Breast Feeding and Physiotherapy

Original Editor - Manisha Shrestha Top Contributors - Manisha Shrestha, Rosie Swift, Kim Jackson, Uchechukwu Chukwuemeka, Muskan Rastogi and Carina Therese Magtibay

Original Editor - User Name

Top Contributors - Manisha Shrestha, Rosie Swift, Kim Jackson, Uchechukwu Chukwuemeka, Muskan Rastogi and Carina Therese Magtibay  

Introduction

Breastfeeding is one of the most effective ways to ensure child health and survival.The importance of breast feeding has been well known in developing countries to decrease mortality and morbidity of infants. But it is equally essential in reducing conditions affecting later life of child such as overweight or obese, diabetes in developed countries and also reduced risk of breast and ovarian cancers in women who breast fed.

Despite many benefits of breast feeding in both mother and baby, nearly 2 out of 3 infants are not exclusively breastfed for the recommended 6 months—a rate that has not improved in 2 decades. It is due to the lack of proper awareness about breast feeding in mothers and her family hinders true informed decision making and other reasons such as improper mother and infant positioning and attachment during breastfeeding.

Exclusive Breast Feeding

According to the World Health Organization (WHO), Exclusive breastfeeding (EBF) is the situation in which an infant receives only breast milk from his/her mother or a wet nurse for the first 6 months and no other solids or liquids with the exception of drops or syrups consisting of vitamins, minerals, supplements, or medicines.

Globally, about 40% of infants were exclusively breastfed and this is expected to rise to 50% by 2025. Worldwide, only 39% of newborns were put to the breast within 1 h of birth, and only 37% of infants were exclusively breastfed. The prevalence of EBP is less in developing countries with 20% Sub-Saharan Africa, 41% in North Africa, 44% in Asia, and 30% in the Latin America.

EBF is an important public health strategy for improving children’s and mother’s health by reducing child morbidity and mortality and helping to control healthcare costs in society.The 2001 WHO EBF-6 recommendation was based on evidence gathered from a systematic review comparing EBF for 6 months to EBF for 3-4 months with continued BF for at least 6 months, examining the impact of these practices on child health, growth, and development, as well as on maternal health.

There were concerns that EBP could result in iron deficiency, other micronutrient deficiencies and growth faltering in susceptible infants. These concerns were directed particularly at populations where maternal nutrition was poor. The risk for iron deficiency in the first 6 months of life can be successfully mitigated by delayed umbilical-cord clamping.

By the age of 6 months, a baby has usually at least doubled his or her birth weight, and is becoming more active. Exclusive breastfeeding is no longer sufficient to meet all energy and nutrient needs by itself, and complementary foods should be introduced to make up the difference. At about 6 months of age, an infant is also developmentally ready for other foods. The digestive system is mature enough to digest the starch, protein and fat in a non-milk diet. Very young infants push foods out with their tongue, but by between 6 and 9 months infants can receive and hold semi-solid food in their mouths more easily. Breastfeeding should continue with complementary feeding up to 2 years of age or beyond, and it should be on demand, as often as the child wants.

Benefits of Breast Feeding

The benefits of breastfeeding in baby:

• Strong mother-child relationship,
• Lowers the incidence of many childhood illnesses, such as gastrointestinal infections, middle ear infections, pneumonia, sudden infant death syndrome, diabetes mellitus, malocclusion, and diarrhea
• Lower malnutrition
• Reduce overweight and obesity
• Supports healthy brain development and is associated with higher performance on intelligence tests among children and adolescents

The benefits of breast feeding in mother:

• Decrease the frequency of hemorrhage (postpartum hemorrhage), postpartum depression, breast cancer, ovarian and endometrial cancer
• Facilitates weight loss
• The lactation amenorrhea method is an important choice for postpartum family planning

The benefits of breast feeding in family and society:

• Reduce expenses (formula milk and later treatment cost, if not breastfed)
• Sustainable environment following decrease in waste
• Reduce economic burden of the country for milk substitutes

Breast Milk

Breastmilk is the ideal food for infants as it is easily digested and efficiently used.. It is a live substance with unparalleled immunological and anti-inflammatory properties that protect against a host of illnesses and diseases for both mothers and children. Breastmilk provides all the energy and nutrients that the infant needs for the first months of life, and it continues to provide up to half or more of a child’s nutritional needs during the second half of the first year, and up to one third during the second year of life.

Constitutes of breast milk

It contain fat, carbohydrates, proteins, vitamins, minerals and water. Breast milk also contains bioactive factors that augment the infant's immature immune system, providing protection against infection, and other factors that help digestion and absorption of nutrients.

Milk contain	Quantity per 100ml
Fat	3.5g
Carbohydrate	7g
Protein	0.9g

Other important points to be noted are:

• The fat is secreted in small droplets, and the amount increases as the feed progresses. As a result, the hindmilk secreted towards the end of a feed is rich in fat and looks creamy white which fulfil hunger, while the foremilk at the beginning of a feed contains less fat and looks somewhat bluish-grey in color fulfil thirst. Thus, breastfeeding should be done for at least 15-20 minutes in order to help baby gain the weight.
• The amount of protein is much higher in animal milk than in human. The much higher protein in animal milks can overload the infant's immature kidneys with waste nitrogen products. Animal milk contain high amount of caesin which is hard to digest and make babies to vomit like curd. Along with that, beta-lactoglobulin in cow milk, which is absent from human milk, can become intolerant to infant.
• The breast milk have enough vitamins and minerals need for infants, except for Vitamin D. The infant needs exposure to sunlight to generate endogenous vitamin D – or, if this is not possible, a supplement. The minerals iron and zinc are present in relatively low concentration, but their bioavailability and absorption is high.
• Immunoglobulin and white blood cells help protect child from infections.

Quantity of Breast Milk

Milk production is related with a dose-response relationship, which mean there is also a positive effect of the number of breastfeeds in the first 24 h on milk production on days 3 and 5 after birth. The interventions that promote an adequate milk supply by the first week postpartum are critical. These include skin-to-skin contact and milk removal (breastfeeding or expressing) within an hour of birth and frequent milk removal during the first 24 h after birth, and early initiation of lactation. Adequate milk production by mother is very important has shown significantly affect in milk production during established lactation.

Colostrum is the special milk that is secreted in the first 2–3 days after delivery. It is produced in small amounts, about 40–50 ml on the first day. On the third day, an infant is normally taking about 300–400 ml per 24 hours, and on the fifth day 500–800 ml.

Reflexes in mother and hormonal control in milk production

Oxytocin reflex

Oxytocin reflex is also known as 'let-down reflex' or 'milk ejection reflex'.

Oxytocin reflex stimulates when

·        A mother expects a feed

·        When the baby is suckling

·        Is conditioned by the mother's sensations and feelings, such as touching, smelling or seeing her baby, or hearing her baby cry, or thinking lovingly about him or her

Sensory nerve cells in the nipple signal brain to release oxytocin

Posterior lobe of the pituitary gland secret oxytocin

Oxytocin causes myoepthelial cells of alveoli to contract causing squeezing out the milk, pushin it down to nipple

Reflexes in baby

• Sucking reflex
• Rooting reflex
• Swallowing reflex
• Gag reflex

Breast feeding and Physiotherapy

Prenatal classes can be used to help inform women about the health advantages of breastfeeding, both for babies and mothers, and instructors can explain to women the process and techniques they can use to breastfeed.

breast feeding in workplace

Ergonomic intervention in mother during breast feeding

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