Breastfeeding

RHANA ANGELA S. MANZANO, MD

RECOMMENDATIONS

● Exclusive breastfeeding for the first 6 months

● When direct breastfeeding is not possible, expressed breast milk should be provided
● Place infants skin to skin with their mothers immediately after birth and encourage
frequent feedings
● Supplements (i.e., water or formula) should not be given unless medically indicated
RECOMMENDATIONS

● Breastfeeding should be well established before pacifiers are used

● Complementary foods should be introduced around 6 months
● Oral vitamin D drops (400 IU/daily) should be given to the infant beginning within
the first few days of age
● Supplemental fluoride should not be provided during the first 6 months of age.
ALL MOTHERS SHOULD RECEIVE

● Breastfeeding assessment by a lactation and/or nurse specialist

● General breastfeeding information
GENERAL BREASTFEEDING
INFORMATION

● Basic positioning of the infact

● Minimum anticipated frequency: 8x/24hrs
● Expected physiologically appropriate colostrum intakes: 15-20ml in first 24hrs
● Infant signs of hunger and adequacy of milk intake
● Common breast conditions
● Proper referral sources when indicated
BASIC POSITIONING
PROPER LATCHING

● Chin touching lip

● Lip curling back
● areola visible above top lip than below
lower lip
● Mouth wide open with big mouthful of
breast
● Sucking pattern change from short sucks
to long deep sucks with pauses
AT 3-5 DAYS OF AGE...

● Stopped losing weight and has lost no more than 8-10% BW

● yellow, seedy stools (approx. 3/day)
● no more meconium stools
● at least 6 wet diapers per day
SPECIAL SITUATIONS

INFANT CONDITIONS MATERNAL CONDITIONS

● Congenital anomalies: craniofacial, ● History of breast or chest surgery

cardiac, respiratory ● Endocrine diseases
● Premature infants, when mother’s
own milk is not available
CONTRAINDICATIONS

● Infant with galactosemia

● Mother with active untreated tuberculosis
● Women who test positive for HIV
● Maternal medications: Amiodarone, Antineoplastic agents, Bromocriptine, Drugs of
abuse, Diethylstilbestrol, Disulfiram, Radioisotopes, Tamoxifen
BREASTMILK EXPRESSION

● Breast stimulation with a hospital-grade electric breast pump combined with hand
expression/breast massages during first few hours post-partum
● Frequent pumping/hand expression (8-10x/day) during 1st 2 weeks
● Pumping 10-15 mins per session during the 1st few days
BREASTMILK COLLECTION

● Handwashing prior to each milk expression

● All equipment should be thoroughly cleaned
● Sterilize equipment once a day
● Collect in sterile glass or hard plastic containers
● Label each container with infant’s identifying information, date, and time of milk
expression
BREASTMILK STORAGE

● Use fresh, unrefrigerated milk within 4 hrs of expression

● Refrigerate milk immediately after expression when the infant will be fed within 72
hrs
● Freeze milk when infant is not being fed, or mother is unable to deliver milk to the
hospital within 24hrs of expression
● In the event that frozen milk partially thaws, complete thawing and feed the milk or
refreeze
Kangaroo-Mother Care
 Kangaroo mother care is care of
preterm infants carried skin-to-skin
with the mother. It is a powerful,
easy-to-use method to promote the
health and well-being of infants
born preterm as well as full-term
Key features

★ early, continuous and prolonged skin-to-skin contact between the mother and the baby
★ exclusive breastfeeding (ideally)
★ it is initiated in hospital and can be continued at home; small babies can be discharged
early
★ mothers at home require adequate support and follow-up
★ it is a gentle, effective method that avoids the agitation routinely experienced in a busy
ward with preterm infants.
When to start KMC?
● Must be judged individually: condition and status of baby and mother
● BW ≥1800g (30-34 weeks AOG or more)
a. May need to address prematurity-related problems first
b. Most cases can start soon after birth
● BW 1200 -1799g (AOG 28-32 weeks)
a. During transport to a medical facility
b. A week or more before KMC can be initiated
● BW < 1200g (AOG <30 weeks)􀄄:weeks before KMC can be initiated
When to start KMC?
● Willingness
● Full-time availability to provide
care
● General health
● being close to the baby
● Supportive family
● Supportive community
When to start KMC
● Short KMC sessions can begin during recovery
when baby still requires medical treatment (IV
fluids, low concentration of additional oxygen)
● For continuous KMC, however, baby’s condition
must be stable; the baby must be breathing
spontaneously without additional oxygen.
● The ability to feed (to suck and swallow) is not an
essential requirement.
● KMC can begin during tube-feeding
Initiating KMC

● When baby is ready for KMC, arrange with the mother a time that is convenient for
her and for her baby
● Ask her to wear light, loose clothing
● Use a private room, warm enough for the small baby
● Encourage her to bring her partner or a companion of her choice if she so wishes
● While the mother is holding her baby, describe to her each step of KMC, then
demonstrate them and let her go through all the steps herself
● Place the baby between the mother’s breasts in an
upright position, chest to chest
● Secure him with the binder
● The head, turned to one side, is in a slightly extended
position to keep the airway open and allows eye-to-
eye contact between the mother and the baby
● The top of the binder is just under baby’s ear
● Avoid both forward flexion and hyperextension of the
head
● The hips should be flexed and extended in a “frog”
position; the arms should also be flexed
● Tie the cloth firmly enough so that when the
mother stands up the baby does not slide out
● Make sure that the tight part of the cloth is over
the baby’s chest
● Baby’s abdomen should not be constricted and
should be somewhere at the level of the
mother’s epigastrium.
● hold the baby with one hand placed behind the
neck and on the back
● lightly support the lower part of the jaw with
her thumb and fingers to prevent the baby’s
head from slipping down and blocking the
airway when the baby is in an upright position
● place the other hand under the baby’s buttocks.
Caring for ● They need to be moved away from skin-to-skin
the baby in contact only for:
a. changing diapers, hygiene and cord
kangaroo care
position b. clinical assessment, according to
hospital schedules or when needed
● Daily bathing is not needed and is not
recommended
● The mother carrying a baby in the KMC position
can do whatever she likes
● Cleanliness and personal hygiene (stress frequent
hand-washing)
● Ensure a quiet environment for her baby and feed
him regularly.
● Mother will best sleep with the baby in
kangaroo position in a reclined or semi-
recumbent position, about 15 degrees from
horizontal.
● Some mothers prefer sleeping on their sides in a
semireclined bed (the angle makes sleeping on
the abdomen impossible)
Length of ● Sessions that last less than 60 minutes should,
KMC however, be avoided because frequent changes are
too stressful for the baby
● The length of skin-to-skin contacts gradually
increases to become as continuous as possible, day
and night, interrupted only for changing diapers,
● When the mother needs to be away from her baby,
he can be well wrapped up and placed in a warm
cot, away from draughts, covered by a warm
blanket, or placed under an appropriate warming
device
Duration of ● Until the baby reaches term (gestational age
KMC around 40 weeks) or 2500g
● Continue breastfeeding
● Mother can return to skin-to-skin contact
occasionally, after giving the baby a bath,
during cold nights, or when the baby needs
comfort
● KMC at home is particularly important in cold
climates or during the cold season and could go
on for longer
Monitoring
● Temperature
the baby’s
condition ● Breathing

● Feeding

● Growth (weight, head circumference)

Discharge ● Baby’s general health is good and there is no
criteria concurrent disease feeding well, and is
exclusively or predominantly breastfed
● Gaining weight (at least 15g/kg/day for at least
3 consecutive days)
● Temperature is stable in the KMC position
(within the normal range for at least 3
consecutive days)
● Mother is confident in caring for the baby and
is able to come regularly for follow-up visits
Routine ● The smaller the baby is at discharge, the earlier and
follow-up more frequent follow-up visits he will need.
➢ 2 follow-up visits per week until 37 weeks post-
menstrual age
➢ 1 follow-up visit per week after 37 weeks

● Evaluate KMC at home during each visit:

➢ Duration, position, clothing, temperature, support
➢ Is the baby showing signs of intolerance? Is it time to
wean?
➢ If not, encourage to continue KMC as much as
possible.
Milk Code
The Philippine Milk Code of 1986/
Executive Order No. 51
"National Code of Marketing of Breastmilk
Substitutes, Breastmilk
Supplement and Other Related Products"
AIM
to contribute to the provision of safe and adequate nutrition for infants by
the protection and promotion of breast feeding, and by ensuring the proper
use of breastmilk substitutes and breastmilk supplements when these are
necessary, on the basis of adequate information and through appropriate
marketing and distribution
SCOPE
to the marketing, and practices related thereto, of the following products:
breastmilk substitutes, including infant formula; other milk products, foods
and beverages, including bottle-fed complementary foods, when marketed
or otherwise represented to be suitable, with or without modification, for
use as a partial or total replacement of breastmilk; feeding bottles and teats
to their quality and availability to information concerning their use
DEFINITION OF TERMS
● “Breastmilk Substitute” - any food being marketed or otherwise
represented as a partial or total replacement for breastmilk, whether or
not suitable for that purpose.
● “Complementary Food” - any food, whether manufactured or locally
prepared, suitable as a complement to breastmilk or to infant formula,
when either becomes insufficient to satisfy the nutritional requirements of
the infant.
DEFINITION OF TERMS
● “Distributor” - a person, corporation or any other entity in the public or
private sector engaged in the business (whether directly or indirectly) of
marketing at the wholesale or retail level a product within the scope of this
Code.
● “Manufacturer” - a corporation or other entity in the public or private sector
engaged in the business or function (whether directly or through an agent or an
entity controlled by or under contract with it) of manufacturing a product within
the scope of this Code.
DEFINITION OF TERMS
● “Infant” - a person falling within the age bracket of 0-12 months.
● “Infant Formula” - a breastmilk substitute formulated industrially in
accordance with applicable Codex Alimentarius standards, to satisfy the
normal nutritional requirements of infants up to between four to six
months of age, and adapted to their physiological characteristics.
DEFINITION OF TERMS
● “Health care system” - governmental, non-governmental or private institutions
or organizations engaged, directly or indirectly, in health care for mothers,
infants and pregnant women; and nurseries or child care institutions. It also
includes health workers in private practice.
● “Health Worker” - a person working in a component of such health care system,
whether professional or non-professional, including volunteer workers.
DEFINITION OF TERMS
● “Container” - any form of packaging of products for sale as a normal retail unit,
including wrappers.
● “Label” - any tag, brand, mark, pictorial or other descriptive matter, written,
printed, stenciled, marked, embossed or impressed on, or attached to, a container
of any product within the scope of this Code.
● “Supplies” - quantities of a product provided for use over an extended period, free
or at a low price, for social purposes, including those provided to families in need.
DEFINITION OF TERMS
● ”Marketing” - product promotion, distribution, selling, advertising,
product public relations, and information services.
● “Marketing personnel” - any person whose functions involve the
marketing of a product or products coming within the scope of this Code.
● “Sample” - single or small quantities of a product provided without cost.
VIOLATIONS OF THE MILK
CODE
1. HEALTH AND
NUTRITIONAL CLAIMS,
CONTENT OF MATERIAL
● All health and nutritional claims for products within the scope of the
Code are absolutely prohibited
● False or misleading information or claims of products within the scope
of the Code are prohibited
2. GIFTS OF ANY SORT
● Milk companies/manufacturers, distributors and representatives of
products covered by EO 51 are prohibited from giving any sort of gift.
● Covered entities cannot give gifts of any sort to any member of the
general public, hospitals, and other health facilities, including their
personnel and members of their families.
3. MARKETING IN THE
HEALTH CARE SYSTEM
● Milk companies or their representatives are prohibited from
using the health workers and the health care system in the
dissemination, distribution and promotion of covered products.
4. MARKETING TO HEALTH
WORKERS
● No financial or material inducements or gifts of any sort to promote
products within the scope of this code shall be offered or given by
milk companies nor accepted by health workers and/or members of
their families.
● No assistance, support, logistics or training from milk companies may
be permitted.
5. CLASSES, SEMINARS AND
OTHER ACTIVITIES
Companies of covered products are prohibited from conducting or being
involved in any breastfeeding promotion or education, production of
information materials on breastfeeding, or holding/participating in
classes or seminars for women and children and other similar activities.
6. POINT-OF-SALE ADVERTISING
There shall be no point of sale advertising, giving of samples or any
promotion devices to induce sales directly to the consumers at the
retail level, such as special displays, discount coupons, premiums,
rebates, special sales, bonus and tie-in sales, loss-leaders, prices or
gifts for the products
7. DONATIONS
● Donations of products, materials, defines and covered under
EO 51 and its IRR are strictly prohibited.
● Donations of products and equipment not falling within the
scope of EO 51 given by regulated entities, whether in kind or
in cash, may only be coursed through the IAC.
SANCTIONS
THANK
YOU!