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July 13, 2012 by Dr. Mandar V. Bichu
   T T feeding!

‘Name two most important ways of reducing infections in newborn babies.’

This used to be one of the favourite questions of our examiners in those long-bygone days of paediatric residency. As a budding paediatrician you were supposed to belt out the answer in a flash – ‘Hand washing before handling the baby and breast-feeding.’ The importance of breast-feeding was thus emphasized right since those formative years as a resident doctor.

Later on in medical practice, one came across many queries and doubts in parental minds regarding breast- feeding. Today I will try and clear out some of these.


Why should one breast feed?

Breast-feeding is the most natural way to feed the baby. It is free, safe, convenient and healthy. Breast-milk is readily available and is always fresh, uncontaminated and at proper temperature. Health-wise it offers many advantages for the baby and the mother.

It contains cells, antibodies, enzymes and other chemicals which protect the baby against many bacterial, viral and parasitic infections. It contains specific growth factors promoting development of brain and retina. Breast-fed children are less likely to get diarrhea, middle ear infections, chest infections, serious life-threatening infections like bacteremia and meningitis. Frequency of colic and atopic eczema is also less in breast-fed children.

For mother, it offers some protection against serious diseases like cancer of breasts and ovaries. It helps her regain her normal figure faster. Frequent breast-feeding is one method to delay conception.

Psychologically breast-feeding plays an important role in emotional bonding of baby and mother. 


When should one start breast-feeding?

Earlier the better. Preferably mother should be encouraged to breast-feed immediately after delivery as that promotes the production of prolactin and oxytocin hormones which facilitate milk production and milk release respectively.

Practically, within an hour after normal delivery and within four hours after a caesarian is the ideal time to start.


What is colostrum?

For first 3-4 days mother secretes yellowish, thick milk in small amounts which is called colostrum. A practice of not giving colostrum to baby should be discouraged at any cost. There is no need to give water, glucose-water, honey or artificial milk in those days when milk hasn’t ‘come in’ breasts and only colostrum is secreted.

Colostrum is sufficient to satisfy the nutritional and fluid requirements of the baby. More importantly it provides a rich supplement of vitamins and antibodies. IgA antibody from colostrum coats the baby’s intestinal lining and prevents harmful proteins from entering and causing allergy.


What is the ideal technique of breast-feeding?

A quiet comfortable setting and a relaxed mother’s mind are the pre-requisites. With baby held closely and facing mother’s breast, nipple of the feeding breast should be touched gently to baby’s cheek or upper lip. Reflexively baby opens mouth widely, seeks nipple and starts sucking. Care should be taken that not only nipple but also most of areola (dark skin around nipple) is in baby’s mouth as the lactiferous sinuses storing milk are present in that area.


How frequently should one breast-feed?

‘Demand feeding’ or feeding the baby as often as it demands (even at night) is the ideal technique. Initially the feeding pattern might be irregular but soon it settles down so that a feed every 2-3 hours is sufficient. More the baby suckles, more is the milk output.

Alternate the side with each feed so that both breasts get same amount of stimulation and continue producing milk.


What should be the duration of one feed?

Babies differ in their feeding habits. Some might take 5 minutes and others might spend half an hour to forty-five minutes. It’s better to allow the baby to suckle till it leaves the breast on its own. Second breast is offered if the baby is still interested even after finishing with first.


What are ‘Fore-milk’ and ‘Hind-milk’?

Breast-milk at the beginning of a feed is greyish, thin and watery and is called ‘Fore-milk’. It is rich in lactose, proteins, vitamins and minerals. ‘Hind-milk’ comes at the end of feeding, is thick, white and rich in fats.

Hind-milk gives satiety (a feeling of fullness) hence it is better to let the slow feeder finish with one breast, rather than switching sides in between.

If  the baby gets only the fore-milk, then because of its high water and sugar content there may be passage of frequent, loose stools. Although this is not pathological, it can be avoided by allowing the baby to get both fore-milk as well as hind-milk.


How to know if breast milk is adequate for the baby?

Adequate weight-gain and frequent passage (6-8 times) of pale yellow or colourless urine are indicators that breast milk intake is adequate for the baby.


Should supplementary feeds be given along with it?

For first three months, there is no need to give anything except breast-milk. Even in dry, hot climates breast-milk is usually sufficient to satisfy water requirements of baby.

Administration of water or gripe-water or any other type of fluid such as juice or a soup prior to fourth month is undesirable as it serves no other purpose than just increasing the risk of infection.

From fourth month onwards breast-feeding should be supplemented with fruit juices, soups, mashed fruits and cereals. This process of ‘Weaning’ is an important one which slowly prepares the baby for ‘normal food’.


How long one should continue breast- feeding?

One can well continue breast-feeding right till the baby becomes two. But we should realize that nutritionally breast milk cannot completely satisfy the demands of a growing baby beyond six months of age and has to be supplemented with other foods.

Exclusively relying on breast-feeding for nutrition beyond six months could lead to nutritional deficiencies – particularly for iron and vitamin D, causing disturbances like anemia and rickets.

In spite of being the most natural way of feeding, breast-feeding still needs to be taught to mothers. Doctors, nurses and elder female family members all have a role to play in that respect. Even best of the players need coaching!

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