What is the best food for your baby?

(1)

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What is the best food for your

baby?

• Perfectly made for your baby – breast

milk contains everything your baby needs according to maturity and age • 100% sterile – no risks of infections

(3)

Helping more than just growth

of your baby

• Protects against Respiratory Infections • Protects against Ear Infections

• Protects against Diarrhea • Boosts brain development • Protects from Allergies

(4)

• 31 % less risk of Inflammatory Bowel

Disease

• Up To 30% less risk of Obesity later in life • Protects from Diabetes

• Protects against Childhood Cancers • Less risk of Sudden Infant Death

Syndrome (Cot death)

(5)

Bonus benefits for the mother

• Faster post-partum recovery • Increases child spacing

• Relieves post-partum depression

• Less risk of Breast Cancer and Ovarian

Cancer

(6)

• Less risk of Type 2 Diabetes

• Less risk of Rheumatoid Arthritis • Less risk of Hypertension

(7)

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Breast Milk

• Optimum nutrition

according to your baby’s needs • Contains Bifidobacteria and Oligosachharides • Gives immunity – protects against infections

• Protects against allergy • No need to prepare

• Free!

Formula Milk

• No protective bacteria • No immunity - recurrent

gut, respiratory and ear infections

• Infection with

Cronobacter sakazakii

and Salmonella enterica • Can cause allergies

• Sleepless nights!

• Costs INR 65,000 to

(9)

Is Cow Milk any better?

• Too much Casein:

Human milk – whey 60% & casein 40%

Cow Milk - 80% casein which baby cannot

digest.

• Too much Sodium: Cow milk has 3 times more salt compared to breast milk.

More salt  Baby’s kidneys make more

urine to excrete that salt  Risk of

(10)

• Too much Calcium and phosphorus:

Breast milk – Calcium (2) : Phosphorus (1) Cow milk – Calcium (2) : Phosphorus (1.5) This excess phosphorus binds with

calcium and body removes it out. So body’s calcium is also removed along with – This risks poor bone growth and hypocalcemic seizures.

• Iron deficiency anemia: ¼ iron as

(11)

• Allergy: 10 – 15% babies on Cow Milk

suffers from occult blood loss in stools. Risks of severe Cow Milk Protein Allergy. • Infections: Bacillus cereus, Brucella,

Campylobacter, E. coli, Listeria, Salmonella, S. aureus, Yersinia

• Malnourishment: Because of Poor

digestion, recurrent infections, anemia. • Cost: INR 15,000 and much more in lost

(12)

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• Exclusive breastfeeding is best!

• Giving some top-milk risks infections and

forfeits many bonus benefits of exclusive breastfeeding. Still, some breastfeeding is always better than no breastfeeding at all. • Exclusive breastfeeding means the infant

(15)

Breastfeed within 1 hour of birth;

Breastfeed exclusively – give nothing else, not even water for the first 6 months;

Breastfeed on demand;

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Milk production starts on second – third day

Milk production starts even during the pregnancy. Secretion starts as soon as the baby and placenta is delivered

facilitated by suckling of baby. Mothers

(18)

First yellow milk is not good for the baby

Colostrum helps fighting infections –

contains secretary immunoglobulins and establishes gut microbial flora which

(19)

Baby cannot be breastfed because mother is lying straight on the bed

(20)

Cow milk is full of calcium!

Excess phosphorous in cow milk

prevents its absorption. So babies on exclusive cow’s milk develop

hypocalcemia along with other ailments.

(21)

Mother’s milk was less in previous pregnancies. So it will be less in this pregnancy

Assess and treat the reasons of

inadequate lactogenesis or delayed lactogenesis II. Monitor breastfeeding sufficiency in baby for the first 5-7 days. Train the mother to prepare and give

(22)

Mother was giving top-milk for first 2-3 days. She cannot breastfeed exclusively for 6 months because her milk supply is now affected.

(23)

Mother cannot make enough milk for twin babies.

Yes, she absolutely can breastfeed her twins, triplets or higher multiples.

Breasts make milk according to the

demand. Higher demand  more milk

production.

(24)

Mother is weak after cesarean section and needs rest for first few hours. Baby can not be breastfed while the mother is sleeping.

(25)

Breastfeeding is a ‘safety net’ against the worst effects of poverty. Exclusive

breastfeeding goes a way toward canceling out the health differences between being

born into poverty and being born into

affluence. Unless the mother is in extremely poor nutritional health, the breast milk of a mother in an African village is as good as the breast milk of a mother in a Manhattan

(26)

NOT valid reasons to give

supplement to baby

1. Jaundice requiring phototherapy –

Breastfeeding MUST be continued

2. Breastfeeding jaundice –

Breastfeeding MUST be continued

3. HBsAg positive mother – Can

(27)

4. Covid-19 positive/suspected

mother-To date, virus has not been found in amniotic fluid or breast milk

If mother wishes, she can breastfeed after respiratory hygiene, wearing a mask and washing hands

(28)

ONLY contraindications of

breastfeeding or breast milk

• Galactosemia

• HIV (relative contraindication – discuss in detail

with mother pros and cons and her wish) • HTLV

• Mother drug addict

(29)

Temporarily withhold

breastfeeding or breast milk

• Untreated brucellosis

• Mother taking chemotherapy

• Mother taking radioactive drugs for imaging

• Mother having active HSV with lesions

over breast (Mother can breastfeed

from unaffected breast or if lesions are not over breast or if lesions can be

(30)

Withhold breastfeeding but can

give expressed breast milk

• Mother has untreated active TB (can

resume breastfeeding once treated for at least 2 weeks and proven

non-contagious)

(31)

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Poor breastfeeding latch

• Get comfortable

• Positioning - सीधा | सहारा | साभने | सभीऩ • Latch when baby’s mouth is fully open • Check if the baby is well-latched

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Inverted Nipples

• Exercise with Hoffman technique during

pregnancy

• Regularly roll the nipples during

pregnancy

• Use a breast pump to stretch the nipples

• Use inverted syringe technique

• Start exclusive breastfeeding after delivery

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Breast Engorgement

• Due to incomplete emptying of breasts – delay in initiation or infrequent

breastfeeding or poor latching

• Breasts become painfully tight and heavy

• Early treatment helps avoid

(40)

• We warm compress the affected breast to relieve pain

• Gentle massage to stimulate ‘let-down’ • Breastfeed

• If baby unable to latch, we empty the breast using hand-expression or breast

pump

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• Avoid vigorous rubbing during cleaning of breasts

• Avoid frequent use of soap to wash nipples

• Never use alcohol for cleaning nipples • Properly position your baby while

breastfeeding

• Check for oral thrush

(43)

• Keep nipples dry when not breastfeeding

• Apply hind milk / coconut oil / ghee over the nipples after breastfeeding

• We use nipple shield for the treatment of sore nipples

• Use nipple shield only for the time till nipple heals – prolonged use may

(44)

Mastitis

• Inflammation of breasts – affected

breast is painful, red, swollen and may be accompanied by fever

• Cause:

– Decreased number of breastfeeding – Use of pacifiers/bottle

(45)

• Treatment:

– Empty the breasts by frequent breastfeeding and manual milk expression

– Continue breastfeeding with affected breast. Express out milk manually if cannot breastfeed – Warm compress and paracetamol for pain

relief

– Plenty of fluids and bed rest

– Antibiotic therapy – Amoxycillin clavulanate / erythromycin / Cephalexin / Clindamycin

(46)

Breast Abscess

• Untreated mastitis can cause abscess • Painful swollen

lumps filled with pus • Fever is present

(47)

• Continue breastfeeding if abscess is not over nipple or areola

• Breastfeeding is safe and helps in treatment

• Express breast milk using

hand-expression or breast pump if mother cannot breastfeed directly. Meanwhile continue breastfeeding with healthy

(48)

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• Breastfeed first –

– Breastfeed as soon as possible within 1st _hour

– Breastfeed first – weigh the baby later – फच्चे की पाइल बी फाद भें फनवा लेना।

• Help mother get a good latch

• Breast pump is your friend! Express as

much as possible to boost milk production

• Avoid pre-lacteal feeds

• Avoid scheduled feeding. Give on-demand

(50)

• Galactogogues help produce breast milk by increasing prolactin levels

• Metoclopramide (10 mg TDS for 7 to 14

days, off label, maternal side effects –

dizziness, nausea, sweating, depression)

and domperidone (10 mg TDS, no CNS side effects) are frequently used as

galactogogues

• Fenugreek (भैथी के लड्डू)

• Until the time breast milk supply increases

(51)

No two souls in this world will ever need

each other in their life like a mother and her newly born baby – Avoid unnecessary

(52)

Keeping baby-mother close 24

hours a day – Kangaroo Care

• Best treatment to boost breast milk production

• Helps early initiation of breastfeeding

• Improves health and brain development of baby

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Is the baby getting enough

milk?

• Baby have signs of good latching • Breastfeeding is comfortable

• Baby gains weight after the first week

• Baby passes urine at least 6 times a day after first 48 hours. During first 48 hours, baby may have only 2 or 3 wet nappies a day

(55)

Baby admitted in NICU since

birth? Here is how to establish

(56)

• Start pumping from first hour using hand expression or a breast pump

• Express every 2 hourly

• Label date and time of expression and store this milk in deep freezer (-20 °C) or ice compartment of refrigerator

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• How will doctors feed expressed breast milk to sick or preterm babies?

By oro-gastric or naso-gastric tube or suthi spoon (paladai)

• How do we re-establish breastfeeding in preterm and sick babies?

Lactation aid (Supplemental Nursing

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• Alveoli are lined by cuboidal cells

• Alveoli produce and store milk

• Many alveoli group to form a lobule • Each lobule is connected to a

lactiferous duct which delivers milk to

(63)

Physiology of lactation

• Milk ducts and alveoli are not fully

developed till pregnancy. So breasts cannot make milk till pregnancy

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• Mothers can feel these changes in her breasts:

– Breasts grow and feel heavy

– Stretch marks and veins over breast skin – Areola grows larger and darker

– Tiny eruptions over areola – Montgomery glands

– Nipples protrude

(66)

• Although breasts develop milk

producing capacity during pregnancy, but circulating high levels of

progesterone inhibits milk secretion during pregnancy

• After birth, placenta is removed and progesterone levels falls rapidly

(67)

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• Prolactin hormone helps breast make milk

• Prolactin increases when baby breastfeeds

• Early initiation = More breast milk!

(69)

• After first few days, prolactin levels reaches static levels – Breasts take control of milk production

• Now frequent emptying of breasts = More breast milk!

(70)

• Two things are necessary for milk production after delivery:

1. Prolactin secretion

2. Fall in progesterone levels

• Mothers having retained placental fragments have delayed lactation

(71)

Prolactin levels increase during breastfeeding

which boosts more milk production

Oxytocin is

secreted when

(72)

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Colostrum

• Present in breasts from 12-16 weeks of pregnancy

• Volume of colostrum during the first 2-3 days is 2-20 ml per feeding

• Colostrum is rich in proteins, salts, fat-soluble vitamins, antioxidants,

immunoglobulins

(75)

• Volume of mother’s milk rapidly increases after 48-72 hours

(76)

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Why Human Milk Banks?

• Breast milk is the only medicine which helps prevent Necrotizing enterocolitis

When it is not possible for a mother to

breastfeed, the first alternative should be pasteurized human milk from other

(78)

Human Milk Bank

• Is a non-profit institution

• Receives the milk donated by motivated mothers having extra breast milk

• Screens donor mothers for HIV, Hepatitis B, Hepatitis C and Syphilis

(79)

• Performs Microbiological evaluation to ensure sterility of Donor Human Milk

• Stores donor human milk

• Distributes donor human milk at no extra cost to beneficiary family

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Pooling

• Once we receive breast milk from donor mother, we mix the donated milk of 3-5 mothers to ensure uniform nutrition in donor human milk

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Pasteurization

• Kills all bacteria in human milk while protecting its valuable immunological properties

• Pasteurization is done using Holder’s

method. We heat the milk at 62.5 °C for

(84)

Microbiological Cultures

• Before reaching the babies, every batch of

donor human milk undergoes

microbiological culture before and after pasteurization

• We have policy to discard the

pre-pasteurized milk if it grows over 100,000

CFU/mL of any bacteria or 10,000 CFU/mL of Enterobacteriaceae or S.

aureus and pasteurized milk if it grows

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Storage

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Transport

• We transport human milk in heat insulating packs maintaining a

temperature of less than 6 °C

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Who gets donor human milk?

• Premature and Low Birth Weight babies • Babies having Necrotizing Enterocolitis,

Gastroschisis or Omphalocele

• Sick babies not having access to their own mother’s milk

(89)

Donor Milk vs. Breast Milk

• Both breast milk and donor human milk protects premature babies against

Necrotizing Enterocolitis

• Pasteurization destroys many valuable properties of breast milk - Donor Human

Milk can never be a substitute of mother’s breast milk – It is only the