DEFINITIONS

Exclusive breastfeeding in the provision of breast milk only, with no other liquids or food given
Complimentary feeding is defined as giving solid or semi solid foods in addition to breast milk

Since 1979 the WHO has recommended that normal full term infants should be exclusively breastfed for four to six months

Increasing reports suggesting an association between discontinuing exclusive breastfeeding prior to six months of age and an increase in infant morbidity and mortality

Throughout the world many professionals as well as a number of government have concluded that there is sufficient evidence to recommend continuing exclusive breastfeeding for about six months

Intrauterine Nutritional immunologic and endocrine need were provided by maternal systems Born Delivered from a protected intrauterine environment sterile, warm, and protective
No longer obtain fluids, nutrients, immune protections, maternal body temperature and sterile environment This transition is filled with life threatening hazards Infant survival

Fig 1. Advantages of Breastfeeding

BREASTMILK Perfect nutrients Easily digested efficiently used BREASTFEEDING Helps bonding and development Helps delay a new pregnancy

Protects against infection

Costs less than artificial feeding

Protects mothers health

Fig 2. Differences between three types of milks HUMAN COW GOAT

FAT
PROTEIN

FAT

FAT

PROTEIN PROTEIN

LACTOSE
LACTOSE LACTOSE

Fig 3. Differences in the quality of the proteins in different milks HUMAN

Anti infective proteins

COWS WHEY PROTEINS

80% Casein

35% Casein
EASY TO DIGEST

CURDS
DIFFICULT TO DIGEST

Fig 4. Differences in the fat of different milks

HUMAN

COWS

LIPASE
ESSENTIAL FATTY ACIDS

Fig 5. Differences in the iron content in different milks HUMAN

50 70 g/100 ml

COWS
50 70 g/100 ml

50

% ABSORBED

10

Fig 6. Steps on how breastfeeding protects against infection

Mother infected White cells in mothers body make antibodies to protect mother

Antibodies to mothers infection secreted in milk to protect baby

Some white cells go to breast and make antibodies there

Fig 7. Importance of colostrums PROPERTY Antibody rich IMPORTANCE Protects against infection and allergy Clears meconium helps to prevent jaundice Help intestine to mature prevents allergy, intolerance Reduces severity of infection prevents eye disease

Many white cells Protect against infection

Purgative
Growth factors Vitamin A rich

Fig 8. Benefits of breastfeeding

EMOTIONAL BONDING

Close, loving relationship between mother and baby

Mother more emotionally satisfied Baby cries less Mother behaves more affectionately Less likely to abuse or abandon baby DEVELOPMENT Children perform better on intelligence tests in later childhood

Fig 9. Risk of diarrhoea by feeding method 13.3

17.3

3.2 1.0
Breast milk only Breast milk & non-nutritious liquids Breast milk & nutritious supplements No breast milk

Fig 10. Dangers of artificial feeding

Interferes with bonding More diarrhoea and respiratory infections Persistent diarrhoea Malnutrition vitamin A deficiency More likely to die MOTHER May become pregnant sooner More allergy and milk intolerance Increased risk of some chronic diseases Overweight

Lower scores on intelligence tests

Increased risk of anaemia, ovarian and breast cancer

Fig 11. Anatomy of the breast

muscle cells

oxytocin makes them contract

Prolactin makes them secrete milk milk collects here

milk secreting cells ducts

lactiferous sinuses nipple areola

Montgomerys glands
Supporting alveoli tissue and fat

Fig 12. The prolactin reflex

Secreted AFTER feed to produce NEXT feed

Sensory impulses from nipple

Prolactin in blood

Baby suckling

More prolactin secreted at night Suppresses ovulation

Fig 13. The oxytocin reflex

Works BEFORE or DURING feed to make milk FLOW
Oxytocin in blood Sensory impulses from nipple

Baby suckling

Makes uterus contract

Fig 14. The oxytocin reflex

Thinks lovingly of baby Sound of baby Sight of baby CONFIDENCE

Worry Stress Pain Doubt

These HELP reflex

These HINDER reflex

Fig 15. Good attachment vs poor attachment

Fig 16. Result of poor attachment

Pain and damage to nipples Breast milk not removed effectively Sore nipples Fissures Engorgement Baby unsatisfied, wants to feed a lot Baby frustated, refuses to suckle Breast make less milk Baby fails to gain weight

Apparent poor milk supply

Fig 17. Causes of poor attachment Use of feeding bottle Inexperienced mother Functional difficulty Before breastfeeding established For later supplements First baby Previous bottle feeder Small or weak baby Breast poorly protractile Engorgement Late start

Lack of skilled support

Less traditional help and community support Doctors, midwives, nurses, not trained to help

Fig 18. The three neonatal reflexes

Rooting reflex
When something touches lips, baby opens mouth puts tongue down and forward

Sucking reflex
When something touches palate, baby sucks

Skill
Mother learns to position baby Baby learns to take breast

Swallowing reflex
When mouth fills with milk, baby swallows

Fig 19. Difference between preterm and term breastmilk FULL TERM FAT
PROTEIN

PRETERM FAT

PROTEIN

LACTOSE

LACTOSE

Fig 20. Breastfeeding a sick baby

If breastfeeding stops
Baby gets less nourishment loses more weight takes longer to recover lacks comfort of suckling Breastmilk decreases

If breastfeeding continues
Baby gets best nourishment loses less weight recovers more quickly is comforted by suckling Breastmilk is produced

Baby may refuse to start again

Breastfeeding continues

Fig 21. Breastfeeding and mothers medication

Breastfeeding contraindicated Some anticancer drugs Radioactive substances (temporarily) Continue breastfeeding : Psychiatric drugs and Side effects possible anticonvulsants Monitor baby for drowsiness Use alternative drug if possible Monitor baby for jaundice Use alternative drug (May decrease milk supply) Safe in usual dosage Chloramphenicol, tetracycline, metronidazole Sulphonamides, cotrimoxazole, dapsone Oestrogen containing contraceptives Thiazide diuretics Most commonly used drugs

RECOMMENDED PRACTICES TO IMPROVE INFANT NUTRITION DURING THE FIRST SIX MONTHS:
Initiate b.f. within about one hour of birth Establish good b.f. skills (proper positioning, attachment, and effective feeding) Breastfeed exclusively for about the first six months
(Linkages-WHO, Feb 2001)

Practice frequent, on - demand b.f., including night feed In areas where vitamin A deficiency occurs, lactating women should take a high - dose vitamin A supplement (200.000 i.u.) as soon as possible after delivery, but no later than 8 weeks postpartum, to ensure adequate vitamin A content in breastmilk

(Linkages-WHO, Feb 2001)

Continue on - demand b.f. and introduce complementary foods beginning around 6 months of age

(Linkages-WHO, Feb 2001)

CONCLUSION
Using the available information on the development of infants immunologic, gastrointestinal, oral motor function, reproductive physiology and nutrient adequacy

the expert concluded that the probable age of readiness for most full term infants to discontinue exclusive b.f. and begin complementary foods appears to be near six months or perhaps a little beyond