BREASTFEEDING

 SUPPLEMENTARY / ARTIFICIAL FEEDING

 IMS ACT
 BABY FRIENDLY HOSPITAL INITIATIVE

MAVEFA ANDRADE
KIRAN GAUDE
MUSTAFA AHMED
SATYAM NAIK
 OBJECTIVES
 FREQUENCY

INTRODUCTION TO
OFBREASTFEEDING
BREASTFEEDING
 DEFINITION OF  SIGN OF GOOD
EXCLUSIVE BREAST ATTATCHMENT
FEEDING  INDICATORS OF ADEQUATE
 ADVANTAGES OF BREAST BREASTFEEDING
FEEDING
 ANATOMY AND  PROBLEMS IN BREAST
PHYSIOLOGY FEEDING
 TYPES AND COMPOSITION  CONTRAINDICATIONS FOR
 NUTRITIVE VALUES BREASTFEEDING
 POSITIONS OF BREAST
FEEDING
CONT..

 NUTRITION TO
BREASTFEEDING MOTHER
 IMS Act
 BABY FRIENDLY HOSPITAL
INITIATIVE
 ARTIFICIAL FEEDING
 METHODS OF FEEDING
TECHIQUES
 EXPRESSION OF BREAST
MILK
 WHAT IS BREASTFEEDING ?

Breastfeeding is a feeding of an infant or young child with breast

milk directly from the female breast that is via lactation which is
rich in protein ,sugar, vitamins, and minerals + numerous bioactive
components such as hormones , growth factors , enzymes and live
cells to support the baby’s healthy growth and development.
 What is exclusive Breast feeding ?
 Exclusive breast feeding is defined as no other food or
drink ,not even water ,except breast milk for 6 months of
life but allows the infant to receive ORS drops and syrup
(vitamin ,mineral and medicine)
What are the Advantages ?
BENIFITS TO BABY
1. NUTRITIVE VALUE
 contains all the nutrients for the growth and development of the baby
 Development of brain
 facilitates absorption of calcium which helps in bone growth
 contains vitamin and minerals , water and electrolyte

2. DIGESTIBILITY
 Easily digestible
 Lipase in breast milk help in digestion of fats and
 provide free fatty acid
PROTECTIVE VALUE
 Immunoglobulin such as Ig A and Ig M
 Protein against various bacterial infection
 Allergic reaction such a colic , asthma and food allergy
 Reduce incidence of cough bronchitis , pneumonia , meningitis and
diarrhoea
MATERNAL BEFIFITS
 Rapid uterine involution
 Less bleeding in postpartum period
 Reduces incidence of ovarian and premenopausal breast cancer
 Improves metabolic efficiency
 Sense of fulfilment
 Promotes physical and emotional bond between mother and
baby
BENEFITS TO FAMILY AND SOCIETY
 Economical
 Healthier
ANATOMY OF THE BREAST
PHYSIOLOGY
lactogenesis is a complex phenomena involving many hormones and
reflexes .two hormones are most important oxytosin and prolactin

PROLACTIN REFLEX ; OXYTOSIN REFLEX :

Milk secretion reflex Milk ejection reflex
TYPES OF MILK
TYPES OF MILK
 COLOSTRUM :
 initial 3-4 days after delivery
 Small in quantity
 Yellow and thick
 Immunoglobin ig A and ig M
 Vitamin A, D, E and K

Benefits
 Boosts immunity
 Prevent allergies and infection
 Reduces inflammation
 Strengthens gut
 Enhances metabolism
TRANSITION MILK:
 Secreted after 3-4 days until 2 weeks
 Small in quantity
 immunoglobin ig G level increases.
 Protein content decreases while sugar and fat
content increases.
MATURE MILK :
 Fallows transition milk
 Thinner and watery
 All essential nutrients for optimal growth
PRETERM MILK
 Before 37 weeks.
 contains proteins, sodium ,iron, immunoglobulins and calories
asper requirement.
FORE MILK:
 Secreted at the start of the feed
 Watery
 Rich in proteins ,sugar ,vitamin ,minerals and
water to quenches thirst.
HIND MILK:
 Comes towards the end of feed .
 Richer in fat
 Sense of satiety
 Composition varies during phase of feeding .
 Optimum growth .
 NUTRITIVE VALUE OF BREASTMILK

 All nutrients in right proportion

for growth and development ( up
to 6 months)
 Facilitates absorption of
calcium( bony growth)
 High percentage of lactulose and
galactose ( brain growth)
 Contains amino acids like taurine
and cystine ( neurotransmitters)
CONT…

 Vitamins , minerals ,electrolytes and

water (maturation of intestinal tract)
 Breast milk fats are polysaturated fatty
acids (myelination of nervous system)
BREASTFEEDING POSITIONS
CRADLE HOLD CROSS CRADLE HOLD
 BACK LYING POSITION FOOTBALL HOLD
(CLUTCH)
SIDE LYING POSITION AUSTRALIAN
HOLD
Position of baby

 Baby should be wrapped properly

in a cloth
 Whole body should be supported
not only neck or shoulder
 Head and body alignment in one
line without any twist in neck
 Baby`s body turned towards
mother(abdomen of baby and
mother touching each other)
 Baby`s nose at the level of nipple
 LATCHING
ATTACHMENT STEPS
 Check your latching position
 Encourage baby to open mouth
 Bring baby to the breast
 Keep baby close during latch on
 Look and listen ( gulping sound)
DETECHMENT STEPS
 In case of chomping or painful
latching
 Ease your clean finger gently
inside the corner of baby`s
mouth to break suction
 SIGNS OF GOOD ATTACHMENT
 The baby`s mouth is wide open
 Most of the nipple and areola in
the mouth, only upper areola
visible, not the lower one.
 The baby`s chin touches the breast
 The baby`s lower lip is everted
EFFECTIVE SUCKING
 Baby suckles slowly and pause in
between, to swallow.
SUCK ,SUCK,SUCK…….AND
SWALLOW
 One may see throat cartage and muscle
moving and hear the gulping sounds of
the milk being swallow.
 Baby`s cheeks are full and not hollow
or retracting during sucking.
 FREQUENCY OF BREAST FEEDING
 Initially 30 minutes after delivery or on self demand
 Usually when baby is hungry till baby satisfy
 Duration depend on vigour of baby and let down reflex
 Continued exclusively for 6 months
 Only breast milk till 6 months
 Complementary feed can be started after 6 month
 Breast feed should be continued till 2 years of age
CONT..
INDICATORS OF ADEQUATE BREAST FEEDING

 The nipples and breast do not hurt while breastfeeding

 let down sensation in mothers breast
 The baby swallowing sounds can be heard
 Baby feeds from one breast until he released the nipple . After a
break the other breast should be offered
 Breast are soften after breast feeding
CONT..

 Baby passing clear dilute urine 6-8 times a day

 Baby passing stools 3-5 times a day
 Baby passing out bright yellow watery stools
 Baby will go up in weight ,will return to his birth weight
within 2 weeks
 baby sleeps well and does not cry frequently
 PROBLEMS IN BREASTFEEDING
INVERTED NIPPLES/ flat
nipples
 Flat nipples comes out easily
 Inverted nipple seems inside
 Difficulty in latching

Treatment
 Can be treated manually
 Stretch and rolled out several
times a day
 A plastic syringe is used to draw
SORE NIPPLE
 incorrect attachment
 Vigorous bites
 Frequent washing with soap
 Pulling the baby off the breast
 Local candidiasis
CONT..

Treatment
 Correct positioning and latching
 Application of hind milk between feed
 Cleaning breast only once ( bathing time )
BREAST ENGORGMENT
 If feeding is delayed or
infrequent
 improper attachment

Signs
 Swollen ,hard ,warm , and
painful
CONT..

Treatment
 Local warm water packs
 Breast massage
 Analgesics to relieve pain
 Expression of milk
 BREAST ABSCESS
 Congested engorged breast ,
cracked nipple ,blocked duct ,
or mastitis

Symptoms
 High grade fever
 Raised blood count
CONT..

Treatment
 Analgesics
 Antibiotic
 Incision
 Drainage
CONT…
NOT ENOUGH MILK
 Defect in physiology
 Problem in skills
 Other conditions ( any illness,
engorgement , insufficient sleep)
Treatment
 Hydration
 correct underlying reason
 Back massage ,frequent
stimulation , position and
balanced diet.
 CONTRAINDICATIONS

 ABSULUTE
 chemotherapeutic agents
 Radiotherapy
 Galactosemia
 lactose intolerance (congenitaL
CONT….
 RELATIVE
 NEITHER BR NOR EXPRESSED
 Active Herpes simplex virus
 HIV
 SHOULD NOT BF BUT CAN FEED EXPRESSED
MILK
 Active tuberculosis
 active varicella
 Breast Abscess
 NUTRITION FOR BREAST FEEDING MOTHER

GET HYDRATED
 Breast feeding every 2-4 hours can be
dehydrating
 Drink at least 8-10 glasses of water
per day
 Fluids also helps to keep up milk
production
 Consume milk fluid juices and soups
 IRON

 Fulfils additional demands in

breast milk
 Iron rich foods includes pulses,
legumes, garden cress seeds,
green leafy vegetables,
watermelon, egg, red meat, dates
CALCIUM AND VITAMIN D
 Natural development of bones of
growing infant
 Best source is milk and milk
products such as yogurt ,cheese,
paneer, green leafy vegetables, ragi
 For vitamin D , Include fatty fish
like tuna, salmon and mackerel,
egg yolk
 Exposure to morning sunlight will
also help to meet vitamin D
requirements
Eat at least 3 nutritious meals a day and do not
skip breakfast

 Mothers can get hungry easily while

breast feeding because breast feeding
uses up calories,
 Thus mother should have 3 regular
meals and 2-3 light snacks every day
as a part of their lactation diet
 Do not skip meals ,particularly
breakfast
 Limit sugars and fats

 Cut down high sugar and high fat

foods
 Like potato chips , chocolates,
cakes and soft drinks
 These foods are full of “ empty “
calories and have little nutritional
value
 Avoid alcohol and smoking

 Alcohol passes quickly into breast

milk and can affect baby
 Avoid smoking and tobacco use
 Avoid dieting

 Dieting during breast feeding may

reduce quality and quantity of breast
milk
 To lose pregnancy weight avoid sugar
and fats
 Moderate exercise and brisk walking
can help
 USE OF GALACTOGOGUES
In India, herbs such as methi seeds , jeera ,
such as goand laddu ( edible gum)
Methi laddu, almond halwa, dried ginger and
recipes using dried bajra and green leafy
vegetables are recommended for increasing
breast milk production and improve lactation
MEAL TIME WHAT TO EAT
Early morning 8 am 1 cup tea (1 tsp sugar ) + 7-8 soaked almond and 4-5 dates

Breakfast 9am 1 glass ( 200ml ) skimmed milk + ½ cup badam sheera + 1 fruit or 3
small methi or palak paratha + half cup curd or raita or 3 slices of whole
wheat bread and 2 eggs + 1 fruit or 1 cup poha or upma + 1 fruit

Mid morning 11am 1 fruit + 1 methi ladoo

lunch 1pm 1 cup salad + 2 rotis or 2 small bajra rotis

1 cup rice + 1 cup vegetables + 1 cup mung curry / dal or 1 cup salad + 2
rotis + 1 cup rice + 1 cup vegetables + 1 cup fish curry

evening 4pm 1 glass milk ( 200 ml) + 1 methi ladoo

Mid eve 6pm 1 cup tea ( 1 tsp sugar ) with sprout bhel or 1 cup vegetable upma
 IMS ACT
 IMS stands for infants milk substitutes feeding bottles and infants
food (regulation of production ,supply and distribution act ) 1992
and amendment act 2003
 IMS is India’s biggest commitment act in the interest of infants and
young children
 IMS act banns any kind of promotions of infants formula, feeding
bottles and infant food for 0-2 years of children
 NGO the breast feeding promotion network of India ( BPNI) has
been widely involved in successful in monitoring and raising
awareness o the IMS act
 Any violation of IMS act can lead to imprisonment
 IMS act 2003

What comes under this act ?

 Infant milk substitute

 Feeding bottles
 Infant foods
 OBJECTIVES KEY PROVISIONS

 Prohibit any kind of promotion

 Educate pregnant and lactating
women
 Restrict and control use of infant
milk substitute and infant food
 Define role and responsibility of
health care institutions and
health workers
 No advertisements and no free
samples
 No free subsides supply of
infant milk
 No poster anywhere
 No financial assistance of any
kind
 ROLE OF HEALTH CARE PROFESSIONAL

 Remove and destroy all the ads

 Refuse to accept the free samples
 Avoid using growth charts extra if
any name or brand on it
 Avoid sponsorship
 Don’t give free samples or
materials to mother.
 Alternative feed agreed criteria for use

 Mother is no more
 Mother is very ill
 Mother is HIV positive and choose
to use breast milk substitute
 Mother reject infant
 Infant depend on artificial feed
 BABY FRIENDLY HOSPITAL INITIATIVE

INTRODUCTION
 Baby friendly hospital initiative was
launched in 1992 in India as per a part
of innocent declaration of breast
feeding the
 BFHI was launched by WHO /UNICEF
 in mid 1991 in Ankara to boost the
breastfeeding practices and counter the
trends or bottle feed
 PURPOSE OF PROMOTING BABY FRIENDLY
HOSPITAL
 For optimum infant nutrition
 Support breast feeding
 Improve antenatal care
 Mother friendly delivery services
 Standardise institutional support of immunisation
 Diarrhoea management
 Promotion of healthy growth and good nutrition
 TEN STEPS TO SUCCESSFUL
BRESATFEEDING
 1a : comply fully with the
international code of marketing of
breast milk substitutes and relevant
world health assembly resolution
 1b :have a written infant feeding
policy that is routinely communicated
to staff and parents
 1c: establish ongoing monitoring and
data management system
 2; ensure that staff have sufficient
knowledge ,competence and skills
to support breastfeeding
 3 : discuss the importance and
management of breastfeeding with
pregnant women and their families
 4 : facilitate immediate and
uninterrupted skin to skin contact and
support mothers to initiate breast
feeding as soon as possible after
birth .
 5: support mother to initiate and
maintain breastfeeding and
manage common difficulties
 6: do not provide breast feed
newborn any food or fluids other
than breast milk, unless
medically indicated
 7: enables mothers and their
infants to remain together and to
practice rooming in 24 hours a
day
 8: support mothers to recognise
and respond to their infant cues
for feeding .
 9; counsel mother to use and risk
of feeding bottles ,teaks and
pacifiers
 10: coordinate discharge so that
parents and their infants have
timely assess to ongoing support
and care
 ARTIFICIAL FEEDING
 Artificial feeding means feeding a
child ither than breast milk .
 It involves the use of breast milk
substitute in the form of liquid milk
that is fresh cows or buffalos milk
or commercially available dried
whole milk it is given when their
alternative feeding criteria is met .
 FACTORS CONTRIBUTING TO RISING
INCIDENCE OF ARTIFICIAL FEEDING
 Lack of interest in breast feeding
 Wrong believes and ignorance related to breastfeeding
 Increasing number of working mothers
 Changing lifestyles
 Availability of alternatives of mothers milk
 Publicity and appealing advertisements
CONT..

 Death and absence of mother

 Prolonged maternal illness
 Complete failure of breast milk production
 Absolute contraindication of breast feeding
 Expressed breast milk is not available
PRINCIPLES
 Only after the failure of all efforts of breastfeeding
 Having information and knowing hazards
 Strict cleanliness
 Fed left should not be fed again
 Fed should be calculated as per body weight
 Correct techniques
 METHODS OF FEEEDING TECHNIQUES

FEEDING WITH CUP / SPOON/WATI

 Low birth weight babies who are able to swallow but cant suck
effectively

PROCEDURE STEPS
 Maintain hand hygiene
 Use clean articles
 Measure the feed
CONT..

 Position the baby comfortably

 Administer small amount of feed into the spoon and pour directly on
tongue
 If the paladai ( cup like utensil with narrow tip ) is used ,hold the
paladai so that the pointed tip stays slightly on the lnfant’s lower lip

 Tilt the paladai to pour small amount if feed into the

Infants mouth
CONT..

 Wait till the baby swallows the milk before the milk is
poured into the mouth again
 Wash and clean the articles by the warm water before
reuse
 After feeding the baby held in sitting position till burped
 The mouth should be wiped and dipper should be
changed if soiled
SPOON FEEDING WATI FEEDING
 BOTTLE FEEDING
 Bottle feeding generally refers to the use of bottles for feeding
PREDURE STEPS
 A bottle and its teak should be cleaned thoroughly from inside and
outside with brush and keep covered
 The formula should be prepared per requirement the baby should be
awake and hungry
 The milk is measured and warmed up
 Should be tested for temperature ,by sprinkling few drops of content in
inner aspect of the wrist
CONT..

 Prepared feed should be covered and kept ready

 If soiled the baby should be cleaned ,dried ,wrapped and comfortable
 Hand should be washed well
 The person feeding the baby shoukd be in comfortable position and hold
the baby’s head in her arm and the hand under the baby’s body
 If any medicine is prescribed it should be fed before the feeding
 If the baby is fed in the cradle and incubator the head end should be raised
and the baby should be turned on the right side .this position helps the food
pass easily
 CONT..

 The teat should touch the corner of the baby’s mouth and when the
baby open the mouth it should be inserted
 The bottle should be helps at an angle and care should be taken to
see that the teat should be completely filled with the food
 The baby should be burped during and after the feeding
 The baby can be held sitting in the lap slightly tilt forward
 After being fed and burped the baby should be laid on their right side
BOTTLE FEEDINNG
OROGASTRIC /NASOGASTRIC FEEDING
CONT..
 GAVAGE FEEDING

 Gavage feeding is an artificial method of giving fluids and nutrients

to children
 Low birth rate infants less than 1.2 kg or preterm baby should be
given , give gavage tube feeding after stabilisation with iv fluids
 On average about 16-17 cm of tube is needed to reach the stomach
from the gum margin.
 CONTINIOUS FEEDING
 Continuous feeding is administered hourly at the rate of enteral
nutrition administration using an electric enteral feeding pump /
syringe pump
 Continuous feeding regimen consists of total volume of feed
administered over 24 hours
 It is used to provide enteral nutrition to neonates with signs of
intolerance with intermittent /bolus feeds
 Respiratory compromised exacerbated by bolus feeds
 Persistent hypoglycaemia
INTERMITTENT FEEDING

Intermittent feeding is administered via an electric enteral

feeding pump or gravity drip
 The intermittent feeding regimen will consist of 6 bolus
feeds ( on bolus every 4 hours)
 EXPRESSION OF BREAST MILK

 When breast milk expression to be done ?

 To maintain milk secretion for preterm baby , low birth weight
infant or sick neonate who is unable to suck or cannot breast feed
for some reason .
 To relieve breast problem like breast engorgement
 To ensure exclusive breast feeding for the baby of working mother
 Expression of breast milk can be done by 2
methods
PUMPING
Pumping of milk involve two methods
1. Manual pumping
 maintain hand hygiene
 Make sure articles are clean and sterilized
 Make sure mother is comfortable and maintain privacy
 Start massaging the mothers breast for few minutes
 CONT..
 Place the breast shield or funnel over the nipples and
slowly start to pump
 Switch breast when milk start slowing down , swap back
again as you may find more milk to express
 One breast produces more milk than other is normal
 Once both breast are emptied , remove the breast shield
and put a lid on the bottle
 Keep in refrigerator for no more than 6 hours
 Wash the sterilize the pump and parts
MANUAL PUMP
ELECTRIC BREAST PUMP
Advantages over manual
pumping
 Time efficient
 Reduces efforts
 MANUAL EXPRESSION OF MILK

There are four steps of manual

expression of breast milk
1: Massage the breasts gently
and the nipple
 2 : place the thumb and index finger
opposite each other just outside the
dark circle around the nipple
 3: press back towards the
chest then gently squeeze
to release milk
 4; repeat step 3 in different
positions around the areola
 REFERENCES :
 Parul Dutta,(2018), Paediatric nursing textbook( ed' 4th) Jaypee Brothers
Medical Publisher ( P) Ltd ( pg. no. 47 to 54)
 GHAI ,O.P.(2010).Essential Paediatrics (9th edition ). Cbs Publishers And
Distributors Pvt . Ltd (pg.no 145 to 158)
 Hockenberry, M.J.( 2009). Wong’s Essentials of Paediatric Nursing (8th edition)
PP (pg no.112 to 265)
 Nutrition during breastfeeding retrieved from
https://healthengine.com.au/info/nutrition-during-breastfeeding
 Definition of exclusive breastfeeding retrieved from
 https://www.who.int/nutrition/topics/infantfeeding_recommendation/en/
THANK YOU