This document discusses breastfeeding, including the physiology of breastfeeding, proper positioning and attachment techniques, advantages for both baby and mother, breastfeeding under special circumstances, and national programs to promote breastfeeding in India. It covers topics like colostrum, exclusive breastfeeding, demand vs scheduled feeding, adequacy assessment, BFHI, and World Breastfeeding Week. The document is authored by Dr. Abhishek Kumar and provides learning objectives and detailed information on various aspects of breastfeeding.

1. BREASTFEEDING
Name - Dr. Abhishek Kumar
Designation - Assistant Professor
College - Narayan Medical College & Hospital
City - Sasaram, Rohtas
State - Bihar
IAPSM Life Membership No: 5179

2. Learning objectives
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Physiology of Breastfeeding
Position & technique of Breastfeeding
Advantages of Breastfeeding
Breastfeeding under special circumstances
National Programmes for promotion of Breastfeeding

3. Reflexes in the mother
• Prolactin reflex – Milk
production reflex
• Oxytocin reflex – Milk ejection
reflex
Reflexes in the baby
• Rooting reflex
• Suckling reflex
• Swallowing reflex
Physiology of Breastfeeding

4. Colustrum – The first Milk
1 First fluid produced by mothers after delivery
2 Also known as ‘Beestings’, ‘First milk’ or ‘Immune Milk
3 Most suitable food immediately after birth of the baby
4
Rich in immunologic components such as secretory IgA, lactoferrin,
leukocytes, as well as developmental factors such as epidermal growth factor.
5 Primary function is immunologic and trophic rather than nutritional

5. Position & technique of breast feeding
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Classical Indian Position
Cradle position
Foot-ball hold position
Supine position
Side lying position

6. Signs of Good Attachment
Baby’s chin touching the breast
Baby’s mouth wide open
Lower lip turned outwards
More areola visible above the baby’s mouth than below
Signs of
Good Attachment

7. Infant receives
only breast milk
No other liquids or solids are given –
not even water –
with the exception of oral rehydration solution,
or drops/syrups of vitamins, minerals or
medicines
Exclusive Breastfeeding

8. 1 Complete food with all nutrients
2 Easily digestible & assimilable
3 Contains hormones & protective antibodies
4 Promotes overall growth & development of the child
5 Contains leukocytes, lactoferrin & bifidus factor to provide
protection & immunity.
Advantages of breast feeding to the baby

9. Advantages to the Mother
EBF serves as a natural contraceptive method
Prevents carcinoma of breast, ovary
& osteoporosis in mother
Acts as anti-diabetogenic factor reducing
insulin requirement
Quick & early involution of uterus &
reduces postpartum bleeding
Quick restoration of original physique

10. Saves money, time, conserves energy
Reduces infant morbidity & mortality
Gold standard of infant feeding
Safe, sound & sustainable feeding
Species specific
Advantages to the Community

11. Breastfeeding under special circumstances
Low Birth Weight Baby –
Infant may not be able to suckle in first few days
Expressed breast milk should be given by nasogastric tube in kangaroo position
Tube feeding till 30-32 weeks of gestation
Babies are usually able to suck after 32 weeks
Kangaroo position is ideal for breastfeeding

12. New Pregnancy during Lactation
Twin Babies feeding
Known as Tandem Nursing
Feeding should be continued till delivery
Both babies can be fed after delivery
Both babies can be fed simultaneously in football hold
position

13. If the infant is ill
Dribbling nose – Both nose & mouth are blocked so, the child
cannot breathe properly. Wipe the nose with thin cloth before
feeding & instill 2 or 3 drops of mother’s milk into the nostrils.
Vomiting & diarrhoea – Should not be stopped in diarrhoea
Fever – Should be fed by expressed breastmilk.

14. If the mother is ill
No maternal illness is
contraindicated for
breastfeeding except she is
on drugs like anti cancer
therapy, lithium, radioactive
compounds & chloromycetin.
• If mother have hepatitis B,
newborn should be
immunized with hepatitis B
vaccine, followed by rapid
schedule.
• Mixed feeding should be
avoided if mother is HIV
positive. Exclusive
replacement feeding can be
done in this case.

15. Breastfeeding in working mother
1
Should take
leave for
exclusive
breastfeeding
2
Must feed the
child before
going to work
3
Intermittent
feeding by
expressed
breast milk
4
Feeding must be
done after
returning home
5
Should be
breastfed more
frequently during
night time
6
Creches can be
established
7
Bottle feeding
should not be
preferred

16. Too-little milk secretion
Best alternative is milk of
another healthy, lactating
mother, also known as wet
nursing.
Next best is humanization
of cow’s milk.

17. Breastfeeding during COVID 19
Risk of breastfeeding is due to close contact between mother and baby
While coughing or sneezing, droplets infected with the virus, leads to
infection to the baby
Feeding practices should be as follows -
• Mother should wear a mask and practice respiratory hygiene
• Mother should wash hands (for 40 seconds) before each feeding session
• Routinely disinfect and clean the surfaces

18. Contd…
Woman with COVID -19 is too unwell to breastfeed – Expressed milk and donor
human milk can be used.
Precautions needed to be taken while using expressed milk -
1. Washing hands before touching breast pump or bottles
2. Dedicated breast pump should be used
3. After each pumping session, appropriate disinfection must be followed

19. Relactation
Re-establishment of lactation in a mother, who has stopped nursing
temporarily due to major illness or surgery.
Reflexes start functioning when the child is put on breast
Induced Lactation
• For woman, who has never been pregnant
• Couple adopts a child
• Feeding is done by nursing supplementer

20. 1
Demand feeding means feeding the child, whenever it
demands & as long as it demands.
2
No restriction on frequency & duration of
breastfeeding.
3
Scheduled feeding – Feeding by time, once in 2 to
3 hours only for few minutes & offering only one
breast each time
4
Alternate breasts should be offered at
each feed.
Demand & Scheduled Feeding

21. Adequacy of Breastfeeding
Wetness Test
If the child passes urine
more than 6 to 8 times in 24
hours, means that mother is
secreting enough milk.
Weight Gain
Can also be assessed by
recording the weight
Assessment
If baby gains 800 gm
per month, that
means breast milk is
adequate.

22. 1
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Global movement jointly developed by WHO & UNICEF
Adopted because of malpractices in breastfeeding
May be due to ignorance & lack of knowledge
Hindrance in breastfeeding by marketers
Promotion of infant milk substitute
Baby Friendly Hospital Initiative (BFHI)

23. World Breastfeeding Week 2021
Celebrated every 1-7 August
An important breastfeeding promotion strategy
A global campaign to raise awareness and galvanise action on themes
related to breastfeeding
Theme for this years is - Protect Breastfeeding: A shared responsibility

24. National Programmes for promotion of Breastfeeding
Pradhan Mantri
Matru Vandana
Yojna (PMMVY)
Mothers Absolute
Affection (MAA)
Breastfeeding
Promotion
Network of India
(BPNI)