BREASTFEEDING • Introduce complimentary foods with continued

• Prolactin: hormone responsible for the synthesis breastfeeding

of milk.
• Produced toward the end of pregnancy • Optimum to breastfeed for 2 years or longer
• Suppressed by estrogen and progesterone BENEFITS OF BREASTFEEDING
until childbirth  Ecological:
• Colostrum: first milk produced (from birth up to -Saves resources
three days); rich in proteins, antibodies, vitamins, -Less waste
and minerals. -No refrigeration
• Oxytocin: hormone responsible for milk let down. -No manufacturing
GLOSSARY -No bottles, cans
• Lactation- the period of milk production -No trucking
-No handling
initiated by the prolactin hormone in the
mammary gland.  For Society
-Smarter
• Lactogenesis-milk synthesis and -Healthier
secretion by the mammary glands. -Less cost to healthcare system
• Colostrum- first liquid secreted at the -Stronger families
beginning of one nursing period  To Families
• Foremilk-milk secreted at the beginning -Less trips to doctors, hospitals
of one nursing period -Less prescriptions
• Hindmilk-milk secreted at the end of one -Less stress
nursing period. -Less illness
-More bonding
Breastfeeding -Inexpensive
• Milk production requires 700–800  Benefits to baby:
kcal/day -Better dental health
-Increased visual acuity
• Lactating women should consume 330
-Decreased duration and intensity of illnesses
kcal/day above their pre-pregnancy
-Less allergies
needs the first six months, 400 kcal/day
-Better health & less risk of illnesses
the second six months
Lactation Nutrient Needs
• This allows a woman to gradually loose
• Energy Intake
weight (1–4 pounds per month)
• 15–20 g of protein and 80 g of
– need about +650 kcals to support milk
production; recommend +500 from food
carbohydrate required per day above pre-
and rest from fat stores;
pregnancy needs
• Exercise
• Fluid/many micronutrient needs are
– intense may raise lactic acid
increased
concentration of breast milk and baby
Obstacles to Breastfeeding
may not like the taste
• Many harmful substances are passed into breast • Vitamin and Minerals
milk, including – maintained in breast milk at expense of
• Illegal drugs, caffeine, nicotine, maternal stores if poor po intake; B6,
prescription, and over-the- B12, A, D;
counter medications • Water
• HIV is passed through breast milk – need plenty of fluids to prevent
• Conflicts with mother’s employment dehydration
Nutritional Needs for Lactation – drink a glass of fluid at each meal and
• Milk production requires 800 kcals per day. each nursing session
• Need for protein during lactation is 25 g per day • Nutrient Supplements
more than woman’s average need. – iron to replace stores
• About 3 L per day of water, juices, milk, soup – often continue prenatal vitamins
contribute to necessary fluids. • Particular Foods
• Rest, moderate exercise, relaxation are necessary – foods with strong or spicy flavors may
alter flavor of breast milk
RECOMMENDATIONS – some infants may be sensitive to
• Exclusive breast feeding until 6 months of age particular foods that mom eats
During Lactation Don’t:
• Don’t drink alcohol
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 • Don’t take medications unless OK by Medical • higher in breast milk overall.
Provider Specifically in breast milk has more:
• Don’t take illegal drugs • cholesterol (CNS
• Don’t smoke myelin sheaths;
• Don’t get into environmental contaminants enzymes)
• Don’t have caffeine • linoleic acid (essential
Lactation and Maternal Health fatty acid)
• Illnesses • carnitine (impt. for fat
– colds: OK to breastfeed; TB/Hepatitis metabolism)
may have to pump • lipases (enzyme for
• HIV Infection and AIDS digestion of fats)
– should NOT breastfeed if there is an Minerals
alternative way of feeding; Generally lower in breast milk
• Diabetes: OK
• 6x more P; 4x more Ca and 3x
• Postpartum Amenorrhea: need birth control
more total ash in cow’s milk
• Breast Health
(higher renal solute load than
Composition of Human vs. Cow’s Milk
breast milk).
• However, bioavailability of
NUTRIENT HUMAN COW
some minerals higher in breast
Protein Lactalbumin Casein
milk [e.g. Fe (5x higher
(3X) absorption than cow’s milk),
Fat 1.2X ---- Zinc]
(linoleic 5X ---- • Fe is however low in milk and
acid) infant needs alternative source
Lactose 1.4X ---- after 6 months
Minerals ---- 3.4X Vitamins
“B” ---- 2- • variable in breast milk depending on diet
vitamins 6X and drug use
Vitamins 2-6X ---- • Vitamin E higher in breast milk than
C,D, E cow’s milk and Vitamin K low in both
• RDA for most vitamins greater during
Breast Milk Composition
lactation than pregnancy except Vit. D &
 Carbohydrate B12 (same); & B6 & Folate (lower)
• Lactose is primary CHO in milk Anti-Infectious Factors
• higher in breast milk vs cow’s • Bifidus factor, lactobifidus, kills
milk enteropathogenic organisms by the
• Bifidus factor = growth factor production of lactic and acetic acids
present only in human milk • IgA, IgM, IgE, IgD, IgG - bacteria &
required for establishing an virus
acidic environment in the gut to • Lactoferrin (binds iron which bacteria
inhibit growth of bacteria, fungi need)
and parasites
• Lysozyme & Lactoperoxidase (bacteria)
 Protein
• Interferon (inhibits viral replication)
 casein:l actalbumin (whey) important How Does a Breast Produce Milk?
• Human milk (40:60) • Milk is made in grapelike structures deep in the
• cows milk (80:20) breast
 Amino Acids • When milk “let’s down” it travels out of the
• (Breast milk low in “grapes” down the stems “ducts” and collects in
phenylalanine and methionine the pools (sinuses) under the dark area (areola)
but high in taurine and cystine behind the nipple
 Total protein 0.7 - 0.9 g/100 ml breast • Baby’s gums press areola to release milk
milk vs 3.5g/ 100 ml in cow’s milk
 Lactoferin => Isolates external iron Lactogenesis
 Secretory IGA => Most important
immunoglobulin, breast milk = only
source for first 6 weeks

 Fats
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 The Cradle Position
• Tummy-to-tummy
• Baby’s head in crook of your elbow
• Shoulders, hips, in straight line
• Level with breast
• Pillow in lap will help

Breastfeeding Your Infant

• Wash your hands Problems in Breastfeeding
• Position yourself comfortably and correctly Flat or Inverted Nipples
• Use pillows or towels for support • Begin treatment late in pregnancy
• Uncover the breast you wish to offer first – Stop if causes uterine contractions
• Breast shells
The Side-lying Position – Wear 1 hour a day and gradually
• Lie on your side increase to several hours
– Dry area under nipple often
• Use pillows
Inverted nipple
• Tummy-to-tummy
Treatment should begin after birth
• Baby’s mouth in line with nipple
• Manually stretch and roll the nipple between the
thumb and finger several times a day
• Teach the mother to grasp the breast tissue so that
areola forms a teat, and allows the baby to feed
• Syringe suction method

Sore Nipple
Look for a cause:
• Check the baby’s attachment at the
breast
The Football Position • Check the baby’s position if attachment
• Baby’s legs are under your arm is poor
• Use pillows • Examine the breasts – engorgement,
• Helpful for baby’s who are having trouble fissures, candida
latching on • Ask if mother washes the
• breasts after each feed (frequent
washing leads to sore nipple)
• If the problem persists, check the baby’s
oral cavity for candida

Sore nipple: management

Give appropriate treatment:

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 – Build mother’s confidence • Breastfeeding is considered adequate if the baby
– Improve the baby’s attachment and • Goes to sleep for 2-3 hrs after each feed
continue breastfeeding • Passes urine 6-8 times in 24 hrs
– Reduce engorgement, feed frequently, • Gains weight at 10-15 gm/kg/day
express breast milk • Crosses birth weight by 2 weeks
– Treat candida Expressed breast milk
Advise the mother to: Indications
– Wash breasts only once a day; avoid – Sick mother, local breast problems
using soap – Preterm / sick baby
– Avoid medicated lotions and ointments – Working mother
– Gently apply hind milk onto nipple and Storage
areola after each feed – Clean wide-mouthed container with tight
lid
Breast engorgement – At room temperature: 6 hrs
Causes – Refrigerator: 24 hours; Freezer (20°C):
• Delayed and infrequent breastfeeds for 3 months
• Incorrect latching of the baby
Treatment
• Give analgesics to relieve pain
• Apply warm packs locally Why some mothers choose formula vs. breast milk
• Gently express milk prior to feed
• Distressed by physical discomfort of early
• Put the baby frequently to the breast
breastfeeding problems.
Full vs. engorged breasts
• Convenience issues
Full breasts:
– 36/72 hours after birth. • Pressures of employment/school
– Hot, heavy, may be hard • Worries that breast shape will change
– Milk flowing • Formula manufacturers manipulate people
– Fever uncommon through their ads
• Doctors and nurses need more lactation training
Engorged breasts: • Moms given very little time to adjust to changes
– can occur at any time during of postpartum
breastfeeding • Family demands
– Painful; edematous • Non-supportive family/health professionals
– Tight, especially nipple area • Embarrassment
– Shiny • Lack of confidence in self
– May look red • Feeling that one cannot produce enough milk
– Milk NOT flowing
– Fever may occur Mother’s milk vs. formula milk
– May cause a decrease in milk supply if it • Formula milk for 3 days old babies is no different
happens often than formula milk for 3 months old infants.
“Not enough milk”: causes • Breast milk is ingeniously different every single
• Not breastfeeding often enough day; adapted to the changing needs of the baby.
• Too short or hurried breastfeeding • Human milk is designed to support the
• Night feeds stopped early development of large brains, capable of
• Poor suckling position processing and storing lots of information.
• Poor oxytocin reflex (anxiety, lack of confidence) • Cows milk is designed to support functions, like
• Engorgement or mastitis constant grazing.
“Not enough milk”: management
• Put baby to breast frequently Barriers to Bonding
• Baby to be correctly attached to breast * A Bottle places a physical barrier between mom and
• Build mother’s confidence baby
• Back massage and relaxation can help
• Use galactogogues (metaclopropamide) *Less skin to skin contact
judiciously
*Less eye contact
Adequate weight gain and urine frequency 5-6 times a
day are reliable signs of enough milk intake * The hormonal connection between the breastfeeding
mother and baby cannot be experienced by the bottle
Adequacy of breastfeeding feeding mother
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Other Options If Breastfeeding is Not Possible
Mom can still use her milk, even if she decides not to
breastfeed:
• Use a breast pump (electric/manual)
• Cup or bowl feeding
• Spoon feeding
• Eyedropper or feeding syringe
• Nursing supplementer
• Get milk from donation bank
• Let the infant indicate when and how much she
wants to eat.
• Serve solid food two or three times per day.
• Begin to offer a cup for water or juice.
• Limit juice to four to six ounces per day.
• Give iron supplements to infants who are
exclusively breastfeeding.

Newborn Visit: Bottle-feeding

• type of formula, preparation
• feeding techniques, and equipment.
• Hold baby in semi-sitting position to feed.
• Do not use a microwave oven to heat formula.
To avoid developing a habit that will harm your
infant's teeth, do not put him to bed with a bottle
or prop it in his mouth.

First Week
• Do not give the infant honey until after her first
birthday to prevent infant botulism.
• To avoid developing a habit that will harm your
infant's teeth, do not put her to bed with a bottle
or prop it in her mouth.
One Month
• Delay the introduction of solid foods until the
infant is four to six months of age. Do not put
cereal in a bottle.
Four Months
– Continue to breastfeed or to use iron-
fortified formula for the first year of the
infant's life. This milk will continue to
be his major source of nutrition.
– Begin introducing solid foods with a
spoon when the infant is four to six
months of age.
– Use a spoon to give him an iron-
fortified, single-grain cereal such as rice.
– If there are no adverse reactions, add a
new pureed food to the infant's diet each
week, beginning with fruits and
vegetables.
– Always supervise the infant while he is
eating.
– Give exclusively breastfeeding infants
iron supplements.
– Continue to give the breastfeeding infant
400 I.U.'s of vitamin D daily if he is
deeply pigmented or does not receive
enough sunlight.
– Do not give the infant honey until after
his first birthday to prevent infant
botulism. .
Six Months