Breast-Feeding, Presentasi Pf Fatimah (Arien)
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Transcript of Breast-Feeding, Presentasi Pf Fatimah (Arien)
dr. Arien Himawan,M.KesPPDS Gizi Klinik
Th 2012
Breast-Feeding
Culture and Breast Feeding
Historical Trends in Breast Historical Trends in Breast FeedingFeeding
THE DEMOGRAPHICS THE DEMOGRAPHICS AND AND
DETERMINANTS OF BREAST-DETERMINANTS OF BREAST-FEEDINGFEEDING
Ethnicity and Breast Feeding in US
The good news is that the U.S. has achieved the first goal
Di Indonesia
SSociocultural ociocultural DDeterminants eterminants
of of BBreast-Feeding reast-Feeding in USin US
Breast Feeding in The Developing World
can be a dangerous source of infection
Maternal Employment & Breast-Feeding
Ten Steps to Successful Breast feeding
1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
2. Train all health care staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within 1 hour of birth.
5. Show mothers how to breastfeed 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 breastfeeding on demand.
9. Give no pacifiers or artificial nipples to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic
A Step-by-Step Approach to Breast-Feeding
THE DECISION TO BRAEST-FEEDThis important decision is usually made early :
about 30% of families decide before pregnancy over 90% by the end of the first trimester of pregnancy
(Post and Singer 1983)A mother choice of feeding methode is
determined by a number of individual, family and sociocultural factors :The emotional motivations The attitude of family members and friendsSocial trends and role models
BREAST-FEEDING EDUCATIONMany hospitals and clinics have developed
breast-feeding education programs
Preparation for Breast-FeedingNipple Conditioning
Mothers should be reassured that breast size does not influence lactation
Nipple Invertion
Early Breast-FeedingThe Postpartum EnvironmentInitiating Breast-FeedingThe First FeedingAdvantage of Early Feedings
The First Two Months of Breast-Feeding
Feeding PatternsBy the third or fourth postpartum day, an infant
typically breast-feeding about 7-8 times a dayconsume 300-400 ml of milk/24 hours Feeding periods average about 10 minutes each breast
The small size of the infant’s stomach the infant will need to be fed frequentlysome infants feeding up to 12-14 times a day
Maternal-Infant Bondinga sense of belonging security and attachment
from the warmth of the mother’s bodyThe closeness and time spent together in the first
month postpartum are important factors in maternal-infant bonding
Importance of Support for The MotherSupport and guidance for the mother during this
periode are critical to continued breast-feeding especially for young, first-time mothers
Stooling Patterns of The Breast-Feeding InfantsStooling begin shortly after birth during the first several days meconium is passed
and the stool appears black and tarryAfter the first week, the breast-feedig infant’s
stools are a mustrad yellow liquid with a yeasty odorThe mother of the breast-feeding infant shoud be
aware many small, yellow, liquid stools are not diarrhea
but the normal pattern
Breast-Feeding Six Months and Beyond
Adding Solid Foods Infants are ready to accept solids
Interest in adult foods show better hand mouth coordinationBegain to lose their vigorous tongue thrust during nursing
Shoud be given at the time of day when mother’s output of milk is lowest
TeethingPrimary theeth began to erupt will bite and chewMost infats quickly learn not to biteQuicky removed when active suckling slow not
allowed to play and nuzzle at nipplePsychological Benefits of Nursings
Feeding more sporadic
WEANING
How Long Should a Mother Breast FeedThe Committee on Nutritional of The US National Academy of
Science recommends exclusive breast feeding for normal Birth – 4 to 6 months
Supplemental feeding is recommended for the remainder of the first year
Immunological benefits and growth factor during newborn period mother should be strongly encouraged to breast feed for at least the first 2 or 3months
The Process of WeaningStudy of culture worldwide the mean age for weaning is around
2.5 yearsSupplemented with other foods 4-6 monthsIn The US 2/3 of mothers stop breast feed before 5-6 months
because of culture attitudesMany infants spontaneously give up breast feeding
supplemental food since 4-6 monthsThere is No ideal duration for breast feeding for all families
Maternal Health During WeaningProblem with plugged duct and breast discomfort
soaking with warm water and manual expression to reduce breast fullness
Weaning & Infant Health in Developing WorldWeaning is a periode when the child is a sharply
increased risk for illness and death (Wharton 1991)During the breast-feeding periode, most infants grow
well and stay relatively healthyAs Supplemental foods began replace breast milk
growth often falters and illness is more commondNo provide immunological benefits of milkSupplemental foods have less nutritional valueWater, food and bottles are frequently contaminated
poor sanitationDiarrheal during weaning is common
Relactation and Induced Lactation
Relactation is the process of restimulating lactationWomen who delivers a low birth weight infant and
spreated from her infant for several weeks will often drop off in milk output
Induced Lactation is the stimulation of lactation in woman who has not been recently pregnant mothers of adopted infants attempt induction and many are at least partially successful in breast feeding
Relactation and induced lactation, the major to milk production is effective, regular suckling of the breasts, together with breast massage and nipple stimulationation
Medication and hormon can be used to help promote lactation
Extraxtion and Storage of Breast Milk
Manual Expression of MilkA simple techniqueMother should wash her handsBreast is massage for several minutes or until mother
feels milk letdownA clean, wide necked container to catch the milk
should be held in one hand, while the other hand pumps the breast
Breast PumpsPrefer to use a breast pumpMore efficient and more comfortableBaby preterm or ill 8 times each day, will avoid
pooling of milk in the glands which can reduce milk secretion
MMilk Storageilk Storage
MMaternal aternal C Concerns oncerns DDuringuring
BBreast-Feedingreast-Feeding
Insufficient Milk and Failure to Thrive
Too Much MilkThe breast become uncomfortably full and leak
milk between feedingMilk output during infant suckling at the
beginning of suckling during milk letdown, so fast and abudant that feeding may be uncomfortable for the infant
If necessary extra milk can be manually express from the best and stored frozen for later use
Breast ProblemsEngorgementLeakingNipple sorenessPlugged Milk DuctsMastitis and Breast Abscesses
Breast-FeedingBreast-Feeding in Special in Special SituationsSituations
Casarean BirthFirst feeding may be deleyed, successful feedings after 12 hours
of deliveryPostoperative pain may inhibit the letdown reflexMother should take pain medication after feeding allows time
for the level of the drug in maternal blood to peak and fall before next feeding
Breast-feeding TwinsFeeding both infants simultaneously and Milk outputs of 1500 to
2500 ml per day
Breast-feeding after Breast SurgeryMay effect a woman’s ability to breast feedSurgery may disrupt the nerve around the nipple and breast, the
milk ducts, the blood supply to the glandsBreast feeding is possible for most women after augmentation
surgeryAfter a breast reduction not possible to breast feedingHad incisions around the aerola as part of their surgery
Infant DisordersRespiratory infections
Upper respiratory tract infections (URIs) common during infancy & interfere with breast feeding
The mother should breast feed while sitting up and hold the infant a more upright position
Nasal secretion should be cleared before beginning feeding
Infant lose some appite when they have an infection need to express some milk manually, usually appetite returns in a day or two
Down’s SyndromeCongenital disorderCan breast feed may take them longer to establish full
suckling 1/3 took more then one week to establish full suckling
The infant has no difficulty suckling immidiately
Cleft lip and PalateCongenital malformations caused by incomplate closure of
the lips and upper jaw during embryonic developmentDifficult for infant to suckleMany infants are fed formulaBreast feeding is possible with some adjustmentsMother assist her infant with a cleft lip in forming a seal
over the nipple by pressing the clift agaist the breast and covering the gap with her finger or thumb
Clift lip are repaired at three weeks postpartum and afterward the infant can ussually breast feed normally
Breast milk JaundiceOne of the metabolic adaptations to life oudside the
uterus is acomplate changeover of hemoglobin in red blood cell which the adult form hemoglobin replaces fetal hemoglobin
Severe replacing breast milk with formula, for 24 hoursThe mother extract regulary to maintain lactation
Metabolic Disorders Galactosemia is a rare 1 in 60.000 infants at birth Infant with galactosemia, one of the enzymes that
metabolizes the galactose to glucose is absent Large amountsof galactose build up, have severe
adverse effesct including metal retardation Galactosemia is contraindicated of breast feeding 1 in 20.000 babies born with Phenylketonuria (PKU)
can not convert phenylalanine to tyrosine Diet rich phenylalanine amino acid accumulated
impairing normal development of the central nervous system and producing metal retardation
Healthy as long as phenylalanine intake is controlled grow and develop normally
Is wean from the breast and placed on a special low phenylalanine formula 6 months as infants fed
No longer contra indication to breast feeding Human milk has relatively low level of phenylalanine
Maternal DisordersDiabetes Mellitus
have beneficial effect on blood sugar control glucose is steadily pulled from maternal blood and converted to galactose and lactose during milk
Chronic diseasescan breast feed successfullylong term therapy with drugs can pass into the milk and harm
the infant formula feeding may be necessery Maternal infections
Not contra indicated during post maternal infectionsAntibodies and immune cell produced by the mother in respon
to infections are passed to the infant in milkThe agents can provide the infant with some protection from
infectionexcample : Rubbella can be passed through breast milk to the infant, but along with the virus travel antibodies and other immune factors that provide passive immunity from the virus, so the baby does not become ill
Breast-Feeding and The Human Immunodeficiency Virus
Protein in Human Milk
Vitamins, Minerals, and Enzymes in Human MilkThe vitamin containt of breast milk is uniquely
suited to the newborn’s need (Lawrence 1994)Mature breast milk contains all of the essensial
mineral necessery for infant growth and development (Riordan 1993)
A variety of enzymes that have digestive functions are secreted into human milk, including lipase, amylase, and proteases are important in that they help the immature gastrointestinal tract of the newborn digest and absorb nutrient in the milk (Hamosh 1989)
Protection from Infectious DiseasesContains a complex variety of anti infective substances
and cell including lymphocytes, immunoglobulins, enzymes, anti imflammatory agents and other protective factors
Breast feeding limits infant exposure to potensial pathogens in other foods and fluids
Adequate breast feeding ensure the nutritional status of the infant, thereby reducing vulverability to disease (Wray 1991)
Contraceptive effects (Wray 1991)Protection From Allergies
Infants are thought to be susceptible to food allergy because their developing intestine is permeable to protein and peptides
Breast feeding defer the introduction of foreign food proteins until the infant’s IgA system become functional and the intestine barrier to food protein mature
Breast-feeding, Maternal Diet and Infant Allergy
Food eaten by a mother during lactation can produce allergies
Cow’s milk consumed by the nursing mother has often been implicated antigens from cow’s milk have been found in the breast milk
In families with strong history of allergy, when suspected food alergens are exclude from the diets
During weaning, solid foods shoud be introduced to the infant implicated
Should be observed for sign of allergy when a new food is introduced
Breast feeding and Chronic Diseases of Later Life
Breast Feeding & Infant Mortality
Thank You