Lactation, Breastfeeding and Infant FeedingChapter 1

Exclusive breastfeeding means giving a baby no other food or drink including water, in addition to breastfeeding with the exception of syrup or drops of vitamins, minerals and medicines (expressed breast milk is also permitted) (Fig. 1.1).

Baby requires breast milk as the predominant source of nourishment and allows the infant to receive liquids (water or water-based drinks, fruit juice).

Infant receives breast milk along with solid and semisolid foods.

It means giving a baby some breastfeeds and some artificial feeds, either milk or cereals or other foods.

Feeding the baby from bottle, whatever is in the bottle, including expressed breast milk.

Breast milk of mothers of low birth weight babies has higher concentration of proteins, essential fatty acids and sodium 2which is more suitable for them. Preterm babies need extraprotection from cold, infections and metabolic derangement. They have more chances of growth failure and necrotizing enterocolitis. Breastfeeding protects low birth weight babies from these adversities.

Fifty percent children below 3 years are malnourished. In two-thirds, it starts in the first year of life. Children are anemic, have vitamins A and D deficiency. Starvation causes 60% of under-5 deaths. Most of these deaths are due to diarrhea and pneumonia. Exclusive breastfeeding up to 6 months and adequate complementary feedings along with breastfeeding thereafter reduces undernutrition, anemia and vitamin deficiencies. In affluent society, 15% children are overweight and a large number of them are obese. Breastfeeding prevents children being obese too.

The effect is seen in infancy, childhood up to 15 years. Breastfed babies have 5–8 higher intelligence quotient (IQ) points than animal milk-fed babies (Figs 1.2A and B). Other proven advantages are visual maturation, language development,

Infants who are not breastfed, and receive formula milk or other replacement feeds have: (i) sixfold increased risk of dying in the first 2 months of life, (ii) fourfold increased risk of dying between 2 and 3 months and (iii) twofold to fivefold increased risk of dying between 4 and 5 months, compared with those who are breastfed. Breastfeeding in the first 6 months of life substantially reduces deaths from diarrhea and acute respiratory infections. Two-thirds of infant deaths occur in the first 2 months of life. When the mother is infected, white cells in mother's body produce antibodies which are secreted in the breast milk to protect the baby.

The young child should be made accustomed to eating family foods. Complementary feeding should be started when the baby can no longer get enough energy and nutrient from breast milk alone. For most babies, this is after 6 months of age. If young children do not have enough good food, they will not have energy to grow and be active. Adequate complementary feeding prevents undernutrition, anemia, vitamin deficiencies, illnesses, and promotes proper growth and development.

It is the breast milk that women produce in the first few days after delivery. It is thick and yellowish or clear in color. The properties and importance of colostrum are mentioned in Table 1.1.

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

Some people call this the breast milk “coming in”.

Foremilk is the milk that is produced early in a feed. It looks bluer than hindmilk. It is produced in larger amounts and it provides plenty of water, proteins, lactose and other nutrients (Fig. 1.3A). Because a baby gets large amount of foremilk, she/he gets all the water that she/he needs from it. Babies do not need other drinks of water before they are 6 months old, even in a hot climate. God has given enough water and food in breast milk. Unnecessary interference by family members causes problems.

Hindmilk is the milk that is produced later in a feed. It looks whiter than foremilk, because it contains more fat (Fig. 1.3B). This fat provides much of the energy of breastfed. This is an important reason not to take a baby off a breast too quickly. He should be allowed to continue until he has had all that she/he wants.

Two 25 ml samples of human breast milk pumped from the same woman, at the same time to illustrate what human breast milk looks like, and how human breast milk can vary. The left hand sample is foremilk, the first milk coming from a full breast. Foremilk has a higher water content and a lower fat content to satisfy thirst. The right hand sample is hindmilk, the last milk coming from a nearly empty breast. Hindmilk has a5

The differences between human milk and animal milk have been shown in Table 1.2 (Fig. 1.4).