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BREASTFEEDING
Lactation
Failure: Myth
or Reality:
Mother’s milk is the universally acknowledged
ideal and complete food for her and the baby. Breastfeeding is instinctive and most mothers
adopt to it naturally. However, at the slightest problem they encounter, they switch over
easily to top milk. Normal healthy newborns do not require any type of pre lacteal feeds,
as colostrum is sufficient to meet the needs of the newborn baby. Link to Colostrum. The administration of pre lacteal feeds
interferes with sucking and prolactin production and ultimately undermines your confidence
in your ability to breastfeed.
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The commonest reason when you feel that you are
having insufficient milk is because your baby cries a lot.
Link to Adequate breastfeeding. From the clinicians
viewpoint, it is necessary to ascertain whether the baby is getting sufficient milk or not or whether there
is a genuine problem.
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Babies
cry for a variety of others reasons (feeling cold, being in a wet
diaper,colic,etc) and not only because of inadequate feeds.
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Your baby who is on exclusive breastfeeds and is
showing appropriate weight gain 18
– 30 grams a day or 500 – 1000 gms per month and
who passes urine at least 6 – 8 times in a day,1
is definitely getting sufficient milk and you requires only positive
support and a reiteration of the adequacy
of your milk for your baby.
Breast-feeding in Special situations:
Special situations arise when you may have a query about continuation of
breastfeeding.
(i) Common Maternal illness:
During most common illness like common cold, bacterial infections, flu, fever etc. you
should continue breastfeeding. This, infact, benefits the baby. If you are breastfeeding,
by the time you show the symptoms of an illness, your baby has already
been exposed to
it. So continue breastfeeding. During your illness you have started producing antibodies
(fighter cells). These pass on to your baby through your milk. Thus providing adequate
protection against the illness.
But in some cases you may be advised
not to breastfeed the baby:
Mothers with untreated tuberculosis
cannot breastfeed till the treatment begins for both the mother and the baby.
Mothers with hepatitis B infection
can breastfeed their babies if the baby has received the hepatitis B vaccine in the
first few days of birth.
For such babies milk from the human
milk banks can be given. Link to human milk banks.
(ii) Mastitis:
Mastitis is the infection of a blocked milk duct. This can causes swelling, redness
and pain in the breast. If this occurs consult your doctor. Link
to mastitis in Breast care.Lots of rest, warm compresses, antibiotics, adequate
breast support and breastfeeding is required. Link to mastitis
in Breast care. Continue feeding, as the infection doesn’t contaminate your
breast milk. Frequent nursing helps in draining your breast thereby preventing the spread.
(iii) Cracked/
sore nipples:
Also called sore nipples, in early days, is due to improper positioning of your baby.
Therefore proper postures during breastfeeding should be adopted. Link to postures during
breastfeeding. Proper care of the
sore nipples should be taken. Link to sore nipples in Breast
care
(iv) Inverted
nipples:
This, if present, in the last months of pregnancy should be corrected with the
doctor’s advice. Link to inverted nipples in Breast
care. If feeding is not possible then breast milk can be given to the baby after expressing the
milk. Link to Expression of breast milk.
(v) Twins:
If you have twins, it is possible to breast-feed them at the same time, having one baby at
each breast. You can hold one baby at each side, called the “football hold,” or
you can cradle them both in front of you with their bodies crossing each other, as they
would have been in uterus. Link to Postures during
breastfeeding. Alternate the breast, each baby uses at each feeding or at least
once a day. If you have any difficulty, please consult your Gynaecologist or
Paediatrician.
(vi)
Breast feeding after Caeserian section:
Nursing after caeserian section is little painful in the beginning.
With the help from a relative nurse one should start
breast-feeding within 4 – 6 hours. It is preferable to put the baby on breast
directly and help the baby to suck on the breast. OR the mother can turn to one side
gently and nurse the baby by “rooming in”. Link to
Postures in breastfeeding. First 24 hours, she can take the posture, which is
comfortable to her and baby for breast-feeding.
(vii)
Premature Babies:
Many premature babies are unable to breast feed, directly in the beginning.
Express the breast milk. Link to expression of breast milk. 8 –10 times/day and collect it in clean bowl, wati or cup for
feeding your baby. This will enable adequate secretion when your baby is able to suck the breast in
future. Human milk
has been shown to be very beneficial to premature and sick newborn by helping growth and
preventing many diseases.
(viii) Breast feeding in a HIV
positive Mother:
The recent is to avoid breastfeeding in HIV positive mothers.
But this is NOT practical in developing countries like India.
Weaning
your baby from breast milk:
Different communities have different cultural beliefs regarding their introduction of
semi solid foods in the infant’s diet. It is important to make this transition to
semi solid food as easy and enjoyable process. The first semi solid foods should normally
be introduced at the age of 4 – 5 months.
You need to be patient
when your baby is first introduced to semi solids
You should not force the baby for eating.
Your baby may often spit the food , this does not
mean that he/she is not hungry or does not like food . This is because the ability to
swallow develops very slowly.
Try to have flexible
schedules based on signs of hunger in your baby.
After the first few
weeks, a healthy infant will develop a self-regulated feeding schedule.
The total number of
feeds per day will slowly decrease to about 6. By the time the infant is 6 months old.
However each infant has his/her own routine which may vary. This
may differ in different
Qualities of weaning food while
being breastfed, weaning food provides additional energy and nutrients to your baby.
All good weaning food
should have:
High energy content.
Should be easily digestible.
Should be semi solid (not very thick) in
consistency.
Should be clean and
freshly prepared.
Should be inexpensive, easy to prepare and tasty.
Remember, what you can't swallow cannot be swallowed baby.
Guidelines during weaning:
It
is important to continue breastfeed, while weaning.
Introduce one food at a
time. Let your child get use to it.
Begin with
a very small
quantity.
Use thinner consistency before and then gradually
increase the consistency to solids as your baby learns to push the food back with help of
the tongue.
If your baby does not
like the food, try mixing it with something else.
Variety in choice of
food is essential.
Try new flavours.
The quantity of each feed should increase as the
frequency decreases.
Avoid distractions
while feeding.
Major
Weaning Foods:
(i)
Cereals
Cereals contain 7 to 12% of protein, 75% of carbohydrate and some amount of
fat. A
thick creamy porridge can be prepared by mixing the cereals with milk / mixture of milk
and water. You can also add a little oil / fat / sugar to make it richer in
calories and
easier to swallow and digest.Cereals like wheat, bajra, jowar, maize, rice, ragi, suji
(rawa/semolina) can be used to prepare porridge.
(ii)
Pulses:
Pulses contain 10 – 25% of protein (soyabean 40%) and are also rich
in vitamins
(Vitamin B-complex) and minerals (iron). Legumes needs to be cooked thoroughly and mashed
to make them easily digestible. When given with cereal staples, they are as nutritious as
the animal foods. Pulses like bengal gram (chana dal), red gram (tuvor dal), green
gram(moong dal),black gram (urad dal), lentils (masoor dal) can be added to the porridge.
(iii) Malting:
This process helps in conserving the nutritive values of cereals and pulses. Cereals
like bajra, jowar, wheat, ragi, etc. and pulses like green gram (moong dal) can be malted.
Malting can be done by:
Soak the cereals or
pulses overnight.
Tie them in a wet cloth until it sprouts (about 2
days).
Dry or roast them.
Make flour of the dried or roasted cereals or
pulses.
Keep them in an airtight container for further
use.
Advantages of malted
foods:
As
the caloric content is in the malted foods, small
amounts can give more Calories and nutrients.
Sprouting increases the content of Vit. B and
Vit. C.
As
it is precooked, it can be stored and can be used
immediately when required.
Milk
and dairy products:
At around 5th - 6th month the frequency of breastfeeding can be
reduced and substituted by animal milk. Cow’s/ buffalo’s /goat’s milk can
be used.
The nutritional content of
various animal milks differs.
This milk contains high
amount of Vit.B6 and calcium, some amount of Vit.A and Vit.C, but very
little iron.
Fat content of the
buffalo’s milk is twice that of human milk and cow’s milk.
Goat’s milk does
not have Vit.B12.
Milk can be given by diluting it
with boiled and cooled water in the proportion of 2:1, initially. Sugar may be added to
make it palatable and increase its caloric contents. It can be given in a bottle / by
cup and spoon.
Fruits:
Commonly given are banana, guava, melons, mango, and citrus fruits and any
other commonly available in your area. Before giving any fruits to your baby wash it with
clean water, peel carefully, de seed it and then mash it. Fruit juices should be strained and diluted with boiled water, in equal amount in
earlier stages.The amount of fruit juice feed should be increased graudually by decreasing
the dilution.
Vegetables:
Strained green leafy vegetables, spinach, mashed potatoes,
tomatoes and gourds can be
started by 5-6 months.
Oils and fats:
Oils make the food palatable, soft and helps in absorption of Vit.A.They can be mixed
with porridge and mashed pulses.
Foods of animal
origin:
All of them are rich in protein, Vit. B12, and iron. They are also easily
digestible if cooked properly. Egg yolk can be given from 4 – 6 months. Avoid egg
white for 8 – 10 months as it may cause allergic reaction. Egg yolk can be added to
the porridge Cooked ground and strained fish and meat can
be given from 7-8 months. Fish should be either baked or boiled or steamed but not fried.
Meat can be given in the form of soups.
Human
Milk Banking:
A human milk bank is an institution established for the purpose of collecting,
screening, processing, storing and distributing donated human milk for the babies with
mother who are not in a position to breast feed.
In
Mumbai(India)the milk bank facility is available at:
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Sion
hospital
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Wadia
hospital
Donors
of Breast Milk:
The mothers expressing
milk to feed their own pre-term sick babies.
Mothers who are
following up in the follow up clinics whose breast milk is in excess of their baby’s
demand and are willing to donate.
These
donors are screened for the diseases like Hepatitis B, Syphilis and HIV.
Advantages:
Used for the feeding of
premature babies, when mother’s milk is not available.
Used for the babies of
the mother’s suffering from mastitis/ breast abscess / breast cancer/on anti-cancer
treatment.
Can be used for babies who have been abandoned.
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Why Breastfeeding
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