BREASTFEEDING

Facilitators: Prof Irimu

Prof Onyango
Dr. Osano

By:
Mercy Gakii
Velma Getuno
Hillary Edalia

OUTLINE
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Anatomy of the breast

Breast milk production and let down reflexes.
Factors that hinder these reflexes and what can be done to remove
them.
Correct attachment (latching) of the baby to the breast.
Correct positioning of the baby during suckling.
Composition of colostrum and mature breast milk.
Fore milk and Hind milk.
Advantages and disadvantages of breastfeeding.
Advantages and disadvantages of replacement feeding AFASS
Breastfeeding and common causes for Childhood Morbidity and
Mortality.
The ten steps to successful breastfeeding.

Anatomy of the Breast.

Milk Production and Let Down Reflex.

Factors hindering reflexes.

Negative

emotional stimuli- frustration, anxiety,

anger.
Painful nipples
Drugs: Oestrogens and High doses of sedatives.
Alcohol intake
Infrequent emptying of the breast leading to breast
engorgement.
Poor positioning of the mother and baby.

Solutions to the hindrances.

1. During pregnancy:
Establish positive attitude from mother and family
especially spouse.
Reassure about the incorrect perceptions about
breastfeeding.
Educate mother about the advantages of
breastfeeding.
Educate the mother on the correct breastfeeding
position.

2. On delivery:
Ensure early initiation of breastfeeding and
encourage mother to feed baby on demand.
Encourage mother to rest adequately and provide
analgesia if in pain.
If breasts engorged, encourage warm compresses
before feed and cold compresses after.

Correct Attachment (Latching)of the baby to the Breast.

Chin

touching breast.
Mouth wide open.
Lower lip turned
outward
More areola seen
above baby mouth than
below.

Correct Positioning of the baby during suckling.

Mother

relaxed and comfortable.

Mother should sit straight and be
well-supported.
Trunk facing forward and lap flat.
Babys head should be slightly
tilted back and ear, shoulder and
hip aligned.
Babys entire body turned toward
mother.
Tummy to tummy .
Babys entire body supported
from head to heel.

Composition of colostrum and mature breast milk.

Per 1L of milk.

Fore milk and Hind milk.

Fore milk
Thinner
Lower fat content
Higher lactose, vitamins
and protein content

Hind Milk:

Thicker
Higher

fat content
Lower lactose content

Advantages of Breastfeeding I
To
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the baby:
Protection from acquiring infections and reduced severity of acute
and chronic- diarrhea, respiratory illnesses, SIDS, necrotizing
enterocolitis, allergy..
Adequate source of energy and nutrients especially before 6
months.
Bonding between baby and mother.
Reduced risk of being overweight/ obese.
Milk sterile, warm, free and better tolerated.
Higher intelligence quotient.
More effective response to vaccines compared to formula fed.
Better development of facial muscles, bones and teeth.

Advantages of breastfeeding II.

To the mother:
A. Short term effects:
1. Lactating amenorrhea contraception.
2. Decreased risk of post partum hemorrhage and faster involution.
3. Decreased risk of post partum depression.
4. Shorter period to regain pre-pregnancy weight.
5. Cheap and readily available.
B. Long term effects:
6. Decreased risk of premenopausal ovarian and breast cancers.
7. Decreased incidence of hypertension, hyperlipidemia and diabetes.
8. Bonding and better emotional security.

Disadvantages of breastfeeding.
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Mother to child transmission of diseases such as HIV

especially in presence of infection, cracked nipples.
Some drugs can be excreted through breast milk and
thus not compatible with breast feeding.
Iron,Vitamin D and K not present in adequate amounts.
Have to be supplemented.
Breast milk jaundice.
May be painful especially if mother not well taught.
Feeling of neglect of the rest of the family.
Only mother can feed the child in cases where EBM not
used thus delayed return to work.

Replacement feeding and the AFASS Criteria.

Replacement feeding refers to:

process of feeding a child who is not receiving any breast

milk with a diet that provides all the nutrients the child needs
AFASS Criteria:
Acceptable
Feasible
Affordable
Sustainable
Safe

Replacement Feeding

Advantages.

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There is no risk of
transmitting HIV through
formula.
Commercial infant formula is
made especially for infants.
Most of the nutrients that a
baby needs have already
been added to the formula.
Other adult family members
can help to feed the baby

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Disadvantages.
If the formula is not prepared
correctly, an infant is more likely
to get sick.
Formula is expensive.
Formula takes time to prepare,
and it must be made fresh for
each feed.
The baby needs to drink from a
cup and this takes time.
Formula does not contain
antibodies, which protect infants
from infection.
Formula feeding does not
protect from pregnancy

If mother does not fit criteria then advise:

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Baby started on NVP prophylaxis.

Keep intervals between feeds as short as possible.
Stops feeding from infected breast incase of an
infection.
Check infants mouth for sores and seek treatment
immediately.
Make a transition to replacement feeds incase of
change in circumstances.

Breastfeeding and Common Causes of Childhood Morbidity

and Mortality.

Exclusive breastfeeding prevalence for First 6 months- 61%

(KDHS 2014).
Has been shown to reduce incidence by (X 5 pneumonia; X7
diarrhea)
Infants not breastfed are 6-10 times more likely to die in their
first month of life.
Reduces U5MR by 13%.
Reduces 16% of NNR and 22% if started on first day of life and
within 1 hour resp.

Ten Steps to successful breastfeeding.

Foundation of WHO/UNICEF Baby Friendly Hospital Initiative.

1. Have a written breastfeeding policy that is routinely communicated

to all health care staff.

2. Train all health care staff in the skills necessary to implement this
policy.

3. Inform all pregnant women about the benefits and management of

breastfeeding.

4. Help mothers initiate breastfeeding within one hour of birth.

5. Show mothers how to breastfeed and how to maintain lactation,

even if they are separated from their infants.

 6.

Give infants no food or drink other than breast-milk, unless medically

indicated.
7.

Practice rooming in - allow mothers and infants to remain together 24 hours

a day.
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Encourage breastfeeding on demand.

9.

Give no pacifiers or artificial nipples to breastfeeding infants.

10.

Foster the establishment of breastfeeding support groups and refer

mothers to them on discharge from the hospital or birth center.

REFERENCES

WHO. Infant and Young Child feeding practices , Section 1 and 2.

UNICEF, UK. The Baby Friendly Initiative.
WHO. Breastfeeding and Replacement feeding practices in the
context of Mother to Child transmission of HIV.
KDHS, 2014.
Buchanan AO and Marquez ML. Nutritional Disorders. Nelsons
Essentials of Pediatrics Seventh Edition pg 86-88, 2015.
Newcomb PA et, al. Lactation and a reduced risk of
premenopausal breast cancer. New England Journal of Medicine,
330: 81-87, 1994.
Mescher AL. Junquiera Basic Histology. Twelfth edition.