BABY FRIENDLY HOSPITAL

INITIATIVE AND EXCLUSIVE

BREAST FEEDING
BABY FRIENDLY HOSPITAL
INITIATIVE
 Definition:
The Baby Friendly Hospital Initiative was
introduced in 1991 by the World Health
Organization/United Nations Children's Fund
(WHO/UNICEF) to promote, protect and support
breastfeeding in the hospital or birth setting. A
key element in this promotion and support is
outlined in their
Ten Steps to Successful Breastfeeding. To date,
approximately 19,000 hospitals and birth centers
in about 125 countries have received the "Baby
Friendly" designation.
 CRITERIA
Ten steps to successful breastfeeding recommended by code of
practice of WHO/ UNICEF :-

Have a written breastfeeding policy that is routinely communicated to

all health care staff.

Train all health care staff in skills necessary to implement this policy.

Inform all pregnant women about the benefits and management of

breastfeeding.

Help mothers initiate breastfeeding within one half-hour of birth.

Show mothers how to breastfeed and maintain lactation,even if they

should be separated from their infants.
 Give newborn infants no food or drink other than
breastmilk, unless medically indicated.
Practice rooming in - that is, allow mothers and
infants to remain together 24 hours a day.
Encourage breastfeeding on demand.
Give no artificial teats or pacifiers (also called
dummies or soothers) to breastfeeding infants.
Foster the establishment of breastfeeding
support groups and refer mothers to them on
discharge from the hospital or clinic.
Step 1. Have a written
breastfeeding policy that is
routinely communicated to all
health care staff.
 Breastfeeding policy
Why have a policy?
Requires a course of action and provides
guidance
Helps establish consistent care for
mothers and babies
Provides a standard that can be evaluated
 Breastfeeding policy
What should it cover?
At a minimum, it should include:
The 10 steps to successful breastfeeding
An institutional ban on acceptance of free or low cost
supplies of breast-milk substitutes, bottles, and teats
and its distribution to mothers
A framework for assisting HIV positive mothers to
make informed infant feeding decisions that meet
their individual circumstances and then support for
this decision
Other points can be added
 Breastfeeding policy
How should it be presented?
It should be:
Written in the most common languages
understood by patients and staff
Available to all staff caring for mothers and
babies
Posted or displayed in areas where
mothers and babies are cared for
Step 2. Train all health-care staff in
skills necessary to implement this
policy.
 Areas of knowledge
Advantages of breastfeeding
Risks of artificial feeding
Mechanisms of lactation and suckling
How to help mothers initiate and sustain
breastfeeding
 How to resolve breastfeeding difficulties
How to assess a breastfeed
Hospital breastfeeding policies and
practices
Focus on changing negative attitudes
which set up barriers
Step 3. Inform all pregnant women
about the benefits of
breastfeeding.
 Antenatal education should
include:
Benefits of breastfeeding
Early initiation
Importance of rooming-in (if new concept)
Importance of feeding on demand
Importance of exclusive breastfeeding
How to assure enough breastmilk
Risks of artificial feeding and use of bottles and
pacifiers (soothers, teats, nipples, etc.)
 Basic facts on HIV
Prevention 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 preparation
Step 4. Help mothers initiate
breastfeeding within a half-hour of
birth.
 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.
 Early initiation of breastfeeding
for the normal newborn
Why?
Increases duration of breastfeeding
Allows skin-to-skin contact for warmth and
colonization of baby with maternal organisms
Provides colostrum as the babys first
immunization
Takes advantage of the first hour of alertness
Babies learn to suckle more effectively
Improved developmental outcomes
 Early initiation of breastfeeding
for the normal newborn
How?
Keep mother and baby together
Place baby on mothers chest
Let baby start suckling when ready
Do not hurry or interrupt the process
Delay non-urgent medical routines for at
least one hour
 Protein composition of human
colostrum
and mature breast milk (per litre)
Constituent Measure Colostrum Mature Milk
(1-5 days) (>30 days)
Total protein G 23 9-10.5
Casein mg 1400 1870
-Lactalbumin mg 2180 1610
Lactoferrin mg 3300 1670
IgA mg 3640 1420
 Step 5. Show mothers how to
breastfeed and how to maintain
lactation, even if they should be
separated from their infants
 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.
 Supply and demand
Milk 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.
 Step 6. Give newborn infants
no food or drink other than breast
milk unless medically indicated
 Decreased frequency or effectiveness of
suckling

Decreased amount of milk removed from

breasts

Delayed milk production or reduced milk supply

Some infants have difficulty attaching to breast if
formula given by bottle
 Acceptable medical reasons for
supplementation or replacement

Infant 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.
 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.
 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.
Step 7. Practice rooming-in
allow mothers and infants to
remain together
24 hours a day.
 Rooming-in
A hospital arrangement where a
mother/baby pair stay in the same room
day and night, allowing unlimited contact
between mother and infant
 Rooming-in
Why?
Reduces costs
Requires minimal equipment
Requires no additional personnel
Reduces infection
Helps establish and maintain
breastfeeding
Facilitates the bonding process
Step 8. Encourage breastfeeding
on demand.
 Breastfeeding on demand:
Breastfeeding whenever the baby or
mother wants, with no restrictions on the
length or frequency of feeds
 On demand, unrestricted
breastfeeding
Why?
Earlier passage of meconium
Lower maximal weight loss
Breast-milk flow established sooner
Larger volume of milk intake on day 3
Less incidence of jaundice
Step 9. Give no artificial teats or
pacifiers (also called dummies
and soothers) to breastfeeding
infants.
 Alternatives to artificial teats
cup
spoon
dropper
Syringe
 Cup-feeding a baby
Step 10.Foster the establishment of
breastfeeding support groups and
refer mothers to them on discharge
from the hospital or clinic.
 The key to best breastfeeding practices
is continued day-to-day support for the
breastfeeding mother within her home and
community.
 Support can include:
Early postnatal or clinic checkup
Home visits
Telephone calls
Community services
Outpatient breastfeeding clinics
Peer counselling programmes
 Mother support groups
Help set up new groups
Establish working relationships with those
already in existence
Family support system
EXCLUSIVE BREAST FEEDING
 Definition:
The feeding of an
infant or young child
with breast milk
directly from female
human breasts rather
than from a baby
bottle or other
container.
 Benefits to the Baby

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

Reduces post delivery

bleeding and anemia
Helps delay next pregnancy
Protective effect against
breast and ovarian cancer
Helps to loose weight
Emotional bonding
Needs no preparation
 Breastfeeding in the Correct Position

Milk producing glands

Lactiferous canaliculi
Lactiferous sinuses
Myoepithelial tissue
Adipose tissue
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
babys mouth
Tongue under the teat
 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 babys
mouth
Tongue away from the teat
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
 Breastmilk Production
The Prolactin reflex
Sensory Impulses
Prolactin in blood from nipple

More prolactin secreted at

night
Secreted after feed to
Baby sucking
produce next feed
Suppresses ovulation
 The Feeling of Not Enough Milk
Not True. Just a perception

Reinforce mothers:
Self confidence is must
Ensure frequent suckling
Ensure effective suckling
 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 mothers confidence to sustain good milk supply and alleviate
feeling of not enough milk.
 Newborn deserves
the best Nutrition,
Improved Survival,
Optimum
Development and
Healthy Life

Breastfeeding can do

this miracle !!!

 INDICATORS OF ADEQUACY :-
Adequacy of breast feeding is indicated and established by
the following:-
Audible feeding sound while swallowing
Let down sensation in mothers breast
Breast is full before the feed and soft after feed
Wet nappies 6 or more in 24 hrs
Frequant soft bowel movements 3 to 8 times in 24 hrs
Average weight gain of 18-30 gm/day
Baby sleeps well and doesnot cry frequently
Baby has good muscle tone and healthy skin
 IMMUNOLOGIC SPECIFICITY
Protection against
pathogens & allergens
Kills pathogenic
organisms or modifies
their growth
Stimulates epithelial
maturation for future
defence
First immunization
Protection against
common respiratory
and intestinal diseases
 IMMUNOLOGIC SPECIFICITY
Colostrum = Babys
first vaccination
Less risk of illness
such as:
Ear infections,
pneumonia, crohns
disease and other
bowel illnesses,
stomach flu and other
intestinal illnesses, ear
infections, childhood
cancers, diabetes,
arthritis, allergies,
asthma and eczema
PERFECT FOOD FOR BABIES
Just the right amount of nutrients in the
right proportions
Over 200 components in human milk
Composition of breast milk:
-Live cells, fat, carbohydrates, proteins,
vitamins, minerals
-Less fat than most other mammals
-More lactose than other mammals
 BREAST MILK COMPOSITION
Fat (4% concentration
provides up to 50% of
caloric needs, cholesterol
levels constant, lipolytic
enzymes aid in fat digestion)
Carbohydrates (lactose =
milk sugar predominantly in
human milk, 7%
concentration provides up to
40% caloric needs, essential
for development of CNS,
enhances calcium & iron
absorption)
 BREAST MILK COMPOSITION
Carbohydrates (Bifidus
factor = growth factor
present only in human milk
required for establishing an
acidic environment in the
gut to inhibit growth of
bacteria, fungi and
parasites)

Protein
-Lactoferin => Isolates
external iron
-Secretory IGA => Most
important immunoglobulin,
breast milk = only source for
first 6 weeks
BENEFITS OF BREASTFEEDING
Ecological:
-Saves resources
-Less waste
-No refrigeration
-No manufacturing
-No bottles, cans
-No trucking
-No handling
BENEFITS OF BREASTFEEDING
For Society
-Smarter
-Healthier
-Less cost to
healthcare
system
-Stronger families
BENEFITS OF BREASTFEEDING
To Families
-Less trips to
doctors, hospitals
-Less prescriptions
-Less stress
-Less illness
-More bonding
-Inexpensive
BENEFITS OF BREASTFEEDING
Benefits to baby:
-Better dental health
-Increased visual
acuity
-Decreased duration
and intensity of
illnesses
-Less allergies
-Better health & less
risk of illnesses
 BENEFITS OF BREASTFEEDING
Benefits to mother:
-Psychological (Attachment,
bonding, security, skin to
skin, fulfillment of basic
needs, relationship)
-Easier weight loss
-Decreased risk of illness
(breast cancer,
osteoperosis, hemmorhage,
ovarian cancer)
-Birth control
-Pride, empowerment,
fulfillment
HARMFUL EFFECTS OF
FORMULA MILK
Why some mothers choose formula
vs. breast milk
Distressed by physical
discomfort of early
breastfeeding problems.

Convenience issues

Pressures of
employment/school

Worries that breast shape will

change

Formula manufacturers
manipulate people through their
ads
Doctors and nurses need more
lactation training
Why some mothers choose formula
vs. breast milk
Moms given very little time to
adjust to changes of
postpartum

Family demands

Non-supportive family/health
professionals

Embarrassment

Lack of confidence in self

Feeling that one cannot

produce enough milk
 Mothers milk vs. formula milk
Human milk is designed
to support the
development of large
brains, capable of
processing and storing
lots of information.

Cows milk is designed

to support functions,
like constant grazing.
 Illness Relative risk
Allergies, eczema 2 to 7
times
Urinary tract infections 2.6
to 5.5 times
Inflammatory bowel disease
1.5 to 1.9 times
Diabetes, type 1 2.4 times
Gastroenteritis 3 times
Hodgkin's lymphoma 1.8 to
6.7 times
Otitis media 2.4 times
Haemophilus influenzae
meningitis 3.8 times
Necrotizing enterocolitis 6 to
10 times
 Illness Relative risk

Pneumonia/lower
respiratory tract
infection 1.7 to 5 times
Respiratory syncytial
virus infection 3.9 times
Sepsis 2.1 times
Sudden infant death
syndrome 2.0 times
Industrialized-world
hospitalization 3 times