Transcript Feeding of healthy newborn babies

Feeding of healthy
newborn babies
Learning objectives - 1

To list the benefits of breast feeding
 Benefits
to baby
 Benefits to mother

To explain the physiology of lactation
 Prolactin
reflex
 Oxytocin reflex
Teaching Aids: ENC
NF- 2
Exclusive breastfeeding
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All healthy infants should be breastfed exclusively
for the first six months of life
Exclusive breastfeeding is defined as "an infant's
consumption of human milk with no supplementation
of any type (no water, no juice, no nonhuman milk,
and no foods) except for vitamins, minerals, and
medications."
Teaching Aids: ENC
NF- 3
Benefits of breast milk to the baby
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Breast milk and human colostrum are made for babies
and is the best first food
Easily digested and well absorbed
Contains essential amino acids
Rich in essential fatty acids
Better bioavailability of iron and calcium
Teaching Aids: ENC
NF- 4
Benefits of breast milk (contd.)
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Prevents under five child deaths
Protects against infections
Prevents allergies
Better intelligence
Promotes emotional bonding
Less heart disease, diabetes and lymphoma
Teaching Aids: ENC
NF- 5
Protection against infection
1. Mother
infected
4. Antibody to
mother’s
infection
secreted in milk
to protect baby
Teaching Aids: ENC
2. WBC in
mother’s
body
make
antibodies
to protect
mother
3. Some
WBCs go
to breast
and make
antibodies
there
NF- 6
Benefits to mother
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Helps in involution of uterus
Delays pregnancy
Decreases mother’s workload, saves time and
energy
Lowers risk of breast and ovarian cancer
Helps reduce weight faster
Teaching Aids: ENC
NF- 7
Benefits to family and society
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Contributes to child survival
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Saves money
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Promotes family planning
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Environment friendly
Teaching Aids: ENC
NF- 8
Anatomy of breast
Myoepithelial cells
Epithelial cells
ducts
Lactiferous sinus
Nipple
Areola
Montgomery gland
Supporting tissue
and fat
Teaching Aids: ENC
Alveoli
NF- 9
Physiology of lactation
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Hormonal secretions in the mother
 Prolactin
helps in production of milk
 Oxytocin
causes ejection of milk
Reflexes in the baby – rooting, sucking &
swallowing
Teaching Aids: ENC
NF-10
Prolactin “milk secretion” reflex
Enhancing factors
Hindering factors
Early initiation
of breastfeeds
Delay in initiation
of breastfeeds,
Pre-lacteal feeds,
Bottle feeding,
Incorrect positioning,
Painful breast
Good attachment
& effective suckling
Frequent feeds
including night
feeds
Emptying
of breast
Prolactin in
blood
Teaching Aids: ENC
Sensory impulse
from nipple
NF- 11
Oxytocin “milk ejection” reflex
Oxytocin contracts
myoepithelial cells
Sensory impulse from
nipple to brain
Baby sucking
Teaching Aids: ENC
NF-12
Oxytocin reflex
Stimulated by
Inhibited by
•Thinks lovingly of baby
•Worry
•Sound of the baby
•Stress
•Sight of the baby
•Pain
•CONFIDENCE
•Doubt
Teaching Aids: ENC
NF-13
Feeding reflexes in the baby
Rooting reflex
Sucking reflex
Swallowing reflex
Teaching Aids: ENC
NF-14
Learning objectives - 2

Ensuring good start
 To
be able to describe how breastfeeding works
 To recognise good and poor attachment and
positioning of a baby feeding at the breast
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Overcoming difficulties
 To
help a mother breastfeed her newborn baby
 Help a mother prevent common problems
Teaching Aids: ENC
NF-15
For successful breastfeeding
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A willing and motivated mother
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An active and sucking newborn
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A motivator who can bring both mother and newborn
together (health professional or relative)
Teaching Aids: ENC
NF-16
Key points of positioning
Mother:
 Make the mother sit in a comfortable and convenient
position (she can feed in lying down position)
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Ensure that she is relaxed and comfortable
Baby:
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Baby’s head and body are in a straight line
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Baby’s whole body is supported
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Baby’s face is opposite the nipple and the breast
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Baby’s abdomen touches mother’s abdomen
Teaching Aids: ENC
NF-17
Good positioning
Teaching Aids: ENC
NF-18
Key points of good attachment
1.
Baby’s mouth is wide open
2.
Baby’s chin touches the breast
3.
Baby’s lower lip is curled outward
4.
Usually the lower portion of the areola is
not visible
Teaching Aids: ENC
NF-19
Good attachment
lower lip is curled outward
chin touches
the breast
Teaching Aids: ENC
baby’s mouth is wide open
lower portion
of the areola is
not visible
NF-20
Good and poor attachment
Teaching Aids: ENC
NF-21
Effective suckling
For an infant who shows signs of good attachment, the
next step would be to assess suckling:
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If the infant takes several slow deep sucks followed
by swallowing and then pauses, then he/she is
sucking effectively
Teaching Aids: ENC
NF-22
Problems in breastfeeding: Inverted nipple
Treatment should begin after
birth
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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
Teaching Aids: ENC
NF-23
Inverted nipple: treatment by syringe method
STEP 1
Before feeds 5-8
times a day
Use 10 or 20cc syringe
Cut along this
line with blade
STEP 2
Insert the plunger
from cut end
STEP 3
STEP 4
Teaching Aids: ENC
Mother gently pulls
the plunger
Press at the edge and
allow air to enter before
removing the syringe
NF-24
Problems in breastfeeding: Sore nipple
Look for a cause:
 Check the baby’s attachment
at the breast
 Check the baby’s position if
attachment is poor
 Examine the breasts –
engorgement, fissures, candida
 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
Teaching Aids: ENC
NF-25
Sore nipple: management
Give appropriate treatment:
 Build mother’s confidence
 Improve the baby’s
attachment and continue
breastfeeding
 Reduce engorgement, feed
frequently, express breast
milk
 Treat candida
Teaching Aids: ENC
Advise the mother to:
 Wash breasts only once a
day; avoid using soap
 Avoid medicated lotions
and ointments
 Gently apply hind milk
onto nipple and areola
after each feed
NF-26
Problems in breastfeeding: Breast
engorgement
Causes
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Delayed and infrequent breastfeeds
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Incorrect latching of the baby
Treatment
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Give analgesics to relieve pain
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Apply warm packs locally
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Gently express milk prior to feed
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Put the baby frequently to the breast
Teaching Aids: ENC
NF-27
Full vs. engorged breasts
Full breasts = NORMAL
Teaching Aids: ENC
Engorged breasts =
ABNORMAL
NF-28
Full vs. engorged breasts
Full breasts:
Engorged breasts:
 can occur at any time during
 36/72 hours after birth.
breastfeeding
 Hot, heavy, may be hard
 Painful; edematous
 Milk flowing
 Tight, especially nipple area
 Fever uncommon
 Shiny
 May look red
 Milk NOT flowing
 Fever may occur
 May cause a decrease in milk
supply if it happens often
Teaching Aids: ENC
NF-29
“Not enough milk”: causes
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Not breastfeeding often enough
Too short or hurried breastfeeding
Night feeds stopped early
Poor suckling position
Poor oxytocin reflex (anxiety, lack of confidence)
Engorgement or mastitis
Teaching Aids: ENC
NF-30
“Not enough milk”: management
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Put baby to breast frequently
Baby to be correctly attached to breast
Build mother’s confidence
Back massage and relaxation can help
Use galactogogues (metaclopropamide) judiciously
Adequate weight gain and urine frequency 5-6 times a day are
reliable signs of enough milk intake
Teaching Aids: ENC
NF-31
Adequacy of breastfeeding
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Breastfeeding is considered adequate if the
baby
 Goes
to sleep for 2-3 hrs after each feed
 Passes urine 6-8 times in 24 hrs
 Gains weight at 10-15 gm/kg/day
 Crosses birth weight by 2 weeks
Teaching Aids: ENC
NF-32
Expressed breast milk
Indications
 Sick
mother, local breast problems
 Preterm
/ sick baby
 Working
mother
Storage
 Clean
 At
wide-mouthed container with tight lid
room temperature: 6 hrs
 Refrigerator: 24
Teaching Aids: ENC
hours; Freezer (20°C): for 3 months
NF-33
EXPRESSING
BREAST MILK
W a sh y ou r h a n ds w e ll w it h soa p a n d
w ater
Pla ce a cle a n con t a in e r be low y ou r b r e a st t o
colle ct m ilk
M a ssa g e t h e br e a st s g e n t ly
t ow a r d t h e n ip ple s
Pla ce y ou r t h u m b a n d in de x f in g e r opposit e
e a ch ot h e r j u st
ou t side t h e da r k cir cle a r ou n d t h e n ipple
N ow pr e ss ba ck t ow a r d y ou r ch e st , t h e n ge n t ly sq u e e z e t o
r e le a se m ilk
Re pe a t st e p 5 a t dif f e r e n t p osit ion s a r ou n d t h e
a r e ola
Teaching Aids: ENC
NF-34
Ten steps to successful breastfeeding
Every facility providing maternity services and care for
newborn infants should
1.
Have a written breastfeeding policy that is routinely
communicated to all health care staff
2.
Train all health care staff in skills necessary to
implement this policy
3.
Inform all pregnant women about the benefits and
management of breastfeeding
Teaching Aids: ENC
NF-35
Ten steps to successful breastfeeding
(contd….)
4.
Help mothers initiate breastfeeding within half
hour of birth
5.
Show mothers how to breastfeed, and how to
maintain lactation even if they are separated from
their infants
6.
Give no food or drink, unless medically indicated
7.
Practice rooming-in : allow mothers and infants to
remain together 24 hrs a day
Teaching Aids: ENC
NF-36
Ten steps to successful breastfeeding
(contd….)
8.
9.
10.
Encourage breastfeeding on demand
Give no artificial teats or pacifiers (also called
dummies or soothers) to breastfeeding infants
Foster the establishment of breastfeeding support
groups and refer mothers to them on discharge
from the hospital.
Teaching Aids: ENC
NF-37