Successful Early Initiation and Exclusive Breastfeeding up to Six Months of Age

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Successful Early Initiation and Exclusive
Breastfeeding up to Six Months of Age
Dr. Pradeep Dubey MD (Ped.),
DCH. Cons. Developmental Neuro Ped.
AADIGURU Early Intervention Centre Wright Town
- Jabalpur
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India is epicenter of Childhood Mortality
Worldwide distribution of child deaths Each dot
represents 5000 deaths Lancet 2003
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Childhood MortalityState of Worlds Children 2008

• 9.7 million lt 5 yrs deaths annually world over
• India 2.1 million (21)

1 million newborns die annually in India
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Post Neonatal interventions - efficacy for
reducing all cause of neonatal mortality

• Neonatal Resuscitation 6-42
• Breastfeeding 55-87
• Prevention and management of hypothermia 18-4
  2
• Kangaroo Mother Care (LBW)incidence of
  infection 51 (7-75)

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Global and National Recommendations for Infant
and Young Child Feeding

• Initiate breastfeeding within one hour of birth
• Exclusive breastfeeding for first 6 months of
  life
• Introduce nutritionally adequate and safe
  complementary foods after the infant reaches 6
  months of age
• Continue to breastfeed for 2 years or beyond.

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What is Exclusive Breastfeeding?

• Giving an infant only breastmilk
• No food or drink other than breastmilk not even
  water
• No Ghutti/Honey etc.

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Benefits to the Baby

• Complete food for the first six months
• Perfect nutrition
• Higher IQ
• Emotional bonding
• Prevents infections
• Prevents chronic diseases
• Easily digested

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Benefits to the Mother

• Reduces post delivery bleeding and anemia
• Helps delay next pregnancy - LAM
• Protective effect against breast and ovarian
  cancer
• Helps to loose weight
• Emotional bonding
• Needs no preparation

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Benefits to the Society

• Reduces absenteeism of mothers from work as they
  are less prone to disease.
• Economical
• Enhances Bonding

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First year is critical!

• Malnutrition strikes the most in infancy
  beginning in 3-4th month , 29-30 at 6 months,
  goes up and peaks about 46 by 18 months, flat
  curve after that (NFHS 3).

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2
3
4
5
Years of life
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Successful Breastfeeding

• Exclusive breastfeeding for the first six months

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U-5 deaths reduction by preventive Interventions
Percent
0
2
4
6
8
10
12
14
16
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Breastfeeding
Complementary feeding
Clean delivery
Hib vaccine
Clean water, sanitation, hygiene
Zinc
Vitamin A
Breastfeeding is defined as exclusive
breastfeeding for first 6 months and continued
breastfeeding during 6-11 months
Intervention
Antenatal steroids
Newborn temperature management
Tetanus toxoid
Antibiotics for PRM
Measles vaccine
Nivirapine and replacement feeding
Insecticide-treated materials
Antimalarial IPT in pregnancy
Source Jones et al. LANCET 200336265-71
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Successful Breastfeeding

• Major Hurdles
• Lack of family support
• Lack of support by health professionals
• Commercial influence
• Feeling of not enough milk among women

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Successful Breastfeeding

• Important Dos
• Initiate breastfeeding as early as possible
  within one hour of birth.
• Do not give the baby any prelacteal feeds
• No bottles, artificial teats or pacifier
• Breastfeeding on demand at least 8-10 times in a
  day and at night a
• Breastfeed in a correct position
• Build mothers confidence to sustain good milk
  supply and alleviate feeling of not enough milk.

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Successful Breastfeeding

• Initiate Breastfeeding Within One Hour of Birth

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Successful Breastfeeding

• No Prelacteal Feeds
• Replace colostrum
• Reduce babys desire for breastfeeding
• Greater risk of infection
• Risk of intolerance, allergy

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Successful Breastfeeding

• No Bottles, Artificial Teats or Pacifiers for
  Breastfeeding Infants
• It lead to nipple confusion

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Successful Breastfeeding Breastfeeding in the
Correct Position

• Milk producing glands
• Lactiferous canaliculi
• Lactiferous sinuses
• Myoepithelial tissue
• Adipose tissue

Anatomy of the Breast
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Successful Breastfeeding

• Build Mothers Confidence
• During prenatal period
• During antenatal Period
• During postnatal period

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The Feeling of Not Enough Milk

• Not true. Just a perception
• Reinstate mothers confidence
• Ensure frequent, effective suckling

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Breastmilk Production
The Prolactin reflex
Sensory Impulses from nipple
Prolactin in blood

• More prolactin secreted at night
• Secreted after feed to produce next feed
• Suppresses ovulation

Baby sucking
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Breastmilk Transfer
The Oxytocin reflex
Sensory Impulses from nipple
Oxytocin in blood

• Works before or during feed to make milk flow
• Makes uterus contract

Baby sucking
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Breastmilk Transfer
How does the mothers confidence play part
Pain Worry Stress Doubt
Thinks lovingly of baby CONFIDENCE Sound of baby
Sight of baby
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Feeding reflexes in the baby
Rooting reflex
Mother learns to position baby
Sucking reflex
Baby learns to take breast
Swallowing reflex
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Signs of Correct Attachment

• Mouth wide open
• Lower lip is turned outside
• Chin touching the breast
• Black part of the breast not visible below the
  lower lip
• Large black portion of breast and nipple
  including milk collecting ducts are inside babys
  mouth
• Tongue under the teat

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Incorrect Sucking Position

• Mouth is not wide open
• Chin is away from the breast
• Baby is sucking only nipple
• Most black portion of the breast is outside the
  babys mouth
• Tongue away from the teat

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Causes of Incorrect Attachment

• Use of feeding bottles. Leads to nipple confusion
• Inexperienced mother
• Functional difficulty with the mother or the baby
• Lack of skilled support

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Conclusion

• Exclusive Breastfeeding for First Six Months
• Being Successful-
• Initiate breastfeeding as early as possible
  within one hour of birth.
• Do not give the baby any prelacteal feeds
• No bottles, artificial teats or pacifier
• Breastfeeding on demand at least 8-10 times in a
  day and at night a
• Breastfeed in a correct position
• Build mothers confidence to sustain good milk
  supply and alleviate feeling of not enough milk.

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Thanks