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108-710: UNICEF, WHO, and many national government health agencies recommend that babies are breastfed exclusively for their first six months of life. Studies have shown that breastfed babies are less likely to suffer from serious illnesses, including gastroenteritis , asthma , eczema , and respiratory and ear infections. Adults who were breastfed as babies may be less likely to develop risk factors for heart disease such as obesity and high blood pressure . There are benefits for mothers too: women who don't breastfeed have increased risk of developing heart disease, hypertension, diabetes, high cholesterol, breast cancer , ovarian cancer and hip fractures in later life. The BFHI aims to increase

216-684: A UNICEF-accredited Baby Friendly hospital. This compared to 30% of mothers in England, 58% for Wales and 57% in Northern Ireland. In 2022, 600,000 newborn babies were supported in the UK, and UNICEF reported that "the majority of maternity units (93%) and health visiting services (90%) across the UK are now working towards Baby Friendly accreditation, and new neonatal and children's centre standards have been introduced to help more services improve care." The first hospitals verified as Baby-Friendly in

324-401: A band of tissue, known as the frenulum , attaches the tongue to the base of the mouth, restricting the tongue's vertical movement and preventing the infant from pressing the breast and nipple into the soft palate . A posterior tongue-tie is a band of tissue that can only be felt on exam, and tends to impact breastfeeding less severely than its anterior counterpart. If it is determined that

432-436: A day. 8. Support mothers to recognize and respond to their infants' cues for feeding. 9. Counsel mothers on the use and risks of feeding bottles, teats and pacifiers. 10. Coordinate discharge so that parents and their infants have timely access to ongoing support and care. The program also restricts use by the hospital of free formula or other infant care aids provided by formula companies and recommends that when formula

540-416: A delay in their milk coming in should consult with a lactation specialist and their pediatrician, as they may need to supplement with donor milk or formula to help the infant gain weight and pump to encourage milk to come in sooner and in greater volume. Breast milk supply augments in response to the baby's demand for milk, and decreases when milk is allowed to remain in the breasts. When considering

648-709: A historical and policy perspective on the rise of the Baby Friendly initiative in part as a response to inappropriate advertising of formula in Africa, which led to poor outcomes among children who traditionally would have been breastfed. A 2021 review of systematic reviews raised further doubts about some of the claims raised in support of the Baby Friendly Initiative, as it was found that the majority of cited studies concluding benefits of implementation were of low or very low quality. The authors raised

756-522: A mother is unable to breastfeed, chooses not to breastfeed, or if her baby (often premature) shows signs that it isn't getting enough breast-milk, a healthy wet nurse or milk from a donor is a healthy alternative to formula. A special formula is manufactured for premature babies, although the World Health Organization recommends it only if breast-milk is medically not an option such as if a premature baby has to be fed formula through

864-410: A mother's breastfeeding capability or the volume of milk she will produce. The process of milk production, termed lactogenesis , occurs in 3 stages. The first stage takes place during pregnancy, allowing for the development of the breast and production of colostrum, the thick, early form of milk that is low in volume, but rich in nutrition. The birth of the baby and the placenta triggers the onset of

972-407: A naturally warm environment that helps them regulate their temperature. It is also beneficial to the mother, as it may improve the development of her milk supply and be beneficial for her mental health. Newborn babies usually breastfeed 8 to 12 times every 24 hours, and they typically express hunger cues every one to three hours for the first two to four weeks of their lives. A newborn has

1080-628: A number of benefits to both mother and baby that infant formula lacks. Increased breastfeeding to near-universal levels in low and medium income countries could prevent approximately 820,000 deaths of children under the age of five annually. Breastfeeding decreases the risk of respiratory tract infections , ear infections , sudden infant death syndrome (SIDS) , and diarrhea for the baby, both in developing and developed countries . Other benefits have been proposed to include lower risks of asthma , food allergies , and diabetes . Breastfeeding may also improve cognitive development and decrease

1188-651: A number of concerns surrounding quantification of long-term outcomes on maternal and child health apart from breastfeeding initiation, and suggested that outcomes may differ substantially among poor and wealthy countries. Additionally, the authors described potential negative outcomes associated with full implementation of the Baby Friendly Initiative, including promoting unrealistic breastfeeding expectations, mothers feeling pressured to breastfeed, and increased feelings of maternal guilt. Further high quality studies were recommended to evaluate both long-term breastfeeding outcomes and other aspects of maternal health. Notably, despite

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1296-478: A number of factors as described in the Process "Delay in milk 'coming in'" subsection below. Oxytocin , which signals the smooth muscle of the uterus to contract during pregnancy, labor, birth and following delivery, is also involved in the process of breastfeeding. Oxytocin also contracts the smooth muscle layer of band-like cells surrounding the milk ducts and alveoli to s the newly produced milk through

1404-591: A pacifier beginning at birth or after lactation was established did not significantly affect the duration of exclusive and partial breastfeeding up to four months of age. The CDC, however, currently (2022) reports that early use of pacifiers can have a negative outcome on the success of breastfeeding and they suggest that it should be delayed until breastfeeding is firmly established. Ankyloglossia, also called "tongue-tie" may cause shallow latch, poor milk transfer, and other problems with breastfeeding. There are two types of tongue-ties; an anterior tongue-tie occurs when

1512-570: A paper published in October 2016. It questioned whether full compliance with the ten steps of the initiative might inadvertently lead to the promotion of potentially hazardous practices and/or counterproductive outcomes. Specific concerns described in this paper included increased risk of sudden unexpected postnatal collapse, rigidly-enforced rooming-in practices leading to exhausted or heavily medicated mothers caring for newborns, and an unnecessary ban on pacifier use. A 2016 systematic review examined

1620-401: A poor, shallow latch, the infant latches close to or at the nipple, causing the mother intense pain during latching that is relieved with infant release from the breast. While the infant is at the breast, the first indicators of a shallow latch are having the areola be largely visible outside the infant's mouth and a narrow infant mouth angle. Additional signs result from poor positioning when

1728-535: A possibly low milk supply, it is important to consider the difference between "perceived low milk supply" and "true low milk supply". Perceived low milk supply occurs when mothers, for a variety of reasons, believe that they are not making enough milk to feed their infant. These reasons may include fussiness, colic , preference for the bottle as opposed to the breast, long nursing duration, decreased sensation of breast fulness, and even decreased frequency of infant stools. However, in these cases, it important to reassure

1836-493: A process which leads to a first breastfeed. Shortly after birth, the infant relaxes and makes small movements of the arms, shoulders and head. If placed on the mother's abdomen the baby gradually inches towards the breast, called the breast crawl and begins to feed. After feeding, it is normal for a baby to remain latched to the breast while resting. This is sometimes mistaken for lack of appetite. Absent interruptions, all babies follow this process. Rushing, by picking up and moving

1944-483: A small stomach capacity, approximately 20 ml. The amount of breast milk that is produced is timed to meet the infant's needs in that the first milk, colostrum, is concentrated but produced in only very small amounts, gradually increasing in volume to meet the expanding size of the infant's stomach capacity. Many newborns will typically feed for 10 to 15 minutes on each breast, however feeds may last up to 45 minutes depending on infant wakefulness and efficiency. It

2052-647: A tertiary referral center for major specialties. It is also a teaching center for basic and post-graduate training of doctors, nurses and allied health professionals. Through its cluster network, the hospital is closely linked with Kwong Wah Hospital and the United Christian Hospital for acute services, as well as Kowloon Hospital and Hong Kong Buddhist Hospital for convalescent rehabilitation and hospice services. Other general and specialty services are supported by Wong Tai Sin Hospital ,

2160-510: A tube to maintain a healthy weight. The World Health Organization advocates the importance of a baby being close to its mother whenever possible even if the mother does not breastfeed. In Canada, the provinces of Quebec and New Brunswick have mandated the implementation of the BFHI. All public health units in Ontario have been required to work towards having BFI designation since 2011. In 2012,

2268-597: A two-day site visit, where assessors evaluate policies, community partnerships and education plans, as well as interview patients, physicians and staff members. As of 2 May 2018, the United States had 512 hospitals that hold the Baby-Friendly designation. This translates to 24.57% of annual births. As of 2019, 28% of hospitals in the U.S. have been accredited by the WHO. One group of authors expressed concerns in

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2376-508: A two-year training post of Family Physicians in QEH in July 1996 to promote high quality health care practitioners and expanded the initiative into a wider programme with corporate support in 1997. It is now an established mandate for HA. To meet growing demand for its services, a number of renovation and reconstruction projects were carried out. These include air conditioning for all hospital wards by

2484-814: A written infant feeding policy that is routinely communicated to staff and parents. 1c. Establish ongoing monitoring and data-management systems. 2. Ensure that staff have sufficient knowledge, competence and skills to support breastfeeding. Key clinical practices 3. Discuss the importance and management of breastfeeding with pregnant women and their families. 4. Facilitate immediate and uninterrupted skin-to-skin contact and support mothers to initiate breastfeeding as soon as possible after birth. 5. Support mothers to initiate and maintain breastfeeding and manage common difficulties. 6. Do not provide breastfed newborns any food or fluids other than breast milk, unless medically indicated. 7. Enable mothers and their infants to remain together and to practise rooming-in 24 hours

2592-436: Is about 54 Calories/100mL. The second type of milk is transitional milk, which is produced during the transition from colostrum to mature breast milk. As the breast milk matures over the course to several weeks, the protein content of the milk decreases on average. The caloric content of breastmilk is reflective of the caloric requirements of the infant, increasing steadily after 12 months. The caloric content of breastmilk in

2700-520: Is consistent empirical evidence that BFHI has led to improvements in breastfeeding outcomes in the very short and short terms, its impact on BF outcomes in the long term remains unclear". Looking at 58 studies, the review found that community support was the key to long-term sustainability of breastfeeding that was initiated in the BFHI hospital setting. A study published in the Journal of Pediatrics in 2019 showed that increased rates of implementation of

2808-509: Is defined as "an infant's consumption of human milk with no supplementation of any type (no water, no juice, no nonhuman milk and no foods) except for vitamins, minerals and medications." Supplementation with human donor breastmilk may be indicated in some specific cases, as discussed below. After solids are introduced at around six months of age, continued breastfeeding is recommended. The American Academy of Pediatrics recommends that babies be breastfed at least until 12 months, or longer if both

2916-657: Is desired. Indications for use of donor breastmilk are very closely outlined by the American Academy of Pediatrics (AAP). Due to low availability and high cost of donor breastmilk, the AAP recommends prioritizing the use of the milk for infants born with a weight of less than 1500g (approximately 3lb 5oz), as it is helpful in decreasing rates of the severe intestinal infection, necrotizing enterocolitis , in this population. Effective positioning and technique for latching on are necessary to prevent nipple soreness and allow

3024-413: Is important for parents to recognize the difference between Nutritive and Non-Nutritive Sucking. Nutritive Sucking follows a slow, rhythmic pattern, with 1–2 sucks per swallow. Non-nutritive sucking is a faster-paced sucking pattern with few swallows. This swallow pattern is often observed at the beginning and/or the end of a feed. At the beginning of the feed, this pattern triggers milk letdown, while at

3132-405: Is important to have the mother-infant dyad evaluated by a breastfeeding specialist or pediatrician to determine the true cause of the symptoms and determine the need for supplementation. Often, these symptoms are caused by poor milk transfer at the breast, and can be solved with adjustments to the latch, but occasionally they may be caused by other processes, unrelated to breastfeeding, so evaluation

3240-418: Is less expensive than infant formula, but its impact on mothers' ability to earn an income is not usually factored into calculations comparing the two feeding methods. It is also common for women to experience generally manageable symptoms such as; vaginal dryness, De Quervain syndrome , cramping, mastitis , moderate to severe nipple pain and a general lack of bodily autonomy. These symptoms generally peak at

3348-408: Is linked to double the rate of readmission to hospital among neonates as compared to formula feeding. Critics of the Baby Friendly Initiative point to this type of data and several anecdotal stories of babies harmed at hospitals following the Baby Friendly Initiative as evidence that the current guidelines are potentially harmful and not meeting the needs of mother or baby. Additionally, critics point to

Baby Friendly Hospital Initiative - Misplaced Pages Continue

3456-521: Is medically needed, it should be given in a small cup or spoon, rather than a bottle and should only be used to supplement breastfeeding. As of 2011, approximately 15,000 facilities in more than 152 countries had been inspected and accredited as "Baby-Friendly." The number of accredited hospitals has continued to grow. As of 2019, a survey found that 28% of the hospitals in the US were registered as Baby Friendly. The World Health Organization recommends that if

3564-540: Is necessary. Supplementation with formula is associated with decreased rates of exclusive breastfeeding at 6 months, and overall decreased length of breastfeeding. In terms of what to supplement with, the first choice is always the mother's own breastmilk, save any medical contraindications to its use. The second best option for supplementation is pasteurized human donor milk . Finally, specific formulas may be used for supplementation if maternal or donor breastmilk are not options. One situation where this may be

3672-472: Is not possible, expressing or pumping to empty the breasts can help mothers avoid plugged milk ducts and breast infection , maintain their milk supply, resolve engorgement , and provide milk to be fed to their infant at a later time. Medical conditions that do not allow breastfeeding are rare. Mothers who take certain recreational drugs should not breastfeed, however, most medications are compatible with breastfeeding. Current evidence indicates that it

3780-551: Is one of the largest district general hospital in Hong Kong . It was named after Queen Elizabeth II . Queen Elizabeth Hospital is a major tertiary hospital in southern Kowloon , with over 1,900 beds. It employs more than 500 physicians and surgeons. The hospital was once the largest in the Commonwealth . Queen Elizabeth Hospital was officially opened on 6 September 1963 by then Governor of Hong Kong, Robert Black . At

3888-430: Is relatively consistent. Breastmilk is made from nutrients in the mother's bloodstream and bodily stores. It has an optimal balance of fat, sugar, water, and protein that is needed for a baby's age appropriate growth and development. That being said, a variety of factors can influence the nutritional makeup of breastmilk, including gestational age, age of infant, maternal age, maternal smoking, and nutritional needs of

3996-611: Is the largest acute hospital in Hong Kong despite not being a teaching hospital. The hospital has a full complement of services including 24-hour Accident and Emergency and specialist services. Clinics are located at three different sites to serve the district. They are the Queen Elizabeth Hospital Specialist Clinic , Yau Ma Tei Polyclinic , and the 'L' Block Clinic. The hospital provides high-intensity care for all clinical specialties, and

4104-507: Is the process where breast milk is fed to a child. Breast milk may be from the breast, or may be pumped and fed to the infant. The World Health Organization (WHO) recommend that breastfeeding begin within the first hour of a baby's birth and continue as the baby wants. Health organizations, including the WHO, recommend breastfeeding exclusively for six months. This means that no other foods or drinks, other than vitamin D , are typically given. The WHO recommends exclusive breastfeeding for

4212-402: Is unlikely that COVID-19 can be transmitted through breast milk. Smoking tobacco and consuming limited amounts of alcohol and/or coffee are not reasons to avoid breastfeeding. Breast development starts in puberty with the growth of ducts, fat cells , and connective tissue. The ultimate size of the breasts is determined by the number of fat cells. The size of the breast is not related to

4320-423: The "golden hour" during the immediate postpartum period, assists in the mother–child bonding for both mother and baby, and is thought to encourage instinctual breastfeeding behavior in the infant. Newborns who are immediately placed on their mother's skin have a natural instinct to latch on to the breast and start nursing, typically within one hour of birth. Success with breastfeeding in this "golden hour" increases

4428-676: The Award of Level 2 Participation stage and is well on its way to receiving BFHI accreditation. The BFHI started in Ireland in 1998 under the auspices of the Irish Health Promoting Hospitals Network (a WHO programme). The BFHI in Ireland became an independent registered charity in mid-2016 and changed their name to Baby Friendly Health Initiative. They offer two levels - a participation or membership level in which maternity facilities are encouraged to implement

Baby Friendly Hospital Initiative - Misplaced Pages Continue

4536-622: The BFHI were temporally associated with a decrease in the rate of infant deaths in the first six days after birth. The authors said that their findings dispelled the suggestion that hospital-based breastfeeding initiatives might increase infant death from asphyxiation. The authors did not discuss the other potential harms to mother and baby that critics have raised, such as increased incidence of neonate hospital admission due to dehydration and poor maternal mental health outcomes. A 2017 study focusing on hospital readmission among infants based on method of feeding raised concerns that exclusive breastfeeding

4644-659: The East Kowloon Clinic and Pamela Youde Clinic. To enhance community participation, an annual health promotion programme and a patient resource centre were established in 1993, giving support to seven self-help patient groups. The hospital organised a Healthwork Campaign for the staffs of 28 hotels in Yau Tsim Mong District and formed partnership programmes with the Hong Kong Hotels Association in 1995–96. In 1994–96,

4752-516: The Initiative not requiring hospitals to inform mothers about the risks of exclusive breastfeeding, and only discussing the risks of not breastfeeding, as providing insufficient information to allow mothers to make a fully-informed decision regarding infant feeding choices. A 2021 article outlines the harms caused by insufficient milk intake in neonates, and discusses accidental neonatal starvation alongside current scientific evidence while offering

4860-710: The Initiative provides support as facilities implement standards relating to policies and procedures, staff education, effective auditing, educating pregnant women and mothers, and other relevant areas. In 1998, its principles were extended to cover the work of community health-care services with the Seven Point Plan for the Promotion, Protection and Support of Breastfeeding in Community Health Care Settings . It has been estimated that if all babies were breastfed, over £35m would be saved by

4968-501: The Ministry of Health and Long Term Care in Ontario added BFI status to their progress indicators for Public Health Units thus requiring all Public Health Units in Ontario to begin implementation of BFI. Other provinces and territories are implementing strategies at regional and local levels. As of 2008, 18 health care facilities (9 hospitals & birthing centres and 9 community health services) had been designated "Baby-Friendly" across

5076-584: The NHS in England and Wales each year in treating gastroenteritis alone. Despite that, in 2013 breastfeeding rates in the UK were amongst the lowest in Europe: 78 per cent of babies born in the UK were breastfed at birth, falling to 63 per cent at one week. Only one in five babies still received breastmilk at six months. In 2013 the success of the initiative in Scotland showed that 90% of Scottish mothers gave birth in

5184-673: The US were on the Pacific Coast. The first US hospital to receive this designation was Evergreen Hospital Medical Center , in Kirkland, Washington , which was certified in September 1996. All of these early adopters were able to achieve 100% breastfeeding initiation rates. In New York City, the Harlem Hospital Center was the first hospital to receive the "Baby Friendly" certification granted by Baby-Friendly USA for

5292-698: The United States, 22.4% of babies are breastfed for 12 months, the minimum amount of time advised by the American Academy of Pediatrics . In India , mothers commonly breastfeed for 2 to 3 years. Supplementation is defined as the use of additional milk or fluid products to feed an infant, in addition to breastmilk, during the first 6 months of life. The Academy of Breastfeeding Medicine recommends only supplementing when medically indicated, as opposed to mixing use of formula and breastmilk for reasons that are not necessarily medical indications. Some medical indications for supplementation include low blood sugar, dehydration, excessive weight loss or poor gain, and jaundice in

5400-448: The aforementioned fluid accumulation in the breast tissue, can cause severe pain. If breastfeeding is suddenly stopped a woman's breasts are likely to become engorged. Pumping small amounts to relieve discomfort helps to gradually train the breasts to produce less milk. There is presently no safe medication to prevent engorgement, but cold compresses and ibuprofen may help to relieve pain and swelling. Pain should go away with emptying of

5508-598: The baby from her breast for a short time until the flow becomes less forceful. Milk may also let-down unexpectedly when a mother hears her baby cry or even only thinks about the baby. Nursing pads may be made or purchased to absorb unexpected milk flows. Infants of mothers with inverted nipples can still achieve a good latch with perhaps a little extra effort. For some women, the nipple may easily become erect when stimulated. Other women may require modified breastfeeding techniques, and some may need extra devices, such as nipple shells, modified syringes, or breast pumps to expose

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5616-552: The baby to foods that the mother has eaten and decrease the risk of diarrheal illness . Although the baby has received some antibodies ( IgG ) through the placenta, colostrum contains a substance which is new to the newborn, secretory immunoglobulin A (IgA). IgA works to attack germs in the mucous membranes of the throat, lungs, and intestines, which are most likely to come under attack from germs. Additionally, colostrum and mature breast milk contain many antioxidant and anti-inflammatory enzymes and proteins that decrease

5724-423: The baby to obtain enough milk. Babies can successfully latch on to the breast from multiple positions. Each baby may prefer a particular position. The "football" hold places the baby's legs next to the mother's side with the baby facing the mother. Using the "cradle" or "cross-body" hold, the mother supports the baby's head in the crook of her arm. The "cross-over" hold is similar to the cradle hold, except that

5832-439: The baby to open their mouth with a wide gape. One way to help the infant achieve a deep latch is to compress the breast tissue into a "U" or "hamburger shape," so that the infant can fit the breast tissue into their mouth. This is done by the mother placing her thumb and fingers in line with the infant's nose and mouth respectively and using this grip to compress the breast tissue. If the newborn seems to need help in latching on,

5940-473: The birth of an infant is followed by massive fluid shifts to both offload excess fluid, which had been used to supply oxygen and nutrients to the fetus through the placenta, which is no longer needed, and supply additional fluid to the breasts in order to start the process of making milk. These fluid shifts often result in some of this excess fluid leaking into the breast tissue. Finally, milk "coming in" can create an uncomfortably full feeling, which combined with

6048-503: The brain, namely estrogen , progesterone , prolactin , which gradually increase throughout the pregnancy, and result in the structural development of the alveolar (milk-producing) tissue and the production of colostrum . While prolactin is the predominant hormone in milk production, progesterone , which is at high levels during pregnancy, blocks the prolactin receptors in the breast, thus inhibiting milk from "coming in" during pregnancy. Many other physiologic changes occur under

6156-429: The breast tissue due to accumulation of fluid in the tissue surrounding and supporting the milk-producing cells and ducts. Engorgement most frequently occurs as milk "comes in" and during the weaning process. As milk is coming in, several processes occur. At the end of pregnancy there is dilation of the blood vessels which supply the breast, allowing for leaking into the tissue or interstitial space . Additionally,

6264-519: The breasts) or both. Primary causes may manifest prior to or during pregnancy, during labor, and even after birth. Secondary causes are far more common than primary ones. One study found that 15% of healthy first-time mothers had low milk supply 2–3 weeks after birth, with secondary causes accounting for at least two-thirds of those cases. Queen Elizabeth Hospital, Hong Kong Queen Elizabeth Hospital ( Chinese : 伊利沙伯醫院 ; Cantonese Yale : Yīleihsābaak Yīyún ), QE or QEH in short,

6372-434: The breasts, decreases blood flow to the alveoli and signals the milk-producing cells to produce less milk. The content of breast milk should be discussed in two separate categories – the nutritional content and the bioactive content, that is the enzymes , proteins , antibodies , and signaling molecules that assist the infant in ways outside of nutrition. The pattern of intended nutrient content in breast milk

6480-558: The breasts. If symptoms continue and comfort measures are not helpful a woman should consider the possibility that a blocked milk duct or infection may be present and seek medical intervention. Although very common, nipple pain and nipple trauma (cracking, open sores) should not be normalized, as these are often signs of a shallow latch or other underlying problem that can be evaluated and fixed . In addition to shallow latch, other causes of nipple pain include, but are not limited to, skin infection or inflammation , blood vessel spasm or

6588-482: The case is in cases of infant metabolic diseases, such as galactosemia . The Academy of Breastfeeding Medicine recommends that supplementation only be used when medically indicated and when overseen by a medical professional, such as a pediatrician or family physician, and after consultation with an IBCLC. Without sufficient breast stimulation, supplementation can reduce the mother's milk production, so pumping would be indicated in these cases if continued breastfeeding

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6696-469: The chin will be close to the breast, and the forehead and nose should be far from the breast. Another sign of a good latch is the contour of the infant's cheeks; the cheeks should be rounded all the way to the edge of the mouth, rather than dimpled or creased at the edge of the mouth. This is a good indicator of effective suck mechanics. Additionally, in order to achieve a deep latch, the infant's mouth must be open wide, preferably wider than 140 degrees. In

6804-639: The city in 2008. In 2011, New York University Langone Medical Center became the second hospital to receive the Baby-Friendly Hospital designation in New York City. The Johns Hopkins Hospital in Maryland describes the process of receiving the Baby Friendly designation. It involves changing long-standing policies, protocols and behaviors. The Baby-Friendly Hospital Initiative includes a very rigorous credentialing process that includes

6912-457: The control of progesterone and estrogen. These changes include, but are not limited to, dilation of blood vessels, increased blood flow to the uterus, increased availability of glucose (which subsequently is passed through the placenta to the fetus), and increased skin pigmentation, which results in darkening of the nipples and areola , formation of the linea nigra , and onset of melasma of pregnancy . The third stage of labor describes

7020-787: The country had been designated "baby-friendly". In 2014 78.60% of babies were born in BFHI hospitals. Between 2001 and 2013, the increase in certified hospitals was from 38 to 176. The UNICEF UK Baby Friendly Initiative was launched in the United Kingdom in 1995. The Initiative works with the National Health Service (NHS) to ensure a high standard of care for pregnant women and breastfeeding mothers and babies in hospitals and community health settings. The Baby Friendly Initiative accredits health-care facilities that adopt internationally recognised best practice standards for breastfeeding. During each stage of accreditation,

7128-472: The country. The B.C. Women's Hospital and Health Centre has been recognized as a breast-feeding and “baby-friendly” hospital by the World Health Organization (WHO) and UNICEF since 2008. It is the largest hospital in Canada to receive the designation. China, now has more than 6,000 Baby-Friendly Hospitals, exclusive breastfeeding in rural areas rose from 29 per cent in 1992 to 68 per cent in 1994; in urban areas,

7236-402: The duct system and out through the nipple. This process is known as the milk ejection reflex , or let-down. Because of oxytocin's dual activity at the breast and the uterus, breastfeeding mothers may also experience uterine cramping at the time of breastfeeding, for the first several days to weeks. Prolactin and oxytocin are vital for establishing milk supply initially, however, once

7344-634: The end of 1996. With a donation from the Hong Kong Jockey Club , the Jockey Club Institute of Radiotherapy and Oncology, and the Jockey Club Institute of Radiology and Imaging were redeveloped. Redevelopment of the Ambulatory Care Centre, with specialist clinics, day surgery and rehabilitation services included under one roof, was completed by 1997. The new Rehabilitation Block opened for service in 1999, and

7452-507: The end of the feed, this may be a signal of the infant tired or becoming relaxed with a slower milk velocity. Numerous health organizations, including, but not limited to, the CDC, WHO, National Health Service, Canadian Pediatric Society, American Academy of Pediatrics, and American Academy of Family Physicians, recommend breastfeeding exclusively for six months following birth, unless medically contraindicated. Exclusive breastfeeding

7560-693: The equivalent of Raynaud Syndrome in the breast, mastitis , plugged ducts, and nipple blebs . Pain caused by a problem deep in the breast may also present with nipple pain due to the paths of nerves in the breast. In addition to the serious nature of many of these causes, nipple pain is a common reason for a mother stopping breastfeeding, so it is important that mothers experiencing nipple pain be evaluated. While milk normally "comes in" by 3 days after birth, there are several reasons this may be delayed. Risk factors for this delay include maternal diabetes , stressful delivery, retained placenta , prolonged labor and birth by C-section . Mothers experiencing

7668-415: The first 12 months of breastfeeding is approximated to be 58-72 Calories/100mL. Comparatively, the caloric content after 48 months is approximately 83-129 Calories/100mL. When a mother has her full milk supply and is feeding her infant, the first milk to be expressed is called the foremilk. Foremilk is typically thinner and less rich in calories. The hindmilk that follows is rich in calories and fat. If

7776-415: The first 6 months of life, followed by continued breastfeeding with appropriate complementary foods for up to 2 years and beyond. Of the 135 million babies born every year, only 42% are breastfed within the first hour of life, only 38% of mothers practice exclusive breastfeeding during the first six months, and 58% of mothers continue breastfeeding up to the age of two years and beyond. Breastfeeding has

7884-455: The hospital completed some major service expansion projects. They included the provision of an Open Heart and Thoracic Surgical Services and an Adolescent Medical Centre. A 24-hour multidisciplinary trauma service was introduced in 1995–96, and various patient-centred services re-organisations were introduced. The medical record system and electronic medical record systems were also introduced in phases beginning in 1994. The hospital pioneered

7992-598: The impact of BFHI implementation on breastfeeding and child health outcomes worldwide and in the United States. The authors suggested that following the BFHI Ten Steps had a positive impact on short, medium, and long-term breastfeeding outcomes. However, they warned their results for the United States explaining "All of the United States BFHI evidence comes from observational studies, the vast majority of which are of very low or low quality. Although there

8100-501: The inability to latch on properly is related to ankyloglossia, a simple surgical procedure to clip the frenulum can correct the condition. The Academy of Breastfeeding Medicine and the Australian Dental Association have raised concern over the growing trend of oral tie surgeries, due to evidence for benefit being low-quality, inconsistent, or unsupported. Engorgement is the swelling and stretching of

8208-487: The increase was from 10 per cent to 48 per cent. In Cuba, 49 of the country's 56 hospitals and maternity facilities have been designated as "baby-friendly". In the six years following the initiation of the BFHI program, the rate of exclusive breastfeeding at four months almost tripled - from 25 per cent in 1990 to 72 per cent in 1996. In Hong Kong several hospitals have shown interest in being designated Baby Friendly. However, only Queen Elizabeth Hospital has advanced past

8316-435: The infant comes toward the breast to latch. If the infant leads with their brow or forehead, they are likely to flex their neck; this mechanism of latching causes the nipple to point down and then hit the hard palate during sucking. From an external view, this manifests as the nose and forehead being close to the breast and the chin far from the breast. This neck flexion also obstructs the normal swallowing mechanism, preventing

8424-411: The infant from drinking efficiently. In addition to not being able to swallow properly, this shallow latch prevents the infant from adequately compressing the glandular tissue behind the nipple and stimulating milk flow; thus, they may begin to apply more suction, which manifests externally as cheek dimpling, or sucking their cheeks in. When the baby suckles muscles in the breast squeeze milk towards

8532-1323: The infant to the breast, or interrupting the process, such as removing the baby to weigh him/her, may complicate subsequent feeding. Activities such as weighing, measuring, bathing, needle-sticks, and eye prophylaxis wait until after the first feeding. Children who are born preterm (before 37 weeks), children born in the early term period (37 weeks–38 weeks and 6 days), and children born with low muscular tone, such as those with chromosomal abnormalities like Down syndrome or neurological conditions like Cerebral palsy , may have difficulty in initiating breast feeds immediately after birth. These late preterm (34 weeks –36 weeks and 6 days) and early term (37 weeks–38 weeks and 6 days) infants are at increased risk for both breastfeeding cessation and complications of insufficient milk intake (e.g., dehydration, hypoglycemia, jaundice, and excessive weight loss). They are often expected to feed like term babies, but they have less strength and stamina to feed adequately. By convention, such children are often fed on expressed breast milk or other supplementary feeds through tubes, supplemental nursing systems , bottles, spoons or cups until they develop satisfactory ability to suck and swallow breast milk. Regardless of feeding method chosen, human milk feedings, whether from

8640-407: The infant's immune system. Produced during pregnancy and the first days after childbirth, colostrum is easy to digest and has laxative properties that help the infant to pass early stools. This aids in the excretion of excess bilirubin , which helps to prevent jaundice . Colostrum also helps to seal the infants gastrointestinal tract from foreign substances and germs, which may sensitize

8748-413: The infant's mouth should be asymmetric , meaning most of the "bottom" of the areola should be in the infants mouth and much more of the "top" of the areola should be visible. This position is helpful in pointing the nipple toward the roof of the infant's mouth, helping the infant recruit more milk. The baby's lips should be flanged out. The neck should be extended to facilitate swallowing, and as such,

8856-665: The infant. The first type of milk produced is called colostrum . The volume of colostrum produced during each feeding is appropriate for the size of the newborn stomach and is sufficient, calorically, for feeding a newborn during the first few days of life. Produced during pregnancy and the first days after childbirth, colostrum is rich in protein and Vitamins A, B12 and K, which supports infants' growth, brain development, vision, immune systems, red blood cells, and clotting cascade. The breast milk also has long-chain polyunsaturated fatty acids which help with normal retinal and neural development. The caloric content of colostrum

8964-561: The infant; true low milk supply; severe nipple pain unrelieved by interventions; and medical contraindications to breastfeeding, as described below. Supplements can be delivered at the breast through a supplemental nursing system in order to stimulate the production of the mother's own milk and to preserve the breastfeeding relationship. Some parents may desire to supplement proactively if early signs of insufficient intake, such as decreased urination, dry mucous membranes, or persistent signs of hunger, are noticed. If these signs are noticed, it

9072-452: The latch process, the infant should be aligned with their abdomen facing their mother, which can be remembered as "tummy-to-mummy," and with their hips, shoulders and head aligned. This alignment helps to facilitate proper, efficient swallowing mechanics. Latching refers to how the baby fastens onto the breast while feeding. Sebaceous glands called Glands of Montgomery located in the areola secrete an oily fluid that lubricate and protect

9180-434: The likelihood of successful breastfeeding at discharge. Skin-to-skin mother-baby contact should still occur, even if the baby is born by Cesarean surgery. The baby is placed on the mother in the operating room or the recovery area. If the mother is unable to immediately hold the baby a family member can provide skin-to-skin care until the mother is able. According to studies cited by UNICEF , babies naturally follow

9288-438: The milk supply is well established, the volume and content of the milk produced is controlled locally. Although prolactin levels are higher on average among breastfeeding mothers, prolactin levels themselves do not correlate to milk volume. At this stage, production of milk is triggered by milk drainage from the breasts. The only way to maintain milk supply is to drain the breasts frequently. Infrequent or incomplete drainage of

9396-494: The mother and child wish. The World Health Organization's guidelines recommend "continue[d] frequent, on-demand breastfeeding until two years of age or beyond. Extended breastfeeding means breastfeeding after the age of 12 or 24 months, depending on the source. In Western countries such as the United States , Canada , and Great Britain , extended breastfeeding is relatively uncommon and can provoke criticism. In

9504-656: The mother is not herself deficient in vitamins, breast milk normally supplies her baby's needs, with the exception of Vitamin D. The CDC , National Health Service (UK), Canadian Paediatric Society , the American Academy of Pediatrics , and the American Academy of Family Physicians all agree that breast milk alone does not provide infants with an adequate amount of Vitamin D, thus they advise parents to supplement their infants with 400 IU Vitamin D daily. Providing this quantity of Vitamin D to breastfeeding infants has been shown to reduce rates of Vitamin D insufficiency (defined as 25-OH vitamin D < 50 nmol/L). However, there

9612-496: The mother or a donor, are important in the brain development of premature infants, and the NICU having a standardized protocol for feeding is protective against dangerous gastrointestinal infections ( necrotizing enterocolitis ) in these infants. Frequent breastfeeding and/or small amounts of supplementation may be needed for successful outcomes; breast pumping and/or hand expression is often helpful in providing adequate stimulation to

9720-416: The mother should focus on helping the infant by bringing their chin to the breast first. This facilitates a deep, asymmetric latch, and also helps the infant extend their neck and tilt their forehead back to maintain this deep latch and ease the swallowing process. In a good latch, a large amount of the areola, in addition to the nipple, is in the baby's mouth. The amount of areola visible on either side of

9828-521: The mother supports the baby's head with the opposite hand. The mother may choose a reclining position on her back or side with the baby lying next to her. No matter the position the parent-infant dyad finds most comfortable, there are a few components of every position which will help facilitate a successful latch . One key component is maternal comfort. The mother should be comfortable while breastfeeding, and should have her back, feet, and arms supported with pillows as necessary. Additionally, when starting

9936-745: The mother's breasts. Starting to breastfeed may be challenging for mothers of preterm infants, especially those born before 34 weeks, because their breasts may still be developing (in Lactogenesis I, see Breastfeeding Physiology). Additionally, mother–infant separation and the stressful environment of the NICU are also barriers to breastfeeding. Availability of a lactation specialist in the NICU can be helpful for mothers trying to establish their milk supply. Additionally, skin-to-skin (Kangaroo Care) has been shown to be safe and beneficial to both mother and baby. Kangaroo Care stabilizes newborn premature infants' vital signs, such as their heart rate, providing

10044-403: The nipple during latching. The visible portions of the glands can be seen on the skin's surface as small round bumps. The rooting reflex is the baby's natural tendency to turn towards the breast with the mouth open wide. When preparing to latch, mothers should make use of this reflex by gently stroking the baby's philtrum, the area between the upper lip and the nose, with their nipple to induce

10152-403: The nipple. La Leche League and Toronto Public Health offer several techniques to use during pregnancy or even in the early days following birth that may help to bring a flat or inverted nipple out. The World Health Organization's Ten Steps to Successful Breastfeeding recommends total avoidance of pacifiers for breastfeeding infants. In 2016 a large review of studies reported that the use of

10260-421: The nipples. This is called the let-down reflex. Some women report that they do not experience anything while others report a tingling feeling which is sometimes described as quite strong. The baby may be seen to respond to the beginning of the flow of milk by changing from quick sucks to deep rhythmic swallows. Sometimes the let-down is so strong that the baby splutters and coughs and the mother may need to remove

10368-543: The numbers of babies who are exclusively breastfed worldwide, a goal which the WHO estimates could contribute to avoiding over a million child deaths each year, and potentially many premature maternal deaths as well. The criteria for a hospital's Baby Friendly accreditation (2018) include: Critical management procedures 1a. Comply fully with the International Code of Marketing of Breast-milk Substitutes and relevant World Health Assembly resolutions. 1b. Have

10476-403: The nutritional benefits of breastmilk, breast milk also provides enzymes, antibodies, and other substances that support the infant's growth and development. The bioactive makeup of breastmilk also changes based on the needs of the infant; for example, when an infant is recovering from an upper respiratory infection , local signaling allows for increased passage of immune cells and proteins to aid

10584-420: The parent that infant weight gain is absolute proof of adequate milk intake. Thus, if the infant breastfeeding exclusively, and is gaining weight appropriately, then the parent can be reassured that they are producing enough milk. True low milk supply can be either primary (caused by medical conditions or anatomical issues in the mother), secondary (caused by not thoroughly and regularly removing milk from

10692-654: The period between the birth of the baby and the delivery of the placenta, which normally lasts less than 30 minutes. The delivery of the placenta causes an abrupt drop off of placental hormones. This drop, specifically in progesterone, allows prolactin to work effectively at its receptors in the breast, leading to an array of changes over the next several days that allow the milk to "come in"; these changes are known collectively as Lactogenesis II. Colostrum continues to be produced for these next few days, as Lactogenesis II occurs. Milk may "come in" as late as five days after delivery; however, this process may be delayed due to

10800-411: The placenta is delivered. Although traditionally, lactation occurs following pregnancy, lactation may also be induced with hormone therapy and nipple stimulation in the absence of pregnancy. Changes in pregnancy , starting around 16 weeks gestational age , prepare the breast for lactation. These changes, collectively known as Lactogenesis I , are directed by hormones produced by the placenta and

10908-530: The risk of obesity in adulthood. Benefits for the mother include less blood loss following delivery , better contraction of the uterus, and a decreased risk of postpartum depression . Breastfeeding delays the return of menstruation , and in very specific circumstances, fertility , a phenomenon known as lactational amenorrhea . Long-term benefits for the mother include decreased risk of breast cancer , cardiovascular disease , diabetes , metabolic syndrome , and rheumatoid arthritis . Breastfeeding

11016-490: The risk of gastrointestinal allergies to food, respiratory allergies to air particles like pollen, and other atopic diseases , such as asthma and eczema . It is recommended for mothers to initiate breastfeeding within the first hour after birth. Uninterrupted skin-to-skin contact and breastfeeding can begin immediately after birth, and should continue for at least one hour after birth. This period of infant-mother interaction, known generally as kangaroo care , or

11124-449: The second stage of milk production, triggering the milk to come in over the next several days. The third stage of milk production occurs gradually over several weeks, and is characterized by a full milk supply that is regulated locally (at the breast), predominately by the infant's demand for food. This differs from the second stage of lactogenesis, which is regulated centrally (in the brain) by hormone feedback loops that naturally occur after

11232-399: The standards and network with other maternity facilities but with no external assessment process, and the designation level where there is external assessment and on-going monitoring to ensure the standards are met and sustained. Sweden is considered the global leader in terms of BFHI implementation: four years after the programme was introduced in 1993, all of the then 65 maternity centres in

11340-496: The start of breastfeeding but disappear or become considerately more manageable after the first few weeks. Feedings may last as long as 30–60 minutes each as milk supply develops and the infant learns the Suck-Swallow-Breathe pattern. However, as milk supply increases and the infant becomes more efficient at feeding, the duration of feeds may shorten. Older children may feed less often. When direct breastfeeding

11448-497: The substantial criticism regarding the increased pressure and anxiety felt by mothers due to Baby Friendly implementation, the current guidelines provided by Baby Friendly USA make no mention of the importance of maternal mental health in the context of a healthy baby, nor do they have any indication of mental health experts having been involved in creating or editing the implementation guidelines. Breastfeeding#Exclusive breastfeeding Breastfeeding , also known as nursing ,

11556-584: The time, it was the largest general hospital in the British Commonwealth , built at a cost of HK$ 70,300,000. Prince Philip, Duke of Edinburgh laid the hospital's foundation stone on 7 March 1959. The hospital is now the largest public hospital in Kowloon. It has 1,906 beds and 13 clinical departments, and a staff force of about 6,850. It serves an effective population of about 900,000 and about one-third of all cancer patients in Hong Kong. It

11664-559: Was insufficient evidence in the most recent Cochrane Review , to determine if this quantity reduced rates of Vitamin D deficiency (defined as 25-OH vitamin D < 30 nmol/L) or rickets . Term infants typically do not need iron supplementation. Delaying clamping of the cord at birth for at least one minute improves the infants' iron status for the first year. When complementary (solid) foods are introduced at about 6 months of age, parents should make sure to choose iron-rich foods to help maintain their children's iron stores. In addition to

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