Download - BREASTFEEDİNG Prof. Dr. Emel Gür İ.Ü. Cerrahpaşa Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları A.B.D
BREASTFEEDİNG
Prof. Dr. Emel Gürİ.Ü. Cerrahpaşa Tıp Fakültesi
Çocuk Sağlığı ve Hastalıkları A.B.D.
RECOMMENDATIONS
• Start breastfeeding within ½-1 hour of birth
• Breastfeed exclusively from 0-6 months of age
• Give complementary foods to all children from 6 months of age
• Continue breastfeeding up to 2 years of age or beyond
Prevalences of Breastfeeding in the World
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l<6mo.HM
20-23 mo.Continue
UndevelopmentDevelopingWorldTürkiye
UNICEF-2006
PREVALENCES OF BREASTFEEDING IN OUR COUNTRY(TNSA-2008)
Year BreastfeedExclusive Breastfeed (0-3 ay)
Exclusive Breastfeed(4-6 ay)
BreastfeedAnd others ( 0-3 ay)
1993 95.2 10.3 4.3 53.3
1998 95.2
9.4 1.3 52.5
2003 95.2 27.3 7.6 37.2
2008 96.7
41.6
23.6
25.6
COMPOSITIONS OF HUMAN MILK AND COW MILK
Contents ( 100 ml. ) Human milk Cow milk
Calories ( kcal ) 70 67
Water ( ml ) 87.6 87.2
Protein 1.1 3.2
Lactose ( g. ) 7.1 4.7
Fat ( g. ) 4.5 3.8
Mineral ( mg. ) 0.20 0.71
Kidney solid load (mosm ) 80.0 220.0
Oral solid load (mosm) 250.0 263.0
COMPOSITIONS OF HUMAN MILK AND COW MILK
Contents (g/dl) Human milk Cow milk
Total protein 1.1 3.2
Casein (% protein) 40.0 82.0
Whey protein (%) 60.0 18.0
Alfa lactalbumin 0.25 0.12
Betalactoglobulin eser 0.30
Lactoferrin 0.17 eser
Albumin 0.05 0.30
Lysozyme 0.05 eser
IgA 0.10 0.003
NPN (mg N/dl ) 50.0 28.0
COMPOSITIONS OF HUMAN MILK AND COW MILK
Contents Human milk Cow milk
Ca mg/dl 34.0 120.0
P mg/dl 15.0 95.0
Fe mg/L 0.5 0.5
I µg/L 30.0-70.0 47.0
Fl µg/L 5.0-50.0 70.0-220.0
Vit A IU/L 1988.0 1025.0
Vit C IU/L 43.0 11.0
Vit D IU/L 22.0 14.0
Vit K IU/L 16.0 60.0
COLOSTRUM
• Colostrum is produced in the first five days after delivery (7-123 ml/day)
• “Coming in”:Increasing of milk production 40 th hour (3-5 th days)
• It is thick and yellowish • Antibody rich• Many white cells• Protein rich (lactose and fat poor)• Zn rich • Growth factors• Vitamin A rich• Purgative
MATURE MILK• It is produced after 15 days• Quantity larger • Fore milk: is produced early in feed• Hind mil is produced later in feed• Fore milk is bluer than hind milk • Fore milk provides plenty of protein, lactose, other
nutrients, water• Hind milk is more whiter than fore milk,• Hind milk contains more fat and provides much of
the energy or a breastfeed• 4-6 th wk: 800 ml/day• 6 th mo. 750-1000 ml/ day
Contents ( 100 ml. ) Colostrum Mature milk
Calories ( kcal ) 67.0 75.0
Protein 2.3 0.9
Whey/casein 90:10 60:40
Lactose ( g. ) 5.7 7.3
Fat ( g. ) 3.0 3.8
Mineral ( mg. ) 0.30 0.20
PROTEINS OF HUMAN MILK
• sIgA,IgM, IgG• Lactoferrin
• Lactalbumin
• Lysozyme• Casein
• İmmun protect• Anti-infective, Fe transport
• Synthesis of lactose• Ca transport
• Anti-infective• Prevent mucosal adhesion Growth factor of
Bifidobacterium bifidum
CARBONHYDRATES and LIPIDS OF HUMAN MILK
Carbohydrates• Lactose• Oligosaccarides• Glucoconjugates
Lipıds• Trigliserid• FFA• LC-PUFA
• Source of energy• Antimicrobial• Antimicrobial
• Source of energy• Anti-infective• Development of brain and
retinea
ANTİMICROBİAL FAKTORS OF HUMAN MILK
• Protein• Lactoferrin• Lysosym• Fibronectin,C3• SIgA• Mucin• Κ-casein• Oligosaccarides• Lipids
Anti-inflamatuar Factors of Human Milk
• Vitamin A,C,E• Catalase• Glutation peroksidase• PAF asetil hidrolase• Αlfa- 1-Antitripsin• PGE 1,2• EGF• TGF-α• TGF-β• IL-10
IMMUNOMODULATORS OF HUMAN MILK
• IL-1-5• IL-6• IL-8• IL-10• IL-12• TNF-α• TNF-β• IFN-γ
GROWTH FACTORS OF HUMAN MILK
• Epidermal Growth Factor(EGF )
• Transforming Growth Faktör-α (TGF- α)
• Transforming Growth Faktör-β (TGF-β)
• Insulin, Insulin-like Growth Factor I-II
• Nerve Growth Factor (NGF )
• Relaxin
• Eritropoetin
• Taurin, Etanolamin, Fosfoetanolamin
Hormones
• Prolactin
• GH, GHRH, Somatostatin
• TRH, TSH, T4, T3, reverse T3
• GnRH, LH
• Parathormon, calsitonin
• Estrogen, progesteron, adrenal steroids
ENZYMES OF HUMAN MILK
• Lipase
• Lipoprotein lipase
• Galactosll transferase
• Sülfidril oksidase
• Lactoperoksidase, tiyosiyanat, hidrojen peroksit
• Lysosyme, peroksidase
ADVANTAGES OF BREASTFEEDING
• Protect the babies from diarrheal disease
(Shigella sp, E.coli G.lambilia,rotavirus)• Protect the babies from
respiratory disease (H.influenzae tip b S.pneumoniae) • Protect the babies from
other infections: urinary infection, AOM, sepsis, meningitis• Prevent allerjik reactions,
diaper rash
• Prevent some chronic disease:• IDDM, Çölyak hast., Ülseratif
kolit, crohn hast.• Prevent obesity, atherosclerosis• Higher scores on intelligence
tests• Establish bonding between
mother and baby• Protect the mothers from breast ca., over ca., anemia, spinal and pelvis fractures Family Planning Economical
More diarrhoea respiratory
infections
Persistent diarhoea
Malnutrition
More likely to die
More allergy Milk intolerance
İncreased risk of chronic diseases
Overweight
Lower scores on intelligence tests
İncreased risk of anemia,Ovarian, breast cancer, Fracture of mothers
oMore likely to die
May become pregnant sooner
LACTOGENESIS
• Stage 1
Pregnancy
Second trimester
• Stage ll
Delivery
• Estrogen, progesteron, placental prolactin produced ductal ve alveolar maturation
• Estrogen, progesteron decrease, prolaktin level is
high Proactin stimulated breast
gland and milk production starts
PHYSIOLOGY OF LACTATION
• Infant sucks
• Prolaktin
(milk production)
• Oksitosin
(milk secretion)
• Message reaches Hypothalamus
• Oxytocin is secreted from posterior pituitary gland
• Prolactin is secreted from anterior pituitary gland
• Situmulates milk producing cells and milk production can start
• Stimulates the contraction of the myoepithelial cells around the milk glands, ducts. Milk is transported to lactiferous sinuses.
Muscle cells
Milk secreting cells
ducts
Lactiferous sinuses
areola
Montgomery’s glands
AlveoliSupporting tissue and fat
ANATOMY OF THE BREAST
Oksitocin reflex
Things lovinglyof babySound of babySight of babyCONFIDENCE Worry
StressPaindoubt
ADVANTAGES OF ROOMİNG-IN DEMAND FEEDING
Advantages of rooming in
Mother can respond to baby
Babies cry less, so less
temptation to give bottle feeds
Mothers more confident about
breastfeeding
Breastfeeding continue longer
Advantages of demand feeding
Breastmilk comes in
sooner Baby gains weight faster Fewer difficulties such
as engorgement Breastfeeding more
easily estabilished
MORE FEEDING=MORE SIGNALS=MORE MILK
(PROVIDED THAT THE SUCKING
IS EFFICIENT)
HOW TO HELP A MOTHER WİTH AN EARLY BREASTFEED
• Avoid hurry and noise
• Ask the mother how she feels and how breastfeeding is going
• Observe a breastfeed
• Help with positioning if necessary
• Give her relevant information
• Answer the mothers questions
CONFIDENCE AND SUPPORT SKILLS
• Accept what a mother thinks and feels• Recognize praise what a mother and
baby are doing right• Give practical help• Give a little, relevant information• Use simple language• Make one or two suggestions, not
commands
BREASTFEED OBSERVATION
• Body position
• Responses
• Emotional bonding
• Anatomy of breast
• Suckling
• Time spend suckling
HOW TO HELP A MOTHER TO POSITION HER BABY
The Four Key Points:• Mother should hold baby’s body close to
hers• Baby’s head and body should be straight
line• Baby’s face should face the breast • If baby is newborn,baby’s bottom
supported
Annenin bebeği tutma şekli
HOW TO HELP A MOTHER TO HELP THE BABY ATTACH
HOW TO HELP THE BABY ATTACH
• Touch her baby’s lips with her nipple
• Wait until her baby’s mouth is opening wide
• Move her baby quickly on to her breast, aim his lower lip below the nipple
SIGNS OF WELL ATTACHMENT TO BREAST AND SUCKLİNG
• Mouth wide open
• Lower lip turned outwards
• Cheeks round
• More areola above baby’s mouth
• Slow deep sucks
• Can see or hear swallowing
CAUSES AND RESULTS OF POOR ATTACHMENT
CAUSES
• Inexperienced mother
• Small or weak baby• Use of feeding bottle• Breast poorly
protractile• Lack of skilled
support
RESULTS• Sore nipples• Fissures• Engorgement• Baby unsatisfied, wants
to feed a lot• Baby refuses to suckle• Baby fails to gain
RELIABLE SINGS THAT A BABY MAY NOT BE GETTING ENOUGH
BREASTMILK
• Poor weight gain
• Passing small amount of concentrated urine
• Less than 500g a month
• Less than birth weight after 2 weeks
• Less than 6 times a day, yellow and strong smelling
POOSIBLE SINGS THAT A BABY MAY NOT BE GETTING ENOUGH BREASTMILK
• Baby not satisfied after breastfeeds• Baby cries often• Very frequent breastfeeds• Very long breastfeeds• Baby refuses to breastfeed• Baby has hard, dry or green stools• No milk comes when mother express• Breasts did not enlarge (during pregnancy)• Milk did not come in (after delivery)
COMMEN REASONS WHY A BABY MAY NOT GET ENOUGH
BREASTMILK
BREASTFEEDİNG FACTORS
• Delayed start• Infrequent feeds• No night feeds• Short feeds• Poor attachment• Bottles• Complementary feeds
MOTHER:PSYCHOLOGICAL
FACTORS
• Lack of confidence• Worry , stress• Dislike of
breastfeeding• Rejection of baby• Triedness
RARE REASONS WHY A BABY MAY NOT GET ENOUGH BREASTMILK
MOTHER:PHYSICAL CONDITION
• Contraceptive pill, diuretics
• Pregnancy• Severe malnutrition• Alcohol• Smoking• Retained piece placenta• Poor breast development
BABY’S
CONDITION• Illness• Abnormality
THIS DO NOT EFFECT THE BREASTMİLK SUPPLY
• Age of mother
• Menstruation
• Returning to a job
• Age of baby
• Caesarian section
• Many children
• Simple, ordinary diet
CONTRENDİCATIONS OF BREASTFEEDING
• Mother with severe disease• Mother with psychosis or severe depression• Mothers with HIV infection• Mothers with HTLV-I (İnsan T-cell lymphotrophic virus-
I) infection• Mother with active pulmoner tuberculosis• Mother with active HSV infection on her nipple• Mothers treated with radioactive substances and
chemoterapy • Infants with rare metabolic diseases (galactosemia,
phenylketonuria and maple syrup urine disease)
BREASTFEEDING WILL BE SUCCESSFUL IN MOST CASES IF :
• The mother feels good about herself
• The baby is well attached to the breast so that he suckles effectively
• The baby suckles as often and for as long as he wants ( at least 10 minutes)
• The environment supports breastfeeding
HOW HEALTH SERVICES CAN SUSTAIN BREASTFEEDING
• Praise all mothers who are breastfeeding• Help mothers to breastfeed in the most healthy
way (breasfeeding counselling)• Encourage mothers to come for help before
they decide to start artificial feeds• Remember to encourage breastfeeding when
you see a mother for a reason• Help mothers to continue breastfeeding in
difficult situations ( returning to work, twin, LBW newborn)