BREASTFEEDING COUNSELLING

PEDIATRIC DEPARTMENT
 ADVANTAGES OF BREASTFEEDING
Breast milk Breastfeeding
• Perfect nutrients • Helps bonding
• Easily digested; and development
efficiently used • Helps delay a new
• Protects against pregnancy
infection • Protects mothers’
health

 Costs less than artificial feeding

 PROTECTION AGAINST INFECTION
1. Mother infected 2. White cells in
mother’s body
make antibodies
to protect mother

4. Antibodies to
mother’s infection 3. Some white cells
secreted in milk to go to breast and
protect baby make antibodies
there
DIFFERENCES BETWEEN COLOSTRUM
AND MATURE MILK
Hindmilk
Foremilk

Fat

Protein

Lactose

Colostrum Mature milk

 COLOSTRUM
PROPERTY IMPORTANCE
• RICH ANTIBODY • PROTECTS AGAINST ALLERGY & INFECTION
• MANY WHITE CELL • CLEARS MECONIUM
• PURGATIVE • HELPS TO PREVENT JAUNDICE
• GROWTH FACTORS • HELPS INTESTINE TO MATURE
• RICH VITAMIN A • PREVENTS ALLERGY, INTOLERANCE
• PREVENTS SEVERITY OF INFECTION
PSYCHOLOGICAL BENEFITS OF
BREASTFEEDING
EMOTIONAL BONDING
• CLOSE, LOVING RELATIONSHIP BETWEEN MOTHER AND BABY
• MOTHER MORE EMOTIONALLY SATISFIED
• BABY CRIES LESS
• BABY MAY BE MORE EMOTIONALLY SECURE
DEVELOPMENT
• CHILDREN PERFORM BETTER ON INTELLIGENCE TESTS
DISADVANTAGES OF ARTIFICIAL
FEEDING
• INTERFERES WITH BONDING
• MORE DIARRHOEA AND PERSISTENT DIARRHOEA
• MORE FREQUENT RESPIRATORY INFECTIONS
• MALNUTRITION; VITAMIN A DEFICIENCY
• MORE ALLERGY AND MILK INTOLERANCE
• INCREASED RISK OF SOME CHRONIC DISEASES
• OBESITY
• LOWER SCORES ON INTELLIGENCE TESTS
• MOTHER MAY BECOME PREGNANT SOONER
• INCREASED RISK OF ANAEMIA, OVARIAN CANCER, AND BREAST CANCER IN MOTHER
 BREAST MILK IN THE SECOND YEAR OF LIFE
100% Gap
Percentage of daily needs

75%

50%
Provided by
550 ml
breast milk
25%

0%
Energy Protein Iron Vitamin A

Nutrient
The Global Strategy for Infant and Young Child
Feeding recommends that:

Infants are exclusively breastfed for the first six

months of life

After six months all babies require complementary

foods while breastfeeding continues for up to two
years of age or beyond

You need to understand why breastfeeding is important so

you can help to support mothers who may have doubts about
the value of breast milk.
ANATOMY OF THE BREAST
Oxytocin makes
Muscle cells them contract
Prolactin makes
Milk-secreting cells
them secrete milk

Ducts

Larger ducts

Nipple

Areola
Montgomery’s glands
Alveoli
Supporting
tissue and fat
 PROLACTIN
• SECRETED DURING AND AFTER FEED TO PRODUCE NEXT FEED

Sensory impulses from

nipples

Prolactin in blood

• More prolactin
Baby suckling secreted at night
• Suppresses ovulation
 OXYTOCIN REFLEX
• WORKS BEFORE OR DURING FEED TO MAKE MILK FLOW

Sensory impulses from

Oxytocin in blood nipples

Baby suckling
• Makes uterus contract
HELPING AND HINDERING OF
OXYTOCIN REFLEX
These help reflex These hinder reflex

• Thinks lovingly of baby • Worry

• Sounds of baby
• Stress
• Sight of baby
• Pain
• Touches baby
• Doubt
• Confidence
SIGNS & SENSATIONS OF ACTIVE OXYTOCIN
REFLEX
A mother may notice:
A squeezing or tingling sensation in her breasts just before
she feeds her baby, or during a feed.
Milk flowing from her breasts when she thinks of her baby, or
hears him crying.
Milk dripping from her other breast, when her baby is
suckling.
Pain from uterine contractions, sometimes with a rush of
blood, during feeds in the first week.
INHIBITOR IN BREAST MILK

Inhibitor If breast remains

full of milk,
secretion stops
ATTACHMENT TO THE BREAST
 GOOD AND POOR ATTACHMENT

WHAT DIFFERENCES DO YOU SEE?

1 2
ATTACHMENT (OUTSIDE APPEARANCE)
WHAT DIFFERENCES DO YOU SEE?

1 2
GOOD ATTACHMENT
a. The baby's chin touches the breast.
b. His mouth is wide open.
c. His lower lip is turned outwards.
d. You can see more of the areola above
his mouth and less below.
RESULTS OF POOR ATTACHMENT
• PAINFUL NIPPLES
• DAMAGED NIPPLES
• ENGORGEMENT
• BABY UNSATISFIED AND CRIES A LOT
• DECREASED MILK PRODUCTION
• BABY FAILS TO GAIN WEIGHT
 REFLEXES IN THE BABY
Rooting Reflex
When something touches lips,
baby opens mouth, puts tongue
down and forward Sucking Reflex
When something touches
palate, baby sucks
Skill
Mother learns to
position baby
Baby learns to
take breast
Swallowing Reflex
When mouth fills
with milk, baby
swallows
BREASTFEED OBSERVATION JOB AID
- THIS FORM WILL HELP YOU TO REMEMBER WHAT TO LOOK FOR WHEN YOU ASSESS A
BREASTFEED.
- THE FORM IS ARRANGED IN 5 SECTIONS:
GENERAL,
BREASTS,
BABY’S POSITION,
BABY’S ATTACHMENT,
SUCKLING.
- THE SIGNS ON THE LEFT ALL SHOW THAT BREASTFEEDING IS GOING WELL.
- THE SIGNS ON THE RIGHT INDICATE A POSSIBLE DIFFICULTY.
GENERAL
Mother:
􀁆 Mother looks healthy
􀁆 Mother relaxed and comfortable
􀁆 Signs of bonding between mother & baby
Baby:
􀁆 Baby looks healthy
􀁆 Baby calm and relaxed
􀁆 Baby reaches or roots for breast if hungry
BREASTS
􀁆 Breasts look healthy
􀁆 No pain or discomfort
􀁆 Breast well supported with fingers away from nipple
BABY’S POSITION
􀁆 Baby’s head and body in line
􀁆 Baby held close to mother’s body
􀁆 Baby’s whole body supported
􀁆 Baby approaches breast, nose to nipple
nipple
BABY’S ATTACHMENT
􀁆 More areola seen above baby’s top lip
􀁆 Baby’s mouth open wide
􀁆 Lower lip turned outwards
􀁆 Baby’s chin touches breast
SUCKLING
􀁆 Slow, deep sucks with pauses
􀁆 Cheeks round when suckling
􀁆 Baby releases breast when finished
􀁆 Mother notices signs of oxytocin reflex
Mother:
􀁆 Mother looks ill or depressed
􀁆 Mother looks tense and uncomfortable
􀁆 No mother/baby eye contact
Baby:
􀁆 Baby looks sleepy or ill
􀁆 Baby is restless or crying
􀁆 Baby does not reach or root
􀁆 Breasts look red, swollen, or sore
􀁆 Breast or nipple painful
􀁆 Breast held with fingers on areola
􀁆 Baby’s neck and head twisted to feed
􀁆 Baby not held close
􀁆 Baby supported by head and neck only
􀁆 Baby approaches breast, lower lip/chin to
􀁆 More areola seen below bottom lip
􀁆 Baby’s mouth not open wide
􀁆 Lips pointing forward or turned in
􀁆 Baby’s chin not touching breast
􀁆 Rapid shallow sucks
􀁆 Cheeks pulled in when suckling
􀁆 Mother takes baby off the breast
􀁆 No signs of oxytocin reflex noticed
A B
HOW TO HELP A MOTHER TO POSITION HER BABY
􀁆 Greet the mother and ask how breastfeeding is going.
􀁆 Assess a breastfeed.
􀁆 Explain what might help, and ask if she would like you to
show her.
􀁆 Make sure that she is comfortable and relaxed.
􀁆 Explain how to hold her baby, and show her if necessary.
􀁆 Show her how to support her breast
􀁆 Explain or show her how to help the baby to attach
􀁆 Look for signs of good attachment. If the attachment is
not good, try again
􀁆 Notice how she responds and ask her how her baby's
suckling feels
 The mother sit in a comfortable and relaxed position
􀁆 A low seat is usually best, if possible one that supports the
‘mother's’ back.
􀁆 If the seat is rather high, find a stool for her to put her feet
onto. However, be areful not to make her knees so high
that her baby is too high for her breast.
􀁆 If she is sitting on the floor, make sure that her back is
supported.
􀁆 If she supports her baby on her knee, help her to hold the

baby high enough so that she does not lean forward to

put him onto her breast.
How to hold her baby
Baby’s head and body in line
Baby held close to mother’s body. The baby's
whole body should almost face his mother's body.
Baby supported. Baby’s whole body supported
with the mother’s arm along the baby’s back. For
older babies, support of the upper part of the body
is usually enough.
Baby approaches breast, nose to nipple
How to support her breast
If she has small and high breasts, she may not need to support them.
She should place her fingers flat on her chest wall under her breast, so
that her first finger forms a support at the base of the breast.
She can use her thumb to press the top of her breast slightly. This can
improve the shape of the breast so that it is easier for her baby to attach
well.
She should not hold her breast too near to the nipple.
Holding the breast too near the nipple makes it difficult for a baby to
attach and suckle effectively. Such as:
- holding the breast with the fingers and thumb close to the areola
- pinching up the nipple or areola between your thumb and fingers, and
trying to push the nipple into a baby’s mouth
- holding the breast in the ‘scissor’ hold – index finger above and
middle finger below the nipple can block milk flow.
How to help the baby to attach
- First holds the baby with his nose opposite her nipple, so that he
approaches the breast from underneath the nipple.
- touch her baby’s lips with her nipple, so that he opens his mouth, puts
out his tongue, and reaches up.
- wait until her baby’s mouth is opening wide, before she moves him
onto her breast. His mouth needs to be wide open to take a large
mouthful of breast.
- It is important to use the baby's reflexes, so that he opens his mouth
wide to take the breast himself. You cannot force a baby to suckle, and
she should not try to open his mouth by pulling his chin down.
- quickly move her baby to her breast, when he is opening his mouth
wide. She should bring her baby to her breast. She should not move
herself or her breast to her baby.
- As she brings the baby to her breast, she should aim her baby's lower
lip below her nipple, with his nose opposite the nipple, so that the
nipple aims towards the baby’s palate, his tongue goes under the
areola, and his chin will touch her breast.
EXPRESSING BREASTMILK
Expressing milk is useful to:
. leave breast milk for a baby when his mother goes out
or works
. feed a low-birth-weight baby who cannot breastfeed
. feed a sick baby, who cannot suckle enough
. keep up the supply of breast milk when a mother or
baby is ill
. prevent leaking when a mother is away from her baby
. help a baby to attach to a full breast
. help with breast health conditions, e.g. engorgement
The most useful way for a mother to express milk is by hand. It needs
no appliance, so she can do it anywhere and at any time. With a good
technique, it can be very efficient.

Why is it helpful to stimulate a mother’s oxytocin reflex

before she expresses milk?
It is important that the oxytocin reflex works to make the milk
flow from her breasts.
The oxytocin reflex may not work as well when a mother
expresses as it does when a baby suckles. A mother needs
to know how to help her oxytocin reflex, or she may find it
difficult to express her milk.
HOW TO STIMULATE THE OXYTOCIN REFLEX

Help the mother psychologically:

Build her confidence
Try to reduce any sources of pain or anxiety
Help her to have good thoughts and feelings about the baby

Help the mother practically:

Sit quietly and privately or with a supportive friend.

Hold her baby with skin-to-skin contact if possible.
Take a warm soothing drin Warm her breasts.
Stimulate her nipples
Massage or stroke the breasts lightly.
Ask a helper to rub her back k.
A helper rubbing a mother's back to stimulate the oxytocin reflex
HOW TO EXPRESS BREASTMILK BY HAND

Wash her hands thoroughly.

Sit or stand comfortably, and hold the container near her
breast.
Put her thumb on her breast ABOVE the nipple and areola,
and her first finger on the breast BELOW the nipple and
areola, opposite the thumb. She supports the breast with
her other fingers.
Press her thumb and first finger slightly inwards towards
the chest wall. She should avoid pressing too far, because
that can block the milk ducts.
Press her breast behind the nipple and areola between her finger and thumb. She must press
.
on the lactiferous sinuses beneath the areola Sometimes in a lactating breast it is possible to
feel the sinuses. They are like pods, or peanuts. If she can feel them, she can press on them.
Press and release, press and release. This should not hurt - if it hurts, the technique is wrong.
At first no milk may come, but after pressing a few times, milk starts to drip out. It may flow in
streams if the oxytocin reflex is active.
Press the areola in the same way from the SIDES, to make sure that milk is expressed from all
segments of the breast.
BREASTMILK STORAGE GUIDELINES