Breast-feeding

Breast milk is the best choice for a child. The American Pediatric Academy (APA) recommends feeding the baby at least the first six months of life only with breast milk, with the introduction of age-appropriate lures from 6 months to 1 year of age. After a year, breastfeeding persists for as long as the baby and his mother want, although after a year breastfeeding should only supplement a complete diet with enough solid food and liquid.

Breastfeeding is one of the most important factors in adapting a newborn to the new conditions of extrauterine life.

Almost every woman is able to breastfeed her child for a long time. But for this it is necessary to fulfill certain conditions, the main of which are:

• early, that is, in the first 30-60 minutes after delivery, the application of the newborn to the breast;
• frequent, active sucking, which is determined not by any schedule, but only by the individual requirement of the child and the degree of his satiety;
• the correct technique of feeding, which ensures effective sucking;
• complete emptying of the breast and getting milk by the baby;
• a positive emotional state of a woman who is breastfeeding.

To ensure successful breastfeeding, doctors should begin work on the formation of the lactation dominant before the birth of the child, telling about the benefits of breast milk for the baby (the optimal composition corresponding to the capabilities of the infant's gastrointestinal tract and providing all nutritional needs, optimal intellectual development, protection from infections, allergies, obesity, Crohn's disease and diabetes) and mothers [decreased fertility during lactation; faster recovery after delivery (i.e., involution of the uterus, weight loss); protection from osteoporosis, obesity, ovarian cancer, premenopausal breast cancer].

In primiparas, lactation is completely established 72-96 hours after birth, in the case of moles, in a shorter time. First, colostrum, high-calorie, high-protein, having a yellowish tinge, with high protective properties, due to the content of antibodies, lymphocytes, macrophages, capable of stimulating the migration of meconium, is produced. Subsequent milk contains a large amount of lactose, which provides an easily accessible source of energy corresponding to the limited capacity of the immature gastrointestinal tract of the newborn; contains large amounts of vitamin E, which can help prevent the development of anemia by increasing the life span of red blood cells, and is also an important antioxidant; has a ratio of calcium and phosphorus 2: 1, which prevents the development of hypocalcemic convulsions; causes favorable changes in the pH of the stool and intestinal flora, thereby protecting the child from bacterial diarrhea; transfers protective antibodies from mother to baby. Breast milk is also a source of -3 and -6 fatty acids. It is believed that these fatty acids and their long-chain polyunsaturated derivatives (AAPH), arachidonic acid (ARA), and docosahexaenoic acid (DHA) provide higher visual and cognitive abilities of infants fed on breastfeeding compared to children who were breastfed. Regardless of the diet of the mother, breast milk also contains cholesterol and taurine, which are extremely important for the development of the brain.

If the mother's diet is varied enough, no mother or baby is needed to use any diets or vitamin supplements, if she is full, the only exception is vitamin D 200 ME once a day from the second month of life for all infants fed only with breast milk. Preterm and black babies, as well as infants who are not very sunny (living in the northern regions), are at risk. Infants younger than 6 months should not be dopaivat in connection with the risk of hyponatremia.

[1], [2], [3],

Benefits of breastfeeding

The benefits of breastfeeding are as follows:

• Less mortality among infants (even in low-income segments of the population).
• The application of the baby to the breast helps reduce the uterus, which prevents postpartum bleeding.
• The direct connection of the mother with the child, eye to eye, establishes an intimate contact between them and promotes an even greater development of the maternal instinct, which is an emotional stimulus for the mother.
• Breastfeeding is already proven experience as a common stimulant for all five senses.
• Breastfeeding is cheap, and breast milk is a pure product.
• It protects against infection, since milk contains IgA, macrophages, lymphocytes (carrying interferon) and lysozyme. Breast milk has an acid reaction, which promotes the growth of beneficial lactobacilli in the intestines of the baby. Gastroenteritis in a child fed by breast milk, always proceeds more easily, since a mother with milk can pass on antibodies to the child (there appears to be an immune dialogue between the mother and the child).
• Breast milk contains less sodium, potassium and chlorides than in milk of other origin, which facilitates the creation of homeostasis by the kidneys.

If this causes dehydration, the risk of fatal hypernatremia is much lower.

[4], [5], [6],

Factors hampering the onset of breastfeeding

• In the hospital, the mother and the newborn are in different wards at night,
• Urbanization and its consequences - the mother must work, and there is no place for feeding the baby at work.
• Young saleswomen, disguised as nannies and delivering food to newborns at home.
• The effect of the example: if older sisters do not breastfeed a newborn, younger sisters find it more difficult to begin breastfeeding later.

[7], [8], [9], [10],

Why should prolonged breastfeeding be promoted?

• This makes the child happy and helps to increase milk production from the mother.
• This reduces the number of problems with the mammary gland - inflammation, swelling, engorgement, the development of abscesses.

Note: sleep is much less likely to be interrupted if at night the baby is in the same bed with the mother.

Ten Principles for Successful Breastfeeding

1. it is important to put the baby to the breast as soon as possible. This must be done in the delivery room. Early attachment to the breast is important for both the child and the mother;
2. from the outset, exclude feeding from the bottle and the use of pacifiers. Do not use the nipple, dummy, bugylki - in the future it will avoid breast failure, provide enough milk and constant contact with the baby. Remember that the more mother feeds her breast, the more milk she will have;
3. Do not limit the duration of feeding and do not tear the baby from the breast before he releases it. For a child, staying near the breast is not only food, it is a feeling of security, comfort and intimacy with the mother;
4. feed your baby at night. The child grows quickly and can not sustain large periods of time without feeding. Night feeding stimulates the production of milk on the following day;
5. the child is important from the very beginning of being together with the mother. The general stay has many advantages, for example:
   1. mom quickly learns to respond to baby signals; it helps to establish strong emotional and psychological connections;
   2. the kid feels protected;
   3. Mom more confidently feeds the child and can apply it to the chest, as soon as the kid wants it (at least 8-12 times a day);
   4. when the mother and the child are together, the risk of developing infectious diseases is reduced;
6. great importance is the position of the baby near the chest. It is a pledge of comfortable, effective feeding and, accordingly, successful lactation. When giving the breast, keep the baby very close, belly to yourself. Your nipple should be at the level of the child's spout. Expect the baby to open his mouth wide, and attach it so that he captures not only the nipple, but most of the areola (the area of the chest around the nipple);
7. in no event up to 6 months. Do not give your child water, tea or other products. By this, you protect the baby from infections, allergies and intestinal disorders and provide the baby with adequate nutrition;
8. do not wash your breasts specially before and after feeding. Excessive washing with soap overdoes the skin of the nipples, can lead to their cracking, and also flushes the microflora useful to the child from the skin of the mother;
9. Do not express milk without special need. Expressing is necessary only in case of forced separation of mother and child or when the child can not suck the breast;
10. To ensure that the baby is healthy, as laid down by nature, WHO recommends breast-feeding for at least two years, of which the first six months - exclusively breast milk.

Contraindications for breastfeeding

• The mother is positive for HBsAg.
• Mother received amiodarone.
• The mother receives antimetabolites.
• Mother gets opiates.

It should be considered a mistake to recommend mothers infected with HIV to switch to artificial feeding, since if the infant has avoided infection in utero, it is unlikely that he can get infected from the mother, and the benefits of breastfeeding may outweigh the small additional risk of infection.

Read more full article: Contraindications to breastfeeding

[11], [12], [13], [14]

Breastfeeding techniques

The mother can take any relaxed, comfortable position for her and must hold the chest with her hand so as to reduce trauma and be sure that the nipple is at the level of the middle of the baby's mouth.

In this position, the nipple stimulates the receptors of the baby's lower lip, a search reflex is triggered and the mouth opens wide. It should be ensured that the baby's lips are at a distance of 2.5-4 cm from the base of the nipple, thus maximally grasping the areola with the lips. The child's tongue then presses the nipple against the hard sky. To have a milk reflex, it will take at least 2 minutes.

The volume of milk with the growth of a child as well as the stimulation of lactation during sucking increases. The duration of the feeding is usually determined by the child himself . Some women need a breast pump to increase or maintain lactation; most women 90 minutes a day expressing, divided into 6-8 approaches, allows you to get enough milk for the baby.

The baby should suck one breast until the breast becomes soft and it does not slow down or stop. Before removing the baby from one breast and offering him another, the mother can interrupt sucking with the help of a finger. In the first days after birth, an infant can only suck one breast for one feeding, in which case the mother should alternate the breast each feeding. If the child falls asleep before the required amount of milk sucks, the mother can remove the baby when the sucking slows, hold the child in a vertical position, so that the swallowed air comes out and offer him a second breast. This method of feeding will keep the baby awake during feeding, and also stimulates the formation of milk in both mammary glands.

Should explain to mothers the benefits of feeding on demand or every 1.5-3 hours (8-12 feedings per day), over time, the frequency of feeding gradually decreases; Some newborns weighing less than 2500 g may need more frequent feeding to prevent hypoglycemia. In the first few days of newborns, it may be necessary to awaken for feeding. Usually it is more convenient for a newborn and a family to work out a schedule that allows a child to sleep at night as long as possible.

Mothers who work outside the house can express milk while they are without a child, this will help maintain lactation. The frequency of expression can vary, but approximately should correspond to the order of the child. Expressed breast milk should be placed immediately in the refrigerator if it is used within 48 hours, in case of longer storage, the milk should be frozen. Milk, which was stored in the refrigerator for more than 96 hours, should be discarded because of the high risk of bacterial contamination. Frozen milk must be thawed in warm water, it is not recommended to use a microwave oven.

If early application for some reason did not take place and the first feeding was postponed for a while, lactation in this case can also be successful and prolonged. It is necessary to replace the sucking of the baby with an early regular colostrum colostomy every 3-3.5 hours. Even if the mammary glands are empty after the birth, you need to massage the nipple and areola, and then carefully discard the colostrum drops, repeating this procedure regularly. The amount of milk will necessarily increase and it will be enough for a day of feeding the baby.

The frequency of applying the baby to the breast can reach 10-12 times a day. As the amount of milk increases, the frequency of feeding will decrease to 7-9. Particularly important in supporting lactation is night feeding.

With proper feeding technique, the duration of feeding should not be limited. After actively sucking one breast and emptying it, the baby needs to be offered another breast. The next feeding should begin already with the breast, which was fed last. But it must be remembered that the use of two mammary glands for one feeding can lead to the fact that the child does not receive the "back", the most energy-valuable milk. Therefore, in any case, you can not quickly mark the breast during feeding. As a rule, on the 6-14th day with this feeding regime, sufficient lactation occurs, the duration of sucking is on the average 20-30 minutes, and the need to feed the baby from two breasts disappears.

Today, it is well known that feeding a child on a hard schedule, with a night break, the use of a bottle with a pacifier when supplemented with a mixture in the period of lactation, that is, in the first days after birth, leads to a decrease in milk production and early loss of lactation in general.

In whatever position the feeding (sitting or lying down) is performed, one must adhere to such basic rules:

• the head and trunk of the baby should be on the same line;
• the face of the child should be facing the breast of the mother, the spout should be in front of the nipple;
• the baby's body should be pressed against the mother's body (abdomen to stomach);
• One should hold the entire body of the child from the bottom with one hand.

Signs of the correct attachment of the baby to the breast:

• the child's chin touches the maternal breast;
• the baby's mouth is wide open;
• the lower lip is inverted;
• cheeks are rounded;
• the greater part of the areola is not visible (mainly the lower part of it);
• mother does not feel pain even with prolonged sucking,
• You can hear the baby swallowing the milk.

Signs of improper feeding of the child:

• the baby's torso is not fully turned towards the mother;
• the chin does not touch the chest;
• The mouth is not wide open, the lower lip is drawn, the cheeks even sink;
• the greater part of the lower part of the areola remains not captured by the infant's mouth;
• sucking movements are fast and short, sometimes there is a smacking;
• sensation of pain in the nipple.

To ensure a long and successful breastfeeding from the first days after returning home from the hospital, you must adhere to the following rules:

• feed the child "on demand", and not "on the regime", that is, you need to give the child the opportunity to feed as much as he wants. In the first weeks of life this can be 8-10 and even 12 times a day. Such frequent feeding of the newborn is physiological and promotes good stimulation of your lactation. Gradually, usually at the 3-4th week of the infant's life, the frequency of feeding decreases and is 6-7 times a day; 
• Avoid night feeding. If the baby wakes up at night and cries, do not give him water or a pacifier, but breastfeed. Remember that it is at night that intensive prolactin production takes place, which is responsible for lactation;
• Breastfeeding should take place in a calm atmosphere. A good mood of the mother, pleasant music, comfort contribute to the intensive production of milk and easy release of milk from the breast;
• the duration of each feeding, as a rule, is 15-20 minutes. Most children during this time suck the right amount of milk and fall asleep. If this does not cause you unpleasant or painful sensations, then it is advisable not to take the baby from the chest and dagi to fully satisfy his sucking reflex;
• a healthy child who receives a sufficient amount of I ore milk does not need additional consumption of water, broths or tea, even on hot days, since female milk contains not only nutrients, but also water needed by the child.

Optimum is considered exclusively breastfeeding during the first 4-5 months. (the child receives only breast milk and no foreign food, not even water), since with sufficient lactation, a rational nutrition of the woman, mother's milk fully meets the physiological needs of the child for the first 5 months. Life.

[15], [16], [17], [18],

Complications of breastfeeding on the part of the child

The primary complication is underfeeding, which can lead to dehydration and hyperbilirubinemia. Risk factors for underfeeding are small or premature newborns, pervious mothers, mother's diseases, severe labor, surgical intervention in childbirth. An approximate assessment of the adequacy of feeding may be given by the number of diapers used; at the age of 5 days, a healthy newborn baby wets at least 6 diapers / sutures and dabs 2-3 diapers a day; a smaller number of diapers may indicate hypohydration and underfeeding. Another parameter that indicates an underfeeding is the weight of the child; lag in weight gain may also indicate malnutrition. Constant anxiety at the age of up to 6 weeks, when colic can develop independently of hunger or thirst, may also indicate an underfeed. Dehydration should be assumed with a decrease in intensity of screaming and skin turgor; drowsiness and lethargy are serious signs of dehydration and prompt to immediately determine the level of sodium due to the possibility of developing hypernatremia.

[19],

Complications of breastfeeding by the mother

The most frequent complications from the mother include breast engorgement, nipple cracks, blockage of the milk ducts, mastitis, anxiety.

Breaking of the mammary glands, which occurs in the early lactation period and lasts for 24-48 hours, can be minimized by an early frequent attachment to the breast. You can also use a comfortable bra for nursing mothers, which should be worn 24 hours a day, as well as a cool compress on the chest after feeding, the use of a soft analgesic (for example, ibuprofen). A breastfeeding woman may also need a massage and a warm compress. If you strain a little milk before feeding, it will allow the baby to better grasp the swollen areola with the mouth. The additional expressing of milk between the feedings reduces the roughing, it is not necessary to express all the milk, but so much to remove the discomfort.

To treat nipple cracks, it is necessary to check the position of the baby during feeding; sometimes infants draw their lips in and suck it, which irritates the nipple. A woman can release her lip with her thumb. After feeding, you need to squeeze out a few drops of milk and allow them to dry on the nipple. After feeding, a cool compress will reduce roughness and provide a further comfortable state.

Blockage of the milk ducts manifests itself as a strained, moderately painful area of the breast of a nursing woman, while it does not have any common signs of the disease. Seals arise in different places, they are painless. Continuation of breastfeeding will ensure the emptying of the breast. Warm compresses and massage of the affected segment can help restore the patency. Also, a woman can change the position during feeding, as different areas of the breast are emptied better depending on the position of the child. A comfortable bra can help, while regular bras with wire inserts and tightening straps can help stagnate milk in the squeezed areas.

Mastitis occurs quite often and manifests itself as a painful, hot, swollen region of the mammary gland of the wedge shape. It develops against the background of engorgement of the mammary gland, blockage of the ducts; infection can occur again, most often caused by penicillin-resistant strains of Staphylococcus aureus, less often - Streptococcus sp or Escherichia coli. Infection can develop fever (> 38.5 ° C), chills, flu-like condition. The diagnosis is based on anamnesis and clinical data. The number of cells (leukocytes> 106 / ml) and the sowing of breast milk (bacteria> 103 / ml) will help to distinguish infectious mastitis from non-infectious mastitis. If the symptoms are not expressed and persist for less than 24 hours, there may be enough conservative treatment (emptying the breast with feeding or pumping, compresses, analgesics, maintaining a bra, protective regime). If improvement does not occur after 12-24 hours or if the activity is high, antibacterial therapy should be initiated using drugs that are safe for the child and effective against S. Aureus (eg cephalexin 500 mg orally 4 times a day); duration of therapy is 10-14 days. Complications of late onset of therapy - relapse and abscess formation. During the treatment, you can continue breastfeeding.

Maternal anxiety, frustration, feelings of dissatisfaction can develop due to lack of experience in breastfeeding, mechanical difficulties in feeding, fatigue and difficulty in determining the adequacy of milk, as well as postpartum physiological changes. These factors and emotions are the most common reasons why women stop breastfeeding. Early observation by a pediatrician or consultation with a lactation specialist is an effective measure to prevent the early cessation of breastfeeding.

One of the decisive factors for the success of lactation is ensuring the appropriate position of the baby near the breast and the correct technique of breastfeeding. The consequences of improper breastfeeding can be:

• the formation of nipple cracks, pain during feeding, the appearance of fear of the occurrence of pain, inhibition of the milk withdrawal reflex;
• ineffective suckling of the baby's breasts, and consequently, his dissatisfaction, weight loss;
• the use of milk and the reduction of its production as a consequence of insufficient emptying of the breast;
• the development of inadequate milk production, the so-called hypochalacia;
• sucking in a significant amount of air (aerophagia), which fills the stomach, stretches it and leads to regurgitation of milk;
• treshina nipple and stagnation of milk, which subsequently leads to mastitis.

To feed was pleasant and easy, you need to take a comfortable position (lying or sitting with a support for the back). The child should be able to study the face, especially the eyes of the mother. It is best to feed the child naked, so that the child is maximally in contact with the mother's body. If the baby is tightly swaddled, then it is impossible to properly attach it to the breast. The child must move freely during sucking, show his emotions, reactions. Free diapering, without restriction of movements, promotes the proper development of the musculoskeletal system, joints, forms the baby's need in breast milk for the renewal of energy.

[20], [21], [22]

Medications and Breastfeeding

Nursing women should avoid medication whenever possible. If drug therapy is necessary, drugs should be avoided, as well as drugs that suppress lactation (bromocriptine, levodopa), choose the safest alternative drug and take it directly after breastfeeding or before the period of the child's longest sleep; This method is less applicable for newborns who eat often and whose feeding regimen has not yet been established. Data on the negative effects of most drugs are derived from reports of individual cases or small-scale studies. The safety of some drugs (for example, acetaminophen, ibuprofen, cephalosporins, insulin) has been proven by extensive research, while others are considered safe only on the basis of the absence of reports of adverse effects. Medications that have been used for a long time are usually safer than new drugs, information about which is limited due to the small experience of their use.

Weaning

As a rule, weaning occurs by mutual consent of the mother and child at any age over 12 months. More often, the rejection of breastfeeding occurs gradually over a period of several weeks or months, while the child is offered new types of solid foods; some babies quit immediately, without any problems, while others retain 1-2 breastfeeds a day to 18-24 months and even longer.