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BREASTFEEDİNG

BREASTFEEDİNG. Prof. Dr. Emel Gür İ.Ü. Cerrahpaşa Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları A.B.D. RECOMMENDATIONS. Start breastfeeding within ½-1 hour of birth Breastfeed exclusively from 0-6 months of age Give complementary foods to all children from 6 months of age

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BREASTFEEDİNG

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  1. BREASTFEEDİNG Prof. Dr. Emel Gür İ.Ü. Cerrahpaşa Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları A.B.D.

  2. RECOMMENDATIONS • Start breastfeeding within ½-1 hour of birth • Breastfeed exclusively from 0-6 months of age • Give complementary foods to all children from 6 months of age • Continue breastfeeding up to 2 years of age or beyond

  3. Prevalences of Breastfeeding in the World UNICEF-2006

  4. PREVALENCES OF BREASTFEEDING IN OUR COUNTRY(TNSA-2008)

  5. COMPOSITIONS OF HUMAN MILK AND COW MILK

  6. COMPOSITIONS OF HUMAN MILK AND COW MILK

  7. COMPOSITIONS OF HUMAN MILK AND COW MILK

  8. COLOSTRUM • Colostrum is produced in the first five days after delivery (7-123 ml/day) • “Coming in”:Increasing of milk production 40 th hour (3-5 th days) • It is thick and yellowish • Antibody rich • Many white cells • Protein rich (lactose and fat poor) • Zn rich • Growth factors • Vitamin A rich • Purgative

  9. MATURE MILK • It is produced after 15 days • Quantity larger • Fore milk: is produced early in feed • Hind mil is produced later in feed • Fore milk is bluer than hind milk • Fore milk provides plenty of protein, lactose, other nutrients, water • Hind milk is more whiter than fore milk, • Hind milk contains more fat and provides much of the energy or a breastfeed • 4-6 th wk: 800 ml/day • 6 th mo. 750-1000 ml/ day

  10. sIgA,IgM, IgG Lactoferrin Lactalbumin Lysozyme Casein İmmun protect Anti-infective, Fe transport Synthesis of lactose Ca transport Anti-infective Prevent mucosal adhesion Growth factor of Bifidobacterium bifidum PROTEINS OF HUMAN MILK

  11. Carbohydrates Lactose Oligosaccarides Glucoconjugates Lipıds Trigliserid FFA LC-PUFA Source of energy Antimicrobial Antimicrobial Source of energy Anti-infective Development of brain and retinea CARBONHYDRATES and LIPIDS OF HUMAN MILK

  12. Protein Lactoferrin Lysosym Fibronectin,C3 SIgA Mucin Κ-casein Oligosaccarides Lipids ANTİMICROBİAL FAKTORS OF HUMAN MILK

  13. Vitamin A,C,E Catalase Glutation peroksidase PAF asetil hidrolase Αlfa-1-Antitripsin PGE 1,2 EGF TGF-α TGF-β IL-10 Anti-inflamatuar Factors of Human Milk

  14. IL-1-5 IL-6 IL-8 IL-10 IL-12 TNF-α TNF-β IFN-γ IMMUNOMODULATORS OF HUMAN MILK

  15. GROWTH FACTORS OF HUMAN MILK • Epidermal Growth Factor(EGF ) • Transforming Growth Faktör-α (TGF- α) • Transforming Growth Faktör-β (TGF-β) • Insulin, Insulin-like Growth Factor I-II • Nerve Growth Factor (NGF ) • Relaxin • Eritropoetin • Taurin, Etanolamin, Fosfoetanolamin

  16. Hormones • Prolactin • GH, GHRH, Somatostatin • TRH, TSH, T4, T3, reverse T3 • GnRH, LH • Parathormon, calsitonin • Estrogen, progesteron, adrenal steroids

  17. ENZYMES OF HUMAN MILK • Lipase • Lipoprotein lipase • Galactosll transferase • Sülfidril oksidase • Lactoperoksidase, tiyosiyanat, hidrojen peroksit • Lysosyme, peroksidase

  18. Protect the babies from diarrheal disease (Shigella sp, E.coli G.lambilia,rotavirus) Protect the babies from respiratory disease (H.influenzae tip b S.pneumoniae) Protect the babies from other infections: urinary infection, AOM, sepsis, meningitis Prevent allerjik reactions, diaper rash Prevent some chronic disease: IDDM, Çölyak hast., Ülseratif kolit, crohn hast. Prevent obesity, atherosclerosis Higher scores on intelligence tests Establish bonding between mother and baby Protect the mothers from breast ca., over ca., anemia, spinal and pelvis fractures Family Planning Economical ADVANTAGES OF BREASTFEEDING

  19. Stage 1 Pregnancy Second trimester Stage ll Delivery Estrogen, progesteron, placental prolactin produced ductal ve alveolar maturation Estrogen, progesteron decrease, prolaktin level is high Proactin stimulated breast gland and milk production starts LACTOGENESIS

  20. Infant sucks Prolaktin (milk production) Oksitosin (milk secretion) Message reaches Hypothalamus Oxytocin is secreted from posterior pituitary gland Prolactin is secreted from anterior pituitary gland Situmulates milk producing cells and milk production can start Stimulates the contraction of the myoepithelial cells around the milk glands, ducts. Milk is transported to lactiferous sinuses. PHYSIOLOGY OF LACTATION

  21. Advantages of rooming in Mother can respond to baby Babies cry less, so less temptation to give bottle feeds Mothers more confident about breastfeeding Breastfeeding continue longer Advantages of demand feeding Breastmilk comes in sooner Baby gains weight faster Fewer difficulties such as engorgement Breastfeeding more easily estabilished ADVANTAGES OF ROOMİNG-IN DEMAND FEEDING

  22. MORE FEEDING=MORE SIGNALS=MORE MILK(PROVIDED THAT THE SUCKING IS EFFICIENT)

  23. HOW TO HELP A MOTHER WİTH AN EARLY BREASTFEED • Avoid hurry and noise • Ask the mother how she feels and how breastfeeding is going • Observe a breastfeed • Help with positioning if necessary • Give her relevant information • Answer the mothers questions

  24. CONFIDENCE AND SUPPORT SKILLS • Accept what a mother thinks and feels • Recognize praise what a mother and baby are doing right • Give practical help • Give a little, relevant information • Use simple language • Make one or two suggestions, not commands

  25. BREASTFEED OBSERVATION • Body position • Responses • Emotional bonding • Anatomy of breast • Suckling • Time spend suckling

  26. HOW TO HELP A MOTHER TO POSITION HER BABY The Four Key Points: • Mother should hold baby’s body close to hers • Baby’s head and body should be straight line • Baby’s face should face the breast • If baby is newborn,baby’s bottom supported

  27. HOW TO HELP A MOTHER TO HELP THE BABY ATTACH HOW TO HELP THE BABY ATTACH • Touch her baby’s lips with her nipple • Wait until her baby’s mouth is opening wide • Move her baby quickly on to her breast, aim his lower lip below the nipple

  28. SIGNS OF WELL ATTACHMENT TO BREAST AND SUCKLİNG • Mouth wide open • Lower lip turned outwards • Cheeks round • More areola above baby’s mouth • Slow deep sucks • Can see or hear swallowing

  29. CAUSES Inexperienced mother Small or weak baby Use of feeding bottle Breast poorly protractile Lack of skilled support RESULTS Sore nipples Fissures Engorgement Baby unsatisfied, wants to feed a lot Baby refuses to suckle Baby fails to gain CAUSES AND RESULTS OF POOR ATTACHMENT

  30. Poor weight gain Passing small amount of concentrated urine Less than 500g a month Less than birth weight after 2 weeks Less than 6 times a day, yellow and strong smelling RELIABLE SINGS THAT A BABY MAY NOT BE GETTING ENOUGH BREASTMILK

  31. POOSIBLE SINGS THAT A BABY MAY NOT BE GETTING ENOUGH BREASTMILK • Baby not satisfied after breastfeeds • Baby cries often • Very frequent breastfeeds • Very long breastfeeds • Baby refuses to breastfeed • Baby has hard, dry or green stools • No milk comes when mother express • Breasts did not enlarge (during pregnancy) • Milk did not come in (after delivery)

  32. BREASTFEEDİNG FACTORS Delayed start Infrequent feeds No night feeds Short feeds Poor attachment Bottles Complementary feeds MOTHER: PSYCHOLOGICALFACTORS Lack of confidence Worry , stress Dislike of breastfeeding Rejection of baby Triedness COMMEN REASONS WHY A BABY MAY NOT GET ENOUGH BREASTMILK

  33. MOTHER: PHYSICAL CONDITION Contraceptive pill, diuretics Pregnancy Severe malnutrition Alcohol Smoking Retained piece placenta Poor breast development BABY’S CONDITION Illness Abnormality RARE REASONS WHY A BABY MAY NOT GET ENOUGH BREASTMILK

  34. THIS DO NOT EFFECT THE BREASTMİLK SUPPLY • Age of mother • Menstruation • Returning to a job • Age of baby • Caesarian section • Many children • Simple, ordinary diet

  35. CONTRENDİCATIONS OF BREASTFEEDING • Mother with severe disease • Mother with psychosis or severe depression • Mothers with HIV infection • Mothers with HTLV-I (İnsan T-cell lymphotrophic virus-I) infection • Mother with active pulmoner tuberculosis • Mother with active HSV infection on her nipple • Mothers treated with radioactive substances and chemoterapy • Infants with rare metabolic diseases (galactosemia, phenylketonuria and maple syrup urine disease)

  36. BREASTFEEDING WILL BE SUCCESSFUL IN MOST CASES IF : • The mother feels good about herself • The baby is well attached to the breast so that he suckles effectively • The baby suckles as often and for as long as he wants ( at least 10 minutes) • The environment supports breastfeeding

  37. HOW HEALTH SERVICES CAN SUSTAIN BREASTFEEDING • Praise all mothers who are breastfeeding • Help mothers to breastfeed in the most healthy way (breasfeeding counselling) • Encourage mothers to come for help before they decide to start artificial feeds • Remember to encourage breastfeeding when you see a mother for a reason • Help mothers to continue breastfeeding in difficult situations ( returning to work, twin, LBW newborn)

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