STORIES TOWARDS MASTERY

BREAST FEEDING
1. PHYSIOLOGY OF BREAST MILK PRODUCTION As soon as delivery of the placenta is over there will be an abrupt decrease both on ESTROGEN and PROGESTERONE- This will stimulate the APG (Anterior Pituitary Gland) to secrete PROLACTIN Note: Be aware that sucking also stimulates PROLACTIN secretion as this will stimulate the nerves and impulse will travel from the nipple to the HYPOTHALAMUS. PROLACTIN will act on the acini cells (ALVEOLAR CELLS) of the breast to produce milk. This milk is called FOREMILK and stored in LACTIFEROUS SINUS. FOREMILK is continuously being produced. What happen next? When the baby sucks on the breast of the mother OXYTOCIN is stimulated and OXYTOCIN will act on two organs. 1. BREAST (Let down reflex) 2. UTERUS (Promotes involution) OXYTOCIN will cause the mammary glands to contract and push the milk forward making it available to the baby. What will stimulate the let down reflex? 1. Sucking of the baby 2. Sound of the baby s cry Note: After the let down reflex a new milk will be formed and this is called HINDMILK and this contains more FATS that is needed for the growing newborn. STAGES OF BREASTMILK 1. COLOSTRUM- 2-4 days present CONTENT: IgA , Fat Soluble minerals, minerals, 2. TRANSITIONAL MILK- 4-14 days CONTENT: Lactose , water soluble vit., mineral

Fats, CHO, CHON.

3. MATURE MILK 14 days Up CONTENT: fats (LINOLEIC ACID) responsible for development of brain and integrity of skin, CHO LACTOSE Easily digested , baby not constipated esp. of sour milk smelling odor of stool . - LACTOSE INTOLERANCE- Deficiency of enzymes LACTAZE that digest LACTOSE CHON- LACTALBUMIN DIFFERENCE WITH COW S MILK Fats , CHO CHON Casting has curd that s hard to digest Minerals Traumatic effect on kidneys of babies , can trigger stone formation. Phosporus

Note: Baby who is breastfed is least likely to develop tetany. It seen that bottle fed infants have more difficulty in regulating calcium and phosphorous. Because cow s milk has more fat contents, this Fatty acid may bind with calcium in the GIT causing more decrease in Calcium. Note: Breast feeding can be initiated if had a CS after 4 hours; NSD- ASAP. ADVANTAGES OF BREAST FEEDING 1. 2. 3. 4. 5. 6. Economical Always available Breast fed baby has a higher IQ than bottle fed baby. It facilitates rapid involution. Incidence of Breast Ca. Has AB (IgA), lactoferrin ,lyzozymes and interferon ( Inhibit and/or destroy pathogenic bacteria and viruses) 7. Has Lactobasillius bifidus interferes with attack of pathogenic bacteria in GIT . 8. Have macrophages. STORE MILK- Plastic storage container. STORE MILK- Good for 6 mos. From freezer put room temp. Don t heat.

DISADVANTAGES OF BREAST FEEDING 1. Possibility of transfer HEP B, HIV, Cytomegalovirus. 2. No iron. 3. Father can t feed and bond as well.

PROPER BREAST FEEDING TECHNIQUE: 1. Be in a comfortable position (most appropriate is Upright Sitting Position to avoids tension). 2. Entire body of the baby should be turned towards the mother s breast. 3. Initiate feeding by stimulating the rooting reflex by touching the side of lips/cheeks then baby will turn to stimulus. Disappear by 6 weeks- by 6 weeks baby can focus. Reflex will be gone. Purpose rooting- to look for food. SUCKING MECHANISM (Breast) 1. Lips of the infants should clamp a C-shape. 2. The tongue thrusts forward to grasp nipple and areola. 3. The nipple is brought against the hard palate as the tongue pulls the areola into mouth. 4. The gum compresses the areola, squeezing milk at the back o f the throat. SUCKING MECHANISM (Bottle) 1. The large rubber nipple strikes the soft palate and interferes with the action of the tongue. 2. The tongue moves forwards against the gum to control the overflow of milk into the esophagus (Same reason why dental malocclusion is prone to bottle fed baby, because they thrust their tongue forward causing problem in the formation of the dental arch. Note: Burp or bubble the baby during and after the feeding to allow escape of air (preventing colic). Sit infant on lap, flexed forward, then pat or rub the back (avoid jarring the infant. CRITERIA OF EFFECTIVE SUCKING 1. Baby s mouth is hiked up to areola. 2. Mom experiences after pain. 3. Other nipple is also flowing with milk.

NOTE: Make sure the mother feeds the baby at the same breast she last feed her baby. This is to facilitate complete emptying of the breast and thereby promote filling of milk. CONTRAINDICATIONS IN BREAST FEEDING: 1. Maternal Conditions. a. HIV, CMV, HEPB b. Receiving Coumadin, Lithium or Metrotrexate c. Has Breast Ca d. Has herpes lesion on breast. 2. Newborn condition- Inborn errors of metabolism such as Erythrobastosis Fetalis- Rh incompatibility , Hyrops Fetalis, Phenylketonuria ,Galactosemia, Tay Sach dse.

PROBLEM EXPERIENCED IN BREAST FEEDING 3RD DAY CHANGES IN BREAST POST-PARTUM ENGORGED BREAST Feeling of fullness and tension in breast. Sometimes accompanied by fever known as MILK FEVER. MGT: Warm compress- for breast feeding mother; Cold compress for bottle feeding and wear supportive bra. When is involution of breast- 4 weeks.

SORE NIPPLE Cracked with painful nipple.MGT: Exposure to air remove bra ad wear dress, if not expose to 20 Watt Bulbavoid wearing plastic liner bra- will create moisture, cotton only.

MASTITIS Inflammation of breast : Staphylococcus aureus FACTORS: 1. Improper breast emptying 2. Unhealthy sexual practices -Manually express inflamed breastfeed on unaffected breast- give antibiotics. - Can still feed on unaffected breast

TYPE OF STOOLS WITH DIFFERENT MILK PRODUCTS: 1. TRANSITIONAL STOOLS green loose and shiny like diarrhea to the untrained eye. 2. BREAST FED STOOLS- golden yellow , soft ,mushy will sour milk smell, frequently passesd; reccur every feeding. 3. BOTTLED STOOL- pale yellow, formed hard with typical offensive odor , seldom passed, 2-3x a day; with food added brown and odorous.