King AbdulAziz University Faculty of Applied Medical Science

ﺑﺴﻢ ﺍﻟﻠﻪ ﺍﻟﺮﺣﻤﻦ ﺍﻟﺮﺣﻴﻢ King Abdul-Aziz University Faculty of Applied Medical Science Clinical Nutrition Department – Second Year Nutrition During Life cycle Breast-feeding

BREAT-FEEDING

● Rooting is a nature reflex for babies. The baby’s mouth opens wide and its head moves quickly from side to side; searching for the nipple. ● To start a baby rooting, the mother must lightly touch her nipple to the baby’s lower lip baby will ‘’root‘’ for breast rapidly lift her breast to its mouth + pull the baby close baby can latch onto the nipple.

●’’latching on’’ is expression used to describe how a baby ‘’grasps’’ the mother’s nipple with his/her mouth. It is a skill that baby must learn with a little help from mother.

1 - Breast Maturation. 2 - Milk Production and Release. 3 - Maintenance of Lactation. 4 - Lactation and Fertility.

1 - Breast Maturation: The breasts begin to develop at puberty, by estrogen and other hormones. Although milk production begins during pregnancy, it is limited by the high levels of estrogen, progesterone, and placental lactogen.

2 - Milk Production and Release: Production of milk involves: ❶ The synthesis of the milk components and passage of into the alveolar lumen. ❷ The second stage is the ejection of milk from the alveoli and ducts. Both of these processes are stimulated by the suckling of the infant. For example milk ejection can become inhibited by stress, or fatigue in the mother.

Colostrum : During the first few days after birth, the breasts secrete a small amount of colostrum, Colostrum is : 1. Rich in protein and lower in fat than mature breast milk. 2. It is abundant in immune and protective factors (antibodies). 3. Laxative. 4. Prepares the baby’s gut for digestion & absorption. By the end of the first week postpartum (labor), colostrum is usually replaced by increasing amounts of mature milk.

Colostrum :

3 - Maintenance of Lactation: When the infant suckles, receptors in the nipple and areola send stimuli to the hypothalamus. The hypothalamus stimulates release of prolactin which stimulates milk secretion, and oxytocin which stimulates ejection of milk from the alveolus.

Prolactin reflex = milk - secreting reflex. Prolactin makes the breast produce milk. Oxytocin reflex = milk –ejection reflex = Let-down reflex. Oxytocin ❶Makes the milk move from alveoli through duct system to the nipple. ❷ Produces uterine contraction.

4 - Lactation and Fertility: Ø lactation is spacing pregnancies. Ø lactation helps to suppress menstruation and ovulation. Ø The duration of lactation amenorrhea is typically 25 to 30 weeks, but this figure varies wide. Ø After menstruation returns ovulation may remain irregular for several months. However, it is worth noting that some women do become pregnant during lactation.

q Initiate breastfeeding within one hour of birth. q Breastfeed exclusively for the first 6 months of age (180 days). q Thereafter give nutritionally adequate and safe complementary foods to all children. q Continue breastfeeding for up two years of ago or beyond.

1 - It is unique food for health, growth, immunity, and development. 2 - Contains several nutrients, including iron and zinc. 3 - Decreases incidence of infectious diseases such as; Bacteremia, diarrhea , respiratory tract infection, Otitis media , urinary tract infection.

4 - Decreases rates of ; Sudden infant death syndrome, type 1 and 2 diabetes, leukemia, overweight and obesity, food allergies, asthma 5 - It also provides enzymes, hormones, growth factors that prevent infection. Adapted from American Academy of Pediatrics: Breastfeeding and the use of human milk, Pediatrics , 115: 496, 2005

1 - Decreased postpartum bleeding. 2 - Decreases risk of breast , ovarian cancer, and osteoporosis. 3 - Increased child spacing. 4 - Helps mother return to pre-pregnant weight. 5 - More rapid uterine involution. 6 - Decreases menstrual blood loss. Adapted from American Academy of Pediatrics: Breastfeeding and the use of human milk, Pediatrics , 115: 496, 2005

1 - Breast-feeding provides economic and social benefits to the family, the healthcare system, the employer, and the nation. 2 - Breast-feeding require fewer physician visits, prescriptions, and hospitalizations; thus medical costs are lower.

1. Have a written breast-feeding policy that is routinely communicated to all health care staff. 2. Train all health care staff in the skills necessary to implement this policy. 3. Inform all pregnant women about the benefits and management of breast-feeding. 4. Help the mother initiate breast-feeding within a half hour of birth. 5. Show mothers how to breast-feed 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 breast-feeding on demand. 9. Give no artificial teats or pacifiers to breastfeeding infants. 10. Foster the establishment of breast-feeding support groups and refer mothers to them on discharge from the hospital or clinic.

Most breast feeding problems are available to new mothers after discharge. ►Sore nipples. ►Engorged breasts. ►Nipple confusion. ►Slow Growth ►Mastitis. ►Leaking Milk.

Sore nipples; Treated by correcting feeding positions , leaving milk drops to dry on the nipple after feeding.

Engorged breasts; breasts Can be reduced milk expression. by frequent nursing or little

Mastitis; Mastitis

Leaking Milk; Treated by gentle pressure on the nipple, or weaning soft disposable bra pads.

1 - Retracted nipples. 2 - Baby′ s mouth not open wide enough. 3 - Baby sucks poorly. 4 - Baby falls asleep while nursing. 5 - Overweight lactation women. 6 - Breast augmentation

a. In general: 1. Mother relaxed and comfortable 2. Breasts look healthy, no redness, no swelling. 3. Baby clam and relaxed. 4. Baby reaches or roots for breast if hungry.

b. Baby’s position:

c. Baby’s attachment: 1. Baby′ s mouth open wide enough. 2. Lower lip turned outwards. 3. Baby’s chin touches breast. 4. More areola seen above the baby’s top lip.

c. Baby’s attachment:

d. Sucking : 1. 2. 3. 4. 5. Slow, deep sucks with pauses. Cheeks round when sucking. We can see or hear the baby swallowing. Baby finishes sucking after 10 minutes. Mother notices signs of oxytocin reflax

d. If the baby : 1. 2. 3. 4. Has from 6 to 8 diapers a day. Passes normal soft stools. Seems contended. Gaining weight. Then you can be sure that baby is being well fed.

Protein of breast milk contains 35% casein so, it is easy to digest. Protein of cow’s milk contains 8 o% casein so, it is difficult to digest.

Yes; When an infant is unable to nurse, we use a breast pump to maintain milk production. Store milk in a sterile container: 1. Up to 48 hours in refrigerator 2. CAUTION: Never heat on stove or put in microwave.

Maternal causes Poor let-down Poor production Infant causes High energy requirement Low net intake Poor intake