Child nutrition and Breast

feeding counselling

BY DR. TAHER KARIRISUPERVISOR: DR. AMANI QOTB

FAMILY MEDICINE PROGRAM

Objectives: To know the skills to conduct a Counselling

Be able to deal with a patient in the clinic

To know the recommendation regarding breastfeeding

Content Epidemiology Counselling Skills Breastfeeding Counselling Child Nutrition Recommendations References

Al Juaid et al.2014

The decline in breastfeeding duration in Saudi Arabia since 1985

Study Insufficient milk)%( Sickness of mother or child)%( New pregnancy)%( Breastfeeding

problems)%( Others)%( 1987, National (Al-Othaimeen 1987 [35]) 22.97 7.4 67.7 - 1.951987, National (Al-Mazrou 1994 [18]) 43 11 4 11 211991, National (Al-Shehri 1995 [20]) 45 9.5 3.5 5 17.51992, Makkah (West) (Kordy 1992 [24]) 30.9 8.4 27.3 1.25 -

1995, Riyadh (Central) (Al-Ayed 1998 [32]) 52.6 - - - 27.5

1999, Riyadh (Central) (Al-Jassir 2004 [19]) 66.1 4.1 5.1 - 20.62001-02, Jeddah (West) (Fida 2003 [33]) 50 8.2 1.8 1.8 10.92002-03, National (Al-Jassir 2006 [34]) 48.3 11.5 13.2 - 8.82004-05, National (El Mouzan 2009 [27]) 45.5 30.4 - 11.9 12.2

2005, Riyadh (Central) (Al-Hreashy 2008 [26]) 49.6 11.2 - 11.6 6.62011, Jeddah (West) (Eldeek 2012 [22]) 32 19 - - 3.3

Conclusion The duration of breastfeeding is decline over time. Older, less educated, multiparous mothers, lived in rural communities & low socio-economic class were more likely to breastfeed and have prolonged duration.

The most common cause of breastfeeding is insufficient breast milk; a reason that may be more perceived than real.

COUNSELLING SKILLS

Listening and Learning Skills Use helpful non-verbal communication

Ask open questions Use responses and gestures that show interest

Reflect back what the mother/caregiver says Empathize – show that you understand how she/he feels

Avoid words that sound judging

Building Confidence and Giving Support Skills

Accept what a caregiver thinks and feels Recognize and praise what a mother/caregiver and child are

doing right Give practical help

Give relevant information Use simple language

Make one or two suggestions, not commands

Breastfeeding Counselling

Approved date, internationally: August 1st-7th, 2015

Approved date, locally: Shawal 16th-22th, 1436H Theme of the World Breastfeeding Week 2015:

Establish good rapport:-Introduce yourself

-Take bio-data-ICEE

Ask about current situation:-Attempts to breast feed ?

-Duration?-Difficulties?

Educate mother about importance of breast feeding:

• Psychological bond

• immunity• allergic disease

and Asthma• Infection

protection• Good laxative.

Benefits for baby:

• uterine bleeding• Natural

contraception• Protect from Breast

& Ovarian cancer• No need to prepare• No cost

Benefits for

mother:

Techniques of breast feedingShould be initiated as soon after delivery

Mother sit comfortably with back supported or on one side.

Better in private comfortable place

Baby should have large part of areola in his mouth.

Baby should be directly facing the nipple, without turning head.

At start compress the nipple with thump and index then give baby.

Start on one breast for 10 mins, then shift to other breast till baby stop.

During first 2 weeks feed on demand or every 2 hours. Feeding less at night is ok but not more than 5 hours between feeds.

Exclusive breast feeding for 6 months. Best to continue breast feeding until baby is 2 years old.

Don’t offer baby any breast milk in bottle during first 6 weeks.

Milk supply increase by adequate fluids, sleep, relaxed environment.

Clean breast with water, keep it dry with loose clothing.

Is Baby Getting Enough Milk?

6-8 wet diapers/ day3-4 bowel movement/ dayBack to birth weight after 2 w.Milk is leaking from the other breastHear the baby swallowing.

Working Mother Maternity leave.

Ask about facilities at work? Nursery? Breaks? Distance from home? Bottles!

-Breast pump!

Contraception-Lactation as contraception:

Before first menstruation up to 95%

After menstruation is unreliable. Combined vs Progesterone only pills.

At end of visit:-If they have any more questions.

-Thank the patient

Barriers of Breastfeeding

Breast(nipple) pain Mastitis Lack of milk secretion Work

Breastfeeding Contraindications

Herpes Simplix of the breasts. Active TB. CMV Chemotherapy

Radiotherapy Drug abuse HIV Galactosemia of the Infant

T cell lymphotropic Viruses type I,II in the

Mother

Mother using Oxidant with child has G6PD

Child Nutrition Recommendations

EvidenceRating

Clinical Recommendation

C

C

C

A toddler’s diet should include two or three servings of milk or other dairy products per day.

Fat and cholesterol should not be restricted in children younger than two years. Children older than two years should consume an average of 30 percent of total energy from fat.

Toddlers should not have more than 4 to 6 ounces of 100 percent fruit juice per day; whole fruits and vegetables should be offered instead.

EvidenceRating

Clinical Recommendation

C Daily supplementation with 200 IU of vitamin D is recommended for toddlers who consume less than 2 cups of milk daily or do not get regular sunlight exposure; otherwise, vitamin and mineral supplementation is unnecessary except in undernourished and chronically ill toddlers.

EvidenceRating

Clinical Recommendation

C

C

C

Good nutritional habits should be fostered by sitting at the table, turning off the television, and interacting socially.

Parents should offer children a variety of foods, expose them repeatedly to healthy foods, and model healthy eating behaviors.

To reassure parents and detect undernourished children, physicians should monitor growth patterns, including body mass index.

Iron Supplements SCREENING Recommendation •Full-term – 1 mg/kg daily (maximum 15 mg) at 4 months old till introduction of a food that rich with iron.

•Premature – 2 to 4 mg/kg daily (maximum 15 mg) after the 2 weeks of age & continued through the first year of life.

WeaningStart to introduce solid food from age of 6 months.

Start with small amount one type of food at a time.

Given before breast feed.

Prepared food at home are best, like:

At 6 months e.g. vegetables, soup, egg yolk, soft fruits, cereals.

At 8-10 months e.g. fish, chicken, meat, bread

After 1 year can eat regular family diet.

Continue breastfeeding up to 2 y.o. Do not add Honey ,Sugar or salts.

Do not feed your child if he able to.

Ensure mother understanding. Take any questions.

Next appointment

Complementary and alternative medicine(CAM)

Home Message Breastfeeding is a public health issue , not merely a lifestyle choice. Family physicians should provide education about breastfeeding & follow up throughout the course of life.

Family physicians should work to remove the barriers of breastfeeding this include advocating for adequate paid maternity leave.

References Fayza Rayes Book

THANK YOU