Breastfeeding prof. Dr. Emel Gür

BREASTFEEDİNG

• Prof. Dr. Emel Gür

• İ.Ü. Cerrahpaşa Tıp Fakültesi

• Çocuk Sağlığı ve Hastalıkları A.B.D.

RECOMMENDATIONS

• Start breastfeeding within ½-1 hour of birth

• Breastfeed exclusively from 0-6 months of age

• Give complementary foods to all children from 6 months of age

• Continue breastfeeding up to 2 years of age or beyond

Prevalences of Breastfeeding in the World

COMPOSITIONS OF HUMAN MILK AND COW MILK

COMPOSITIONS OF HUMAN MILK AND COW MILK

COMPOSITIONS OF HUMAN MILK AND COW MILK

COLOSTRUM

• Colostrum is produced in the first five days after delivery (7-123 ml/day)

• “Coming in”:Increasing of milk production 40 th hour (3-5 th days)

• It is thick and yellowish

• Antibody rich

• Many white cells

• Protein rich (lactose and fat poor)

• Zn rich

• Growth factors

• Vitamin A rich

• Purgative

MATURE MILK

• It is produced after 15 days

• Quantity larger

• Fore milk: is produced early in feed

• Hind mil is produced later in feed

• Fore milk is bluer than hind milk

• Fore milk provides plenty of protein, lactose, other nutrients, water

• Hind milk is more whiter than fore milk,

• Hind milk contains more fat and provides much of the energy or a breastfeed

• 4-6 th wk: 800 ml/day

• 6 th mo. 750-1000 ml/ day

PROTEINS OF HUMAN MILK

• sIgA,IgM, IgG

• Lactoferrin

• Lactalbumin

• Lysozyme

• Casein

CARBONHYDRATES and LIPIDS OF HUMAN MILK

• Carbohydrates

• Lactose

• Oligosaccarides

• Glucoconjugates

• Lipıds

• Trigliserid

• FFA

• LC-PUFA

ANTİMICROBİAL FAKTORS OF HUMAN MILK

• Protein

• Lactoferrin

• Lysosym

• Fibronectin,C3

• SIgA

• Mucin

• Κ-casein

• Oligosaccarides

• Lipids

Anti-inflamatuar Factors of Human Milk

• Vitamin A,C,E

• Catalase

• Glutation peroksidase

• PAF asetil hidrolase

• Αlfa- 1-Antitripsin

• PGE 1,2

• EGF

• TGF-α

• TGF-β

• IL-10

IMMUNOMODULATORS OF HUMAN MILK

• IL-1-5

• IL-6

• IL-8

• IL-10

• IL-12

• TNF-α

• TNF-β

• IFN-γ

GROWTH FACTORS OF HUMAN MILK

• Epidermal Growth Factor(EGF )

• Transforming Growth Faktör-α (TGF- α)

• Transforming Growth Faktör-β (TGF-β)

• Insulin, Insulin-like Growth Factor I-II

• Nerve Growth Factor (NGF )

• Relaxin

• Eritropoetin

• Taurin, Etanolamin, Fosfoetanolamin

Hormones

• Prolactin

• GH, GHRH, Somatostatin

• TRH, TSH, T4, T3, reverse T3

• GnRH, LH

• Parathormon, calsitonin

• Estrogen, progesteron, adrenal steroids

ENZYMES OF HUMAN MILK

• Lipase

• Lipoprotein lipase

• Galactosll transferase

• Sülfidril oksidase

• Lactoperoksidase, tiyosiyanat, hidrojen peroksit

• Lysosyme, peroksidase

ADVANTAGES OF BREASTFEEDING

• Protect the babies from diarrheal disease

• (Shigella sp, E.coli

• G.lambilia,rotavirus)

• Protect the babies from respiratory disease

• (H.influenzae tip b

• S.pneumoniae)

• Protect the babies from other infections:

• urinary infection,

• AOM, sepsis, meningitis

• Prevent allerjik reactions, diaper rash

LACTOGENESIS

• Stage 1

• Pregnancy

• Second trimester

• Stage ll

• Delivery

PHYSIOLOGY OF LACTATION

• Infant sucks

• Prolaktin

• (milk production)

• Oksitosin

• (milk secretion)

ADVANTAGES OF ROOMİNG-IN DEMAND FEEDING

• Advantages of rooming in

• Mother can respond to baby

• Babies cry less, so less

• temptation to give bottle feeds

• Mothers more confident about

• breastfeeding

• Breastfeeding continue longer

MORE FEEDING=MORE SIGNALS=MORE MILK (PROVIDED THAT THE SUCKING IS EFFICIENT)

HOW TO HELP A MOTHER WİTH AN EARLY BREASTFEED

• Avoid hurry and noise

• Ask the mother how she feels and how breastfeeding is going

• Observe a breastfeed

• Help with positioning if necessary

• Give her relevant information

• Answer the mothers questions

CONFIDENCE AND SUPPORT SKILLS

• Accept what a mother thinks and feels

• Recognize praise what a mother and baby are doing right

• Give practical help

• Give a little, relevant information

• Use simple language

• Make one or two suggestions, not commands

BREASTFEED OBSERVATION

• Body position

• Responses

• Emotional bonding

• Anatomy of breast

• Suckling

• Time spend suckling

HOW TO HELP A MOTHER TO POSITION HER BABY

• The Four Key Points:

• Mother should hold baby’s body close to hers

• Baby’s head and body should be straight line

• Baby’s face should face the breast

• If baby is newborn,baby’s bottom supported

HOW TO HELP A MOTHER TO HELP THE BABY ATTACH

• HOW TO HELP THE BABY ATTACH

• Touch her baby’s lips with her nipple

• Wait until her baby’s mouth is opening wide

• Move her baby quickly on to her breast, aim his lower lip below the nipple

SIGNS OF WELL ATTACHMENT TO BREAST AND SUCKLİNG

• Mouth wide open

• Lower lip turned outwards

• Cheeks round

• More areola above baby’s mouth

• Slow deep sucks

• Can see or hear swallowing

CAUSES AND RESULTS OF POOR ATTACHMENT

• CAUSES

• Inexperienced mother

• Small or weak baby

• Use of feeding bottle

• Breast poorly protractile

• Lack of skilled support

RELIABLE SINGS THAT A BABY MAY NOT BE GETTING ENOUGH BREASTMILK

• Poor weight gain

• Passing small amount of concentrated urine

POOSIBLE SINGS THAT A BABY MAY NOT BE GETTING ENOUGH BREASTMILK

• Baby not satisfied after breastfeeds

• Baby cries often

• Very frequent breastfeeds

• Very long breastfeeds

• Baby refuses to breastfeed

• Baby has hard, dry or green stools

• No milk comes when mother express

• Breasts did not enlarge (during pregnancy)

• Milk did not come in (after delivery)

COMMEN REASONS WHY A BABY MAY NOT GET ENOUGH BREASTMILK

• BREASTFEEDİNG FACTORS

• Delayed start

• Infrequent feeds

• No night feeds

• Short feeds

• Poor attachment

• Bottles

• Complementary feeds

RARE REASONS WHY A BABY MAY NOT GET ENOUGH BREASTMILK

• MOTHER:

• PHYSICAL CONDITION

• Contraceptive pill, diuretics

• Pregnancy

• Severe malnutrition

• Alcohol

• Smoking

• Retained piece placenta

• Poor breast development

THIS DO NOT EFFECT THE BREASTMİLK SUPPLY

• Age of mother

• Menstruation

• Returning to a job

• Age of baby

• Caesarian section

• Many children

• Simple, ordinary diet

CONTRENDİCATIONS OF BREASTFEEDING

• Mother with severe disease

• Mother with psychosis or severe depression

• Mothers with HIV infection

• Mothers with HTLV-I (İnsan T-cell lymphotrophic virus-I) infection

• Mother with active pulmoner tuberculosis

• Mother with active HSV infection on her nipple

• Mothers treated with radioactive substances and chemoterapy

• Infants with rare metabolic diseases (galactosemia, phenylketonuria and maple syrup urine disease)

BREASTFEEDING WILL BE SUCCESSFUL IN MOST CASES IF :

• The mother feels good about herself

• The baby is well attached to the breast so that he suckles effectively

• The baby suckles as often and for as long as he wants ( at least 10 minutes)

• The environment supports breastfeeding

HOW HEALTH SERVICES CAN SUSTAIN BREASTFEEDING

• Praise all mothers who are breastfeeding

• Help mothers to breastfeed in the most healthy way (breasfeeding counselling)

• Encourage mothers to come for help before they decide to start artificial feeds

• Remember to encourage breastfeeding when you see a mother for a reason

• Help mothers to continue breastfeeding in difficult situations ( returning to work, twin, LBW newborn)