A paper on
A Complete Nutrition for Infants
September 16, 1999
: BREAST FEEDING A BOON TO A CHILD
Target Group : Mothers
especially pregnant and lactating mothers and mothers unsuccessful
or reluctant in breast feeding.
Message areas identified
Breast feeding is must till
4 months age.
Colostrum should be given to child.
Do not give up, continue breast feeding till one year.
CONVEY OF THE MESSAGE BY GROUP
Breast feeding is most natural
and economical way of feeding. It is accepted all over world
by all mothers.Only small numbers of mothers, who are cautious
about their figure and mothers who are working, feed their
babies with artificial milk at early stage and soon their
milk dries up. Infact breast milk is the most superior to
any other milk and is only complete diet, a poor mother can
provide to her baby.
PHYSIOLOGY OF LACTATION
The physiology of lactation
is complex. The mothers emotional response and her desire
to feed baby plays a great role in it. Relaxed mothers feed
babies better than anxious mothers. The mammary gland consist
of nipple surrounded by areola, interstitial tissue, fat and
milk ducts. The actively secreting breast consist of 20 segments
which converge to nipple. In pregnancy breast enlarges and
new small ducts and buds are formed. The milk is secreted
by their lining cells. Milk production depends on mothers
reflexes and also on infant reflexes on each other.
A. MOTHER REFLEXES
Prolactin reflex is responsible for secretion of milk and
it is main hormonal influence. The sucking of newborn stimulates
production of impulses from nipple areola to vagus nerve to
anterior pituitary which leads to secretion of prolactin.
A-2. Let down reflex or milk
ejection reflex, is psychosomatic. The physical component
of reflex can be influenced by mothers emotions as well as
the infant sucking areola. The impulse passes from vagus nerve
to posterior pituitary which releases oxytocin in blood. This
acts on muscles cells of areoli, squeezes milk out of them
and propel down in terminal lacteals. This reflex seems to
be more sensitive even to small emotional and psychological
disturbances. Anxiety inhibit this reflex.
B. INFANT REFLEXES
Sucking is most important
of infant reflexes. Sucking is least part in suckling. Starting
reflex is stimulated by contact of mothers breast to baby
cheeks. Baby open the mouth and nipple is drawn into it.
B-1. Nipple is sucked into
B-2. Sucking is assisted by
tongue which draws nipple into oropharnyx.
B-3. Infants starts rhythmic
movement of mandible, Which applies pressure of lacteal sinuses
under areola. This helps expression of milk. Sucking of both
breast as early as possible after delivery is essential for
establishing successful breast feeding. Proper emptying of
breast during suckling is another important factor for successful
and prolonged breast feeding. For this reason mother should
feed their babies frequently and also during night if necessary.
So there will be no clamming back effect of milk flow due
to breast engorgement.
OUTPUT OF BREAST MILK
Output Months Lactation
per day in ml.
per day in ml.
ADVANTAGES OF BREAST
FEEDING FOR BABY AND MOTHER -
1. It is safe clear
sterile, hygienic, cheap, economical and easily available
to infant at correct temperature whenever infant needs it.
2. It fully meets nutritional requirements of infant
in first few months of life.
3. It contains antimicrobial
factors like macrophage,lymphocytes, secretary igA, antibodies,
lysozymes, lactoferrin (iron binding protein), anti streptococcal
factor and antibodies to fight against E.coli and viruses
which provide protection not only against diarrhoel disease
but also respiratory infections during first few months of
Breast-fed babies have fewer
illnesses because human milk transfers to the infant a mother's
antibodies to disease. About 80 percent of the cells in breast
milk are macrophages, cells that kill bacteria, fungi and
viruses. Breast-fed babies are protected from a number of
diseases like diarrhoea,pneumonia, botulism, bronchitis, staphylococcal
infections, influenza, ear infections, and German measles.
Also mothers produce antibodies to whatever disease is present
in their environment, making their milk capable to fight the
diseases their babies are exposed to as well.
4. It is easily digested
and utilised by both normal and premature babies.
5. It promotes bonding
between mother and infant. Nursing may have psychological
benefits for the infant as well, creating an early attachment
between mother and child. At birth, infants see only 12 to
15 inches, the distance between a nursing baby and its mother's
face. Infants as young as 1 week prefer the smell of their
own mother's milk. When nursing pads soaked with breast milk
are placed in their cribs, they turn their faces towards it.
6. Suckling is good
for baby and helps in development of jaws and teeth. Sucking
at the breast promotes good jaw development as well. It's
more difficult to get milk out of a breast than a bottle,
and the exercise strengthens the jaws. It also encourages
the growth of straight, healthy teeth. The baby at the breast
also can control the flow of milk by sucking and stopping.
With a bottle, the baby must constantly suck.
7. Prevents malnutrition
and reduces infant mortality.
8. It prevents hypocalcemia
9. It produces lactational
amenorrhea which acts as a natural contraceptive to delay
10. Involution of uterus
takes place better when mother feeds baby.
11. It also reduces
chances of breast cancer, cancer of ovary in mothers.
12. No babies are allergic
to their mother's milk, although they may have a reaction
to something the mother eats. If she stops the intake of that
food from her diet, the problem resolves itself.
13. Composition of
milk is ideal for baby's growth.
COMPOSITION OF MILK FROM VARIOUS
SOURCES FOR COMPARISON
a) Though some nutrients are less in breast milk they
are just enough for need of a baby. A high protein and mineral
content in cow's/buffalo's milk is not good as it imposes
great strain on excretory capacity of infant's immature kidney.
b) Breast milk is easily
digestible. It contains protein lactalbumin, lactglobulin
but less casein. Whereas cow milk has more casein which is
inferior in quality & not easily digestible.
c) Fat contents present
in mother's and cow's milk is identical but the quality of
fat is better in mother's milk though it depends on mothers
diet.Fatty acids essential for infant are higher in breast
milk than cow's milk. Most of the lipids in mothers milk are
formed (3) by triglycerides and linolenic acid.
d) Lactose is principle
carbohydrate in breast milk. It is slowly absorbed and digested.
It stimulates growth of microorganisms, which synthesis Vitamin
B. Breast milk contains small amount of N2 containing oligosaccharide
which stimulates growth of Lactobaciles bifidus. This organism
breaks down lactose into lactic acid and acetic acid and produces
acid reaction which inhibits growth of pathogens and protects
baby from gastro enteritis.
e) Mineral contents
in the breast milk are Potassium, Calcium, Phosphorus, Chloride,
Sodium, Iron, Copper in trace amount which are digested by
the babies hence they do not suffer from severe anemia.
f) Vitamins : Mother
milk contains Vitamin C provided the diet of mother is not
deficient in ascorbic acid.
COLOSTRUM AND ITS IMPORTANCE
The first thick yellowish
secretion produced by the mothers after delivery is Colostrum
which should be fed to baby as it is good for growth and general
well being. It has life saving properties. It has high concentration
of antibodies and WBC which protect new born from infection.
It also contains certain growth promoting substances which
lack in infant's body. Hence it is essential that infant is
breast fed from day one. Actual breast milk is secreted from
TECHNIQUE AND MANAGEMENT
OF BREAST FEEDING
Mother may feed their baby
lying on her side or in a siting position, by holding a baby
on her laps and supporting baby's head on her forearm in slightly
inclined position. Mother should guide the infant in breast
feeding by supporting breast with fingers and pressing on
areola by the thumb.
TIME AND DURATION OF FEEDING
The average baby has ability
to suck immediately after birth so the baby should be put
to breast immediately.They should be fed on demand schedule
i.e.when baby is hungry. More the suckling more will be production
of milk. But mother must use her intelligence to feed the
baby. If baby starts crying within 2 hours, reason is not
hunger but could be wet nappy or baby needs cuddling.
Duration of feeding varies
from 5-20 minutes or even more. Some babies are slow feeders
but take same amount of milk as fast feeders. If we stop slow
feeders before he is ready he may not take enough milk also
he may not get hind milk (energy rich that he needs to grow).
Amount and composition : The
amount of milk is not same through out the day. It is maximum
when mother has rest and has her meal. The composition also
varies. At initiation of breast feeding it looks watery as
it contains more water & Carbohydrates and at the end of feed,
milk is thicker and contains more proteins and fat. On an
average mother can yield 850 ml milk/day.
Barping/Breaking up wind:
After each breast feed infant is held in upright position
either on lap or shoulder and to gently pat on baby at back
helping to bring out swallowed air from stomach. It at least
takes 5 minutes.
CONTRA INDICATION OF BREAST
A) From Mother's Side
1) Mastitis, fissuring, cracked
nipple, purperal sepsis or any other infection to mother.
The bacteria can be transmitted to infant.
2) Chronic illness, nephritis,
cardiac disease and in severe anemia breast milk should not
3) Tuberculosis is not contra
indication for breast feeding. she can feed when she is having
Anti Tuberculosis drugs and under coverage of INH & BCG to
4) Grossly epileptic.
5) Psychologically disturbed
or insane mother.
6) A few viruses can pass through
breast milk, however. HIV, the virus that causes AIDS, is
one of them. Women who are HIV positive should not breast-feed.
A few other illnesses - such
as herpes, hepatitis, and beta streptococcus infections--can
also be transmitted through breast milk. But that doesn't
always mean a mother with those diseases shouldn't breast-feed
"Each case must be evaluated on an individual basis with the
woman's doctor," she says.
7) Breast cancer is not passed
through breast milk. Women who have had breast cancer can
usually breast-feed from the unaffected breast.
B) From Baby's Side
1) Severe cleft lip and cleft
2) Marked prematurity.
3) Very ill baby.
FAILURE OF BREAST FEEDING
1) Retraction of nipple.
2) Sore or cracked nipple
is painful so mother refuse to feed.
3) Incidence of breast feeding
among caesarean section babies are less, they are not put
to breast for few days as a result breast milk dries up. More
over babies get used to bottle feeding.
4) When babies are too weak
to suck or too small. Mothers milk dries up due to lack of
nipple stimulation and proper emptying of breast.
5) Also success depends on
mothers mental makeup. Reluctant and unwilling mothers fail
to feed their babies. some women just don't feel comfortable
with the idea of nursing. They don't want to handle their
breasts, or they want to think of them as sexual, not functional.
They may be concerned about modesty and the possibility of
having to nurse in public. They may want a break from child
care to let someone else feed the baby, especially in the
wee hours of the morning.
If a woman is unsure whether
she wants to nurse, she can try it for a few weeks and switch
if she doesn't like it. It's very difficult to switch to breast-feeding
after bottle-feeding is begun.
CARE AND CLEANLINESS ABOUT
a) Nipples including
areola are to be cleaned with sterile water, by a piece of
clean cloth before and after each feed. Breast should be washed
by soap water every day. It should be well supported by well
fitted brassier to prevent engorgement.
b) Preparation of successful
i) Antenatal care for retracted
nipple is taken by advising mothers to put on breast shield.
ii) Duct patency in breast is ensured by manual massage of
breast and expression of colostrum during pregnancy.
iii) Breast should be made empty after each feed by manually
expressing residual milk especially in early weeks of breast
feeding. It should also be done in cases where mother is unable
o feed babies during first few weeks. This prevents painful
c) Cracked Nipple :
caused by prolonged sucking when mother has enough milk or
result of biting of oedematus nipple of an engorged breast
by hungry baby. Mother is advised to stop feeding on that
breast for shorter period and she should apply betadine cream
to nipple.Milk expressed should be given to baby.
d) Engorged Breast
: Breast feeding becomes painful if baby is fed before relieving
engorgement. Cracked nipple is produced secondary infection
which leads to breast abscess.
i) Mild Milk Engorgement :
Mother is advised to support breast by using tight brassier.
She should restrict water and salt to certain extent,cold
compress and light massage are applied. Hand expression of
milk is done before baby put to breast.
ii) Moderate: Breast is lumpy
and auxiliary glandular swelling is present along with all
instruction in (di), tablet Mixogen is advised.
iii) Severe : Veins prominent,
breast are tender. Breast pump used for expression of milk
Antibiotics plus Mixogen is advised till inflammation subsides.
iv) Breast Abscess : It should
be drained and proper antibiotic treatment should be given.
FOR BREAST FEEDING SUCCESS
It's helpful for a woman who
wants to breast-feed to learn as much about it as possible
before delivery, while she is not exhausted from caring for
an infant around-the-clock. The following tips can help successful
breast feeding : -
1) Start feeding early
Feeding should begin within an hour after delivery if possible,
when an infant is awake and the sucking instinct is strong.
Even though the mother won't be producing milk yet, her breasts
contain colostrum, a thin fluid that contains antibodies to
2) Proper positioning
The baby's mouth should be wide open, with the nipple as far
back into his or her mouth as possible. A nurse, midwife,
or other knowledgeable person can help her find a comfortable
3) Demand feeding should
Newborns need to nurse frequently, at least every two hours,
and not on any strict schedule. This will stimulate the mother's
breasts to produce plenty of milk. Later, the baby can settle
into a routine. But because breast milk is more easily digested
than other milk, breast-fed babies need feeding more frequently
than bottle-fed babies.
4) No supplements
Nursing babies don't need sugar water or formula supplements.
These may interfere with their appetite for nursing, which
can lead to a diminished milk supply. The more the baby suckles
at the breast, the more milk the mother will produce.
5) Delay artificial nipples
Artificial nipples require a different sucking action
than real ones. Sucking at a bottle could also confuse some
babies in the early days. They, too, are learning how to breast-feed.
6) keep the nipples dry
In the early postpartum period or until her nipples toughen,
the mother should air dry them after each nursing to prevent
them from cracking, which can lead to infection. If her nipples
do crack, the mother can coat them with breast milk or other
natural moisturizers to help them heal. Vitamin E oil or vasline
are commonly used. Proper positioning at the breast can help
prevent sore nipples.
7) Watch for infection
Symptoms of breast infection include fever and painful lumps
and redness in the breast. These require immediate medical
8) Expect engorgement
A new mother usually produces lots of milk, making her breasts
big, hard and painful for a few days. To relieve this engorgement,
she should feed the baby frequently and on demand until her
body adjusts and produces only what the baby needs. In the
meantime, the mother can take over-the-counter pain relievers,
apply warm, wet compresses to her breasts, and take warm baths
to relieve the pain.
9) Take a balanced diet
and take enough rest
To produce plenty of good milk, the nursing mother needs
a balanced diet that includes 500 extra calories a day and
six to eight glasses of fluid. She should also rest as much
as possible to prevent breast infections, which are aggravated
MEDICINES AND NURSING MOTHERS
Most medications have not been
tested in nursing women, so no one knows exactly how a given
drug will affect a breast-fed child. However drugs should
be taken in moderation and only when necessary.
Even mothers who must take daily medication for conditions
such as epilepsy, diabetes, or high blood pressure can usually
breast-feed. They should first check with the child's pediatrician,
To minimize the baby's exposure, the mother can take the drug
just after nursing or before the child sleeps.
A list of drugs that are
usually compatible with breast-feeding-
alcohol in moderation (large
amounts of alcohol can cause drowsiness, weakness, and abnormal
weight gain in an infant)
aspirin (should be used with
caffeine (moderate amounts
in drinks or food)
Drugs That Are NOT Safe
Drugs that should never be
taken while breast-feeding include:
A drug for Parkinson's disease, it also decreases a woman's
Most Chemotherapy Drugs for
Cancer: Since they kill cells in the mother's body, they may
harm the baby as well.
Ergotamine (for migraine headaches):
Causes vomiting, diarrhea, convulsions in infants.
Lithium (for manic-depressive
illness): Excreted in human milk.
Methotrexate (for arthritis):
Can suppress the baby's immune system.
Drugs of Abuse: Some drugs,
such as cocaine and PCP, can intoxicate the baby. Others,
such as amphetamines, heroin and marijuana, can cause a variety
of symptoms, including irritability, poor sleeping patterns,
tremors, and vomiting. Babies become addicted to these drugs.
Tobacco Smoke: Nursing mothers
should avoid smoking. Nicotine can cause vomiting, diarrhoea
and restlessness for the baby, as well as decreased milk production
for the mother. Maternal smoking or passive smoke may increase
the risk of sudden infant death syndrome (SIDS) and may increase
respiratory and ear infections.
Following questions were asked
to group of mothers after the end of the lecture.
A. For the Pregnant
1.Are you working ?
2.Is this your first child ?
3.If no, have you breast fed your previous child ?
4.How long ?
5.If yes, how do you intend to breast feed your child ?
6.When would you start supplementary feeding ?
7.Have you got elders in house who have given you knowledge
of breast feeding ?
B. For Lactating Mothers.
1.Are you working ?
2.Did you put your child immediately for breast feeding ?
3.Do you give any liquid to the child ?
4.How long do you intend to feed your child ?
RESULTS AND DISCUSSIONS
After hearing the lectures
a number of questions were raised by interested mothers and
they were satisfied by appropriate answers.
Qes.1. My mother in
law insisted that I should not give yellow discharge which
came few hours after my delivery and child should not be put
to breast feeding immediately after birth as discharge is
harmful, Is it so ?
Ans. No. Mothers and grand mothers must be explained
that milk secreted in first few days after delivery i.e.colostrum
is essential for the baby. Though it is secreted in small
amount it is enough to meet all needs of newborn. Some grand
parents feel it is harmful but should be taken into confidence
and told that it is not so, in fact it is rich in vitamin
A and K and antibodies which protect child against life threatening
diseases. It also protects baby from allergic diseases like
asthma or eczema.
Qes.2. What is harm
in giving water,honey, glucose water or artificial milk in
first few days?
Ans. The harm of giving water, honey, glucose water
or artificial milk is that, these also called prelacteal feeds,
when given, the baby may not suck from breast if baby's stomach
is full with prelacteal feeds, such feeds may be contaminated.
If feeds are given by bottle, baby gets used to it and may
not suckle at breast.
Qes.3. Do breast fed
babies need water, fruit juice, soup, milk, cereals in first
4-6 months as my child is born during summer season?
Ans. No. From birth to 4-6 months breast milk is all
food and drink that baby needs. Even in hot climate breast
milk contains sufficient water for young baby's needs. Any
other food than breast milk in first 4 months of life may
not be tolerated by infant and may prove harmful.
Qes.4. How do I know
that my milk is enough for baby because my baby keeps on crying
Ans. A baby having only mother's milk ( No water also)
and urinating 6-7 times or more in 24 hours is getting enough
milk. However if your baby is crying all the time it is not
always due to hunger. The baby may want to be held and cuddled,
may have wet nappy, may have colic or may be feeling cold
or hot. Adequate weight gain also helps to know whether baby
is getting enough milk or not. But many people wrongly assume
that baby must gain 2 pounds or 1 kilo/month but number of
babies may gain only 1/2 of that.
Qes.5. Is there any
drug to increase milk supply ?
Ans. There is no need for medicines to increase milk
output. Frequent sucking at breast and no bottle feeding is
more important to assure adequate supply of breast milk.
Qes.6. My milk appears
too thin. Is it bad ?
Ans. In beginning of feed fore milk appears blue and
watery. It is rich in protein, lactose, vitamin, minerals
and water. Towards end of feed hind milks looks whiter because
it is rich in fat. Babies need both. That is why it is important
that baby be allowed to keep sucking from one side till he
gets hind milk and leaves breast on his own.
Qes.7. I am a working
woman. In first 3-4 months of breast feeding my baby will
be used to it.Then how can I resume the work?
Ans. As per government rules women are entitled to
3 months maternity leave.She is also allowed to take any leave
due to her after three months. Working mothers should breast
feed her baby whenever she is at home including nights. In
the absence, expressed milk can be stored for baby. This can
be stored for 8 hours at room temperature without getting
spoiled. Avoid bottle feeding. Let baby be given milk by spoon
or cup. If child finds bottle feeding easier he starts avoiding
breast usually in breast feeding failure.
Qes.8. My child passes
stool once in 3-5 days. Is it due to constipation because
of inadequate milk my child gets ?
Ans. No.Some babies pass motion once in 3-5 days but if motions
are not hard and dry it need not be treated, it is absolutely
normal. Frequent watery motions in a child who is active and
passes urine adequately is also normal.
A detailed lecture along with
the illustrations on importance of breast feeding to group
of pregnant women and lactating mothers was given. From their
over whelming response and their queries which are given in
detail in result & discussion it is quite conclusive that
these mothers in future will definitely go for breast feeding
to their infants.