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:
Mother looks healthy Mother looks ill or depressed
Mother relaxed and comfortable Mother looks tense and uncomfortable
Signs of bonding between mother & baby No mother/baby eye contact
Baby: Baby:
Baby looks healthy Baby looks sleepy or ill
Baby calm and relaxed Baby is restless or crying
Baby reaches or roots for breast if hungry Baby does not reach or root
BREASTS
Breasts look healthy Breasts look red, swollen, or sore
No pain or discomfort Breast or nipple painful
Breast well supported with fingers away from nipple Breast held with fingers on areola
BABY’S POSITION
Baby’s head and body in line Baby’s neck and head twisted to feed
Baby held close to mother’s body Baby not held close
Baby’s whole body supported Baby supported by head and neck only
Baby approaches breast, nose to nipple Baby approaches breast, lower lip/chin to
nipple
BABY’S ATTACHMENT
More areola seen above baby’s top lip More areola seen below bottom lip
Baby’s mouth open wide Baby’s mouth not open wide
Lower lip turned outwards Lips pointing forward or turned in
Baby’s chin touches breast Baby’s chin not touching breast
SUCKLING
Slow, deep sucks with pauses Rapid shallow sucks
Cheeks round when suckling Cheeks pulled in when suckling
Baby releases breast when finished Mother takes baby off the breast
Mother notices signs of oxytocin reflex 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
