Breast Feeding - Park's Textbook of Preventive and Social Medicine

1. INTRODUCTION

Key fact: Infant mortality rates in developing countries are 5-10 times higher among children who have not been breast-fed or who were breast-fed for less than 6 months.

2. PHYSIOLOGY / OUTPUT OF BREAST MILK

• Secretion: Poor Indian women secrete 400-600 ml/day during the first year
• Protein content: 1.1 g per 100 ml
• Energy value: 70 kcal per 100 ml

3. INITIATION OF BREAST FEEDING

• Breast feeding should be initiated within one hour of birth (instead of waiting several hours as is often customary)
• Although there is little milk at that time, it helps to:
  • Establish feeding
  • Build a close mother-child relationship known as "bonding"

4. COLOSTRUM

• The first milk secreted is called colostrum
• It is the most suitable food for the baby in the early period because:
  • Contains high concentration of protein and other nutrients
  • Is rich in anti-infective factors - protects against respiratory infections and diarrhoeal diseases
  • Supplementary feeds are not necessary during this time
• Regular milk comes in on the 3rd to 6th day after birth
• The baby should be allowed to breast-feed on demand (demand feeding)

5. EXCLUSIVE BREAST FEEDING

• No other food is required until 6 months after birth
• At 6 months, breast milk should be supplemented by additional foods rich in protein and other nutrients (animal milk, soft-cooked mashed vegetables, etc.) - these are called supplementary/complementary foods
• It is neither necessary nor desirable to train a baby to "feed by the clock" - intervals may vary from 1 to 4 hours according to the baby's needs

6. ADVANTAGES OF BREAST FEEDING

For the Infant:

1. Safe, clean, hygienic, cheap and available at correct temperature
2. Fully meets nutritional requirements in the first few months of life
3. Contains antimicrobial factors: macrophages, lymphocytes, secretory IgA, anti-streptococcal factor, lysozyme, and lactoferrin - protect against diarrhoeal diseases, necrotizing enterocolitis, and respiratory infections
4. Easily digested and utilized by both normal and premature babies
5. Promotes "bonding" between mother and infant
6. Sucking is good for the baby - helps development of jaws and teeth
7. Protects babies from tendency to obesity
8. Prevents malnutrition and reduces infant mortality
9. Provides biochemical advantages - prevention of neonatal hypocalcaemia and hypomagnesemia
10. Helps parents space children by prolonging the period of infertility (lactational amenorrhoea)
11. Special fatty acids in breast milk lead to increased IQ (breast-fed baby likely to have IQ ~8 points higher) and better visual acuity

For the Mother:

• Lowers risk of postpartum haemorrhage and anaemia
• Boosts immune system
• Delays next pregnancy (lactational amenorrhoea)
• Reduces insulin requirements in diabetic mothers
• Protects from ovarian and breast cancers
• Protects from osteoporosis

7. BREAST FEEDING AND CONTRACEPTION (Lactational Amenorrhoea Method - LAM)

• Lactation prolongs postpartum amenorrhoea and provides some degree of protection against pregnancy
• No more than 5-10% of women conceive during lactational amenorrhoea
• This risk exists only during the month preceding resumption of menstruation
• Once menstruation returns, continued lactation no longer offers protection
• By 6 months after childbirth, about 20-50% of women are menstruating and need contraception
• LAM cannot be depended upon alone - contraceptives should be used, that will not affect lactation in the early postpartum period

8. ROOMING-IN

• Keeping the baby's crib by the side of the mother's bed is called "rooming-in"
• Advantages:
  • Mother gets to know her baby
  • Better chance for breast feeding success
  • Allays fear of baby being misplaced in central nursery
  • Builds mother's self-confidence
• BFHI Step 7 mandates: mothers and infants remain together and practice rooming-in 24 hours a day

9. BABY FRIENDLY HOSPITAL INITIATIVE (BFHI) - 2018 Revised Guidelines

The Ten Steps to Successful Breastfeeding:

10. ARTIFICIAL FEEDING

• Failure of breast milk
• Prolonged illness of the mother
• Death of the mother

Important: It is very important to advise mothers to avoid feeding bottles as bacteriological contamination and nutritional inadequacy are major risks.

11. ASSESSMENT OF BREAST FEEDING (IMNCI Framework)

Signs of Good Attachment (all 4 must be present):

• Chin touching breast
• Mouth wide open
• Lower lip turned outwards
• More areola visible above than below the mouth

Feeding Problem Classification:

12. BREASTFEEDING IN SPECIAL CONTEXTS

Kangaroo Mother Care (KMC):

• Introduced in Colombia in 1979 by Drs. Hector Martinez and Edzar Rey
• For low birth weight babies (<2000 g)
• Involves: early and continuous skin-to-skin contact, breast-feeding support, and supportive care
• Can be practiced even at home

Breast Feeding and Infant Mortality:

• Infant health is directly related to breastfeeding because of nutritional content and natural immunizing agents in breast milk
• Early weaning and bottle-fed infants under poor hygienic conditions are more prone to die than breast-fed infants in similar conditions

Breastfeeding and Vaccination:

• Breastfeeding is NOT a contraindication to vaccination of either the mother or a breastfeeding child (including MMR)

13. NATIONAL PROGRAMMES RELATED TO BREAST FEEDING

• IYCF (Infant and Young Child Feeding) training provided to doctors, nurses, and ANMs
• Includes training in exclusive breast-feeding and complementary feeding
• NSSK (Navjaat Shishu Suraksha Karyakram): covers immediate newborn care including early initiation of breast feeding
• Community-based promotion of breastfeeding through ASHAs under HBNC (Home Based Newborn Care)

QUICK SUMMARY MNEMONICS

• S - Safe, clean, hygienic, cheap
• A - Antimicrobial factors (IgA, lysozyme, lactoferrin, macrophages)
• F - Fully meets nutritional needs for 6 months
• E - Easily digested (even premature babies)
• B - Bonding (mother-child)
• O - Obesity prevention; Osteoporosis prevention (mother)
• N - Neonatal hypocalcaemia prevention; No malnutrition
• D - Delays next pregnancy; Dental/jaw development