Breastfeeding: An Emotion

What can be so pure and good for a newly born baby. The first food of the baby is breast milk or mother’s milk. It is the only food the baby can consume. It's not only only a physical process but an emotional and mental process also. Mother and her child goes through an emotional and hormonal change during the process which is beyond the scope of science to feel it.This helps baby to grow and get nourishment.

Health professionals recommend that breastfeeding must begin within the first hour of a baby's life and continue as often and as much as the baby wants. During the first few weeks of life babies may nurse roughly every two to three hours, and the duration of feeding is usually ten to fifteen minutes on each breast. Older children feed less often. There are multiple advantages of breast-feeding to the child and to the mother also.

1) Nutritional superiority - Breast milk contains all kind of nutrients required for a baby's proper mental and physical growth.                     

a) Carbohydrates -  Lactose is present in the breast milk they help in growth of lacto bacilli in the intestine and also help absorption of calcium. Galactose found in the milk help in formation of galactocerebrosides. 

b) Fats - Breast milk contains omega 2&6 fatty acids which are necessary for synthsis of cholesterol and prostaglandins. The PUFA content of milk help in mylination of nerve fibers. It also contains DEHA, which help in brain and retina formation. 

c) Protein - The protein present in the milk are easily digested. These proteins help in neuromodulation and neuro transmission. 

d) Water -  Breast milk contains enough water and electrolytes in them to fully satisfy baby's need. 

e) Vitamins -  The vitamins present in the milk is sufficient for babies first 6 month of life. 

2)Immunological Benefits -  Breast milk contains a number of Immunological benificial factors which help baby in their protection against diseases. 

. PABA = It protect against malaria. 

. Lactoferrin = It protects against E.Coli

. Lipases = It protects against Intestinal pathogens

. It also contains Lactglobulins, Lysozyme, Lactalbumin and Immunoglobulin mainly IgA. 

 

3) Mental Growth = Studies have shown that breast feed babies have higher IQ and and are more attached to mother that who recieve other form of milk. 

4) Protection against allergies = Babies are highly exposed to risk of allergies due to their low immunity which is supplement by the immunity gained from mother’s milk. 

5) Benefits to Mother = Breast-feeding soon after delivery helps in involution of uterus and prevent postpartum haemorrhage. Breast feeding also reduces the chance of ovarian and breast carcinoma. It also help mother in preventing pregnancy for next 6 months. It also help mothers by helping them to loose extra weight that is gained during pregnancy. 

Thus Breast-feeding is a convenient and best way of raising a healthy baby. It helps to build a special and beautiful relation between a mother and her baby.  

Thank you

Sneha Kashyap

2nd year MBBS

GMC BETTIAH

                                           

Breastfeeding: Good Vs Poor Latch

Hello friends!

On International Breastfeeding week, I would like to discuss the difference between Good and Poor Latching during Breastfeeding.

Advantages of Breastfeeding to Neonate

Hello friends!

On the International Breastfeeding week, I would like to share the advantages of Breastfeeding in neonates.

Advantages of breastfeeding to the neonate 

❖ Breast milk provides optimum nutrition for babies. 

❖ During breastfeeding, approximately 0.25-0.5 grams per day of secretory antibodies IgA antibodies pass to the baby via milk. This is one of the most important features of colostrum. 

❖ Breast milk contains several anti-infective factors such as bile salt stimulated lipase and lactoferrin. 

❖ Bile salt stimulated lipase protects against amoebic infections and lactoferrins bind to iron and inhibits the growth of intestinal bacteria. 

❖ Breastfeed infants tend to have fewer cavities and promote proper development of babies' jaw and teeth. 

❖ Babies benefit emotionally because they are held more. 

❖ Breastfed infants tend to have higher IQs due to good brain development early in life. 

❖ In the long term, breastfed babies have a decreased risk of malnutrition, obesity, and heart disease compared to formula-fed babies.

That's all.

Thank you

Isha Kumari

2nd year MBBS

GMC Bettiah

Breastfeeding: Facts

Hello friends!

On the International Breast feeding week, I would like to share some must know facts about Breastfeeding.

Fact 1: Breastfeeding for the first six months is crucial.

WHO recommends that mothers should initiate breastfeeding within one hour of birth. Infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health, and thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods, while continuing to be breastfed; and breastfeeding should continue for up to two years or beyond.

Fact 2: Breastfeeding protects infants from childhood illnesses

Breast milk is the ideal food for newborns and infants. It gives infants all the nutrients they need for healthy development. It is safe and contains antibodies IgA that help protect infants from common childhood illnesses such as diarrhoea and pneumonia, the two primary causes of child mortality worldwide. Breast milk is readily available and affordable, which helps to ensure that infants get adequate nutrition.

Fact 3: Breastfeeding also benefits mothers

Exclusive breastfeeding is associated with a natural (though not fail-safe) method of birth control (98% protection in the first six months after birth). It reduces risks of breast and ovarian cancer, type II diabetes, and postpartum depression.

Fact 4: Breastfeeding has long-term benefits for children

Beyond the immediate benefits for children, breastfeeding contributes to a lifetime of good health. Adolescents and adults who were breastfed as babies are less likely to be overweight or obese. They are less likely to have type-II diabetes and perform better in intelligence tests.

Fact 5: Infant formula does not contain the antibodies found in breast milk.

The long-term benefits of breastfeeding for mothers and children cannot be replicated with infant formula. When infant formula is not properly prepared, there are risks arising from the use of unsafe water and unsterilized equipment or the potential presence of bacteria in powdered formula. Malnutrition can result from over-diluting formula to "stretch" supplies. While frequent feeding maintains breast milk supply, if formula is used but becomes unavailable, a return to breastfeeding may not be an option due to diminished breast milk production.

Fact 6: Transmission of HIV through breastfeeding can be reduced with drugs

An HIV-infected mother can pass the infection to her infant during pregnancy, delivery and through breastfeeding. However, antiretroviral (ARV) drugs given to either the mother or HIV-exposed infant reduces the risk of transmission. Together, breastfeeding and ARVs have the potential to significantly improve infants' chances of surviving while remaining HIV uninfected. WHO recommends that when HIV-infected mothers breastfeed, they should receive ARVs and follow WHO guidance for infant feeding.

Fact 7: Marketing of breast-milk substitutes are highly monitored.

An international code to regulate the marketing of breast-milk substitutes was adopted in 1981. It calls for: all formula labels and information to state the benefits of breastfeeding and the health risks of substitutes. No promotion of breast-milk substitutes. No free samples of substitutes to be given to pregnant women, mothers or their families. No distribution of free or subsidized substitutes to health workers or facilities.

Fact 8: Support for mothers is essential.

Breastfeeding has to be learned and many women encounter difficulties at the beginning. Many routine practices, such as separation of mother and baby, use of newborn nurseries, and supplementation with infant formula, actually make it harder for mothers and babies to breastfeed. Health facilities that support breastfeeding by avoiding these practices and making trained breastfeeding counsellors available to new mothers encourage higher rates of the practice. To provide this support and improve care for mothers and newborns, most countries have implemented the WHO-UNICEF Baby-friendly Hospital Initiative, which sets standards for quality care.

Fact 9: Mothers should continue breastfeeding at work

Many mothers who return to work abandon breastfeeding partially or completely because they do not have sufficient time, or a place to breastfeed, express and store their milk. Mothers need a safe, clean and private place in or near their workplace to continue breastfeeding. Enabling conditions at work, such as paid maternity leave, part-time work arrangements, on-site crèches, facilities for expressing and storing breast milk, and breastfeeding breaks, can help.

Fact 10: Solid foods should be phased in at six months

To meet the growing needs of babies at six months of age, mashed solid foods should be introduced as a complement to continued breastfeeding. Foods for the baby can be specially prepared or modified from family meals.

By- 

Mukesh Kumar

2nd year MBBS

Southern Medical University, China

Technique of Breastfeeding

Hello friends!

On International Breastfeeding Week, I am sharing the proper technique for Breastfeeding. 

Must know methods for everyone.

Techniques of Breastfeeding 

Breastfeeding is nature's precious gift for infants. Breastfeeding is advised because human milk is species-specific nourishment for the baby, produces optimum growth and development, and provides substantial protection from illness. Lactation is beneficial to the mother's health and biologically supports a special MOTHER-BABY relationship.

But most breastfeeding problems are caused by the poor attachment of the baby to the breast. Thus, it is very important to learn how to feed the baby with the correct position and attachment.

Support the mother's body as support back well and use pillow, cushion, or footstool to provide comfort. Before breastfeeding, every mother should wash their hands. 

The correct way to support baby -

1. In sitting position 

a) Cradle hold-

Hold the baby horizontally facing the mother. When nursing from the right breast, use the right arm to rest on the forearm, baby's back supports on the same forearm and holds baby's bottom with hand. Support the breast with the left hand. 

b) Transition hold (cross over hold)

When nursing from the right breast, use the left arm to hold the baby. Support baby back with the left forearm, while placing the thumb and fingers at the base of the baby's head below the ears of the baby. Support the breast with the right hand. 

c) Football hold

Hold the baby under the mother's arm and let the baby face towards the breast. Support the baby with a pillow underneath. Hold the baby close the mother with the nose pointing to the nipple, use the forearm to support baby back and neck, and the hand to hold the baby head. This position is suitable for mothers who have had a Caesarean section. Since mother does not put pressure on the abdomen. 

2.Inside lying hold 

Baby and mother lying on their sides facing each other. The mother should be relaxed. The baby needs to well supported and secure as tuck a rolled-up towel or small pillow firmly behind baby' back to keep in position. Adjust the baby's distance from the lower breast by placing a folded blanket under the baby's head. To assist with the latch on using the opposite hand to support the breast(right hand for left breast vice-versa) 

Getting baby latch on to the breast -support the base of the baby's head. Baby's head slightly extended, so that the nipple is aimed at the roof of the baby's mouth. Lightly touch the baby's lip with the nipple and wait till baby opens his/her mouth wide. Bring baby to mother's breast. Not mother breast to the baby. 

Signs of good attachment-baby open his/her mouth wide with lips flanged out, more areola is seen above the baby's lip then below baby's chin is pressed onto the breast. 

Breastfeeding should not hurt if the mother keeps a finger into the corner of baby's mouth to break the suction and gently take baby off mother's breast.

By- 

Shashikala Kumari

2nd year MBBS

GMC Bettiah

Documentation and prescription for home oxygen

This post is only relevant to practicing physicians/ residents.

Facebook: Schizophrenia treatment

Q2) A schizophrenic patient was on chlorpromazine and olanzapine for the past 6 months, with each drug being prescribed for atleast 6 weeks. The patient is still symptomatic. What is next line of management?
A) Haloperidol depot
B) Aripiprazole
C) Risperidone depot
D) Clozapine

#Medicowesome
#Psychiatry
#Pharmacology

Answer to the above question is D) Clozapine.
Explanation: If two drugs are used for schizophrenia and yet no improvement is seen, then Clozapine is used. Clozapine is DOC for resistant schizophrenia.

Some key points of Clozapine:-
1) It is most effective Antipsychotic
2) Clozapine is most toxic Antipsychotic.
3) It causes following special side effects:-
    a) Agranulocytosis :
-Therapeutic Drug monitoring (TDM) cannot be done because plasma concentration is not proportional with agranulocytosis
- Hence it is C/I with Carbamazepine.
   b) De novo seizure.
   c) Myocarditis.
   d) Sedation - Most common side effect.
   e) Sialorrhea- Wet pillow syndrome.
4) It shows Antisuicidal effect.

That's all!

- Demotional bloke!

Facebook: Acid and Alkali ingestion question.

Q1) In a child with accidental alkali ingestion, which of the following is recommended as acute treatment:-

A) Administer mild acid

B) Administer milk

C) Administer rice

D) Gag the child to induce emesis

So answer to the above question is Milk, Option B.

For acute administration of caustic ingestion, dilution with milk or water is recommended.

Contraindications in case of caustic ingestion:-

1) Neutralization

2) Induce emesis

3) Gastric lavage

Some key points:-

Acid ingestion produces coagulative necrosis and a somewhat protective thick eschar.

Alkali ingestion produces:-

1) Liquefactive necrosis

2) Saponification of fat

3) Exothermic reaction

PS: Do follow our Facebook Medicowesome page for more such questions.

 

Simplifying Carotid Sheath For AIIMS Aspirants

Carotid Sheath

C - Cervical Fascia Modification
A - Ant'r relation = Ansa Cervicalis
R - ❌
O - ❌
T - Tenth nerve/ vagus is a content
I - Internal Jugular Vein  & Internal Carotid are contents
D - DOES NOT contain External Carotid

Happy Preparing :)

Post BCG injection site reaction

Hello Awesomites!


Today,the mother came with one week 5 day old newborn. She noticed a papule in left upper arm of newborn. She was afraid and thus visited the OPD.On history, the child was vaccinated on day 0 . So we counselled her as it was Post-BCG Vaccination injection site reaction characterized by a papule, which may be red, tender and indurated. The papule commences two or more weeks after vaccination and then may progress to become ulcerated healing after 2-5 months leaving a superficial scar.


I forgot to take picture due to rush. You can google the pictures.

-Upasana Y. 

Rett syndrome notes

Hello friends!

Today we are going to learn about Rett syndrome. 

*Frequency : 1 in 15,000.

*90% of the cases are SPORADIC

*5-10% are X-Linked Dominant, so more common in females. 

(Remember males get only one X chromosome from mother whereas females get X chromosome each from mother and father).

*Mutation in gene : MeCP2.

*Virtually always seen in girls because males usually die in utero or shortly after birth.

*Important finding : Decreased pontine NE and Nigro-striatal Dopamine levels.

Clinical features : 

*At birth : Normal growth and normal head circumference.

*Normal attainment of milestones till 5-6 months of age, later there will be progressive regression of language (both receptive and expressive) and motor milestones.

*It causes Acquired Microcephaly.

*Hallmark : Repetitive hand writing movements with loss of purposeful movements.

*It can cause 5 As:

Apnea (intermittent)

Ataxia

Autistic behaviour

Arrhythmias

Acquired Microcephaly

*In addition to all of these, cyanosis, GTCS can also be seen.

*Staging :

Stage 1 : Onset stage (6-18 months)

Stage 2 : Rapid destructive (1-4 years) - 

Stage 3 : Plateau phase (2-10 years)

Stage 4 : Late motor phase (decreased motor movts) - Scoliosis can occur.

*Imaging : No pathognomonic finding. However, significant reduction on brain weight upto 60-80% is often seen.

*HPE : Decreased synapses, dendritic length and branching.

*Treatment : Supportive.

Hope it will help :)

Madhuri.

Pediatric Residency Series: Conferences

The Table below has the name of some Pediatric conferences and the respective subspecialty                          

Pediatric Conferences 

Subspecialty	Conference	Dates	Link
Everything / all subspecialties	Pediatric Academic Societies (PAS)	April/May	https://2020.pas-meeting.org/
	Southern Society of Pediatric Research (SSPR)  (Mainly for Southern states)	February	https://www.southernspr.org/l/default.asp
Pediatric Cardiology	American Heart Association conference(AHA)	November	https://professional.heart.org/professional/EducationMeetings/MeetingsLiveCME/ScientificSessions/UCM_316900_Scientific-Sessions.jsp
	American College of Cardiology conference(ACC)	March	https://accscientificsession.acc.org/
	CHOP: Annual Update on Pediatric and Congenital Cardiovascular Disease	February	https://chop.cloud-cme.com/default.aspx?P=5&EID=928
Pediatric Allergy/Immunology	American Academy of Allergy, Asthma, and Immunology (AAAAI)	March	http://aaaai2020.org/
	American College of Allergy, Asthma, and Immunology (ACAAI)	November	https://annualmeeting.acaai.org/
	Texas Allergy, Asthma, and Immunology Society (TAAIS) -no poster presentations	April	https://taais.org/intro-view/2020-taais-annual-meeting/
Pediatric Neurology	Child Neurology Society (Getting a poster in may be difficult)	October	https://www.childneurologysociety.org/meetings/future-cns-annual-meetings.
	American Academy of Neurology	April/May	https://www.aan.com/conferences-community/upcoming-conference-dates/
Child Abuse	Ray E. Helfer Society.	April	https://www.helfersociety.org/
Pediatric Genetics	American Society of Human Genetics (ASHG) annual meeting	October	https://www.ashg.org/2019meeting/
	Annual Clinical Genetics Meeting (ACGM)	March	https://www.acmgmeeting.net/acmg2020/Public/mainhall.aspx
	Society For Inherited Metabolic disorders (SIMD)	March/April	https://www.simd.org/meetings/
Pediatric Hematology/Oncology	American Society of Pediatric Hemato-Oncology (ASPHO)	May	http://aspho.org/meetings/conference/overview
	American Society of Clinical Oncology (ASCO)	Variable	https://www.asco.org/meetings
	American Society of Hematology	February	https://icaho.binayfoundation.org/ash-review-2020/?gclid=Cj0KCQiAxfzvBRCZARIsAGA7YMygEl2NN94_002yg6RkPits6AjbbfMLdhbPSAHzHvMaE1xyc7rOtc4aAs5fEALw_wcB
Pediatric Hospitalist Medicine	Pediatric Hospitalist Medicine Conference	July	https://www.hospitalmedicine.org/event/pediatric-hospital-medicine/

 

Will be updated as soon as more info become available :)

Do not forget to leave comments about names of conferences you know for different subspecilaties so they can be added to the table. 

-Murad