Additional Support

1. Additional Support

2. HAND EXPRESSION • Good to: • Increase milk supply • Done between breastfeeds • When the mother has to leave the child at home • Done when away/not at home

4. Hand expression • Wash hand before expressing milk • Put fingers where baby’s lips would be • - This is approximately where the mother should put her fingers • Press in towards the rib cage • Squeeze and release rhythmically • - Avoid puckering the skin or sliding fingers over the skin

5. Hand expression • Press from all sides (first finger and thumb are on opposite position - like clock) • Express one side for 3-5 minutes until the milk slows • Then express the other side • Keep changing sides • May take 30 minutes to express enough

7. Cup feeding Good for: • Giving expressed breastmilk if mother has to leave infant (Keep for 8 hours without fridge – it may ‘split’ and look spoilt but it is not) • Infants who are using a feeding bottle - cups are MUCH safer

8. Why are cup-feeding safer than bottle feeding ? Easy to clean Less likely to be carried around = bacteria can’t breed Less risk of diarrhea, ear infection, tooth decay Somebody has to feed the baby more bonding Does not interfere with suckling at the breast It enables a baby to control his own intake

10. The baby should be held up-right – to prevent choking The baby will refuse when they have had enough May need to increase feeding frequency

11. Cup feeding • Remember to clean hands before cup feeding • After use clean the cup thoroughly using soap and hot water. Keep cup in clean area. • If possible before being used again rinse the cup in boiling water to kill any germs.

12. MINIMISING THE RISK OF ARTIFICIAL FEEDING IN EMERGENCIES

13. Approx 20% <6m NOT breastfed in the Philippines • Operational Guidance on IFE and Philippines laws > infant formula is last resort

15. BUT DESPITE EFFORTS: • SOME MOTHERS WILL NOT RELACTATE • SOME WILL CONTINUE TO DO MIXED FEEDING • SOME WILL NOT WANT WET NURSES • OLDER INFANTS WILL BE FED ‘OLDER’ MILKS

16. There is still need to: ‘MINIMISE THE RISKS’ – ILLNESS, MALNUTRITION & DEATH (Operational Guidance on IFE)

17. HOW? • EXPLAIN TO MOTHER/CAREGIVER THAT IF SHE USES FEEDING BOTTLE AND TEAT, THERE IS A HIGH CHANCE THAT THE BABY WILL GET SICK WITH DIARRHOEA, BECOME MALNOURISHED AND EVEN DIE

18. Minimizing the risks… THROW AWAY ALL FEEDING BOTTLES AND TEATS EVACUATION CENTRES, CLINICS, HOSPITALS, BARANGUAY HEALTH STATIONS AND HOMES SHOULD BE BOTTLE / TEAT FREE AREAS

19. Note bottled water is not sterile it needs to be boiled • Formula should be made with boiled water no less than 70 degrees centigrade due to the possible contamination by bacteria during manufacture. (Don’t leave boiled water for more than 30 mins). Once made then formula should be cooled rapidly e.g. by placing in cold water.

20. RELACTATION

21. Relactation • Most women can relactate if THEY WANT TO • Can relactate at any time even after menopause • Easier for women who stopped breastfeeding recently

22. Relactation • A Grandmother in Afghanistan starting relactation • Note poor positioning and attachment! Photo: ACF Afghanistan

23. Conditions for relactation • Motivation 2. Stimulation of the nipples - preferably done by the infant suckling - hand or mechanical expression • Ongoing Support and Encouragement • Practical assistance so time to breastfeed frequently – relived of duties/chores • Family and community acceptance and support

24. Process of relactation • Encourage mother/wet nurse to breastfeed whenever the child shows interest and is willing • Need to try to breastfeed at least every two hours - 8-12 times every 24 hours

25. Process of relactation • Infant suckle on both breasts, and for as long as possible at each feed – at least 10-15 minutes on each breast • Offer each breast more than once if infant is willing to continue suckling

26. Process of relactation • Relactation takes take time so she will need to rest • ONLY SHE should care for the child • Hold infant close to her • Sleep with him/her • Give skin-to-skin contact as often as possible • Kangaroo Care may be helpful

28. Kangaroo Care • Should not only be used for relactation – it is good: • to increase milk supply • keeps mother and baby together • keeps baby warm • Have baby in a sling or inside clothes with a belt around bottom • Keep baby’s hand free

29. Cup feed measured milk supplements, six times in 24 hours to begin with • Always put the infant to the breast to suckle before giving a cup feed A child who is more than six months old also needs complementary foods ---- these should be nutritious foods, not watery drinks

30. If the infant is not willing to suckle… - Infants who have never breastfed or have become used to bottle feeding may not want to suckle the breast

31. If the infant is not willing to suckle… • Suggest: • Extra skin-to-skin contact • Kangaroo Care • Offering breast at any time infant shows any interest • Expressing frequently; stimulate breast and nipple • Use drop and drip method….

32. Drip milk SLOWLY from a spoon or a container directly onto the breast while the mother is breastfeeding • This encourages an infant to breastfeed

33. This should NOT be used in evacuation centres without medical support

34. Thank you!