BREASTFEEDING Best Food For the Newborn

Josephine T.R. Holgado,M.D.,D.P.P.S. October 31, 2012 Calamba Medical Center

INTRODUCTION
W.H.O. strongly recommends exclusive breastfeeding for the first six months of life.

INTRODUCTION
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. 4. Help mothers initiate breastfeeding within a 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 newborn infants no food or drink other than breastmilk, unless medically indicated. 7. Practise rooming-in - allow mothers and infants to remain together - 24 hours a day. 8. Encourage breastfeeding on demand. 9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants. 10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic. * A summary of the main recommendations of the Joint WHO/UNICEF Statement (1989) called "Protecting, Promoting and Supporting Breastfeeding: The Special Role of Maternity Services"

INTRODUCTION
Summary of the International Code of Marketing of Breastmilk Substitutes* The Code includes these 10 important provisions: 1. No advertising of all breastmilk substitutes** to the public. 2. No free samples to mothers. 3. No promotion of products in health care facilities, including no free or low-cost formula. 4. No company representatives to contact mothers. 5. No gifts or personal samples to health workers. Health workers should never pass products on to mothers. 6. No words or pictures idealizing artificial feeding, including pictures of infants, on the labels. 7. Information to health workers must be scientific and factual. 8. All information on artificial infant feeding must explain the benefits and superiority of breastfeeding, and the costs and hazards associated with artificial feeding. 9. Unsuitable products, such as sweetened condensed milk should not be promoted for babies. 10. Manufacturers and distributors should comply with the Code's provisions even if countries have not acted to implement the Code. * The International Code of Marketing of Breastmilk Substitutes was adopted by the World Health Assembly in 1981 as a tool to protect breastfeeding. ** Breastmilk Substitutes include: infant formula, follow-up formula, feeding bottles, teats, baby food and beverages etc.

INTRODUCTION
Republic Act No. 7600 AN ACT PROVIDING INCENTIVES TO ALL GOVERNMENT AND PRIVATE HEALTH INSTITUTIONS WITH ROOMING-IN AND BREAST-FEEDING PRACTICES AND FOR OTHER PURPOSES.

OBJECTIVES
General Objective To acquire a general knowledge on the importance and practice of breastfeeding

OBJECTIVES
Specific Objectives 1. To determine the benefits of breastfeeding 2. To find out the different positions to breastfeed 3. To know the steps on correct latching 4. To enumerate the absolute and temporary contraindications to breastfeeding 5. To know how to express and store breastmilk 6. To differentiate full breasts from engorged breasts 7. To find out the management of sore nipples and mastitis

BENEFITS OF BREASTFEEDING
Health benefits for infants 1. gives infants all the nutrients they need for healthy development. 2. safe and contains antibodies that help protect infants from common childhood illnesses - such as diarrhoea and pneumonia, the two primary causes of child mortality worldwide. 3. readily available and affordable, which helps to ensure that infants get adequate sustenance

BENEFITS OF BREASTFEEDING
Health benefits for mothers 1. associated with a natural (though not fail-safe) method of birth control (98% of protection in the first 6 months after birth) if done exclusively 2. reduces risks of breast and ovarian cancer later in life, 3. helps women return to their pre-pregnancy weight faster, 4. lowers rates of obesity.

POSITIONS
1. Cross-cradle Hold

2. Cradle Hold
3. Football Hold

4. Side-lying Hold
5. Football Hold for twins

Good and poor attachment

Key points to good attachment

The mouth is widely open The lower lip is turned outwards The chin is touching the breast More areola is visible above the babys mouth than below it The tongue is forward in the mouth, and may be seen over the bottom gum

CORRECT LATCHING/SUCKLING
VIDEOS GOOD ATTACHMENT POSITIONING

CONTRAINDICATIONS
ABSOLUTE Mental Disorder Mental Retardation Seizure Disorder Cardiac Disease Advanced Nephritis Open Tuberculosis Thyrotoxicosis

CONTRAINDICATIONS
TEMPORARY intake of drugs like anticoagulants, antibiotics, toxic substances like mercury and benzene mechanical problems like retracted and oversized nipples.

Drugs of Abuse for Which Adverse Effects on the Infant During Breastfeeding Have Been Reported*
Drug Reported Amphetamine Cocaine Heroin Marijuana Phencyclidine Effect or Reasons for Concern Irritability, poor sleeping pattern Cocaine intoxication: irritability, vomiting, diarrhea, tremulousness, seizures Tremors, restlessness, vomiting, poor feeding Only 1 report in literature; no effect mentioned; very long half-life for some components Potent hallucinogen

* The Committee on Drugs strongly believes that nursing mothers should not ingest drugs of abuse, because they are hazardous to the nursing infant and to the health of the mother. Drug is concentrated in human milk.
The Transfer of Drugs and Other Chemicals Into Human Milk American Academy of Pediatrics Committee on Drugs Pediatrics 2001;108;776

Drugs for Which the Effect on Nursing Infants Is Unknown but May Be of Concern*
Drug Antidepressants
Fluoxetine

Reported or Possible Effect

Colic, irritability, feeding and sleep disorders, slow weight gain Galactorrhea in mother; drowsiness and lethargy in infant; decline in developmental scores Decline in developmental scores

Antipsychotic
Chlorpromazine

Haloperidol

The Transfer of Drugs and Other Chemicals Into Human Milk AAP Committee on Drugs Pediatrics 2001;108;776

Drugs for Which the Effect on Nursing Infants Is Unknown but May Be of Concern*
OTHERS Drug
Amiodarone Chloramphenicol Clofazimine Lamotrigine Metoclopramide Metronidazole

Reported or Possible Effect

Possible hypothyroidism Possible idiosyncratic bone marrow suppression Potential for transfer of high percentage of maternal dose; possible increase in skin pigmentation Potential therapeutic serum concentrations in infant None described; dopaminergic blocking agent In vitro mutagen; may discontinue breastfeeding for 1224 h to allow excretion of dose when single-dose therapy given to mother See metronidazole

Tinidazole

Drugs That Have Been Associated With Significant Effects on Some Nursing Infants and Should Be Given to Nursing Mothers With Caution*
Drug Acebutolol 5-Aminosalicylic acid Atenolol Bromocriptine Aspirin (salicylates) Clemastine neck stiffness (1 case) Ergotamine medications) Lithium Phenindione Phenobarbital Reported Effect Hypotension; bradycardia; tachypnea Diarrhea (1 case) Cyanosis; bradycardia Suppresses lactation; may be hazardous to the mother Metabolic acidosis (1 case) Drowsiness, irritability, refusal to feed, high-pitched cry, Vomiting, diarrhea, convulsions (doses used in migraine One-third to one-half therapeutic blood concentration in infants Anticoagulant: increased prothrombin and partial thromboplastin time in 1 infant; not used in United States Sedation; infantile spasms after weaning from milk containing phenobarbital, methemoglobinemia (1 case)

Primidone Sedation, feeding problems Sulfasalazine(salicylazosulfapyridine) Bloody diarrhea (1 case) * Blood concentration in the infant may be of clinical importance.

Maternal Medication Usually Compatible With Breastfeeding

Drug
Alcohol (ethanol)

Reported Sign or Symptom in Infant or Effect on Lactation

With large amounts, drowsiness, diaphoresis, deep sleep, weakness, decrease in linear growth, abnormal weight gain; maternal ingestion of 1 g/kg daily decreases milk ejection reflex Irritability, poor sleeping pattern, excreted slowly; no effect with moderate intake of caffeinated beverages (23 cups per day) Goiter Sleepiness

Caffeine

Carbimazole Chloral hydrate Contraceptive pill with estrogen/progesterone Rare breast enlargement; decrease in milk production and protein content (not confirmed in several studies) Indomethacin Seizure (1 case) Iodides May affect thyroid activity; see iodine Iodine Goiter Iodine (povidone-iodine, eg, in a vaginal douche) Elevated iodine levels in breast milk, odor of iodine on infants skin Isoniazid None; acetyl (hepatotoxic) metabolite secreted but no hepatotoxicity reported in infants

Maternal Medication Usually Compatible With Breastfeeding

Drug
Morphine Nalidixic acid Nitrofurantoin Phenytoin Sulfapyridine Sulfisoxazole Tetracycline Tolbutamide

Reported Sign or Symptom in Infant or Effect on Lactation

None; infant may have measurable blood concentration Hemolysis in infant with glucose-6-phosphate dehydrogenase (G-6PD) deficiency Hemolysis in infant with G-6-PD deficiency Methemoglobinemia (1 case) Caution in infant with jaundice or G-6-PD deficiency and ill, stressed, or premature infant; appears in infants milk Caution in infant with jaundice or G-6-PD deficiency and ill, stressed, or premature infant; appears in infants milk None; negligible absorption by infant Possible jaundice

Food and Environmental Agents: Effects on Breastfeeding

Agent Reported Sign or Symptom in Infant or Effect on Lactation
Aspartame Caution if mother or infant has phenylketonuria Bromide (photographic laboratory) Potential absorption and bromide transfer into milk; Chocolate (theobromine) Irritability or increased bowel activity if excess amounts ($16 oz/d) consumed by mother Fava beans Hemolysis in patient with G-6-PD deficiency Fluorides Hexachlorobenzene Skin rash, diarrhea, vomiting, dark urine, neurotoxicity, death Hexachlorophene None; possible contamination of milk from nipple washing Lead Possible neurotoxicity Mercury, methylmercury May affect neurodevelopment Polychlorinated biphenyls and polybrominated biphenyls Lack of endurance, hypotonia, sullen, expressionless facies Silicone Esophageal dysmotility Tetrachloroethylene cleaning fluid (perchloroethylene) Obstructive jaundice, dark urine Vegetarian diet Signs of B12 deficiency

EXPRESS BREASTMILK
VIDEO ON HAND EXPRESSION

BREASTMILK STORAGE
Breastmilk Fresh, room temperature Fresh, refrigerated Thawed, after freezing Frozen (-20 to 0 F) Frozen in home freezer (5 - 15 F) Frozen in small interior freezer Hospital Use 4 hours 72 hours 24 hours 12 months 6 months 2 weeks Home Use 8 hours 8 days 24 hours 12 months 6 months 2 weeks

*Do not store milk in the door compartments of the refrigerator or freezer

CHARACTERISTICS OF FULL BREASTS

NORMAL 36/72 hours after birth. Hot, heavy, may be hard Milk flowing or dripping Fever uncommon

CHARACTERISTICS OF ENGORGED BREASTS

ABNORMAL can occur at any time during breastfeeding Painful. edematous Tight, especially nipple area Shiny May look red Milk NOT flowing Fever may occur Engorgement may cause a decrease in milk supply if it happens often

Management of Sore Nipples

Look for a cause:
Check the babys position at the breast

Check the babys attachment at the breast. Examine the breasts engorgement, fissures, candida.
Check the baby for candida. Give appropriate treatment: Build the mothers confidence Improve the babys attachment and continue breastfeeding Reduce engorgement, feed frequently, express breast milk Treat candida.

Advise the mother to: Wash breasts only once a day, avoid using soap Avoid medicated lotions and ointments Gently smooth hindmilk into nipple and areola after a breastfeed.

MASTITIS
Manifestations: fever with temp > 38 C or with flu-like symptoms affects only one part of the breast Well-defined, red, sore, and swollen area Pathophysiology: a blocked duct so milk does not flow from that part of the breast. Complication: If no treatment is given and milk is not removed by feeding or expression the mother may develop an abscess

Causes of Mastitis
Fissured nipples Not feeding often enough Tight clothes Holding the breast during a feed Baby poorly attached and not removing the milk properly from all parts (lobes) of the breast

Management of Mastitis
Breastfeed frequently at least every 3 hours. Using different feeding position may help clear the blockage If mother cannot breastfeed from affected breast, express milk every 3 hours until improved If no change within 24 hours or if mother lives far from the health facility, she should begin antibiotics immediately

Management of Mastitis
Give Cloxacillin 500 mg q 6 hours for 10 days. If severe pain, give paracetamol. Reassess in 2 days. If no improvement or worse, refer to a hospital. Do not give sugar water, formula or other prelacteals

SUMMARY
It is BEST for babies up to 2 years and beyond. B - Bonds the mother and the child; E Economical in terms of time, money and convenience, S Safe for it prevents diarrhea and other diseases, allergies and provides antibodies against infection and necessary nutrients in the proper quality and quantity and T Tried and Tested for years since it is always at the right Temperature and with contraceptive effect, especially with exclusive breastfeeding.

SUMMARY
The six maternal conditions that are absolute contraindications to breastfeeding can be coined from the acronym: MRS CANOT, namely: Mental disorders and Retardation and Seizure disorders, Cardiac diseases, Advanced Nephritis, open Tuberculosis and Thyrotoxicosis. Temporary contraindications to breastfeeding are intake of drugs like anticoagulants, antibiotics, toxic substances like mercury and benzene and mechanical problems like retracted and oversized nipples.

THANK YOU!