Pediatrics
Breastfeeding
Breastfeeding for MBBS pediatrics: lactation physiology, breast milk composition, correct latch, lactation problems and BFHI, mapped to NMC codes PE7.1 to PE7.11.
MedNext Academy | 3 min read
Breastfeeding
Breastfeeding for MBBS pediatrics: lactation physiology, breast milk composition, correct latch, lactation problems and BFHI, mapped to NMC codes PE7.1 to PE7.11.
This chapter covers the physiology of lactation, composition and advantages of breast milk, correct breastfeeding technique, common lactation problems and the Baby-Friendly Hospital Initiative. It emphasises early initiation, exclusive breastfeeding for six months and skilled latch support.
High-yield: Breastfeeding
- Breastfeeding should be initiated within one hour of birth, and colostrum, the first thick yellow milk, should be given rather than discarded.
- Exclusive breastfeeding is recommended for the first six months, with no prelacteal feeds or water, and continued breastfeeding to two years or beyond.
- Prolactin makes milk and oxytocin ejects it (the let-down reflex), while regular breast emptying maintains the milk supply.
- Human milk has lower protein but better protein quality, higher lactose, living immune factors and a lower mineral load than cow's milk.
- Cow's milk has higher protein and mineral content but is biologically mismatched for human infants and should not replace breast milk in infancy.
- Four signs of good positioning are head and body in line, baby facing the breast, baby close to mother and whole body supported.
- Four signs of good attachment are a wide-open mouth, everted lower lip, chin touching the breast and more areola visible above than below the mouth.
- The Baby-Friendly Hospital Initiative (BFHI) by WHO and UNICEF operationalises the Ten Steps to Successful Breastfeeding and the International Code of Marketing of Breast-milk Substitutes.
- A cracked nipple usually indicates a shallow latch, and correcting attachment is the primary treatment.
- Engorgement is typically bilateral and early, mastitis has fever with localised inflammation, and a breast abscess has pus collection needing drainage.
- Advantages of breastfeeding include reduced infant infection, better neurodevelopment, lactational amenorrhoea and reduced maternal breast and ovarian cancer risk.
- Supplementation without breast expression reduces supply because the breast receives the signal that less milk is needed.
- World Breastfeeding Week is observed from 1 to 7 August each year.
- Antenatal breast care and counselling should cover colostrum, first-hour initiation, exclusive breastfeeding, correct positioning and a caesarean feeding plan.
Breastfeeding best-practice targets
- **Initiation:** Within one hour of birth, giving colostrum, no prelacteal feeds.
- **Exclusive breastfeeding:** For the first six months, no water or other feeds.
- **Good attachment:** Wide mouth, everted lower lip, chin to breast, more areola above.
- **Hormones:** Prolactin makes milk, oxytocin ejects it, emptying sustains supply.
NMC competencies in this chapter
- **PE7.1:** Awareness of cultural beliefs and practices of breastfeeding
- **PE7.2:** Physiology of lactation
- **PE7.3:** Composition and types of breast milk; human milk versus cow's milk
- **PE7.4:** Advantages of breast milk
- **PE7.5:** Correct technique of breastfeeding and wrong techniques
- **PE7.6:** Baby-Friendly Hospital Initiative
- **PE7.7:** Breast examination and common lactation problems
- **PE7.8:** Antenatal breast care and preparing mothers for lactation
- **PE7.9:** Educate and counsel mothers for best practices in breastfeeding
- **PE7.10:** Respect patient privacy during breastfeeding care
- **PE7.11:** Participate in Breastfeeding Week celebration
Frequently Asked Questions
When should breastfeeding be initiated and for how long is it exclusive?
Breastfeeding should be initiated within one hour of birth with colostrum given, and should be exclusive for the first six months with no prelacteal feeds or water, then continued alongside complementary foods to two years or beyond.
Which hormones control lactation?
Prolactin stimulates milk production and oxytocin causes milk ejection through the let-down reflex, while regular and complete breast emptying maintains ongoing supply. Stress can block let-down.
What are the signs of good attachment?
Good attachment shows a wide-open mouth, an everted lower lip, the chin touching the breast, and more areola visible above the mouth than below. Poor, shallow attachment is the usual cause of a cracked nipple.
How do you tell engorgement, mastitis and abscess apart?
Engorgement is usually bilateral and early, mastitis presents with fever and a localised area of inflammation, and a breast abscess is a localised pus collection that requires drainage in addition to antibiotics.
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