dr. Arien Himawan,M.KesPPDS Gizi Klinik

Th 2012

Breast-Feeding

Culture and Breast Feeding

Historical Trends in Breast Historical Trends in Breast FeedingFeeding

THE DEMOGRAPHICS THE DEMOGRAPHICS AND AND

DETERMINANTS OF BREAST-DETERMINANTS OF BREAST-FEEDINGFEEDING

Ethnicity and Breast Feeding in US

The good news is that the U.S. has achieved the first goal

Di Indonesia

SSociocultural ociocultural DDeterminants eterminants

of of BBreast-Feeding reast-Feeding in USin US

Breast Feeding in The Developing World

can be a dangerous source of infection

Maternal Employment & Breast-Feeding

Ten Steps to Successful Breast feeding

1. Have a written breastfeeding policy that is routinely communicated to all health care staff.

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

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

4. Help mothers initiate breastfeeding within 1 hour of birth.

5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.

6. Give newborn 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.

8. 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 clinic

A Step-by-Step Approach to Breast-Feeding

THE DECISION TO BRAEST-FEEDThis important decision is usually made early :

about 30% of families decide before pregnancy over 90% by the end of the first trimester of pregnancy

(Post and Singer 1983)A mother choice of feeding methode is

determined by a number of individual, family and sociocultural factors :The emotional motivations The attitude of family members and friendsSocial trends and role models

BREAST-FEEDING EDUCATIONMany hospitals and clinics have developed

breast-feeding education programs

Preparation for Breast-FeedingNipple Conditioning

Mothers should be reassured that breast size does not influence lactation

Nipple Invertion

Early Breast-FeedingThe Postpartum EnvironmentInitiating Breast-FeedingThe First FeedingAdvantage of Early Feedings

The First Two Months of Breast-Feeding

Feeding PatternsBy the third or fourth postpartum day, an infant

typically breast-feeding about 7-8 times a dayconsume 300-400 ml of milk/24 hours Feeding periods average about 10 minutes each breast

The small size of the infant’s stomach the infant will need to be fed frequentlysome infants feeding up to 12-14 times a day

Maternal-Infant Bondinga sense of belonging security and attachment

from the warmth of the mother’s bodyThe closeness and time spent together in the first

month postpartum are important factors in maternal-infant bonding

Importance of Support for The MotherSupport and guidance for the mother during this

periode are critical to continued breast-feeding especially for young, first-time mothers

Stooling Patterns of The Breast-Feeding InfantsStooling begin shortly after birth during the first several days meconium is passed

and the stool appears black and tarryAfter the first week, the breast-feedig infant’s

stools are a mustrad yellow liquid with a yeasty odorThe mother of the breast-feeding infant shoud be

aware many small, yellow, liquid stools are not diarrhea

but the normal pattern

Breast-Feeding Six Months and Beyond

Adding Solid Foods Infants are ready to accept solids

Interest in adult foods show better hand mouth coordinationBegain to lose their vigorous tongue thrust during nursing

Shoud be given at the time of day when mother’s output of milk is lowest

TeethingPrimary theeth began to erupt will bite and chewMost infats quickly learn not to biteQuicky removed when active suckling slow not

allowed to play and nuzzle at nipplePsychological Benefits of Nursings

Feeding more sporadic

WEANING

How Long Should a Mother Breast FeedThe Committee on Nutritional of The US National Academy of

Science recommends exclusive breast feeding for normal Birth – 4 to 6 months

Supplemental feeding is recommended for the remainder of the first year

Immunological benefits and growth factor during newborn period mother should be strongly encouraged to breast feed for at least the first 2 or 3months

The Process of WeaningStudy of culture worldwide the mean age for weaning is around

2.5 yearsSupplemented with other foods 4-6 monthsIn The US 2/3 of mothers stop breast feed before 5-6 months

because of culture attitudesMany infants spontaneously give up breast feeding

supplemental food since 4-6 monthsThere is No ideal duration for breast feeding for all families

Maternal Health During WeaningProblem with plugged duct and breast discomfort

soaking with warm water and manual expression to reduce breast fullness

Weaning & Infant Health in Developing WorldWeaning is a periode when the child is a sharply

increased risk for illness and death (Wharton 1991)During the breast-feeding periode, most infants grow

well and stay relatively healthyAs Supplemental foods began replace breast milk

growth often falters and illness is more commondNo provide immunological benefits of milkSupplemental foods have less nutritional valueWater, food and bottles are frequently contaminated

poor sanitationDiarrheal during weaning is common

Relactation and Induced Lactation

Relactation is the process of restimulating lactationWomen who delivers a low birth weight infant and

spreated from her infant for several weeks will often drop off in milk output

Induced Lactation is the stimulation of lactation in woman who has not been recently pregnant mothers of adopted infants attempt induction and many are at least partially successful in breast feeding

Relactation and induced lactation, the major to milk production is effective, regular suckling of the breasts, together with breast massage and nipple stimulationation

Medication and hormon can be used to help promote lactation

Extraxtion and Storage of Breast Milk

Manual Expression of MilkA simple techniqueMother should wash her handsBreast is massage for several minutes or until mother

feels milk letdownA clean, wide necked container to catch the milk

should be held in one hand, while the other hand pumps the breast

Breast PumpsPrefer to use a breast pumpMore efficient and more comfortableBaby preterm or ill 8 times each day, will avoid

pooling of milk in the glands which can reduce milk secretion

MMilk Storageilk Storage

MMaternal aternal C Concerns oncerns DDuringuring

BBreast-Feedingreast-Feeding

Insufficient Milk and Failure to Thrive

Too Much MilkThe breast become uncomfortably full and leak

milk between feedingMilk output during infant suckling at the

beginning of suckling during milk letdown, so fast and abudant that feeding may be uncomfortable for the infant

If necessary extra milk can be manually express from the best and stored frozen for later use

Breast ProblemsEngorgementLeakingNipple sorenessPlugged Milk DuctsMastitis and Breast Abscesses

Breast-FeedingBreast-Feeding in Special in Special SituationsSituations

Casarean BirthFirst feeding may be deleyed, successful feedings after 12 hours

of deliveryPostoperative pain may inhibit the letdown reflexMother should take pain medication after feeding allows time

for the level of the drug in maternal blood to peak and fall before next feeding

Breast-feeding TwinsFeeding both infants simultaneously and Milk outputs of 1500 to

2500 ml per day

Breast-feeding after Breast SurgeryMay effect a woman’s ability to breast feedSurgery may disrupt the nerve around the nipple and breast, the

milk ducts, the blood supply to the glandsBreast feeding is possible for most women after augmentation

surgeryAfter a breast reduction not possible to breast feedingHad incisions around the aerola as part of their surgery

Infant DisordersRespiratory infections

Upper respiratory tract infections (URIs) common during infancy & interfere with breast feeding

The mother should breast feed while sitting up and hold the infant a more upright position

Nasal secretion should be cleared before beginning feeding

Infant lose some appite when they have an infection need to express some milk manually, usually appetite returns in a day or two

Down’s SyndromeCongenital disorderCan breast feed may take them longer to establish full

suckling 1/3 took more then one week to establish full suckling

The infant has no difficulty suckling immidiately

Cleft lip and PalateCongenital malformations caused by incomplate closure of

the lips and upper jaw during embryonic developmentDifficult for infant to suckleMany infants are fed formulaBreast feeding is possible with some adjustmentsMother assist her infant with a cleft lip in forming a seal

over the nipple by pressing the clift agaist the breast and covering the gap with her finger or thumb

Clift lip are repaired at three weeks postpartum and afterward the infant can ussually breast feed normally

Breast milk JaundiceOne of the metabolic adaptations to life oudside the

uterus is acomplate changeover of hemoglobin in red blood cell which the adult form hemoglobin replaces fetal hemoglobin

Severe replacing breast milk with formula, for 24 hoursThe mother extract regulary to maintain lactation

Metabolic Disorders Galactosemia is a rare 1 in 60.000 infants at birth Infant with galactosemia, one of the enzymes that

metabolizes the galactose to glucose is absent Large amountsof galactose build up, have severe

adverse effesct including metal retardation Galactosemia is contraindicated of breast feeding 1 in 20.000 babies born with Phenylketonuria (PKU)

can not convert phenylalanine to tyrosine Diet rich phenylalanine amino acid accumulated

impairing normal development of the central nervous system and producing metal retardation

Healthy as long as phenylalanine intake is controlled grow and develop normally

Is wean from the breast and placed on a special low phenylalanine formula 6 months as infants fed

No longer contra indication to breast feeding Human milk has relatively low level of phenylalanine

Maternal DisordersDiabetes Mellitus

have beneficial effect on blood sugar control glucose is steadily pulled from maternal blood and converted to galactose and lactose during milk

Chronic diseasescan breast feed successfullylong term therapy with drugs can pass into the milk and harm

the infant formula feeding may be necessery Maternal infections

Not contra indicated during post maternal infectionsAntibodies and immune cell produced by the mother in respon

to infections are passed to the infant in milkThe agents can provide the infant with some protection from

infectionexcample : Rubbella can be passed through breast milk to the infant, but along with the virus travel antibodies and other immune factors that provide passive immunity from the virus, so the baby does not become ill

Breast-Feeding and The Human Immunodeficiency Virus

Protein in Human Milk

Vitamins, Minerals, and Enzymes in Human MilkThe vitamin containt of breast milk is uniquely

suited to the newborn’s need (Lawrence 1994)Mature breast milk contains all of the essensial

mineral necessery for infant growth and development (Riordan 1993)

A variety of enzymes that have digestive functions are secreted into human milk, including lipase, amylase, and proteases are important in that they help the immature gastrointestinal tract of the newborn digest and absorb nutrient in the milk (Hamosh 1989)

Protection from Infectious DiseasesContains a complex variety of anti infective substances

and cell including lymphocytes, immunoglobulins, enzymes, anti imflammatory agents and other protective factors

Breast feeding limits infant exposure to potensial pathogens in other foods and fluids

Adequate breast feeding ensure the nutritional status of the infant, thereby reducing vulverability to disease (Wray 1991)

Contraceptive effects (Wray 1991)Protection From Allergies

Infants are thought to be susceptible to food allergy because their developing intestine is permeable to protein and peptides

Breast feeding defer the introduction of foreign food proteins until the infant’s IgA system become functional and the intestine barrier to food protein mature

Breast-feeding, Maternal Diet and Infant Allergy

Food eaten by a mother during lactation can produce allergies

Cow’s milk consumed by the nursing mother has often been implicated antigens from cow’s milk have been found in the breast milk

In families with strong history of allergy, when suspected food alergens are exclude from the diets

During weaning, solid foods shoud be introduced to the infant implicated

Should be observed for sign of allergy when a new food is introduced

Breast feeding and Chronic Diseases of Later Life

Breast Feeding & Infant Mortality

Thank You