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Breast feeding

A paper on

BREAST FEEDING

A Complete Nutrition for Infants

By

Dr. Vaishali Mandar Joshi

Homeopathic Physician & Nutritionist

Mumbai, India
September 16, 1999

TOPIC : 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 LECTURE

INTRODUCTION

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

A-1. 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 mouth.

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

   Months       Lactation Output    Months       Lactation Output
                       per day in ml.                         per day in ml.

0-2
530    
13-15
515
3-4
   640         
16-18
440
5-6
  730      
19-24
400
7-8
660    
25-36
425
9-10
600
37-38
345
11-12
525
 

 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 life.

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 and hypomagnesemia.

9. It produces lactational amenorrhea which acts as a natural contraceptive to delay next pregnancy.

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

milk per 100ml calories proteins fats carbohydrate calcium
Human
71
1.2
3.8
7.0
33
cow's
69
3.3
3.7
4.8
125
Buffallo
102
3.8
7.5
4.9
200
Goat's
102
3.3
4.5
4.4
130


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 3-4 days.

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 FEEDING

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 be given.

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 baby.

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 palate.

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 BREAST FEEDING

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 breast feeding.

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 engorgement.

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.

TIPS 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 disease.

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 nursing position.

3) Demand feeding should be followed
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 attention.

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 by fatigue.

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, however.
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-

many antibiotics

antiepileptics

most antihistamines

alcohol in moderation (large amounts of alcohol can cause drowsiness, weakness, and abnormal weight gain in an infant)

most antihypertensives

aspirin (should be used with caution)

caffeine (moderate amounts in drinks or food)

codeine

decongestants

insulin

quinine

thyroid medications

ibuprofen

Drugs That Are NOT Safe While Nursing

Drugs that should never be taken while breast-feeding include:

Bromocriptine (Parlodel): A drug for Parkinson's disease, it also decreases a woman's milk supply.

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 Women.

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.

9. CONCLUSION

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.

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