BABY CARE
last update: 28 April 2020

Breastfeeding

All you need to know about breastfeading. Why breastfeeding is so important? What is the benefit?

 

Why breastfeeding is so important? What is the benefit?

why breastfeeding is do important?

Nothing is better than breast milk for the beginning of life. It is estimated that many children suffering from various diseases, including diarrhea, respiratory infections and other infections because they are not breast-fed correctly. Many babies suffering from diseases other than contrairiam if they had been breastfed. 
The WHO (World Health Organization) recommends exclusive breastfeeding from birth to 4-6 months, however, many mothers do not begin to give breast milk or other artificial foods before 4 months. The most common reasons for this are due to mothers believe they have enough milk or else, the fact they have had some difficulty breast-feeding or need to be absent from the baby a long time. 

The three components that make a difference in breastfeeding: 

  • Emotional aspect of baby and mother
  • Nutritional aspect of milk, colostrum to mature milk in the baby's development
  • Immune aspect - protection against infections transferred through breast milk

 

Emotional component of breastfeeding

Breastfeeding helps mother and baby to form a close and loving relationship, which makes the mother feel emotionally satisfied. The intimate contact soon after birth helps to develop this relationship. Babies cry less, and may develop faster, if they stay near their mother and are put to the breast in the 1st half-hour of birth. 
Nursing mothers relate more affectionate way with their babies, and have less need of your attention. Breastfeeding is a gesture of love and affection that will give emotional child secure, base the development of his personality. Some studies even suggest that breast milk can help the child to develop intellectually. 


Nutritional and immunological component of breast milk composition

Colostrum is the breastmilk that women produce in the first days after delivery. It is thick and yellowish or transparent color. Its properties, rich in many anti-infectious factors, notably antibodies (secretory IgA - Main immunity factor in breast milk) and vitamin A, protect the baby against infections and allergies, as the newborn can not produce their own antibodies (proteins in the blood and breast milk that fight infection). 
In addition to easily digestible and practical use, breast milk is economical and has an important laxative preparation and digestive effect to accept the mature or mature milk.

Breast milk composition


Changes in the composition of breast milk

The mature milk is the breast milk which is produced after a few days after the colostrum. The amount of milk becomes larger, and the breasts are completely filled, hard and heavy. He called it "milk let-down." 

The initial or previous milk that is produced early in the feeding, provides a lot of protein, lactose (the special sugar present in all milks) and other nutrients. The baby can drink large amounts of milk, and thus receive all the water it needs. 

The final or last milk, it appears whiter than the initial milk, because it contains more fat. This fat provides an important part of the energy of a breastfeed, and therefore a good reason not to take the baby very quickly chest. 


How does breastfeeding work?

How does breastfeeding work?

When the baby nurses are sent sensory impulses through the nipple to the brain (anterior pituitary gland), which produces prolactin (hormone responsible for milk production), responsible for the production of milk for the next feeding. The peak of prolactin occurs about 30 minutes after the last feeding. 

With the continuation of stimuli caused by the suction nipple, sensory impulses are sent back through the nipple to the brain (this time to the posterior pituitary gland), which produces oxytocin. This chemical causes the milk to flow within through contraction of specific cells (myoepithelial), which help to expel the milk out of the alveoli (small bags milk secreting cells in the breast) and continue through ducts ( small tubes that carry milk to the nipple). 

This flow of milk from the breast due to the release of oxytocin (known as reflection of descent and eject milk) also functions as a reflection psychosomatic, and therefore, distress situations, agitation, fear and stress for the mother, may exert an inhibitory action on the production of milk. Conversely, pleasant feelings, well-being, serenity and mother's confidence, stimulate it. 

Milk production is also controlled within the breast. There is a substance - bromocriptine - which can inhibit or reduce the production of milk. If the breast is too full, one inhibiting factor causes the cells to stop producing milk - protection mechanism against overfilling. If the baby stops sucking a breast, it stops producing milk. And to continue their production, breast milk must be removed. 


How to put your baby on the breast?

How to put ypu baby on the breast

Some nursing babies satisfactorily in positions that are difficult to others. This is especially so with children over 2 months of age. There is no reason to try to change the position of a baby if he's fine drawing breastmilk, and his mother is comfortable. 

For the feed is appropriate that mother and child acquire the following attitudes: 

  • The mother is relaxed and comfortable
  • All the baby's body leaning against the mother and facing her
  • The baby's face was facing the breast, with his nose on the nipple. If the baby is a newborn, the mother should support not only the head and shoulders, but also their buttocks.
  • The mother should hold the chosen to breastfeed chest, placing your fingers pincer, with the index finger to support the base of the breast and your thumb to gently press the top of the breast. In this way the nipple is prominent and easier to pick up the baby in the chest. The mother's fingers should not be close to the nipple.
  • Then play with the nipple on the lips (rooting reflex and hold), and the baby opens his mouth and puts his tongue out and down
  • Wait until the baby well open his mouth, to take you quickly to the breast so that it matches the lower lip turned out and his chin leaning against the bosom, and snapping his chest
  • Most of the mammary areola should appear above the upper lip of the baby and the lower part below the lower lip

Breastfeeding

Why does the baby refuse to suckle?

why does the baby refuse to suckle?

The refusal by the baby is a common reason for stopping breastfeeding. Rejection normally cause great disturbance in the mother, who may feel rejected and frustrated. 
Often the refusal to nurse can be overcome, but it is necessary to know what (s) reason (s) leading (m) the baby denial. In breast rejection of the evaluation should be considered four different situations: 

1. The baby is ill, in pain or sedated? 
When a baby is sick you can take the breast but suck less than in previous feedings. The stuffy nose or mouth pain due to infection (eg. Thrush (oral thrush)), takes the baby to nurse a few times, then stop and cry. In another situation, when the unborn child has been subject to pressure from extraction forceps that sometimes cause injuries (bruises) on the head, the newborn cries and refuses when the mother by adopting the best position tries to nurse him. While a sleepy and listless baby, who apparently refuses the breast, can sleep due to medication given to the mother during childbirth or another. 

2. Are there any difficulties with breastfeeding technique? 
Sometimes breastfeeding becomes unpleasant and frustrating for the baby.

  • Point is then possible causes for the refusal of the breast: 
  • Was fed with bottle Can not enough milk due to engorgement or takes ineffective breast
  • Restriction of breastfeeding, breastfeeding only at certain times
  • Pressure on the baby's head, due to poor positioning or technique
  • Too much milk to flow rapidly due to a hiperprodu tion of milk. In this situation, it is common for the baby to breastfeed for a minute and then drop the chest, choking and crying
  • Initial difficulties in coordinating suction. Some babies take longer than others to begin to feed themselves effectively.

3. Any change upset the baby? 
Some babies have strong feelings, refusing to suckle when they are upset. They can not cry and simply reject the breast. This behavior is most common when the child is between 3-12 months.

The sudden refusal to nurse, may be due to the following situations:

  • Separation from the mother, when you start working, for example
  • A change in family routine (moving house or family visits)
  • Mother's illness or infection of the breast
  • A new person to take care of the baby
  • A change in the mother's smell (soap or other food)

4. The refusal is "apparent" or "real"? 
Sometimes a baby behaves so that the mother thinks he is refusing the breast. However, this denial does not correspond to reality, and is especially so in two stages of child development:

When a newborn seeks bosom, he moves his head from side to side, as if to say "no". However, this is a normal behavior of an unborn child.
Between the age of 4-8 months, babies they are easily distracted, especially when they hear a noise, which can suddenly stop breastfeeding.

 

What to do to go back to breastfeeding?

We can not force a baby to breastfeed.

Sometimes you even need the help of a caregiver to her mother again feel self-confident, happy with your baby and enjoy breastfeeding. Do mother and baby enjoy breastfeeding again, may not be easy, however, the benefits that brings both worth the effort to try. Here are some suggestions that may help the mother and son in this relearning process. 

1. Keep join the baby whenever possible 

  • Must be the mother to care for the baby the maximum time that is allowed. Ask grandparents or others to support in other ways, such as help with household chores and caring for older children. 
  • The mother should bring the baby in her arms frequently, thereby allowing more skin-to-skin on other occasions apart from feedings. 
  • If having a job, you should talk with your doctor, to consider medical permission to inability to work for family care, and thus spend more time with his son.

breastfeeding 

2. Breastfeed when the baby want 

  • The mother should not be in a hurry to breastfeed again, but offer the breast when the baby shows interest. 
  • The mother can suckle at different positions, and even after a feeding bottle. 
  • The mother should also offer the breast when he feels the milk ejeição reflex (breast milk flow due to release of oxytocin). 

3. Help the baby to suckle 

  • Manually extract some breast milk directly into the baby's mouth. 
  • Correctly position the baby is, so that it is easy to take the breast. 
  • Avoid pressing the back of the head or rocking baby ça the breast. 

4. Feed the baby with glass to breastfeed again 

  • The mother can express milk by hand and feed the baby a glass (or cup and spoon). 
  • One should avoid using bottle, teats or pacifiers of any kind. 

 

Breast problems

Flat or inverted nipples

Breast problemsThe most important approach should occur shortly after birth when the unborn child begins to suckle.

It's important that the mother: 

  • Trust yourself - the mother should know that can be hard at first, but with patience and persistence she can succeed. The baby's sucking helps pull her nipples out, breasts and improve and become softer one to two weeks after delivery
  • Meet the breastfeeding technique - the baby needs to grab a good part of the breast
  • Contact skin-to-skin contact with the newborn - the mother must leave the baby explore her breasts, allowing you to take in the breast your way when you are interested. Some babies learn best by themselves
  • Learn how to externalize the nipple before breastfeeding - the mother can use a hand pump or a syringe to pull the nipple. This procedure should take place for 1 minute
  • Learn to shape the breast to facilitate the handle - the mother should support the breast from below with the fingers (index and middle), and lightly press the top with the thumb

 

If the baby can not suckle effectively in the first two weeks, the mother should:

  • Manually express breast milk and give the baby for a small glass - the extraction of milk helps maintain the soft breasts, facilitating the production of milk and the baby takes the breast
  • Express milk directly into the baby's mouth - this can any of immediate food, getting less frustrated, and may be more willing to breastfeed.

 

For a greater comfort

Medela

 

 

 

 

You may choose to use a nipple former, whose silicone membrane exerts a slight pressure on the areola, gradually forcing the nipple out. You can start by applying it 2h a day on the 34th and 35th weeks of pregnancy, and spacing the applications every 3 or 4 days from that time on.

  • Place the silicone membrane in the shell;
  • Make sure it is settled all the way around;
  • Place the Nipple former inside the bra with the silicone opening membrane centered over the nipple;
  • The ventilation holes in the shell should face upwards;
  • It is recommended to use a bra for breastfeeding, as theses are larger and the Nipple Maker will adjust more comfortably.

Warning: Do not feed the baby with the milk accumulated in the shell. Discard this milk


Engorgement of the breasts

Engorgement of the breasts
When the breast is not completely emptied, the milk accumulates in lactóforos ducts (small tubes that carry milk to the nipple), and the pressure therein increases, causing edema (swelling due to fluid in the surrounding tissues). The increased pressure within the sinus and the obstruction of the ducts leads to generalized inflammation of the breast - mastitis - due to the passage of milk from the alveoli (small bags milk secreting cells) into the mammary tissue. Therefore, one should not advise the mother to "rest" the breast. 

To treat breast engorgement is necessary to extract milk with a good emptying and decrease inflammation of the breasts.

Therefore, it is recommended the following: 

  • If the baby is able to breastfeed, should be fed often - this is the best way to express breast milk
  • If the baby can not breastfeed - the mother should extract it manually or with the help of a pump. Sometimes it takes just squeeze the breast with the exit of some milk so that the breast becomes soft enough for the baby pick up again
  • Before to breastfeed or express breast milk manually, the mother should stimulate milk flow within (reflection of oxytocin). For this, the mother should: put a warm compress on her breasts, a hot water bottle or take a warm shower (+ 20-30 minutes); massage the breast lightly; and stimulate the breast and skin of the nipple
  • After a feeding, it is advisable to mother put a cold compress on her breasts. This procedure should take about 8 minutes and be repeated after a pause of the same duration.

 

Blocked ducts and mastitis

blocked ducts and mastitis

The ducts obstructed develop when the milk is not removed from the breast part, due to stagnation and accumulation of milk, which becomes thicker. The first manifestations are the appearance of a lump (aka, seed) associated with flushing (redness) of the skin over the lump - Breast inflammation - also called non-infectious mastitis. 
In this situation, the woman usually has no fever and feels well. If there is a bacterial contamination, translated by growing complaints - edema (swelling), intense local pain, redness of stress, onset of fever and malaise - the mother suffers from an infectious mastitis. 

The main cause of the obstruction of the ducts and mastitis due to poor drainage milk of all or part of the breast. When it reaches the entire breast, it can be due to two main reasons: 

  • Feedings uncommon (common causes: mother tired, eating pattern change)
  • Suction ineffective (for poor handle on the chest).

A poor drainage of the breast may be due to:

  • Pressure tight clothes - usually a bra, especially if used at night or if the mother sleeping on the breast by compressing it, can block the flow of milk
  • Poor drainage from the bottom of a massive bosom - because of the way the breast is suspended
  • Ineffective sucking - because insufficient empty handle only part of the breast

The most important approach is the obstructed duct in improving milk flow from the affected part of the breast. For this, one must look for the cause of poor drainage and correct it.

The mother should check that:

  • The handle of the chest is correct
  • There is pressure from clothes or if the breast is compressed by the sleeping position
  • Holds the areola with your fingers in order to block the flow of milk
  • The blocked duct is in the lower part of the breast. In this case, you must raise over the breast while the breast feeding infant, to help drain the bottom of the breast

Although the cause, the mother should:

  • Breastfeeding often
  • Gently massage the breast while the baby is suckling
  • Apply warm compresses between feedings
  • Start breastfeeding the breast that is smoothly
  • Breastfeeding your baby in different positions - helps drain the milk from different parts of the breast 
  • removing the milk manually, if breastfeeding is difficult

Usually, a duct obstructed or mastitis improves rapidly (one day), when the breast affected part improves drainage. However, if the manifestations of infection are severe or there is no improvement lactation after 24 hours, the mother should be seen immediately by a doctor, who should advise on non-pharmacological measures and should medica it. 

 

Painful nipples, cracks and fissures

Painful nipples, cracks and fissures
The painful nipples often appear when there is stagnation of breast milk and engorgement of the breasts. Granddaughters conditions, the baby just Aboca the nipple and has on it all its suction force. Other situations that favor the appearance of cracks and crevices, usually painful: 

  • Feedings too long
  • Use of the nipple as a pacifier
  • Poor breastfeeding technique
  • Little proper hygiene breasts
  • The too sudden interruption of breastfeeding

Addressing these situations goes first to seek the cause by breast-feeding baby observation (ineffective handle?), Breast (engorgement signs of cracks, fissures, infection?) And the baby's mouth (thrush? (Candidiasis oral)), tongue-tied? (short brake the tongue).


Fissures and cracks typically cause the withdrawal of the mother to breast-feed, so that appropriate treatment should:

  • Increasing the mother's self-confidence - because the pain is transient
  • Improve the baby picks
  • Reducing engorgement, if necessary
  • Consider treatment for infection by fungus (Candida), the skin of the nipple and areola are reddish, bright or thin. It can also occur pruritus (itching) Local and / or pain

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Extraction breastmilk

What are the situations that justify the extraction of breast milk? 
There are many situations in which the extraction of breast milk is important and helpful to enable restart breastfeeding: 

  • Relieve engorgement
  • Unblock the clogged duct or facilitate the flow of stasis (stagnation) of breast milk
  • Feed the baby while learning to suck a flat or inverted nipple
  • Feed the unborn child presenting incoordination breastfeeding
  • Feeding a baby who "refuse" the chest while learning to like to suck
  • Feeding a low-weight baby who can not breastfeed
  • Feed a sick baby who can not extract the needed breast milk
  • Maintain lactation (physiological process of milk production) in the period in which the mother or the baby is sick
  • Leave breast milk for the baby while the mother works outside, and can not breastfeed
  • Prevent the milk drain the breast when the mother is away from baby.

 

 

What is the better way to extract breast milk manually? 
Normally you do not need any support instrument to remove the milk, the mother can do it anywhere and time. However, although an efficient technique is more easy to manually extract the milk when the breasts are softer than when engorged and painful. 
To be an effective extraction of milk is useful to occur a greater flow of milk in the breast, mechanism assigned to a hormone (oxytocin), released when the baby mama.

The mother can help stimulate your reflection of descent and ejection of milk (reflection of oxytocin) through the following practical steps:

  • Sitting in a quiet and comfortable environment
  • Holding the baby in his arms, so that there is skin-to-skin, while removing the breast milk
  • Drink some nice fluid (should not be coffee)
  • Heat the breasts, with the application of warm compresses or takes a shower bath
  • Stimulate the nipples, pulling and twisting them gently with your fingers
  • Massage or gently stimulate the breasts
  • Massaging the back (the back) to the mother (as described below technique)

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Massage technique to stimulate the descent and eject milk 

The mother should be seated and leaning forward, with his head in his arms folded on a table. The breasts should be hanged without any clothing to sustain them or protect them. The person performing the massage should press firmly the back from top to bottom, with fists and thumbs forward in a circular motion, parallel to the dorsal (back) to the right and left. Each session should last 2-3 minutes. 

 

How to extract breast milk manually?

Must be the mother to manually extract their own milk.

To do this properly and effectively is useful and necessary to follow the following steps:

  • Wash hands
  • Sit or stand confortavelmeente foot and hold the container near the breast
  • Put your fingers like pincers - with the thumb over the nipple and areola and forefinger oppositely underneath, holding the breast with the remaining fingers of the same hand, press with your fingers pincer (thumb and forefinger) breast by behind the nipple and areola in order to exert pressure on lactóforos breasts (widest part of the ducts where breast milk is deposited), which are located beneath the areola. Sometimes the mother can feel the lactóforos breasts, reminiscent of the shape of peanuts.
  • Using the correct technique - just firm and successively press the breast and then relieving force. At first the milk can not get out, but after a few movements begins to drip and can flow well to the stimulus of descent and ejection (oxytocin reflex) has been effective.
  • Evenly press the areola in the same way across the back to ensure that the milk is extracted from all breast segments
  • Avoid squeezing the nipple. His expression does not lead to drainage of breast milk
  • Remove each breast milk for at least 3 to 5 minutes until it flows slowly. After repeating once again on both. Extract breast milk suitably takes about 20 to 30 minutes, especially in the early days when only a small amount is produced.

What is the frequency with which the mother should express milk?

  • The mother should express milk depending on the situations where it is necessary. 

To start the lactation (physiological process of breast milk production), feed a low birth weight baby or a sick newborn:

  • The mother should express milk on day 1, the first 6 hours after birth, if possible. It is advisable to remove as much as she can and as often as the mammary baby, that is, in 3 hours, including at night.

To increase the milk production, if it is decreasing after a few weeks of breastfeeding:

  • Extract amiudadamente for a few days (every half hour or 1 hour), and at least 3 for 3 hours to overnight.

To store milk for the baby while the mother is working:

  • Remove as much milk as possible before going to work, to leave the baby. The mother is important to remember to express milk while at work in order to help maintain milk production.

To relieve symptoms caused by engorgement of the breasts:

  • Extract only the amount of milk needed

To keep the skin healthy nipple:

  • Remove a small drop to pass the nipple after a bath
  • Pumps for breast milk extraction
  • There are manual and electric

how to know if your baby is getting enough milk?

How to know if your baby is getting enough milk?

Almost all the mothers have enough milk for one or even two babies. Sometimes even when the mother thinks it does not have enough milk, the baby is nursing well and getting all the nutrients you need. However, it also happens the baby to suck the necessary due usually to an "ineffective catch" breast and more rarely because his mother can not produce enough milk. 

There are two indirect ways to identify if the baby is breast-feeding enough.

Are they: 

  • Measure the increase in baby weight - this is the most accurate signal and greater confidence. In the first 6 months of life, an infant should win at least 500 g weight in each month or 125 g per week. If a baby increases less than 500 g in a month, did not get enough weight. Rather, it won the expected weight, then it is necessary to get the milk.
  • Assess the baby's urinary volume - this method is useful and fast, although less stringent than the last. A baby breastfeeding enough milk usually diluted urine eliminates at least 6 to 8 times per day. While the baby who is not getting enough milk, urine less than 6 times a day, and often less than four.
  • Other suggestive signs are more concentrated urine, with a dark orange or yellow coloration, particularly if the baby is older than 4 months, and urine with a strong odor

These two methods show whether a baby exclusively breastfed your chest is getting enough milk. However, if administered other liquids, can not be sure whether the infant is to acquire necessary. 

 

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