1. Successful Early Initiation and Exclusive Breastfeeding up to Six Months of Age
“NUTRITIONAL STATUS OF <5 CHILDREN IS MOST SENSITIVE INDICATOR – DR.AMRITYA.SEN”
Dr. Pradeep Dubey
MD (Ped.), DCH.
Cons. Developmental & Neuro Ped.
“AADIGURU”
Early Intervention Centre
Wright Town - Jabalpur

2. India is epicenter of Childhood Mortality
This is very famous slide of year which you might have seen thousand times. India continue to be epicenter of childhood mortality even in
Worldwide distribution of child deaths
Each dot represents 5000 deaths
Lancet 2003 2

3. Childhood Mortality State of World’s Children 2008
9.7 million < 5 yrs deaths annually world over
India million (21%)
India contribute to 21% of underfive child mortality world over. While contribution of neonatal deaths to underfive deaths is about 37% in rest of the world, in India it is 50%.
Out of 2.1 million underfive deaths every year in India . One million deaths are in neonatal period.
1 million newborns die annually in India 3

4. Post Neonatal interventions - efficacy for reducing all cause of neonatal mortality
Neonatal Resuscitation :6-42%
Breastfeeding :55-87%
Prevention and management of hypothermia :18-42%
Kangaroo Mother Care (LBW):incidence of infection :51% (7-75%)
The Bellagio Child Survival Series published in The Lancet in identified newborn survival as a priority, but lacking on information and action
This data from Lancet neonatal survival series presents information regarding efficacy and costs of interventions for newborn care.
Here we will focus on first four interventions:

5. Global and National Recommendations for Infant and Young Child Feeding
Initiate breastfeeding within one hour of birth
Exclusive breastfeeding for first 6 months of life
Introduce nutritionally adequate and safe complementary foods after the infant reaches 6 months of age
Continue to breastfeed for 2 years or beyond.

6. What is Exclusive Breastfeeding?
Giving an infant only breastmilk
No food or drink other than breastmilk— not even water
No Ghutti/Honey etc.

7. Benefits to the Baby Complete food for the first six months
Perfect nutrition
Higher IQ
Emotional bonding
Prevents infections
Prevents chronic diseases
Easily digested

8. Benefits to the Mother Reduces post delivery bleeding and anemia
Helps delay next pregnancy - LAM
Protective effect against breast and ovarian cancer
Helps to loose weight
Emotional bonding
Needs no preparation

9. Benefits to the Society
Reduces absenteeism of mothers from work as they are less prone to disease.
Economical
Enhances Bonding

10. Underweight (-2sd) NFHS-3
First year is critical!
Malnutrition strikes the most in infancy beginning in 3-4th month , % at 6 months, goes up and peaks about 46% by 18 months, flat curve after that (NFHS 3).
Brain development
10 lakh children
die during
first month,
14 lakhs by
1 year, and 20 lakhs
by 5 yrs. 2/3rd are related to poor feeding. 1 2 3 4 5
Underweight (-2sd) NFHS-3
Over 60 million
In this slide you will see how first year is so critical – as among first 5 years of life shown as bars. The underweight bar is what begins in 3rd month of life and reaches about 29-30% by six months according to NFHS-3. After this it peaks by 18 months and then it almost flat – meaning thereby that action to ‘prevent under-nutrition’ should be a priority. Look at the brown line zooming through first – five years. This is for brain development and 70% brain develops during first year, 90% by end of 2 years .Finally, see out of approximately 20 Lac children who die annually( in India) around 14 lac die during first year of life. And rest later in four years. All this makes “first year” so critical.
Years of life 10

11. Successful Breastfeeding…
Exclusive breastfeeding for the first six months

12. U-5 deaths reduction by preventive Interventions
Percent 0% 2% 4% 6% 8%
10%
12%
14%
16%
18%
Breastfeeding
Complementary feeding
Clean delivery
Hib vaccine
Clean water, sanitation, hygiene
Zinc
Vitamin A
Breastfeeding is defined as exclusive breastfeeding for first 6 months and continued breastfeeding during 6-11 months
Intervention
Antenatal steroids
Newborn temperature management
Tetanus toxoid
Antibiotics for PRM
Measles vaccine
Nivirapine and replacement feeding
Insecticide-treated materials
Antimalarial IPT in pregnancy
Source: Jones et al. LANCET 2003;362:65-71

13. Successful Breastfeeding…
Major Hurdles
Lack of family support
Lack of support by health professionals
Commercial influence
Feeling of not enough milk among women

14. Successful Breastfeeding…
Important Do’s
Initiate breastfeeding as early as possible within one hour of birth.
Do not give the baby any prelacteal feeds
No bottles, artificial teats or pacifier
Breastfeeding on demand at least 8-10 times in a day and at night a
Breastfeed in a correct position
Build mother’s confidence to sustain good milk supply and alleviate feeling of not enough milk.

15. Successful Breastfeeding…
Initiate Breastfeeding Within One Hour of Birth

16. Successful Breastfeeding…
No Prelacteal Feeds
Replace colostrum
Reduce baby’s desire for breastfeeding
Greater risk of infection
Risk of intolerance, allergy

17. Successful Breastfeeding…
No Bottles, Artificial Teats or Pacifiers for Breastfeeding Infants
It lead to nipple confusion

18. Successful Breastfeeding… Breastfeeding in the Correct Position
Milk producing glands
Lactiferous canaliculi
Lactiferous sinuses
Myoepithelial tissue
Adipose tissue
Anatomy of the Breast

19. Successful Breastfeeding…
Build Mother’s Confidence
During prenatal period
During antenatal Period
During postnatal period

20. The Feeling of “Not Enough Milk”
Not true. Just a perception
Reinstate mother’s confidence
Ensure frequent, effective suckling

21. Sensory Impulses from nipple
Breastmilk Production
The Prolactin reflex
Sensory Impulses from nipple
Prolactin in blood
More prolactin secreted at night
Secreted after feed to produce next feed
Suppresses ovulation
SLIDE-12(Production of breatsmilk - Prolactin reflex)
We will now see how the breast milk is produced. As the baby suckles on the breast ..-click-..
it provides a sensory stimulus through nerve endings in the nipple to the anterior pituitary gland situated in the brain …-click-…
resulting in the release of hormone called prolactin.. This hormone acts on glands in the breast for milk production. Thus, milk production is dependent on the sucking stimulus i.e. more the baby sucks more prolactin will be secreted and hence more milk will be produced …-click-…
More prolactin is produced at night. Prolactin is helpful in producing next feed and in suppression of ovulation.
Baby sucking

22. Sensory Impulses from nipple
Breastmilk Transfer
The Oxytocin reflex
Sensory Impulses from nipple
Oxytocin in blood
SLIDE-12(Production of breatsmilk - Prolactin reflex)
We will now see how the breast milk is produced. As the baby suckles on the breast ..-click-..
it provides a sensory stimulus through nerve endings in the nipple to the anterior pituitary gland situated in the brain …-click-…
resulting in the release of hormone called prolactin.. This hormone acts on glands in the breast for milk production. Thus, milk production is dependent on the sucking stimulus i.e. more the baby sucks more prolactin will be secreted and hence more milk will be produced …-click-…
More prolactin is produced at night. Prolactin is helpful in producing next feed and in suppression of ovulation.
Works before or during feed to make milk flow
Makes uterus contract
Baby sucking

23. Breastmilk Transfer How does the mother’s confidence play part
Pain Worry Stress Doubt
Thinks lovingly of baby
CONFIDENCE Sound of baby Sight of baby
SLIDE-12(Production of breatsmilk - Prolactin reflex)
We will now see how the breast milk is produced. As the baby suckles on the breast ..-click-..
it provides a sensory stimulus through nerve endings in the nipple to the anterior pituitary gland situated in the brain …-click-…
resulting in the release of hormone called prolactin.. This hormone acts on glands in the breast for milk production. Thus, milk production is dependent on the sucking stimulus i.e. more the baby sucks more prolactin will be secreted and hence more milk will be produced …-click-…
More prolactin is produced at night. Prolactin is helpful in producing next feed and in suppression of ovulation.

24. Feeding reflexes in the baby
Rooting reflex
Mother learns to position baby
Sucking reflex
Baby learns to take breast
Swallowing reflex

25. Signs of Correct Attachment
Mouth wide open
Lower lip is turned outside
Chin touching the breast
Black part of the breast not visible below the lower lip
Large black portion of breast and nipple including milk collecting ducts are inside baby’s mouth
Tongue under the teat

26. Incorrect Sucking Position
Mouth is not wide open
Chin is away from the breast
Baby is sucking only nipple
Most black portion of the breast is outside the baby’s mouth
Tongue away from the teat

27. Causes of Incorrect Attachment
Use of feeding bottles. Leads to nipple confusion
Inexperienced mother
Functional difficulty with the mother or the baby
Lack of skilled support

28. Exclusive Breastfeeding for First Six Months
Conclusion
Exclusive Breastfeeding for First Six Months
Being Successful-
Initiate breastfeeding as early as possible within one hour of birth.
Do not give the baby any prelacteal feeds
No bottles, artificial teats or pacifier
Breastfeeding on demand at least 8-10 times in a day and at night a
Breastfeed in a correct position
Build mother’s confidence to sustain good milk supply and alleviate feeling of not enough milk.

29. Thanks