BREAST FEEDING

Introduction:
Breast feeding is the process of suckling or nursing, giving baby milk from the breast. Breastfeeding
encourages postpartum uterine involution and slows down the natural return of the menses.
Breast milk is the most appropriate nourishment for most infants. It is easily digested. It is sterile and
contains nutrient needed by the infant in ideal proportion. It also contains immunoglobulin.
The National Institute of Allergy and Infectious Diseases notes that breast feeding helps prevent the
development of food allergies as the child grows older. However keeping an infant on exclusive breast
feeding does delay the onset of allergies by delaying the infant exposure to food that might prompt
allergies.
An infant should nurse to 10 to 12 times a day initially. The interval between the feeding will grow as
the infant grows. Typically full-term infant will nurse every 2 to 3 hours.

Definition by WHO: The WHO states that breast feeding is "an unequalled way of providing ideal food
for the healthy growth and development of infant.

Variation in the composition of breast milk:

Colostrum: Colostrum is the breast milk that women produce in the first few days after delivery. It is
thick and yellowish or clear in color. It contains more protein than mature milk.

Mature milk: Mature milk is the breast milk that is produced after a few days. The quantity becomes
larger and the breasts feel full hard and heavy.

Nutrient for breast feeding women:

Energy: Energy needed to support milk production is obtained in part by mobilization of fat stores, with
the remaining kilocalories provided by the diet. On average breast feeding women lose weight slowly
about 0.8 kg per month, with the weight stabilizing after about six months. Based on this rate of weight
loss, a breast feeding women needs an extra intake of 330 kilocalories per day during first six months of
lactation and 400 extra kilocalories daily during second six months. To ensure adequate milk production
and avoid nutrient deficiencies, a nursing mother should consume at least 1800 kilocalories per day.

Protein: The RDA for protein is 1.3 grams per kilograms per day or an additional 25 gram over the nonpregnant RDA.

Vitamins and minerals: Breast feeding women needs higher amount of most vitamins than during
pregnancy. But the recommended intake of vitamin D and vitamin K is same during lactation and
pregnancy while RDA for Niacin and Foliate is lower during lactation than during pregnancy.
Iron needs decrease below non-pregnant value because iron losses from menstruation are not present
during the early months of exclusive breast feeding.

Water: A nursing mother should drink about 2 liters of water per day and at least 1 cup of water each time
she breast feeds her baby. Coffee and other caffeinated beverages are acceptable if limited to 1 or 2 cups
per day if they do not replace other fluids. Because caffeine passes into the breast milk, caffeine can make
some breast fed infants wakeful and jittery (nervous and excited).

Food choices:
Nursing mom should choose food that have the vitamins and minerals they need and make choices that
are low I added sugar and solid fats. Nursing mother should eat plenty of vegetables, the source of many
essential micronutrients.

Supplementation:
A breast feeding woman who avoids all animal products may need routine vitamin or mineral
supplementation. Vitamin B12 is likely to be too low in the milk of nursing vegans and should take
vitamin B12 supplementation. For breast feeding woman who do not get regular sun exposure and do not
drink milk and other fortified products, vitamin D supplementation may be warranted.

Benefits of breast feeding:

Both the infant and mother gets benefit from breast feeding.
Benefits for infants:

Optimal nutrition for infant.

Strong bonding with mother.
Safe, fresh milk.
Enhanced immune system.
Reduce risk of respiratory tract infection and asthma.
Protection against allergies and intolerance.
Promotion of correct development of jaws and teeth.

Association with higher intelligence quotient and school performance through adolescence.
Reduced risk of chronic disease obesity, type 1 and type 2 diabetes, heart disease, hyper tension,
hyper cholesterolemeia and childhood leukemia.
Reduced risk of sudden infant death syndrome.
Reduced risk for infant morbidity and mortality.

Benefits for mother:

Strong bonding with infant.

Increased energy expenditure, which may lead to faster return to pre pregnancy weight.
Faster shrinking of the uterus
Reduced postpartum bleeding and delayed the menstrual cycle.
Decreased risk for chronic disease such as type 2 diabetes, breast and ovarian cancer.
Improve bone density and decreased risk of hip fracture.
Enhanced self-esteem in the maternal role.
Time saved from preparing and mixing formula.
Money saved from not buying formula and increased medical expenses associated with formula
feeding.

Health risk of not breast feeding:

For infants:

Increased incidence of infectious morbidity.

Elevated risk of childhood obesity.
Risk of type 1 and type 2 diabetes.
Risk of leukemia.
Elevated risk of sudden infant death syndrome (SIDS).

For mother:

Increased incidence of pre-menopausal breast cancer, ovarian cancer, type 2 diabetes and
metabolic syndrome

Things to be avoided when breastfeeding:

1.

Caffeine: Consuming coffee, tea and caffeinated sodas in moderation is fine when you are breast
feeding. Breast milk usually contains less than 1% of the caffeine ingested by the mom. And if
you drink no more than three cups of coffee spread throughout the day there is little to no
caffeine detected in the baby's urine. However if you feel that your infant becomes more fussy or
irritable when you consume excessive amount of caffeine (usually more than five cups of
caffeinated beverages per day), consider decreasing your intake.

2.

Alcohol: Alcohol passes through your milk to your babies, so it is best to avoid habitual use
while breast feeding. Alcohol can change the taste of your milk and this may be objectionable to
some babies. Breast feeding should be avoided for two hours after the drink.

3.

Mercury: Including fish in your diet is a good way to get protein and omega-3 fatty acids.
However nearly all fish contains some traces of mercury. Most people are not affected by these
tiny amounts of mercury. But in babies and some children mercury can cause damage to nervous
system. That's why lactating women needs to avoid fish that are high in mercury namely shark,
sword fish, king mackerel and tile fish.
Feeding technique:
Feeding should takes place in a loving and warm environment. A breast feeding mother holds
her baby close, at a distance that encourages mother-baby eye contact.
Babies swallow air while feeding and they need to be burped. Babies generally need to be
burped after 15 minutes. Just as the infant sends signals of readiness for feeding, she also signals
fullness. Fullness cuss includes fussiness, playfulness, sleep or just turning away. Parents need to
learn these cusses and respond to them.
Status of breast feeding practice in Nepal:
Breast milk is the main food for the infants of rural Nepal. The findings of Nepal fertility survey
1976 show that 17% of eligible women do not breast feed their children. The proportion of breast
feeding for 24 months or more is lower for women in Terai (78%) and Mountains (78.6%) than
in Hills (87%). The age of mothers, their education and socio-economic status are the main
determinants of breast feed. Younger mothers are most likely to terminate breast feeding fast as
compared to older counter parts. Three times higher risk of terminating breast feeding was found
for educated mothers as compared to illiterate mothers.