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 foods
in addition to breast milk
DEFINITIONS
Since 1979 the WHO has recommended
that normal full term infants should be
exclusively breastfed for four to six
months


Increasing reports suggesting an
association between discontinuing
exclusive breastfeeding prior to six
months of age and an increase in infant
morbidity and mortality
Throughout the world many
professionals as well as a number
of government have
concluded that there is sufficient
evidence to recommend continuing
exclusive breastfeeding for about
six months
Nutritional immunologic and endocrine need
were provided by maternal systems
Delivered from a protected intrauterine
environment sterile, warm, and protective
No longer obtain fluids, nutrients,
immune protections, maternal body temperature
and sterile environment
This transition is filled with life
threatening hazards
Intrauterine
Born
Infant survival
BREASTMILK BREASTFEEDING
Fig 1. Advantages of Breastfeeding
Perfect
nutrients
Easily digested
efficiently used
Protects against
infection
Costs less than
artificial feeding
Protects mothers
health
Helps delay a new
pregnancy
Helps bonding and
development
FAT
PROTEIN
LACTOSE
HUMAN
FAT
PROTEIN
LACTOSE
COW
FAT
PROTEIN
LACTOSE
GOAT
Fig 2. Differences between three types of milks
WHEY
PROTEINS
CURDS
Fig 3. Differences in the quality of the proteins
in different milks
Anti infective
proteins
35%
Casein
HUMAN
EASY TO
DIGEST
80%
Casein
COWS
DIFFICULT TO
DIGEST
LIPASE

ESSENTIAL
FATTY ACIDS
HUMAN COWS
Fig 4. Differences in the facts of different milks
COWS
50 70 g/100 ml
HUMAN
50 70 g/100 ml
ABSORBED
50
%
10
Fig 5. Differences in the iron content in
different milks
Fig 6. Steps on how breastfeeding protects
against infection
Mother
infected
Antibodies to
mothers
infection
secreted in
milk to protect
baby
White cells in
mothers body
make
antibodies to
protect mother
Some white
cells go to
breast and make
antibodies there
PROPERTY IMPORTANCE
Antibody rich

Many white cells
Purgative

Growth factors

Vitamin A rich
Protects against infection
and allergy
Protect against infection
Clears meconium helps to
prevent jaundice
Help intestine to mature
prevents allergy, intolerance
Reduces severity of infection
prevents eye disease
Fig 8. Importance of colostrums
EMOTIONAL BONDING
Close, loving relationship between
mother and baby
Mother more emotionally satisfied
Baby cries less
Mother behaves more affectionately
Less likely to abuse or abandon baby
DEVELOPMENT
Children perform better on intelligence
tests in later childhood
Fig 9. Benefits of breastfeeding
Breast milk
only
1.0
3.2
Breast milk &
non-nutritious
liquids
13.3
Breast milk &
nutritious
supplements
17.3
No breast milk
Fig 10. Risk of diarrhoea by feeding
method
MOTHER
Fig 12. Dangers of artificial feeding
More diarrhoea
and respiratory
infections
Persistent
diarrhoea
Malnutrition
vitamin A
deficiency
More likely
to die
May become
pregnant sooner
Interferes with bonding
Lower scores on
intelligence tests
Overweight
Increased risk
of some chronic
diseases
More allergy and
milk intolerance
Increased risk of
anaemia, ovarian
and breast cancer
Fig 13. Anatomy of the breast
oxytocin makes
them contract
Prolactin
makes them
secrete milk
milk
collects
here
ducts
milk secreting
cells
muscle cells
Supporting
tissue and fat
lactiferous sinuses
nipple
areola
Montgomerys glands
alveoli
Fig 14. The prolactin reflex
Secreted AFTER
feed to produce
NEXT feed
More prolactin
secreted at
night
Suppresses
ovulation
Prolactin
in blood
Baby
suckling
Sensory
impulses
from nipple
Fig 15. The oxytocin reflex
Works BEFORE or
DURING feed to
make milk FLOW
Makes uterus
contract
Oxytocin
in blood
Baby
suckling
Sensory
impulses
from nipple
Fig 16. The oxytocin reflex
These HELP reflex
Worry
Stress
Pain
Doubt
These HINDER
reflex
Thinks lovingly
of baby
Sound of baby
Sight of baby
CONFIDENCE
Fig 18. Good attachment vs poor attachment
Fig 20. Result of poor attachment
Pain and damage to nipples
Sore nipples
Fissures
Engorgement
Breast milk not removed
effectively
Baby unsatisfied,
wants to feed a lot
Apparent poor milk supply
Breast make less milk
Baby frustated,
refuses to suckle
Baby fails to gain
weight
Use of feeding
bottle


Inexperienced
mother

Functional
difficulty


Lack of skilled
support
Before breastfeeding
established
For later supplements

First baby
Previous bottle feeder

Small or weak baby
Breast poorly protractile
Engorgement
Late start

Less traditional help and
community support
Doctors, midwives, nurses,
not trained to help
Fig 21. Causes of poor attachment
Fig 22. The three neonatal reflexes
Rooting reflex
When something touches
lips, baby opens mouth
puts tongue down and
forward
Sucking reflex
When something
touches palate,
baby sucks
Swallowing reflex
When mouth fills
with milk, baby
swallows
Skill
Mother
learns to
position
baby
Baby
learns to
take
breast
FAT
PROTEIN
LACTOSE
FULL TERM
FAT
PROTEIN
LACTOSE
PRETERM
Fig 23. Difference between preterm and term
breastmilk
Fig 25. Breastfeeding a sick baby
If breastfeeding
stops
Breastmilk decreases
Baby may refuse to
start again
gets less nourishment
loses more weight
takes longer to recover
lacks comfort of suckling
Baby
If breastfeeding
continues
gets best nourishment
loses less weight
recovers more quickly
is comforted by suckling
Breastmilk is produced
Breastfeeding continues
Baby
Breastfeeding
contraindicated
Some anticancer drugs
Radioactive substances
(temporarily)
Continue breastfeeding :
Side effects possible
Monitor baby for
drowsiness
Psychiatric drugs and
anticonvulsants
Use alternative drug if
possible
Monitor baby for
jaundice
Chloramphenicol,
tetracycline, metronidazole
Sulphonamides,
cotrimoxazole, dapsone
Use alternative drug
(May decrease milk
supply)
Oestrogen containing
contraceptives
Thiazide diuretics
Safe in usual dosage Most commonly used drugs
Fig 27. Breastfeeding and mothers medication
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)
Practice frequent, on - demand b.f.,
including night feed

In areas where vitamin A deficiency
occurs, lactating women should take a
high - dose vitamin A supplement
(200.000 i.u.) as soon as possible after
delivery, but no later than 8 weeks
postpartum, to ensure adequate vitamin
A content in breastmilk
(Linkages-WHO, Feb 2001)
Continue on - demand b.f. and introduce
complementary foods beginning around
6 months of age
(Linkages-WHO, Feb 2001)
Using the available information on
the development of infants
immunologic, gastrointestinal, oral
motor function, reproductive
physiology and nutrient adequacy
the expert concluded that the probable age
of readiness for most full term infants to
discontinue exclusive b.f. and begin
complementary foods appears to be near
six months or perhaps a little beyond
CONCLUSION