newborn nutrition and growth
TRANSCRIPT
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Newborn Newborn NutritionNutrition
Dr Varsha atul Shah Dr Varsha atul Shah
Department of Department of NeonatologyNeonatology
Singapore General Singapore General HospitalHospital
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Newborn nutritionNewborn nutrition
Newborns adapt rapidly from a relatively Newborns adapt rapidly from a relatively constant intrauterine supply of nutrients constant intrauterine supply of nutrients to intermittent feeding of milkto intermittent feeding of milk
Normal, full-term newborns double their Normal, full-term newborns double their birth-weight by about 5 months of life and birth-weight by about 5 months of life and triple their birth-weight by 1 year of lifetriple their birth-weight by 1 year of life
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Principles of nutritional supportPrinciples of nutritional support From 24/52 to 39/52 gestation fetal growth increases at a From 24/52 to 39/52 gestation fetal growth increases at a
rate of approximately 15 g/kg/D rate of approximately 15 g/kg/D
Term neonates loss about 5 to 10% of their birth-weight Term neonates loss about 5 to 10% of their birth-weight in the first 10 days to 2weeks of lifein the first 10 days to 2weeks of life
Preterm infant loss 10 to 20% of their birth-weight Preterm infant loss 10 to 20% of their birth-weight because of their immature skin and kidneys, regain BW because of their immature skin and kidneys, regain BW by 7-14 daysby 7-14 days
Term infants have sufficient glycogen and fat store to Term infants have sufficient glycogen and fat store to meet energy demands while preterm infants rapidly meet energy demands while preterm infants rapidly deplete their limited endogenous nutrient store and hence deplete their limited endogenous nutrient store and hence become hypoglycaemic and catabolicbecome hypoglycaemic and catabolic
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How to assess nutrient How to assess nutrient requirement requirement
in preterm infants?in preterm infants?
Use intrauterine growth chartsUse intrauterine growth charts
Use nutrient accretion rate dataUse nutrient accretion rate data
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Nutritional GoalNutritional Goal
To achieve normal growth and To achieve normal growth and developmentdevelopment
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Nutrient requirementsNutrient requirements
Energy (EEnergy (Eintakeintake = E = E storedstored + E + Eexpendedexpended + E + Eexcreted excreted ))
Healthy term babies grow well with intake of Healthy term babies grow well with intake of 90-120 90-120
kcal/kg/Dkcal/kg/D
125 - 140 kcal/kg/D125 - 140 kcal/kg/D is the energy required by preterm is the energy required by preterm
infants to achieve a growth rateinfants to achieve a growth rate of 15 g/kg/Dof 15 g/kg/D
Conditions that result in increased energy requirements Conditions that result in increased energy requirements
include; CLD, steroid therapy and infection etcinclude; CLD, steroid therapy and infection etc
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Nutrient requirementsNutrient requirements
WaterWater
Infant’s water requirements depend on Infant’s water requirements depend on gestational age, postnatal age and gestational age, postnatal age and environmental conditions (phototherapy, environmental conditions (phototherapy, radiant warmer)radiant warmer)
Term infants ingest Term infants ingest 140-180 mls/kg/D140-180 mls/kg/D of fluid of fluid
Preterm infants may require fluid intake of up to Preterm infants may require fluid intake of up to 200 ml/kg/D in the first week of life. Conversely 200 ml/kg/D in the first week of life. Conversely fluid restriction may be necessary for infants fluid restriction may be necessary for infants with RDS, CLD CHF, PDA or renal insufficiencywith RDS, CLD CHF, PDA or renal insufficiency
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ProteinProtein
Recommended allowance:15-20 % of daily caloriesRecommended allowance:15-20 % of daily calories
If energy intake is low, dietary protein cannot be utilized If energy intake is low, dietary protein cannot be utilized
fully for tissue synthesis hence azotemia can occurfully for tissue synthesis hence azotemia can occur
Term infants : 2.2 g/kg/DTerm infants : 2.2 g/kg/D can be achieved can be achieved
through through
VLBW infants: 3-3.5 g/kg/DVLBW infants: 3-3.5 g/kg/D protein supplementprotein supplement
ELBW infants: 3.6-3.8 g/kg/DELBW infants: 3.6-3.8 g/kg/D eg. Promodeg. Promod
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FatFat Recommended daily intake: 50% of daily calories for Recommended daily intake: 50% of daily calories for
preterm infants <1750 grams, 30-40% for term and more preterm infants <1750 grams, 30-40% for term and more mature infantsmature infants
Fat intake of > 60% of total calories may lead to ketosisFat intake of > 60% of total calories may lead to ketosis
EFA must be provided in the dietEFA must be provided in the diet
Preterm infants vulnerable to EFA deficiency because of Preterm infants vulnerable to EFA deficiency because of insufficient fat absorption, increased fat requirement and insufficient fat absorption, increased fat requirement and rapid brain growth and myelinization and limited adipose rapid brain growth and myelinization and limited adipose reservesreserves
Fat digestion and absorption is limited in preterm infants Fat digestion and absorption is limited in preterm infants because of bile salt deficiency secondary to reduced because of bile salt deficiency secondary to reduced synthesis and ineffective ileal resorption of bile acidssynthesis and ineffective ileal resorption of bile acids
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CarbohydratesCarbohydrates
Carbohydrate constitute 40-50% of total daily caloriesCarbohydrate constitute 40-50% of total daily calories
Almost all the CHO in the human milk and infant Almost all the CHO in the human milk and infant
formula is lactoseformula is lactose
Preterm formula contains 50% lactose and 50% glucosePreterm formula contains 50% lactose and 50% glucose
Intestinal mucosal lactase activity is active by the 28th Intestinal mucosal lactase activity is active by the 28th
week. Glycosidase activity is also active in preterm week. Glycosidase activity is also active in preterm
infants hence these infants tolerate preterm formula infants hence these infants tolerate preterm formula
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Minerals Minerals
Accretion of Ca, Phosphorus, Mg and iron is maximal Accretion of Ca, Phosphorus, Mg and iron is maximal at the third trimester of pregnancy. Preterm infants at the third trimester of pregnancy. Preterm infants are prone to mineral deficiency because of this as are prone to mineral deficiency because of this as well as difficulty in estabilizing aedquate enteral well as difficulty in estabilizing aedquate enteral intake of the early weeks of life. The intake of the early weeks of life. The daily daily recommended allowancerecommended allowance for preterm infants : for preterm infants :
Sodium/PotassiumSodium/Potassium : 2-3 mEq/kg/D: 2-3 mEq/kg/D
CaCa : 210 mg/kg/D: 210 mg/kg/D
PhorphorusPhorphorus : 140 mg/kg/D: 140 mg/kg/D
MagnesiumMagnesium : 10 mg/kg/D: 10 mg/kg/D
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The quantity of iron in the breast milk is
less compared to infant formula.
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VitaminsVitamins
Are essential metabolic cofactorsAre essential metabolic cofactors
Toxicity can occur with fat-soluble vitamin Toxicity can occur with fat-soluble vitamin because it can be stored in the tissuesbecause it can be stored in the tissues
Toxicity with water-soluble vitamin is unusual Toxicity with water-soluble vitamin is unusual because of high renal clearance and low storage because of high renal clearance and low storage capacitycapacity
Vitamin content in breast milk changes with Vitamin content in breast milk changes with course of lactationcourse of lactation
Preterm infants have no reserve for vitamins, Preterm infants have no reserve for vitamins, hence prone to deficiencyhence prone to deficiency
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VitaminsVitamins
Daily recommended intake:Daily recommended intake:
Vitamin AVitamin A : 1500 iu/kg/D: 1500 iu/kg/D
Vitamin DVitamin D : 400 iu/kg/D: 400 iu/kg/D
Vitamin EVitamin E : 6-12 iu/kg/D: 6-12 iu/kg/D
Vitamin KVitamin K : 0.5-1 mg: 0.5-1 mg
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Trace elementsTrace elements
Are accumulated during the third Are accumulated during the third trimester, hence preterm infants are trimester, hence preterm infants are prone to deficiency statesprone to deficiency states
Most preterm formula have adequate Most preterm formula have adequate amount of trace elements.amount of trace elements.
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Types of enteral feedsTypes of enteral feeds Human milk (provides 67 kcal/100 ml)Human milk (provides 67 kcal/100 ml)
Infant formula (provides 67 kcal/100ml)Infant formula (provides 67 kcal/100ml)
Preterm formula (provides 81 kcal/100 Preterm formula (provides 81 kcal/100 ml)ml)
Transitional formulaTransitional formula
Specialized formula eg. PregestimilSpecialized formula eg. Pregestimil
Anti-reflux formulaAnti-reflux formula
Soy formulaSoy formula
Lactose free formulaLactose free formula
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Soy protein-based formula is Soy protein-based formula is NOT indicated in:NOT indicated in:
baby <1800gbaby <1800g
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Additives to Infant FormulaAdditives to Infant Formula
NucleotidesNucleotides LCPUFAsLCPUFAs TaurineTaurine IronIron PrebioticsPrebiotics Probiotics (bifidobacteria, Probiotics (bifidobacteria,
lactobacillus, saccharomyces, lactobacillus, saccharomyces, streptococcus thermophilus)streptococcus thermophilus)
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Enteral feeding methodEnteral feeding method
Breast feedingBreast feeding
Bottle feedingBottle feeding
Oral gastric feedingOral gastric feeding
Naso-gastric feedingNaso-gastric feeding
Transpyloric feedingTranspyloric feeding
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Human milkHuman milk It is the preferred milk for term infant It is the preferred milk for term infant
When fortified, it is also the nutritionally optimal When fortified, it is also the nutritionally optimal diet for preterm infantsdiet for preterm infants
Milk produced by women who delivered Milk produced by women who delivered prematurely contains increased amount of protein, prematurely contains increased amount of protein, sodium and zinc but decreased amount of Vitamin sodium and zinc but decreased amount of Vitamin A. The composition changes to approach that of A. The composition changes to approach that of term milk after a few weeksterm milk after a few weeks
Human milk contain factors protective of infection – Human milk contain factors protective of infection – leucocytes, immunoglobulins, lactoferrin, lysozymes leucocytes, immunoglobulins, lactoferrin, lysozymes and complementand complement
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Human milkHuman milk Human milk has growth and differentiation factors that may Human milk has growth and differentiation factors that may
promote intestinal maturation (epidermal growth factor)promote intestinal maturation (epidermal growth factor)
Human milk also contain enzymes eg bile salt-stimulated Human milk also contain enzymes eg bile salt-stimulated lipaselipase
Composition of breast milk varies with mother’s health and Composition of breast milk varies with mother’s health and nutritional statusnutritional status
Protein, sodium, mineral and immunoglobulin contents are Protein, sodium, mineral and immunoglobulin contents are highest in colostrum, intermediate in transitional milk and highest in colostrum, intermediate in transitional milk and lowest in the mature milklowest in the mature milk
‘‘Hindmilk’ (milk expressed at the end of a feeding) has the Hindmilk’ (milk expressed at the end of a feeding) has the
highest fathighest fat
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AAP Recommendations AAP Recommendations for Breastfeedingfor Breastfeeding
Human milk for all infants from 0-6 monthsHuman milk for all infants from 0-6 months Breastfeeding to begin within 1 hour of Breastfeeding to begin within 1 hour of
deliverydelivery Frequent nursing 8-12x/dayFrequent nursing 8-12x/day No supplements unless medically indicatedNo supplements unless medically indicated Start weaning after 4-6 monthsStart weaning after 4-6 months Introduce each food type graduallyIntroduce each food type gradually Human milk plus solid food from 6-12 monthsHuman milk plus solid food from 6-12 months Reduce milk feeds correspondinglyReduce milk feeds correspondingly
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Benefits of BreastfeedingBenefits of Breastfeeding Infant Infant
Nutritional composition-less obesityNutritional composition-less obesity Growth and development-improves cognitive Growth and development-improves cognitive
functionfunction Acute illness-reduces diarrhoea,otitis media, Acute illness-reduces diarrhoea,otitis media,
pneumoniapneumonia Chronic diseases-reduces atopy, allergiesChronic diseases-reduces atopy, allergies
Maternal effectsMaternal effects Body composition and metabolismBody composition and metabolism Reduces breast and ovarian cancerReduces breast and ovarian cancer Reduces perimenopausal osteoporosis and Reduces perimenopausal osteoporosis and
fracturefracture Child spacingChild spacing
Economic factorsEconomic factors
Psychosocial aspects-skin to skin contact, bondingPsychosocial aspects-skin to skin contact, bonding
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Contraindications to Contraindications to BreastfeedingBreastfeeding
Miliary TBMiliary TB
Cancer of breastCancer of breast
GalactosemiaGalactosemia
Maternal drug abuseMaternal drug abuse
Maternal medication eg. Maternal medication eg.
chemotherapychemotherapy
Maternal HIV infectionMaternal HIV infection
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Problems associated with Problems associated with BreastfeedingBreastfeeding
UnderfeedingUnderfeeding
Vitamin K low- higher incidence of Vitamin K low- higher incidence of hemorrhagic disease of the newbornhemorrhagic disease of the newborn
Iron low- need to supplement if still Iron low- need to supplement if still on full breastfeeding after 6 months on full breastfeeding after 6 months
Prolonged unconjugated Prolonged unconjugated hyperbilirubinemiahyperbilirubinemia
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Recognised benefits of breastfeeding include all of
the following EXCEPT:
Lesser risk of haemorrhagic disease of the
newborn.
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Nursing Feeding GuidelinesNursing Feeding Guidelines
Choice of nutrition for newborn is in Choice of nutrition for newborn is in accordance to the parent’s wishesaccordance to the parent’s wishes
Breastfeeding should always be Breastfeeding should always be encouragedencouraged
Consult mother before offering Consult mother before offering formula milk to infantformula milk to infant
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Feeding of Healthy NewbornFeeding of Healthy Newborn
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Full term healthy baby Full term healthy baby requiredrequired
90 – 120 kcal / kg / day90 – 120 kcal / kg / day
Intake of fluid targeted atIntake of fluid targeted at 140 – 180 ml / kg / day140 – 180 ml / kg / day
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Benefits of breast milk to the Benefits of breast milk to the babybaby
Breast milk and human colostrum are made for babies Breast milk and human colostrum are made for babies and is the best first foodand is the best first food
Easily digested and well absorbedEasily digested and well absorbed Contains essential amino acids Contains essential amino acids Rich in polyunsaturated essential fatty acidsRich in polyunsaturated essential fatty acids Carbohydrate content in human milk is higher than Carbohydrate content in human milk is higher than
cow’s milkcow’s milk.. Better bioavailability of iron and calciumBetter bioavailability of iron and calcium Lesser risk of haemorrhagic disease of the newbornLesser risk of haemorrhagic disease of the newborn The quantity of iron in the breast milk is less comparedThe quantity of iron in the breast milk is less compared
cow’s milk formulacow’s milk formula..
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Problems associated with Problems associated with BreastfeedingBreastfeeding
UnderfeedingUnderfeeding
Vitamin K low- higher incidence of Vitamin K low- higher incidence of hemorrhagic disease of the newbornhemorrhagic disease of the newborn
Iron low- need to supplement if still Iron low- need to supplement if still on full breastfeeding after 6 months on full breastfeeding after 6 months
Prolonged unconjugated Prolonged unconjugated hyperbilirubinemiahyperbilirubinemia
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Contraindications to Contraindications to BreastfeedingBreastfeeding
Miliary TBMiliary TB
GalactosemiaGalactosemia
Maternal drug abuseMaternal drug abuse
Maternal medication eg. Maternal medication eg.
chemotherapychemotherapy
Maternal HIV infectionMaternal HIV infection
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Nursing Feeding GuidelinesNursing Feeding Guidelines
Choice of nutrition for newborn is in Choice of nutrition for newborn is in accordance to the parent’s wishesaccordance to the parent’s wishes
Breastfeeding should always be Breastfeeding should always be encouragedencouraged
Consult mother before offering Consult mother before offering formula milk to infantformula milk to infant
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Benefits of breast milk Benefits of breast milk (contd.)(contd.)
Protects against infectionProtects against infection Prevents allergiesPrevents allergies Better intelligence Better intelligence Promotes emotional bondingPromotes emotional bonding Less heart disease, diabetes and Less heart disease, diabetes and
lymphoma lymphoma
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1. Mother infected
4. Antibody to mother’s infection secreted in milk to protect baby
2. WBC in mother’s body make antibodies to protect mother
3. Some WBCs go to breast and make antibodies there
Protection against Protection against infectioninfection
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Benefits to motherBenefits to mother
Helps in involution of uterusHelps in involution of uterus Delays pregnancyDelays pregnancy Decreases mother’s workload, saves Decreases mother’s workload, saves
time and energytime and energy Lowers risk of breast and ovarian Lowers risk of breast and ovarian
cancercancer Helps regain figure faster Helps regain figure faster
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Benefits to familyBenefits to family
Contributes to child survivalContributes to child survival
Saves moneySaves money
Promotes family planningPromotes family planning
Environment friendlyEnvironment friendly
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Anatomy of breastAnatomy of breastMyoepithelial cells
Epithelial cells
ducts
Lactiferous sinus
Areola
Montgomery gland
AlveoliSupporting tissue and fat
Nipple
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Physiology of lactation Physiology of lactation
Hormonal secretions in the motherHormonal secretions in the mother Prolactin helps in production of milkProlactin helps in production of milk
Oxytocin causes ejection of milkOxytocin causes ejection of milk
Reflexes in the baby – rooting, sucking Reflexes in the baby – rooting, sucking
& swallowing & swallowing
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Prolactin productionProlactin production
Enhanced byEnhanced by How early the baby is put to the breastHow early the baby is put to the breast How often and how long baby feeds at How often and how long baby feeds at
breastbreast How well the baby is attached to the How well the baby is attached to the
breast breast
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Prolactin reflexProlactin reflex
Hindered byHindered by Delayed initiation of breastfeedsDelayed initiation of breastfeeds Prelacteal feedsPrelacteal feeds Making the baby wait for feedsMaking the baby wait for feeds Dummies, pacifiers, bottlesDummies, pacifiers, bottles Certain medication given to mothersCertain medication given to mothers Painful breast conditions Painful breast conditions
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Enhancing factors Hindering factors
Emptying of breast
Sucking
Expression of milk
Night feeds
Bottle feeding,Incorrect positioning,
Painful breast
Sensory impulse from nipple
Prolactin in blood
Prolactin “milk secretion” Prolactin “milk secretion” reflexreflex
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Baby sucking
Sensory impulse from nipple to brain
Oxytocin contracts myoepithelial cells
Oxytocin “milk ejection” reflexOxytocin “milk ejection” reflex
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•Thinks lovingly of baby
•Sound of the baby
•Sight of the baby
•CONFIDENCE
•Worry
•Stress
•Pain
•Doubt
Stimulated by Inhibited by
Oxytocin reflexOxytocin reflex
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Mother learns to position baby
Baby learns to take breast
Rooting reflex
Swallowing reflex
Sucking reflex
Feeding reflexes in the babyFeeding reflexes in the baby
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Composition of preterm and full Composition of preterm and full term milk (g/dl)term milk (g/dl)
3.5
1.0
7.0
Fat
Protein
Lactose
3.5
2.0
6.0
Full Term Preterm
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How breast milk composition varies
Colostrum Foremilk Hindmilk
Fat
Protein
Lactose
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For successful breastfeedingFor successful breastfeeding
A willing and motivated motherA willing and motivated mother
An active and sucking newbornAn active and sucking newborn
A motivator who can bring both mother and A motivator who can bring both mother and
newborn together ( health professional or newborn together ( health professional or
relative )relative )
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Successful breastfeedingSuccessful breastfeeding
Have a written breastfeeding policyHave a written breastfeeding policy
Motivate mother from antenatal periodMotivate mother from antenatal period
Put to breast within 30 minutes of birthPut to breast within 30 minutes of birth
Promote rooming -in of mother and babyPromote rooming -in of mother and baby
Promote frequent breastfeedingPromote frequent breastfeeding
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Successful breastfeeding Successful breastfeeding (contd.)(contd.)
Don’t give prelacteal feedsDon’t give prelacteal feeds
Don’t use bottle to feedDon’t use bottle to feed
Support mother in breastfeeding the babySupport mother in breastfeeding the baby
Arrange mother craft classes in health facilitiesArrange mother craft classes in health facilities
Treat breastfeeding problems earlyTreat breastfeeding problems early
Exclusive breastfeeding till 6 monthsExclusive breastfeeding till 6 months
Addition of home-based semisolids after 6 monthsAddition of home-based semisolids after 6 months
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Position of baby in relation to Position of baby in relation to the motherthe mother
The baby’s whole body should face the The baby’s whole body should face the mother and be close to hermother and be close to her
The baby’s head and neck should be The baby’s head and neck should be supported, in a straight line with his body, to supported, in a straight line with his body, to face the breastface the breast
Baby’s abdomen should touch mother’s Baby’s abdomen should touch mother’s abdomen, to be as close as possible to his abdomen, to be as close as possible to his mothermother
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Signs that a baby is attached Signs that a baby is attached well at the breast well at the breast
The baby’s mouth is wide openThe baby’s mouth is wide open The baby’s chin touches the breastThe baby’s chin touches the breast The baby’s lower lip is curled outwardThe baby’s lower lip is curled outward Usually the lower portion of the Usually the lower portion of the
areola is not visibleareola is not visible
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Signs that a baby is attached well at Signs that a baby is attached well at the breast the breast
baby’s mouth is wide openlower lip is curled outward
lower portion of the areola is not visible
chin touches the breast
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Treatment of inverted nippleTreatment of inverted nipple
Treatment should begin after Treatment should begin after birthbirth
Syringe suction methodSyringe suction method Manually stretch and roll Manually stretch and roll
the nipple between the the nipple between the thumb and finger several thumb and finger several times a daytimes a day
Teach the mother to grasp Teach the mother to grasp the breast tissue so that the breast tissue so that areola forms a teat, and areola forms a teat, and allows the baby to feedallows the baby to feed
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Sore nippleSore nipple
CausesCauses Incorrect attachment : Nipple Incorrect attachment : Nipple
sucklingsuckling Frequent use of soap and waterFrequent use of soap and water Candida (fungal) infectionCandida (fungal) infection
Treatment Treatment Continue breastfeeding and Continue breastfeeding and
correct the position & attachment correct the position & attachment Apply hind milk to the nipple after Apply hind milk to the nipple after
a breastfeed a breastfeed Expose the nipple to air between Expose the nipple to air between
feedsfeeds
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Breast engorgement Breast engorgement CausesCauses Delayed and infrequent Delayed and infrequent
breastfeedsbreastfeeds
Incorrect latching of the babyIncorrect latching of the baby
Treatment Treatment Give analgesics to relieve painGive analgesics to relieve pain
Apply warm packs locallyApply warm packs locally
Gently express milk prior to feedGently express milk prior to feed
Put the baby frequently to the Put the baby frequently to the
breastbreast
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Causes of “Not enough Causes of “Not enough milk”milk”
Not breastfeeding often enoughNot breastfeeding often enough Too short or hurried breastfeedingToo short or hurried breastfeeding Night feeds stopped earlyNight feeds stopped early Poor suckling positionPoor suckling position Poor oxytocin reflex (anxiety, lack of Poor oxytocin reflex (anxiety, lack of
confidence)confidence) Engorgement or mastitisEngorgement or mastitis
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Management of “Not enough Management of “Not enough milk”milk”
Put baby to breast frequentlyPut baby to breast frequently Baby to be correctly attached to breastBaby to be correctly attached to breast Build mother’s confidenceBuild mother’s confidence Use galactogogues judiciously Use galactogogues judiciously
Adequate weight gain and urine frequency 5-6 Adequate weight gain and urine frequency 5-6 times a day are reliable signs of enough milk times a day are reliable signs of enough milk intake intake
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Expressed breast milkExpressed breast milkIndicationsIndications Sick mother, local breast problems Sick mother, local breast problems Preterm / sick babyPreterm / sick baby Working motherWorking mother
StorageStorage Clean wide-mouthed container with tight lidClean wide-mouthed container with tight lid At room temperature 8-10 hrsAt room temperature 8-10 hrs Refrigerator – 24 hours, Freezer - 20° C – for Refrigerator – 24 hours, Freezer - 20° C – for
3 months 3 months
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Ten steps to successful Ten steps to successful breastfeeding breastfeeding
Every facility providing maternity services and Every facility providing maternity services and care for newborn infants shouldcare for newborn infants should
Have a written breastfeeding policy that is Have a written breastfeeding policy that is
routinely communicated to all health care staffroutinely communicated to all health care staff
Train all health care staff in skills necessary to Train all health care staff in skills necessary to
implement this policyimplement this policy
Inform all pregnant women about the benefits and Inform all pregnant women about the benefits and
management of breastfeeding management of breastfeeding
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Ten steps to successful Ten steps to successful breastfeeding breastfeeding
(contd….)(contd….) Help mothers initiate breastfeeding within half Help mothers initiate breastfeeding within half
hour of birthhour of birth Show mothers how to breastfeed, and how to Show mothers how to breastfeed, and how to
maintain lactation even if they are separated maintain lactation even if they are separated
from their infantsfrom their infants Give no food or drink, unless medically Give no food or drink, unless medically
indicatedindicated Practice rooming-in : allow mothers and infants Practice rooming-in : allow mothers and infants
to remain together 24 hrs a dayto remain together 24 hrs a day
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Encourage breastfeeding on demandEncourage breastfeeding on demand Give no artificial teats or pacifiers (also Give no artificial teats or pacifiers (also
called dummies or soothers) to called dummies or soothers) to breastfeeding infantsbreastfeeding infants
Foster the establishment of Foster the establishment of breastfeeding support groups and refer breastfeeding support groups and refer mothers to them on discharge from the mothers to them on discharge from the hospital.hospital.
Ten steps to successful Ten steps to successful breastfeeding breastfeeding
(contd….)(contd….)
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Bottle FeedingBottle Feeding
Parents can share caring for newbornHigher incidence of allergic reaction(cow)Problem with powder concentrationCow milk not acceptable for infant feeding.Too much protein,calcium,phosphate, sodium, potassium
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Parenteral Nutrition (PN)Parenteral Nutrition (PN)
Infused via peripheral or central vein
Indication:When extended period >7days of inability to take enteral feedings