LESSON PLAN ON BREAST FEEDING SUBM ED TO: Mrs.K Sunil Kumari H.O.D,Child Health Department M.Sc (N) I**Year Student EBM College of Nursing EBM College of Nursing SUBMITTED 04/12/2017STUDENT PROFILE ‘Name Of The Student Teacher Course College Name Of The subject Name Of The Topic Unit Name Of The Supervisor Group Venue Date And Time Method Of Teaching AN Aids Mrs, $.Tulasi M.Sc (N) 1" year EBM College of Nursing Child Health Nursing Breast Feeding Unit V Mrs K Sunil Kumari B.Se (N) III- Year B.Sc (N) III - year class room 14 12 2017, 10:30 Am Lecture cum Discussion Black Board, Chart, Flash Card, PPTOBJECTIVES GENERAL OBJECTIVES: By the end of the session, the students will be able to gain in depth knowledge about the Breast feeding. SPECIFIC VES: ‘At the end of the session students will be able to Introduction of Breast Feeding Definition of Breast Feeding Explain the Anatomy of the Breast Explain the Physiology of Lactation Explain the role of hormones in milk production Reflexes in the baby Lis out the composition of Human Milk Know the types of milk Discuss the advantages and contraindications Know the Breast Feeding Positions Know the Breast Feeding Pattern Discuss the Good and Poor attachment of the babyNo | OBJECTIVE | TIME L Ss. To introduce the topic To Define the Breast Feeding min CONTENT IN ENGLISH INTRODUCTION; The basic food for infant is milk and breast feeding is the most natural method. Breast Feeding is must to meet the nutritional nee: emotional needs and psychological needs of the infant and chil. Breast milk is natural readymade food which is the most suitable for the neonates because of its nutritional value, protection fiom the infection against diseases and the financial and social implications it has for a poor. Virtually all mothers can breastleed, provided they have accurate information, and the support of their family, the health care system and society at large. According to WHO: Breastfeeding is the normal way of providing young infants with the nutrients they need Tor healthy growth and development. TEACHER | LEARNER ACTIVITY ACTIVITY Lecture cum | Listening Discussion Lecture cum |_Listening Discussion AV AIDS | EVALUATION Black Board with, Chal: Black Board ‘with, Chal:Explain the Anatomy of the Breast Imin 2min Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to ‘two years of age or beyond. ANATOMY OF THE BREAS Breasts are bilateral glandular structures. The shape of breast varies among the women and also in different periods of life, But the size of base of the breast is fairly constant ‘Human normally consists of two complex mammary glands, one in each breast and each complex mammary gland consists of 10-20 simple slands or segments of glandular tissues + Themipale- delivers breast milk to the baby + The-areola- supports the nipple, contains the Montgomery's gland and finally makes the Lecture cum Discussion Lecture cum Discussion Listening, Listening, pT pernipple visible to the baby during breastfeeding, Montgomery's glands- secrete an oily fluid which moisturizes the nipple during breastfeeding Alveoli- they are very small sacs and millions in number made of milk-secreting cells. Prolactin hormone makes these cells produce milk Mitk:secreting Cubuidal cells - They produce or secrete milk in the breastlobules Myo epiial-celt- contrast nd equcze out the milk and oxytocin hormone makes the myo epithelial cells contract. Lactiferous Ducts- also known as small tubes amy milk from the alveoli to the outside. It is vital to note that milk is stored in the alveoli and small ducts between feeds, Lactiferous_sinuses/Ampulla- they enlarge or dilate during feeding and hold the breast milk temporarily during the feed. Adipose tissue /fat- surround the alveoli and ucts to give the breast is shape PHYSIOLOGY OF LACTATION: sn the baby sucks the sensory nerve endings in the breast are stimulated and impulses are carried by Lecture cum Discussion Listening,4 Explain the Physiology of Lactation Smin the vagus nerve to the Hypothalamus. J This causes the anterior pituitary to release prolactin, into the Blood stream Prolactin acts on the milk producing cells of the breast Milk is secreted Sensory nerve impulses that stat when the baby sucks on the nipple causes the posterior pituitary to incon Which makes the myo epithetial cells around the alveoli and ducts contract, Milk ejectidi/let down reflex. This squeezes milk irom the alveoli ducts and sinuses towards the nipple Lecture Discussion Listening, Black, board with, chalk /Explain the role of hormones in milk production 2min Hypothalamus PRH = Prolactin-releasing hormone PRODUCTION; There are to hormones that directly affect breastfeeding: Prolactin Helps in production of milk Oxytocin-Helps in ejection of milk PROLACTIN The level of prolactin in the blood increases markedly during pregnancy, and stimulates the Leotre Discussion | Lecture cum Discussion Listening, Listening, PPT/ Chart3min growth and development of the mammary tissue, in preparation for the production of milk. However, milk is not secreted then, because progesterone and estrogen, the hormones of pregnancy, block this action of prolactin, Afier delivery, levels of progesterone and orstrogen fall rapidly, prolactin is no longer blocked, and milk secretion begins. oxyTocts: Oxytocin starts working when a mother expeets a feed as well as when the baby is suckling. The reflex becomes conditioned to the mother’s sensations and feelings, such as touching, smelling or seeing her baby, or hearing her baby cry, oF thinking lovingly about him o her. “The posterior lobe sceretes oxytocin. The oxytocin reflex is also called the “letdown reflex” or the “milk ejection rellen”. Oxytocin makes the myoepithelial cells around the alveoli muscle cells to contract. This makes the milk, which has collected in the alveoli, flow along and fill the ducts. i makes the milk that is already in the breast flow for the current feed, and helps the baby to get the milk easily Oxytocin makes a mother’s uterus contract after delivery and helps to reduce bleeding. Suckling affects the release of other pituitary hormones, including gomudanaphin releasing. Locmre Discussion Listening, PPT/ Chart6 To know the reflexes in newborn 2min hormone (GnRH), follicle stimulating hormone, and tuteinising hormone, which results in suppression of ovulation and menstruation. EFLEXES IN THE BABY: The baby’s reflexes are important for appropriate breastfeeding. ‘The main reflexes are rooting, suckling and swallowing. ROOTING REFLEX: When something touches a baby's lips or cheek, the baby turns to find the stimulus, and ‘opens his or her mouth, putting his or her tongue down and forward, This is the rooting reflex and is present from about the 32nd week of pregnancy. SUCKING REFLEX; ‘When something touches a baby’s palate, he or she starts to suck it, This is the sucking reflex. 5 mouth fills with milk, he or she swallows. This isthe swallowing reflex. ‘Coordination of suckling, swallowing and breathing appears between 32 and 35 weeks of pregnancy, Lecture cum Discussion Listening, Black board with chalk w7 | List out the composit- | Imin onof human milk 8 Toknow the | Imin types of milk COMPOSITION: Human milk Nutrients/1000nt Water - 88g. Enorgy - 65kcal Protein - Lg Carbohydrates - 74g Fat- 34g, Calcium - 28mg Phosphorous - 1 Iron - _ Carotene - 137g mg ‘Thiamine - 0.02mg Riboflavin -0.02mg, Vitamin C= 3mg Caseinogens-lactalbumin ration ~1:2 TYPES OF MILK: Colostrum,Transtional milk, Mature milk COLOSTRU First 2 or 3 days ‘+ Most suitable food for new born + Its either yellowish or creamy in colour + It is much thicker than the milk that is produced later. = Aka: “First Mik’," Immune Milk’ ‘Beesting’ + Contains immunogiobuiin’s e.g11GA.IgM, IgG Leotre Discussion Lecture Discussion Listening, Listening Black board with chalk per aDiscuss the Advantages and eonitra- indications of breast feeding min 2min ‘TRANSITIONAL MILK: © From 2-5 to 10®-14" day + More amount of milk than colostrums Breasts will become larger and firmer during, this stage. MATURE MILK: From 14" day onwards There are two types of mature milk: Fore-milk: This type of milk is found during the beginning of the feeding and contains water, vitamins, and protein. ‘Hind-milk: This type of milk occurs after the initial release of milk, rich in fat & provides energy ADVANTAGES OF BREAST FEEDING: * Breast milk is the natural food, readily available, warm and free from contamination Breast milk is an ideal food which is easily digestible It boosts immunity, meets nutritional requirement, provides immunoglobulin’s, reduces malnutrition and increases 1Q of the baby ‘Breast milk is available 24 hours a day and requires no special preparation and without any cost + Psychological benefit of mother-child Lecture Discussion Lecture cum Discussion Listening, Listening, per Black board with chalk 23min bonding Helps in involution of the uterus It acts as a natural contraception to the smother Lessens the incidence of gastrointestinal infections, allergies, ete, [Nursing mothers are less prone to get ovarian and breast cancer Breast feeding satisfies the emotional needs which is essential for the growth of the neonates Breast feeding is more convenient for the mother and has a feeling of satisfaction and sense of fulfilment ‘The baby also feels warm and secure CONTRAINDICATIONS; In Infant: Gross Prematurity Galactosemia (a rare genetic metabolic disorder) Cleft palate Biological mother(where child is passed on to the another couple) In Moth Cracked nipples Active Tuberculosis Malignaney(breast abscess) HIV, Hepatitis Band C Lecture cum Discussion Listening, Black board with, chalk Fry10 ‘To know the breast feeding, positions Imin Herpes lesions on breast Mother on certain medivations-Anticancer therapy, radioactive isotope, ee + Post partum Psychosis and Epilepsy Tobacco, Alcohol and Drug Abuse BREAST FEEDING POSITIONS: Cradle hold oy * Cross-cradle hold Lecture cum Discussion Listening, Flash cards crsu ‘To know the breast feeding pattem Imin © Clutch or Football bold Reclining or Side-lying Lecture cum Discussion Lecnure Discussion Listening, Listening, Flash Black, ‘with, cchalke 6Depends mainly on: = BABY's Needs + BABY’s Size + BABY Suckling strength + Mother's milk supply First Feed: ‘Normal Delivery: > -Lhour Cs 4- Ghours Fist 24s, tan interval of 2-3hes 3th patter by the end of fst week Demand Feeding “The baby is pt to the breast as soon a the aby teoomes hungry. There is no restriction of the tuber of feeds and duration of suckling time Lecture Duration of feed: cum Listening The initial feeding should last for 5-1Omin at | iscussion cach breast. Thereafter, the time spent is gradually increased Baby is fed from one breast completly so that baby gets both the FORE MILK and the HIND: MILK: AMOUNT OF FEED: First Day 60m\kg/24hrs Third Day 100m y/24hes Tenth Day 1S0mUKg/24hrs However the baby ean take as mich as he wants, FEEDING AT FREQUENT INTERVALS ABOUT. 6-8 TIMES A DAY Black board with chalk ieTo discuss ‘200d and poor | 2min attachment of the baby ‘To stimulate the nipple and remove milk from the breast, and to ensure an adequate supply and a good flow of milk, a baby needs to be well ‘attached so that he or she can suckle effectively. Good attachment ~ inside the infant's mouth: * much of the areola and the tissues underneath it, including the larger ducts are in the baby's mouth + the breast is stretched out to form a long ‘teat’, but the nipple only forms about one third ofthe ‘teat’ + the baby’s tongue is forward over the lower ‘gums, beneath the milk ducts (the baby's tongue is in fact cupped around the sides of the “eat") + The baby is suckling from the breast, not from the nipple Leotre Discussion Lecture Listening, Flash cardi v7Tmin Poor attachment — inside the infant's mouth: + only the nipple is in the baby's mouth, not the underlying breast tissue or ducts + The baby’s tongue is back inside his or her ‘mouth, and cannot reach the ducts to press on them. Good and poor attachment external signs: The four signs of good attachment are: + more of the areola is visible above the baby's top lip than below the lower lips + the baby's mouth is wide open; + the baby's lower lip is curled outwards; + The baby’s chin is touching or almost touching the breast ‘The signs of poor attachment are: + more of the areola is visible below the baby's bottom lip than above the top lip — or the amounts above and below are equal + the baby's mouth is not wide open + the baby’s lower lip points forward or is turned inwards; + The baby's chin is away from the breast cum Discussion Listening, Flash cards 18SUMMARY: So Till Now We Have Discussed About The Breast Feeding Introduction, Definition, Anatomy Of The Breast, Physiology OF Lactation, Hormones Control On Milk Production, Reflexes In The Baby, Composition Of Human Milk, Types Of Milk, Advantages jo0d And Poor Attachments, And Contraindications, Breast Feeding Positions, Breast Feeding Patter CONCLUSION: Breast Feeding is an ideal food to meet the nutritional needs, emotional needs and psychological needs of the infant and child, Breast milk is natural readymade food which is the most suitable for the neonates because of its nutritional value, protection from the infection against diseases and the financial and social implications it has for a poor. BIBLIOGRAPHY; * D.C. DUTTA Text Book of Obstetrics, 7 Edition 2011, New * A PADMAJA Text Book of Child Health Nursing, 1" Edition 2016, Jaypee Publishers, Pg.No:172,17 * MANOI YADAV Text Book of Chikd Health Nursing, Edition 2013, Pee Vee Publishers, Py No:148-150,235 # Web site : wun slideshare.org, wikipedia breast ral Book Agency (P) Lid Py.Nor15449-453. 40 19