breastfeeding and nutrition by jess wong hui juan 05022017

Breastfeeding

Wong Hui Juan (Jess)

Nutritionist, IBCLC

5/2/2017 1Wong Hui Juan, Jess, Breastfeeding and Nutrition

Malaysian Breastfeeding Policy

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5/2/2017Wong Hui Juan, Jess, Power of nutrition in the first 1000 days

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OUTLINE

• Theory

• Video Display

• Q&A Session

5/2/2017 5

OBJECTIVE

• To have knowledge and skill on how to breastfeeding

• To have a better understanding about baby behavior and feeding

Wong Hui Juan, Jess, Breastfeeding and Nutrition

Infant stomach capacity

Jess Wong Hui Juan @Dec. 2015

BREASTMILK

• GOLD STANDARD

• CUSTOM MADE NUTRITION

• IS MORE THAN NUTRITION


Human milk is the gold standard for preterm and term infants

Most complete form of nutrition for infants.

Protects against bacteria

All breast milk not alike, contents changes

A mother's milk has just the right amount of—Fat

—Carbohydrate

—Protein

—Minerals

—Vitamins

—Water

THE UNIQUENESS OF BREASTMILK


Stages of breastmilk

•The content of breastmilk changes over the course of baby's development.

•There are essentially 3 stages of breastmilk:• colostrum

• transitional milk

• mature milk. 2 3


Colostrum – The liquid GOLD

• Produced from the 7th month of pregnancy to first few days after baby's birth.

• Thick, sticky and clear to yellowish in colour.

• Produced in very small amounts to suit baby’s small stomach

• Is the perfect food for newborn baby

• Rich in carbohydrates, protein and antibodies


ColostrumFunctions:

- Acts like “paint coating”- Protect baby’s gut from infections.

Colostrum helps "seal" the permeable newborn intestines to prevent harmful substances from penetrating the gut.

- Acts as first immunisation against many bacteria

- Helps establish good bacteria in baby’s gut.

- laxative and helps the baby to pass meconium- to prevent jaundice.


The GOLDEN rule of milk production

Nutrilact

Your baby is getting enough milk if…

Regains birth weight by two weeks of age

After day 4, baby has at least 3 solid diapers per day

Between day 2 & day 3, baby’s poo change from black to green then to yellow

After day 4 or 24 hours after your milk comes in, baby have at least 5 very wet diapers that is pale yellow.

Coping with low milk supply

Take it one step at a time

Set short and realistic goal

It will past & be patient

Forgive yourself for anything you

regret

Realize you are a successful

breastfeeding mother

Nutrilact

Water in breastmilk

•Breastmilk is very rich in water (88%)- no supplemental water even in hot, dry climates.- does not overload a baby’s kidneys and the baby

does not retain unnecessary fluid.

•Giving water or other fluids such as teas, may disruptthe breastmilk production


Flavour in breastmilk

•Affected by what mother eats.

•The variation in flavour can help the baby get used to family foods.

Preterm breastmilk

• Milk from mother who give birth before 37 weeks geastation has MORE protein, Ig A, lactoferrinthan mature milk - more suited for the needs of a premature baby.

• A mother’s milk can even be used before the baby is able to breastfeed. She can express her milk, and fed her baby by cup or spoon.


Transitional milk

• Produced from 3 to 5 days after birth until the mature milk come in (2 -3 weeks).

• It is intermediate in composition in between colostrum and mature milk.

• The immunoglobulins and protein contents decrease whereas fat and sugar contents increase.


Mature Milk

• Contains ALL major nutrients:• Proteins/carbohydrates/fats

• Vitamins and minerals

• water

• Changes in relation to: • the time of day

• the length of breastfeed

• the needs of the baby

• diseases with which the mother has had contact


BASIC NUTRITIONAL INFORMATION

• According to a British report, each 100 ml of mature breast milk (comes in three or four days after birth) yields approximately

• 58 - 72 calories

• 89.97 g water

• 7.4 g carbohydrates (primarily lactose)

• 4.2 g fat

• 0.9 g protein

Generally, human milk contains about 20 calories per ounce, but the fat content can vary greatly throughout the day and during a single pumping session.

Composition:Colostrum vs Mature Milk


• Breastfeed on demand. This allows baby to adjust intake in response to changes in breast milk. Additionally, more frequent feedings may boost fat content of your milk.

• Let baby take his time at each breast. Premature breast-switching can rob babies of higher-fat “hind” milk.


Breastmilk vs Formula Milk


Whats Inside ?


History of Commercially Available Infant Formulas in the United States

Cow-milk-based formulas1867 – Formula contained wheat flour, cow

milk, malt flour, and potassium bicarbonate

1915 – Formula contained cow milk, lactose, oleo oils, and vegetable oils; powdered form

1935 – Protein content of formula considered

1959 – Iron fortification introduced

1960 – Renal solute load considered; formula as a concentrated liquid

1962 – Whey:casein ratio similar to human milk

1984 – Taurine fortification introduced

Late 1990s – Nucleotide fortification introduced

Early 2000s – Long-chain polyunsaturated fatty-acid fortification introduced

Non cow-milk-based formulas1929 – Introduction of commercially available

soy formula (soy flour)

Mid 1960s – Isolated soy protein introduced

Is it same?


1.The importance of breastfeeding to the Baby

Human milk:• Provides ideal nutrition

• Protects against many infections

• Prevent some infant deaths

• Reduces risk of allergies

• Reduces risk of conditions such as juvenile-onset diabetes, ( in families with a history of these conditions)

• may assist in blood pressure regulation

• Reduction of obesity in later life

• Readily available, no preparation , suited to the child’s need

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Session 3: Promoting Breastfeeding During Pregnancy Ministry of Health Malaysia

Children who DO NOT breastfeed or receive breastmilk may be at increased risk of:

• Infections such as diarrhea and gastrointestinal infections, respiratory infections and urinary tract infections

•Eczema and other atopic conditions

•Necrotising enterocolitis, in preterm infants

• Lower developmental performance and educational achievement, thus reducing earning potential

•Ear Infections (otitis media)

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Children who DO NOT breastfeed or receive breastmilk may be at increased risk of:

•Developing juvenile onset insulin dependant diabetes mellitus,

•higher blood pressure

•obesity in childhood

• later heart disease

•dying in infancy and

early childhood

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2.The importance of breastfeeding to the Mother

Women who DO NOT breastfeed may increase risk of:

• Breast cancer, and some forms of ovarian cancer

• Hip fractures in older age

• Retention of fat deposited during pregnancy which may result in later obesity

• Anaemia due to low contraction of the uterus and early return of menses,

• Frequent pregnancies due to lack of child -spacing effect of breastfeeding

• Fewer opportunities to be close to their baby.

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3.The importance of skin-to-skin contact immediately after birth

•Keeps baby warm and calm

•Promotes bonding, helps breastfeeding get started

•Helps the baby learn that the breast is a safe place

•Enables colonization of the baby’s gut with the mother’s normal body bacteria gut

•Assists with metabolic adaptation and blood glucose stabilization in the baby

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4. The importance of early initiation of breastfeeding

• To ensure the success of exclusive breastfeeding

• To ensure baby get enough colostrum

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5. The importance of rooming –in 24 hours a day

• Babies sleep better and cry less

• Mother-baby sleep/awake rhythm would be disrupted if separated

• B’feeding is well established, continues longer and baby gains weight quickly

• Feeding in response to a baby’s cues

• Mother becomes confident

• Mother can observe their baby all the time

• Baby get fewer infections compare to stay in a nursery

• promotes bonding between mother and baby

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6. The importance of feeding on demand or baby-led feeding

• Babies get more immune-rich colostrum

• Faster development of milk supply

• Faster weight gain

• Less neonatal jaundice

• Less breast engorgement

• Mother learns to respond to her baby

• Easy establishment of breastfeeding

• Less crying – less temptation to supplement

• Longer breastfeeding duration

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7. The importance of feeding frequently

To ensure baby will get enough milk

•Feed on demand and not the clock

•Nurse every chance mother have

•Express milk after feeding the baby

•Get enough rest, calories and fluids

•For working mothers, nurse baby the last thing in the morning and the first thing in the evening

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7. The importance of feeding frequently

To ensure baby will get enough milk

•Do not use pacifiers

• If possible, use double pump.•Pump on one side while feeding baby

on the other •Pump more at work. •Relax. •Spend your weekends by direct

feeding child fully. Especially for relactating. •Co-sleep at night.

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8. The importance of good attachment and positioning

Position for Mother

• Comfortable

• Back, feet and breast supported (as needed)

Position for baby

• Body in line

• close to mother’s body, facing breast, nose opposite nipple

(Baby brought to breast, not breast to baby)

• Head, shoulders supported

• (whole body supported for premature baby)

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9. The importance Exclusive Breastfeeding for first 6 months, giving no other liquid or food

• provides all the nutrients and water that a baby needs to grow and develop in the first six months

• First 6 months means:

• to the end of 6 completed months or 28 weeks or 180 days (not the start of 6 months)

• NO drinks or food given to baby other than breastmilk

• Most exclusively breastfed young infants feed at least eight to twelve times in 24 hours, including night feeds.

• Vitamins, mineral supplements or medicines can be given, if needed.

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Exclusive breastfeeding for First 6 months

Any of these will interfere:

• If baby is given:

–any drinks or foods other than breastmilk.–Given pacifier/dummy/ soother

• Limits placed on number of breastfeeds

• Limits placed on sucking time/ length of breastfeed

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Exclusive breastfeeding for First 6 months

Few points why it is important

• Reduce diarrhoea and infectious diseases

–Reduce infant deaths

• Reduce risk of respiratory infection for baby

• Get the right antibodies to protect baby from illness

• Develop jaw, teeth and speech development

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10. The importance of continuing breastfeedingafter 6 months

After 6 months:

• children should receive complementary food

• and continue to breastfeed

• Breastmilk continue to be important, providing 1/3 to ½ the calories for the child at 12 months

• Should be continued up to 2 years and beyond

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Other benefits of breastfeeding

• Economic

• Readily available

• Simple; with no equipment or preparation needed

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Other benefits of breastfeeding

• If a baby is NOT breastfed:- Need to buy replacement milk

• expensive

- Need time to prepare milk

- Need to keep feeding equipment

clean

- Loss of income through absence

from work to care for ill child

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Introduction

• In normal breastfeeding, there are 2 elements necessary for getting milk from the breast to the baby :

1. A breast that produces and releases milk

2. A baby who is able to remove the milk from the breast with effective suckling

47Session 6: How Milk Gets from Breast to Baby

Ministry of Health Malaysia

Parts of the Breast involved in Lactation



Breast Anatomy



Inside the Breast

• Fat and supporting tissue - give the breast its size and shape

• Nerves - transmit messages from the breast to the brain to trigger the release of lactation hormones

• Alveoli - produce milk

• Milk ducts - carry milk to the nipple.



Breast Milk Production and Regulation



Milk Production

•1st stages of milk production• Under control of hormones

•During pregnancy• Glandular tissue in breast makes colostrum• Pregnancy hormones prevent larger quantity of milk

•After delivery• Increased milk quantity in breast as hormones of pregnancy

drop 30-40 hours after delivery• 2 hormones become important: Prolactin, Oxytocin



PROLACTIN

•Hormone that makes the alveoli produce milk.

•Works after a baby has taken a feed to make the milk for the next feed.

• can also make the mother feel sleepy and relaxed.

• Level is high in the first 2 hours after birth

•Highest level at night• breastfeeding at night allows for more prolactin secretion.



Hormones

Session 6: How Milk Gets from Breast to Baby Ministry of Health Malaysia

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Baby stomach


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PROLACTIN RESPONSE

•More Prolactin secreted at night

•Suppress ovulation



• causes the muscle cells around the alveoli to contract • and makes milk flow down the

ducts. • This is essential to enable the baby

to get the milk.

• This process is called the oxytocin reflex/ milk ejection reflex/ letdown. • It may happen several times during

a feed.

OXYTOCIN


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OXYTOCIN REFLEX


•Works BEFORE or DURING feed to make milk flow

•May have certain signs of oxytocin reflex

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Signs of Oxytocin Reflex

•Painful uterine contractions, sometimes with rush of blood

•Sudden thirst

•Milk spraying from breasts/ leaking from breasts

•Feeling squeezing sensation in breast

** may NOT always feel physical sensation



Oxytocin Reflex

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INC

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SE O

XY

TOC

IN

DEC

REA

SE O

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Session 6: How Milk Gets from Breast to BabyMinistry of Health Malaysia

How mother can assist Oxytocin to work• Seeing, Hearing, Touching and

Thinking lovingly about baby

• Feeling pleased about her baby and confident

• Relaxing and getting comfortable for feeds

• Expressing little milk and gently stimulating the nipple

• Keeping the baby near

• Massage upper back



Feedback Inhibitor Of Lactation (FIL)

•Milk contains an inhibitor that can reduce milk production.

•The amount of milk that is produced depends on how much is removed.

— If milk is not removed and the breast is full, this inhibitor decreases production of milk.

— If milk is removed from the breast, then the inhibitor level falls and milk production increases.

• To ensure plentiful milk production, make sure that milk is removed from the breast efficiently.




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How to prevent FIL from collecting and reducing milk production

• Make sure that the baby is well attached

• Encourage frequent breastfeeds• Allow baby to feed for as long as she

or he wants at each breast• Let the baby finish the first breast

before offering the second breast• If baby does not suckle, express the

milk

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Feedbackinhibitor

Session 6: How Milk Gets from Breast to BabyMinistry of Health Malaysia

Baby’s Role in Milk transfer



Baby’s Role

•Baby suckling controls:• Prolactin production

• Oxytocin reflex

• Removal of inhibitor within the breast

•For mother to produce milk for baby’s needs• Baby must suckle often

• Must suckle in the right way



Good Attachment

• Nipple and areola are stretched out to form a long “teat” in the baby’s mouth.

• The large ducts that lie beneath the areola are inside the baby’s mouth.

• The baby’s tongue reaches forward over the lower gum.

• When a baby takes the breast into his or her mouth in this way, the baby is well attached and can easily get the milk.

• .

• Internal view



• Internal view

Poor Attachment

• Nipple and areola are not stretched out to form a long “teat” in the baby’s mouth.

• The milk ducts are not inside the baby’s mouth.

• baby’s tongue is back inside the mouth, cannot press out the milk

• sucking only on the nipple, • cannot suckle effectively or get the

milk easily.

.



How to decide:if baby is well/poorly attached

Good Attachment

• Baby’s mouth wide open

• The lower lip is turned out

• chin is touching the breast (or nearly so).

• More areola is visible above the baby’s mouth than below.

Poor attachment

• Mouth not wide open

• The lower lip is pointing forward.

• The chin is away from the breast.

• More areola is visible below the baby’s mouth (or equal amount above and below)



Action of Suckling

•There are 3 reflexes involved in suckling

Rooting Reflex

Swallowing Reflex

Sucking reflex

AUTOMATIC REFLEX



Action of Suckling

•When breast touches the baby’s lips (or the baby smells the milk)• The baby put their head back slightly• opens their mouth wide• puts their tongue down and forward, to seek the breast.

(rooting reflex)

•When baby close enough to the

breast• takes a large enough mouthful• can bring the nipple back 3X normal size

until it touches the soft palate (sucking reflex)



Action of Suckling

• Muscles then move the tongue in a wave from the front to the back of the mouth, expressing the milk from the ducts beneath the areola into the baby’s mouth.

• The baby swallows when the back of the mouth fills with milk (swallowing reflex).



Signs that a Baby is Suckling Effectively

•The baby takes slow, deep sucks, sometimes pausingfor a short time

•You can see or hear the baby swallowing

•The baby’s cheeks are full and not drawn inward duringa feed

•The baby finishes the feed and releases the breast byhimself or herself and looks contented



Signs that a Baby is NOT Suckling Effectively•Makes rapid sucks

•makes smacking or clicking sounds

• cheeks drawn in

• fusses or appears unsettled at the breast

• comes on and off the breast.feeds very frequently

• feeds for a very long time - for more than an hour atEVERY feed (unless low birth weight)

• is not contented at the end of a feed



Artificial Teats and Suckling Difficulties•Artificial teats and pacifiers may cause difficulties for

the breastfeeding baby• difficulty suckling at the breast because of different mouth

action• baby may prefer the artificial teat and find it difficult to

breastfeed

•Artificial teats may…

Reduce suckling

time

Reduce breaststimulation

Reduce milk

production

Reduce milk

renewal



What are the main ways to ensure a good milk supply?



Signs that a Baby is NOT Suckling Effectively• Help the baby to breastfed soon after birth

• Make sure the baby is well attached at the breast

• No artificial dummies or teats

• Breastfeed exclusively

• Feed the baby as frequently as he or she wants, for as long as he or she wants at a feed.

• Feed the baby at night



List key elements of positioning for successful and comfortable

breastfeeding

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Session 7 : Helping With a BreastfeedMinistry of Health Malaysia

Positioning for Breastfeeding

• Means how the mother holds the baby to help to attach well to the breasted

• If baby poorly attached• Help mother to position

• If baby well attached and sucking effectively• Do not interfere

• Tell her key points to build her confidence

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Mother’s position

Positions that a mother

may use:• sitting on the floor/ ground • sitting on a chair• lying down• standing up• walking.

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In sitting or lying down position , a mother should be:

1. Comfortable

2. Back supported

3. Feet supported if needed.

3. Breast supported, if needed.

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Lying down side position

Football hold (Underarm position)

Cradle Hold

Cross cradle (Cross arm)


Baby’s position

The baby can also be in

different positions:

• Along the mother’s arm.• under the mother’s arm• along her side.

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4 key points to help ensure baby is comfortable:1. In line

(Head,shoulder and body straight)

2. Close(to mother’s body, baby brought to

breast, not breast to baby)

3. Supported

(at head, shoulders. If prem/newborn-

whole body)4. Facing

(baby’s nose to the nipple)

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Describe why Hand Expression is useful and how to Hand Express

85

Session 11 : If Baby Cannot Feed at the Breast Ministry of Health Malaysia

Why might it be useful for a mother to know how to hand express?

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Hand expressionUseful to know :

•For breast comfort– Relieve engorgement/blocked duct

•To help baby to breastfeed

•To soften areola so that baby can attach

•To keep up milk production

•To obtain milk—baby is unable to breastfeed

—mother and baby are separated

—milk is needed for another baby

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Hand expression

Advantages compared to breast pumps

•No worries about missing part or faulty equipment

•Hand expression - very effective & quick

•Prefer skin-to-skin stimulation (hand & breast)

•Hand expression - gentler than a pump

• Less risk of cross-infection

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When to express?

• baby cannot feed at the breast

• mothers are away from their baby

• mother wants drops of milk to encourage baby to suck

• breasts are overfull or blocked duct

• want some hind milk to rub on sore nipples

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How to express?

Key steps:

• Encourage milk to flow

• Compress breast over ducts

• Repeat in all parts of the breast

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Key steps:

STIMULATE

OXYTOCIN

REFLEX

Encourage the milk to flow:

• sitting comfortably & relaxed• thinking about her baby/looking at the

baby• warming her breast• Massaging/stroking breast & rolling

nipple between fingers• having back massaged

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Back massage


Breast Expression Technique

• Wash hands with soap and clean water

• Can continue massage during expression

• Using clean/sterile container

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Encourage milk to flow

help oxytocin reflex to work- be comfortable and relaxed- Sit comfortably in a quiet/private

area and relax - think about baby/look at photograph- warm the breast , gentle massage/

stroking- gently roll nipple between finger

and thumbneed not do once used to expression

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Compress the breast over the ducts

1. Feel for the ducts (near outer edge of the areola)2. Place thumb on the opposite side3. Support breast with other finger of the hand

X

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Compress the breast over the ducts

4. gently press thumb and first finger back toward the chest wall 5. press thumb and first finger together

-this will compress milk duct between them-helps milk flow towards nipple

6. Release the pressure and repeat compress and release movement until milk drips out

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Repeat the process around the edge of areola

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When to Express Breastmilk?

•If baby not able to suckle

• Express soon after delivery

(by 6 hours preferably)

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How Long to Express Breastmilk?

Reason Length

To get colostrums – baby not able to suck

5-10 min every 1-2 hours

To increase milk production 20 min every 2 hours (at least 6 times or more per 24 hours)

Just softening the areola 3 or 4 times

To clear a blocked duct Compress & massage until the lump has cleared

Working mother 15 min or 30 min100


Expressing Colostrum

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What not to do during milk expression

•Not touch the mother’s breast when teaching hand expression

•Mother should not squeeze the nipple itself

•Should avoid sliding or rubbing her fingers along the breast when compressing

• If both expressing and breastfeeding an older baby • Express first, then breastfeed so that able to get fat-

rich hind milk more efficiently

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Check list for choosing a breast pump(if mother using pump to express)

• Does the mother find it works well?

• Is it easily available at an affordable price?

• Is it comfortable to use: arm position, weight, adjustable suction

• Is the size of the breast cup/funnel and insert if available, suitable for the size of the nipple & breast?

• Can Milk be stored in a collection container, in standard thread containers, or is there a need to purchase special container?

• What is the noise level when in use?

• Is it safe to use & easy to clean & sterilise?

• Is it easy to assemble with few parts?

• Are there clear instructions for use?

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How to cup feed a baby

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Cup Feeding

Cup feeding can be used for:• babies who are able to swallow

but cannot (yet) suckle well enough.—have difficulty attaching well—attach & suckle for a short time—tire quickly before abtained

enough milk

• A baby of 30-32 weeks gestation can often begin to take feeds from a cup.

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Cup Feeding a Baby

• Hold baby sitting upright or semi-upright on your lap.

• Hold small cup to the baby’s lips.

• Tip the cup so that the milk just reaches the baby’s lips.

• The cup rests lightly on the baby lower lip & the edges of the cup touch the outer part of the baby lip.

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Advantages / Disadvantages

Advantages

• Readily available• Safe (allow the baby to control the

amount&rate feeding)• Avoid nipple confusion• Less chance of contamination• Pleasant for the baby• To use his or her tongue and to

learn tastes• Stimulates the baby’s digestion• Encourages coordinated

breathing/suck/swallow

Disadvantages

• Milk can be wasted if the baby dribbles

• Prefer the cup more if they do not go to the breast regularly

• SCN Nurse may prefer Cup feeding to be used instead of getting the mother to come for direct breastfeeding because it is easy to do

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Other method of feeding – Supplementary Nursing System

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Other method of feeding – S N S with Syringe

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Method of Storing and Thawing Expressed Breastmilk

111 Session 11 : If Baby Cannot Feed at the Breast Ministry of Health Malaysia

Storing Expressed Breastmilk

General guidelines:

•Wash hands when handling

•Container must be suitable

• glass/plastic-covered• very clean/sterile (wash with hot

soapy water and rinse with hot water)

•Store only the amount required in one container that the baby take at one feeding

• If several containers, should be labelled with name and date. Use oldest milk first.

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Storing Expressed Breastmilk

113Session 11 : If Baby Cannot Feed at the Breast


Storage MethodMethod of storage Healthy Baby Ill Baby

Fresh Milk

Room Temperature

(25° – 37°C)

4 hrs 4 hrs

Air condition Room

15° – 25°C

8 hrs -

< 15°C 24 hrs -

Refrigerator

(2° – 4°C)

< 8 days 48 hrs

Frozen Milk

Freezer compartment inside

refrigerator

(1 door fridge)

2 weeks 2 weeks

Freezer part of a refrigerator-

freezer

(2 doors fridge)

3 months 3 months

Separate deep freeze 6 months 3 months

Thawed in a refrigerator 24 hrs

(do not refreeze)

12 hrs

(do not refreeze)114


8 days

Refrigerator(2° – 4°C)

Breastmilk Storage

6 months

Deep freeze

115

3 months

Freezer part of a refrigerator-freezer


Maintain cold chain during

transportation

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Thawing• Frozen breastmilk may be thawed slowly in a

refrigerator and used within 24 hours.

• It can be defrosted by standing in a jug of warm water and used within one hour, as it is warm.

• Do not boil milk or heat it on the stove, over a direct fire or in a microwave oven • this destroys some of its properties and can burn the

baby’s mouth.

**Milk should not be stored above 37°C

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Thawing

• Warm only the amount of milk that will be used at one feeding. Milk cannot be saved once it has been warmed.

• The fat may separate out in small globules. Gently shake it to re- combine the fat with the rest of liquid.

• Feed the milk to the baby with a cup. A spoon may be used for small amounts.

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Summary

• If mother-baby separated, teach and help mother to maintain lactation

• Various ways of milk expression but hand expression is preferred

• EBM can be given by various method

• Proper management of EBM is important to ensure babies health

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Striving for a perfect balance: Life, Work and Breastfeeding

Wong Hui Juan, Jess, Power of nutrition in the first 1000 days

5/2/2017 121Wong Hui Juan, Jess, Power of nutrition in the first 1000 days

Obese

Overweight

Normal

Wasted

Severe wasted

Risk of overweight

REMEMBER

•NO BREAST MILK IS LOW IN QUALITY

•EAT WELL, SO TO SUPPLEMENT BABIES WELL

•BREASTFEED ON DEMAND


THANK YOU

jessnutrition.blogspot.com

Nutrilact = Nutrition + Lactation

[email protected]

Jess Wong Hui Juan @ 2017

breastfeeding and nutrition by jess wong hui juan 05022017

Health & Medicine