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Exclusive breastfeeding in the
provision of breast milk only, with
no other liquids or food given
Complimentary feeding is defined
as giving solid or semi solid foodsin addition to breast milk
DEFINITIONS
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Since 1979 the WHO has recommended
that normal full term infants should be
exclusively breastfed forfour to six
months
Increasing reports suggesting an
association between discontinuing
exclusive breastfeeding prior to sixmonths of age and an increase in infant
morbidity and mortality
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Throughout the world many
professionals as well as a number
of government have
concluded that there is sufficient
evidence to recommend continuing
exclusive breastfeeding forabout
six months
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Nutritional immunologic and endocrine need
were provided by maternal systems
Delivered from a protected intrauterineenvironment sterile, warm, and protective
No longer obtain fluids, nutrients,immune protections, maternal body temperature
and sterile environment
This transition is filled with lifethreatening hazards
Intrauterine
Born
Infant survival
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BREASTMILK BREASTFEEDING
Fig 1. Advantages of Breastfeeding
Perfectnutrients
Easily digestedefficiently used
Protects againstinfection Costs less than
artificial feeding
Protects mothershealth
Helps delay a newpregnancy
Helps bonding anddevelopment
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FAT
PROTEIN
LACTOSE
HUMAN
FAT
PROTEIN
LACTOSE
COW
FAT
PROTEIN
LACTOSE
GOAT
Fig 2. Differences between three types of milks
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WHEY
PROTEINS
CURDS
Fig 3. Differences in the quality of the proteins
in different milks
Antiinfective
proteins
35%
Casein
HUMAN
EASY TODIGEST
80%
Casein
COWS
DIFFICULT TODIGEST
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LIPASE
ESSENTIALFATTY ACIDS
HUMAN COWS
Fig 4. Differences in the fat of different milks
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COWS5070 g/100 ml
HUMAN5070 g/100 ml
ABSORBED
50
%
10
Fig 5. Differences in the iron content in
different milks
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Fig 6. Steps on how breastfeeding protectsagainst infection
Motherinfected
Antibodies to
mothersinfection
secreted inmilk to protect
baby
White cells inmothers body
makeantibodies to
protect mother
Some whitecells go to
breast and makeantibodies there
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PROPERTY IMPORTANCE
Antibody rich
Many white cellsPurgative
Growth factors
Vitamin A rich
Protects against infectionand allergy
Protect against infection
Clears meconium helps toprevent jaundice
Help intestine to matureprevents allergy, intolerance
Reduces severity of infectionprevents eye disease
Fig 7. Importance of colostrums
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EMOTIONAL BONDINGClose, loving relationship betweenmother and baby
Mother more emotionally satisfied
Baby cries less
Mother behaves more affectionately
Less likely to abuse or abandon babyDEVELOPMENT
Children perform better on intelligencetests in later childhood
Fig 8. Benefits of breastfeeding
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Breast milkonly
1.0
3.2
Breast milk &
non-nutritiousliquids
13.3
Breast milk &
nutritioussupplements
17.3
No breast milk
Fig 9. Risk of diarrhoea by feedingmethod
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MOTHER
Fig 10. Dangers of artificial feeding
More diarrhoeaand respiratoryinfections
Persistentdiarrhoea
Malnutritionvitamin Adeficiency
More likelyto die
May becomepregnant sooner
Interferes with bonding
Lower scores onintelligence tests
Overweight
Increased riskof some chronicdiseases
More allergy andmilk intolerance
Increased risk ofanaemia, ovarianand breast cancer
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Fig 12. The prolactin reflex
Secreted AFTERfeed to produceNEXT feed
More prolactinsecreted atnight
Suppresses
ovulation
Prolactinin blood
Babysuckling
Sensory
impulsesfrom nipple
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Fig 14. The oxytocin reflex
These HELP reflex
Worry
Stress
Pain
Doubt
These HINDERreflex
Thinks lovingly
of baby
Sound of baby
Sight of baby
CONFIDENCE
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Fig 15. Good attachment vs poor attachment
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Fig 16. Result of poor attachment
Pain and damage to nipples
Sore nipples
Fissures
EngorgementBreast milk not removed
effectively
Baby unsatisfied,
wants to feed a lotApparent poor milk supply
Breast make less milk
Baby frustated,
refuses to suckle
Baby fails to gain
weight
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Use of feeding
bottle
Inexperiencedmother
Functionaldifficulty
Lack of skilledsupport
Before breastfeedingestablishedFor later supplements
First babyPrevious bottle feeder
Small or weak babyBreast poorly protractileEngorgementLate start
Less traditional help andcommunity support
Doctors, midwives, nurses,
not trained to help
Fig 17. Causes of poor attachment
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Fig 18. The three neonatal reflexes
Rooting reflex
When something toucheslips, baby opens mouthputs tongue down andforward
Sucking reflex
When somethingtouches palate,baby sucks
Swallowing reflex
When mouth fillswith milk, baby
swallows
SkillMotherlearns topositionbaby
Babylearns totakebreast
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FAT
PROTEIN
LACTOSE
FULL TERM
FAT
PROTEIN
LACTOSE
PRETERM
Fig 19. Difference between preterm and termbreastmilk
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Fig 20. Breastfeeding a sick baby
If breastfeedingstops
Breastmilk decreases
Baby may refuse tostart again
gets less nourishmentloses more weighttakes longer to recover
lacks comfort of suckling
Baby
If breastfeedingcontinues
gets best nourishmentloses less weightrecovers more quickly
is comforted by suckling
Breastmilk is produced
Breastfeeding continues
Baby
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Breastfeedingcontraindicated
Some anticancer drugsRadioactive substances(temporarily)
Continue breastfeeding :Side effects possibleMonitor baby for
drowsiness
Psychiatric drugs andanticonvulsants
Use alternative drug ifpossible
Monitor baby forjaundice
Chloramphenicol,tetracycline, metronidazole
Sulphonamides,cotrimoxazole, dapsone
Use alternative drug(May decrease milksupply)
Oestrogen containingcontraceptives
Thiazide diureticsSafe in usual dosage Most commonly used drugs
Fig 21. Breastfeeding and mothers medication
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RECOMMENDED PRACTICES TO
IMPROVE INFANT NUTRITION
DURING THE FIRST SIX MONTHS:
Initiate b.f. within about one hour of birth
Establish good b.f. skills (proper
positioning, attachment, and effective
feeding)
Breastfeed exclusively for about the first
six months
(Linkages-WHO, Feb 2001)
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Practice frequent, on - demand b.f.,including night feed
In areas where vitamin A deficiency
occurs, lactating women should take ahigh - dose vitamin A supplement
(200.000 i.u.) as soon as possible after
delivery, but no later than 8 weeks
postpartum, to ensure adequate vitaminA content in breastmilk
(Linkages-WHO, Feb 2001)
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Continue on - demand b.f. and introduce
complementary foods beginning around6 months of age
(Linkages-WHO, Feb 2001)
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Using the available information onthe development of infants
immunologic, gastrointestinal, oralmotor function, reproductive
physiology and nutrient adequacy
the expert concluded that the probable ageof readiness for most full term infants to
discontinue exclusive b.f. and begincomplementary foods appears to be near
six months or perhaps a little beyond
CONCLUSION
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