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Professor Hassan Bella
College of Medicine King Faisal University

Basic Questions
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What is the best time for the first feed ? Within 1st half hour after birth What is the best duration for a feed ? 5 to 10 minutes How frequent should a baby be breastfed ? On demand What is the desirable duration of breastfeeding ? 2+ years What should the breastfeeding mother do if her child has diarrhea? Continue to breastfeed

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What should the breastfeeding mother do if she gets pregnant? Continue to breastfeed In what way will breastfeeding affect the mother body & breasts? Improves body & breast What about the use of pacifiers? Not desirable Have you heard of the BFHI? Baby Friendly Hospital Initiative Have you heard of the International Code for Marketing Mother’s Milk Substitutes ? ُEthical code of marketing artificial milks

 Plays

important role in health problems of mothers & children  Morbidity & mortality lower in exclusively breastfed infants  Susceptibility to infection & severity of illness less in breastfed babies

Trends of Breastfeeding in Developing Countries
 Steep

decline in BF  More decline in larger towns & cities  Decline has reached rural areas

Causes of Breastfeeding Decline in KSA
 Increasing

urbanization  Mother’s work  Negative attitude towards breastfeeding
– Fear of limitation of activities – Fear of failure – Cosmetic reasons

Causes of Breastfeeding Decline in KSA
 Aggressive

marketing & advertising of

formula  Negative influence of health care personnel  Hospital practices

Advantages of Breastfeeding
 Complete

nutrition - composition varies with needs  Easily digested due to contents  Anti-infective properties:
– Anti-viral factors – Polymorphs, lymphocytes, lysozymes – Antibodies – IgA (diarrhea & respiratory)

 Acidity

stools acidic against gram –ve bacteria colon

Advantages of Breastfeeding
 Less

risk of allergy  Mother – infant bonding -intimacy  Sterile  Cheap & economical

Mature Breast milk consists of:
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Proteins & aa for optimal physical & neurol develop. Fat – 90% absorbed by baby (Cow 6065%) unsaturated CHO – Principal CHO lactose (1.5 times cow’s) Minerals - K, Ca, P, Cl, & Na Vitamins - Enough for infant during 3 – 6/12

Volume of Milk Produced
– 1st week 450 ml/day  600 – 700

ml/day during 1st year – Caloric value of human milk 70 cal/100 ml – Healthy baby requires 150 ml/kg – 1st. 6/12 – Healthy baby needs around 120 cal/kg by 1 yr

Types of Feeding
Test Feeding
 when

baby is hungry after a feed or looses wt, test feeding is done to check if baby receives sufficient milk  by weighing at beginning & end of feed  difference is the amount suckled

Types of Feeding
Test Feeding

this at every feed for 24 hrs.  average amount per feed is measured If feed is deficient put baby more frequently to stimulate lactation

Types of Feeding
Demand Feeding

child whenever hungry Powerful stimulus to lactation Promotes steady weight gain

Types of Feeding Scheduled Feeding

hrs) Small & weak infant prefers 2 to 3 hrs intervals Not recommended  insufficient milk syndrome  failure of lactation

fed at fixed time intervals (3 to 5

Contraindications to Breastfeeding Very few absolute contraindications  All mothers are capable of breastfeeding successfully

Temporary contraindications
 Acute

mother illness eg Septicemia, Nephritis  Eclampsia , Profuse hemorrhage, Active TB  Ca breast --- Severe prot. Malnutrition --severe neurosis --- Severely cracked nipple ---Mother on radioactive anti-thyroid treatment or cytotoxic drugs

How to Promote Breast Feeding
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Education of high school girls about BF importance ANC education of mothers about breast & nipple care Medical staff should set example for mothers in BF Legislation to support working mothers to breastfeed Legislation against advertising breast milk substitutes

How to Promote Breast Feeding
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Encourage BF during early PNC & 2nd. Year Adoption of feed – on –demand policy Baby to be put to breast as soon as possible after delivery Rooming – in should be encouraged Giving of colostrum should be encouraged Appropriate contraceptives should be used

Baby Friendly Hospital Initiative (BFHI)
– Launched by WHO & UNICEF in

1991 – To encourage BF in maternity facilities – Easier to convince newly delivered mothers of BF benefits – A joint WHO/ UNICEF statement – 10 steps to successful breastfeeding

10 Steps To Successful Breastfeeding
Every facility providing maternity service & care for newborn infants should:
 Have

written BF policy  communicated to staff  Train staff in skills to implement policy  Inform all pregnant women on BF benefits  Initiate BF within half hour after delivery  Show mother how to breastfeed & how to maintain lactation during temporary separation

10 Steps To Successful Breastfeeding
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Give newborn no food or drink other than breast milk Practice rooming - in Encourage breastfeeding – on – demand Give no artificial teats or pacifiers to infants Establish BF support groups for referral

 Process

of getting baby used to eating foods other than breast milk using the cup & spoon  Weaning period starts from time of introducing foods other than breast milk to breast milk & ends with complete withdrawal of breast  Most critical in child life  Most malnutrition start during this period

When to start weaning & how to practice it?  BF alone adequate for the first 4 months  New food should be introduced at 4 – 6 months  Too early solid food  too fat baby  Too late solid food  chewing problem  Once introduced solid foods should be given regularly

When to start weaning & how to practice it?  One type of food should be given at a time, initial refusal accepted  Home prepared weaning foods are better  Use cup & spoon for feeding  Avoid communal dish for children  Child should be given at least 100 – 150 ml of water or diluted fluids per day

When to start weaning & how to practice it?  Give 3 – 5 feeds/ day & more for ill child or child with poor wt. Gain  Avoid high protein cereals. Start by one containing rice  Sugar should not be added  Use fresh boiled vegetables, stewed or mashed fruits  Look up details for what should be given at each age

Dangers of Weaning Period Malnutrition  Infection  Weanling diarrhea

Improving Weaning Practices
 Health

staff should popularize home weaning foods through education, demonstration & material support  Educate mothers on good weaning practices  There is need for studying nutritional values of local foods