Breast

feeding in
newborn
 Objectives
1. Discuss breastfeeding
• I.Benefits of breastfeeding
• II. Composition of breastmilk
• III.Proper Technique of breastfeeding
• IV.Prolactin reflex, and factors affecting it
• V.oxytocin reflex, and factors affecting it
• VI.Explain how to recognize if the baby is
breastfeeding well
2. Discuss problems with breastfeeding

3. Describe Expression of breastmilk and

cup feeding
Breast Anatomy - Structure

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 Prolactin Reflex
Secretion continues AFTER
feed to produce NEXT feed

To increase milk productions

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Oxytocin Reflex

For milk ejection

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Helping and Hindering the Oxytocin Reflex

For milk ejection

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Advantages of Breastfeeding

Breastmilk Breastfeeding
 Perfect nutrients  Helps bonding and
 Easily digestible development
 Ready to serve  Helps in adequate
 Protects against growth and
infection development

 Protects against adult

 Enhances brain & visual
onset diseases development
(diabetes, high blood  Baby has higher
pressure) intelligence quotient
 Prevents hypothermia

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Advantages of Breastfeeding (contd.)

Mother Family Society

 Reduces post  Economic benefits  Eco-friendly
delivery bleeding  Human
and anemia  Less illnesses
resource
 Family bonding
 Delays next development
pregnancy  Economy
 Protects breast and development
ovarian cancer
 Protects obesity and
shapes body
 Convenient

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What is Early
Feeding within 1 hour of the baby's birth.
Breastfeeding?
Baby awake, has strong suck reflex in the
1st hour after birth
Baby's sucking helps mother make breast
milk
Why do Early
Colostrum is good for the baby
Breastfeeding?
Mothers have less bleeding after birth
Skin to skin contact helps baby maintain
body temperature
Helps bonding between mother and baby
Feeding the baby ONLY at the breast (no
water, other liquids or food)
Exclusive
Recommended for first 6 months of a
Breastfeeding
baby's life
Helps baby live, grow and develop.
 Breastmilk
• Living fluid
– White blood cells, macrophages
– Anti-infective factors
– Antibodies against infections
– Growth factors(EGF, NGF, ILGF, VEGF)
– Immunological factors (cells, cytokines,
chemokines, oligosaccharides)
• Immunological, hormonal, enzymatic, trophic,
bioactive activity in breast milk

Chirico G et al Antiinfective Properties of Human Milk

J. Nutr. 138: 1801S–1806S, 2008.
 Colostrum
Milk secreted during the first 1-3 days
after delivery
What is it? Yellow and thick, containing more
antibodies and white blood cells
Has higher protein and fat content

It is the baby's first immunization

Benefits to Helps to expel meconium and prevent
Baby jaundice
Most suited for the baby's needs
 Mechanism of Protection Against
Infection

When Mother White cells in

infected 1 2 mother’s body
make antibodies
to protect her

Some white cells

4 3 go
to her breast and
These antibodies are make antibodies
secreted in breastmilk there
to protect baby

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• Transitional milk: after 3-4days until 2 weeks.
Immunoglobulin and protein content decreases
while fat and sugar content increase
• Mature milk: after transitional milk; thinner
and watery but contains all essential nutrients
• Preterm milk: contatin more proteins, sodium,
iron, IG and calories as per requirements of
preterm baby
• Foremilk: rich in proteins, sugar, vitamins,
mineral and water, quenches baby’s thirst
• Hindmilk: richer in fat that provides energy
and gives a sense of satiety.
 Prelacteal feeds
Giving something other than breast milk to
newborns before the mother's milk flows
What is it? regularly.
Examples: Water, glucose water, honey,
formula milk, 'lito', 'ghuti', 'ghee' etc.

•Baby feeds less on breast and so mother

makes less milk
Risks to
Chance of infections increases
Baby All nutrients of breast milk will not absorb
well
 Initiating Breast Feeding
Mother's position: Help the mother into a comfortable
position
Help the baby attach:
• Ask mother to hold her breast in a "C" hold (thumb on top
and other fingers below breast) with fingers away from
areola.
• Touch the outer edge of the baby's lips with the nipple
• Wait for the mouth to open wide
• Move baby on to the breast with baby's lower lip below
the nipple.
• Do not move baby's head but support the back of the
neck and move the whole body.
• Look at how the baby is attached and sucking.
• Explain to mother how she can tell if the baby is sucking
well.
Attachment at Breast

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 Good attachment
• Chin is touching the breast
• Baby's mouth is wide open
• Baby's lower lip is everted
• More areola is visible above than below
the breast
What Differences Do You See?

Picture 1 Picture 2

GOOD ATTACHMENT POOR ATTACHMENT

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What Differences Do You See?

Picture 1 Picture 2

ATTACHMENT, OUTSIDE APPEARENCE

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 Feeding Reflexes in the Baby
Rooting reflex
When something
touches lips,
baby opens mouth
Sucking reflex
puts tongue down
and forward When something touches
palate baby sucks

Skill
Mother learns to position baby
Baby learns to take breast

Swallowing reflex
Gag reflex When mouth fills with milk,
When something touches baby swallows
anterior part of the tongue,
baby pushes it out.

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 Sucking
• Slow deep sucks
• Some pauses
• You can hear the baby swallow when
feeding
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 Good position
• Mother's position: comfortable
• Baby's position:
– Baby is close to the mother
– Head and body are in a straight line
– Baby is facing breast with nose close to
the nipple
– Whole body is fully supported.
 Advice to the mother
• Give only breast milk in the first 6 months
• Feed the baby on demand
• Alternate which breast is used to start feeding (if
left breast was given at last feed start with right
breast)
• If baby still wants to feed more after the first
breast, give the second breast
• Empty first breast before starting on the other (this
provides hind milk)
• Use comfortable and different positions
• Get enough rest
• Eat one extra meal a day
 Epidemiology

• Worldwide, it is estimated that only 34.8% of infants

are exclusively breastfed for the first 6 months of
life, the majority receiving some other food or fluid in
the early months.

WHO Global Data Bank on Infant and Young Child Feeding, 2009.

• In Nepal, 70% exclusively breastfed till 6

months of age
World Breastfeeding Trends initiative (WBTi) Nepal report 2015

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 Conditions for which Human Milk has
been Suggested to Possibly have a
Protective Effect
• Diarrhea • Crohn disease
• Otitis media • Childhood cancer
• Urinary tract infection • Lymphoma
• Necrotizing • Leukemia
enterocolitis • Recurrent otitis media
• Septicemia • Allergy
• Infant botulism • Obesity and overweight
• Insulin-dependent • Hospitalizations
diabetes mellitus • Infant mortality
• Celiac disease

Nelson textbook of pediatrics

 Successful breastfeeding signs
• 7% or less weight loss in first few days after birth
• Return to birthweight by at least 2 weeks
• Weight gain per day of 20-30g during first 3 months
• Lactation established in mother by 2 to 4 days after
birth
• At least eight breastfeeding events every 24 hours
• Baby is latching onto breast easily
• Three to six stools and four to six voids by 5 to 7 days
of age

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 Common Problems Faced

• Breast Engorgement
• Breast Abscess
• Sore/ Crack Nipple
• Perceived Insufficiency
• Difficult positioning/attachment

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Inhibitor in Breastmilk

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Consequences of Poor Attachment

 Pain and damage to nipples Sore nipples

Fissures

 Breastmilk not removed effectively Engorgement

Baby unsatisfied,
wants to feed more
Apparent poor milk supply
Baby frustrated,
refuses to suckle
Breasts make less milk
Baby fails to gain
weight

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Causes of Poor Attachment

Use of feeding bottle

Inexperienced mother
first baby
Functional difficulty
LBW and sick baby
nipple poorly protactile
large/flat nipple
engorgement
late start
Lack of skilled support
less traditional help and community support
doctors, midwives, nurses not trained to help

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 Method of milk expression
• Wash the hand properly before she
express
• Hold container under her nipple
• Place thumb on top of breast at least 4 cm
from the tip of breast
• Other fingers on the undersurface
• Compress and release the breast tissue all
the way around
• Change side alternatively
• Express at least 8-10 times in 24 hrs
Expression of breastmilk
Cup feeding
• Storage
– Room temp 6hr
– Refrigerator 24hr
– Freezer 3mths

• Breast milk banking

 HIV and Breast feeding
• Important modality of transmission in developing
countries
• Risk highest in early months of BF
• Risk factors: mastitis, detectable level of virus in
milk and low maternal CD4 count
• Should only give commercial infant formula milk
• If you do not have access to formula milk may be
advised to breastfeed while both mother and baby
are taking antiretroviral treatment.
• Mixing breastmilk and other foods before 6 month
increases your baby’s risk of HIV. You can mix-
feed your baby after six months.
Thank you