2. Successful Early Initiation and Exclusive Breastfeeding up to Six Months of Age

3. Helping Women to Be Successful in Breastfeeding the Baby

4. 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.

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

6. 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

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

8. Economic benefits of BF US $3.6 billion saving if EBF ↑ 64% to 75% (in hospital) ↑ 29% to 50% (at 6 months) [Weimer J,US dept. Agriculture Report-13] Medical cost at 12 months US $200 less in BF compared to formula fed [Honey & ware 1997]

9. Exclusive Breastfeeding & Lipid Profile S. Cholesterol, total triglycerides and poor HDL/LDL ratio significantly more in EBF infants compared to mixed-feds and formula-feds and improve by six months of age for better brain growth [Eur J Clin Nutr 2008; 62:203-209]

10. Exclusive Breastfeeding & Anemia Term AGA infants on Exclusive Breastfeeding till 6 months born to Anemic or Non-anemic mothers Do not develop Iron Deficiency Anemia [International Breastfeed J 2007;3:3]

11. First year is critical! Malnutrition strikes the most in infancy beginning in 3-4 th month, 29-30 % at 6 months, goes up and peaks about 46% by 18 months, flat curve after that (NFHS 3). Years of life Brain development Underweight (-2sd) NFHS-3 Over 60 million 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.

12. Percentage of Neonatal Deaths (2-28 days) Saved with Early Initiation Risk of neonatal death is 4 fold, if milk based fluids or solids are given to breastfed neonates Imitation after day 1 is associated with 2.4 fold increase in risk of death 1/18 PEDIATRICS 2006; 117:380-386

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

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

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

16. Is Breast feeding So Simple? Animal Kingdom: 1.Offspring on feet 2.Moves to udders 3.Makes position No role of Mother Human Beings: 1.Baby holds neck 3 mo 2.Walks at 1 yr 3.Mother makes position No role of Baby

17. How to Protect Breastfeeding Make National breastfeeding policy Include Breastfeeding in clinical practice Obtain Training in breastfeeding management

18. Global Strategy for Infant and Young Child Feeding Adopted by the WHA and UNICEF Executive board in 2002

19. Strategies Development of BREASTFEEDING support clinics/ Lactation management clinics in hospitals run by skilled/ trained counselors Promoting BREASTFEEDING friendly PHCs/Private clinics/hospitals supported by SKILLED staff. Building IYCF counselling as service in job profile of workers Developing community led initiatives :Peer counselling support groups Eliminate MISINFORMATION from media (International Code) Establishing national and state level resource centers

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

21. 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.

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

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

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

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

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

27. More prolactin secreted at night More prolactin secreted at night Secreted after feed to produce next feed Secreted after feed to produce next feed Suppresses ovulation Suppresses ovulation The Prolactin reflex Baby sucking Sensory Impulses from nipple Prolactin in blood Breastmilk Production

28. The Oxytocin reflex Breastmilk Transfer Works before or during feed to make milk flow Works before or during feed to make milk flow Makes uterus contract Baby sucking Sensory Impulses from nipple Oxytocin in blood

29. How does the mother’s confidence play part Breastmilk Transfer Thinks lovingly of baby CONFIDENCE Sound of baby Sight of baby Pain Worry Stress Doubt

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

31. 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

32. 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

33. 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

34. 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.

35. Be a leader

36. Thank you friends