lecture 7 exclusive breast feeding and introduction of complementary foods

8/13/2019 Lecture 7 Exclusive Breast Feeding and Introduction of Complementary Foods

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Exclusive breastfeeding in the

provision of breast milk only, with

no other liquids or food given

Complimentary feeding is defined

as giving solid or semi solid foodsin addition to breast milk

DEFINITIONS


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Since 1979 the WHO has recommended

that normal full term infants should be

exclusively breastfed forfour to six

months

Increasing reports suggesting an

association between discontinuing

exclusive breastfeeding prior to sixmonths of age and an increase in infant

morbidity and mortality


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Throughout the world many

professionals as well as a number

of government have

concluded that there is sufficient

evidence to recommend continuing

exclusive breastfeeding forabout

six months


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Nutritional immunologic and endocrine need

were provided by maternal systems

Delivered from a protected intrauterineenvironment sterile, warm, and protective

No longer obtain fluids, nutrients,immune protections, maternal body temperature

and sterile environment

This transition is filled with lifethreatening hazards

Intrauterine

Born

Infant survival


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BREASTMILK BREASTFEEDING

Fig 1. Advantages of Breastfeeding

Perfectnutrients

Easily digestedefficiently used

Protects againstinfection Costs less than

artificial feeding

Protects mothershealth

Helps delay a newpregnancy

Helps bonding anddevelopment


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FAT

PROTEIN

LACTOSE

HUMAN

FAT

PROTEIN

LACTOSE

COW

FAT

PROTEIN

LACTOSE

GOAT

Fig 2. Differences between three types of milks


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WHEY

PROTEINS

CURDS

Fig 3. Differences in the quality of the proteins

in different milks

Antiinfective

proteins

35%

Casein

HUMAN

EASY TODIGEST

80%

Casein

COWS

DIFFICULT TODIGEST


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LIPASE

ESSENTIALFATTY ACIDS

HUMAN COWS

Fig 4. Differences in the fat of different milks


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COWS5070 g/100 ml

HUMAN5070 g/100 ml

ABSORBED

50

%

10

Fig 5. Differences in the iron content in

different milks


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Fig 6. Steps on how breastfeeding protectsagainst infection

Motherinfected

Antibodies to

mothersinfection

secreted inmilk to protect

baby

White cells inmothers body

makeantibodies to

protect mother

Some whitecells go to

breast and makeantibodies there


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PROPERTY IMPORTANCE

Antibody rich

Many white cellsPurgative

Growth factors

Vitamin A rich

Protects against infectionand allergy

Protect against infection

Clears meconium helps toprevent jaundice

Help intestine to matureprevents allergy, intolerance

Reduces severity of infectionprevents eye disease

Fig 7. Importance of colostrums


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EMOTIONAL BONDINGClose, loving relationship betweenmother and baby

Mother more emotionally satisfied

Baby cries less

Mother behaves more affectionately

Less likely to abuse or abandon babyDEVELOPMENT

Children perform better on intelligencetests in later childhood

Fig 8. Benefits of breastfeeding


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Breast milkonly

1.0

3.2

Breast milk &

non-nutritiousliquids

13.3

Breast milk &

nutritioussupplements

17.3

No breast milk

Fig 9. Risk of diarrhoea by feedingmethod


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MOTHER

Fig 10. Dangers of artificial feeding

More diarrhoeaand respiratoryinfections

Persistentdiarrhoea

Malnutritionvitamin Adeficiency

More likelyto die

May becomepregnant sooner

Interferes with bonding

Lower scores onintelligence tests

Overweight

Increased riskof some chronicdiseases

More allergy andmilk intolerance

Increased risk ofanaemia, ovarianand breast cancer


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Fig 12. The prolactin reflex

Secreted AFTERfeed to produceNEXT feed

More prolactinsecreted atnight

Suppresses

ovulation

Prolactinin blood

Babysuckling

Sensory

impulsesfrom nipple


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Fig 14. The oxytocin reflex

These HELP reflex

Worry

Stress

Pain

Doubt

These HINDERreflex

Thinks lovingly

of baby

Sound of baby

Sight of baby

CONFIDENCE


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Fig 15. Good attachment vs poor attachment


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Fig 16. Result of poor attachment

Pain and damage to nipples

Sore nipples

Fissures

EngorgementBreast milk not removed

effectively

Baby unsatisfied,

wants to feed a lotApparent poor milk supply

Breast make less milk

Baby frustated,

refuses to suckle

Baby fails to gain

weight


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Use of feeding

bottle

Inexperiencedmother

Functionaldifficulty

Lack of skilledsupport

Before breastfeedingestablishedFor later supplements

First babyPrevious bottle feeder

Small or weak babyBreast poorly protractileEngorgementLate start

Less traditional help andcommunity support

Doctors, midwives, nurses,

not trained to help

Fig 17. Causes of poor attachment


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Fig 18. The three neonatal reflexes

Rooting reflex

When something toucheslips, baby opens mouthputs tongue down andforward

Sucking reflex

When somethingtouches palate,baby sucks

Swallowing reflex

When mouth fillswith milk, baby

swallows

SkillMotherlearns topositionbaby

Babylearns totakebreast


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FAT

PROTEIN

LACTOSE

FULL TERM

FAT

PROTEIN

LACTOSE

PRETERM

Fig 19. Difference between preterm and termbreastmilk


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Fig 20. Breastfeeding a sick baby

If breastfeedingstops

Breastmilk decreases

Baby may refuse tostart again

gets less nourishmentloses more weighttakes longer to recover

lacks comfort of suckling

Baby

If breastfeedingcontinues

gets best nourishmentloses less weightrecovers more quickly

is comforted by suckling

Breastmilk is produced

Breastfeeding continues

Baby


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Breastfeedingcontraindicated

Some anticancer drugsRadioactive substances(temporarily)

Continue breastfeeding :Side effects possibleMonitor baby for

drowsiness

Psychiatric drugs andanticonvulsants

Use alternative drug ifpossible

Monitor baby forjaundice

Chloramphenicol,tetracycline, metronidazole

Sulphonamides,cotrimoxazole, dapsone

Use alternative drug(May decrease milksupply)

Oestrogen containingcontraceptives

Thiazide diureticsSafe in usual dosage Most commonly used drugs

Fig 21. Breastfeeding and mothers medication


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RECOMMENDED PRACTICES TO

IMPROVE INFANT NUTRITION

DURING THE FIRST SIX MONTHS:

Initiate b.f. within about one hour of birth

Establish good b.f. skills (proper

positioning, attachment, and effective

feeding)

Breastfeed exclusively for about the first

six months

(Linkages-WHO, Feb 2001)


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Practice frequent, on - demand b.f.,including night feed

In areas where vitamin A deficiency

occurs, lactating women should take ahigh - dose vitamin A supplement

(200.000 i.u.) as soon as possible after

delivery, but no later than 8 weeks

postpartum, to ensure adequate vitaminA content in breastmilk



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Continue on - demand b.f. and introduce

complementary foods beginning around6 months of age



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Using the available information onthe development of infants

immunologic, gastrointestinal, oralmotor function, reproductive

physiology and nutrient adequacy

the expert concluded that the probable ageof readiness for most full term infants to

discontinue exclusive b.f. and begincomplementary foods appears to be near

six months or perhaps a little beyond

CONCLUSION


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lecture 7 exclusive breast feeding and introduction of complementary foods

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