Breast Feeding

Breast Feeding [email protected] Human milk is the most appropriate of all available milks for the human infants , since its uniquely adapted to his needs. ►

Anatomy of the breast: The breast is made of many lobules of gland tissues. ►

Each lobule is made of many little secretory alveoli which make milk. ►

The milk passes into ducts which take it to wider sinuses (lactiferous sinuses) which lie under the areola. ►

Milk collect in these sinuses both before & during feeding . Lactiferous ducts take the milk from the sinuses to outside through the nipple. ►

Many sensory nerve endings in the nipple .

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The myoepithelial muscle cells around the ducts & sinuses , contract & make the milk flow. ►

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Physiology of breast feeding: ►Two main reflexes in the mother are necessary for lactation, both of them are started by the baby suckling or licking the nipple. ►Sensory impulses from the sensory nerves in the nipple pass along the vagus nerve to the hypothalamus & then to the pituitary gland. ►These impulses stimulate the pituitary to produce 2 hormones, prolactin from the anterior pituitary & oxytocin from the post. ►Prolactin causes secretion of milk by the alveoli (milk secretion reflex) & it also acts on the ovary & inhibit ovulation . ►The oxytocin makes the myoepithelial cells around the alveoli & milk ducts contract  incr the pressure in the ducts & milk flow out of the breast (milk flow reflex or let down reflex ejection reflex). When this reflex is functioning well, milk flow from opposite breast as infant start nursing. ►The mother’s psychological state is important for milk flow reflex.

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Composition Of Human Milk: ►Colostrum: It’s the secretion of the breasts during the later part of pregnancy & for 2-4 days after delivery. ►Its deep lemon yellow in color & alkaline. ►It contains several times the protein of mature breast milk, more minerals but less carbohydrate & fat. It also contains some unique immunological factors. ►After the first few days of lactation colostrum is replaced by secretion of a transitional form of milk. rd ►Mature breast milk by the 3 or 4th wk. ►

Calories: ►Carbohydrate: Found more in human milk than cow milk ►Fat : Qualitative human milk contains twice as much of the more absorbable fat. ►Protein: Human milk contains less protein than cow milk, which contain high amount of casein. The amount protein in breast milk is still quite adequate for the normal infant. ►Minerals: All minerals are much more in cow milk than human milk except iron & copper. Human milk iron may be sufficient for the infant as its better absorbable. ►

Calcium & phosphorus are needed during period of rapid growth, adequate balance is maintained on breast milk despite its low content. ►

►Vitamins:

Varies with maternal diet. ►Each has large amount of vitamin A ►Breast milk contain more Vitamin C & D ►Low level of vitamin K ►Cow milk easily contaminated & it’s a good culture medium.

Many infections are milk borne e.g. streptococcal, TB, diphteria, typhoid, salmonella & brucellosis. ►

Advantages of breast feedings: It’s the natural food for human infants Always available at the proper temp Require no preparation time Its fresh & free of contaminated bacteria, so reduce the chance of GIT disturbances. Among the lower socioeconomic groups, the breast fed infants are more likely to survive. Allergy & intolerance to bovine milk (diarrhoea, intestinal bleeding, occult melena, colics & atopic eczema) create disturbance of feeding. These difficulties are unlikely to occur in breast fed babies. Human milk contains antibodies against viral and bacterial infections, contain relatively high concentration of secretory IgA which prevent microorganisms from adhering to intestinal mucosa. It also contains substances that inhibit the growth of many common viruses. Macrophages in human milk, may synthesize ► ► ► ►

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complement & lactoferrin. Human milk also contain lactoferrin, an iron binding protein, which has an inhibitory effect on the growth of E coli in intestine. ►If the mother diet is sufficient & properly balanced, her milk supplies the necessary nutrients except, perhaps fluoride & after several months vitamin D. The iron content of human milk is somewhat low. However most normal infants have sufficient iron store for the first 6 months of life. Human milk iron is well absorbed. ►Vitamin K contents of human milk is low & may contribute to hemorrhagic disease of the newborn. ►Psychological advantages of breast feeding for both mother & infant ►Transmission of HIV by BF is well documented ►CMV, rubella V, hepatitis B V, herpes simplex V have been demonstrated in breast milk ►Decrease breast cancer ►Contraception (suppressed ovulation) ►Uterus involution & body shape (energy loss) Establishing & maintaining the milk supply: The most satisfactory stimulus to the secretion of human milk is regular & complete emptying of the ►

breasts. BF should be started as soon as possible after delivery . BF on demands, otherwise every 3 hrs. Appropriate care for tender nipples Avoid addition of bottle feeding . Breast milk can be kept in freezer for one month & in refrigerator for 1 day & reused. Happy relaxed state of mind, good diet, appropriate hygiene, clear instruction about the technique of BF & eventually weaning are very important ►

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Nursing mothers should not take drugs unless they are absolutely necessary. Antithyroid drugs, anticancer drugs, INH, metronidazole, chloamphinicol, sulphonamides & others should not continue BF during these therapies. ►

Smoking cigarette & alcohol drinking should be discouraged. ►

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Technique of Breast feeding : Started as soon as possible after delivery. At the feeding time , the infant should be hungry, dry & neither too cold nor too warm. The baby should be held comfortable in semi sitting position. The mother should also be in comfortable position back is supported, one arm supporting baby’s body and head, the other holding the breast. Several reflexes that facilitate BF are present at birth. These include the rooting, sucking, swallowing & satiety reflexes The infant should not be pulled from the breast. At the end of feeding, the infant should be held erect over the mother shoulder to expel swallowed air (eructation) ► ►

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Both breasts should used at each feeding in early weeks of life to encourage maximal milk production. The most common cause of early failure to thrive is poorly managed breast engorgement, which rapidly decreases milk supply. ►

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•Is the infant position correct ? If the infant has not fed in the previous hour, ask the mother to put her infant to the breast. Observe the breast feed for 4 minutes.

If the infant was fed during the last hour, ask the mother if she can wait and tell you when the infant is willing to feed again.

TO CHECK POSITIONING, LOOK FOR: Infant’s neck is straight or bent slightly back, Infant’s body is turned towards the mother, Infant’s body is close to the mother’s body, and Infant’s whole body is supported (if all of these signs are present, the positioning is good)

• • • • • • • • •Is the infant able to attach ? TO CHECK ATTACHMENT,(Latch On) LOOK FOR: Chin touching the breast, Mouth widely open, Lower lip turned outward, and More areola visible above than below the mouth (if all of these signs are present, the attachment is good) ►Is

the infant Suckling effectively ? (that deep sucks, sometimes pausing). ►Clear a blocked nose if it interferes with

is, slow breast

feeding ►Look ►

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for ulcers or white patches in the mouth (thrush).

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Unrelieved engorgement can result from : Long intervals between feeding (not exclusively breast fed during the first 6 months) Improper infant suckling Sore nipples (improper positioning, attachment) Maternal or infant illness Nursing from one breast Rigid time restriction should not be imposed. ► •

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Sensible guidelines are 5min/ breast at each feeding day one,10min/breast/feed day 2 & 15/breast/ feed thereafter. ►

Determining the adequacy of milk supply: Sleep 2- 4 hrs between feeding & gaining wt properly. ►

3 possibilities should be excluded before assuming that a mother cannot produce sufficient milk: ►

Error in feeding technique Maternal factors related to diet, rest & emotion. Physical disturbance of the infant

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Working mothers can express her breast milk & kept in fridge or freezer & given later by cup or bottle with small hole. Weaning from BF : Contraindication to BF : Acute maternal infection may contraindicate BF if the infant does not have the same infection (AIDS, HCV etc) ►

Mothers with septicemia, active TB, typhoid fever, breast Cancer & malaria, substance abuse, severe neurosis or psychosis should not BF their babies. Infant disorder e.g. galactosaemia. ►

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