Requerimientos

Visit an antenatal clinic and carry out breast examination with special emphasis on anatomical variations of breasts and nipples

Visit an antenatal clinic and interview a pregnant woman on knowledge, attitude and planned practice on breastfeeding and assess the baby friendly hospital initiative (BFHI) activity of the clinic

Counsel a mother on importance of breastfeeding

Counsel a mother on how to practice exclusive breastfeeding

Visit a postnatal ward and practice positioning and attachment of a newly born baby on the breast

Visit a newborn nursery (special care unit) and assist in the breastfeeding of sick a baby Visit a child health clinic and counsel a mother returning to work after maternity leave on feeding

Visit a local breastfeeding support group and write a report on its activities

Visit a prevention of mother to child transmission of HIV (PMTCT) programme and learn how to counsel on feeding options for an HIV infected mother.

Take an infant and young child feeding history DEFINITIONS (according to WHO)

Infant and young child feeding: The whole complex of dietary, behavioural and physiological process involved in the child’s ingestion of food

Exclusive breastfeeding: All the child’s fluid, energy and nutrients are provided by breast milk. Vitamins may be added.

Almost exclusive breastfeeding: Use of water or other non-nutritive liquids in addition to breast milk

Partial breastfeeding: Mixed feeding with breast milk, (other milks) plus other sources of energy and nutrients.

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Complementary feeding: Other foods or liquids provided along with breast milk.

Complementary food: Any nutrient –containing food or liquid given along with breast milk during the period of complementary feeding.

Transitional foods: Complementary foods especially designed to meet the nutritional needs of young children.

Family foods: Complementary foods that are the same as those consumed by rest of the family

Weaning: Putting a complete stop to breastfeeding.

BREASTFEEDING

Advantages of breastfeeding

Breastfeeding has nutritional, immunologic and developmental benefits. Breast milk is a whole food for the newborn and meets all requirements in the first 6 months of life.

Breast milk has several components that promote brain development leading to better school performance. Exclusive breastfeeding in the first 6 months of life reduces deaths from diarrhoea by a factor of 7, and pneumonia by a factor of 5. Overall exclusive breastfeeding prevents 13% of under five mortality. Early initiation of breastfeeding reduces risk of neonatal death by a factor of 4, i.e. 16% neonatal deaths are prevented if a baby is breastfed within the first day of life and 22% if initiation within 1^st hour of birth. Non breastfed children are more likely to fall sick and be hospitalized than breastfed ones irrespective of their socioeconomic status. Exclusive & continued breastfeeding for the first 2 years of life associated with better growth. Breast milk is a low cost high quality food; it is natural and sustainable resource which offers food security to the child and protects the environment.

Breastfeeding contributes to the psychological wellbeing of the infant by promoting bonding between mother and baby. The baby thus feels securely attached to the mother. Babies who are securely attached are able to re-establish a sense of wellbeing after a stressful event. Insecure attachment may signal later dysfunctional development and behaviour. The direct eye-to-eye contact between the baby and mother enables them to interact meaningfully. Breastfeeding on demand helps the young infant develop a sense of basic trust as his needs are met consistently. Breastfeeding may reduce chance of obesity and metabolic syndrome in adulthood.

If the mother exclusively breastfeeds and feeds several times a day and night she can be protected from another pregnancy. Child spacing favours child survival.

Mother also benefits from breastfeeding as they have reduced risk of postpartum haemorrhage, breast and ovarian cancer.

Anatomy of the breast (figure 1)

The breast is composed of the main body, areola and the nipple. In the main body are glandular tissues (alveoli) several of which drain into a milk (lactiferous) ducts. These ducts dilate in the areola and are known as lactiferous sinuses which finally open into the nipple. Each alveolus is surrounded by smooth muscles. Milk glands and ducts are

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supported by fat tissue and it is this fat that is mainly responsible for the size of the breast. There is also a good blood and nerve supply.

The areola and nipple contain smooth muscles. Each nipple has 15-25 openings. The areola contains several sebaceous glands (Montgomery glands) which secrete a substance that has antibacterial and lubricating properties. There is a rich nervous supply. The skin of the areola and nipple is much darker than the rest of the breast. The sizes of both the areola and nipple vary in different women.

Figure 1: anatomy of the breast

29 Physiology of lactation

Preparation of the breast for lactation: During pregnancy there is proliferation of the ducts and alveoli under the influence of pregnancy related hormones: oestrogen, progesterone, human placental lactogen (HPL) and human chorionic gonadotrophin (HCG).

Lactogenesis (initiation of milk secretion): Stage I starts about 12 week before delivery; stage II is the first few days after birth. During pregnancy prolactin hormone stimulates glandular activity and they begin to secrete colostrum. Though there is milk production during pregnancy, increased production is inhibited by placental hormones especially progesterone. Delivery of the baby removes inhibition of prolactin activity resulting in creased milk synthesis. This process rather than suckling is responsible for the initial breast milk production. The volume of the milk produced rapidly increases as the amount of lactose in the milk rises.

Stage III lactogenesis (maintenance of established lactation) this stage of