 In this part, we will be discussing about why babies don't gain weight in the first few weeks, first few months, you know, and in my experience, literally in 90% of the time, it's a breastfeeding factor, okay? Most of our babies are nipple latching. Even if they are not nipple latching, there is more of a pyrrole going in the mouth. Babies are too far from the breast, you know. Mothers are not breastfeeding 10 to 12 times or at least minimum eight times. Many babies are not fed at night thinking that they need to sleep. There are a lot of factors, a lot of breastfeeding factors. And we have created an amazing tutorial on what are these breastfeeding factors, you know. Even if babies who are not fed within an hour or I would say as soon as babies born, those babies have kind of difficulty latching. Actually, that's what we have seen in the hospital setting. Also, babies who are not, you know, kept with mother. If babies are separated from mothers, those babies also have kind of difficulty latching and then also having difficulty for gaining adequate amount of weight, you know. So, do look at this tutorial. Second tutorial is more about what are the other factors which can reduce breast milk supply, you know, or say for example, mother's psychological condition. So, there are certain psychological conditions where mother will not be able to kind of produce and also release that milk. So, second tutorial is on that very good. It has come out really well. We have covered pretty much all the topics. Third tutorial is on, of course, I mean with mother's psychological condition, there are other conditions like mother's physical condition, you know, if she is on any, if she has some addiction like tobacco will decrease the breast milk supply. If she has any other medical condition which will reduce breast milk supply. So, we have mentioned some of the important points. And the last tutorial is on basically how to increase those breast milk supply, you know, because there are very good physical way to increase breast milk supply. Now, many times, you know, mothers feel that, oh, if I take this medicine or if I take this galactogog, if I take this satavari and if I take that, you know, all that thing is really secondary, you know. I mean, if there is a proper emptying of breast, if the latch is good and if mother understand those important counseling points, you know, milk definitely comes. But there are other ways to increase breast milk supply because if you, lot of time, if you see say a mother after two or three months, you know, and if you have never seen that mother before. So, obviously, she may not know a lot of those important counseling points. So, you can tell her what all things that she can do. There are 10 physical ways that she can increase her supply. So, that tutorial is also really good. Main thing is of course, you know, your KMC, you keep the baby as close as possible. And of course, latching, latching, latching, latching, you know. I mean, if you do not have latching, baby will not have proper milk transfer, you know, because milk, if baby is only sucking on nipple, nipple will not release breast milk, you know. Baby has to press on the lower areola to be able to bring that milk out. So, of course, you know, I have also discussed about ways to improve latching in this tutorial also. And then of course, you know, expressing by hand, you know, post feeding or between feeding will increase the supply, you know, frequent feeding will improve supply, relaxation of mother, release of oxytocin will improve mother supply. Lot of time what I tell mothers, you know, especially when mother is very educated, she gets very nervous, she gets very stressed. So, I tell her, why don't you take a break when she, when baby is sleeping, if you are not sleepy, just go out, go for a walk, you know, just listen to some nice music, take a break, because when she takes a break and when she is a little bit confident when you tell her, you know, what to do and, you know, give her a positive advice or recommendations, you know, her milk supply will increase. But to have that increased supply and to have a let down reflex, let down reflex is a release of milk, you know, mother needs to be in a very cool and composed state of mind. And for that, it's important to take a break and just, you know, she can just maybe watch a movie, you know. So, do recommend that because for new mothers, you know, she feels that she has to be with the baby all the time, she has to be perfect mother, she has to do this, she has to do that. There are so many thought process going on and I had the same issue. In fact, I would say, no, no, my baby is sleeping, I have to be there, you know, whenever she makes up, I have to be there. No, that's not, I mean, you don't have to do that. So, just tell mother to relax. You can do some massage, you know, you can make her listen to some good, you know, maybe if she's religious, she can kind of read some books, some good books, you know, some good stories, whatever she likes, whatever makes her happy. So, keep mother happy and that will automatically increase breast milk supply through increased oxytocin. But first and foremost is latching. So, do think of that latching points and that, you know, all those 45 points and you will definitely see improvement in milk supply. Okay. So, thank you and enjoy. breast milk. Recommended solutions for those reasons. Poor weight gain in babies from birth to six months of age has one main cause. It is that the baby does not get enough breast milk. There are many reasons why a baby may not get enough breast milk. They are divided into four categories. The first category is breastfeeding factors. The second category is the mother's psychological factors. The third category is the mother's physical condition. The fourth category is the baby's physical condition. In this tutorial, we will discuss some of the breastfeeding factors. The other three categories are explained in another tutorial. Delayed start of breastfeeding is the first breastfeeding factor. It should start within an hour of birth. Doing so will help the baby to learn deep attachment to the breast. Pregnant women must be trained in breastfeeding skills in their last trimester. Skin-to-skin contact after birth is essential to start breastfeeding. It is explained in other tutorials in the same series. The second breastfeeding factor is poor positioning of the baby. Mother should not bend the baby's neck forward. This happens when the baby's nose is positioned above the nipple. Nostrils of the baby's nose should always be in line with the nipple. As adults, we extend our neck by tilting our heads backwards to drink water. Similarly, the baby's neck must be extended to drink milk. Mother can pull the baby more towards the other breast to extend its neck. Mother should not turn the baby's neck sideways. This will make it difficult for the baby to swallow milk. Baby's chest and tummy should be lightly pressed into the mother's chest. Baby should be facing the breast and not the mother's face while feeding. In this picture, the baby's face is positioned correctly in the cross-cradle hold. Baby's upper lip is at the 9 o'clock position on the right breast. Baby's lower lip is at the 3 o'clock position. Baby's legs should be tucked well under the mother's arm. Otherwise, the baby will slip down causing nipple feeding. Baby's hip can be seated in the fold of the mother's elbow. This will prevent the baby from slipping down. The third breastfeeding factor is poor attachment of the baby to the breast. Mother must wait for at least 2 to 3 minutes till the baby is fully healed. Mother must wait for at least 2 to 3 minutes till the baby opens its mouth widely. It should be open between 120 and 160 degrees wide. Only then should the mother put her breast in the baby's mouth. Baby's lips and chin should never be far from the areola. Baby's mouth should be deeply pressed into the mother's breast. Otherwise, dimples will appear in the baby's cheeks when it sucks milk. Dimples in the cheeks also appear when there is nipple latching. Another cause of dimples is when more of the upper areola is in the baby's mouth. Mother's fingers compressing the breast should be parallel to the baby's lips. This will ensure that a big part of lower areola goes into the baby's mouth. If the baby sucks only the nipple, it will never get enough milk. Deep attachment to the breast is very important. It is important to check if the baby's attachment to the breast is deep. To do so, the mother can press the breast near the baby's lower lip. The entire lower part of the areola must be in the baby's mouth while feeding. Baby's upper lip should be just above the mother's nipple. Baby's lower lip should be at the border of the areola. If the areola is small, baby's lower lip should be on the breast. This will help the baby get enough milk. Deep attachment to the breast is explained in another tutorial. The fourth breastfeeding factor is the mother not feeding hind milk to the baby. Baby must be fed the thick hind milk that comes after feeding the four milk. It is rich in good fats that are essential for the baby's brain and growth. Not giving hind milk will result in poor weight gain. Mother can check whether the baby has been fed hind milk. To do so, she can express her milk by hand. If thin milk comes out, then the baby has not got hind milk yet. The mother should continue to feed from the same breast. Also, she may see a good flow of thick milk when she expresses milk. This is another sign to continue feeding from the same breast. The fifth breastfeeding factor is feeding at fixed times. Breastfeeding cannot be scheduled like adult meals. The baby must be fed according to its early hunger cues. Early hunger cues are sucking fingers, turning its head from side to side, etc. The mother must recognize these cues and feed the baby immediately. She should not wait till the baby starts crying as crying is a late hunger cue. The sixth breastfeeding factor is not feeding enough times. The baby must be breastfed at least 10 to 12 times in 24 hours. The maximum frequency depends on the baby's hunger cues. Sometimes the baby may want to have milk several times in 1 hour. The baby must be fed as many times as it wants. The seventh breastfeeding factor is not feeding at night. Prolactin levels in a lactating mother are higher at night. Prolactin is a hormone that helps in the production of breast milk. Not feeding at night will reduce breast milk supply. So babies must be breastfed at least 3 to 4 times during the night. Sometimes the baby doesn't wake up for more than 3 hours at night. The mother must wake the baby up for breastfeeding. She can do this by tickling the baby's feet or the baby's back. She can also wake the baby up by making it sit. The eighth breastfeeding factor is the short duration of breastfeeding. The baby must be fed as long as it wants to feed. Mother should not take the baby off the breast if the baby is feeding. Only when the baby shows signs of fullness the mother should stop feeding. Fulness signs are closing its mouth, turning its head away from the breast etc. The ninth breastfeeding factor is the baby falling asleep while feeding. In the first few weeks of breastfeeding the baby may sleep off while feeding. This leads to inadequate milk intake. As mentioned earlier the mother should immediately wake the baby up. She must keep waking the baby up and feeding until the baby refuses to feed. The tenth breastfeeding factor is not offering both breasts to the baby. Some mothers feed the baby from one breast and never offer the other breast. Mother must offer the other breast to the baby after one breast is emptied. The baby will decide whether it wants to feed on the other breast. The eleventh breastfeeding factor is using feeding bottles. Nipple shields etc. This doesn't let the baby naturally attach deeply to the mother's breast. To avoid them the mother must be taught the correct breastfeeding technique. The last breastfeeding factor is giving other food or fluids to the baby. Baby must be exclusively breastfed for the first six months of life. Other fluids or food are not as safe and nutritious as breast milk. They may cause infections. They will also fill the baby's tummy. Therefore the baby will not feel hungry to have mother's milk. This brings us to the end of this tutorial. Thank you for joining. Welcome to the spoken tutorial on the other reasons for not getting enough breast milk. In this tutorial we will learn about the other reasons why a baby may not be getting enough breast milk. Recommended solutions for those reasons. There are many reasons why a baby may not get enough breast milk. They are divided into four categories. The first category is breastfeeding factors. It is discussed in another tutorial in the same series. The second category is the mother's psychological factors. The third category is the mother's physical condition. The fourth category is the baby's physical condition. Let us start with the second category of reasons. We will discuss five common psychological factors of mothers. The first psychological factor is the mother's lack of confidence. New mothers often question their ability to breastfeed properly. Breastfeeding is a skill and it takes time to learn this skill. Mothers must be patiently guided to learn the correct breastfeeding technique. The second psychological factor is the mother's worry or stress. New mothers are worried about the baby's health. Their worry increases in stressful times like a pandemic. Worried mothers are often tempted to bottle feed. Also the stress affects their milk supply. Mothers must have a supporting family to rest and relax. Their doubts must be resolved by regular follow-ups with an expert. The third psychological factor is the mother's dislike of breastfeeding. Some mothers do not prefer breastfeeding. Some mothers do not prefer breastfeeding their baby. This can result in the baby not getting enough breast milk. The fourth psychological factor is the mother's rejection of the baby. Some mothers express strong negative feelings about the baby. They dislike and regret the birth of the baby. There is absence of affectionate behaviour such as kissing, cuddling etc. They feel better when the baby is away from them. In such cases the mother may not breastfeed the baby at all. The fifth psychological factor is the mother's tiredness. New mothers are often sleep deprived and fatigued. This may affect their breast milk production. It may also reduce the breastfeeding frequency. Next we will discuss the third category of reasons. It is the mother's physical condition. The mother may be using contraceptive pills or blood pressure lowering pills. This may affect her breast milk production. In such cases she should consult her doctor to help her out. Another factor that can affect breastfeeding is the mother's pregnancy. Some mothers stop breastfeeding when pregnant. This may cause the child to not get enough nourishment. Mother should know that it is safe to continue breastfeeding when pregnant. The next factor is the mother's severe malnutrition. It can affect the composition of the breast milk. Also the mother may be too weak to feed the baby adequately. If the mother drinks alcohol it can decrease her milk production. The baby may not get enough breast milk. Another factor is the mother's smoking habits. Smoking may decrease milk supply and even change the composition of breast milk. The next factor is a remaining piece of the placenta in the mother. It will not let the mother's prolactin levels rise. Prolactin is a hormone that helps in breast milk production. Therefore she may not be able to breastfeed adequately. However this is a rare cause detected by doctors. Poor breast development is another factor that can affect breastfeeding. Some mothers may not have enough of the milk making tissues in their breast. Next we will discuss the fourth category of reasons. It is the baby's physical condition. During sickness the baby may stop breastfeeding or vomit breast milk. Many newborns have dry mucus in the nose. This blocks their nose and affects their breathing while breastfeeding. Therefore babies take their mouth off the breast frequently while breastfeeding. Putting nasal saline drops in the baby's nose can help clear mucus. Nasal saline drops are available in the pharmacy. Four to five drops in each nostril 15 minutes before feeding will cause the baby to vomit. This will help clear the mucus. It is important to breastfeed frequently to help the baby heal faster. Some babies are born with birth defects. They include Down syndrome, cleft lip or palate and congenital heart disease. They can also have poor muscle development. They will further affect their ability to suck. Such birth defects can affect the baby's ability to breastfeed. Exclusive breastfeeding is a must for a baby from birth to six months of age. For proper growth a baby should be fed enough breast milk every day. If there is any problem while breastfeeding immediately consult an expert. Ensure that the baby gets enough milk through breastfeeding. This brings us to the end of this tutorial. Thank you for joining. Welcome to the spoken tutorial on physical methods to increase the amount of breast milk. In this tutorial we will learn how to increase the amount of breast milk using different physical methods. Let us first begin with kangaroo mother care. In this method the baby should be in skin-to-skin contact with the mother as long as possible. Note that the procedure for kangaroo mother care has been explained in another tutorial of same series. Next we will learn how to improve the let down reflex or oxytocin reflex. Before that we should know what is oxytocin. Oxytocin is a hormone which encourages the let down reflex because of which the milk is pushed out just by thinking about the baby. Therefore to push the milk out first mother should relax and then look at her calm baby. She can also smell her baby's unwashed clothes and listen to soothing music as well. Alternately other methods that will help to push the milk out are hot water fermentation, massage of the upper back and massage of the breast. Let us see how to do hot water fermentation. Mother should take a warm water bath or keep a warm cloth on her breast. Both these methods will help circulation of milk in the breast and push the milk out. Next let us learn about massaging. Massaging of the upper back and neck will help the milk to flow freely since the same nerve goes to the upper back and the breast. Massaging the breast before feeding opens the milk ducts. Hence the milk will flow freely and the breast will be emptied completely leading to higher milk production. Another method of increasing the amount of breast milk is to encourage the baby to latch on correctly. Let us see how to do so. Rub the nipple on the upper lip of the baby. This will help the baby to open mouth widely and will help with correct latch and give sufficient milk to the baby. Make sure during breastfeeding mother supports the full body of the baby. Baby's tummy should touch mother's tummy. Baby's head, neck and body are always in a straight line. Baby's nose is in line with mother's nipple. The chin should be brought forward and pushed into mother's breast. The lower lip is called outward. Ensure that the baby takes in more part of lower ariola while latching so that the upper ariola is more visible than the lower ariola. Please note ariola is the dark area around the nipple. Next let us look at another physical method which is gentle pressing of the breast. To do so gently hold and squeeze the breast during breastfeeding. Gentle pressure on the milk glands helps to release more milk. This will help to give out more milk with each suck of the baby. Gentle pressing of the breast has been explained in another tutorial of same series. An interesting fact is that nighttime feeding is important. Let us understand why. The amount of hormone prolactin in breast milk is higher during the night. When the baby feeds more at night it improves the amount of milk during breastfeeding. Thereby helping in growth of the baby. Another important factor to increase the amount of breast milk is the breastfeeding frequency. Baby should be fed minimum 10-12 times in 24 hours. And it is also important to feed the baby at least 2-3 times at night. Do not keep the baby hungry. Watch out for early hunger signals such as baby moves her arms and legs, baby turns towards anything that is touched to her cheek and she opens her mouth. Remember, crying of the baby is a late signal of hunger. Therefore feed the baby on early hunger signs. Also, removal of hind milk is important. Hind milk is the milk present in the back part of the breast. It is made up of fats, it is thick in consistency. Therefore mother should ensure complete emptying of one breast and then offer the other breast. Now let us discuss about expressing the milk from the breast after feeding the baby. Expressing is manual removal of milk with mother's own hands. To do so, mother keeps her fingers and thumb at the margin of areola and skin of the breast. Then gently presses the areola inward towards the chest. Compressing and then releasing. It is done even if the baby has suckled completely. Mother should remove the milk even in between two feeds. Removing milk frequently will improve the amount of breast milk. Always remember the following. Avoid use of artificial nipples and formula milk as they reduce mother's milk. Avoid feeding cow or goats milk or formula milk. Avoid nipple shields as it creates nipple confusion for the baby. Remember, the baby should be breast fed whenever she shows early hunger signs. The health worker should build mother's confidence by guiding her about correct latching technique. Monitor the weight of the baby daily to ensure that the baby starts gaining 25-30 grams of weight per day. This brings us to the end of this tutorial. Thanks for joining.