Successful Early Initiation and Exclusive Breastfeeding up to Six Months of Age

Helping Women to Be Successful in Breastfeeding the Baby

Global and National Recommendations for Infant and Young Child Feeding

Initiate breastfeeding within one hour of birth Exclusive breastfeeding for first 6 months of life Introduce nutritionally adequate and safe complementary foods after the infant reaches 6 months of age Continue to breastfeed for 2 years or beyond.

Benefits to the Baby

Complete food for the first six months Perfect nutrition Higher IQ Emotional bonding Prevents infections Prevents chronic diseases Easily digested

Benefits to the Mother

Reduces post delivery bleeding and anemia Helps delay next pregnancy - LAM Protective effect against breast and ovarian cancer Helps to loose weight Emotional bonding Needs no preparation

Benefits to the Society

Reduces absenteeism of mothers from work as they are less prone to disease. Economical Enhances Bonding

Economic benefits of BF
US $3.6 billion saving if EBF 64% to 75% (in hospital) 29% to 50% (at 6 months) [Weimer J,US dept. Agriculture Report-13]

Medical cost at 12 months US $200 less in BF compared to formula fed [Honey & ware 1997]

Exclusive Breastfeeding & Lipid Profile

S. Cholesterol, total triglycerides and poor HDL/LDL ratio significantly more in EBF infants compared to mixed-feds and formula-feds and improve by six months of age for better brain growth [Eur J Clin Nutr 2008; 62:203-209]

Exclusive Breastfeeding & Anemia

Term AGA infants on Exclusive Breastfeeding till 6 months born to Anemic or Non-anemic mothers Do not develop Iron Deficiency Anemia [International Breastfeed J 2007;3:3]

First year is critical!

Malnutrition strikes the most in infancy beginning in 3-4th month , 29-30 % at 6 months, goes up and peaks about 46% by 18 months, flat curve after that (NFHS 3).

Brain development

10 lakh children die during first month, 14 lakhs by 1 year, and 20 lakhs by 5 yrs. 2/3rd are related to poor feeding.

Underweight (-2sd) NFHS-3

Over 60 million

Years of life

Percentage of Neonatal Deaths (2-28 days) Saved with Early Initiation

25 22.3 16.3

Risk of neonatal death is 4 fold, if milk based fluids or solids are given to breastfed neonates Imitation after day 1 is associated with 2.4 fold increase in risk of death

20 15 10 5 0 Within 1 hour

1-24 hour

Initiation of breastfeeding

PEDIATRICS 2006; 117:380-386

1/18

U-5 deaths reduction by preventive Interventions Percent

0%
Breastfeeding Complementary feeding Clean delivery Hib vaccine Clean water, sanitation, hygiene Zinc

2%

4%

6%

8%

10%

12%

14%

16%

18%

Intervention

Vitamin A Antenatal steroids Newborn temperature management Tetanus toxoid Antibiotics for PRM Measles vaccine Nivirapine and replacement feeding Insecticide-treated materials Antimalarial IPT in pregnancy

Breastfeeding is defined as exclusive breastfeeding for first 6 months and continued breastfeeding during 6-11 months

Source: Jones et al. LANCET 2003;362:65-71

Successful Breastfeeding

Initiate Breastfeeding Within One Hour of Birth

What is Exclusive Breastfeeding?

Giving an infant only breastmilk No food or drink other than breastmilk not even water No Ghutti/Honey etc.

Is Breast feeding So Simple?

Animal Kingdom: 1.Offspring on feet 2.Moves to udders 3.Makes position No role of Mother Human Beings: 1.Baby holds neck 3 mo 2.Walks at 1 yr 3.Mother makes position No role of Baby

How to Protect Breastfeeding

Make National breastfeeding policy Include Breastfeeding in clinical practice Obtain Training in breastfeeding management

Global Strategy for Infant and Young Child Feeding

Adopted by the WHA and UNICEF Executive board in 2002

Strategies

Development of BREASTFEEDING support clinics/ Lactation management clinics in hospitals run by skilled/ trained counselors Promoting BREASTFEEDING friendly PHCs/Private clinics/hospitals supported by SKILLED staff. Building IYCF counselling as service in job profile of workers Developing community led initiatives :Peer counselling support groups Eliminate MISINFORMATION from media (International Code) Establishing national and state level resource centers

Successful Breastfeeding
Major Hurdles Lack of family support Lack of support by health professionals Commercial influence Feeling of not enough milk among women

Successful Breastfeeding
Important Dos Initiate breastfeeding as early as possible within one hour of birth. Do not give the baby any prelacteal feeds No bottles, artificial teats or pacifier Breastfeeding on demand at least 8-10 times in a day and at night a Breastfeed in a correct position Build mothers confidence to sustain good milk supply and alleviate feeling of not enough milk.

Successful Breastfeeding
No Prelacteal Feeds Replace colostrum Reduce babys desire for breastfeeding Greater risk of infection Risk of intolerance, allergy

Successful Breastfeeding

No Bottles, Artificial Teats or Pacifiers for Breastfeeding Infants

It lead to nipple confusion

Successful Breastfeeding
Breastfeeding in the Correct Position

Milk producing glands Lactiferous canaliculi Lactiferous sinuses Myoepithelial tissue Adipose tissue

Anatomy of the Breast

Successful Breastfeeding
Build Mothers Confidence During prenatal period During antenatal Period During postnatal period

The Feeling of Not Enough Milk

Not true. Just a perception Reinstate mothers confidence Ensure frequent, effective suckling

Breastmilk Production
The Prolactin reflex Sensory Impulses from nipple More prolactin secreted at night Secreted after feed to produce next feed Baby sucking Suppresses ovulation

Prolactin in blood

Breastmilk Transfer
The Oxytocin reflex Oxytocin in blood Sensory Impulses from nipple

Baby sucking

Works before or during feed to make milk flow

Makes uterus contract

Breastmilk Transfer
How does the mothers confidence play part Pain Worry Stress Doubt

Thinks lovingly of baby CONFIDENCE Sound of baby Sight of baby

Feeding reflexes in the baby

Rooting reflex

Mother learns to position baby

Sucking reflex

Baby learns to take breast Swallowing reflex

Signs of Correct Attachment

Mouth wide open Lower lip is turned outside Chin touching the breast Black part of the breast not visible below the lower lip Large black portion of breast and nipple including milk collecting ducts are inside babys mouth Tongue under the teat

Incorrect Sucking Position

Mouth is not wide open Chin is away from the breast Baby is sucking only nipple Most black portion of the breast is outside the babys mouth Tongue away from the teat

Causes of Incorrect Attachment

Use of feeding bottles. Leads to nipple confusion Inexperienced mother Functional difficulty with the mother or the baby Lack of skilled support

Conclusion
Exclusive Breastfeeding for First Six Months
Being Successful Initiate breastfeeding as early as possible within one hour of birth. Do not give the baby any prelacteal feeds No bottles, artificial teats or pacifier Breastfeeding on demand at least 8-10 times in a day and at night a Breastfeed in a correct position Build mothers confidence to sustain good milk supply and alleviate feeling of not enough milk.

Be a leader

Thank you friends