With more than one million lives of children less than five years at stake, it is surprising that such a simple and natural thing as breast feeding is not practiced by every mother. Breast feeding is the best nutrition for every baby in the first six months of life. Ideally, all babies should receive only breast-feed and nothing else, not even water, during the first six months, and any amount of breast-feeding is advantageous for the mother and baby. Composition of breast milk changes over time to accommodate the needs of the growing infant.
Why breast feed?
Breast feeding is convenient, virtually free, available at the right temperature at all times and does not need any sterilisation. Breast milk is easily digested and well absorbed, so much so, that babies on breast feed may not pass stools for one to two weeks, which is perfectly normal. Nutritionally, mother’s milk is a complete food providing all the essential nutrients in the right quantity, provided of course that the mother is not deficient nutritionally. Although breast milk contains lesser amount of calcium and iron than animal milk, whatever amount is present is almost completely absorbed in contrast to animal milk, consumption of which by young infants can lead to iron and/or calcium deficiency.
Breast feeding decreases the risk of serious infections in the baby like diarrhoea and pneumonia, and some of these advantages persist even after stopping breast feeding. Breast feeding also decreases the risk of ear infections and feeding the baby in lying down position does not increase the risk for same. Babies who are breast fed are at decreased risk of sudden death in the first year. Exclusive breast feeding for three to four months decreases the incidence of clinical asthma, atopic dermatitis, and eczema, and is perhaps the only thing we can do to decrease the risk of these diseases in our children.
The long term advantages of breast feeding include lower chances of celiac disease (wheat allergy) and inflammatory bowel disease, a serious condition affecting the intestines. Obesity is the epidemic of 21st century with more than 50 per cent of school children in big cities being overweight or frankly obese. Breastfed babies are not only less heavy (thereby healthier) during the first one to two years, but this advantage continues into adolescence and adulthood. Any breast-feeding given during infancy results in 15 to 30 per cent reduction in adolescent/adult obesity; each month of breast-feeding is associated with a four per cent reduction in risk. Breastfed infants self-regulate intake volume, and the early programming of self-regulation, in turn, affects adult weight gain.
Infants who are fed by bottle, formula, or expressed breast milk will have increased bottle emptying, poorer self-regulation, and excessive weight gain in late infancy (older than six months) compared with infants who only nurse from the breast. Breast feeding reduces the risk of another lifestyle disease and a major killer of adult population, diabetes mellitus. Exclusive breast-feeding for even three months leads to a 30 to 40 per cent reduction in the risk of diabetes, both type I and type II. Breastfed babies are also at lesser risk of leukaemia (blood cancer) by 15 to 20 per cent.
What should interest the ladies (even gentlemen) more than anything else, would be better intelligence scores and better school performance noted in exclusively breast fed babies compared to formula fed babies. It is therefore surprising that parents who are willing to spend a fortune on their children’s education can’t spare those few months to give exclusive breast feeding to their babies!
If a baby is born preterm, it is even more important to restrict feeding to breast milk only, as this reduces the risk of serious diseases like blood infections and necrotizing enterocolitis. Breast milk in this group of children improves their growth as well as intelligence much more in comparison to babies born at term. It also decreases the risk of readmission to hospital and long term problems like hypertension, diabetes and obesity.
Coming to the practical issues regarding breast feeding, it should commence as soon as possible after the birth of the baby, but preferably within 30 to 60 minutes. Caesarean delivery should not preclude early breast feeding and all the hospitals and nursing homes should ensure that mothers are assisted to initiate breast feeding early and supported thereafter as well. Normal babies without any medical problems should not be separated from their mothers and should be encouraged to lie in skin to skin contact with their moms. Early use of formula feeding/bottle feeding hinders the establishment of lactation and may even lead to lactation failure. Bottle-feeding is an easier process compared to breastfeeding, and who does not want to take an elevator instead of the staircase even when we know that going upstairs is good for health! Moreover, formula feed is sweeter and babies also, like most of us, have a sweet tooth (not literally).
Babies need to continue on exclusive breast feeds for six months and in case of any problems, expert help may be sought which is readily available in the form of your obstetrician or paediatrician. Some hospitals have special lactation nurses/ lactation consultants who can provide specialised care on one to one basis. Healthy term babies need to be fed on demand; some babies would feed every half an hour and some would sleep for up to four hours at a stretch. Also, let the baby suckle on the breast for as long as the baby wants; suckling is also an emotional requirement for the baby in addition to providing milk to satisfy the hunger. Remember every baby is different.
The most common reason for shifting to bottle feed/formula is ‘not enough milk’. All mothers feel that their baby is not getting enough milk, but the only indicator of adequacy of feeding is weight gain. A baby who is gaining more than 30 gm/day after the first seven to ten days of life is getting adequate feeds. A mother will always produce enough milk to satisfy the baby’s demand. Remember the following points: feed the baby when he/she is hungry; the more you feed the baby, the more milk will be produced; make sure that both breasts are used equally; offer both breasts at each feed; switch between breasts midfeed; start new feed on alternate breasts.
Some mothers would insist that they want to start top feeds once a day to either make the baby used to formula feed or for exigencies when they have to go out. Remember, even single top feed can decrease the amount of breast milk produced; if you want to go out, expressing breast milk is a good option. Invest in a good breast pump that costs up to ` 2000. Expressed milk can be stored at room temperature for four to six hours and in refrigerator for up to 24 hours. Be sure that the expressed milk is given with a katori/ spoon and not a bottle. After six months, the babies don’t need to be given formula; breast feeding needs to be continued on demand and baby should receive semi-solid diet. In fact babies on breast feed don’t need any top milk for the first two years of life. It is recommended that breast-feeding be continued for at least two years or till when we definitely know it is going to confer some benefit. After two years mothers can decide to continue depending on their convenience; in fact some mothers continue breast feeding up to five years.
So, happy breast feeding for a healthy nation!