EXPERT SPEAK: Feeding first and feeding right- the importance of breastfeeding

A mother had come to the Out-Patient Department with her home-delivered, two days old baby for birth vaccination. On examination, the child looked irritable and dehydrated. The child had not been breastfed, only goatmilk had been given, as per the community practices. This was a common practice followed by the mother’s whole community, and she had been advised by her elders to do so. 

The yellowish milk secreted right after childbirth called “colostrum”, is highly nutritious and rich in Vitamin A. It has less fat and hence easier to digest, and high protein content. It is also high in immunoglobulin and has anti-infective properties. It is essential to the health of the neonate. Colostrum is the first immunization of a child and depriving a child of it can help prevent the building up of natural immunity. This immunity has proven to reduce the incidence and severity of pneumonia and diarrhea in neonates. As per National Guidelines on Infant and Young Child Feeding India only 15.8% of newborns are started breastfeeding within one hour of birth, and merely 37.1% within one day of birth. 

As per World Health Organization (WHO), “Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers.” Then why do women struggle to feed the children appropriately despite the given data worldwide which re-iterates the same hypothesis repeatedly?

As a pediatrician working in a government hospital in Pune, there are some concerns that I see across all socio-economic strata. I will try to address them here:

NOT ENOUGH MILK

The most common complaint witnessed is the feeling that the mother has regarding not having enough milk to suffice her neonate’s appetite. This is not without medical explanation; the suckling reflex is a reflex that is initiated by the baby sucking on the mother’s breasts and releasing a hormone called prolactin which further increases milk production. This takes 2 days to activate and hence gradually the milk production of the mother increases. This advised to not let this be a cause of concern.  As long as the baby is gaining weight, passing urine adequately and crying for feeds, the baby is doing well.

COW’S MILK IS *NOT* THE WAY TO GO

A lot of babies admitted in the first 6 months, come with cases of diarrhea and anemia have a history of intake of cow’s milk. Cow’s milk has a protein called ‘casein’ which causes allergy in infants as the alimentary tract is not developed enough to digest this protein. The manifestations are diarrhea, dehydration, and rash. The mother’s milk is the best form of feed for the infant. It contains the exact amount of proteins, fats, nutrients, and immunoglobulins. It is a complete meal and no additive is required for the first 6 months.

 CHILD IS NOT GAINING WEIGHT

Despite feeding adequately the infant may be cranky. Not gaining weight properly is another common complaint. This is because the milk is divided into foremilk and hindmilk. The foremilk is the milk secreted initially which is thin and high in protein content. The hindmilk is milk secreted at the end which is containing more fat and causes satiety.

The solution for this is to always drain out the milk completely for one breast before moving on to the other. This will ensure the baby to have adequate nutrition and satiety.

  Breastfeeding is advantageous to the mother as well. It prevents breast engorgement and infection in the mother. It increases mother-baby bonding. Lactation also acts as a natural contraceptive. It helps all moms who hate exercising lose weight naturally. Studies suggest it helps prevent breast and cervical cancer as well.

Around 6 months of age, complementary feeds can be introduced to the baby’s diet. Complementary Feeds are supplementary foods to be given in addition to breastmilk. They are important for the growing needs of the baby. Breastfeeding is advised to be continued up to 2 years and beyond. The purpose of complementary feeding is to compliment the breast milk and provide adequate nutrients and energy for the rapidly growing body of the child.

The cereal of the family should be used to make the first solid feed of an infant. Porridge made with semolina (sujji), wheat flour (atta), millets by using water. Sugar, jaggery, and ghee can be started at six months. Mashed fruits can be given at this point. Traditional foods like khichadi, dosa, kheer can be incorporated with varying consistency. 

Exclusive breastfeeding is imperative for every child for the initial six months of life. It provides the infant natural immunity and helps mothers create a natural bond with their infant. A healthy infant is a happy infant after all.

Edited  by Jaya Narayan

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