CM5.{12,16-17} | CM5.{12,16-17} | Breastfeeding Skills and Counselling — Summary & Reflection

KEY TAKEAWAYS

Exclusive breastfeeding (EBF) means breast milk only (no water, other milk, or food) for the first 6 months, followed by continued breastfeeding with complementary foods up to 2 years (WHO). India's EBF rate is 63.7% (NFHS-5); early initiation within 1 hour 41.8%. Colostrum (days 1-5): small volume (2-20 mL/feed), rich in secretory IgA, Vitamin A, and growth factors — the 'first vaccine.' Mature breast milk: ~70 kcal/100 mL, protein ~1.1 g, fat ~4 g, lactose ~7 g; foremilk (hydration) vs hindmilk (energy — allow full drainage of one breast before switching). Breastfeeding benefits: infant (diarrhoea RR 0.36, ARI RR 0.57, IQ +3.4 points, obesity protection); maternal (breast cancer RR 0.78, ovarian cancer, LAM contraception). Four holds: cradle, cross-cradle (best for teaching), football (best post-CS), laid-back. Good latch signs: wide gape, lower lip flanged, more areola below, chin to breast, no pain, audible swallowing. Manual expression: Marmet technique (C-shaped fingers at areola edge, push-back → roll). Common problems: engorgement (frequent feeds, warm compress), sore nipples (correct latch first), mastitis (do NOT stop breastfeeding, antibiotics), perceived insufficient milk (latch correction, more frequent feeding). Contraindications: galactosaemia (absolute); HIV in low-resource settings = breastfeed with ART (NACO guidelines).

REFLECT

You are the medical officer on duty when a postnatal ward nurse calls you about a 36-hour-old newborn who has lost 250 g (8% of birth weight of 3,100 g) and is jaundiced. The mother is frustrated and says she 'has no milk' and wants formula. You sit beside her and observe a feed. The baby's lower lip is tucked in, the mother's nipple is flat and creased after the feed, and the feeding session lasted 60 minutes but the baby remains unsettled. Describe your clinical assessment (is this breastfeeding jaundice or physiological weight loss from insufficient intake?), the specific latch corrections you will demonstrate, and the exact words you would use to counsel this mother to continue breastfeeding rather than switch to formula.