Breastfeeding
Breastfeeding is the feeding of an infant or young child with breast milk directly from female human breasts (i.e., via lactation) rather than from a baby bottle or other container. Babies have a sucking reflex that enables them to suck and swallow milk. Most mothers can breastfeed for six months or more, without the addition of infant formula or solid food
Human breast milk is the healthiest form of milk for human babies. There are few exceptions, such as when the mother is taking certain drugs or is infected with tuberculosis or HIV. Breastfeeding promotes health, helps to prevent disease and reduces health care and feeding costs. Artificial feeding is associated with more deaths from diarrhea in infants in both developing and developed countries. Experts agree that breastfeeding is beneficial, but may disagree about the length of breastfeeding that is most beneficial, and about the risks of using artificial formulas.
Emphasizing the value of breastfeeding for both mothers and children, the World Health Organization (WHO) and the American Academy of Pediatrics (AAP) both recommend exclusive breastfeeding for the first six months of life and then supplemented breastfeeding for at least one year and up to two years or more. While recognizing the superiority of breastfeeding, regulating authorities also work to minimize the risks of artificial feeding.
The acceptability of breastfeeding in public varies by culture and country. In Western culture, though most approve of breastfeeding, some mothers may be reluctant to do so out of fear of public opinion.
Not all the properties of breast milk are understood, but its nutrient content is relatively stable. Breast milk is made from nutrients in the mother's bloodstream and bodily stores. Breast milk has just the right amount of fat, sugar, water, and protein that is needed for a baby's growth and development. Because breastfeeding uses an average of 500 calories a day it helps the mother lose weight after giving birth. The composition of breast milk changes depending on how long the baby nurses at each session, as well as on the age of the child. The quality of a mother's breast milk may be compromised by smoking, and drinking. .
Ø Benefits to breastfeeding for the infant.
These include:
1. Less necrotizing enterocolitis in premature infants
Necrotizing enterocolitis (NEC) is an acute inflammatory disease in the intestines of infants. Necrosis or death of intestinal tissue may follow. It is mainly found in premature births. In one study of 926 preterm infants, NEC developed in 51 infants (5.5%). The death rate from necrotizing enterocolitis was 26%. NEC was found to be six to ten times more common in infants fed formula exclusively, and three times more common in infants fed a mixture of breast milk and formula, compared with exclusive breastfeeding. In infants born at more than 30 weeks, NC was twenty times more common in infants fed exclusively on formula. A 2007 meta-analysis of four randomized controlled trials found "a marginally statistically significant association" between breastfeeding and a reduction in the risk of NEC.
2. Greater immune health
During breastfeeding antibodies pass to the baby . Breast milk contains several anti-infective factors such as bile salt stimulated lipase (protecting against amoebic infections), lactoferrin (which binds to iron and inhibits the growth of intestinal bacteria) and immunoglobulin A protecting against microorganisms.
3. Fewer infections
Among the studies showing that breastfed infants have a lower risk of infection than non-breastfed infants are:
In a 1993 University of Texas Medical Branch study, a longer period of breastfeeding was associated with a shorter duration of some middle ear infections (otitis media with effusion) in the first two years of life.
A 1995 study of 87 infants found that breastfed babies had half the incidence of diarrheal illness, 19% fewer cases of any otitis media infection, and 80% fewer prolonged cases of otitis media than formula fed babies in the first twelve months of life.
Breastfeeding appeared to reduce symptoms of upper respiratory tract infections in premature infants up to seven months after release from hospital in a 2002 study of 39 infants.
A 2004 case-control study found that breastfeeding reduced the risk of acquiring urinary tract infections in infants up to seven months of age, with the protection strongest immediately after birth.
The 2007 review for AHRQ found that breastfeeding reduced the risk of acute otitis media, non-specific gastroenteritis, and severe lower respiratory tract infections.
4. Less tendency to develop allergic diseases (atopy)
In children who are at risk for developing allergic diseases (defined as at least one parent or sibling having atopy), atopic syndrome can be prevented or delayed through exclusive breastfeeding for four months, though these benefits may not be present after four months of age. However, the key factor may be the age at which non-breastmilk is introduced rather than duration of breastfeeding. Atopic dermatitis, the most common form of eczema, can be reduced through exclusive breastfeeding beyond 12 weeks in individuals with a family history of atopy, but when breastfeeding beyond 12 weeks is combined with other foods incidents of eczema rise irrespective of family history.
5. Protection from SIDS
Breastfed babies have better arousal from sleep at 2–3 months. This coincides with the peak incidence of sudden infant death syndrome. Study conducted in University of Münster has shown that breastfeeding reduces the risk of sudden infant death syndrome by approximately 50% at all ages throughout infancy.
6. Higher intelligence
Studies examining whether breastfeeding in infants is associated with higher intelligence later in life include:
Horwood, Darlow and Mogridge (2001) tested the intelligence quotient (IQ) scores of 280 low birthweight children at seven or eight years of age. Those who were breastfed for more than eight months had verbal IQ scores 6 points higher (which was significantly higher) than comparable children breastfed for less time.They concluded "These findings add to a growing body of evidence to suggest that breast milk feeding may have small long term benefits for child cognitive development.
The 2007 review for the WHO concluded "Subjects who were breastfed experienced... higher performance in intelligence tests."
7. Diabetes
Infants exclusively breastfed have less chance of developing diabetes mellitus type 1 than peers with a shorter duration of breastfeeding and an earlier exposure to cow milk and solid foods. Breastfeeding also appears to protect against diabetes mellitus type 2, at least in part due to its effects on the child's weight.
8. Obesity
Breastfeeding appears to reduce the risk of extreme obesity in children aged 39 to 42 months.[ The protective effect of breastfeeding against obesity is consistent, though small, across many studies, and appears to increase with the duration of breastfeeding.
9. Other long term health effects
In one study, breastfeeding did not appear to offer protection against allergies. However, another study showed breastfeeding to have lowered the risk of asthma, protect against allergies, and provide improved protection for babies against respiratory and intestinal infections. A review of the association between breastfeeding and celiac disease (CD) concluded that breast feeding while introducing gluten to the diet reduced the risk of CD. The study was unable to determine if breastfeeding merely delayed symptoms or offered life-long protection.
An initial study at the University of Wisconsin found that women who were breast fed in infancy may have a lower risk of developing breast cancer than those who were not breast fed.
Breastfeeding may decrease the risk of cardiovascular disease in later life, as indicated by lower cholesterol and C-reactive protein levels in adult women who had been breastfed as infants. Although a 2001 study suggested that adults who had been breastfed as infants had lower arterial distensibility than adults who had not been breastfed as infants. The 2007 review for the WHO concluded that breastfed infants "experienced lower mean blood pressure" later in life. Nevertheless, the 2007 review for the AHRQ found that "the relationship between breastfeeding and cardiovascular diseases was unclear".
Ø Principles of breast feeding
§ Breast feeding should be initiated within the first half-hour after birth
§ Colostrum is the most suitable food for the baby during the first few days after birth because it contains a high concentration of nutrients and anti-infective substances.
§ The baby should be allowed to suckle from both the breasts during each feeding
§ It is desirable to feed the baby on demand it helps baby to get weight
§ The intervals between feeds vary between 1-4 hours
§ An interval of 6 hours during night should be encouraged.
§ The mother should be taught to give the baby a full feed so that her breasts are emptied
§ The mother shold be instructed to feed the child even when the child is ill.
§ A baby should be fed for as long as possible at least for one year
§ When the baby is 4-6 months old weaning should be started.
§ Weigh the child every month and plot the weight on a growth chart.
Ø Problems in breast feeding
§ Emotional:worry, shock or anxiety can stop the flow of milk. Emotional problems can interfere with the “let down” reflex.
§ Flat nipples: most common in women who are having their first baby.teach the mother to squeeze her nipples and pull them gently.she should do this for several minutes every day.
§ Engorged breasts
§ Sore or cracked nipples
§ Painful tender breasts
§ The baby may have a blocked nose and be unable to suck properly
§ The may be having respiratory infection palate.
§ The baby may be premature and too weak to suck
§ Mothers inexperience
Ø Infant weight gain
Breastfed infants generally gain weight according to the following guidelines:
0–4 months: 170 grams per week†
4–6 months: 113–142 grams per week
6–12 months: 57–113 grams per week
† It is acceptable for some babies to gain 113–142 grams (4–5 ounces) per week. This average is taken from the lowest weight, not the birth weight.
The average breastfed baby doubles its birth weight in 5–6 months. By one year, a typical breastfed baby will weigh about 2½ times its birth weight. At one year, breastfed babies tend to be leaner than bottle fed babies. By two years, differences in weight gain and growth between breastfed and formula-fed babies are no longer evident.
Ø Methods and considerations
There are many books and videos to advise mothers about breastfeeding. Lactation consultants in hospitals or private practice, and volunteer organisations of breastfeeding mothers such as La Leche League International also provide advice and support.
· Early breastfeeding
In the half hour after birth, the baby's suckling reflex is strongest, and the baby is more alert, so it is the ideal time to start breastfeeding. Early breast-feeding is associated with fewer nighttime feeding problems.
.
· Exclusive breastfeeding
Two 25ml samples of human breast milk. The left hand sample is foremilk, the watery milk coming from a full breast. The right hand sample is hindmilk, the creamy milk coming from a nearly empty breast.
Exclusive breastfeeding is defined as "an infant's consumption of human milk with no supplementation of any type (no water, no juice, no nonhuman milk, and no foods) except for vitamins, minerals, and medications." National and international guidelines recommend that all infants be breastfed exclusively for the first six months of life. Breastfeeding may continue with the addition of appropriate foods, for two years or more. Exclusive breastfeeding has dramatically reduced infant deaths in developing countries by reducing diarrhea and infectious diseases. It has also been shown to reduce HIV transmission from mother to child, compared to mixed feeding.
· Expressing breast milk
When direct breastfeeding is not possible, a mother can express (artificially remove and store) her milk. With manual massage or using a breast pump, a woman can express her milk and keep it in freezer storage bags, a supplemental nursing system, or a bottle ready for use. Breast milk may be kept at room temperature for up to ten hours, refrigerated for up to eight days or frozen for up to four to six months. Research suggests that the antioxidant activity in expressed breast milk decreases over time but it still remains at higher levels than in infant formula.
Expressing breast milk can maintain a mother's milk supply when she and her child are apart. If a sick baby is unable to feed, expressed milk can be fed through a nasogastric tube.
Expressed milk can also be used when a mother is having trouble breastfeeding, such as when a newborn causes grazing and bruising. If an older baby bites the nipple, the mother's reaction - a jump and a cry of pain - is usually enough to discourage the child from biting again.
It is generally advised to delay using a bottle to feed expressed breast milk until the baby is 4–6 weeks old and is good at sucking directly from the breast. As sucking from a bottle takes less effort, babies can lose their desire to suck from the breast. This is called nursing strike or nipple confusion. To avoid this when feeding expressed breast milk (EBM) before 4–6 weeks of age, it is recommended that breast milk be given by other means such as feeding spoons or feeding cups. Also, EBM should be given by someone other than the breastfeeding mother (or wet nurse), so that the baby can learn to associate direct feeding with the mother (or wet nurse) and associate bottle feeding with other people.
· Mixed feeding
Expressed breast milk (EBM) or infant formula can be fed to an infant by bottle
Predominant or mixed breastfeeding means feeding breast milk along with infant formula, baby food and even water, depending on the age of the child. Babies feed differently with artificial teats than from a breast. With the breast, the infant's tongue massages the milk out rather than sucking, and the nipple does not go as far into the mouth; with an artificial teat, an infant will suck harder and the milk may come in more rapidly..
· Tandem breastfeeding
Feeding two children at the same time is called tandem breastfeeding The most common reason for tandem breastfeeding is the birth of twins, although women with closely spaced children can and do continue to nurse the older as well as the younger. As the appetite and feeding habits of each baby may not be the same, this could mean feeding each according to their own individual needs, and can also include breastfeeding them together, one on each breast.
Tandem breastfeeding may also occur when a woman has a baby while breastfeeding an older child. During the late stages of pregnancy the milk will change to colostrum, and some older nurslings will continue to feed even with this change, while others may wean due to the change in taste or drop in supply. Feeding a child while being pregnant with another can also be considered a form of tandem feeding for the nursing mother, as she also provides the nutrition for two.
· Weaning
Weaning is the process of introducing the infant to other food and reducing the supply of breast milk. The infant is fully weaned when it no longer receives any breast milk. Most mammals stop producing the enzyme lactase at the end of weaning, and become lactose intolerant. Humans often have a mutation, with frequency depending primarily on ethnic background, that allows the production of lactase throughout life and so can drink milk - usually cow or goat milk - well beyond infancy.
Bibliography
1. Marlow R. Dorothy, Redding A. Barbara, “Text book of Pediatric Nursing”, 6th edition, Elsevier publications, Philadelphia
2. Gupta Piyush, “Essential Pediatric Nursing”, A. P Jain & Co.
3. Pillitteri Adele, “ Child health nursing, Care of the child and family”, Lippincott, Philadelphia, New York
4. Lippincott, “Text book of Paediatric Nursing”, Mosby Publishers