Infant Care and Feeding PPT 2021 Part 3

INFANT
CARE &
FEEDING
ABOUT ME
DIANNE GAY LEAÑO
23 years old
FSUU BS Nursing
Batch 2017
Top 17 November 2017

PNLE (85.20)
References
●Fundamentals of Midwifery
●Oxford Handbook of Midwifery
●Pediatric Lecture Presentation

02
INFANT
FEEDING
Table of Contents Expression of Breast Milk
BREASTFEEDING
Constituents of Breast Milk
Breastfeeding Problems
Advantages of Breastfeeding
Contraindications for Lactation and Nutrition

Breastfeeding
Laws of Breastfeeding
Management of
Breastfedding Milk Ejection Reflex
Support for Breastfeeding
Schedule of Feeding
Constituents
of Breast 01
Milk
Colostrum
CONSTITUENTS OF BREAST
MILK
Colostrum
• Provides complete nutrition
• Produced in the first 3 days after delivery
• Volume: 2–10mL daily

MILK
Colostrum
• Transparent and yellow, due to high B-
carotene content
• Easily digested and absorbed
• Energy content: 58kcal/100mL

MILK
Colostrum
• Rich in immunoglobulins (passive immunity)
• Contains higher levels of protein and vitamins A

and K than mature milk
• Contains lower levels of sugar and fat than mature

milk
MILK
Colostrum
• Presence of lacto bifidus factor
• Stimulates the passage of meconium

Breast Milk
MILK
Breast Milk
Breast milk is a complex fluid that contains above
200 known constituents, and changes to meet the
needs of the infant, from:
• Colostrum to transitional then mature milk
• The beginning to the end of the feed
• Morning to evening.
MILK
Breast Milk
NUTRITIONAL
COMPOSITION
MILK
Breast Milk
• Carbohydrate: Lactose (disaccharide)
• Fat: Most variable constituent

Provides 50% of energy
Linoleic and linolenic acids; essential for
development of the nervous system
MILK
Breast Milk
• Protein: Whey protein (growth and energy)
Consists of anti-infective factors including:
Lactalbumin
Immunoglobulins
Lactoferrin
Lysozyme and other enzymes
Hormones and growth factors
MILK
Breast Milk
• Non-protein nitrogens: the three most
important are:
Taurine
Nucleotides
Carnitine
MILK
Breast Milk
• Minerals and trace elements:

sodium, calcium, phosphorus,
magnesium, zinc, copper, and iron
MILK
Breast Milk
• Vitamins: human milk contains all the
vitamins required for a term neonate,
with the possible exception of vitamins
D and K
MILK
Breast Milk
• Enzymes: breast milk contains at least
70 enzymes
Two most important are amylase and
lipase.
MILK
Breast Milk
IMMUNOLOGICAL
PROPERTIES OF
BREAST MILK
MILK
Breast Milk
• Immunoglobulins: IgA, IgG, IgM,
IgD, and IgE, which are active against
specific organisms, e.g. Salmonella
species and poliovirus
MILK
Breast Milkand
• Cells: B lymphocytes, T lymphocytes, macrophages,
neutrophils.
The actions of these cells include:
• Production of antibodies against specific microbes
• Killing of infected cells
• Production of lysozyme and activation of the immune
system
• Phagocytosis of bacteria
MILK
Breast Milk
• Lacto bifidus factor: promotes an acidic
environment suitable for the growth of
Lactobacillus bifidus and inhibits the growth
of pathogenic organisms
MILK
Breast Milk
• Lactoferrin: reduces iron availability

for bacterial growth, by binding to iron.
It also acts as a bacteriostatic agent.
MILK
Breast Milk
• Binding proteins: increase the
absorption of nutrients, therefore
reducing those available to be utilized
by bacteria
Advantages of
02
Breastfeeding
ADVANTAGES OF
BREASTFEEDING
Best for baby
Reduces incidence of allergies
Economical – no waste
Antibodies – greater immunity to infections
Stool inoffensive – never constipated
Temperature always correct and constant
ADVANTAGES OF
BREASTFEEDING
Fresh milk – never goes sour in the breast
Emotionally bonding
Easy once established
Digested easily w/in 2 to 3 hours
Immediately available
Nutritionally balanced
Gastroenteritis greatly reduced
Contraindications
for 03
Breastfeeding
CONTRAINDICATIONS FOR
BREASTFEEDING
Cancer
 Anticancer treatments are normally highly toxic
 Pump and dump
 Mastectomy: breastfeed from the other breast
 Lumpectomy: seek advice from surgeon if may be
able to feed from the treated breast
BREASTFEEDING
Breast Surgery
 Breast reduction and augmentation are not
contraindications
 Depends upon the surgical techniques used
 Advice should be sought from the surgeon
 Unilateral mastectomy: perfectly possible to
breastfeed using the other breast
BREASTFEEDING
Breast Injury
 Serious damage caused by burns and
accidents may have caused scarring that
makes breastfeeding impossible.
BREASTFEEDING
HIV Infection
HIV may be transmitted in breast milk
May breastfeed exclusively for 12 months
Management
of 04
Breastfeeding
Skin-to-Skin
Contact
MANAGEMENT OF
BREASTFEEDING
Skin-to-Skin Contact
• Initiate as soon as possible after birth.
• Place the naked, dried baby against their
mother’s skin.
• Place a blanket around them both to ensure
neither becomes cold.
• Very small babies may also need a hat.
MANAGEMENT OF
BREASTFEEDING
Skin-to-Skin
• If the mother so wishes, place Contact
the baby inside her
nightgown.
• Provide a calm, unhurried atmosphere.
• Ensure that the mother and baby are uninterrupted
during this time.
• Skin-to-skin contact should last until after the first
breastfeed or until the mother chooses to end it.
Positioning and
Attachment
MANAGEMENT OF
BREASTFEEDING
Positioning and Attachment
 Comfort of the mother should be ensured
 Talk the mother through the process as far as
possible
 For the infant to suckle successfully at the
breast, two processes need to be correct. These
are positioning and attachment.
MANAGEMENT OF
BREASTFEEDING
PRINCIPLES OF
EFFECTIVE
POSITIONING
MANAGEMENT OF
BREASTFEEDING
• The baby’s head and body should

be in a straight line.
MANAGEMENT OF
BREASTFEEDING
• The mother should hold the

baby’s body close to hers.
MANAGEMENT OF
BREASTFEEDING
• The baby should face the breast

with the nose opposite the nipple.
MANAGEMENT OF
BREASTFEEDING
• The position should be sustainable

for both the mother and the baby.
MANAGEMENT OF
BREASTFEEDING
The following should be

avoided:
MANAGEMENT OF
BREASTFEEDING
• Holding the back of the baby’s

head.
MANAGEMENT OF
BREASTFEEDING
• Holding the breast away from

the baby’s nose.
MANAGEMENT OF
BREASTFEEDING
• Holding the baby in a bottle-

feeding position.
MANAGEMENT OF
BREASTFEEDING
• Taking the breast down to the baby

rather than bringing the baby to the
breast.
MANAGEMENT OF
BREASTFEEDING
ATTACHMENT OF
THE BABY AT THE
BREAST
MANAGEMENT OF
BREASTFEEDING
The three main reflexes required for a baby
to attach effectively are:
• Rooting reflex
• Sucking reflex
• Swallowing reflex
MANAGEMENT OF
BREASTFEEDING
PROCESS OF
ATTACHMENT
MANAGEMENT OF
BREASTFEEDING
In order to attachPositioning and baby
correctly, the Attachment
needs
to:
• Open their mouth in a wide gape with their
tongue down and forward
• The lower lip, then the tongue, should be
the first point of contact
MANAGEMENT OF
BREASTFEEDING
• The first contact should be well away from
the base of the nipple
• They should then reach up and bring their
mouth over the nipple, taking in a large
portion of breast tissue to form the teat.
MANAGEMENT OF
BREASTFEEDING
RECOGNIZING
CORRECT
ATTACHMENT
MANAGEMENT OF
BREASTFEEDING
• The baby’s mouth is wide open (wider than
100 ° ) and they have a large mouthful of
breast.
• The chin should indent the breast.

MANAGEMENT OF
BREASTFEEDING
• There should be more areola visible above
his top lip than below the baby’s bottom lip.
• The nose should be close to the breast but

not squashed.
MANAGEMENT OF
BREASTFEEDING
• The cheeks are round and full.
• The whole of the lower jaw moves.

MANAGEMENT OF
BREASTFEEDING
• The lower lip is curled outwards but
this is not always easily visible if the
baby is close to the breast.
MANAGEMENT OF
BREASTFEEDING
• The mother feels a strong, and sometimes
uncomfortable, ‘drawing’ sensation as the
baby scoops up the nipple and breast tissue,
draws it into his or her mouth and
commences suckling.
MANAGEMENT OF
BREASTFEEDING
• Swallowing may be heard but this only

indicates that milk is flowing, not that the
positioning and attachment are correct.
Measures to
Enhance
Breastfeeding
Success
MANAGEMENT OF
BREASTFEEDING
Enhancing Breastfeeding Success
NIGHT FEEDS
The advantages of night feeds include:
• Prolactin levels are higher at night, and a
breastfeed at night will result in a greater
prolactin surge.
MANAGEMENT OF
BREASTFEEDING
• Exclusive breastfeeding that incorporates
night feeds raises prolactin levels which, in
turn, inhibits luteinizing hormone release,
this prevents ovulation..
MANAGEMENT OF
BREASTFEEDING
• Frequent feeds, including night feeds,

help to prevent/reduce engorgement
when the milk first comes in.
MANAGEMENT OF
BREASTFEEDING
• There is a soporific effect on the

mother, which improves the quality of
sleep.
MANAGEMENT OF
BREASTFEEDING
ROOMING-IN
Rooming-in, which allows mother and babies to remain
together for 24h a day, has been shown to:
• Improve breastfeeding outcomes
• Improve mother–baby relationship
• Preferable to nursery care for both mother and baby.
Support
for 05
Breastfeeding
Partners
SUPPORT FOR
BREASTFEEDING
Partners
• The male partner has a strong

influence upon the choice of infant
feeding method.
SUPPORT FOR
BREASTFEEDING
Partners
• The partner’s positive attitude to
breastfeeding is important for the
mother initiating and continuing to
breastfeed.
SUPPORT FOR
BREASTFEEDING
Partners
• Women need to talk to their partners antenatally

about breastfeeding, as a woman’s guesses about
her partner’s ideas of breastfeeding have often been
found to be inaccurate.
SUPPORT FOR
BREASTFEEDING
Partners
• Partners need to be informed of the

benefits of breastfeeding for both baby
and mother.
SUPPORT FOR
BREASTFEEDING
Partners
• Partners should be involved in

antenatal preparation for breastfeeding
whenever possible.
SUPPORT FOR
BREASTFEEDING
Partners
• Partners are invaluable in providing

emotional and practical support for
breastfeeding mothers.
SUPPORT FOR
BREASTFEEDING
Partners
• Partners wishing to undertake shared care
of the baby should be encouraged to look at
alternatives to feeding, e.g. bathing the
infant, skin-to-skin contact.
Family and
Friends
SUPPORT FOR
BREASTFEEDING
Family and Friends
• Family and friends exert a strong

influence on a mother’s decision about
breastfeeding.
SUPPORT FOR
BREASTFEEDING
Family and Friends
• About one in four mothers are helped

by a relative or friend when they have
problems breastfeeding.
SUPPORT FOR
BREASTFEEDING
Family and Friends
• First-time mothers are more likely to

turn to relatives and friends for
assistance.
SUPPORT FOR
BREASTFEEDING
Family and Friends
• Breastfeeding mothers who were breastfed
themselves are more likely to be
breastfeeding at 4 weeks than those who had
been bottle fed.
SUPPORT FOR
BREASTFEEDING
Family and Friends
• Breastfeeding mothers whose friends

mostly bottle fed are more likely to
discontinue in the first 2 weeks postnatally.
Expression
of 06
Breast Milk
Why Express?
EXPRESSION OF BREAST
MILK
Why Express?
GENERAL BREAST COMFORT:
• To relieve discomfort from overfull breasts if a
feed has been missed
• To prevent leakage if mother and child are apart
• To maintain healthy skin or to assist healing
MILK
Why Express?
TO ASSIST A BABY TO BREASTFEED:
• Expressing a small amount of breast milk will enable
baby to smell and taste the milk
• Softening an overfull or engorged breast = enabling
attachment
• Milk may be expressed gently into the baby’s mouth if he
or she has a weak suck
MILK
Why Express?
TO PREVENT OR RELIEVE BREAST
CONDITIONS:
• Overfull breasts due to a feed being missed
• Engorgement
• Blocked duct
• Mastitis
MILK
Why Express?
TO STIMULATE MILK SUPPLY:
• When mother and baby are separated or baby is
unable to suckle
• If additional stimulus is required to increase or
induce lactation
MILK
Why Express?
TO MAINTAIN MILK SUPPLY:
• When mother and baby are separated
(hospitalization, return to work)
• When the mother has to suspend breastfeeding
temporarily (medication)
Methods of
Expression
MILK
Methods of Expression
HAND OR MANUAL
EXPRESSION
MILK
• Usually gentler than using a pump

• Can be undertaken anywhere
• No/minimal equipment needed
MILK
• Requires skill, and some mothers find

it difficult and prefer to use a pump.
MILK
• Risk of cross-infection is reduced with

hand expression as less equipment is
required.
MILK
• Useful as a self-help method if

blocked ducts, engorgement, or mastitis
occurs.
MILK
• When mother first starts to express breasts,
only small amounts will be expressed, but
with practice it will become easier and she
will be able to express more.
MILK
HOW TO HAND
EXPRESS
MILK
The mother should: Methods of Expression
• Wash her hands
• Use a wide-mouthed sterile container to collect
the milk
• Sit comfortably in a warm, peaceful and relaxing
environment if possible
• Lean very slightly forward.
MILK
• Encourage the let-down reflex by:
• Relax with a warm drink, music, or TV
• Being near the baby/photo of baby
• Warming the breasts
• Gently pulling or rolling the nipples
• Gently massaging the breasts by stroking wit
the finger tips, rolling with the knuckles, or using
circular movements.
MILK
The mother should then:
• Make a ‘C’ shape with her thumb above
and her fingers below the breast near the
edge of the areola but away from the nipple
MILK
MILK
• Gently press her thumb and

fingers together, release the fingers
and repeat in a rhythmic pattern
MILK
MILK
• Sometimes it is helpful to press

inwards and back towards the chest
wall while squeezing
MILK
• The fingers should be
repositioned at intervals to allow
drainage from all the lactiferous
ducts
MILK
BREAST PUMPS
MILK
HAND PUMP
 Mainly for relieving the breasts
 Simple design; simple vacuum principle
 Not suitable for expressing milk which is
to be stored and given to a baby
MILK
BATTERY-OPERATED PUMP
Rhythmic vacuum
Useful if expressing on a regular basis
Less tiring than a hand pump
MILK
ELECTRIC PUMP Methods of Expression
 Heavy and bulky; less portable; efficient
 Commonly used within hospitals, usually shared
by several mothers
 Ideally all mothers should be given their own:
collection beaker, tubing, and sterilizing
equipment
Principles of
Expression
MILK
Principles of Expression
Establishment of lactation:
• Expression should commence as soon as
possible after the birth.
• Express frequently, 6–8 times in 24h, more if

possible.
MILK
Principles of Expression
• Express at least once during the night.
• Avoid set patterns of expressing, instead aim

to imitate the irregular feeding pattern adopted
by most babies.
Storage of
Breast Milk
MILK
Storage of Breast Milk
Fresh breast milk can be:
• Kept for up to 5h at room temperature
• Stored in a refrigerator at a temperature 2–4
° C for up to 5 days
MILK
If milk is not to be used within 24h, freezing is
recommended:
• Kept frozen in an ice-making compartment for
2 weeks
• Kept safely up to 6 months in a domestic
freezer
MILK
Any plastic container that can be sterilized
and made airtight, is suitable for storing
breast milk. Many commercial products are
available.
Reheating
Expressed
Breast Milk
MILK
Reheating EBM
Frozen milk can be:
• Thawed slowly in a refrigerator but must be
used within 24h or discarded
• Thawed at room temperature and used
immediately
MILK
Reheating EBM
• Frozen milk should never be thawed or heated in
a microwave
• Some prefer to warm the milk to body
temperature
• Never re-freeze breast milk
Breastfeeding
07
Problems
Sleepy/Non-
feeding Baby
BREASTFEEDING
PROBLEMS
Sleepy/Non-feeding Baby
CAUSES
BREASTFEEDING
PROBLEMS
• Drugs given to the mother in labor
• Unpleasant experience at the breast
• Frustration as a result of not obtaining
nourishment due to poor fixing
BREASTFEEDING
PROBLEMS
• Jaundice
• If lethargic when awake the baby may not
be receiving adequate nutrition
• Baby is ill
BREASTFEEDING
PROBLEMS
MANAGEMENT
BREASTFEEDING
PROBLEMS
• A breastfeeding history should be taken to
see if the reason can be identified.
• A breastfeed should be observed and

positioning and attachment improved.
BREASTFEEDING
PROBLEMS
• If necessary wake the baby and give additional
feeds (EBM or colostrum if possible) until the
situation has improved.
• If the baby is jaundiced encourage the baby to

feed as frequently as possible.
BREASTFEEDING
PROBLEMS
• Feed the baby when he or she is half
asleep.
• Encourage the baby to stay awake whilst

feeding by keeping the baby cooler during
feeds.
BREASTFEEDING
PROBLEMS
• Switch feed — thatSleepy/Non-feeding Baby
is change the baby
from one breast to the second as the baby
becomes sleepy.
• Change the baby’s position while feeding

to stimulate the baby to suckle more
vigorously.
BREASTFEEDING
PROBLEMS
• Encourage mother to adopt skin-to-skin
as much as possible — do not offer the
breast let the baby find it.
• Change nappy to wake the baby.

BREASTFEEDING
PROBLEMS
• Bath the baby.
• Sit in a warm bath to feed the

baby.
Sore/Cracked
Nipples
BREASTFEEDING
PROBLEMS
Sore/Cracked Nipples
CAUSE
BREASTFEEDING
PROBLEMS
• Poor positioning and attachment of
the baby at the breast.
• Engorgement, which may prevent

good attachment.
BREASTFEEDING
PROBLEMS
• Baby with a short tongue orSore/Cracked Nipples
tongue tie, a high palate or
a mismatch between the size of the mothers nipple and
the baby’s mouth.
• Pulling the baby off the breast without first breaking

the seal between the baby’s mouth and the mother’s
breast.
BREASTFEEDING
PROBLEMS
• Use of soap and scented bath products, antiseptic
sprays
• Thrush infections
• Expressing too vigorously with a breast pump

BREASTFEEDING
PROBLEMS
MANAGEMENT
BREASTFEEDING
PROBLEMS
• Observe a feed and assist the mother to
attain better positioning and attachment.
• Provide emotional support to the mother

BREASTFEEDING
PROBLEMS
Sore/Cracked
• If engorgement is present, expressNipples
a small
amount of milk to soften the area immediately
behind the nipple area.
• If the baby has a short tongue, or tongue-tie an

exaggerated fix may help.
BREASTFEEDING
PROBLEMS
• Alter the position of the baby at different
feeds.
• If the nipple is cracked, correct positioning

usually enables the mother to feed without
severe pain.
Inverted Nipples
BREASTFEEDING
PROBLEMS
Inverted Nipples
MANAGEMENT
BREASTFEEDING
PROBLEMS
Inverted Nipples
• The mother should be reassured that the
baby breast feeds not nipple feeds.
• Skilled help with attachment is important

for these women in the first few days
postpartum.
BREASTFEEDING
PROBLEMS
Inverted
• Expressing a small amount of milk Nipples
to soften the area
around the areola can sometimes be helpful.
• Lactation can be initiated and sustained with a breast

pump and further attempts made at attaching made when
the milk has ‘come in’ and the breasts are softer.
BREASTFEEDING
PROBLEMS
• Dummies and nipple shields shouldNipples
Inverted be
avoided as they require a different action
and may confuse the baby.
• Mothers with inverted nipples can be as

successful breastfeeding as mothers with
protractile nipples.
Engorgement
BREASTFEEDING
PROBLEMS
Engorgement
There are two types of engorgement:

• Milk arrival engorgement
• Secondary engorgement
BREASTFEEDING
PROBLEMS
Engorgement
MILK ARRIVAL ENGORGEMENT
 2nd–4th days postnatal as the milk ‘comes in’
 Caused by increased blood supply to the breasts and
extra lymph fluid
 S/sx: Red, painful, swollen breasts; mild pyrexia and flu-
like symptoms
 May result in mastitis
BREASTFEEDING
PROBLEMS
Engorgement
SECONDARY ENGORGEMENT
Same s/sx but occurs at any time
D/t ineffective drainage of the breasts
BREASTFEEDING
PROBLEMS
Engorgement
MANAGEMENT
BREASTFEEDING
PROBLEMS
Engorgement
• Warm flannels can be used to aid the
milk flow
• Expressing a small amount of milk

will also help to get the milk flowing
BREASTFEEDING
PROBLEMS
Engorgement
• Improve positioning and
attachment
• Encourage the baby to feed

frequently
BREASTFEEDING
PROBLEMS
Engorgement
• Analgesia may be required (paracetamol is
usually the drug of choice).
• Reassure the mother that it is a temporary

situation.
Blocked Duct/s
BREASTFEEDING
PROBLEMS
Blocked Duct/s
 Generally feel well but will present with a
localized tender lump or a feeling of bruising
 Usually occurs in one breast and can occur at
any time during the breastfeeding period
 Temperature not usually raised
BREASTFEEDING
PROBLEMS
Blocked Duct/s
MANAGEMENT
BREASTFEEDING
PROBLEMS
Blocked Duct/s
• Ensure effective positioning and
attachment.
• Feed from the affected side first for the

next two feeds, then alternate.
BREASTFEEDING
PROBLEMS
Blocked Duct/s
• Ensure the baby feeds frequently.
• Use warm flannels, the shower or bath

to bathe in warm water
BREASTFEEDING
PROBLEMS
Blocked Duct/s
• Massage the lump gently towards the
nipple during a feed, after a feed or while in
the bath.
• Remove any white spot from the nipple.

BREASTFEEDING
PROBLEMS
• Use alternate positions. Blocked Duct/s
• Feed the baby with its chin on the

same side as the affected duct.
• Avoid bras that dig into the breast.

Mastitis
BREASTFEEDING
PROBLEMS
Mastitis
SIGNS AND
SYMPTOMS
BREASTFEEDING
PROBLEMS
Mastitis
• Red, swollen, usually painful area on the breast
(outer, upper area)
• Lumpy breast that feels hot to touch
• Whole breast may ache and become red
• Flu-like symptoms which arise very quickly
and rapidly get worse
BREASTFEEDING
PROBLEMS
Mastitis
PREVENTION OF
NON-INFECTIVE
MASTITIS
BREASTFEEDING
PROBLEMS
Mastitis
The condition is often a consequence of
engorgement and the following simple
measures can help to avoid or reduce
the risk of mastitis:
BREASTFEEDING
PROBLEMS
Mastitis
• Ensure correct positioning and attachment
• Avoid suddenly going longer between

feeds — reduce gradually if possible
BREASTFEEDING
PROBLEMS
Mastitis
• Avoid pressure on the breasts by either
clothing or the fingers
• Commence self-help measures as soon as

symptoms occur.
BREASTFEEDING
PROBLEMS
Mastitis
SELF-HELP
MEASURES
BREASTFEEDING
PROBLEMS
Mastitis
These measures will help to relieve

engorgement and blocked ducts as
well as mastitis:
BREASTFEEDING
PROBLEMS
Mastitis
• Breastfeeding must be continued if

possible, it is the most effective way to
reduce the symptoms
BREASTFEEDING
PROBLEMS
Mastitis
• Reassure the mother that her milk will
not harm the baby
• Ensure correct positioning and

attachment
BREASTFEEDING
PROBLEMS
Mastitis
• Increase the frequency of feeds and if the breasts
are uncomfortably full express between feeds
• Ensure adequate drainage of the breasts and

express gently following feeds until resolved
BREASTFEEDING
PROBLEMS
Mastitis
• Feed from the affected breast first
• Try using different positions for

feeding
BREASTFEEDING
PROBLEMS
Mastitis
• Prior to feeding, apply warmth to the breast and
gently express to soften the breast enabling the baby
to attach more effectively
• If necessary, express breast milk by hand or pump

until breastfeeding can be resumed
BREASTFEEDING
PROBLEMS
Mastitis
• Gently massage the breast towards the nipple to
help the milk flow while feeding
• Check positioning of the fingers when feeding

and check to see if clothing is restrictive
BREASTFEEDING
PROBLEMS
• Rest Mastitis
• Plenty of fluids
• An anti-inflammatory agent may help,

e.g. ibuprofen.
BREASTFEEDING
PROBLEMS
Mastitis
INFECTIVE
MASTITIS
BREASTFEEDING
PROBLEMS
Mastitis
Bacterial infections result from organisms
breaching the preventative barrier of the skin
and multiplying in spite of the body’s
defense system.
BREASTFEEDING
PROBLEMS
Mastitis
The epithelium of the breast and nipple
may be damaged by:
• Incorrect positioning and attachment
• Sensitivity to creams, lotions, and sprays.
BREASTFEEDING
PROBLEMS
Mastitis
TREATMENT OF INFECTIVE MASTITIS
• Self-help measures should be initiated
• Systemic antibiotics compatible with breastfeeding
• Beneficial bacteria killed by the antibiotics can be
restored by taking live yogurt
Breast Abscess
BREASTFEEDING
PROBLEMS
Breast Abscess
 Rare but serious medical condition
 S/sx: pyrexia, severe flu-like symptoms,
affected area very painful and swollen
 Presents as a localized breast infection with the
presence of pus
BREASTFEEDING
PROBLEMS
Breast Abscess
 Pus is not considered harmful to the baby
but if blood is also present, the baby may
vomit
 Often results from unresolved mastitis.
BREASTFEEDING
PROBLEMS
Breast Abscess
MANAGEMENT
BREASTFEEDING
PROBLEMS
Breast Abscess
• Refer immediately to a doctor, who
will prescribe antibiotics.
• Aspiration of the abscess or surgical

drainage may be required.
BREASTFEEDING
PROBLEMS
• The mother should continue to feedBreast
on theAbscess
unaffected
breast.
• It is preferable for the mother to continue breastfeeding

on the affected breast; pump and dump
• The mother may need to boost the milk supply on the

affected side once the infection has cleared.
Insufficient Milk
Supply
BREASTFEEDING
PROBLEMS
Insufficient Milk Supply
One of the most commonly quoted

reasons for women discontinuing
breastfeeding
BREASTFEEDING
PROBLEMS
MANAGEMENT
BREASTFEEDING
PROBLEMS
• Reassure the mother Insufficient
that this canMilk
usually be
Supply
dealt with because actual insufficient milk is
extremely rare.
• A breast feed should be observed and the

positioning and attachment improved as
necessary.
BREASTFEEDING
PROBLEMS
• There should be no time limit on the
frequency or duration of feeding.
• The baby should drain one breast before

being offered the second.
BREASTFEEDING
PROBLEMS
• Different feeding positions may be suggested, as
this will assist drainage of all areas of the breast.
• Women should be encouraged and supported to

continue breastfeeding. Supplementary feeds
should not be suggested.
Candida
Infection
BREASTFEEDING
PROBLEMS
Candida Infection
SIGNS AND
SYMPTOMS
BREASTFEEDING
PROBLEMS
Candida Infection
MOTHER
• Hypersensitive or itchy nipples even when
wearing loose clothing.
• Pink and shiny nipples and areola.

BREASTFEEDING
PROBLEMS
Candida Infection
• Shooting pains deep in the breast after
feeding which may continue for up to an
hour.
• Cracked nipples that will not heal.

BREASTFEEDING
PROBLEMS
Candida Infection
• Loss of color in the nipple or areola.
• Pain in both breasts.

BREASTFEEDING
PROBLEMS
BABY Candida Infection
• Creamy white spots in the mouth which do not
rub off
• Baby keeps pulling away from the breast, which
may be a result of a sore mouth
• A windy unsettled baby
• Nappy rash.
BREASTFEEDING
PROBLEMS
Candida Infection
MANAGEMENT
BREASTFEEDING
PROBLEMS
Candida Infection
• Ensure correct positioning and
attachment.
• Continue breastfeeding.
BREASTFEEDING
PROBLEMS
Candida Infection
• Refer to the GP for treatment.
• Both the mother and baby need to be

treated simultaneously to prevent reinfection
even if only one shows signs of infection.
BREASTFEEDING
PROBLEMS
Candida Infection
• Surface infection on the nipple is treated by
application of an antifungal cream (usually
miconazole) is prescribed.
• Oral treatment is required for infected milk ducts

(usually nystatin or fluconazole is prescribed).
BREASTFEEDING
PROBLEMS
Candida Infection
• Babies are usually prescribed nystatin

drops.
BREASTFEEDING
PROBLEMS
• Strict hygiene should beCandida Infection
observed —
washing of hands and use of separate towels
for each member of the family.
• Any EBM collected during the infected

period is best discarded to prevent
reinfection.
BREASTFEEDING
PROBLEMS
Candida Infection
• Acidophilus capsules may help restore the
normal, healthy bacterial flora which helps
prevent thrush infections.
• Painkillers may help the mother to cope

with the pain.
Lactation
and 08
Nutrition
Foods to Avoid
While
Breastfeeding
LACTATION AND NUTRITION
Foods to Avoid
OILY FISH
Can be included in the diet but no
more than two servings a week
Foods to Avoid
LARGE FISH
> Shark, swordfish, and marlin should
be avoided all together as they contain
large amounts of mercury
Foods to Avoid
ALCOHOL
 Passes into the blood stream and levels
peak at 30–90min after consumption
 Daily consumption should not exceed 1
unit/day
Foods to Avoid
PEANUTS
 Avoid eating peanuts if they, the infant’s
father or siblings suffer from allergic
conditions such as hay fever, asthma, or
eczema.
Foods to Avoid
CAFFEINE
 Tea, coffee, cola, energy drinks, and
chocolate should be limited as it can make
some babies restless
 May cause breast pain in some women
Laws
of 09
Breastfeeding
LAWS OF BREASTFEEDING
1. Executive Order 51 (Milk Code)

 Prohibition of formula milk
2. Republic Act 7600 (Breastfeeding and

Rooming-In Act of 1992)
 Prohibits bottle feeding
 Mother and child friendly
 Provides rooming-in in each hospital
Milk
Ejection 10
Reflex
MILK EJECTION REFLEX
Prolactin
PROLACTIN REFLEX
1. Nerve impulses from sucking go to brain
2. The pituitary gland releases prolactin into the
blood
3. Alveolar cells secrete milk and swells the
alveoli
MILK EJECTION REFLEX
Oxytocin
MILK EJECTION/OXYTOCIN REFLEX
1. Nerve impulses from sucking go to brain
2. The pituitary gland releases oxytocin into the
bloodstream
3. Muscles around alveoli in the breast contract
and squeeze the milk to the nipple
Schedule
of 11
Feeding
SCHEDULE OF FEEDING
0-6 months - breastmilk

6-12 mos - BM + Baby food
12mos-2yo - BM + Table food
2yo and above - table food
SCHEDULE OF FEEDING
Order of Solid Food Introduction
1. Rice Cereals
2. Vegetables
3. Fruits
4. Egg Yolk
5. Meat
6. Whole Egg
7. Fish and seafoods
8. Sweeteners, canned foods
THANK
YOU
FOR
LISTENING!
DO YOU
HAVE ANY
QUESTIONS?
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Infant Care and Feeding PPT 2021 Part 3

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INFANT

DIANNE GAY LEAÑO

Top 17 November 2017

●Oxford Handbook of Midwifery

●Pediatric Lecture Presentation

Contraindications for Lactation and Nutrition

• Produced in the first 3 days after delivery

• Volume: 2–10mL daily

• Easily digested and absorbed

• Energy content: 58kcal/100mL

• Contains higher levels of protein and vitamins A

• Contains lower levels of sugar and fat than mature

• Presence of lacto bifidus factor

• Stimulates the passage of meconium

• Fat: Most variable constituent

• Minerals and trace elements:

• Lactoferrin: reduces iron availability

• The baby’s head and body should

• The mother should hold the

• The baby should face the breast

• The position should be sustainable

The following should be

• Holding the back of the baby’s

• Holding the breast away from

• Holding the baby in a bottle-

• Taking the breast down to the baby

• The chin should indent the breast.

• The nose should be close to the breast but

• The cheeks are round and full.

• The whole of the lower jaw moves.

• Swallowing may be heard but this only

• Frequent feeds, including night feeds,

• There is a soporific effect on the

• The male partner has a strong

• Women need to talk to their partners antenatally

• Partners need to be informed of the

• Partners should be involved in

• Partners are invaluable in providing

• Family and friends exert a strong

• About one in four mothers are helped

• First-time mothers are more likely to

• Breastfeeding mothers whose friends

• Usually gentler than using a pump

• Requires skill, and some mothers find

• Risk of cross-infection is reduced with

• Useful as a self-help method if

• Gently press her thumb and

• Sometimes it is helpful to press

• Express frequently, 6–8 times in 24h, more if

• Avoid set patterns of expressing, instead aim

• A breastfeed should be observed and

• If the baby is jaundiced encourage the baby to

• Encourage the baby to stay awake whilst

• Change the baby’s position while feeding

• Change nappy to wake the baby.

• Sit in a warm bath to feed the

• Engorgement, which may prevent

• Pulling the baby off the breast without first breaking

• Expressing too vigorously with a breast pump

• Provide emotional support to the mother

• If the baby has a short tongue, or tongue-tie an

• If the nipple is cracked, correct positioning