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8/6/2019 Breast Feeding-physiology of Lactation,Composition of Breast Milk,Colostrum,Initiation &
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Anatomy
y Milk producing glands
y Lactiferous canaliculi
y Lactiferous sinuses
y Myoepithelial tissue
yAdipose tissue
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PHYSIOLOGY OF LACTATION
y Milk is produced as a result of the interaction between
hormones and reflexes.
y Two hormones come into play during lactation.
y PROLACTIN
y OXYTOCIN
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PROLAC
TI
REFLEX(ALSO K OWN AS MILK SECRETIONREFLEX)
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PROLACTIN REFLE
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y More the baby sucks at breast, greater is the milkproduction.
y Earlier the baby is put to breast, sooner is the reflexinitiated.
y The greater the demand, more is the milk produced.
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y Feed early, frequently and completely
y
Empty both breasts at each feed
y Ensure that the baby is properly attached to the breast.
y Prolactin is produced during night
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OXYTOCIN REFLEX(ALSO CALLED IL EJECTION REFLEX)
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PROLACTIN REFLEX
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y Oxytocin is post. pituitary hormone which causescontraction of the milk from the glands into the
lactiferous sinuses and the lactiferous ducts.
y Suckling, thought, sight and sound of the babystimulation of nerve endings oxytocin secreted
contraction of glands breast milk secreted
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OXYTOCIN REFLEXHELP HINDER
THINKS LOVINGLY OF BABY WORRY
SOUND OF BABY STRESS
SIGHT OF BABY PAIN
CONFIDENCE DOUBT
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yThis stresses the importance of asupportive health professional or arelative to reassure the mother andhelp her gain confidence so that shecan successfully breastfeed her baby.
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Neonatal reflexesy Rooting Reflex
y Suckling Reflexy Drawing nipple and areola to form a elongated teat inside
mouth
y Pressing streched nipple & areola with the jaw and tongueagainst the palate
y Drawing milk from the lactiferous sinuses by wave likeperistaltic movement of the tongue on the underneath ofareola & nipple compressing against palate above.
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Neonatal reflexes
y Swallowing Reflex
y One to three suckles fill baby's mouth with milkfollowing which baby swallows and then breathe.
y Suck-swallow-breathe cycle lasts for one second
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CO POSITIONy Different at different stages after birth:-
y Colostrum
y Transitional milk
y Mature milk( Fore milk & Hind milk)
y Preterm milk
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CO POSITION :- COLOSTRUy Milk secreted during the initial 3-4 days after delivery.
y
Yellow and thick
y Containsy More minerals & Proteins
y More antibodies and cells
y Increased amounts of vitamins A, D,E and K.
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CO POSITION:- Transitionalmilk
y The milk secreted after 3-4 days and until 2 weeks.
y The immunoglobulin and protein content decrease
y The fat and sugar content increases.
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CO POSITION:- ature ilk
y Mature milk follows transitional milk.
y It is thinner and watery but contains all the nutrientsessential for optimal growth of the baby.
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CO POSITION:- ature ilky FOREMILK :- Milk secreted at the start of a feed.
y It is watery and is rich in proteins, sugar, vitamins,
minerals and water that satisfies the babys thirst.
y HINDMILK:- Milk produced at the end of feed and isricher in fat content and provides more energy, and
satisfies the babys hunger.
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CO POSITION:- ature ilky Bacterial & Viral antibodies esp IgA
y Many factors which inhibit growth of virus & bacteria
y
Macrophages which synthesize :-y Complement
y Lysozyme
y Lactoferrin (inhibitory effect on E.Coli)
y
Bile salt stimulated lipase (inhibit giardia lamblia &entamoeba histolytica.
y Breast milk is defecient in Vitamin D, K iron &flouride.
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Nutrient Content/100 ml
MacronutrientCalories
ProteinsFatLactose
67 kcal
1.1 gm3.5 gm7.0gm
MicronutrientsSodium
PotassiumCalciumPhosphorusIronZinc
0.9meq
1.4meq35mg15mg30-50 ugm120 ugm
VitaminsVitamin A Vitamin C
5.2 mg
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CONSTITUENT BREAST MILK(gms/ltr)
PROTEINS: 11
casein 04
soluble proteins 07
lactalbumin 3.5
beta-lactoglobulin 00
lactotransferrin 1-2
immunoglobulin 1-2lysozyme 0.5
Non protein nitrogenous substances: 0.32
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CO POSITION:- Preterm ilky Milk produced by mother who delivers prematurely,
contains more:-
y proteins,
y sodium,
y iron,
y immunoglobulins
y calories
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Parameter Human milk Cow milk
Bacterial contamination None Likely
Anti infective subtance Many None
Protein 1% total & 0.5 % casein 4% & 3%
Amino acid More for growing brain &retina
less
Fat 4% but more unsaturated
& essential fatty acid
4% but less EFA & more
saturated
Lipase Present Absent
Lactose 7% 4.5 %
alts (Na, , l ) orrect amount ery ig
Minerals ( a, PO4) orrect amount ery ig
Iron mall amount but wellabsorbed
mall amount but poorlyabsorbed
itamin Enoug Extra needed
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INITIATION OF BREASTFEEDING
BREASTFEEDING SHOULD BE INITIATEDAS EARLY AS POSSIBLE,WITHIN 30 MINSIN VAGINAL DELIVERY AND 4 HRS IN
CEASERIAN DELIVERY.
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POSITIONING:- OTHER
y Mother can take any position that is comfortable to
her.
y Her back should be well supported and she should notbe leaning on her baby.
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POSITION OF BABYy Babys whole body must be well supported not just
neck or shoulders.
y Babys head and body are in a line without any twist inthe neck.
y Babys body turned towards the mother with thebabys abdomen touching the mothers abdomen.
y Babys nose is at the level of the nipple.
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GOOD
POSITION
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ATTACH ENTyAfter proper positioning, the babys cheek is touched
and that will make the baby open her mouth(rootingreflex)
yAllow the baby to have a wide open mouth and thebaby should be quickly brought on to the breastensuring that the nipple and most of the areola is
within the babys mouth.
y It is important that baby is brought on the motherrather than mother leaning on to the baby.
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SIGNS OF GOODATTACH ENTy The babys mouth is wide open.
y Most of the nipple and areola in the mouth , onlyupper areola visible, not the lower one.
y The babys chin touches the breast.
y The babys lower lip is everted.
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INCORRECT SUCKING POSITIONy Mouth is not wide open
y Chin is away from the breast
y Baby is sucking only nippley Most black portion of the breast is outside the babys
mouth
y Tongue away from the teat
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y MOTHERS AT RISK FOR PROBLEMS IN BREAST
FEEDING.-Primipara mothers
-Mothers who have had problems in breastfeeding inprevious pregnancy.
-Mothers with inverted nipple , retracted nipple.
-Mother who have not been motivated to breastfeed.
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EFFECTIVE SUCKLING
y Baby suckles slowly pauses in between two swallow.
y Babys cheeks are full and not hollow or retractingduring sucking.
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Global Recommendations for Infantand
YoungChild Feedingy Exclusive breastfeeding for 6 months
y Continue breastfeeding for up to 2 years or beyond.
y Introduce nutritionally adequate and safecomplementary foods after the infant reaches 6
months of age, while continuing to breastfeed for 2years or beyond.
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What is
Exclusive Breastfeeding?y Giving an infant only breastmilk, with the
exception of drops or syrups consisting of
vitamins, mineral supplements, or drugs
y No food or drink other than
breastmilknot even water
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BREAST ILK:BENEFITSy Nutritional superiority-contains all the nutrients.
y Carbohydrates-contains lactose in high conc.(6-
7mg):- helps in absorption of calcium & enhances thegrowth of lactobacilli in the intestine.
y Proteins-low protein content as baby cannotmetabolize high protein load.
contains lactalbumin & lactoglobulin which are easilydigested.
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y Contains taurine and cysteine,necessary forneurotransmission & neuromodulation.
y Fats-rich in pufas,necessary for the myelination of thenervous system.
Contains omega 2 & omega 6important forformation of prostaglandins and cholesterol,base for
steroid hormones.
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BENEFITS OF BREAST FEEDINGTo the Mother
y Reduces post delivery bleeding and anemia
y Helps delay next pregnancy
y Protective effect against breast and
y ovarian cancer
y Helps to loose weight