Este artigo publicado no Pediatrics tenta analisar e relacionar o volume e frequência das mamadas com o conteúdo de gordura do leite materno durante 24h.
Conclui que os lactentes devem ser amamentados em livre demanda de dia e de noite.
Moringa is a plantfood of high nutritional value, ecologically and economically beneficial and readily available in the countries hardest hit by the food crisis. http://miracletrees.org/ http://moringatrees.org/
Estamos nos preparando para em 2019 comemorar 40 anos desse Cuidado tão especial para os recém natos prematuros e suas mães.
Nessa publicação científica cita muitos trabalhos brasileiros.
Prof. Marcus Renato de Carvalho
Aleitamento materno e adiposidade adultaLaped Ufrn
Aleitamento materno e adiposidade adulta (JPed 2014) - Artigo apresentado em Reunião Científica da Liga Acadêmica de Pediatria da UFRN - LAPED UFRN - Natal - RN - Brasil.
Moringa is a plantfood of high nutritional value, ecologically and economically beneficial and readily available in the countries hardest hit by the food crisis. http://miracletrees.org/ http://moringatrees.org/
Estamos nos preparando para em 2019 comemorar 40 anos desse Cuidado tão especial para os recém natos prematuros e suas mães.
Nessa publicação científica cita muitos trabalhos brasileiros.
Prof. Marcus Renato de Carvalho
Aleitamento materno e adiposidade adultaLaped Ufrn
Aleitamento materno e adiposidade adulta (JPed 2014) - Artigo apresentado em Reunião Científica da Liga Acadêmica de Pediatria da UFRN - LAPED UFRN - Natal - RN - Brasil.
Constraints of exclusive breastfeeding practice among breastfeeding mothers i...Oba Adeboye
Exclusive breastfeeding is recommended for the first six months of life as the best way of feeding an infant. The result of this study will increase the knowledge and encourage mothers on exclusive breastfeeding in Alimosho General Hospital, Igando and also show them the dangers of not practicing exclusive breastfeeding. It will also help the Nurse to debunk myths about exclusive breastfeeding. Using a concurrent mixed method approach, a structured questionnaire was administered to 100 breastfeeding mothers. Breastfeeding was perceived as essential to baby's health. It strengthens the physical and spiritual bond between mothers and their children. Exclusive breastfeeding was considered essential but demanding. The research however reveals larger percentage of the respondents are between 25-35 years in the study
Breast feeding and complimentary feeding are two best practices which reduce infant mortality and morbidity.this presentation will be helpful in understanding the art and science of both interventions.
Semana Mundial de la Lactancia Materna 2015
Amamantar y trabajar: ¡Hagamos que sea posible!
La lactancia materna beneficia a los bebés, a las madres y a las empresas.
Entre los beneficios para el empleador:
Lealtad con la empresa como resultado de la gratitud y la satisfacción
Menor ausentismo porque los bebés se enferman con menos frecuencia y menor gravedad
Retención de empleados (lo cual reduce la necesidad de capacitación y la pérdida de personal calificado)
Mayor productividad
Los gobiernos, los empleadores, los compañeros de trabajo y la comunidad pueden ayudar a las mujeres que trabajan fuera de casa a continuar amamantando a sus bebés. Las facilidades básicas que deben ser proporcionadas son:Licencia por maternidad, sala de lactancia y menos horas de trabajo o un horario flexible durante la lactancia
Folletos sobre Lactancia Materna y Trabajo para Empresarios.
Amanhã publicaremos o 3o. e último folheto dessa sério da OPAS/OMS
Parabéns!
Semana Mundial de la Lactancia Materna 2015
Amamantar y trabajar: ¡Hagamos que sea posible!
La lactancia materna beneficia a los bebés, a las madres y a las empresas.
Entre los beneficios para el empleador:
Lealtad con la empresa como resultado de la gratitud y la satisfacción
Menor ausentismo porque los bebés se enferman con menos frecuencia y menor gravedad
Retención de empleados (lo cual reduce la necesidad de capacitación y la pérdida de personal calificado)
Mayor productividad
Los gobiernos, los empleadores, los compañeros de trabajo y la comunidad pueden ayudar a las mujeres que trabajan fuera de casa a continuar amamantando a sus bebés. Las facilidades básicas que deben ser proporcionadas son:Licencia por maternidad, sala de lactancia y menos horas de trabajo o un horario flexible durante la lactancia
Folletos sobre Lactancia Materna y Trabajo para l@s compañer@s do trabajo
Amanhã publicaremos o 3o. e último folheto dessa sério da OPAS/OMS
Parabéns!
Constraints of exclusive breastfeeding practice among breastfeeding mothers i...Oba Adeboye
Exclusive breastfeeding is recommended for the first six months of life as the best way of feeding an infant. The result of this study will increase the knowledge and encourage mothers on exclusive breastfeeding in Alimosho General Hospital, Igando and also show them the dangers of not practicing exclusive breastfeeding. It will also help the Nurse to debunk myths about exclusive breastfeeding. Using a concurrent mixed method approach, a structured questionnaire was administered to 100 breastfeeding mothers. Breastfeeding was perceived as essential to baby's health. It strengthens the physical and spiritual bond between mothers and their children. Exclusive breastfeeding was considered essential but demanding. The research however reveals larger percentage of the respondents are between 25-35 years in the study
Breast feeding and complimentary feeding are two best practices which reduce infant mortality and morbidity.this presentation will be helpful in understanding the art and science of both interventions.
Semana Mundial de la Lactancia Materna 2015
Amamantar y trabajar: ¡Hagamos que sea posible!
La lactancia materna beneficia a los bebés, a las madres y a las empresas.
Entre los beneficios para el empleador:
Lealtad con la empresa como resultado de la gratitud y la satisfacción
Menor ausentismo porque los bebés se enferman con menos frecuencia y menor gravedad
Retención de empleados (lo cual reduce la necesidad de capacitación y la pérdida de personal calificado)
Mayor productividad
Los gobiernos, los empleadores, los compañeros de trabajo y la comunidad pueden ayudar a las mujeres que trabajan fuera de casa a continuar amamantando a sus bebés. Las facilidades básicas que deben ser proporcionadas son:Licencia por maternidad, sala de lactancia y menos horas de trabajo o un horario flexible durante la lactancia
Folletos sobre Lactancia Materna y Trabajo para Empresarios.
Amanhã publicaremos o 3o. e último folheto dessa sério da OPAS/OMS
Parabéns!
Semana Mundial de la Lactancia Materna 2015
Amamantar y trabajar: ¡Hagamos que sea posible!
La lactancia materna beneficia a los bebés, a las madres y a las empresas.
Entre los beneficios para el empleador:
Lealtad con la empresa como resultado de la gratitud y la satisfacción
Menor ausentismo porque los bebés se enferman con menos frecuencia y menor gravedad
Retención de empleados (lo cual reduce la necesidad de capacitación y la pérdida de personal calificado)
Mayor productividad
Los gobiernos, los empleadores, los compañeros de trabajo y la comunidad pueden ayudar a las mujeres que trabajan fuera de casa a continuar amamantando a sus bebés. Las facilidades básicas que deben ser proporcionadas son:Licencia por maternidad, sala de lactancia y menos horas de trabajo o un horario flexible durante la lactancia
Folletos sobre Lactancia Materna y Trabajo para l@s compañer@s do trabajo
Amanhã publicaremos o 3o. e último folheto dessa sério da OPAS/OMS
Parabéns!
p&f wineries is a young family owned winery from Slovenia that rapidly expanded from exporting to two countries (in 2009) to more than 18 countries today. At this moment we are the most succesfull export cellar from Slovenia, producing yearly over 610.000 9 liter cases. Our modern approach to winemaking combined with creative passion for marketing, proofed to open new doors to exporting markets.
http://pfwineries.com/
Estamos realizando o II CONGRESSO VIRTUAL DE ALEITAMENTO MATERNO (CONVIAM) nos dias 23 e 24 de maio de 2013.
E resolvemos mostrar como foi o I Congresso em 2011 - reunindo dados dos participantes em uma bela apresentação feita pela Branda Luz da FW2 Agência Digital.
Em ano que não teremos ENAM ou Congresso de Bancos de Leite. Um desafio operacional para todos nós: conferencistas, participantes, organizadores, técnicos de informática, apoiadores...
Mais uma forma de nos prepararmos para a Semana Mundial de Aleitamento cujo tema é a “Aconselhamento” para evidenciar a importância da escuta empática por profissionais de saúde e/ou mães experientes.
A experiência de pioneirismo na web com o aleitamento.com que este ano comemora 17 anos nos motivou. O sucesso do I Congresso Virtual realizado em 2011 mostrou que é viável este empreendimento.
Devido a limitações técnicas e humanas nosso Congresso tem uma programação diária de 5-6h “ao vivo” conforme recomendações para este tipo de evento. Contudo, no site do evento, para os congressistas haverá um resumo do conteúdo sobre os temas abordados: artigos, fotos, vídeos, livros...
Teremos nesta 2ª. edição do ConViAM um número de conferencistas aquém do que gostaríamos. Muitos amigos e profissionais não puderam ser convidados, devido apenas a limitações de espaço. Entretanto, teremos uma equipe de renomados docentes, especialistas, experientes e atuantes profissionais de diferentes formações – uma equipe interdisciplinar.
En el marco del curso Nutrición y otras recomendaciones a la medre que amamanta, desarrollado por el programa SOS Telemedicina, se presenta la conferencia de la Dra. Evelyn Niño sobre Mujer – lactancia y trabajo.
Uma imagem vale mais do que 1.000 palavras!
CHARGE é um estilo de ilustração que tem por finalidade satirizar, por meio de uma caricatura, relatar algum acontecimento atual com um ou mais personagens envolvidos. A palavra é de origem francesa e significa carga, ou seja, exagera traços do caráter de alguém ou de algo para torná-lo burlesco. Muito utilizadas em críticas políticas no Brasil (Wikipedia).
A redução da maioridade penal precisa ser mais debatida na sociedade brasileira e com essa 3a. edição já chegamos a 75 charges que criticam essa medida que está sendo tomada de forma apressada.
Prof. Marcus Renato de Carvalho - Faculdade de Medicina - UFRJ.
Divulgação do PPGCC e Eventos da UFPB 2015Felipe Pontes
Essa apresentação foi feita no III Talking Management, no dia 28/09/2015 no Unibê Business School.
Nesta apresentação são divulgados os eventos da UFPB, assim como o nosso PPGCC.
Promoção da amamentação e alimentação complementar
Projeto de Inclusão Social e Desenvolvimento Comunitário
Amamentação e alimentação saudável para crianças pequenas
Tendo em vista a importância da Segurança Alimentar e Nutricional, o Senac São Paulo e o Santander Universidades disponibilizam esta cartilha que tem como objetivo apoiar ações de promoção da amamentação e alimentação complementar para crianças menores de dois anos. Esta ação integra o “Projeto de Inclusão Social e Desenvolvimento Comunitário” que oferece atividades educacionais voltadas à melhoria da qualidade de vida das populações e que são comprometidas com a responsabilidade social e ambiental e a valorização da cidadania das comunidades. Esta cartilha foi elaborada para ajudar você a tirar as dúvidas mais comuns e fornecer algumas dicas que podem auxiliar a amamentação e introdução de novos alimentos. Dessa forma, deverá contribuir com as políticas públicas em desenvolvimento no país e estabelecer uma mobilização nacional dirigida à redução da mortalidade infantil.
A amamentação é mais fácil quando as mães têm informações sobre as práticas saudáveis para ela e para os seus bebês, incluindo a importância do aleitamento exclusivo durante os primeiros seis meses de vida. Mesmo quando existem obstáculos, a amamentação pode ser mantida se as mães receberem a compreensão e apoio dos familiares, dos amigos, da equipe de saúde e no seu ambiente de trabalho. A crescente urbanização e as mudanças nas estruturas familiares têm debilitado estes mecanismos de apoio social.
* Expediente
Coordenação Geral: Senac São Paulo
Gerência de Desenvolvimento: Área Desenvolvimento Social
Organizador: Jorge Carlos Silveira Duarte
Textos: Julio Gaspar Ana Julia Colameo
Revisão e ampliação: Jeanini Maria Salve Rosana De Divitis Siomara Roberta de Siqueira
Ilustrações: Rogério Augusto
Projeto gráfico: ASA Assessoria e Comunicação
Expressed breast milk on refrigerator storageAsha Reddy
In conclusion, we can store mother’s milk at refrigerator temperature of 4ºC for 96 hours without changing its overall integrity in the form of pH, serum albumin, total protein, lipid and lactose content and can use it for feeding neonates and infants.
CLINICAL BRIEF
A Quality Improvement Initiative: Improving Exclusive
Breastfeeding Rates of Preterm Neonates
Amanpreet Sethi1 & Meena Joshi1 & Anu Thukral1 & Jagjit Singh Dalal1 &
Ashok Kumar Deorari1
Received: 7 October 2016 /Accepted: 31 January 2017 /Published online: 24 February 2017
# Dr. K C Chaudhuri Foundation 2017
Abstract This study is a single center quality improve-
ment (QI) initiative in a tertiary care neonatal intensive
care unit which was done with an objective to increase
the proportion of neonates receiving mother’s own milk
(at postnatal age of 7 d) from the current rate of 12.5%
to 30% over a period of six weeks. Additional objec-
tives were to evaluate the proportion of mothers’ ex-
pressing breast milk within 3 h of birth, on day one
and three and the amount of expressed breast milk
(EBM) on day one and day seven. A team was formu-
lated to evaluate the reasons for inadequate breast milk
expression and to plan the steps for promoting the
same. Comprehensive postnatal breast feeding counsel-
ing (CPNC) to promote early breast milk expression
was initiated soon after the birth of a preterm neonate.
CPNC was done for next fifteen mothers and their
breast feeding support was streamlined. The effect of
CPNC and teamwork was discussed amongst the team
members every day and adjustments incorporated (Plan-
Do-Study-Act cycle). The proportion of neonates receiv-
ing mother’s only milk (MOM) on day 7 increased to
80% (12/15) after 4 wk of QI. Thus, a simple and
feasible CPNC package lead to improved breast milk
output in mothers.
Keywords Breast milk . Neonate . Quality improvement
Introduction
Exclusive breastfeeding for six months is the most effective
preventive strategy for under-five mortality [1]. Host resis-
tance factors are abundant in fresh breast milk and when prop-
erly collected and stored, it provides the highest quality of
anti-infective properties. [2, 3] However, for various reasons,
mothers of these neonates face multiple challenges in estab-
lishing and maintaining an adequate supply of milk, this phe-
nomenon being more common in preterm neonates [4, 5]. The
gap in current evidence based implementation is the strategy
to reduce the time to first milk expression and to increase
frequency of expression and night time expression of milk in
these mothers. It is also known that mothers of extremely
preterm neonates should be taught early and effective milk
expression techniques [6].
The authors identified problem of delayed breast milk ex-
pression by mothers of preterm neonates whose babies were
admitted in the neonatal intensive care unit (NICU). The fre-
quency of milk expression in these mothers was limited to two
to three times in the entire day leading to most neonates re-
ceiving predominant formula feed for the first one week.
In view of the existing evidence and the identified problem,
the authors formulated an aim to increase the proportion of
breast milk intake in the admitted preterm neonates o.
CLINICAL BRIEF
A Quality Improvement Initiative: Improving Exclusive
Breastfeeding Rates of Preterm Neonates
Amanpreet Sethi1 & Meena Joshi1 & Anu Thukral1 & Jagjit Singh Dalal1 &
Ashok Kumar Deorari1
Received: 7 October 2016 /Accepted: 31 January 2017 /Published online: 24 February 2017
# Dr. K C Chaudhuri Foundation 2017
Abstract This study is a single center quality improve-
ment (QI) initiative in a tertiary care neonatal intensive
care unit which was done with an objective to increase
the proportion of neonates receiving mother’s own milk
(at postnatal age of 7 d) from the current rate of 12.5%
to 30% over a period of six weeks. Additional objec-
tives were to evaluate the proportion of mothers’ ex-
pressing breast milk within 3 h of birth, on day one
and three and the amount of expressed breast milk
(EBM) on day one and day seven. A team was formu-
lated to evaluate the reasons for inadequate breast milk
expression and to plan the steps for promoting the
same. Comprehensive postnatal breast feeding counsel-
ing (CPNC) to promote early breast milk expression
was initiated soon after the birth of a preterm neonate.
CPNC was done for next fifteen mothers and their
breast feeding support was streamlined. The effect of
CPNC and teamwork was discussed amongst the team
members every day and adjustments incorporated (Plan-
Do-Study-Act cycle). The proportion of neonates receiv-
ing mother’s only milk (MOM) on day 7 increased to
80% (12/15) after 4 wk of QI. Thus, a simple and
feasible CPNC package lead to improved breast milk
output in mothers.
Keywords Breast milk . Neonate . Quality improvement
Introduction
Exclusive breastfeeding for six months is the most effective
preventive strategy for under-five mortality [1]. Host resis-
tance factors are abundant in fresh breast milk and when prop-
erly collected and stored, it provides the highest quality of
anti-infective properties. [2, 3] However, for various reasons,
mothers of these neonates face multiple challenges in estab-
lishing and maintaining an adequate supply of milk, this phe-
nomenon being more common in preterm neonates [4, 5]. The
gap in current evidence based implementation is the strategy
to reduce the time to first milk expression and to increase
frequency of expression and night time expression of milk in
these mothers. It is also known that mothers of extremely
preterm neonates should be taught early and effective milk
expression techniques [6].
The authors identified problem of delayed breast milk ex-
pression by mothers of preterm neonates whose babies were
admitted in the neonatal intensive care unit (NICU). The fre-
quency of milk expression in these mothers was limited to two
to three times in the entire day leading to most neonates re-
ceiving predominant formula feed for the first one week.
In view of the existing evidence and the identified problem,
the authors formulated an aim to increase the proportion of
breast milk intake in the admitted preterm neonates o ...
Concepção, gravidez, parto e pós-parto: perspectivas feministas e interseccionais
Livro integra a coleção Temas em Saúde Coletiva
A mais recente publicação do Instituto de SP traça a evolução da política de saúde voltada para as mulheres e pessoas que engravidam no Brasil ao longo dos últimos cinquenta anos.
A publicação se inicia com uma análise aprofundada de dois conceitos fundamentais: gênero e interseccionalidade. Ao abordar questões de saúde da mulher, considera-se o contexto social no qual a mulher está inserida, levando em conta sua classe, raça e gênero. Um dos pontos centrais deste livro é a transformação na assistência ao parto, influenciada significativamente pelos movimentos sociais, que desde a década de 1980 denunciam o uso irracional de tecnologia na assistência.
Essas iniciativas se integraram ao movimento emergente de avaliação tecnológica em saúde e medicina baseada em evidências, resultando em estudos substanciais que impulsionaram mudanças significativas, muitas das quais são discutidas nesta edição. Esta edição tem como objetivo fomentar o debate na área da saúde, contribuindo para a formação de profissionais para o SUS e auxiliando na formulação de políticas públicas por meio de uma discussão abrangente de conceitos e tendências do campo da Saúde Coletiva.
Esta edição amplia a compreensão das diversas facetas envolvidas na garantia de assistência durante o período reprodutivo, promovendo uma abordagem livre de preconceitos, discriminação e opressão, pautada principalmente nos direitos humanos.
Dois capítulos se destacam: ‘“A pulseirinha do papai”: heteronormatividade na assistência à saúde materna prestada a casais de mulheres em São Paulo’, e ‘Políticas Públicas de Gestação, Práticas e Experiências Discursivas de Gravidez Trans masculina’.
Parabéns às autoras e organizadoras!
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Existem cada vez mais evidências de que os setores de bebidas e alimentos ultra processados, fórmulas infantis, micronutrientes, pesticidas e manipulação genética de alimentos, além de atores associados, frequentemente tentam atrasar, enfraquecer, distorcer e/ou impedir o desenvolvimento de políticas e programas de alimentação e nutrição que possam contribuir efetivamente para sistemas alimentares mais saudáveis e sustentáveis.
Este documento estabelece um roteiro para introduzir e implementar, na Região das Américas, o Projeto de abordagem da OMS para a prevenção e gestão de conflitos de interesse na formulação de políticas e implementação de programas de nutrição no âmbito nacional, publicado pela OMS em dezembro de 2017.
Conflito de interesse segundo a OMS é uma situação em que o interesse primário de uma instituição pode ser indevidamente influenciado pelo interesse de um ator não estatal, de tal forma que afete (ou possa parecer afetar) a independência e objetividade do trabalho do governo no campo da saúde pública.
O projeto de abordagem da OMS é um processo decisório cujo objetivo é ajudar os Estados a identificar, prevenir e gerenciar potenciais conflitos de interesse quando da sua interação com atores não estatais (principalmente comerciais) nas políticas e programas de nutrição.
Considerando a complexidade do projeto de abordagem da OMS, este documento também fornece uma 'ferramenta de triagem' simplificada para apoiar e permitir sua aplicação.
Essa ferramenta de triagem foi desenvolvida pela OPAS, com o apoio de funcionários de ministérios da saúde e de organizações da sociedade civil.
Este roteiro tem como objetivos:
- apresentar os princípios fundamentais da abordagem da OMS aos tomadores de decisão das agências governamentais relevantes;
- adaptar e desenvolver formatos complementares da abordagem da OMS que se encaixem nos processos decisórios existentes em nível nacional;
- e complementar a ferramenta completa da OMS com uma ferramenta de triagem mais curta para aumentar a acessibilidade e possibilitar um envolvimento e uso mais efetivos na tomada de decisões relativas a potenciais interações com atores não estatais.
A publicação explica como esses objetivos podem ser abordados usando um método em 3 estágios. Ela também inclui anexos que cobrem estudos de caso, programas para oficinas e uma ferramenta de triagem para avaliar potenciais interações com atores não estatais: indústrias, comerciantes, empresas... Inclusive, no patrocínio de Congressos, Encontros, Reuniões científicas e apoio as Associações e Sociedades de profissionais de saúde.
Recomendamos!
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Promoção comercial dos ditos substitutos do leite materno:
Implementação do Código Internacional -
relatório de situação mundial em 2024
Esta publicação fornece informações atualizadas sobre o estado de implementação do Código Internacional de Comercialização de Substitutos do Leite Materno (de 1981) e subsequentes resoluções da Assembleia Mundial da Saúde (relacionadas com o “Código”) por países. Apresenta o estatuto jurídico do Código, incluindo até que ponto as disposições de recomendação foram incorporadas nas legislações nacionais.
O relatório centra-se na forma como as medidas legais delineiam processos de monitorização e aplicação para garantir a eficácia das disposições incluídas.
Também destaca exemplos importantes de interferência de fabricantes e distribuidores de substitutos do leite materno nos esforços para enfraquecer e atrasar a implementação de proteções contra o marketing antiético.
O Brasil aparece classificado como “substancialmente alinhado com o Código” devido à NBCAL – Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças de Primeira Infância, Bicos, Chupetas e Mamadeiras, que está em constante atualização desde sua primeira versão de 1988.
Esse status no traz esperança de continuar avançando, principalmente contra o marketing digital perpetrado pelas redes sociais e pelas ditas “influenciadoras”.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Maternidade pública de Salvador lança caderneta específica para acompanhamento da gestação de Homens Trans. A Unidade de saúde da Universidade Federal da Bahia mantém ações de acolhimento à população transexual. Medida visa preencher lacuna do sistema de saúde.
A iniciativa foi idealizada e produzida pela Maternidade Climério de Oliveira da UFBA em Salvador.
“A caderneta tem como objetivo promover inclusão social, visibilidade e pertencimento, além de produzir dados qualitativos e quantitativos sobre gestações transmasculinas. O uso do instrumento pode contribuir na elaboração de políticas públicas que propiciem o acesso, o cuidado seguro e a garantia de direitos, conforme estabelecido nos princípios do SUS (universalidade, equidade e integralidade)”, disse Sinaide Coelho, superintendente da MCO-UFBA.
TRANSGESTA
Trata-se de uma iniciativa voltada às pessoas que se reconhecem e se declaram transexuais, travestis, transgêneras, intersexo e outras denominações que representam formas diversas de vivência e de expressão de identidade de gênero. Desde o início, o programa realizou o acompanhamento de 7 homens trans gestantes, que resultou no nascimento de nove bebês na maternidade.
Parabéns!
Todo o nosso apoio: essa Caderneta será citada no V Seminário online anual preparatório para a SMAM 2024 em www.agostodourado.com
Prof. Marcus Renato de Carvalho
www.aleitamento.com
ALIMENTAÇÃO DE LACTENTES E CRIANÇAS PEQUENAS EM SITUAÇÕES DE EMERGÊNCIA:
manual de orientações para a comunidade, profissionais de saúde e gestores de programas de assistência humanitária.
*Tema da SMAM 2009 e que abordaremos novamente no www.agostodourado.com desse ano.
As calamidades e emergências complexas têm um impacto devastador sobre a vida das pessoas. Repentinamente, elas perdem suas casas e são obrigadas a viver fora de seu local de origem, muitas vezes com a cisão abrupta da unidade familiar. O acesso aos serviços de saúde primários costuma ficar prejudicado ou completamente inviabilizado e os sistemas de saúde podem entrar em colapso. A água potável e os alimentos geralmente se tornam escassos, as condições de segurança precárias. Durante os desastres é preciso enfrentar o desafio de lidar com um grande número de pessoas em choque, muitas delas doentes, feridas ou traumatizadas por suas experiências. As mulheres e crianças são as vítimas que mais necessitam de cuidados. Muitas mulheres perdem seus maridos/companheiras, filhos, pais ou parentes e, mesmo assim, precisam iniciar imediatamente o trabalho de reconstruir seus lares, de organizar o espaço para continuar vivendo e de cuidar dos membros mais frágeis da família. O impacto sobre as mulheres pode ser imenso, tanto físico quanto emocional e social. Atenção extra e cuidados especiais precisam ser oferecidos às mulheres com crianças pequenas, órfãos e gestantes.
A Amamentação cruzada não é recomendada e as lactantes devem receber um acolhimento carinhoso para que possam continuar amamentando ou serem apoiadas para a relactação.
Prof. Marcus Renato de Carvalho
www.aleitamento.com
Você gostaria de saber mais sobre como ter uma amamentação prazerosa?
Tirar as principais dúvidas sobre aleitamento?
Como doar seu leite com segurança e ter apoio de um Bancos de Leite Humano?
Quais medicamentos pode tomar enquanto está amamentando?
Baixe agora o Aleitamento App!
O que você irá encontrar:
- dicas desde a gestação até a volta ao trabalho,
- espaço para crianças com dicas de livros,
- diário do bebê,
- rede de apoio / cuidado paterno e muito mais!
* Estamos sem patrocínio e precisamos do seu apoio para que essa ferramenta continue disponível gratuitamente.
=> Nosso aplicativo é sempre atualizado com informações baseadas em evidências científicas e notícias do universo da saúde materno-infantil.
É grátis e muito fácil baixar:
https://aleitamento.com.br/instalar/
ou acesse pelo celular o Google Play Store e na Apple Store, faça o download de “Aleitamento Lactare”
Programadora: Clara
Watanabe
Divulgação: aleitamento.com
Curadoria de conteúdo: Prof. Marcus Renato de Carvalho @marcus.decarvalho
Amamentação e desenvolvimento sensório psico-motor dos lactentes: “Trilhos anatômicos”, bases neurais da motricidade do sistema estomatognático e suas repercussões sistêmicas.
O lactente é preparado para a amamentação desde a décima segunda semana de gestação, quando inicia o ato reflexo de deglutir o líquido amniótico. A região do encéfalo responsável pela elaboração desses primitivos atos motores é o tronco encefálico. O RN adquire controle motor no sentido céfalo caudal. Isso se dá porque a deposição de mielina obedece à mesma direção. Acrescente-se o fato de o aumento expressivo dos prolongamentos de neurônios ocorrer, principalmente, até os 2 anos de idade. A amamentação, que deve ser mantida pelo menos até que o lactente complete 24 meses de vida, ou mais, funcionaria como uma forma de estimulação perfeita durante esse período crítico do desenvolvimento motor. No lactente, fase em que predominam as ações motoras do orbicular dos lábios e do bucinador (inervados pelo facial), a deglutição é visceral. Entre 7 e 8 meses de idade ocorre a erupção dos dentes incisivos decíduos. O contato inter incisal deflagra a mudança de dominância motora do facial para a do trigêmeo. O padrão de deglutição muda de visceral para somático. Os músculos masseter, pterigoideo medial e temporal (inervados pelo trigêmeo) fazem parte da linha profunda anterior e se comunicam com o occipto frontal (inervado pelo facial), limite cranial da linha superficial posterior. A atuação conjunta dessas duas linhas miofasciais permite que o lactente abandone sua postura flexora com o fortalecimento gradual da musculatura extensora. A amamentação promove, portanto, um adequado sincronismo das ações motoras estimuladas pelos nervos facial e trigêmeo, cujos núcleos se situam no tronco encefálico e estabelecem contato com diversas vias neurais importantes para a organização dos movimentos. Influência o tônus neuromuscular, a postura e o desenvolvimento motor do lactente.
Juliana de Magalhães Faria, Antonio de Padua Ferreira Bueno, Marcus Renato de Carvalho.
Publicado na Revista Fisioterapia Ser • vol. 18 - nº 4 • 2023.
Juliana é Fisioterapeuta em instituições públicas e/ou
privadas há 22 anos, onde adquiriu experiência na área da Saúde e Educação, Pediatria, Fisioterapia em reabilitação de bebês e crianças com problemas neurológicos, estimulação sensório psicomotora, correção postural, reabilitação de pacientes com limitações ortopédicas e neurológicas...
Especialista em Atenção Integral à Saúde Materno-infantil na Maternidade Escola da UFRJ onde iniciou esse artigo que começou com o seu TCC em 2006-7.
Os Princípios de Yogyakarta são um documento sobre direitos humanos nas áreas de orientação sexual e identidade de gênero, publicado em novembro de 2006 como resultado de uma reunião internacional de grupos de direitos humanos na cidade de Joguejacarta (em indonésio: Yogyakarta), na Indonésia.
Os Princípios foram complementados em 2017, expandindo-se para incluir mais formas de expressão de gênero e características sexuais, além de vários novos princípios.
Os Princípios, e sua extensão de 2017, contêm um conjunto de preceitos destinados a aplicar os padrões da lei internacional de direitos humanos ao tratar de situações de violação dos direitos humanos – LGBTQIA+ - de lésbicas, gays, bissexuais, transgêneros, intersexuais e demais expressões de gênero.
São 29 princípios:
1. Direito ao Gozo Universal dos Direitos Humanos
2. Direito à Igualdade e a Não-Discriminação
3. Direito ao Reconhecimento Perante a Lei
4. Direito à Vida
Direito à Segurança Pessoal
6. Direito à Privacidade
7. Direito de Não Sofrer Privação Arbitrária da Liberdade
8. Direito a um Julgamento Justo
9. Direito a Tratamento Humano durante a Detenção
10. Direito de Não Sofrer Tortura e Tratamento ou Castigo Cruel, Desumano e Degradante
11. Direito à Proteção Contra todas as Formas de Exploração, Venda ou Tráfico de Seres Humanos
12. Direito ao Trabalho
13. Direito à Seguridade Social e outras Medidas de Proteção Social
14. Direito a um Padrão de Vida Adequado
15. Direito à Habitação Adequada
16. Direito à Educação
17. Direito ao Padrão mais Alto Alcançável de Saúde
18. Proteção contra Abusos Médicos
19. Direito à Liberdade de Opinião e Expressão
20. Direito à Liberdade de Reunião e Associação Pacíficas
21. Direito à Liberdade de Pensamento, Consciência e Religião
22. Direito à Liberdade de Ir e Vir
23. Direito de Buscar Asilo
24. Direito de Constituir uma Família
25. Direito de Participar da Vida Pública
26. Direito de Participar da Vida Cultural
27. Direito de Promover os Direitos Humanos
28. Direito a Recursos Jurídicos e Medidas Corretivas Eficazes
29. Responsabilização (“Accountability”).
Fonte: Wikipedia + JusBrasil
"Amamentação, sistemas de primeira alimentação
e poder corporativo: um estudo de caso sobre o mercado e as práticas políticas da indústria
transnacional de alimentação infantil no Brasil"
Artigo original: Breastfeeding, first-food systems and corporate power: a case study
on the market and political practices of the transnational baby food industry in Brazil.
Métodos da pesquisa: Usamos um desenho de estudo de caso, extraindo dados de documentos e entrevistas com informantes-chave (N=10).
Resultados: As taxas de amamentação despencaram no Brasil para um mínimo histórico na década de 1970. O ressurgimento da amamentação a partir
de meados da década de 1980 refletiu o fortalecimento do compromisso para a política nacional e uma lei de proteção da amamentação, resultante, por sua vez, de ações coletivas levadas a cabo por coligações de amamentação, defensores e mães. No entanto, mais
recentemente, as melhorias na amamentação estabilizaram no Brasil, enquanto a indústria aumentou as vendas de CMF
( Fórmulas Lácteas Comerciais) no Brasil em 750% entre 2006 e
2020. À medida que as regulamentações se tornaram mais rigorosas, a indústria promoveu de forma mais agressiva os CMF para bebés mais velhos e crianças pequenas, bem como para produtos especializados. fórmulas. A indústria de alimentos para bebés é fortalecida através da associação com grupos industriais poderosos e emprega lobistas com bom acesso aos decisores políticos.
A indústria conquistou a profissão pediátrica no Brasil através de sua associação de longa data com a Sociedade Brasileira de Pediatria.
...
Parabenizamos os autores: Cindy Alejandra Pachón Robles, Mélissa Mialon, Laís Amaral Mais, Daniela Neri, Kimielle Cristina Silva e Phillip
Baker.
Tradução: Moises Chencinski
* Referência: Robles et al. Globalization and Health (2024) 20:12
https://doi.org/10.1186/s12992-024-01016-0
GLOBAL BREASTFEEDING SCORECARD 2023
As taxas de amamentação estão aumentando em todo mundo através da melhoria dos sistemas de promoção, proteção e apoio.
A amamentação é essencial para a sobrevivência e saúde infantil. O leite materno é um produto seguro, natural, nutritivo e sustentável. O padrão ouro para a alimentação dos lactentes. O leite materno contém anticorpos que ajudam a proteger contra muitas doenças infantis, como como diarreia e doenças respiratórias. Estima-se que o desmame precoce seja responsável por 16% das mortes infantis a cada ano.
As crianças amamentadas têm melhor desempenho em testes de inteligência e têm menos probabilidade de ter excesso de peso ou obesidade na vida adulta. As mulheres que amamentam também têm um risco reduzido de câncer e diabetes tipo II.
O “Global Breastfeeding Scorecard” examina as práticas atuais de amamentação em todo o mundo, considerando o momento de iniciação, exclusividade nos primeiros seis meses de vida e continuação até os dois anos de idade.
Além disso, documenta o desempenho nacional em indicadores-chave de como a amamentação é protegida e apoiada. Essa edição 2023 registra o progresso e os desafios na melhoria da amamentação. O relatório destaca histórias de sucesso em vários países que reforçaram as suas políticas e programas de amamentação.
Oito iniciativas fundamentais e seus impactos são analisadas:
1. Assegurar e ampliar o financiamento de políticas para aumentar as taxas de amamentação desde o nascimento até aos dois anos de vida dos lactentes;
2. Implementar integralmente o Código de Comercialização de Substitutos do Leite Materno (NBCAL no Brasil);
3. Garantir legalmente licença parentalidade (licença maternidade e paternidade) remunerada e políticas de apoio à amamentação no local de trabalho;
4. Implementar os Dez Passos para o Sucesso da Amamentação nas maternidades – a IHAC;
5. Melhorar o acesso as capacitações em Aconselhamento em amamentação;
6. Fortalecer os vínculos entre as unidades de saúde e as comunidades;
7. Fortalecer os sistemas de monitoramento que acompanham o progresso das políticas, programas de aleitamento, e o seu financiamento;
8. Apoio IYCF (Infant and Young Child Feeding / Alimentação de lactentes e pré-escolares) em Emergências
...
CONCLUSÃO
O Scorecard demonstra que há progressos na proteção e no apoio à amamentação. Mas, ainda temos desafios significativos no aleitamento materno. São necessários mais investimentos e ações políticas ousadas para melhorar os ambientes propícios à proteção, promoção e apoio à amamentação.
Essa importantíssima publicação é do GLOBAL BREASTFEEDING COLLECTIVE, um conjunto de dezenas de instituições e experts no tema com o apoio do UNICEF.
Tradução livre do Prof. Marcus Renato de Carvalho www.aleitamento.com
Workplace breastfeeding support for working women: A scale
development study
Artigo científico publicado no European Journal of Obstetrics & Gynecology and
Reproductive Biology: X
O objetivo deste estudo foi desenvolver uma escala para avaliar o apoio ao aleitamento materno no local de trabalho.
Métodos
O estudo foi realizado com 490 mulheres trabalhadoras que se inscreveram nos ambulatórios da mulher e da criança de um hospital na Turquia. Os dados do estudo foram coletados por meio de um 'Formulário de Informações Pessoais' e da 'Escala de Apoio à Amamentação no Local de Trabalho para Mulheres Trabalhadoras'. Os dados foram analisados nos softwares SPSS 25 e AMOS 21. No processo de desenvolvimento da escala; Utilizaram-se a validade de conteúdo, a análise fatorial exploratória, os métodos de correlação item escore total e o coeficiente alfa de Cronbach.
Resultados
O índice de validade de conteúdo da escala foi de 0,90 e o valor de alfa de Cronbach foi de 0,93. O valor da escala de Kaiser-Meyer-Olkin foi de 0,91, o teste de Bartlett foi χ2 = 11.573,924 e p < 0,000. De acordo com os resultados da análise fatorial exploratória para a validade de construto da escala, a escala foi composta por 31 itens e 6 fatores.
Conclusões
A escala desenvolvida pode ser utilizada para avaliar o apoio à amamentação no local de trabalho para mulheres trabalhadoras como um instrumento de medida válido e confiável.
Excelente instrumento: tema da SMAM 2023 - Amamentação / Direito da Mulher Trabalhadora.
Profa. Carla Taddei afirma nessa entrevista que a AMAMENTAÇÃO modula a MICROBIOTA, e, portanto, se sobrepõe ao parto normal na transmissão materno infantil de “bactérias do bem”.
E em outra pesquisa mostrou que os prematuros de UTI Neonatal que tomavam leite materno tinham menos tempo de internação, independentemente se receberam leite da própria mãe ou leite humano pasteurizado do Banco de Leite da maternidade.
Está comprovado cientificamente que a Amamentação dá resiliência para a microbiota e, mesmo que a criança precise de antibiótico ou que tenha alguma outra enfermidade, o Aleitamento humano vai garantir a estrutura daquela comunidade microbiana (que antigamente chamávamos de flora intestinal).
Dra. Carla Taddei é Professora Associada do Laboratório de Microbiologia Molecular do HU da USP.
Fonte: Super Saudável, Ano XXIII, número 100 – outubro a dezembro de 2023.
Leia mais sobre esse tema no nosso portal www.aleitamento.com
As bactérias do leite humano - Microbioma do leite materno tem um efeito protetor contra infecções.
Prof. Marcus Renato de Carvalho
Esse é o capítulo sobre políticas públicas de promoção, proteção e apoio ao aleitamento da 4ª edição do livro “Amamentação – bases científicas” – GEN Editora, 2017.
“Manejo Ampliado” é um conjunto de saberes que vão mais além dos conhecimentos biomédicos necessários para a assistência clínica ao binômio lactante-lactente.
É a capacitação de profissionais para elaborarem programas, políticas, eventos em prol da amamentação, com enfoque de gênero, interseccionalidade, diversidade e inclusão.
São apresentadas várias iniciativas internacionais e nacionais das ONGs e dos governos municipais, estaduais e federal.
Inclui um histórico das Semanas Mundiais de Aleitamento e dos Encontros Nacionais de Aleitamento desde 1991.
É o aleitamento pela ótica da saúde coletiva.
Mande suas críticas, sugestões e outras iniciativas não citadas.
Prof. Marcus Renato de Carvalho
www.aleitamento.com
Orientação sobre regulamentação de medidas destinadas a restringir o marketing digital de substitutos do leite materno (em tradução livre)
É urgente a proteção da amamentação nas redes sociais
"Guidance on regulatory measures aimed at restricting digital marketing of breast-milk substitutes".
As redes sociais se tornaram rapidamente a fonte predominante de exposição à promoção de substitutos do leite materno a nível mundial. O marketing digital amplifica o alcance e o poder da publicidade e de outras formas de promoção em ambientes digitais, e a exposição a promoção comercial digital aumenta a compra e a utilização dos ditos substitutos do leite materno.
À luz destas evidências, a 75ª. Assembleia Mundial da Saúde solicitou que a OMS desenvolvesse orientações para os Estados-Membros sobre medidas regulamentares destinadas a restringir a comercialização digital de substitutos do leite materno. Esta orientação aplica-se à comercialização de produtos abrangidos pelo Código Internacional de Comercialização de Substitutos do Leite Materno (NBCAL no Brasil), bem como a alimentos para lactentes e crianças pequenas que não sejam substitutos do leite materno.
Parabenizamos o nosso colega e amigo Cristiano Boccolini (Institute of Scientific and Technological Communication—ICICT, Oswaldo Cruz Foundation—Fiocruz, Brazil) um dos autores dessa inédita publicação.
Prof. Marcus Renato de Carvalho
www.aleitamento.com
Este Guia, “Alimentação complementar de bebês e crianças pequenas de 6 a 23 meses de idade”, substitui os Princípios Orientadores para Alimentação Complementar do Lactente Amamentado e princípios orientadores para alimentação crianças não amamentadas de 6 a 24 meses de idade.
A alimentação complementar saudável é definida como o processo de fornecimento de alimentos além do leite materno ou fórmula láctea quando por si só não são mais suficientes para atender necessidades nutricionais. Geralmente começa aos 6 meses de idade e continua até 24 meses de idade, embora a amamentação deve permanecer além deste período.
Essa etapa é um momento crítico para o desenvolvimento para as crianças aprenderem a aceitar alimentos e bebidas saudáveis a longo prazo. Também coincide com o período de pico para o risco de crescimento insuficiente e deficiências nutricionais.
As consequências imediatas, como a desnutrição durante estes anos de formação –
bem como no útero e nos primeiros 6 meses de
vida - incluem crescimento insuficiente significativo, morbidades e mortalidade e atraso motor, retardo do desenvolvimento cognitivo e sócio emocional.
Mais tarde, pode levar a um risco aumentado de doenças não transmissíveis (DNT). No
longo prazo, desnutrição na primeira infância causa redução da capacidade de trabalho e dos rendimentos e, entre as meninas, redução da capacidade reprodutiva. A Alimentação Complementar inadequada com alimentos ultra processados pode resultar em Obesidade, Diabetes tipo 2, hipertensão…
Os primeiros dois anos de vida também são um período crítico para o desenvolvimento do cérebro, a aquisição de linguagem e maturação das vias sensoriais para a visão
e audição, e o desenvolvimento de melhor desempenho das funções cognitivas.
Estas novas diretrizes estão atualizadas com evidências mais sólidas e têm muitos princípios em comum com o que preconiza o “Guia Alimentar para Crianças Brasileiras menores de 2 anos”. (Baixe aqui no nosso SlideShare).
Prof. Marcus Renato de Carvalho
www.aleitamento.com
Apresentamos a Carta do Recife: Por uma política pública de atenção integral aos homens na saúde para promoção da paternidade e do cuidado no Brasil que apresenta uma breve síntese das reflexões e discussões desenvolvidas ao longo do Seminário Nacional e Internacional "Paternidade e Cuidado" que aconteceu em Recife, entre 30 de agosto e 1º de setembro de 2023.
Nesta carta, apresentamos algumas notas e proposições a toda a sociedade brasileira, dialogando especialmente com gestores/as da União, estados e municípios, legisladores/as, órgãos do poder judiciário, empresas, empregadores/as, sindicatos, movimentos sociais, pesquisadores/as, entidades vinculadas ao controle social e à sociedade em geral.
Abraços,
Coordenação de Atenção à Saúde do Homem (COSAH/CGACI/DGCI/SAPS/MS)
Núcleo de Pesquisas Feministas em Gênero e Masculinidades - GEMA/UFPE
Núcleo GenSex/Fiocruz
Núcleo Tramas/UFPA
UFMT
Estivemos presentes e ratificamos essas análises e recomendações.
Prof. Marcus Renato de Carvalho
Representante do Parents in Science / Faculdade de Medicina - UFRJ
www.aleitamento.com
A Federação Internacional de Ginecologia e Obstetrícia (FIGO) reconhece a Amamentação
como uma prática protetora que pode salvar vidas e recomenda que seja iniciada dentro da 1ª hora de vida (conhecida como “hora mágica” ou "hora de ouro").
Através das recomendações do
melhores práticas, a OMS sugere que a amamentação “temprana” e oportuna na sala de parto pode trazer grandes benefícios para ambos – tanto para a mãe quanto para o bebê.
Alguns aspectos importantes da hora mágica, como o contato pele a pele e o início
no início do aleitamento materno, pode prevenir a hemorragia pós-parto, facilita a involução uterina e produz amenorreia lactacional, que é um método contraceptivo (LAM) útil.
A amamentação no início da vida traz benefícios a longo prazo para a mãe e para a criança.
...
Parabéns a FIGO!
Amamentação na primeira hora: proteção sem demora!
Prof. Marcus Renato de Carvalho
www.aleitamento.com
O atendimento ambulatorial de Puericultura é destinado à criança saudável, para a prevenção, e não para o tratamento de doenças. Sendo
assim, diante dos novos conceitos de programming
e epigenética, fica clara a necessidade da assistência à saúde da criança se iniciar antes
mesmo de seu nascimento.
A ANS em 2013, pela Resolução Normativa nº 338, incluiu o procedimento pediátrico “atendimento ambulatorial em puericultura” no rol de consultas, passando a valer desde janeiro de 2014. Uma vez incluído, o procedimento passou a fazer parte da cobertura assistencial mínima
obrigatória pelos planos privados de assistência
à saúde suplementar: operadoras, Unimed...
O atendimento pediátrico a gestantes (terceiro trimestre) foi contemplado pelo Código
nº 1.01.06.04-9 com indicação de remuneração pelo Porte 2B, lembrando aos pediatras a importância do preenchimento correto do código da ANS nas guias de consulta para o devido reembolso desse valor diferenciado.
Vamos incentivar as gestantes a marcarem uma Consulta Pediátrica Pré-Natal?
Prof. Marcus Renato de Carvalho
Este documento apresenta a posição conjunta e a visão de um grupo de trabalho especializado, global e multissetorial sobre a implementação da Metodologia Mãe Canguru (MCC) para todos os bebês prematuros ou com baixo peso ao nascer (BPN), como base para o cuidado de recém-nascidos prematuros e/ou doentes.
O documento resume as informações básicas, as evidências e a justificativa para disponibilizar o MMC para todos os recém-nascidos prematuros ou de BPN e busca mobilizar a comunidade internacional de saúde materna, neonatal e infantil e as famílias para se unirem para apoiar a implementação do MMC para todos os prematuros ou bebês com baixo peso ao nascer para melhorar a saúde e o bem-estar deles e de suas mães e famílias.
Este documento de posição destina-se a ser utilizado por gestores, parceiros de desenvolvimento, lideranças do pessoal de saúde, pediatras neonatologistas, lideranças da sociedade civil (por exemplo, organizações de pais e profissionais) e organizações de pesquisa envolvidos na pesquisa de implementação do MMC.
O MMC é uma intervenção que permite à mãe assumir um papel central em sua própria vida
e os cuidados do seu recém-nascido, revertendo assim a mudança de poder entre a mãe e o responsável pelos cuidados de saúde, prestadores ou sistemas de saúde. Humaniza os cuidados maternos e neonatais, capacitando e envolvendo
aqueles que mais cuidam do RN, em vez de focar predominantemente em soluções tecnológicas.
Assim, o MMC pode servir como ponto de partida para uma reformulação mais ampla do sistema de saúde e para a prestação de serviços,
transformação dos cuidados maternos e neonatais, e um modelo do que pode ser realizado quando
as partes interessadas relevantes têm o poder de desempenhar os papéis que lhes são naturalmente confiados no cuidado dos seus
recém-nascidos.
Esse documento mostra como o Cuidado Mãe-Canguru pode ser revolucionário na atenção neonatal.
Prof. Marcus Renato de Carvalho
www.aleitamento.com
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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
2. BREASTFEEDING MOTHERS SHOULD be made aware of
the variability of milk volumes per breastfeeding,
the frequencies of breastfeedings, and the distribution of
milk intake by day and by night of healthy breastfed
infants.1
Mothers among the !Kung hunter-gatherers have
been observed to breastfeed 4 times every hour during
the day and at least once at night.2 In contrast, Cadogan,3
in his essay to the Governors of the Foundling Hospital
(London, United Kingdom) in 1748 recommended that
infants be suckled only 4 times a day and not at night,
because he considered the night feeding to result in
breastfed infants’ becoming “over fat and bloated.” Re-
laxation of the concept of scheduled breastfeeding was
first strongly promoted by Wickes4 in 1953 and subse-
quently advocated by community support groups such
as La Leche League and the Australian Breastfeeding
Association that were at the vanguard of the movement
back to breastfeeding in the early 1970s in Western
societies. As a result, infants were breastfed more fre-
quently both by day and by night. It now is recognized
that breast milk provides the optimal nutrition for in-
fants, and current recommendations to mothers are that
infants be breastfed “on demand” (according to their
appetite) exclusively for the first 6 months of life.5,6
Bangladeshi infants have been found to consume half
their daily milk intake between 6 AM and 6 PM.7 Matheny
and Picciano8 in the United States investigated whether
measurement of milk production over a 12-hour period
could be doubled to determine the 24-milk production.
Studying 4-week-old infants, they found that more milk
was consumed between 6 AM and 6 PM and less was
consumed between 2 PM and 2 AM. Doubling of either of
these 12-hour intakes resulted in significant inaccuracies
in estimation of 24-hour milk consumption. The product
of the volume of 1 or 2 consecutive breastfeedings and
the number of breastfeedings in the period also has been
found to be inaccurate.9 The data of Cregan et al10 show-
ing variation in the volume and the frequency of breast-
feedings over 24 hours for Australian infants also suggest
that these calculations would be inaccurate. However,
for accurate assessment of milk production, the necessity
of a full 24-hour period of measurement of milk intake
in our society for infants between 4 and 26 weeks has
not been determined.
A wide variation in the frequency of breastfeeding has
been recorded in the United States and Sweden in ex-
clusively breastfed infants.11,12 These authors collected
longitudinal records of the number, time of day, and
duration of breastfeedings of infants between 2 and 26
weeks of age, but no information was provided on the
volume of milk consumed at each breastfeeding by these
infants. Previously, interest has focused on the nutrient
intake of the infant, and the total consumption has been
quoted with no information provided on the volume of
milk consumed from each breast.13,14 Therefore, it was
not possible to assess how the infant feeds to appetite in
relation to the volume of milk available in the mother’s
breasts. Furthermore, the literature on the frequency of
breastfeeding generally fails to define what constitutes a
breastfeeding. Although Ho¨rnell et al11 defined “one
breastfeeding episode” as the “duration of suckling 2
minutes or longer and separated from previous breast-
feed by at least 30 minutes,” this does not consider
whether the infant fed from 1 breast or both during that
episode.
In this article, we investigate the volume and the
pattern of milk intake in a cross-sectional study of 1- to
6-month-old infants who were being exclusively breast-
fed on demand, and we examine the contribution of
each breast. This is the first article to describe the vari-
ation in the volume of milk consumed from each breast
at each breastfeeding, the degree of fullness of each
breast before and after each breastfeeding, and the fat
content of the milk consumed from each breast through-
out the day and night. This will provide a normal refer-
ence range to enhance clinicians’ support for breastfeed-
ing mothers.
METHODS
Data were collected from 71 mothers who were exclu-
sively breastfeeding on demand healthy, term infants
who were aged between 1 and 6 months. These mothers
were participants in studies that were conducted in this
laboratory from 2000 to 2004.15–17 These studies were
approved by the Human Research Ethics Committee of
The University of Western Australia.
The mothers test-weighed their infants before and
after each breastfeeding from each breast on a Medela
electronic Baby Weigh Scale (Medela AG, Baar, Switzer-
land) for a period of 24 hours plus 1 breastfeeding. A
corrected 24-hour production for each breast then was
determined using these data, but no correction for infant
insensible water loss was made; therefore, milk produc-
tion may be underestimated by 3% to 10%.18–20 All
measurements of breastfeed amounts, storage capacity,
and milk production are expressed in grams that can be
considered to be nearly equivalent to mL because the
density of milk is 1.03 g mLϪ1.21 For each mother, the
breast that had the higher 24-hour production was
termed “more productive” and the breast that had the
lower 24-hour production was termed “less productive.”
In addition, milk samples (Յ1 mL) were collected by
hand expression into 5-mL polypropylene plastic vials
(Disposable Products, Adelaide, Australia), immediately
before and after each breastfeeding from each breast.
Samples were frozen as soon as possible and kept at
Ϫ15°C for analysis. The cream content of the milk sam-
ples was measured by the creamatocrit method,22 and
the fat content of each sample, in grams per liter, was
calculated as 5.37 ϫ creamatocrit ϩ 5.28.15
The original estimation of fat content as a function of
e388 KENT, et al
3. degree of breast emptying was introduced by Daly et al,23
whereby fat content was best predicted using a quadratic
function with degree of emptying as a predictor. Al-
though time since last breastfeeding and individual
breast had a small effect, the best predictor of fat content
was degree of emptying. This accounted for 68% of
variation, which was deemed satisfactory given the
physiologic process being measured. Degree of fullness
was calculated as 1 Ϫ degree of emptying, and it was
obtained via inverse calculation of degree of emptying
using the equation fat ϭ 21.50 ϩ 9.38 ϫ (degree of
emptying) ϩ 70.99 ϫ (degree of emptying)2.23 This re-
lationship between degree of emptying and fat content
was individualized, whereby for each woman, minimal,
median, and maximal fat content over 24 hours was set
to correspond to degree of fullness of 1, 0.6892, and 0,
respectively, that protected against physiologically im-
possible estimates (ie, degree of fullness exceeding 1 or
becoming negative). The storage capacity (the amount of
milk available to the infant when the breast is full) was
determined using a regression line relating change in
degree of fullness at each feeding to the amount of milk
removed from the breast at that feeding. Assuming that
a change in degree of fullness of 0 corresponds to a
feeding amount of 0, the regression line was forced to
pass through the origin. Storage capacity then could be
calculated as the amount of milk that corresponds to a
change in degree of fullness of 1. The volume of avail-
able milk in the breast before each breastfeeding was
calculated as the degree of fullness multiplied by the
storage capacity of the breast.
We defined a breastfeeding as an infant’s taking milk
from 1 breast. When the next breastfeeding was Ͼ30
minutes after the end of the first, the breastfeeding was
considered to be unpaired. When the infant took milk
from the other breast within 30 minutes of finishing on
the first breast, the breastfeedings were considered to be
paired. When the infant fed again from the first breast
within 30 minutes of finishing on the second breast, the
breastfeedings were considered to be clustered. A meal
was defined as an unpaired breastfeeding, or 2 paired
breastfeedings, or 3 clustered breastfeedings. This defi-
nition of a “meal” is equivalent to “1 breastfeeding epi-
sode” as defined by Ho¨rnell et al.11 Four breastfeedings
were 0 g when the infant went to the breast and appar-
ently suckled but there was no difference between the
infant’s weight from before to after the breastfeeding.
For this study, the day was divided into 4 intervals.
Morning was considered to be from 4:01 AM to 10:00 AM,
day was 10:01 AM to 4:00 PM, evening was 4:01 PM to
10:00 PM, and night was 10:01 PM to 4:00 AM.
Descriptive summaries of continuous data used
means and SDs or medians and interquartile ranges
(IQRs), depending on data normality. Inference was
based on summary data averaged over 24 hours (n ϭ
71), overall summaries for individual breasts (n ϭ 142),
and all individual breastfeedings recorded over 24 hours
(n ϭ 775). Analyses of individual breastfeedings were
weighted according to the number of breastfeedings re-
corded per woman. Paired and unpaired univariate com-
parisons of summary data were performed using t tests
or their nonparametric equivalents depending on data
normality. Multivariate analysis was based on analysis of
variance with repeated measures performed using Proc
GLM (SAS 8.02; SAS Institute Inc, Cary, NC), and good-
ness of fit was assessed via analysis of residuals. Linear
and polynomial regression analyses were used to assess
relationships. Two-sided P values are quoted, and P Ͻ
.05 was regarded as statistically significant.
RESULTS
The characteristics of the mothers are presented in Table
1. There were 41 male and 30 female infants. There was
no significant difference either between the mean age of
the male and female infants or in the age and parity of
their mothers.
Frequency and Volume of Breastfeedings
A total of 775 breastfeedings were monitored. Each in-
fant had 11 Ϯ 3 breastfeedings per day (range: 6–18).
The interval between breastfeedings was 2 hours 18
minutes Ϯ 43 minutes (range: 4 minutes to 10 hours 58
minutes). Of these breastfeedings, 345 (44.5%) were
unpaired (182 from the more productive breast and 163
from the less productive breast), with an interval of Ͼ1
hour until the next breastfeeding for 90% of these
breastfeedings. A total of 412 (53.2%) breastfeedings
were paired, and 18 (2.3%) were clustered. That is, there
were 7.9 Ϯ 1.8 meals per day (range: 4–13), and the
interval between meals was 3 hours 2 minutes Ϯ 41
TABLE 1 Subject Characteristics
Mean Ϯ SD Range
Mother
Age, y 31.8 Ϯ 4.3 23–42
Parity 1.7 Ϯ 0.8 1–4
Infant
Age, wk 15.3 Ϯ 5.9 4–26
24-h breast milk intake, g
Total 788 Ϯ 169 478–1356
More productive breast 459 Ϯ 106 253–769
Less productive breast 339 Ϯ 90 161–553
Breast storage capacity, g
More productive breast 193 Ϯ 60 76–382
Less productive breast 164 Ϯ 53 74–320
Average breastfeed volume, g
More productive breast 84 Ϯ 28 32–131
Less productive breast 67 Ϯ 26 27–147
Breastfeed frequency, feeds per day
More productive breast 5.6 Ϯ 1.6 3–9
Less productive breast 5.4 Ϯ 1.5 3–9
Fat content of milk, g/L
More productive breast 41.3 Ϯ 8.4 22.5–60.8
Less productive breast 40.9 Ϯ 8.4 22.3–61.6
PEDIATRICS Volume 117, Number 3, March 2006 e389
4. minutes (range: 40 minutes to 10 hours 58 minutes).
Thirteen percent of infants always had paired breastfeed-
ings (n ϭ 9), 30% of infants always had unpaired breast-
feedings (n ϭ 21), and the remaining 57% of infants had
a mixture of paired and unpaired breastfeedings (n ϭ
41).
There were no changes in the breastfeeding fre-
quency with age of the infant and no significant differ-
ence in breastfeeding frequency between girls and boys.
The more productive breast was fed from as frequently
as the less productive breast, and when the breastfeed-
ings were paired, the more productive breast was offered
first as frequently as the less productive breast. There
was no relationship between the number of breastfeed-
ings per day and the 24-hour milk production of the
mothers.
The infants took 76.0 Ϯ 12.6 g (range: 0–240 g) at
each breastfeeding. There was an inverse relationship
between the number of breastfeedings per day and the
average breastfeeding volume (r2 ϭ 0.442; P Ͻ .001; n ϭ
142 breasts). The average meal was 101.4 Ϯ 15.6 g
(range: 0–350 g). The average breastfeeding volume was
unrelated to the age of the infant (P ϭ .421), but there
was an increase in the maximum breastfeeding volume
with advancing age between 4 and 26 weeks (r2 ϭ 0.09;
P Ͻ .010). The maximum breastfeeding volume of boys
was greater than that of girls (154.6 Ϯ 54.8 g for boys vs
129.8 Ϯ 29.0 g for girls; P ϭ .029), but there was no
significant difference in the average breastfeeding (79.3
Ϯ 26.9 g for boys vs 73.0 Ϯ 22.4 g for girls; P ϭ .299).
The average breastfeeding from the more productive
breast was higher than that from the less productive
breast (P Ͻ .001; Table 1), and individual breastfeedings
from the more productive breast were larger than from
the less productive breast (P Ͻ .001; Fig 1).
Breastfeeding volumes were significantly associated
with breastfeedings’ being unpaired, paired, or clustered.
For an unpaired breastfeeding, the infants consumed 90
Ϯ 26 g (range: 0–240 g). When the breastfeedings were
paired, the infants consumed 73 Ϯ 11 g (range: 5–185 g)
for the first breast and 54 Ϯ 9 g (range: 0–176 g) from
the second. For the clustered breastfeedings, the infant
took a median of 42 g (IQR: 31–103 g) from the first
breast, a median of 20 g (IQR: 8–44 g) from the second
breast, and a median of 31 g (IQR: 6–73 g) from the third
breast. For the paired breastfeedings, when the more
productive breast was fed from first, the infant took
more (P Ͻ .0001) from the first breast than from the
second breast (Fig 1). When the less productive breast
was fed from first, the infant took similar volumes from
each breast (Fig 1).
Storage Capacity, Degree of Fullness, and Available Milk
The storage capacity of each breast was 179 Ϯ 59 g
(range: 74–382 g). There was no association between
the storage capacity and time after birth (r2 ϭ 0.015; P ϭ
.155; n ϭ 142 breasts). There was a positive relationship
between the storage capacity and the 24-hour milk pro-
duction (r2 ϭ 0.393; P Ͻ .001; n ϭ 142 breasts), the
maximum breastfeeding (r2 ϭ 0.460; P Ͻ .001; n ϭ 142
breasts), and the average breastfeeding (r2 ϭ 0.297; P Ͻ
.001; n ϭ 142 breasts) from each breast. There was a
significant difference (P ϭ .013) between the total breast
storage capacity for mothers who were breastfeeding
boys (394 Ϯ 126 g) compared with those who were
breastfeeding girls (333 Ϯ 71 g). There was a significant
difference (P ϭ .003; Table 1) between the storage ca-
pacity of the more productive breast (193 Ϯ 60 g; range:
76–382 g) and the less productive breast (164 Ϯ 53 g;
range: 74–320 g).
For unpaired breastfeedings, there was no significant
difference between the more and less productive breasts
in the degree of fullness of the breast at the beginning of
the feed (prefeed; 0.69 Ϯ 0.10). This was significantly
higher (P ϭ .032) than the prefeed degree of fullness of
the first breast of a paired breastfeeding. For paired
breastfeedings, there was a significant difference (P ϭ
.001) between the prefeed degree of fullness for the
breasts (0.63 Ϯ 0.08 and 0.52 Ϯ 0.07 for the first and
second breasts, respectively) regardless of whether the
breast was the more or less productive. When the breast-
feedings were clustered, the “third” breast had a prefeed
degree of fullness of 0.26 Ϯ 0.07. For the 0-g feeds, the
mean difference in the cream content of the samples that
were collected before and after the breastfeeding was
1.4%, and the prefeed degree of fullness ranged from
0.21 to 0.58. There was a significant relationship be-
tween the volume of milk available in the breast and the
volume of milk consumed at each breastfeeding (r2 ϭ
0.358; P Ͻ .001; n ϭ 775 breastfeedings).
For unpaired breastfeedings, the available milk was
different between the more productive breast and the
less productive breast (P ϭ .003; Fig 2), but a similar
percentage of the available milk was removed (72 Ϯ 7%
FIGURE 1
Volume of milk consumed at a breastfeeding from the more productive breast (e) and
the less productive breast (u) when the breastfeedings were unpaired or paired. Values
are means with SEM represented by vertical bars. a More productive and less productive
breasts are different (P Ͻ .0001).
e390 KENT, et al
5. and 69 Ϯ 8% from the more and less productive breasts,
respectively). The degree of fullness of the breast at the
end of the breastfeeding (postfeed) was 0.19 Ϯ 0.06 for
both the more and the less productive breasts.
When the breastfeedings were paired and the more
productive breast was fed from first, there was a signif-
icant difference in the available milk (118 Ϯ 19 g and 80
Ϯ 14 g for the more and less productive breasts, respec-
tively; P Ͻ .0001; Fig 2), whereas when the less produc-
tive breast was fed from first, there was no significant
difference between the breasts in the available milk (Fig
2). The percentage of available milk that was removed
during paired breastfeedings was significantly less than
during an unpaired breastfeeding (P Ͻ .0001), but a
similar percentage of the available milk was removed (63
Ϯ 8%), regardless of the order from which the breasts
were fed. There was a significant difference (P ϭ .003)
between the postfeeding degree of fullness for the
breasts (0.20 Ϯ 0.05 and 0.26 Ϯ 0.05 for the first and
second breasts, respectively) regardless of whether the
more or less productive breast was first. For the clustered
breastfeedings, 47 Ϯ 13 g was available in the “third”
breast, 47% of the available milk was removed, and the
postfeeding degree of fullness was 0.19 Ϯ 0.05 (n ϭ 4).
Total 24-Hour Milk Production
The overall 24-hour milk production for both breasts
combined was 788 Ϯ 169 g (range: 478–1356 g; Table
1). A significant difference in the 24-hour milk produc-
tion between the more productive and less productive
breasts was evident (P Ͻ .001; Table 1), with an absolute
median difference between the breasts of 106 g (IQR:
39–173 g; range: 5–441 g). For the majority of the
mothers (76%), the right breast was the more produc-
tive, resulting in a significant difference between the
right and the left breasts (426 Ϯ 116 g [range: 161–769
g] and 372 Ϯ 109 g [range: 177–601 g], respectively; P ϭ
.003).
There was a significant difference in milk production
(P ϭ .036) between mothers of boys (831 Ϯ 187 g) and
those of girls (755 Ϯ 151 g). No significant effects on
milk production were associated with time after birth (r2
ϭ 0.037, n ϭ 71), parity (r2 ϭ 0.051, n ϭ 71), or
maternal age (r2 ϭ 0.028, n ϭ 71). There was no rela-
tionship between the “cold” and “warm” months of the
year and the 24-hour milk production (r2 ϭ 0.010; P ϭ
.413).
Overall, infants consumed 64% of their 24-hour in-
take (497 Ϯ 17 g) in 6.8 Ϯ 0.3 feedings between 6 AM
and 6 PM and 275 Ϯ 13 g in 4.0 Ϯ 0.2 feedings between
6 PM and 6 AM. Between 2 PM and 2 AM, they consumed
322 Ϯ 12 g (42% of their 24-hour intake) in 5.1 Ϯ 0.2
feedings and 450 Ϯ 16 g in 5.7 Ϯ 0.2 feedings between
2 AM and 2 PM. Younger infants, up to 9 weeks of age,
consumed 443 Ϯ 32 g (61% of their 24-h intake) in 7.0
Ϯ 0.7 feedings between 6 AM and 6 PM and 275 Ϯ 15 g in
4.7 Ϯ 0.4 feedings between 6 PM and 6 AM. Between 2 PM
and 2 AM, they consumed 328 Ϯ 15 g (45% of their
24-hour intake) in 5.8 Ϯ 0.6 feedings and 390 Ϯ 29 g in
5.6 Ϯ 0.7 feedings between 2 AM and 2 PM.
Night Feedings
The majority (64%) of infants breastfed between 1 and 3
times at night (10 PM to 4 AM), and the number of
nighttime breastfeedings did not change between 4 and
26 weeks. Only 36% of infants did not feed during the
night.
There was no significant difference in the total 24-
hour milk production for infants who did and did not
breastfeed at night. Mothers of infants who breastfed at
night had a total breast storage capacity of 342 Ϯ 95 g,
which was not significantly different (P ϭ .078) from
that of mothers of infants who did not breastfeed at
night (386 Ϯ 108 g). There was no significant difference
in the total number of breastfeedings per 24 hours be-
tween infants who did and did not breastfeed at night,
with the median numbers of 11 breastfeedings (IQR:
8–13; range: 6–18) and 10 breastfeedings (IQR: 10–12;
range: 6–17), respectively (P ϭ .890). Infants who
breastfed at night had fewer breastfeedings at night (me-
dian: 1; IQR: 1–2) than during any other interval (P Ͻ
.001). There was a median of 3 breastfeedings (IQR: 3–4;
range: 1–6) during all other intervals, irrespective of
whether the infants breastfed at night.
Statistically different volumes were measured at dif-
ferent intervals of the day (P ϭ .019; Fig 3), with the
night breastfeedings being the largest and increasing
with both age and degree of fullness of the breast (r2 ϭ
0.255; P Ͻ .001; n ϭ 81). Infants who breastfed at night
had significantly larger breastfeedings during the night
compared with the morning (P ϭ .012), the day (P ϭ
.002), and the evening (r2 ϭ 0.294; P ϭ .001; n ϭ 496
FIGURE 2
Volume of milk available before each breastfeeding from the more productive (e) and
the less productive (u) breasts when the breastfeedings were unpaired or paired. Values
are means with SEM represented by vertical bars. More productive and less productive
breasts are different (a P ϭ .003; b P Ͻ .0001).
PEDIATRICS Volume 117, Number 3, March 2006 e391
6. breastfeedings; Fig 3A). From the less productive breast,
the infants had smaller breastfeedings in the evening
than during the night and the morning (P Ͻ .05). Al-
though the night breastfeedings were larger from the
more productive breast, because the night breastfeedings
were less frequent than during the rest of the day, 20 Ϯ
7% of the total 24-hour milk production was consumed
at night, which was significantly less (P Ͻ .008) than
that taken during the morning (28 Ϯ 9%), the afternoon
(28 Ϯ 8%), and the evening (24 Ϯ 8%).
Infants who did not breastfeed at night had signifi-
cantly larger breastfeedings during the morning than
during the day and the evening (P Ͻ .001) from both the
more and the less productive breasts (Fig 3B). These
infants took more of the 24-hour milk production (40 Ϯ
12%) during the morning than during the day (29 Ϯ
10%) and during the evening (25 Ϯ 9%; P Ͻ .001).
The volume of milk that was available at the begin-
ning of a breastfeeding in the breasts of mothers who
breastfed at night ranged from 88.9 g for the less pro-
ductive breast in the evening to 125.8 g for the more
productive breast at night. For mothers who breastfed
only during the day, the volume of milk that was avail-
able at the beginning of a breastfeeding ranged from
83.7 g in the evening for the less productive breast to
156.0 g in the morning for the more productive breast.
For mothers who breastfed at night, more milk re-
mained in the breast at the end of breastfeedings in the
morning and the night (degree of fullness: 0.27 and 0.24,
respectively) than during the day or the evening (degree
of fullness: 0.17 and 0.18, respectively; P Ͻ .001). For
mothers who breastfed only during the day, more milk
remained in the breast at the end of breastfeedings in the
morning (degree of fullness: 0.31) than during the day
or the evening (degree of fullness: 0.18 and 0.20, respec-
tively; P Ͻ .001).
Fat Content of Breast Milk
The average fat content of the milk was 41.1 Ϯ 7.8 g/L
and ranged from 22.3 to 61.6 g/L. The average fat con-
tent was not associated with either the time after birth
(r2 ϭ 0.036, n ϭ 71) or the number of breastfeedings
during the day (r2 ϭ 0.013, n ϭ 775). There was an
inverse relationship between the mean fat content of the
milk and the 24-hour milk intake from that breast (P ϭ
.007, r2 ϭ 0.089, n ϭ 142). The average 24-hour fat
intake of the infants was 32.0 Ϯ 7.7 g (range: 15.4–49.5
g) and was not related to the frequency of breastfeed-
ings.
Analysis of the individual breastfeedings showed that
there was no effect on the average milk fat content as a
result of the gender of the infant (P ϭ .160); more or less
productive breast (P ϭ .332); unpaired, paired, or clus-
tered breastfeedings (P ϭ .339); or whether the infant
breastfed at night or not (P ϭ .830). The mean fat
content of the milk was significantly related to time of
day (P Ͻ .001) and was higher (P Ͻ .008) during the day
and the evening (42.8 Ϯ 9.1 and 43.2 Ϯ 9.1 g/L, respec-
tively) compared with the morning and the night (37.1
Ϯ 10.1 and 37.2 Ϯ 10.3 g/L, respectively).
The interval between meals was independent of the
volume of the previous meal (paired or unpaired breast-
feeding). The interval was also independent of the aver-
age fat content of the milk consumed in that meal or the
amount of fat in the meal.
DISCUSSION
Frequency and Volume of Breastfeedings
The spectrum of breastfeeding behavior of normal in-
fants who were exclusively breastfed ranged between
having a few large breastfeedings and having frequent
small breastfeedings during 24-hour periods, and the
infants distributed the number of breastfeedings evenly
when comparing morning with afternoon and evening,
with fewer breastfeedings at night. The wide range in
FIGURE 3
Volume of milk consumed at a breastfeeding from the more productive breast (e) and
the less productive breast (u) during the morning (4:01 AM to 10:00 AM), day (10:01 AM to
4:00 PM), evening (4:01 PM to 10:00 PM), and night (10:01 PM to 4:00 AM) by infants who
breastfed at night (A) or did not breastfeed at night (B). Values are means with SEM
represented by vertical bars. More productive and less productive breasts are different
(a P Ͻ .05; b P Ͻ .0001).
e392 KENT, et al
7. frequency of “meals” that we observed was very similar
to that described by Butte et al,24 Cregan et al,10 and
Ho¨rnell et al.11 The inverse relationship between the
number of breastfeedings per day and the average
breastfeeding volume is consistent with the lack of a
relationship between the number of breastfeedings per
day and the 24-hour milk production of the mothers.
The volume of milk consumed during a breastfeeding
depended on (1) whether the breast was the more or less
productive breast, (2) whether the breastfeeding was
unpaired or paired, (3) whether it was the first or the
second breast of paired breastfeedings, and (4) the time
of day (Figs 1 and 3).
For 53% of the meals, 1 breast was sufficient to satisfy
the infant for at least 1 hour. This is consistent with the
unpaired breastfeedings, particularly from the more pro-
ductive breast, being larger than the average breastfeed-
ing (Fig 1) and supports the advice of Riordan and
Aurbach25(p247) that after breastfeeding becomes estab-
lished, it may not be necessary to use both breasts at
each meal, and also the recommendation of the National
Health and Medical Research Council6 that both breasts
be offered at each meal, but the infant may or may not
feed from the second breast. For the 44% of the breast-
feedings that were paired, if the second breast was the
less productive breast, then the breastfeeding volume
could be considered to be a “top up.” However, if the
second breast was the more productive breast, then the
infant took an equal volume to the first breast. There-
fore, the milk yield from the second breast, when the
infant chooses to feed from it, may provide a significant
volume of milk.
The larger breastfeedings in the morning compared
with the evening were also observed by Butte et al.24 For
infants who breastfed at night, although there were
fewer breastfeedings during this time, those from the
more productive breast were the largest of the 24-hour
period, and the nighttime intake composed 20% of the
total 24-hour intake. For the infants who did not breast-
feed at night, the morning breastfeedings were the larg-
est (Fig 3B).
Some mothers are concerned about the frequency of
breastfeeding and wish to extend the interval between
breastfeedings. We found that some infants would
breastfeed again within 1 hour after breastfeedings of up
to 175 g, and others would not breastfeed for Ͼ8 hours
after a breastfeeding of as little as 35 g. In fact, the
interval after the largest meal of 350 g was only 3 hours
35 minutes. Infants of the 5 mothers with total storage
capacity of Ͻ235 mL all breastfed at night. However,
most of the infants of mothers with larger storage capac-
ities chose to breastfeed at night. Infants may need to
feed at night if they have a relatively small stomach
capacity and/or a rapid gastric emptying time.
Storage Capacity, Degree of Fullness, and Available Milk
The storage capacity that was calculated in this study is
similar to that calculated by Kent et al26 for the first 6
months of lactation (196 Ϯ 57 g). It is smaller than that
measured by Daly et al27 (242 mL; SD: 129) by Comput-
erized Breast Measurement; however, that study in-
cluded 1 breast with an unusually large storage capacity
of 606 mL. The relationship between storage capacity of
the breast and the 24-hour milk production is similar to
that found by Kent et al.26 In the current cross-sectional
study, there was no relationship between the storage
capacity of the breast and the age of the infant. However,
in a longitudinal study, the mean storage capacity at 1
month (179.9 Ϯ 20.2 g) increased to 234.6 Ϯ 17.5 g at 6
months (mean Ϯ SEM), indicating that the storage ca-
pacity of the breast can change during lactation.26 Be-
cause the maximum breastfeeding increased between 4
and 26 weeks and there was a relationship between the
storage capacity and the maximum breastfeeding, it is
likely that the storage capacity of the breast is able to
change to meet an increase in demand for milk.
Anecdotally, mothers usually first offer the breast that
feels more full. The data on the prefeeding degree of
fullness of the breast confirm this subjective choice of
the mothers. The prefeeding degree of fullness and the
storage capacity allow calculation of the volume of avail-
able milk in the breast. The volume of milk that is
available accounted for most of the differences in vol-
ume of milk consumed at each breastfeeding (Figs 1 and
2). For unpaired breastfeedings, not only was there more
milk available in the more productive breast, but also the
infants took a higher percentage of that available milk
than during a paired breastfeeding.
The observation that the breasts are rarely drained at
the end of a breastfeeding was also noted by Dewey et
al,20 who found that an extra 12% of milk could be
expressed after a breastfeeding. Because breast expres-
sion is not always effective in removing all of the avail-
able milk,15 this finding is consistent with the infants’
removing 63% to 72% of the available milk during a
breastfeeding. This suggests that the breasts do not need
to be drained at every feeding to maintain adequate milk
production.
Total 24-Hour Milk Production
The 24-hour milk production was within the normal
range of 440 to 1220 g,26 except for 2 mothers, who
produced 1298 g and 1356 g. The average of 798 g is
similar to the data presented by Dewey and Lo¨nnerdal.14
It is important to note the wide SD and bear in mind that
the variation in milk production is related to the varia-
tion in the growth rates of the infants.12,26,28 In addition,
the higher milk intake of male infants was also noted by
Butte et al29 and is consistent with their higher growth
rate.30 The lack of effect of either maternal age or parity
PEDIATRICS Volume 117, Number 3, March 2006 e393
8. on milk production is in agreement with the findings of
Dewey and Lo¨nnerdal.14
Consistent milk intake from 1 to 6 months supports
previous findings.26 This is not surprising considering 2
factors. First, younger infants (1–3 months of age) grow
more rapidly than older infants (4–6 months of age).30
Second, smaller infants have a larger surface area to
volume ratio and therefore have a relatively higher met-
abolic rate per kilogram of body weight31 and use rela-
tively more of their nutrient intake for maintenance of
body temperature than do older, heavier infants.
Differences in milk production of right and left breasts
have been noted previously. Mitoulas et al32 found a
significant difference between breasts, with the right
breast being more productive (443 vs 356 g/24 hours).
In addition, Cox et al33 showed that the right breast was
often more productive than the left. In this context, it is
interesting to note that when we measured the milk
production of 4 mothers who were exclusively express-
ing their milk for their infants (Ͼ660 g/day), there was
a significant difference (P ϭ .03) between the left and
the right breasts (unpublished results). Three of these
mothers, who were double pumping and therefore sub-
mitting both of their breasts to equivalent vacuums and
times of expression, had the largest differences between
the breasts. This leads us to suggest that the difference in
milk production between the breasts may be attributable
to differences in intrinsic milk production rather than
the infant’s preference. The 24-hour milk production of
mothers of infants who breastfed at night was the same
as for those who did not breastfeed at night, similar to
the observations of Butte et al.24
The current data for infants up to 26 weeks of age
confirm the findings of Matheny and Picciano8 for
4-week-old infants that more milk is consumed between
6 AM and 6 PM and less is consumed between 2 PM and 2
AM. The uneven distribution of the volumes of breast-
feedings of both infants who breastfeed at night and
those who do not breastfeed at night (Fig 3) explains
why doubling of either of these 12-hour intakes will
result in significant inaccuracies in estimation of 24-
hour milk consumption. Therefore, our measurements
confirm that in our society, a full 24-hour period of
measurement of milk intake is necessary for accuracy.
Fat Content of Breast Milk
The fat content of the milk that we measured was similar
to that measured by Dewey and Lo¨nnerdal,14 and the
24-hour fat intake of the infants was similar to that
measured previously.12,14 Fat content of the milk at dif-
ferent times of day reflects the higher degree of milk
removal during the day and evening and the higher
degree of fullness in the morning and night. The changes
in fat content of milk from the beginning to the end of
the first and second breasts of a paired breastfeeding
described by Woodward et al34 can be explained by the
degrees of fullness that we have calculated. The lower fat
content of milk from the first breast at the beginning of
the breastfeeding that they measured reflects the moth-
er’s starting to feed her infant on the fuller breast, and
the higher fat content of milk from the first breast at the
end of the breastfeeding reflects the higher degree of
milk removal from the first breast.
Because the breast was not full at the beginning of
each breastfeeding for the whole day, the fat content of
the fore-milk was not always low. Because the fat intake
of the infants was not related to the frequency of breast-
feedings, mothers can be reassured that infants who take
frequent small breastfeedings have the same daily fat
intake as infants who take infrequent large breastfeed-
ings.
An understanding of the patterns of milk intake by
the breastfed infant has implications for mothers who
need to express their milk either fully for a preterm
infant or when they return to the paid workforce. Given
the variability in breastfeeding patterns, it may be un-
reasonable to expect all breasts to yield the same volume
of milk at the same rate when the mother is using an
electric breast pump, and the breast may not need to be
totally drained at every expression to maintain an ade-
quate supply of milk. Breast pump settings and regimens
may need to be customized for each mother.
CONCLUSIONS
Healthy, exclusively breastfed 1- to 6-month-old infants
consume 0 to 240 g of milk between 6 and 18 times
during 24 hours, with 64% of infants breastfeeding 1 to
3 times at night. The right breast usually produces sig-
nificantly more milk than the left, and the volume of
milk consumed at each breastfeeding is related to the
volume of milk available in the breast, whether the
breastfeeding is unpaired or paired, and the time of day.
On average, 67% of the available milk is consumed at
each breastfeeding. The fat content of breast milk varies
between mothers (22.3–61.6 g/L) and within and be-
tween breastfeedings, but the amount of fat consumed
by the infant is independent of the frequency of breast-
feeding.
ACKNOWLEDGMENTS
The research described in this article was funded by
Medela AG, which is gratefully acknowledged.
We thank the participating breastfeeding mothers and
infants for their time, the Australian Breastfeeding As-
sociation for recruiting volunteers, and Tracey Williams
for technical assistance.
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