breast feeding indication and contraindications

1. Breast feeding

2. There are 3 types of feeding • Breast feeding • Artificialfeeding(formulafeeding) • Mixedfeeding

3. Breast feeding is the process of feeding an infant with milk produced in a woman’s mammary glands. Breast milk is an ideal food for children of 1-st year because it has related relationship with his tissues. Organizations such as the American Academy of Pediatrics (AAP) recommend that breast feeding has to last at least for the first six months of life. However, it is recommended that some breast feeding continue for 1 year of life and more.

4. Humanmilkcontains • 0.8% to0.9% of protein. Themainproteinsarecasein, alpha-lactalbumin, lactoferrin, IgA, lysozymeandserumalbumin. Non-proteinnitrogen-containingcompoundsincludeurea, uricacid, creatine, creatinine, aminoacidsandnucleotides. • 3% to5% of fat. In breast milk fats composition polyunsaturated fatty acids predominate. • 6.9% to7.2% ofcarbohydrates.Carbohydratesaremainlylactoseandseverallactose-basedoligosaccharideshavebeenidentifiedasminorcomponents. • 0.2% of ash (minerals).

5. Preferences of breast feeding Nutritive value Proteins of breast milk mainly are lactalbumins which have been decomposed by digestive enzymes easy. Proteins of breast milk contain essential amino acids which are necessary for central nerve system’s maturation (methionine, cystine, taurine). Proteins of breast milk contain small quantity of phenylalanine and thirosine that is optimal for metabolism. Breast milk fats contain enzyme lipase which make digestion easier. Polyunsaturated fatty acids are necessary for central nerve system’s maturation especially arachidonic acid. Breast milk carbohydrates mainly are β- lactose. During it’s digestion in intestine acidic pH is created. It promotes for suppression of pathogenic microflora and development of normal microflora. Breast milk contains microelements (iron, copper) and optimal ratio Ca and P (2:1).

6. Hormonal activity - breast milk contains hormones (corticosteroids, thyroxin, adrenocorticotropic hormone and others). Child receives them with milk and it prevents increased load on his hypothalamo-pituitary-thyroid system.

7. Immunological activity - breast milk contains immunoglobulins, macrophages, T- and B- lymphocytes, neutrophils and complement components. Psychological factor – during process of feeding relationship between mother and baby is established.

8. Contraindications • from mother side – cesarean section, large hemorrhage during delivery • from baby side – asphyxia, intracranial birth trauma, hemolytic disease of newborns, prematurity 2-3 degrees, malformations).

9. Common signs of hunger include: • Being more alert or active • Mouthing (putting hands or fists into mouth and making a sucking motion) • Turning head and searching a nipple • In the later stages of hunger, a baby may also cry. During the first few days, the baby can be sleepy and may not be awake to demonstrate any of these signs. For this period, the mother needs to wake the baby every one to two hours for feedings. In addition, the baby may fall asleep during feeding and may need to be awakened to continue feeding.

10. Volume of feeding During first 10 days of life necessary food volume is defined 1. by Zaytsev’s formula V=2%∙M*n 2. formula of Finkelshteyn 70∙n, if birth weight was less than 3200g 80∙n if birth weight was more than 3200 g.

11. Volumetric method • 2 weeks till 6 weeks — 1/5 of weight • 6 weeks till 4 month — 1/6; • 4 month till 6 month— 1/7; • 6 month till 8 month — 1/8; • 8 month till 12 month — 1/9

12. Technique of feeding • Mother should support the breast with her hand by positioning her thumb on top, and her other four fingers on the bottom. The fingers should be kept far back enough so that it leaves enough of the nipple and areola (the darker skin around the nipple) for the baby to latch onto. The mother may need to support her breast for the entire feeding. • Gently slide by nipple from the middle of the baby’s bottom lip, down to the chin. This will encourage the baby to open his mouth.

13. Make sure the baby has taken in much of the areola as possible, with more areola showing at the top lip than at the bottom lip. The baby should not be latched by nipple only. Baby must take areola also to stimulate milk production.

14. Make sure the baby’s nose is nearly touching the breast and not pressed by it. Then, listen to sounds of swallowing and look at movement of baby’s lower jaw.

15. Important hints for mothers • 10-15 min before feeding it is advised to drink cup of tee with milk to stimulation of liquid. • Process of feeding should last 20 min • Taking turns of the breasts every feeding • In case of hypogalactia – both breasts should be used every feeding • Massage and shower after feeding

16. Hypogalactia is the decrease of secretory abilities of mammary gland, which is evident like disorders of lactogenesis, lactopoesis or milk ejection processes, as well as like decrease duration of lactations (less than 5 months). Primary and secondary hypogalactiaaredistinguished.

17. Development of primary hypogalactia is connected with neuro-endocrine disorders on base of general infantilism, endocrine diseases and elderly age of mother at birth of first child.

18. Secondary hypogalactia • complications of pregnancy and delivery • diseases of the mammary glands, • incorrect feeding technique, • absence of the care for mammary glands • somatic diseases • deficient diet of mother • overfatigue and neurasthenia, stresses, psychic traumas, psychological problems. • Secondaryhypogalactiais also promoted by later application to breast, weak sucking reflex of newborn, defects of the development of palate and upper lip in baby.

19. Risk groups of hypogalactia development 1) women with dysfunction of gonads; 2) endocrine pathology, obesity; 3) anemia in anamnesis; 4) pyelonephritis in anamnesis; 5) after caesarean section; 6) after preterm delivery and delayed labor.

20. Ways of lactation maintenance • knowledge about importance and preferences of breast feeding; • correct feeding technique; • calm situation in family; • care of relatives; • sufficient night sleep and day rest; • correct balanced diet;

21. Ways of lactation maintenance • free feeding maternity hospital; • use lactogenic (milk-producing) tea if required • polyvitamins intake.

22. Treatment of hypogalactia • Primary hypogalactia is treated by introduction of hypophyseal hormones: prolactin (lactogenic factor, mammotrophin) and oxytocin.

23. Therapy of secondary hypogalactia • correct diet of mother (walnuts, yeast, honey if there is no allergy on them, leaf lettuce, carrot, watermelon) • additional taking of liquids before and after breast feeding • proper day regimen. • frequent feeding without night break. • to feed a baby from both breasts. • to massage breasts and shower-massage after feeding. • Pumping more frequently

24. Medicamental and physiotherapy treatment • Nicotine acid 50 mg per os 2 times a day for 15-20 minutes before feeding, at ineffectiveness dose can be increased up to 100 mg; • Glutamic acid 1.0 g 3 times a day in 20 minutes after meal, taking sweet tea after it. More efficient is a combination with ascorbic acid – 0.25 g 3 times a day; • Apilak in tablets 0.01 g 3 times a day under language up to complete resorption; • Polyvitamins 1 dragée 3 times a day after meal; • Vitamin E 0.1- 0.2 g 3 times a day

25. At persistent hypogalactia – use the physiotherapy procedures: ultrasound in usual dosage or UVR on mammary glands, covered areolas, electrophoresis with nicotine acid on mammary glands, acupuncture; • At neurosis of mother use sedatives – a valerian, motherwort, peony, during 5-7 days; The complex of treatment is used during 2 weeks, with repetition through 2-3 weeks.

26. Contraindications to breast feeding 1. on the side of mother: • infectious diseases - a tuberculosis, syphilis, tetanus, smallpox • severe chronic diseases in stage of decompensation - a heart diseases, kidneys, liver • acute psychic diseases • malignant neoplasms • using some medicines - isoniasid, cytostatics, antihypertension preparations, lithium salts and others 2. on the side of child: galactosemia, phenylketonuria, disease «urine with smell of maple syrup»