Ten steps to successful breastfeeding

Ten steps to successful breastfeeding

اسلاید 1: www.tabaye.ir

اسلاید 2: Ten steps to successful breastfeedingStep 1.Have a written breastfeeding policy that is routinely communicated to all health care staff.A JOINT WHO/UNICEF STATEMENT (1989)Slide 4.1.2

اسلاید 3: Breastfeeding policy Why have a policy?Requires a course of action and provides guidanceHelps establish consistent care for mothers and babiesProvides a standard that can be evaluatedSlide 4.1.3

اسلاید 4: Breastfeeding policy What should it cover?At a minimum, it should include:The 10 steps to successful breastfeedingAn institutional ban on acceptance of free or low cost supplies of breast-milk substitutes, bottles, and teats and its distribution to mothersA framework for assisting HIV positive mothers to make informed infant feeding decisions that meet their individual circumstances and then support for this decisionOther points can be addedSlide 4.1.3

اسلاید 5: Breastfeeding policy How should it be presented?It should be:Written in the most common languages understood by patients and staffAvailable to all staff caring for mothers and babiesPosted or displayed in areas where mothers and babies are cared forSlide 4.1.4

اسلاید 6: Step 1: Improved exclusive breast-milk feeds while in the birth hospital after implementing the Baby-friendly Hospital InitiativeAdapted from: Philipp BL, Merewood A, Miller LW et al. Baby-friendly Hospital Initiative improves breastfeeding initiation rates in a US hospital setting. Pediatrics, 2001, 108:677-681.Slide 4.1.5

اسلاید 7: Ten steps to successful breastfeedingStep 2.Train all health-care staff in skills necessary to implement this policy.A JOINT WHO/UNICEF STATEMENT (1989)Slide 4.2.1

اسلاید 8: Areas of knowledgeAdvantages of breastfeedingRisks of artificial feedingMechanisms of lactation and sucklingHow to help mothers initiate and sustain breastfeedingHow to assess a breastfeedHow to resolve breastfeeding difficultiesHospital breastfeeding policies and practicesFocus on changing negative attitudes which set up barriersSlide 4.2.2

اسلاید 9: Additional topics for BFHI training in the context of HIVTrain all staff in: Basic facts on HIV and on Prevention of Mother-to-Child Transmission (PMTCT)Voluntary testing and counselling (VCT) for HIVLocally appropriate replacement feeding optionsHow to counsel HIV + women on risks and benefits of various feeding options and how to make informed choicesHow to teach mothers to prepare and give feedsHow to maintain privacy and confidentialityHow to minimize the “spill over” effect (leading mothers who are HIV - or of unknown status to choose replacement feeding when breastfeeding has less risk)Slide 4.2.3

اسلاید 10: Step 2: Effect of breastfeeding training for hospital staff on exclusive breastfeeding rates at hospital dischargeAdapted from: Cattaneo A, Buzzetti R. Effect on rates of breast feeding of training for the Baby Friendly Hospital Initiative. BMJ, 2001, 323:1358-1362.Slide 4.2.4

اسلاید 11: Slide 4.2.5Step 2: Breastfeeding counselling increases exclusive breastfeedingAll differences between intervention and control groups are significant at p<0.001.From: CAH/WHO based on studies by Albernaz, Jayathilaka and Haider.Age:(Albernaz) (Jayathilaka)(Haider)2 weeks after diarrhoea treatment4 months3 months

اسلاید 12: Which health professionals other than perinatal staff influence breastfeeding success?Slide 4.2.6

اسلاید 13: Ten steps to successful breastfeedingStep 3.Inform all pregnant women about the benefits of breastfeeding.A JOINT WHO/UNICEF STATEMENT (1989)Slide 4.3.1

اسلاید 14: Antenatal education should include:Benefits of breastfeedingEarly initiationImportance of rooming-in (if new concept)Importance of feeding on demandImportance of exclusive breastfeedingHow to assure enough breastmilkRisks of artificial feeding and use of bottles and pacifiers (soothers, teats, nipples, etc.)Basic facts on HIVPrevention of mother-to-child transmission of HIV (PMTCT)Voluntary testing and counselling (VCT) for HIV and infant feeding counselling for HIV+ women Antenatal education should not include group education on formula preparationSlide 4.3.2

اسلاید 15: Slide 4f

اسلاید 16: Step 3: The influence of antenatal care on infant feeding behaviourAdapted from: Nielsen B, Hedegaard M, Thilsted S, Joseph A, Liljestrand J. Does antenatal care influence postpartum health behaviour? Evidence from a community based cross-sectional study in rural Tamil Nadu, South India. British Journal of Obstetrics and Gynaecology, 1998, 105:697-703.Slide 4.3.3

اسلاید 17: Step 3: Meta-analysis of studies of antenatal education and its effects on breastfeedingAdapted from: Guise et al. The effectiveness of primary care-based interventions to promote breastfeeding: Systematic evidence review and meta-analysis… Annals of Family Medicine, 2003, 1(2):70-78.Slide 4.3.4

اسلاید 18: Ten steps to successful breastfeedingStep 4.Help mothers initiate breastfeeding within a half-hour of birth.A JOINT WHO/UNICEF STATEMENT (1989)Slide 4.4.1

اسلاید 19: New interpretation of Step 4 in the revised BFHI Global Criteria (2006):“Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour and encourage mothers to recognize when their babies are ready to breastfeed, offering help if needed.”Slide 4.4.2

اسلاید 20: Early initiation of breastfeeding for the normal newborn Why?Increases duration of breastfeedingAllows skin-to-skin contact for warmth and colonization of baby with maternal organismsProvides colostrum as the baby’s first immunizationTakes advantage of the first hour of alertnessBabies learn to suckle more effectivelyImproved developmental outcomesSlide 4.4.3

اسلاید 21: Early initiation of breastfeeding for the normal newborn How?Keep mother and baby togetherPlace baby on mother’s chestLet baby start suckling when readyDo not hurry or interrupt the processDelay non-urgent medical routines for at least one hour Slide 4.4.4

اسلاید 22: Impact on breastfeeding duration of early infant-mother contactAdapted from: DeChateau P, Wiberg B. Long term effect on mother-infant behavior of extra contact during the first hour postpartum. Acta Peadiatr, 1977, 66:145-151.Early contact: 15-20 min suckling and skin-to-skin contact within first hour after deliveryControl: No contact within first hourSlide 4.4.5

اسلاید 23: Temperatures after birth in infants kept either skin-to-skin with mother or in cotAdapted from: Christensson K et al. Temperature, metabolic adaptation and crying in healthy full-term newborns cared for skin-to-skin or in a cot. Acta Paediatr, 1992, 81:490.Slide 4.4.6

اسلاید 24: Protein composition of human colostrum and mature breast milk (per litre)From: Worthington-Roberts B, Williams SR. Nutrition in Pregnancy and Lactation, 5th ed. St. Louis, MO, Times Mirror/Mosby College Publishing, p. 350, 1993.Slide 4.4.7

اسلاید 25: Effect of delivery room practices on early breastfeeding Adapted from: Righard L, Alade O. Effect of delivery room routines on success of first breastfeed .Lancet, 1990, 336:1105-1107.63% P<0.00121% P<0.001Slide 4.4.8

اسلاید 26: Ten steps to successful breastfeedingStep 5.Show mothers how to breastfeed and how to maintain lactation, even if they should be separated from their infants.A JOINT WHO/UNICEF STATEMENT (1989)Slide 4.5.1

اسلاید 27:  Contrary to popular belief, attaching the baby on the breast is not an ability with which a mother is [born…]; rather it is a learned skill which she must acquire by observation and experience.From: Woolridge M. The “anatomy” of infant sucking. Midwifery, 1986, 2:164-171.Slide 4.5.2

اسلاید 28: Effect of proper attachment on duration of breastfeedingAdapted from: Righard L, Alade O. (1992) Sucking technique and its effect on success of breastfeeding. Birth 19(4):185-189.P<0.001P<0.01P<0.01P<0.015 days exclusive breastfeeding1 month2 months3 months4 monthsAny breastfeedingSlide 4.5.3

اسلاید 29: Step 5: Effect of health provider encouragement of breastfeeding in the hospital on breastfeeding initiation ratesAdapted from: Lu M, Lange L, Slusser W et al. Provider encouragement of breast-feeding: Evidence from a national survey. Obstetrics and Gynecology, 2001, 97:290-295.Slide 4.5.4

اسلاید 30: Effect of the maternity ward system on the lactation success of low-income urban Mexican women Slide 4.5.5From: Perez-Escamilla R, Segura-Millan S, Pollitt E, Dewey KG. Effect of the maternity ward system on the lactation success of low-income urban Mexican women. Early Hum Dev., 1992, 31 (1): 25-40.NUR, nursery, n-17RI, rooming-in, n=15RIBFG, rooming-in with breastfeeding guidance, n=22NUR significantly different from RI (p<0.05) and RIBFG (p<0.05)

اسلاید 31: Supply and demandMilk removal stimulates milk production.The amount of breast milk removed at each feed determines the rate of milk production in the next few hours.Milk removal must be continued during separation to maintain supply.Slide 4.5.6

اسلاید 32: Ten steps to successful breastfeedingStep 6.Give newborn infants no food or drink other than breast milk unless medically indicated.A JOINT WHO/UNICEF STATEMENT (1989)Slide 4.6.1

اسلاید 33: Slide 4n

اسلاید 34: Long-term effects of a change in maternity ward feeding routinesAdapted from: Nylander G et al. Unsupplemented breastfeeding in the maternity ward: positive long-term effects. Acta Obstet Gynecol Scand, 1991, 70:208.P<0.001P<0.01Slide 4.6.2

اسلاید 35: The perfect match: quantity of colostrum per feed and the newborn stomach capacityAdapted from: Pipes PL. Nutrition in Infancy and Childhood, Fourth Edition. St. Louis, Times Mirror/Mosby College Publishing, 1989.Slide 4.6.3

اسلاید 36: Decreased frequency or effectiveness of sucklingDecreased amount of milk removed from breastsDelayed milk production or reduced milk supplySome infants have difficulty attaching to breast if formula given by bottleImpact of routine formula supplementationSlide 4.6.4

اسلاید 37: Determinants of lactation performance across time in an urban population from MexicoMilk came in earlier in the hospital with rooming-in where formula was not allowedMilk came in later in the hospital with nursery (p<0.05)Breastfeeding was positively associated with early milk arrival and inversely associated with early introduction of supplementary bottles, maternal employment, maternal body mass index, and infant age.Adapted from: Perez-Escamilla et al. Determinants of lactation performance across time in an urban population from Mexico. Soc Sci Med, 1993, (8):1069-78.Slide 4.6.5

اسلاید 38: Summary of studies on the water requirements of exclusively breastfed infantsNote: Normal range for urine osmolarity is from 50 to 1400 mOsm/kg.From: Breastfeeding and the use of water and teas. Division of Child Health and Development Update No. 9, Geneva, World Health Organization, reissued, Nov. 1997.Slide 4.6.6

اسلاید 39: Medically indicatedThere are rare exceptions during which the infant may require other fluids or food in addition to, or in place of, breast milk. The feeding programme of these babies should be determined by qualified health professionals on an individual basis.Slide 4.6.7

اسلاید 40: Acceptable medical reasons for supplementation or replacementInfant conditions:Infants who cannot be BF but can receive BM include those who are very weak, have sucking difficulties or oral abnormalities or are separated from their mothers.Infants who may need other nutrition in addition to BM include very low birth weight or preterm infants, infants at risk of hypoglycaemia, or those who are dehydrated or malnourished, when BM alone is not enough.Infants with galactosemia should not receive BM or the usual BMS. They will need a galactose free formula. Infants with phenylketonuria may be BF and receive some phenylalanine free formula.Slide 4.6.8UNICEF, revised BFHI course and assessment tools, 2006

اسلاید 41: Maternal conditions: BF should stop during therapy if a mother is taking anti-metabolites, radioactive iodine, or some anti-thyroid medications.Some medications may cause drowsiness or other side effects in infants and should be substituted during BF.BF remains the feeding choice for the majority of infants even with tobacco, alcohol and drug use. If the mother is an intravenous drug user BF is not indicated.Avoidance of all BF by HIV+ mothers is recommended when replacement feeding is acceptable, feasible, affordable, sustainable and safe. Otherwise EBF is recommended during the first months, with BF discontinued when conditions are met. Mixed feeding is not recommended.Slide 4.6.9

اسلاید 42: Maternal conditions (continued): If a mother is weak, she may be assisted to position her baby so she can BF.BF is not recommended when a mother has a breast abscess, but BM should be expressed and BF resumed once the breast is drained and antibiotics have commenced. BF can continue on the unaffected breast.Mothers with herpes lesions on their breasts should refrain from BF until active lesions have been resolved.BF is not encouraged for mothers with Human T-cell leukaemia virus, if safe and feasible options are available.BF can be continued when mothers have hepatitis B, TB and mastitis, with appropriate treatments undertaken.Slide 4.6.10

اسلاید 43: Ten steps to successful breastfeedingStep 7.Practice rooming-in — allow mothers and infants to remain together — 24 hours a day.A JOINT WHO/UNICEF STATEMENT (1989)Slide 4.7.1

اسلاید 44: Rooming-inA hospital arrangement where a mother/baby pair stay in the same room day and night, allowing unlimited contact between mother and infantSlide 4.7.2

اسلاید 45: Rooming-in Why?Reduces costsRequires minimal equipmentRequires no additional personnelReduces infectionHelps establish and maintain breastfeedingFacilitates the bonding processSlide 4.7.3

اسلاید 46: Morbidity of newborn babies at Sanglah Hospital before and after rooming-inAdapted from: Soetjiningsih, Suraatmaja S. The advantages of rooming-in. Pediatrica Indonesia, 1986, 26:231.Slide 4.7.4n=205n=17n=77n=11n=61n=17n=25n=4

اسلاید 47: Effect of rooming-in on frequency of breastfeeding per 24 hoursAdapted from: Yamauchi Y, Yamanouchi I . The relationship between rooming-in/not rooming-in and breastfeeding variables. Acta Paediatr Scand, 1990, 79:1019.Slide 4.7.5

اسلاید 48: Ten steps to successful breastfeedingStep 8.Encourage breastfeeding on demand.A JOINT WHO/UNICEF STATEMENT (1989)Slide 4.8.1

اسلاید 49: Breastfeeding on demand:Breastfeeding whenever the baby or mother wants, with no restrictions on the length or frequency of feeds.Slide 4.8.2

اسلاید 50: On demand, unrestricted breastfeeding Why?Earlier passage of meconiumLower maximal weight lossBreast-milk flow established soonerLarger volume of milk intake on day 3Less incidence of jaundiceFrom: Yamauchi Y, Yamanouchi I. Breast-feeding frequency during the first 24 hours after birth in full-term neonates. Pediatrics, 1990, 86(2):171-175.Slide 4.8.3

اسلاید 51: Breastfeeding frequency during the first 24 hours after birth and incidence of hyperbilirubinaemia (jaundice) on day 6From: Yamauchi Y, Yamanouchi I. Breast-feeding frequency during the first 24 hours after birth in full-term neonates. Pediatrics, 1990, 86(2):171-175.932124953321709Slide 4.8.4

اسلاید 52: Mean feeding frequency during the first 3 days of life and serum bilirubinFrom: DeCarvalho et al. Am J Dis Child, 1982; 136:737-738.Slide 4.8.5

اسلاید 53: Ten steps to successful breastfeedingStep 9.Give no artificial teats or pacifiers (also called dummies and soothers) to breastfeeding infants.A JOINT WHO/UNICEF STATEMENT (1989)Slide 4.9.1

اسلاید 54: Slide 4t

اسلاید 55: Slide 4u

اسلاید 56: Alternatives to artificial teatscupspoondropperSyringeSlide 4.9.2

اسلاید 57: Cup-feeding a babySlide 4.9.3

اسلاید 58: Proportion of infants who were breastfed up to 6 months of age according to frequency of pacifier use at 1 monthNon-users vs part-time users: P<<0.001Non-users vs. full-time users: P<0.001From: Victora CG et al. Pacifier use and short breastfeeding duration: cause, consequence or coincidence? Pediatrics, 1997, 99:445-453.Slide 4.9.4

اسلاید 59: Ten steps to successful breastfeedingStep 10.Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.A JOINT WHO/UNICEF STATEMENT (1989)Slide 4.10.1

اسلاید 60:  The key to best breastfeeding practices is continued day-to-day support for the breastfeeding mother within her home and community.From: Saadeh RJ, editor. Breast-feeding: the Technical Basis and Recommendations for Action. Geneva, World Health Organization, pp.:62-74, 1993.Slide 4.10.2

اسلاید 61: Support can include:Early postnatal or clinic checkupHome visitsTelephone callsCommunity servicesOutpatient breastfeeding clinicsPeer counselling programmesMother support groupsHelp set up new groupsEstablish working relationships with those already in existenceFamily support systemSlide 4.10.3

اسلاید 62: From: Jelliffe DB, Jelliffe EFP. The role of the support group in promoting breastfeeding in developing countries. J Trop Pediatr, 1983, 29:244.Types of breastfeeding mothers’ support groupsTraditionalModern, non-traditionalSelf-initiatedGovernment planned through: networks of national development groups, clubs, etc. health services -- especially primary health care (PHC) and trained traditional birth attendants (TBAs)extended familyculturally defined doulasvillage womenby mothersby concerned health professionalsSlide 4.10.4

اسلاید 63: Step 10: Effect of trained peer counsellors on the duration of exclusive breastfeedingAdapted from: Haider R, Kabir I, Huttly S, Ashworth A. Training peer counselors to promote and support exclusive breastfeeding in Bangladesh. J Hum Lact, 2002;18(1):7-12.Slide 4.10.5

اسلاید 64: Home visits improve exclusive breastfeedingFrom: Morrow A, Guerrereo ML, Shultis J, et al. Efficacy of home-based peer counselling to promote exclusive breastfeeding: a randomised controlled trial. Lancet, 1999, 353:1226-31Slide 4.10.6

اسلاید 65: Combined Steps: The impact of baby-friendly practices: The Promotion of Breastfeeding Intervention Trial (PROBIT)In a randomized trial in Belarus 17,000 mother-infant pairs, with mothers intending to breastfeed, were followed for 12 months.In 16 control hospitals & associated polyclinics that provide care following discharge, staff were asked to continue their usual practices.In 15 experimental hospitals & associated polyclinics staff received baby-friendly training & support.Adapted from: Kramer MS, Chalmers B, Hodnett E, et al. Promotion of breastfeeding intervention trial (PROBIT) A randomized trial in the Republic of Belarus. JAMA, 2001, 285:413-420.Slide 4.11.1

اسلاید 66: Communication from Chalmers and Kramer (2003)Differences following the interventionSlide 4.11.2

اسلاید 67: Effect of baby-friendly changes on breastfeeding at 3 & 6 monthsAdapted from: Kramer et al. (2001)Slide 4.11.3

اسلاید 68: Impact of baby-friendly changes on selected health conditionsAdapted from: Kramer et al. (2001)Note: Differences between experimental and control groups for various respiratory tract infections were small and statistically non-significant.Slide 4.11.4

اسلاید 69: Combined Steps: The influence of Baby-friendly hospitals on breastfeeding duration in SwitzerlandData was analyzed for 2861 infants aged 0 to11 months in 145 health facilities. Breastfeeding data was compared with both the progress towards Baby-friendly status of each hospital and the degree to which designated hospitals were successfully maintaining the Baby-friendly standards.Adapted from: Merten S et al. Do Baby-Friendly Hospitals Influence Breastfeeding Duration on a National Level? Pediatrics, 2005, 116: e702 – e708.Slide 4.11.5

اسلاید 70: Proportion of babies exclusively breastfed for the first five months of life -- Switzerland.Adapted from: Merten S et al. Do Baby-Friendly Hospitals Influence Breastfeeding Duration on a National Level? Pediatrics, 2005, 116: e702 – e708.Slide 4.11.6

اسلاید 71: Median duration of exclusive breastfeeding for babies born in Baby-friendly hospitals -- Switzerland.Adapted from: Merten S et al. Do Baby-Friendly Hospitals Influence Breastfeeding Duration on a National Level? Pediatrics, 2005, 116: e702 – e708.Slide 4.11.7