Exclusive breastfeeding in the provision of breast milk only, with no other liquids or food given

Complimentary feeding is defined as giving solid or semi solid foods in addition to breast milk

DEFINITIONS

Since 1979 the WHO has recommended that normal full term infants should be exclusively breastfed for “four to six months”

Increasing reports suggesting an association between discontinuing exclusive breastfeeding prior to six months of age and an increase in infant morbidity and mortality

Throughout the world many professionals as well as a number of government have concluded that there is sufficient evidence to recommend continuing exclusive breastfeeding for “about six months”

Nutritional immunologic and endocrine need were provided by maternal systems

Delivered from a protected intrauterine environment sterile, warm, and protective

No longer obtain fluids, nutrients, immune protections, maternal body temperature

and sterile environment

This transition is filled with life threatening hazards

IntrauterineIntrauterine

BornBorn

Infant survival

BREASTMILK BREASTFEEDING

Fig 1. Advantages of Breastfeeding

Perfect nutrients

Easily digested efficiently used

Protects against infection Costs less than

artificial feeding

Protects mothers health

Helps delay a new pregnancy

Helps bonding and development

FAT

PROTEIN

LACTOSE

HUMAN

FAT

PROTEIN

LACTOSE

COW

FAT

PROTEIN

LACTOSE

GOAT

Fig 2. Differences between three types of milks

WHEY PROTEINS

CURDS

Fig 3. Differences in the quality of the proteins in different milks

Anti – infective proteins

35%Casein

HUMAN

EASY TO DIGEST

80%Casein

COW’S

DIFFICULT TO DIGEST

LIPASE

ESSENTIALFATTY ACIDS

HUMAN COW’S

Fig 4. Differences in the facts of different milks

COW’S50 – 70 g/100 ml

HUMAN50 – 70 g/100 ml

ABSORBED

50

%

10

Fig 5. Differences in the iron content in different milks

Fig 6. Steps on how breastfeeding protects against infection

Mother infected

Antibodies to mother’s infection

secreted in milk to protect

baby

White cells in mother’s body

make antibodies to

protect mother

Some white cells go to

breast and make antibodies there

PROPERTY IMPORTANCEAntibody rich

Many white cellsPurgative

Growth factors

Vitamin A rich

Protects against infection and allergyProtect against infectionClears meconium helps to prevent jaundiceHelp intestine to mature prevents allergy, intoleranceReduces severity of infection prevents eye disease

Fig 8. Importance of colostrums

EMOTIONAL BONDINGClose, loving relationship between mother and babyMother more emotionally satisfied Baby cries lessMother behaves more affectionatelyLess likely to abuse or abandon baby

DEVELOPMENTChildren perform better on intelligence tests in later childhood

Fig 9. Benefits of breastfeeding

Breast milk only

1.0

3.2

Breast milk & non-nutritious

liquids

13.3

Breast milk & nutritious

supplements

17.3

No breast milk

Fig 10. Risk of diarrhoea by feeding method

MOTHER

Fig 12. Dangers of artificial feeding

More diarrhoea and respiratory infections

Persistent diarrhoea

Malnutrition vitamin A deficiency

More likely to die

May become pregnant sooner

Interferes with bonding

Lower scores on intelligence tests

Overweight

Increased risk of some chronic diseases

More allergy and milk intolerance

Increased risk of anaemia, ovarian and breast cancer

Fig 13. Anatomy of the breastoxytocin makes them contract

Prolactin makes them secrete milk

milk collects here

ducts

milk secreting cells

muscle cells

Supporting tissue and fat

lactiferous sinuses

nipple

areola

Montgomery’s glands

alveoli

Fig 14. The prolactin reflex

Secreted AFTER feed to produce NEXT feed

More prolactin secreted at nightSuppresses ovulation

Prolactin in blood

Baby suckling

Sensory impulses from nipple

Fig 15. The oxytocin reflex

Works BEFORE or DURING feed to make milk FLOW

Makes uterus contract

Oxytocin in blood

Baby suckling

Sensory impulses from nipple

Fig 16. The oxytocin reflex

These HELP reflex

Worry Stress Pain Doubt

These HINDER reflex

Thinks lovingly of baby

Sound of baby Sight of baby CONFIDENCE

Fig 18. Good attachment vs poor attachment

Fig 20. Result of poor attachment

Pain and damage to nipples Sore nipples Fissures

EngorgementBreast milk not removed effectively

Baby unsatisfied, wants to feed a lot

Apparent poor milk supply

Breast make less milk

Baby frustated, refuses to suckle

Baby fails to gain weight

Use of feeding bottle

Inexperienced mother

Functional difficulty

Lack of skilled support

Before breastfeeding established For later supplementsFirst babyPrevious bottle feeder

Small or weak babyBreast poorly protractileEngorgementLate startLess traditional help and community supportDoctors, midwives, nurses, not trained to help

Fig 21. Causes of poor attachment

Fig 22. The three neonatal reflexes

Rooting reflexWhen something touches lips, baby opens mouth puts tongue down and forward Sucking reflex

When something touches palate, baby sucks

Swallowing reflexWhen mouth fills with milk, baby swallows

SkillMother learns to position baby Baby learns to take breast

FAT

PROTEIN

LACTOSE

FULL TERM

FAT

PROTEIN

LACTOSE

PRETERM

Fig 23. Difference between preterm and term breastmilk

Fig 25. Breastfeeding a sick baby

If breastfeedingstops

Breastmilk decreasesBaby may refuse to start again

– gets less nourishment– loses more weight– takes longer to recover– lacks comfort of suckling

Baby

If breastfeedingcontinues

– gets best nourishment– loses less weight– recovers more quickly– is comforted by suckling

Breastmilk is producedBreastfeeding continues

Baby

Breastfeeding contraindicated

Some anticancer drugs Radioactive substances (temporarily)

Continue breastfeeding : Side effects possible Monitor baby for drowsiness

Psychiatric drugs and anticonvulsants

Use alternative drug if possible Monitor baby for jaundice

Chloramphenicol, tetracycline, metronidazoleSulphonamides, cotrimoxazole, dapsone

Use alternative drug (May decrease milk supply)

Oestrogen containing contraceptives Thiazide diuretics

Safe in usual dosage Most commonly used drugs

Fig 27. Breastfeeding and mother’s medication

RECOMMENDED PRACTICES TO IMPROVE INFANT NUTRITION

DURING THE FIRST SIX MONTHS:

Initiate b.f. within about one hour of birth

Establish good b.f. skills (proper positioning, attachment, and effective feeding)

Breastfeed exclusively for about the first six months

(Linkages-WHO, Feb 2001)

Practice frequent, on - demand b.f., including night feed

In areas where vitamin A deficiency occurs, lactating women should take a high - dose vitamin A supplement (200.000 i.u.) as soon as possible after delivery, but no later than 8 weeks postpartum, to ensure adequate vitamin A content in breastmilk

(Linkages-WHO, Feb 2001)

Continue on - demand b.f. and introduce complementary foods beginning around 6 months of age

(Linkages-WHO, Feb 2001)

Using the available information on the development of infants immunologic, gastrointestinal, oral motor function, reproductive physiology and nutrient

adequacy

the expert concluded that the probable age of readiness for most full term infants to

discontinue exclusive b.f. and begin complementary foods appears to be near

six months or perhaps a little beyond

CONCLUSION