk
  • 29. Let down reflex  Ejection of the milk by…... Nerve stimulate by sucking, love, sight, smell, cry, touch Oxitocine released by P.P.G Contraction of myoepithelium Leads to ejection of milk in lactiferous sinus- ducts
  • 30. Stanya paana vidhi  First feeding given after 3 to 4 days after delivery. (su.shaa.10)  After that, maghu+ghruta in panitala pramana 2 times in a day 1st day Ananta churna+ madhu sarpi 3 times in day with mantra siddha 2nd day Lakshmanaa sidhdha ghruta 3rd day Lakshmana sidhdha ghruta
  • 31.  धारी स््ादु बिुल शुर्धध दुग्धा  स्नाि अनुसलप्ि शुक्ल ्स्रं  प्रजा स्थापन औषधध धारण  क ु मारं प्रांगमुखम  प्रथम दक्षक्षणं स्िनं पाययेि (ch.sha.8)
  • 32.  Prashasta tithi  Shirah snaata, upavasa  Dhaatri- praak mukhi, dakshina stana dhauta, ishata parisruta, abhimantra  नाना स्िन्य प्रयोग असात्म्याद व्याधध जन्म  If milk is not parisruta, by atistabdha, stanyapurna stan paan, utsuhit srotas- shishu becomes kaasa shwasamayi  To prevents sudden gushing of milk while baby sucking vigorously. By this chances of aspiration occurs. Sudden gushing can cause aspiration of milk in trachea.
  • 33. ्जवतयत््ा  जस्रयाः स्िन्यं आममे्, स्िन्य क्षीरे पाकतनषेध, अक््धथिे हििम  न क्षुधधि- dehydration, thirst  न शोकािव- psychologically depressed, , hypothalamo pitutary mammary axis  श्रान्ि- energy deficit  प्रदुटिधािु- illness  गसभवणी- paarigarbhik, phaakk  ज््र- risk of contamination  अतिक्षीण- malnourished  अतिस्थूल- obese  प्दग्ध- hot, spicy food  प्रुर्धधािार से्ी  अजीणव औषध- secrets in the milk
  • 34. Feeding problem  Drashti dosha- attractive, well sized breast attracts attention of people. They looked while mother feeds baby or other activity. Cause pain and flow reduction.  Stana kilaka- trun, kita, shuka, makshika are taken by the bhojana, gose in to sira of stana, cause obstruction, cause abscess  Virudhdhahar, khudhita, vichetasa- stanya roga kara  Vitiated by graha, shakuni, putana  Kshira alasaka- tridosha dushit dugdha.
  • 35. Common feeding problems  Prime gravid mother- anxiety, worry, lack of confidence  Mechanical- cleft lip, palate, incorrect sucking and swallowing in preterm.  Retracted nipple  Sore/ cracked nipple  Enlarged breast
  • 36.  Bottle feed  Formula feed  Sugar, honey, water, gripe water  Supplementary food  Painful condition like Breast engorgement, cracked nipples etc.  Lack of night feeding, Inadequate emptying of breast  Sick mother/ sick baby/ preterm baby  Anxiety, stress, lack of love, anger, not enough sleep etc.
  • 37. Breast feeding technique  Position- any comfortable position  Lie down or sitting  Should not leaning on the baby.  baby’s whole body supported. Not only neck or shoulder  Head and body are in one lie  Abdomen of baby and mother should touch  Nose- at level of the nipple
  • 38.
  • 39.  After birth baby should put on mothers abdomen.  In case of LSCS, put between the breast within 4 hrs.  Mother sit comfortably and keep head slightly raised and offer alternate breast at each feed.  Hollow of elbow- neck put comfortably, Back and buttocks supported by forearm and hand.  Touch baby cheek or side of mouth to her breast to stimulate rooting reflex.
  • 40.  For effective sucking, seal around nipple and areola should be done.  If sucks only nipple, milk is not ejected, and milk not properly taken by baby- vigorously suck and cause nipple sour.  During feed, if baby goes in to sleep, gentle tickling around the ear or soles, avoid tv during this.  Baby enjoys maternal warmth, cuddling  One breast should completely empty first than other breast.  After feeding should burp.
  • 41.  Healthy baby do have enough stores of glycogen and not need any complimentary feeds.  Bottle feed can cause contamination and diarrhea, nipple confusion, bottle teat is easy to suck.
  • 42. Signs of attachment  1. mouth widely open  2. nipple, areola should cover in mouth  3. chin should touches the breast  4. lower lip is everted
  • 43.
  • 44. Reflexes  1. rooting-  When cheeks/ side of mouth touch, baby opens the mouth.  Reflex is search for the nipple  Helps to find the nipple.  Sucking-  Palate is touched with nipple, baby starts suckling movement.  It is very strong and starts immediately after birth.  Sucking with bottle is passive process and baby has to control the flow of milk.  Breast feeding requires active efforts, nipple confusion and refuses to feed.
  • 45.  Swallowing reflex  When mouth is field wit milk, baby reflex swallow the milk. It requires couple of suckles to trigger swallowing reflex.  It requires coordination with breathing.  Suckle and swallow cycle lasts for one second.
  • 46. Advantages of Breast milk  Nutritive value – protein, fats, carbohydrates..  Digestibility  Lower risk of infection  Protects from allergy  Mental growth  Emotional bonding  Maternal advantages  Economic factors  Other
  • 47.  Always available- no preparation time  Proper temperature  Clean and fresh  Free of contaminating agents  Cheap
  • 48. Criteria for adequate feeding  Weight gain (1% per day)  Urine output (> 6 times/24 hours)
  • 49. Relactation: for continue production of milk  Emptying of milk 8-10 times/day  Suckle like procedure by fingers at areola (nipple exercise)  Night feeding (minimum 2 times)
  • 50. Examination of breastmilk  अप्सु परीक्षेि  शंख अ्भास  अप्सु नयस्िम एकीभा्ं गच्च्छति  अफ े तनलम, अिंिुम, न उत्प्ल्िे, न अ्सीदति  क ु मारस्य आरोग्यं, शरीर उपचय, बल ्ृजर्धध (सु.तन.१० )
  • 51. स्िन्याभा्े पथ्य व्य्स्था स्िन्याभा्े पय्छागं गव्यं ्ा िद गुणं पपबेि् | िस््ेन पञ्च मूलेन जस्थराभयां ्ा ससिा युिं ||  Ajaa/cow has modified as close as possible to level and constitution of human milk, given the strength to baby.  Hasva panchmula- may decrease the solute load  Sita- to componset less lactose.  Dhaatri- baby specific and species specific.
  • 52. स्तन्यनाश / स्तन्यक्षय Causative factors: शुकक्रोधलङ्घनआयासाः स्िन्य नाशस्य िेि्ः (अ.ि.उ.१)  क्रोर्धध, शोक, अ्ात्सल्य  लंघन, आयास  रुक्ष अन्नपान, कशवन  स्िन्य क्षये स्िन्योम्लावनिास्िन्य सम्भ्ो अल्पिा ्ा िर ्लेटम ्धवन द्रव्य उपयोगः (सु.सू.१५/१६)
  • 53. Treatment  स्िन्यस्य ससधु्ज्यावतन मधान्यानुपजाः रसाः |  क्षीरं क्षीररन्य औषधः शोकादवस्च प्पयवयः ||  स्िन्यजनन गण कषाय  क्षीरजनन मद्य ससधु ्ज्यव  शाक ससर्धधाथवक ्ज्यव  लसून प्लांडू से्न  मधुर अम्ल ल्ण भूतयटठ आिार  क्षीर पान  भय शोक आयास ्जवन  शयन सुख
  • 54. स्िन्य जनन कषाय  प्रण शाली षजटिक इक्षु्ासलका दभव क ु श काश गुन्द्रा इत्कि िृणमूलातन इति |
  • 55. स्िन्य शोधन कषाय  पाठा मिौषध सुरदारु मुस्िा मू्ाव गुडुधच ्त्सफ़ल ् ककरातिक्ि किुरोहिनी सारर्ा
  • 56. Medication to lactating mother  All medicine secrets in breast milk.  Minimize it by told to mother to take the drug after immediate feeding.  Anti cancer drug
  • 57. Artificial feeding  Infants formulas are food products designed to provide for the nutritional needs of infants under 1 year old who are not drinking breast milk.  They include powders , concentrated liquids or ready-to-use forms.  Infants formulas vary in nutrients , calorie count , taste, ability to be digested , and cost.
  • 58.  Almost all babies and infants do well on these formulas. These formulas are made with cow’s milk protein that has been changed to be more like breast milk.  Lactose and minerals from the cow’s milk ,as well as vegetable oils, minerals and vitamins also in the formula milk. Hypoallergic Formulas (Protein hydrolyzed Formulas)  This types of formula may be helpful for infants who cannot digest cow milk protein and for those with skin rashes or wheezing caused by allergies. It is more expensive than regular formulas.
  • 59.  Lactose-free Formulas- These formulas are used for galactosemia, lactose intolerance.  Soy- Based Formula- These formulas are made using soy protein. They do not contain lactose.
  • 60. Disadvantages of formula feeds  Chances of excess quantity feeding  Variation in dilutions and preparation  Not cost effective  Bacterial contamination
  • 61. Method of Feeding <30 wks <1200gm IV Fluid 30-32wks 1200-1500gm Naso/Oro gastric feeding 32-34wks >1800gm Spoon/palady/breast feeding
  • 62. Methods of feeding  Palade feeding  Spoon feeding  Bottle feeding  Gavage feeding- Naso gastric feeding Naso Jejuneal feednig
  • 63.  1st need of baby after birth is feeding.  Absence of mother, death, mechanical or pathological problems- alternative should search.  Human milk is species specific instead of animal milk.  Wet nurse, step mother, upmaata  Concept is not only for feeding, also for bathing, playing, caring.  To hold, to protect, to give shelter  One who protects and cares the baby in all its aspects.  पुर शरीर रक्षाथव स््शरीर उपशोषण  सिन्िे स्व दुखातन  Word meaning is to hold, to protect and to give shelter. Like amalki.. धात्री
  • 64. Examination of Dhatri  समान ्णो  यो्नस्था  अनािुर अव्यंग अव्यसन  क ु लेजािा  तनरोगी  अप्रूप  अजुगुजप्सि good mood, no psychological problems  देश जाति ्णव प्रकृ ति सम  अक्षुद्र कमव, न लोलुप no bed intention or behavior  जीप्ि ्त्सा – पु ्त्सा
  • 65.  बिु क्षीर, हिि आिार से्ी  अनुच्च्चारशातयनी  क ु शल उपचारा  शुधच, अशुधच द््ेषी  स्िन संपियुक्ि  ्यामा स्री प्रचुर क्षीरा भ्ति (दल्िण)  २ धारी (अ. ि.)
  • 66.  कृ शां च नटिपुटपां च बृियेिेन ससर्धयति  क्षार प्रधान औषध not given. प्रजा नाश कर  क्षारो धारीणां न शस्यिे  धारी स्िन्य प््ृर्धयथे मुदगयुष ् रसाशतन  स्िन्य शोधन and ्धवन गण  बला िैल, ्योनाक िैल, कपपत्थ िैल, मत्स्य िैल, सिकार िैल  गुरुअन्न स्नेि मांसातन हद्ा स््ाप ् ्जवयेि
  • 67. चिकित्सा (का.धच.१९)  सुखम दुखम हि बालानाम धारीमूलम  तनत्य संशोधनपरा, तनत्य प्रेचन  अजीणव अपप न शस्यिे  तिक्षनाजग्न-बृिणं  मन्दाजग्न- दीपन  प्षमाजग्न- पथ्यािार  षट्पल & कल्याणक घृि use  म्रक्षण, उद््िवन स्नान, शुक्लांबर, धमवरति- साजत््क आिारमेद्जस््नां धारीणां ससराकमव प्रशस्यिे  स्नेिन-स््ेदन् शोधन
  • 68. Human Milk Banking  Includes screening, collecting, processing, storing, and distribution of donating milk.  Who and unisef- biological mother – not possible to feed- used human milk fro another sources.  Banked/ pooled milk is best next option  Most suitable for preterm, sick baby  PDHM-pasturised donor human milk
  • 69. Indication  Inadequate lactation  Flat/ inverted nipple  Multiple baby  Orphaned neonate  Nicu  Risk of breast milk  Temporary interruption  Formula intolerance  Diarrhea  Imuno deficiency  hiv
  • 70. 1. screening  Major issue is transmission of infection via milk.  Detailed medical history of donor is taken  Blood screening for hiv, hepatitis b and c, syphilis  Consent taken by donor and doctor both, neither her or her infant suffer from disease.
  • 71. 2. collection  Strict aseptic precautions are taken  Bacterial count before pasteurization - <103 colony forming unit  Pasteurization- 560C for 30minutes  By those, most of virus and bacteria killed without compromisation in nutritional, immunological property  Again check for microbial growth.
  • 72. 3. storage 40 C 72 hours -200C 3-6 month -370C frozen