Breastfeeding should be sustained for at least 6 months exclusively and continued until 24 months with the introduction of complementary foods at 6 months. The mother has primary responsibility to sustain breastfeeding but requires support from family, community, employers, educators, media, healthcare workers, and national policies. Sustaining breastfeeding long-term involves addressing issues at multiple levels from individual knowledge and skills to societal mindsets and resource allocation by the nation.

1. Dr Shivu P.
MBBS, DCH.
Consultant in Pediatrics,
GGSVMH, Mysuru.
No. 757, Vinayamarga,
11th cross, Siddarthanagar,
Mysore 11. PIN: 570011.
Mobile number:
9448477380,
Land phone: 0821 2561277,
0821 4000778
Mail:
shivup.183@gmail.com
Visit:
www.slideshare.net/drshivu

2. India: National Family Health Survey. 2015-16
NFHS 4
2005 – 06
NFHS 3
Children under the age of 3 years breast fed within
one hour of birth (%)
41.6 23.4
42.8
Urban
41.1
Rural
Children under the age of 6 months exclusively breast
fed (%)
54.9 46.4
52.1
Urban
56.0
Rural

3. Karnataka: National Family Health Survey. 2015-16
NFHS 4
2005 – 06
NFHS 3
Children under the age of 3 years breast fed within
one hour of birth (%)
56.4 35.6
53.7
Urban
58.2
Rural
Children under the age of 6 months exclusively breast
fed (%)
54.4 58.6
46.9
Urban
58.2
Rural

4. Mysuru: National Family Health Survey. 2015-16
NFHS 4
2005 – 06
NFHS 3
Children under the age of 3 years breast fed within
one hour of birth (%)
51.6 NA
34.1
Urban
63.6
Rural
Children under the age of 6 months exclusively breast
fed (%)
NA NA

5. • Sustaining for how
long?
• Who has to sustain?
• Who are all responsible
for sustaining?

6. • Breast feeding?
• Feeding the child with
the breast milk directly
from the breast.

7. • No contamination,
• No adulteration,
• At correct temperature,
• Hygienic,
• Nutritious,
• Species specific,
• Gestation specific,
• Contains protecting cells – no one can
manufacture this.
• Economic,
• Mother friendly,
• Baby friendly,
• Less disturbance to the family / neighbors /
society,
• Environmental friendly – less waste generation.
• Nation friendly: saves lakhs of rupees to the
family, crore of rupees to the nation.
• Creates Positive health for the mother,
• Creates Positive health for the baby,
Feeding the child
with the breast milk
directly from the
breast – why?

8. • Mother,
• Baby,
• Family members,
• Community,
• Employer,
• Education,
• Media,
• Mindset of the people,
• Health personnel.
• Indigenous people.
• Nation,
Together means?

9. • Sustaining for how long?
• Six months - exclusive
breast feeding.
• Continue till the age of
twenty four months.
• Weaning six months
onwards.

10. Who has to sustain?
The primary person involved in this
process is the mother,
She has to get the support from all the
people like the husband, parents,
family members, neighbors,
community, employer, nation.

11. • What are the needs from the
mother side to sustain the breast
feeding.
• Normal anatomy of the breast,
• Normal physiology,
• Good secretion,
• Gained knowledge / skill of
feeding the baby.

12. Normal physiology

13. • Lactiferous glands (Milk secreting glands);
the exocrine gland which secretes the milk
by extracting the nutrients from the
interstitial space and from the blood. The
muscle cells which surrounds the gland helps
the gland to contract and make the milk to
flow towards the ducts.
Note: the secretion of milk from the gland and
its contents depends on the nutrition of the
mother. Good nutrition is vital in secreting
good quality and quantity of milk.

14. Good nutrition is vital both in pregnancy
and lactation as the body gains about 12
kgs in pregnancy in which the breast is
going to gain 1 to 2 kgs of weight.
Who influences all these things:
Mothers own knowledge on diet,
family knowledge on diet and cooking,
family economy / income,
the nation and the policy which influences
their income directly and indirectly.

15. • Love and affection, is the physiological process
through which the blood vessels relax and
maintain the normal pressure under
physiological condition, make the blood
supply to the breast optimum and facilitates
the milk secretion, not only in the feeding
breast, but even from the opposite breast.
• Mother child bondage, relations and
affections among the family members /
relatives / community are the determinants of
love and affection.

16. Gained knowledge / skill of feeding the baby
– Good feeding technique is the key to the
successful feeding establishment.
Seniors, education, health personnel's,
mothers own knowledge on breast feeding ,
her courage to face the ill guiding people are
some of the determinants .

17. Breast feeding and Physics - Pressure.

18. Breast feeding and Physics-
Circumferential pressure.

19. Breast feeding and
Physics-
Suction Pressure.

20. Breast feeding and physics.
Circumferential pressure and suction
pressure.

21. Good position in breast feeding
Baby’s body is well supported.
Baby is held close to the mother.
The entire body of the baby is turned
towards the mother (But not only the
head).
Baby’s head is in close contact with the
mother with good attachment to the nipple
and areola.
Baby’s abdomen is in close contact with
the abdomen of the mother.
With this the baby ‘s mouth, chin and the
umbilicus will come in straight line (i.e. the
head, neck, and the body of the baby are
kept in the same plain).

22. Good position in breast feeding
Chin of the baby is in close contact with the breast , that is there is no gap between the
breast and the chin of the baby.
Most of the areola of the breast is inside the mouth of the baby.
Baby’s mouth is wide open.
Tongue of the baby latches the nipple and areola.
Lips are everted out (turned out) and grasping the areola well.
Lips and gums are fitted firmly and circumferentially like a purse string, over the areola in
air tight fashion.

23. Bad position in breast feeding

24. Poor attachment.

25. Poor attachment.

26. Good attachment.

27. Good attachment.

28. Good
attachment.
If the baby breast feeds with good
attachment then only the milk will be filled
inside the stomach and there is no collection
of air.
Even then it is better to burp for about 20
minutes after each feed because, even a
minute amount of air can also cause problem.

29. Poor attachment.
If there is poor attachment then some amount of air will enter in to the mouth through the
gap between the mouth of the baby and the breast, that will enter in to the stomach as the
baby swallows the milk mixed with the bubbles of air.
Later they may enter in to the intestine where they form the air columns or the child may
vomit the milk as the air bubbles comes out through the esophagus and then through the nose
and mouth.

30. What are the needs from
the baby side to
sustain the breast
feeding.
Healthy baby.
Baby who is able to feed.

31. If the Baby is unable to sustain breast feeding.
Then, Who is going to take care of such neonates?
Who is going to look after the neonates at the time of its
entry to this world in a condition where breast feeding
is going to be sustainable.
Who is going to train the people who make the entry of the
neonate to this world in a condition where breast
feeding is going to be sustainable in an affordable way
even in the small villages.
Where you are going to take care? NICU /Ward – Public /
Private.

32. What are the prerequisites for the sustainability of breast
feeding?
Good ANC care,
Good fetal monitoring,
Good nutrition to the mother,
Delivering the baby in a condition where the baby is able to
establish breast feed immediately and sustain in long run,
Good care of the new born till they are able sustain breast
feeding.
Economic influence on these issues both in public and private
sector.
Generation of required qualified skilled work personnel for
the same in a economical way and making them to serve
even in the peripheries meeting all their requirement to
serve the people without any compromise.

33. How family members can involve in the
process of sustaining breast feeding?
Unit family issues,
Combined family issues,
Showing love and affection to the
mother and the baby,
Helping the mother in the process of
feeding, burping, caring the mother
and newborn.
Providing adequate rest to the mother
by sharing house hold works.

34. Burping after the feed.
As the air is lighter than fluid (that is the milk) all the air bubbles will fuse at the top of
the stomach (that is at the fundus of the stomach) when the baby is kept in erect
posture either over the shoulder or over the lap. This fused air bubble (that is only the
air) will come out through the mouth of the baby leaving only the milk which is settled
at the bottom (Body and the Pylorus) of the stomach . Thus only milk will enter in the
intestine.

35. Poor burping – Short burping – No burping.
• Will lead to vomiting, as the air tries to come out of the
stomach which is mixed with milk.
• Air mixed milk may come out both through the mouth and
nostrils.
• When the milk sticks to the nose, they may get discomfort
in the nose or blocked nose and the baby does not know
how to clear the nose and it will not be able breath
through the nose, so it will continuously cry to breath
himself through the mouth.
• Baby may be hungry, but it will not be able to feed as the
mouth is going to be covered with breast during the breast
feeding and the nose is already blocked and it gets
suffocated if it tries to feed.

36. Poor burping – Short burping – No burping.
• The air which enters the small intestine makes the
intestine to bloat up and thus the baby gets the
pain in the abdomen, and the baby will cry with
this pain disturbing the entire family and the
neighbors, till the air gets out of the intestine from
the bottom as flatus.
The air columns which are formed between the milk in the lumen of the intestine and the
wall of the intestine will interfere with the digestion and absorption of the milk and thus
poor weight gain by the baby.
Lack of sleep by the baby make it irritable child with poor growth and poor performance in
the life.
Sleepless night by the members of the family may interfere with the earning by the family
members.

37. Burping after the feed
Any one in the family can involve in this lovely job of burping and enjoying with the baby.

38. • Community:
• Breast feeding support group.
• Neighbors helping in the care of the mother
/ baby,
• Tolerating the baby’s cry,
• Showering love and affection to the mother
and the baby,
• Giving good and useful advises,
• Guiding the mother with their experiences.

39. • Employer,
• Providing suitable working hours to
the pregnant and feeding mothers,
• Infant caring centers at working
place,
• Feeding places,
• Maternity / Paternity leave,
• Toilets,

40. • Education,
• How the mother is going to get the knowledge
about the breast feeding,
• When she is going to get this knowledge,
• How mistakes in breast feeding can be
avoided,
• Who is going to identify the mistakes
• Who is going to identify the problems with
the breast and breast feeding and manage the
same?

41. • Education.
• Should we hide all these knowledge and make
both the mother and the baby to suffer later?
• If we are educating in these issues which is the
right time - degree courses / high school ?
• Do all the girls go to school, if so till what class
– thus how many mothers we are going to miss
in the process of educating in breast feeding
skills?

42. • Media.
• How to reach the unreached?
• How often the media needs to address
these issues?
• If it is not commercialized, then whether
that media is going to sustain or not?
• If so who is going to support them
economically?

43. Mindset of the people:
Should we talk these things openly or behind the
screen?
What are the problems which can arise if it
becomes an open discussions?
What are the mistakes which can happen if these
aspects remains behind the screen?
Do our people need to change to save this
environment?

44. • Health personnel:
• ?SBA
• LHW’
• Staff nurses’
• Doctors,
• Super specialists,
• Their generation cost,
• Their stay,
• Their sustainability in service at different geographical
places,
• Updates in the field for the same people.

45. • Indigenous people.
• Easy availability,
• Their perceptions,
• Their cultural influences,
• Taboos and superstitions they follow.
• Faith on them by the elders and family
members.

46. • Nation.
• Its understanding capabilities on these issues and
if the nations understands these issues then the
next is how fast it understands and creates policies
for the same e. g. maternity leave.
• The money spent on these issues for promotion,
manpower / generation of skilled personnel,
infrastructure, implementation, incorporating
these issues in education all these needs to be
done by the nation.

47. • Sustaining for how long?
• Who has to sustain?
• Who are all responsible for
sustaining?
• It is every ones responsibility
starting from the baby to the leaders
of the nation and all together
working makes the breast feeding
sustainable in long run.