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Breastfeeding Education

Lesson - 1
• Breastfeeding from Birth to 2Y
• Skin to Skin Contact

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BREASTFEEDING FROM BIRTH
TILL 2 YEARS and MORE

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Why breastfeed?

Breast milk is a gift that


only you can make for
your baby.

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World Health Organization (WHO) recommends
that breast milk is the only food your baby needs
for the first six months of life. This is called
“Exclusive Breastfeeding.”

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Exclusive Breastfeeding
Means an infant receives only breast milk from the
mother or a wet nurse, or expressed breast milk, and
no other liquids or solids.

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Exclusive Breastfeeding
It is allowed to give drops or syrups consisting
of vitamins, mineral supplements or medicines
prescribed by a doctor.

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Exclusive Breastfeeding
No water or other drinks or foods (such as tea, juice,
sugar water, porridge, fresh milk or formula) during
the first six months.

HONEY

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Risk of giving formula, water, tea
Overfill a baby’s stomach so the baby
does not suckle at the breast
Mean Volume Mean Volume Mean Volume
37 ml/24H 408 ml/24H 705 ml/24H

5-7 ml 22-27 ml 60-81 ml

DAY 1 DAY 3 DAY 10

Baby’s stomach size


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Exclusive Breastfeeding
Even in hot, dry climates, breast milk fully meets a
baby’s need for fluids.

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To achieve optimal
growth,development and health, babies
should be exclusively breastfed for the
first six months of life.

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Breastfeeding for the first 6 months
Breast milk contains the perfect balance of nutrients
for a baby, unlike infant formula, other powdered milk
or fresh milk.

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Your milk is specially designed for your baby:
Nothing else comes close.

Rich with antibodies


(special proteins that
fight infection) to help
the baby defend against
illnesses.
It is called
“baby’s first vaccine.”

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Colostrum
• The perfect first food
• Only few teaspoons at first 3-4 days
• Low fat and high protein content
• High level of antibodies “Babies first
vaccine”
• Acts as natural laxative to help clear the
meconium (the dark sticky stool)

Foremilk Hindmilk
• What baby receives at the • What baby receives at the
beginning of breastfeeding end of breastfeeding
• High water content helps • Baby should finish feeding at
quench baby’s thirst one breast before moving to
• Contains plenty of lactose and the other
proteins but very little fat • Contains plenty of fat and
calories

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Nothing else comes close
Breast Milk
• Formula lacks many of the
good things babies need

• Formula is more difficult


Formula
to digest than breast milk,
resulting in more spit up
and constipation.

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Nothing else comes close
• The first 2 years of life
are crucial for brain
development.
• Breast milk unique
ingredients allow full growth
of brain tissues.
• Most research show
association between MRI images, taken while children were asleep, showed that
infants who were exclusively breastfed for at least three months
breastfeeding and higher IQ had enhanced development in key parts of the brain compared
to children who were fed formula or a combination of formula
in children and teenagers. and breastmilk. Images show development of myelization by age,
left to right. Credit: Baby Imaging Lab/Brown University (Photo :
Credit: Baby Imaging Lab/Brown University)

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Formula-fed babies are more likely to get
• Diarrhea
• Ear infections
• Pneumonia
• Asthma
• Diabetes
• Obesity
• Some cancers
• SIDS (sudden infant death
syndrome)

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Babies who are fed both breast milk
and formula get more health benefits
than if only formula, but much less
than if only breast milk.

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Why to avoid using bottles and teats?
Some babies may prefer artificial teats and
refuse to suckle on the mother’s breast.

Giving pacifier instead of a breastfeeding, result


in baby taking less milk.

Teats, bottles, and pacifiers can carry infections.

Risk of dental carries and other dental issues.

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Breastfeeding it’s best for you.
• Breast milk is always
ready,right temperature,
sterile and requires no
preparation
• Helps you bond with your
baby
• Helps you to loss weight that
you gained during pregnancy
• Lowers your risk of getting,
ovarian cancer, breast cancer
and diabetes
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Breastfeeding It’s best for your family.

• Less trips to doctors,


hospitals
• Less prescriptions
• Less illness
• Less expenses
• More bonding between
family

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Breastfeeding Is Environment Friendly

Ecological:
• Healthy and smart children
• Saves resources
• Less waste
• No bottles, cans
• Less expenses on health care
system

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Continue Breastfeeding
For Up To Two Years or More

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Breastfeeding after 6 months
• It is recommended that a mother continues to breastfeed
her child up to two years and beyond as long as she and
the child wish to continue.

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Breastfeeding after 6 months
• Breast milk remains an important source of energy,
protein and other nutrients such as vitamin A and iron,
even when babies begin to consume additional foods
after 6 months of age.
• Breast milk helps protect a child against diseases for as
long as the child breastfeeds.

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Breastfeeding after 6 month
Breastfeeding can comfort a child who is upset and is an
important source of nourishment during a child’s illness.

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In Summary
• Breast milk is a gift that only you
can make for your baby.
• Breast milk is the only food
your baby needs for the first six
months of life.
• It is recommended to continue
breastfeeding up to two years
and beyond.

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Skin to Skin contact

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When to do skin to skin contact?
All stable babies and mothers benefit from skin-to-
skin contact immediately after birth.
Skin to skin contact should continue for at least
an hour after birth.

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When to do skin to skin contact?
All babies should be dried off as they are placed
on the mother’s skin. The baby doesn’t need to be
bathed immediately after birth.

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When to do skin to skin contact?
Encourage skin-to-skin contact as soon as possible after
caesarean section :
Following general anesthesia, contact can occur in the
recovery room.

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When to do skin to skin contact?
Encourage skin-to-skin contact as soon as possible after
caesarean section :
Following spinal or epidural, contact can occur in the
operation room, as mother is usually alert.

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When to do skin to skin contact?
Babies who are not stable immediately after birth can
receive skin-to-skin contact later when they are stable.

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When to do skin to skin contact?
In twin delivery, the first infant can have skin to skin contact
until the mother starts labour for the second birth.
The first twin can be held by a family member for warmth
and contact while the second twin is born.
Then the two infants are held by the mother in skin to skin
contact and assisted to breastfeed when ready.

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When to do skin to skin contact?
The father or other family member can give skin-to-skin
contact (to keep the baby warm & comforted).

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Why is skin to skin contact important?
Calms the mother & baby and helps to stabilize
the baby‘s heart beat and breathing and keeps
the baby warm..

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Why is skin to skin contact important?
Assists the metabolic adaptation and blood glucose
stabilization in the baby.

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Why is skin to skin contact important?
Reduces infant crying, thus reducing stress & energy loss.

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Why is skin to skin contact important?
Enables colonization of the baby‘s gut with mother‘s
normal body bacteria.

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Why is skin to skin contact important?
Facilitates bonding between the mother & her baby

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Breast crawl and self attachment
Skin-to-skin contact allows the baby to find the breast
and self attach, which is more likely to result in effective
suckling . Babies are usually alert in the first one to two
hours of age, then they sleep for long periods of time.

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Breast crawl and self attachment
skin-to-skin helps a mother to recognize these pre-feeding
behaviors of her baby:
• Touching nipple with his hand
• Putting his hand to his mouth
• Focusing on the areola (dark skin)
• Moving toward the breast
• Finding nipple and attaching to the breast

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Breastfeeding Education
Lesson - 2
Good Start
(Rooming In • Demand Feeding • Signs of Enough Milk)

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Breastfeeding a good start:

• Rooming In

• Demand Feeding

• Signs of Enough Milk

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Rooming in

Allows mothers and infants to remain


together 24 hours a day.

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Importance of Rooming in
It calms the mother & baby and helps to increase
bonding between them.

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Importance of Rooming in
• Enables demand feeding
• Helps mother and baby to recognize each other
• Reduces exposure to infection

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Importance of Rooming in
It allows mothers to recognize hunger cues of the baby.

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Importance of rooming in
Allows frequent feeds, for good milk production

Breast is a gland (like a factory).

More feeds =
more signals =
more milk

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Demand Feeding

Demand feeding or baby-led feeding means to feed :


• Whenever baby wants (follow baby’s early hunger cues)
• As long as baby wants (when baby is full, he gets off the breast)
• When baby is full ,he gets off the breast
• But in first few days some babies sleep a lot, if he sleep more than
2-3 hours awake him and feed

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Importance of demand feeding
• Ensures sufficient milk production
• Decreases breast encouragement

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Importance of Night Feeding

Breastfeeding at night:
• Enhance Milk production: hormone of milk (prolactine is higher at
night)
• Breastfeeding mothers get more sleep
• Facilitates prompt responses to hunger signs of baby
• Is protective against “ sudden infant death syndrome” or cot death
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Night Feeding
Tips for breastfeeding at night

• Mother and baby sleep in the same room


• Breastfeeding in lying position
• Safe co-sleeping and bed sharing
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Sleeping with your baby is safe EXCEPT IF:
• You use a sofa or an armchair.
• You are extra sleepy (sleeping pills, drugs, alcohol…) or extra tired.
• You or your husband are smokers.
• Your baby was born preterm (or with small weight).

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Safe sleeping practices
• The safest sleeping position for your baby is on his BACK (not side or
tummy).
• Keep away from pillows and bed sheets.
• Make sure your baby cannot fall.
• Never leave him alone in an adult bed.
• The safest place for your baby to sleep in, is a cot by the side of your bed.
• (NEVER in ANOTHER ROOM until 6 months)

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How do I know my milk is enough?
1. Sufficient breastfeeds:
Around 8-12 times in 24 hours
Around 15-30 minutes per feed

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Warning sings of baby not taking enough milk
• Very long feeds (more than 40 minutes)
• Very short feeds (less than 10 minutes)
• Very frequent feeds (more than 12 feeds in 24 hours)
• It could be due to the baby being not well attached at the breast.

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How do I know my milk is enough?
2.Urine Output

Day 1-2: From day 3:


At least 2-3 times in 24 hours At least 6 times in 24 hours
sometimes dark orange color Pale color

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How do I know my milk is enough?

3. Stool (poops)

Day 1-2 : Day 3-4: From Day 5:


At least 1 time At least 3 times At least 4 times
Black and sticky Dark green Yellow, very loose and seedy

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How do I know my milk is enough?

4. Consistent weight gain:

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How do I know my milk is enough?
5. Baby is satisfied and sleeps after feed

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How do I know my milk is enough?
6. Breasts are full before and soft after feeding

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Summary:
How do I know if my milk is enough?
My baby:
1. Breastfeed at lease 8 times in 24 hours (10-12 feeds for
newborn)
2. Passes pale urine at least 6 times in 24 hours (for the 1st
month)
3. Passes at least 4 yellow stools in 24 hours from day 5 (for
the 1st month)
4. Gains weight consistently
5. Is satisfied and sleeps after feeding
My breasts are full before and softer after a feed
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Getting Breastfeeding off To a Good Start

Good Start,
Enough milk,
Deep sleep

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Breastfeeding Education
Lesson - 3
• Position and Attachment
• Hand Expression & Cup Feeding
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Mother & Baby Position & Attachment

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Mother’s position
1. Sitting position

• Mother can sit in a chair, couch,


bed or on the floor
• Sit straight with well Supported
back (use pillow)
• Feet well supported so legs are
not hanging (use footrest)

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Mother’s position
2. Side-lying position
• Lye on your side
• You can use pillow under your
head if you wish
• Night feeding in this position
helps mother to rest

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Mother’s position
3. Laid-Back

• This is the natural breastfeeding


position (best to use for the first 40
days)
• You can lean back on bed or coach
• Have your head and shoulders well
supported

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Unwrap the baby for feeding
• Better to unwrap for deeper
attachment
• If you like to wrap:
use thin blanket
wrap only the arms (Batman
wrap)
Don’t wrap with heavy
blanket:
Sleepy baby (too warm)
Wrong attachment
No contact between mother
and baby
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Baby’s Position
1. Cradle hold Position
• The baby is facing mother, lying on
his side
• Head and shoulders and hips in
straight line
• The baby’s body is well supported
by mother’s arm (same side as the
breast)
• His legs are wrapped in around
mother’s body
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Baby’s Position
2. Cross Cradle hold Position
• Mother holds her baby with the
opposite arm.
• Baby’s body completely facing
mother’s body.
• The back is supported by her
forearm, the shoulders and neck
by her hand, with her fingers
resting behind baby’s ear.

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Baby’s Position
3. Under Arm Position
• The baby is positioned on a
pillow to the side of the mother

• The mother’s hand and wrist


support baby’s back and
shoulder (not head)

• Her fingers rest behind baby’s


ear
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Baby’s Position
4. Side Lying Position
• Mother lies down on her side
• Baby also lies down on her/his side
• Baby’s body completely facing and
in contact with the mother’s body
(especially his leg)
• Baby’s back supported by mother’s
hand or by placing a rolled towel

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Baby’s Position
5. Laid-Back or natural BF position
• Lean back on bed or sofa and be well
supported
• Let your baby’s whole front touch your
whole front
• Let your baby’s cheek rest somewhere
near your bare breast
• Observe your baby going to your
breast
• Help him as much as you like
http://www.llli.org/faq/positioning.html

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Baby’s Position
6. Twin Position
Underarm hold Natural breastfeeding position

Parallel hold

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Attachment/Latch on
• In natural BF position, the baby
attaches by himself
• For the other positions,the mother
has to follow these steps:
• Position your baby so that his nose,
rather than his mouth, is in front of
the nipple
• Brush your nipple against the
baby’s top lip to open her/his mouth
(Like a yawn)
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Attachment/Latch on

• With the chin making the first


contact
• Aiming the lower lip as far as
possible from the nipple
• When baby gaps and drops his
tongue, bring him deeply onto
the breast

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Signs of deep attachment Signs of shallow attachment
• Chin touching breast • Chin away from breast
• Mouth wide open • Mouth not wide open
• Lower lip turned outwards • Lower lip pointing forward, or
• Areola: more visible above than turned in
below the mouth(Asymmetric) • Areola: more visible below
than above, or equal amounts
(Symmetric)

 
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Signs of effective suckling
• Slow, deep sucks and swallowing
sounds
• Cheeks full and not drawn in
• Baby feeds calmly
• Baby finishes feed by himself,
satisfied and sleep
• Breasts are softer after feed
• Mother feels no pain

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Cradle

Baby’s
Natural BF position Positions Cross cradle

Side lying Under arm


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key points of positioning
• Baby close to mother

• Facing breast

• Well supported

• Head, shoulder and hip in line

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Signs of deep attachment/latch
Asymmetric latch: more
areola visible above top lip
Wide mouth
Nose free

Lip turned outward


Cheeks round

See/hear
swallowing
Chin Touching

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Hand Expression of Breast Milk

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Why Learn to Hand Express?
To soften the engorged areola before latching the baby

To relief discomfort and engorged breast


To encourage a baby to breastfeed by expressing few
drops (baby smells and tastes the milk)
To keep up the milk production
(to increase milk supply)
To rest severe cracked nipples and give them
time to heal

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1. Preparation to encourage milk flow

Being comfortable and relaxed.

Thinking or looking at your baby


(or even at his photograph)
Warming your breast and gently
massaging or stroking it.

Leaning forward
(so that gravity will help the milk to flow)
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1
Wash your hands well with soap and water

2
Place a clean container below your breast to collect milk

3
Massage the breasts gently toward the nipples

Place your thumb and index finger opposite each other


4
(C hold) just outside the dark circle around the nipple
(about 2.5-3.5 cm from the base of the nipple)

5 Now press back toward your chest, then gently


compress to release milk
Repeat (press - compress - relax) at different
6
positions around the areola
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Hand expression: so useful…

1 Massage the breast

2 Make a C shape

Press back toward the chest wall, compress


3 thumb & index together, relax. Repeat step 3.

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How Frequent and How Long to Hand
Express to get enough milk

Express while switching between breasts


To get colostrum
It might takes 5 -10 minutes to get a
teaspoon of colostrum

Express at least:
To increase milk • 6 or more times in 24 hours
production • For about 15-20 minutes
• Including at least once at night
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Cup-Feeding
It is recommended to use a small soft cup

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Advantages of Cup Feeding
Cup feeding:
• Allows the baby to use his or her tongue to taste and
take breast milk
• A cup is easier to clean than a bottle and teat
• Less risk of ‘nipple preference” than by using an
artificial teat

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Steps of cup-feeding

• Baby is fully awake, calm and alert


• Hold him in an upright position
supporting his shoulders and neck
• With the cup about half-full, hold
it so that it is just touching your
baby’s mouth

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Steps of cup-feeding
• Cup should reach the corners of his mouth and touch
lightly on his lower lip.
• DO NOT POUR the milk into his mouth; tip the cup just
enough so that he can lick the milk himself, bringing his
tongue forward to do it.

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Steps of cup-feeding
• DO NOT take the cup away when the baby pauses, unless
he pulls away.
• Allow him to start again when he is ready.
• Follow your baby’s cues and let him set his own pace.

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Breastfeeding Education
• Complementary Food

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Complementary food

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World Health Organization (WHO)
Recommendation
• Infants should be exclusively breastfed for the first six
months of life to achieve optimal growth, development
and health.
• Complementary food: Your baby needs other foods and
liquids in addition to breast milk at around 6 months of
age.
• Continuation of breastfeeding until 2 years or beyond:
introduction of complementary food doesn’t mean
stopping breastfeeding
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Why to start complementary feed
at 6 months?
• Starting other foods in addition to breast milk at 6
months helps a child to grow well.
• At about 6 months of age, an infant is also
developmentally ready for other foods.

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Evolution of your baby’s nutritional needs

1y-2y
Complementary food
6m-1y Breastfeeding
Breastfeeding
Complementary food

0-6m
Only
Breastfeeding
NB: Even if your baby is not breastfeeding, it is
advisable to start complementary food at 6 months

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Signs of your baby’s readiness for
complementary food
Your baby can support his head and neck and
able to sit

Your baby does not push food out of his mouth

Your baby can look at the food, pick it up and


put it in his mouth all by himself

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How to feed your baby?
• Talk to your baby lovingly and look into his eyes
• Feed your baby with the family
• Encourage your baby to eat by letting him touch the
food and try feeding himself
• It is ok to make a mess: it is how your baby learns
about his food
• Pay attention to the signs that your baby is hungry or
is full
• Do not force your baby to finish his food
• Offer a small amount,lots of time, to let him gradually
get used to new foods
• Remove any distractions while eating (e.g. TV, games)

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Keep it clean!

Clean the surface

Use clean utensils to


prepare food

Use clean baby utensil

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Safe preparation of your baby’s food
Storing up to 3-4 Hand washing
months freezer

Storing up to
1-2 days
Fridge

Home made
food

Keeping up to
2 hrs in room
temperature
19-26°C
Baby eating

Keep extra food (not used)


in clean containers
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Food consistency

6 Months 8 Months 12 Months


Water as soon as
• Mashed food • Semi solid • Family food
starting food
• Thick enough to
stay in the spoon
(more energy)

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Offer variety of food

Meat, chicken, fish


(protein, zinc, iron)
Vegetables and fruits
(vitamins carotene, vitA) Bread, rice, pasta
(carbohydrate)

Dairy product
(protein, Ca, vitB) Pulses
(protein, iron) Oil and butter
(essential fat)
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Key Message 1:
• Animal source food are specially
good for children, to help them grow
strong and lively.

Key Message 2:
• Peas, beans, lentils, and nuts and
seeds are also good source of protein
for children

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Key Message 3:
• Dark green leaves and orange
colored fruits and vegetables help a
child to have healthy eyes.

Key Message 4:
• A growing child needs 3 meals plus
snacks, give a variety of foods.

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Frequency and amounts of foods
Age Frequency Amount at each meal
3 meals per a day increasing gradually to
7- 9 months plus frequent breast 2/3 of a 250 ml cup /
feeding meal.
3 meals + 1snack
3/4 of a 250 ml cup/
9 -11 months between meals
meal
+breast feeding
3 meals + 2snack
A full 250 ml cup/
12 – 24 months between meals +
meal
breast feeding

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First foods first!
From 6 months
• First foods: Vegetables, fruits and rice
• Next foods :
 Meat, chicken and fish
 Cereals (pasta, noodles, bread)
 Pulses (lentils, beans)
 full fat dairy products (yoghurt, custard) with no
added sugar

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Food to introduce one at a time
Introduce one at a time to check for any
sign of allergy:
• cow’s milk, soy milk
• wheat, corn, gluten
• eggs, fish, sea food
• peanuts, seeds

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Signs of allergy
• Breathing difficulties
• Runny nose
• Skin reaction: red rashes, itchy
patches and swelling around the
mouth
• Red and itchy eyes
• Stomach upset: vomiting, diarrhea,
constipation, colics…

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Foods to avoid below 1 year
Honey Salt

Sugar
Fresh milk

Tea
Spices

Sweet
Avoid nuts children < 5y drinks

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If your baby is sick
• Breastfeed more frequently
• Encourage the child to eat and drink more
• After illness :provide extra food to help your baby
recover quickly

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Prevention of iron deficiency
• Iron from breastmilk is easily absorbed
• If your baby is on formula : give formula with iron
fortified
• No cow’s milk until he is over 12 months old
• Iron found in meat, poultry, and fish is more easily
absorbed than iron found in plant-based and iron-
fortified foods
• Drinking coffee or tea with a meal lowers the amount of
iron absorbed
• Vitamin C (lemon, orange) helps the body to absorb iron

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Meat product

Dry fruit Green leaves


Iron

Egg Vegetable

iron absorption Vitamin C


iron absorption
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The end

Any questions?

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