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Breastfeeding Techniques and Challenges

The document discusses techniques for breastfeeding and formula feeding. It provides details on proper positioning for breastfeeding, the importance of the rooting reflex, encouraging milk production, and burping the infant. Formula feeding should mimic breastfeeding positions. The document also compares the nutritional composition of breast milk and cow's milk, lists different types of milk used in formulas, and discusses common first year feeding problems like underfeeding, overfeeding, regurgitation, diarrhea, constipation, and colic.

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23 views4 pages

Breastfeeding Techniques and Challenges

The document discusses techniques for breastfeeding and formula feeding. It provides details on proper positioning for breastfeeding, the importance of the rooting reflex, encouraging milk production, and burping the infant. Formula feeding should mimic breastfeeding positions. The document also compares the nutritional composition of breast milk and cow's milk, lists different types of milk used in formulas, and discusses common first year feeding problems like underfeeding, overfeeding, regurgitation, diarrhea, constipation, and colic.

Uploaded by

api-3829364
Copyright
© Attribution Non-Commercial (BY-NC)
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Pediatrics

Dr. Haydar
1-Oct-06 Lec: -2-

Technique of Breast Feeding

The mother should be comfortable and the infant positioned so that nothing
interfere with mouth to breast contact . The breast from which the infant nurses
should be supported with opposite hand , with the thumb and index fingers above
nipple to allow the infant easy access to the nipple .
The rooting reflex should be explained to the parents to make initiation of breast
feeding easier . The entire nipple and most of the areola should be placed in the infant
mouth .
Breast feeding should begin as soon as after delivery as the condition of the
mother and baby is permits that .
Psychological condition of the mother is very important in giving successful
breast feeding , for example worry and unhappiness are the most effective means for
decreasing or abolishing breast secretions .
Encouragement of good hygiene and good diet of the mother are also important
for good breast feeding .

The infant should empty at least one breast at each feeding ; otherwise , it will not to
be stimulated to refill . Both breast should be used at each feeding in the early weeks
to encourage maximal production of milk ( by milk ejection reflex ) .
At the end of nursing period , the infant should be held erect over the mother
shoulder or on her lap with or without gently rubbing or patting the back to assist in
expelling the swallowed air .

Formula Feeding :-

The basis for most formulas are whole cows milk or its modified forms .Breast
milk are considered superior to formula feeding , in spite of that many infants
received formula feeding from birth , either they employed outside the home , or
many mothers are reluctant to nurse their infants , other believe that nursing will limit
their activities or they fear failure of nursing , and some consider breast feeding
socially unacceptable . The technique of formula feeding is similar to that of breast
feeding with the caregiver and the infant in comfortable position . The milk should be
warmed to a suitable temperature , and eructation of swallowed air during feeding is
very important to avoid regurgitation or abdominal discomfort .

Full term baby require 150-170 ml/kg/24 hr , this amount is very important for
maintain of haemostasis and in preventing hyperosmolarity and this amount of water
must be present in artificial formula .
Most of the artificial formulas now a day contain added vitamins and minerals .

1
Differences between Breast Milk and Cow Milk :-

1) Colostrum :- it is found in breast milk and not found in cow milk . Colostrum
is the secretion of breast during the later part of the pregnancy and for the 2-4
days after delivery , it has deep lemon –yellow color , it is alkaline in reaction
. The total amount of secretion 20-40 ml per day , it contains several times
protein more than the usual breast milk and more minerals but less
carbohydrates and fat , also it contains unique immunologic factors .
2) Water :- the amount in each one is nearly same .

3) Calories :- the energy value may vary slightly ( about 20 kcal per oz or 0.67
per ml ) .
4) Protein :- cows milk contains 3 times protein more than breast milk ( cows
milk contains 3.3% protein ) . Other difference is that cows milk protein is
mainly of casein while breast milk protein mainly of whey protein .
5) Carbohydrate :- human milk contains 6.5-7% and cows milk 4.5% of lactose .
6) Fat :- the fat content of cows milk is about 3.5 , in human milk the fat varies
somewhat with maternal diet . The fat of each mainly of triglyceride , but
human milk contains more absorbable type ,olein
7) Minerals :- cows milk contains much more of all the minerals except iron and
copper than human milk . Breast milk iron although low , but it is better
absorbed through the infant G.I.T.
8) Vitamins :- cows milk is low in vitamin C and D . Breast milk contains
adequate amount of vitamin C if the mother eats appropriates foods . Also vit
D is adequate unless the mother is insufficiently exposed to sun light or has
darkly pigmented skin . Cows milk contains more vitamin K . Vit A and B are
same in both
9) Bacterial content :- human milk is usually not contaminated , but many
pathogenic microorganisms may enter breast milk through mastitis like TB ,
typhoid , herpes virus , rubella , HB , mumps and H.I.V. while cows milk is
usually contaminated by pathogenic and non-pathogenic bacteria .
10) Digestibility :- usually cows milk forms large curd than breast milk , and cows
milk is less digestible than breast milk . But curd in cows milk can be reduced
by boiling .

Milk used in formula :-

There are many types of milk used formula , like :-


Raw milk , pasteurized milk , homogenized milk , evaporated milk , prepared
milk , dried whole milk , dried skim milk , acid and fermented milk , goat milk , milk
protein , milk substitutes and hypoallergenic milk , elemental dietary substitutes for
milk .

2
First year Feeding Problems :-

1) Underfeeding :- usually suggested by restlessness and crying and by failure to


gain weight adequately , also constipation , failure to sleep and irritability .
Treatment consist of increasing fluid and caloric intake .
2) Overfeeding :- it is either quantitative or qualitative , usually characterized by
regurgitation , vomiting , abdominal distention and discomfort with flatulence
and rapid gaining of weight . Treated by decreasing the caloric intake to
acceptable level and education of the parents about proper feeding of infant .
3) Regurgitation and vomiting :- regurgitation means retaining of small amount
of swallowed food and occur immediately after feeding while vomiting occur
some time after feeding . Regurgitation is a natural occurrence during the first
6 month of life or it may be due to over feeding , while vomiting may be due
to underlying pathology or disease .
4) Loose or diarrhea stool :- the stool of the breast milk infant is usually softer
and more frequent than cows milk fed infant .

Loose stool may be due to overfeeding . Actual diarrhea in breast fed infant is unusual
and should be considered infectious until proved otherwise .

5) Constipation :- the etiology of it in breast fed infant is usually unknown


especially in one who receiving adequate amount of milk , nearly the same in
cows milk fed infants . Whenever constipation or obstipation is present since
birth or shortly after that , so rectal examination should be performed .
Constipation in artificially fed infants may be caused by insufficient amount of
food or fluid , or may be due to diets containing too much fat or protein .
Treated by prune juice as temporary measure or add some bulk to food
( fibers) enemas and suppositories should never be more than temporary
measures .
6) Colic :- it is paroxysmal abdominal pain characterized by sever crying ,
flushing of face , circumoral pallor , abdominal distention and the legs are
draw up on the abdomen . The etiology usually not clear , but it may be
associated with hunger and with swallowed air that pass to the intestine . Or
may be due to over feeding or high carbohydrate diets . Careful physical
examination should be done to exclude intussusception or strangulated hernia ,
also hair in infant eye , otitis media , nephritis or other infections or
pathologies should be excluded .

Written By:
Rand Aras Najeeb

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Common questions

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Colostrum, the initial secretion from the breast during late pregnancy to a few days post-delivery, contains a higher concentration of protein and immune factors compared to mature breast milk . These components are crucial for infant development as they provide necessary proteins for growth and immunological protection that quell potential infections during the early stages of life . Colostrum's unique deep lemon-yellow color and alkaline nature distinguish it from mature breast milk .

Human breast milk contains mainly whey protein, while cow's milk is primarily composed of casein, making the protein content of cow's milk three times higher than that of breast milk . In terms of digestibility, breast milk forms a softer curd and is more digestible than cow's milk, which forms a larger curd, although boiling cow's milk can reduce the curd size .

Initiating breastfeeding immediately post-delivery holds significant implications for both mother and infant. It promotes bonding, stimulates milk production, and can begin to establish a healthy feeding routine if the mother and infant's conditions permit . This early initiation leverages the infant's rooting reflex, which simplifies breastfeeding commencement, and aids in the psychological adaptation as it helps the mother gain confidence in breastfeeding .

Colic is characterized by paroxysmal abdominal pain, leading to severe crying, flushed face, and abdominal distention. The exact cause is unclear but may be related to intestinal gas from overfeeding or inappropriate diets . Management involves ruling out other serious issues like infections, adjusting feedings to prevent air swallowing, and sometimes dietary changes. Environmental modifications, such as maintaining calm environments and gentle massaging, can also help alleviate symptoms .

Contamination of breast milk can occur through mastitis related to infections such as TB, typhoid, and viruses like herpes, rubella, and HIV. Cow's milk is often contaminated with pathogenic and non-pathogenic bacteria . These hazards are mitigated for breast milk by maintaining proper hygiene and treating any underlying infections promptly. For cow's milk, pasteurization and proper handling procedures reduce the risk of bacterial contamination before consumption .

Cow's milk contains higher levels of most minerals compared to human breast milk, except for iron and copper, which are more bioavailable in breast milk . The significance of this composition lies in the infant's capacity to absorb nutrients; breast milk's lower mineral content is adequate due to its higher bioavailability, supporting healthy growth and development without overloading the infant's developing kidneys .

The psychological condition of the mother significantly impacts breast milk production. Stress factors such as worry and unhappiness can decrease or even abolish breast secretions . To mitigate these negative impacts, ensuring the mother's comfort and emotional well-being is crucial. Encouraging good hygiene and a well-balanced diet can also support successful breastfeeding .

Burping is essential post-feeding because it helps expel swallowed air that can cause discomfort and regurgitation in infants. Recommended techniques include holding the infant erect over the mother's shoulder or on her lap while gently rubbing or patting the back . This practice eases digestion and prevents abdominal discomfort .

Underfeeding is typically addressed by increasing the infant's fluid and caloric intake to alleviate symptoms such as restlessness, crying, and inadequate weight gain . In contrast, overfeeding, which may result in symptoms like regurgitation and abdominal discomfort, should be managed by decreasing caloric intake to an acceptable level and educating parents on proper feeding practices .

Breastfeeding techniques emphasize the importance of positioning for both mother and infant to facilitate mouth-to-breast contact and encourage milk production through the milk ejection reflex. Psychological factors of the mother play a significant role in successful breastfeeding . In contrast, formula feeding requires precision in preparing and warming the formula, with careful attention to preventing regurgitation by managing the amount of swallowed air . Both methods require comfort and careful attention to the infant's cues, but they demand different types and levels of parental involvement, especially in monitoring and preparation .

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