reastfeeding is one of the most effective ways to ensure child health and survival. However, nearly two out of three infants are not exclusively breastfed for the recommended six months according to the World Health Organisation.
The importance of mother feed cannot be ignored. Breast milk is the ideal food for infants. It is safe, clean and contains antibodies that help protect against many common childhood illnesses. Breast milk provides all the energy and nutrients that the infant needs for the first months of life, and it continues to provide up to half or more of a child’s nutritional needs during the second half of the first year, and up to a third during the second year of life.
Breastfed children perform better on intelligence tests, are less likely to be overweight or obese and less prone to diabetes later in life. Women who breastfeed also have a reduced risk of breast and ovarian cancers.
The WHO and the UNICEF recommend that children initiate breastfeeding within the first hour of birth and be exclusively breastfed for the first six months of life – meaning no other foods or liquids are provided, including water.
Infants should be breastfed on demand – that is as often as the child wants, day and night. No bottles, teats or pacifiers should be used.
From the age of six months, children should begin eating safe and adequate complementary foods while continuing to breastfeed for up to two years and beyond.
A WHO report published in April 2022 revealed that formula milk companies post content on their social media accounts around 90 times per day, reaching 229 million users; representing three times as many people as are reached by informational posts about breastfeeding from non-commercial accounts. This pervasive marketing is increasing purchases of breast-milk substitutes and therefore dissuading mothers from breastfeeding exclusively as recommended by the WHO.
If mothers have difficulty in feeding they must immediately consult a doctor, nurse or available health care professional, as poor feeding may lead to poor weight gain of baby. Also, poor milk outflow may lead to breast engorgement and other breast complications. It is advisable to drink plenty of water before every feed and to keep nutrition optimum. It is advisable to take protein, such as lean meat and chicken, fish, eggs, nuts, seeds, soya foods and pulses. Dairy foods, such as milk, cheese and yoghurt are rich sources of calcium. No-dairy sources suitable for vegans include tofu, brown bread, pulses and dried fruit.
Healthy snacks that mothers can choose from include sandwiches filled with salad, grated cheese, mashed salmon or cold meat, yoghurts, hummus with bread or vegetable sticks, ready-to-eat dried apricots, figs or prunes, vegetable and bean soups, wholegrain cereals with milk, fruit juice, baked beans on toast or a baked potato. Also, mothers should know what is not safe to take during lactation phase. Caffeine occurs naturally in lots of foods and drinks, including coffee, tea and chocolate. It’s also added to some soft drinks and energy drinks, as well as some cold and flu remedies. Caffeine is a stimulant and can make your baby restless. Try decaffeinated tea and coffee, herbal teas, 100 percent fruit juice (but no more than one 150ml glass per day) or mineral water. Avoid energy drinks, which can be very high in caffeine. Alcohol and marijuana also affect infants and must be withheld. Few medications are contraindicated while breastfeeding. Although many medications do pass into breast milk, most have no known adverse effect on milk supply or on infant well-being. Mothers on medicines for epilepsy, cancer, oral retinoids for acne and recreational drugs must consult their physician regarding feeding.
For effective breastfeeding, mothers need to learn the right technique of breastfeeding as poor suckling by baby is the most common complaint of mothers. Failure to achieve optimum position while feeding leads to loss of motivation towards breastfeeding. Always bring the baby to the breast and let them latch themselves. Avoid leaning the breast forward into the baby’s mouth, as this can lead to poor attachment. The baby needs to get a big mouthful of the breast. Placing the baby with their nose level with the nipple will encourage them to open their mouth wide and attach to the breast well. When the baby’s mouth is open wide enough their chin should be able to touch the breast first, with their head tipped back so that their tongue can reach as much of your breast as possible. With the baby’s chin firmly touching your breast and their nose clear, their mouth should be wide open. When they attach the mother should see much more of the darker nipple skin above her baby’s top lip than below their bottom lip. The baby’s cheeks will look full and rounded as they feed. If the baby’s nose seems to be blocked, mothers may give saline nasal drops before feeding so as to make it comfortable and ready for feeding.
There are a number of ways a mother can tell if the baby is getting enough milk. The baby starts feeding with a few rapid sucks followed by longer sucks. Their cheeks stay rounded out, not sucked in, and the mothers can hear them swallowing. Babies seem calm during feeding and come off the nursing mother’s breast themselves when they’ve had enough. They appear content and satisfied after most feeds. They should be healthy and gaining weight. After the first few days, a baby should have at least six wet nappies a day. After about five to six days, your baby’s stool should stop looking black and thick, and they should also have at least two soft or runny yellow stools. It is absolutely okay if the baby has one after every feed as far as it is taking feed on demand and gaining weight.
There are a few tips for those who wish to express and save milk. Wash your hands with soap and warm water first. Gentle massage or warm compresses may help milk to let down. Cup your breast with one hand then, with your other hand, form a “C” shape with your forefinger and thumb. Squeeze gently, keeping your finger and thumb a few centimetres away from your nipple, just outside the darker area around it (areola). Do not squeeze the nipple itself as you could make it sore. This should not hurt. Release the pressure, then repeat, building up a rhythm. Try not to slide your fingers over the skin. Drops should start to appear, and then your milk usually starts to flow. If no drops appear, try moving your finger and thumb slightly, but still avoid squeezing the darker area near your nipple. When the flow slows down, move your fingers round to a different section of your breast, and repeat. When the flow from one breast has slowed, swap to the other breast. Keep changing breasts until your milk drips very slowly or stops altogether.
There are breast pumps available in the market to assist express milk. Both manual and electric pumps are available. Electric pumps are more effective but costly. The electric-generated suction helps suck milk out of ducts, but one must be careful in operating them as initial high suction can damage breast tissues. Therefore, it should be started with gradual suction power ensuring that the suction cup is of appropriate size and fits in well. The pump should never cause bruising or catch the nipple as it’s sucked into the funnel.
Breast milk can be stored in a sterilised container or in special breast milk storage bags in the fridge for up to eight days at 4 degrees C or lower. If the temperature is higher than 4 degrees C, it should be used within three days. One can store it for two weeks in the ice compartment of a fridge and for up to six months in a freezer. Breast milk that’s been cooled in the fridge can be carried in a cool bag with ice packs for up to 24 hours.
For use, one can defrost it by putting it in a jug of warm water or holding it under running warm water. Do not re-freeze milk that’s been defrosted. Once the baby has drunk from a bottle of breast milk, it should be used within one hour, and anything left over should be thrown away.
It is important to note that there are a few medical conditions where direct breastfeeding or even giving expressed milk to an infant is not safe. These diseased conditions include infections like HIV, tuberculosis, ebola virus, herpes simplex, varicella and brucellosis etc. In such cases, mothers need to consult a physician for advice.
The writer is a consultant in family medicine [MBBS, FCPS, MRCGP(int)]