Breastfeeding is a natural and vital process in which a mother provides nourishment to her infant by feeding them breast milk produced by her mammary glands. This intimate and bonding experience offers numerous health benefits for both the baby and the mother. Breast milk is uniquely tailored to meet the nutritional needs of the infant, providing essential nutrients, antibodies, and enzymes that promote healthy growth and development. Beyond its nutritional value, breastfeeding establishes a strong emotional connection between the mother and child, fostering a sense of security and comfort. The act of breastfeeding also helps the mother recover from childbirth by aiding in the contraction of the uterus and facilitating postpartum weight loss.

1. BREAST FEEDING AND
COMPLEMENTARY FEEDING
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1
By
Ponsiano K. Nuwagaba
@CDS Department, KyU

2. BREASTFEEDING
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3. PRESENTATION OUTLINE
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 Definition of terms
 Composition of breast milk
 Properties/ functions of BM
 Benefits of breastfeeding
 Ten steps of breast feeding
 Complementary feeding
 Dangers ofArtificial feeding
 AFASS” criteria for replacement feeding
 Policy guidelines onYoung Infant feeding
 Conclusion

4. DEFINITION OF TERMS
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- Breast feeding: Is the method of feeding a baby with milk
directly from the mother’s breast. (WHO/UNICEF report 1998)
- Exclusive Breastfeeding: Feeding a child through only
breastfeeding, giving no other liquids or solids, not even water,
with the exception of prescribed drops or syrups consisting of
vitamins and mineral supplements or medicines, and expressed
breast milk.
- Replacement Feeding: The process of feeding a child who is
not receiving any breast milk with a diet that provides all the
nutrients the child needs, until the child is fully fed on family
foods. Replacement feeds do not include black coffee/tea, fruit
juices, over-diluted milk.
- Mixed Feeding: Feeding both breast milk and other foods or
liquids to a child under 6 months

5. DEFINITION OF TERMS CONT’D
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- Complementary feeding: Giving a child other foods (solid or
semi-solid) in addition to breastfeeding or replacement feeding to
meet baby’s nutrient requirements from 4 to 6 months.
- Weaning: The process of gradually introducing the infant to other
foods other than breast milk or artificial milk. (over course of 1
month).
- Re-lactating: Re-establishing breastfeeding after a mother had
stopped, whether in the recent or distant past

6. Anatomy and Physiology
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7. Anatomy and Physiology
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 Breast enlargement
 During pregnancy and lactation indicates the mammary glands are
becoming functional
 Breast size before pregnancy does not determine the amount of milk a
woman will produce
 Hormones during pregnancy
 Estrogen stimulates the ductile systems to grow, then estrogen levels
drop after birth
 Progesterone increases the size of alveoli and lobes
 Prolactin contributes to increase in breast tissue during pregnancy

8. Anatomy and Physiology cont’d
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 Alveoli secrete milk and contract when stimulated
 Oxytocin stimulates milk secretion and is released during the
‘let down’ or milk ejection reflex
 After let down, milk travels into the ductules, then to the larger
– lactiferous or mammary ducts
 Hormones during breastfeeding
 Prolactin levels rise with nipple stimulation
 Alveolar cells make milk in response to prolactin when
the baby sucks
 Oxytocin causes the alveoli to squeeze the newly produced milk
into the duct system

9. COMPOSITION OF BREAST MILK
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◼ Has the right amount of nutrients in the right proportions and
right temperature
◼ It includes:
-Live cells, fat, carbohydrates, proteins, vitamins, minerals
-Less fat than most other mammals
-More lactose than other mammals

10. PROPERTIES / FUNCTIONS OF BM
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 Biological specificity- long chain omega 3 fatty acids
important for brain and retinal development leading to
higher IQ
 Immunologic specificity- protection against pathogens and
allergins
-Colostrum acts as the baby’s first vaccination against
infections
-Provides less risk of infections like ear infections, pneumonia,
intestinal diseases, childhood cancers, diabetes, arthritis,
allergies, asthma and eczema.

11. 5/9/2023
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Breast milk
• Perfect nutrients
• Easily digested,
efficiently used
• Protects against
infection
• Costs less than
artificial feeding
• Helps bonding
and
development
• Helps delay a
new pregnancy
• Protects
mother’s health
Breastfeeding
Benefits of breastfeeding

12. Protection Against Infection
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White cells in
mother’s body
make antibodies
to protect mother
Mother
infected
Antibodies to
mother’s infection
secreted in milk to
protect baby
Some white cells
go to breast and
make antibodies
there
2
3
1
4

13. Psychological Benefits of Breastfeeding
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 Emotional bonding
 Close, loving relationship between
mother and baby
 Mother more emotionally satisfied
 Baby cries less
 Mother behaves more affectionately
 Less likely to abuse or abandon baby
 Development
 Children perform better on
intelligence tests in later childhood

14. Ecological benefit of breastfeeding.
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-Saves resources
-Less waste
-No refrigeration
-No manufacturing
-No bottles, cans
-No trucking
-No handling

15. BENEFITS OF BREASTFEEDING
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◼ Benefits to baby:
-Better dental health
-Increased visual acuity
-Decreased duration and intensity of illnesses
-Less allergies
-Better health & less risk of illnesses

16. BENEFITS OF BREASTFEEDING
◼ For Society
-Smarter children
-Healthier children
-Less cost to
healthcare system
-Stronger families
 To Families
-Less trips to doctors,
hospitals
-Less prescriptions
-Less stress
-Less illness
-More bonding
-Inexpensive
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17. BENEFITS OF BREASTFEEDING
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◼ Benefits to mother:
-Psychological (Attachment, bonding, security, skin to
skin, fulfillment of basic needs, relationship)
-Decreased risk of illness (breast cancer, osteoperosis,
hemmorhage, ovarian cancer)
-Birth control?? (in earlier days)
-Pride, empowerment, fulfillment

18. Breastfeeding techniques/methods
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 Good positioning and attachment leads to
effective suckling.
 Early breastfeeding failures deprive infants of the
benefits, and leave many mothers disappointed
 Breastfeeding is a natural process, but many mothers
need a lot of help

19. 4 key points in positioning
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Baby’s body needs to be;
 In line with ear, shoulder, and hip in a straight line
so that the neck is not twisted not bent forward or
far back
 Close to the mother’s body so that the baby is
brought to the breast rather than the breast taken
to the baby
 Supported at the head, shoulder and if new born,
the whole body supported
 Facing the breast with baby’ nose to the nipple as
s/he comes to the breast

20. How to Help a Mother Who is Sitting Down
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Underarm position Cross Cradle for Small Infants
Cradle position
7/1
7/1

21. How to Help a Mother Who is Lying
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Lying Down

22. Feeding Twins
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Under arm Position
for Twins

23. Feeding Twins
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Cross Position
for Twins

24. Barriers to Breastfeeding
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 Breast Pathology
Flat/inverted nipples, breast reduction surgery that
severed milk ducts, previous breast abscess, extremely
sore nipples(cracked, bleeding, blisters, abrasions)
 Hormonal pathology
Failure of lactogenesis, hypothyroidism
 Overall health
Smoking, anemia, poor nutrition, depression

25. Barriers to Breastfeeding
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Contraindications of breastfeeding
-HIV/AIDS infection(policy guideline changing with
introduction of Option B).
Temporary interruption of breastfeeding
-Serious illness (e.g. sepsis)
-Herpes simplex virus 1 infection (HSV-1)
-Varicella
-Active TB

26. Barriers to Breastfeeding…
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- Medication in mother (sedatives, antiepileptics,
opioids, radioactive iodine – J-131, cytotoxic
chemotherapy)
-Mastitis, abscess of breast
-Hepatitis B, C
-Using addictive substances

27. Barriers to Breastfeeding,,,
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 Psychosocial
Restrictive feeding schedules, mother without support
system, not rooming in with baby, bottle
supplementing when not medically required
 Others
Previous breastfed infant who failed to gain weight
well, perinatal complication (hemorrhage and
infections.

28. Ten steps to successful breastfeeding
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• 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 how to maintain
lactation even if they should be separated from their infants.

29. Ten steps to successful breastfeeding
cont’d
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• Give newborn infants no food or drink other than breast milk,
unless medically indicated.
• Practice rooming-in – 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.

30. COMPLEMENTARY FEEDING
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• Complementary feeding means giving other foods in
addition to breast milk
• These other foods are called complementary foods.
• Breastfeeding for two years or longer helps a child to
develop and grow strong and healthy, but when a child
reaches 6months of age, breast milk alone is not enough for
the rapid growth and development.
28/3

31. Complementary Foods - definitions
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• “Any energy-containing foods that displace breastfeeding
and reduce the intake of breast milk.” (AAP)
• “any nutrient containing foods or liquids other than breast
milk given to young children during the periods of
complementary feeding….[when] other foods or liquids
are provided along with breast milk.” (WHO)
• “any foods or liquids other than human milk or formula
that are fed during the first 12 months of life.” (Healthy
Start Guidelines)

32. Complementary feeding
◼ The process of giving an
infant other foods and
liquids along with breast
milk or non-human milk
as breast milk alone is no
longer sufficient to meet
the nutritional
requirements.
◼ These foods should
complement rather than
replace breast milk.
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33. Appropriate Complementary
Feeding
1. Timely: Introduced when need for energy
and nutrients exceeds that provided by BF.
2. Adequate: Should provide sufficient
energy, protein, and micronutrients
3. Properly Fed: Active feeding method and
proper frequency according for age
4. Safe: Should be hygienically prepared,
stored and fed
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34. Foods to Avoid
◼ Tea & coffee: interfere with iron
absorption
◼ Aerated beverages: No nutritional value
◼ Too much sugary drinks & Fruit juices:
cause decreased appetite for other
nutritious foods and also may cause loose
stools.
◼ Nuts: may cause choking unless
grounded into pastes. 5/9/2023
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35. Stomach size
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36. Responsive feeding
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37. Suitable Feeding Situation
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38. Key Messages
◼ Complementary feeding should begin soon after
completing 6 months of age along with continued
breastfeeding
◼ Complementary foods should be of right consistency,
energy dense and the variety to provide all nutrient
demands of a growing child.
◼ Child should be fed patiently giving adequate attention
and time
◼ Foods should be prepared, stored and fed
hygienically to the children.
◼ Continue feeding during illness and increase during
convalescence.
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39. Dangers of Artificial Feeding
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• Interferes with bonding
• More diarrhea and
respiratory infections
• Persistent diarrhea
• Malnutrition,
Vitamin A deficiency
• More likely to die
• More allergy and milk
intolerance
• Increased risk of some
chronic diseases
• Overweight
• Lower scores on
intelligence tests
For the mother:
• May become pregnant sooner
• Increased risk of anaemia, ovarian and breast cancer

40. AFASS Criteria for Replacement Feeding
Acceptable Mother perceives no significant cultural or social barriers to
replacement feeding
Feasible Mother has adequate knowledge, skills, resources, and support to
correctly mix formula or milk, and feed the infant up to 12 times in
24 hours
Affordable Mother and family can pay the costs of replacement feeding—fuel,
clean water, and all ingredients— without compromising the health
and nutrition of the family.
Sustainable Mother has access to a continuous and uninterrupted supply of all
ingredients needed for safe replacement feeding as long as the
infant needs it
Safe Replacement feeds are correctly and hygienically stored, prepared,
and fed in nutritionally adequate amounts. Infant is fed by clean
hands and preferably by cup
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41. Why some mothers choose formula vs. breast milk
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◼ 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 not providing lactation training

42. Why some mothers choose formula vs. breast milk
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◼ 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

43. Uganda Policy Guidelines on Infant and
Young Child Feeding (2009)
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 Feeding infants under normal circumstances
1. Counsel and support all mothers to initiate breastfeeding within
an hour after delivery, exclusively breastfeed infants for the first
6 months unless medically contra-indicated
2. Counsel & support mothers to introduce adequate, safe &
appropriate complementary feeds at 6 months while continuing
to breastfeeding up to 2 years and beyond
3. Provide pregnant & lactating mothers to consume adequate
quantities of nutrient dense foods

44. Policy Guidelines cont’d
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 Feeding HIV exposed infants
1. Provide HCT services to all pregnant and lactating mothers and
help them to disclose their results to key family members for
IYCF support
2. Counsel and support mothers to initiate breastfeeding within an
hour after delivery, exclusively breastfeed infants for the first 6
months unless replacement feeding isAFASS
3. Counsel & support mothers to introduce adequate, safe &
appropriate complementary feeds at 6 months while continuing
to breastfeeding up to 12 months unless replacement feeding is
AFASS

45. Policy Guidelines cont’d
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 Feeding HIV exposed infants cont’d
4 Provide HIV testing to HIV exposed infants (6 weeks - 18 months)

46. Policy Guidelines cont’d
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 Feeding infants in other exceptionally difficult
circumstances
1. Provide malnourished children with appropriate medical care,
nutrition rehabilitation and follow up
2. Support LBW babies who can suckle to breastfeed and use
assisted expressed breast milk by cup or NGT for those who
can not suckle
3. Counsel and support families to practice optimal IYCF in
emergencies

47. Other Options If Breastfeeding is Not Possible
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Mom can still use her milk,even if she decides not to breastfeed:
◼ Use a breast pump (electric/manual)
◼ Cup or bowl feeding
◼ Spoon feeding
◼ Eyedropper or feeding syringe
graphics.iparenting.com/. ../womanpumping.jpg

48. Conclusion.
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There is no freedom of choice for humans
if it has been taken away from them
at the beginning.
Breast-feeding is not a choice,
but an obligation to the choice,
Give your child the freedom of choice.

49. References
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1. WHO (2007) Evidence of long term effects of
breastfeeding: systemic reviews and meta-analysis. Geneva
2. WHO ( Nov 2010) Caring for newborns and children in
the community
3. MOH ( 2009) Policy on Infant and young child feeding.
Kampala
4. WHO and UNICEF (1998) complementary food and
feeding, http://
www.unicef.org/programme/breatfeeding/food.htm
accessed on 14/5/2013