Course contents

Why Breastfeeding is Important

  1. 1 Why Breastfeeding is Important

Biochemistry

  1. 1 a. Protein
  2. 2 b. Carbohydrates
  3. 3 c. Milk Lipids (fats)
    1. 3.1 Foremilk vs Hindmilk
    2. 3.2 Breastmilk storage capacity
    3. 3.3 Cholesterol
  4. 4 d. Vitamins
  5. 5 e. Minerals
    1. 5.1 Calcium
    2. 5.2 Iron
    3. 5.3 Iodine
  6. 6 f. Water
  7. 7 The taste of breastmilk
    1. 7.1 Dietary advice
  8. 8 What should I remember?
  9. 9 Self-test Quiz

Immunology

  1. 1 Protective components of breastmilk
    1. 1.1 Proteins
      1. 1.1.1 Immunoglobulins
      2. 1.1.2 Lactoferrin
      3. 1.1.3 Alpha-Lactalbumin
      4. 1.1.4 Lysozyme
    2. 1.2 Carbohydrates
      1. 1.2.1 Oligosaccharides
    3. 1.3 Lipids and milk fat globules
    4. 1.4 Cellular components
    5. 1.5 Other protective factors
  2. 2 What should I remember?
  3. 3 Self-test Quiz

Relative risks

  1. 1 Acute diseases attributable to artificial feeding
    1. 1.1 Diarrhea, otitis media and pneumonia
    2. 1.2 Urinary Tract Infection
    3. 1.3 Necrotising Enterocolitis
    4. 1.4 Septicemia and Meningitis
  2. 2 Non-communicable diseases attributable to artificial feeding
    1. 2.1 Type 1 Diabetes Mellitus (Insulin-dependent diabetes)
      1. 2.1.1 Type 2 Diabetes and Metabolic Syndrome
    2. 2.2 Celiac Disease
    3. 2.3 Obesity
    4. 2.4 Childhood Cancer
    5. 2.5 Inflammatory Bowel Diseases
    6. 2.6 Allergic Responses
  3. 3 Intelligence
  4. 4 Sudden Infant Death Syndrome (SIDS)
  5. 5 Maternal Health
  6. 6 SUMMARY
  7. 7 What should I remember?
  8. 8 Self-test Quiz
  9. 9 Assessment Quiz

Communication Skills

  1. 1 Personal Qualities
    1. 1.1 Genuineness
    2. 1.2 Non-possessive love
    3. 1.3 Empathy
  2. 2 What should I remember?
  3. 3 Self-test quiz

Non-verbal

  1. 1 Are you really listening?
    1. 1.1 Posture
    2. 1.2 Appropriate body motion
    3. 1.3 Eye contact
    4. 1.4 Minimal encouragers
    5. 1.5 Non-distracting environment
    6. 1.6 Time
  2. 2 What should I remember?
  3. 3 Self-test Quiz

Listening skills

  1. 1 Reflective listening
    1. 1.1 Paraphrasing
    2. 1.2 Reflecting feelings
      1. 1.2.1 How do you correctly interpret her feelings?
  2. 2 Appropriate questioning
    1. 2.1 About questioning
  3. 3 What should I remember?

Building confidence

  1. 1 Acceptance
  2. 2 Avoiding judgmental words
  3. 3 Acknowledge what is right
  4. 4 Use language that is easily understood
  5. 5 Provide relevant information
  6. 6 What should I remember?

An example

  1. 1 An example of good communication skills
  2. 2 Assessment Quiz

Pregnancy Care

  1. 1 Baby Friendly Step 3 and Point 3
  2. 2 Broaching the topic
  3. 3 When the mother does not breastfeed
    1. 3.1 Breastmilk substitutes
  4. 4 What should I remember?
  5. 5 Skills Competency #1

The feeding decision

  1. 1 What is most influential?
  2. 2 How can we influence the decision?
    1. 2.1 In the community
    2. 2.2 Prenatal education
  3. 3 What should I remember?
  4. 4 Self -test quiz

The barriers

  1. 1 Addressing societal barriers
  2. 2 Health provider knowledge, skills and management
    1. 2.1 Baby Friendly Step 2 and Point 2
  3. 3 Postnatal perceptions
    1. 3.1 Breastfeeding and separations
  4. 4 Breastfeeding in special circumstances
  5. 5 What should I remember?

Physical preparation

  1. 1 What physical preparation should mothers do?
  2. 2 Prenatal breast examination
    1. 2.1 Inspection
    2. 2.2 Palpation
  3. 3 Record-keeping
  4. 4 What should I remember?
  5. 5 Self-test Quiz
    1. 5.1 Assessment Quiz

Birthing and Physiology

  1. 1 Lactation physiology
    1. 1.1 What could delay or inhibit secretory activation?
      1. 1.1.1 Stress and breastfeeding
  2. 2 What should I remember?
  3. 3 Self-test quiz

The first hours

  1. 1 Baby Friendly Step 4
  2. 2 Immediately following birth
  3. 3 The first breastfeed
  4. 4 The role of the birth attendants
  5. 5 Addressing barriers to skin-to-skin
  6. 6 Maternal-infant bonding
  7. 7 What should I remember?
  8. 8 Self-test quiz

Labor interventions

  1. 1 Analgesia during labor
  2. 2 Neuraxial pain relief (epidural/spinal)
    1. 2.1 Is breastfeeding affected?
  3. 3 Cesarean (caesarean) section
    1. 3.1 How it was ...
    2. 3.2 How it should be ...
  4. 4 Assisting a mother following an assisted delivery
  5. 5 What should I remember?
  6. 6 Self-test quiz

Postnatal interventions

  1. 1 Separation of mother and newborn
    1. 1.1 Effect on oxytocin
    2. 1.2 Effect on breastfeeding
  2. 2 Washing mother or newborn
  3. 3 Suctioning of the newborn
  4. 4 What should I remember?
  5. 5 Self-test quiz
  6. 6 Assessment Quiz

Breastfeeding the Baby

  1. 1 When should baby be fed?
  2. 2 It's a team effort!
    1. 2.1 Preparing to guide the mother
  3. 3 What should I remember?

Positioning Principles

  1. 1 Mother and baby
    1. 1.1 Biological nurturing position
  2. 2 What about other positions?
  3. 3 What should I remember?
  4. 4 Self-test Quiz

Breastmilk transfer

  1. 1 Understanding the anatomy
  2. 2 Milk ejection reflex
  3. 3 Negative pressure transfer
  4. 4 What should I remember?
  5. 5 Self-test Quiz

Assessing breastfeeding

  1. 1 The five-step process
    1. 1.1 1. Gather information and plan for the visit
    2. 1.2 2. Feeding observation
      1. 1.2.1 What is involved in a 'naturalistic observation'?
    3. 1.3 3. Exploration of strategies for improvement
    4. 1.4 4. Develop an action plan
    5. 1.5 5. Communication of results
  2. 2 What should I remember?
  3. 3 Assessment Quiz
  4. 4 Skills Competency #2

A time to learn

  1. 1 How to provide education effectively
  2. 2 Postnatal education
  3. 3 What should I remember?
  4. 4 Self-test quiz

Practical skills

  1. 1 Baby Friendly Step 5 and Point 4
  2. 2 Expressing breastmilk
    1. 2.1 Hand expressing
    2. 2.2 Pumping breastmilk
    3. 2.3 Storing breastmilk for a healthy baby
    4. 2.4 Using the expressed breastmilk
    5. 2.5 Skills Competency #3
  3. 3 Supporting mothers who are separated from their infants
    1. 3.1 Employment and breastfeeding
      1. 3.1.1 Prenatal preparations
  4. 4 What should I remember?
  5. 5 Self-test quiz

Breastfeeding messages

  1. 1 Baby Friendly Step 8
  2. 2 How often should a baby breastfeed?
  3. 3 Is the baby getting enough breastmilk?
    1. 3.1 Observations to make to ensure good intake
      1. 3.1.1 Normal output table
    2. 3.2 Twins, or more!
      1. 3.2.1 Can mothers produce enough milk for multiples?
      2. 3.2.2 Assisting breastfeeding
  4. 4 Beginning complementary foods
    1. 4.1 Baby Friendly Point 5
  5. 5 Weaning
  6. 6 What should I remember?
  7. 7 Self-test quiz

Normal growth

  1. 1 Weighing of babies is not an innocuous procedure
  2. 2 What influences movement through growth curves?
  3. 3 Accurately weighing an infant
  4. 4 What should I remember?
  5. 5 Self-test Quiz

Sleep

  1. 1 Rooming-in in Hospital
    1. 1.1 Baby Friendly Step 7
    2. 1.2 Addressing the barriers
  2. 2 Sleep
    1. 2.1 What's normal?
  3. 3 Sleep in the home situation
    1. 3.1 Sleep location
    2. 3.2 Breastfeeding to prevent SIDS
  4. 4 What should I remember?
  5. 5 Self-test Quiz

Psychological support

  1. 1 Maternal self-confidence and self-efficacy
    1. 1.1 Influencing self-confidence and self-efficacy
    2. 1.2 The power of words
  2. 2 What should I remember?
  3. 3 Self-test Quiz

Discharge planning

  1. 1 Preventing common problems
    1. 1.1 Timing of follow-up
    2. 1.2 Critical warning signs
    3. 1.3 Contraception
  2. 2 Consolidating learning
  3. 3 Referral to mother-to-mother support network
    1. 3.1 Baby Friendly Step 10 and Point 7
  4. 4 What should I remember?
  5. 5 Self-test Quiz
  6. 6 Assessment Quiz

Infant Challenges

  1. 1 Infant risk factors
    1. 1.1 Identified during pregnancy
    2. 1.2 Identified during birthing
    3. 1.3 Identified postpartum

Late preterm; Non-latching

  1. 1 The 'late preterm' baby
    1. 1.1 Postpartum care
      1. 1.1.1 The first 12 - 24 hours
      2. 1.1.2 Discharge planning
    2. 1.2 Lactation Management
    3. 1.3 What should I remember?
    4. 1.4 Self-test quiz
  2. 2 The Non-latching Baby
    1. 2.1 Your first responsibility
    2. 2.2 Principles of management
      1. 2.2.1 The Action Plan
        1. 2.2.1.1 Some general tips
    3. 2.3 Breast refusal in the older baby
    4. 2.4 What should I remember?
    5. 2.5 Self-test quiz

Hypoglycemia; Jaundice

  1. 1 Pathologic Neonatal Hypoglycemia
    1. 1.1 Physiology
      1. 1.1.1 Routine glucose screening
    2. 1.2 Diagnosing pathologic neonatal hypoglycemia
      1. 1.2.1 Which infants are at risk?
      2. 1.2.2 Clinical signs to observe for:
    3. 1.3 You can prevent pathologic hypoglycemia!
      1. 1.3.1 What about early feeding?
    4. 1.4 Clinical management of pathologic hypoglycaemia
    5. 1.5 What should I remember?
    6. 1.6 Self-test quiz
  2. 2 Jaundice
    1. 2.1 Normal serum bilirubin levels
    2. 2.2 Causes of abnormal bilirubin levels
    3. 2.3 Physical appearance
    4. 2.4 Management of hyperbilirubinemia
    5. 2.5 What should I remember?
    6. 2.6 Self-test quiz

Supplementation

  1. 1 Baby Friendly Point 5 and Step 6
  2. 2 In-hospital breastmilk substitutes
  3. 3 Medical indications for supplementation
    1. 3.1 Supplementing the breastfed infant
    2. 3.2 What effect do supplements have?
      1. 3.2.1 Short-term effect on the mother
      2. 3.2.2 Short-term effect on infant health
        1. 3.2.2.1 Effect on digestion and absorption
        2. 3.2.2.2 Effect on serum glucose levels
        3. 3.2.2.3 Effect on jaundice
        4. 3.2.2.4 Effect on atopic disease
      3. 3.2.3 Effect on breastfeeding
    3. 3.3 Human Immunodeficiency Virus (HIV)
    4. 3.4 Legal implications
    5. 3.5 What should I remember?
    6. 3.6 Self-test quiz

Feeding-line device at the breast

  1. 1 When to choose an at-breast feed line
  2. 2 How to use a tube-feeding device at the breast
    1. 2.1 Assemble what you need
    2. 2.2 Preparation
    3. 2.3 Technique

Cup feeding

  1. 1 When to choose cup feeding
  2. 2 How to cup feed
    1. 2.1 Equipment
    2. 2.2 Preparation
    3. 2.3 Technique

Finger Feeding

  1. 1 When to consider finger feeding
  2. 2 How to finger feed
    1. 2.1 Equipment
    2. 2.2 Preparation
    3. 2.3 Technique

Bottle feeding

  1. 1 When to use bottle feeding
  2. 2 Considerations when bottle feeding a breastfed infant
  3. 3 Bottle feeding technique
    1. 3.1 Assess a bottle feed
  4. 4 Good bottle feeding practices are essential
    1. 4.1 Preventable dangers
  5. 5 Skills Competency #4

Crying baby

  1. 1 My baby cries a lot. What should I do?
    1. 1.1 To swaddle or not to swaddle?
  2. 2 Pacifiers/Dummies
    1. 2.1 Baby Friendly Step 9 and Point 4
    2. 2.2 Sucking and breastfeeding
  3. 3 When crying is excessive
    1. 3.1 Lactose malabsorption/overload
      1. 3.1.1 Presentation
      2. 3.1.2 Management
    2. 3.2 Colic
      1. 3.2.1 Management
    3. 3.3 Gastroesophageal Reflux
      1. 3.3.1 Gastroesophageal Reflux Disease
      2. 3.3.2 Breastfeeding Management
  4. 4 What should I remember?
  5. 5 Self test quiz

Inadequate weight gain

  1. 1 Definition of failure to thrive (FTT)
  2. 2 Cause of failure to thrive
  3. 3 What to do about excessive newborn weight loss
    1. 3.1 History and examination
      1. 3.1.1 Management
        1. 3.1.1.1 Supplementing
  4. 4 What to do when you suspect FTT
    1. 4.1 Record a thorough history
    2. 4.2 Examination of the baby
      1. 4.2.1 Test weighing
  5. 5 Management
    1. 5.1 Parent education and counseling
    2. 5.2 Step 1
    3. 5.3 Step 2
      1. 5.3.1 What supplement shall I use?
      2. 5.3.2 When to supplement
    4. 5.4 Step 3
    5. 5.5 Step 4
  6. 6 What should I remember?
  7. 7 Self-test quiz
  8. 8 Assessment Quiz

Maternal Challenges

  1. 1 Maternal risk factors
    1. 1.1 Identified during pregnancy
    2. 1.2 Identified during birthing
    3. 1.3 Identified postpartum

Engorgement

  1. 1 Breast fullness
    1. 1.1 Signs and Symptoms
  2. 2 Engorgement
    1. 2.1 Clinical Management
    2. 2.2 Advanced care
      1. 2.2.1 Areolar oedema/edema
      2. 2.2.2 Overactive milk production
  3. 3 What should I remember?
  4. 4 Self-test quiz

Nipple Pain

  1. 1 Management basics
    1. 1.1 Supportive strategies
      1. 1.1.1 Topical applications
  2. 2 Identification and Management of Specific Causes
    1. 2.1 Technique factors
    2. 2.2 Inverted or non-protractile nipples
    3. 2.3 Ankyloglossia (tongue tie)
      1. 2.3.1 Treatment
    4. 2.4 Fungal overgrowth (candidiasis, thrush, yeast)
      1. 2.4.1 Presentation and Diagnosis
      2. 2.4.2 Management
    5. 2.5 Bacterial infections
  3. 3 What should I remember?
  4. 4 Self-test quiz

Breast Problems

  1. 1 Blocked (Plugged) Duct
  2. 2 Mastitis
    1. 2.1 Causes
    2. 2.2 Preventing Mastitis
    3. 2.3 Diagnosis
    4. 2.4 Management
    5. 2.5 Complications
  3. 3 What should I remember?
  4. 4 Self-test quiz

Insufficient breastmilk

  1. 1 How is breastmilk production regulated?
    1. 1.1 Lactogenesis III (Maintenance)
      1. 1.1.1 Breast storage capacity and rate of breastmilk production
  2. 2 Perceived breastmilk insufficiency
  3. 3 Confirmed breastmilk insufficiency
    1. 3.1 Management
  4. 4 What should I remember?
  5. 5 Self-test quiz

Medical, Surgical Issues

  1. 1 Diabetes mellitus
    1. 1.1 Impact on lactation
  2. 2 Maternal overweight and obesity
  3. 3 Thyroid disease
  4. 4 Hepatitis
  5. 5 HIV
    1. 5.1 International Recommendations for infant feeding
      1. 5.1.1 World Health Organization
        1. 5.1.1.1 Breastfeeding guidelines
    2. 5.2 When infant formula is being considered ...
  6. 6 Breast surgery
  7. 7 Breastfeeding and medication usage
  8. 8 What should I remember?
  9. 9 Self-test quiz
  10. 10 Assessment Quiz

Promotion, Protection and Support

  1. 1 Promotion, Protection and Support

The International Code of Marketing of Breastmilk Substitutes

  1. 1 Aim of the WHO Code
    1. 1.1 The safe and adequate nutrition of all infants.
  2. 2 What's covered by the WHO Code?
    1. 2.1 Breastmilk substitutes
    2. 2.2 Promotion and product information
      1. 2.2.1 Free samples
  3. 3 What can you do?
  4. 4 What should I remember?
  5. 5 Self-test quiz

The Baby Friendly Initiative

  1. 1 Innocenti Declaration
  2. 2 The Baby Friendly Initiative
    1. 2.1 Baby Friendly hospitals
    2. 2.2 Baby Friendly communities
    3. 2.3 Does Baby Friendly Work?
    4. 2.4 Becoming accredited
  3. 3 What should I remember?
  4. 4 Self-test quiz

Young Child Feeding

  1. 1 What should I remember?

Local initiatives

  1. 1 Breastfeeding in public
    1. 1.1 Baby Friendly Point 6
  2. 2 Supporting mothers in the community
    1. 2.1 Baby Friendly Step 10 and Point 7
  3. 3 Engaging the Community
  4. 4 What should I remember?
  5. 5 Self-test quiz

Infant feeding in emergencies

  1. 1 The problem
  2. 2 The solution for the breastfed infant
    1. 2.1 Some frequently asked questions
  3. 3 The solution for the artificially fed infant
  4. 4 What can you do to help?
  5. 5 Assessment Quiz

Closing session

  1. 1 Have you completed everything?
    1. 1.1 Skills competencies
    2. 1.2 Nine assessment quizzes