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Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers. Virtually all mothers can breastfeed, provided they have accurate information, and the support of their family, the health care system and society at large. As a global public health recommendation, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health.
Breastfeeding is a process of feeding new-born milk directly from the breast. Exclusive breastfeeding is defined as giving the infant only breast milk and nothing else for the first six months of life. This is he recommended optimal infant feeding practise. There should be no added water, water-based drinks or juice. However, the infant can still take medicine, vitamins and minerals. The keyword in the definition is the duration and exclusivity of breast milk. The infant may receive the breast milk directly from the mother’s breast, or expressed from the mother or wet nurse.
Exclusive breastfeeding should be initiated within the first hour after birth, and should last for 6 months. This practise should be promoted, protected and supported. At six months, to meet the infant’s evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond. Supplementary feeding is when formula milk is introduced within the first 6 months of life in addition to breast milk, while replacement feeding is when breast milk was not given at all. Supplementary and replacement feeding are strongly discouraged except for rare medical conditions.
Milk from human females provides all the nutrients that a baby needs, as well as substances that promotes growth and helps fight infection.
Hormonal changes in the female body during pregnancy prepare the breast to produce milk. After birth, when the baby first sucks on the mother’s breast, the nerves in the areola (the dark, central part around the nipple of the breast) stimulate the pituitary gland, located at the base of the brain, to release the hormones prolactin and oxytocin.
Prolactin makes the lobules, or milk-producing cells, in the breast secrete milk. Oxytocin causes the smooth muscles surrounding the lobules to squeeze the milk into the breast’s ductal system, a response known as let-down or milk ejection. The ductal system carries the milk to the nipple where the baby suckles.
For the first three to four days after the baby’s birth, the milk released from the mother’s breast is colostrum, a thick, yellowish fluid rich in protein, antibodies, and other infection-fighting agents that is more concentrated than mature breast milk. It is also lower in fats and carbohydrates. It is recommended by WHO as the perfect food for the new-born and feeding should be initiated within the first hour after birth.
Colostrum is replaced by early, or transitional, milk, which is thinner, lighter in colour, and more plentiful. Within about two weeks of the baby’s birth, early milk is replaced by bluish-white mature milk. The mother of a premature infant has milk higher in protein and salt concentrations that meet her baby’s special needs.
Perhaps the most important advantage to breast-feeding is that breast milk provides an infant with significant protection against: chronic diseases such as allergies and asthma; infectious diseases including meningitis, diarrhoea, ear infections, and pneumonia. The immune components of breast milk constantly change to meet the infant’s need to be protected against new infections.
As the infant’s own immune system grows more capable, the concentration of antibodies and anti-infection agents in the milk gradually declines.
Breast-feeding also benefits the mother by reducing her risk of developing ovarian cancer, pre-menopausal breast cancer, osteoporosis, and hip fractures in later life.
Breast-feeding facilitates bonding between a mother and infant that is emotionally satisfying to both participants. The mother develops nurturing behaviours. The infant, in turn, learns trust.
Because of the global benefits of breastfeeding, the Breastfeeding policy of Nigeria, Breastfeeding Promotion & Counselling Group of Nigeria, and the Academy of Breastfeeding Physicians recommends breastfeeding rather than bottle feeding as the best way to nourish infants and young children.
For successful breast-feeding, the baby should be held facing the mother directly, abdomen to abdomen, with the head, neck, and body in a straight line, and the mouth level with the mother’s nipple.
The mother should have proper back support, and she should cradle the baby’s head in the crook of her arm. Some babies have to overcome difficulties such as a weak sucking reflex, which can occur as a result of birth-related problems, maternal medications, or initial feeding with an artificial nipple and bottle.
Sometimes babies develop discomfort or excessive gas from breast-feeding. These symptoms may result from the mother’s consumption of cow’s milk and dairy products, or from other foods and food additives in the mother’s diet. Eliminating the offending food from the mother’s diet will often improve the infant’s symptoms.
Sore nipples, caused by the infant’s sucking, can be prevented by encouraging the baby to take the nipple and the areola deep within the mouth.
Engorgement, or pressure within the breast from excessive milk, can be prevented and treated by frequent breast-feeding or by use of a breast pump.
Breast pain may be a sign of mastitis, an infection of breast tissue that requires medical attention.
During its first days and weeks, a newborn infant normally feeds 8 to 12 times or more in 24 hours. The frequent breast-feeding stimulates the mother’s hormonal system to increase milk production. Physicians advise mothers to breast-feed the baby on demand rather than by an hourly schedule. This practice not only ensures that the baby receives the proper nutrition, but also that the mother’s milk supply is maintained.
Milk at the beginning of a feeding session is different in composition than milk at the end—the hind milk, or later milk, is much richer in fats
Physicians recommend that a breast-feeding session begin and continue on one breast until the baby spontaneously stops feeding; then the mother should offer the other breast, allowing the baby to feed until completely satisfied. Halting feedings after a predetermined time may prevent the infant from obtaining the extra fat calories in the hind milk necessary for proper growth.
Mothers may use either hand or a breast pump to remove milk from the breast. Both techniques are useful for relieving pressure in the breast when mother and infant cannot be together for a normal feeding session. A nursing mother can bottle and refrigerate the milk so obtained, and use it to feed her infant at another time—a useful option for mothers who work outside the home.
Some paediatricians recommend that infants breast-feed for at least the first year of life, and possibly into the second and third years for optimal development. For the first six months of life, the healthy infant needs no food or fluid other than breast milk. Beyond that age, mother’s milk should be increasingly complemented with solid food and other fluids.
WHO recommends that infants start receiving complementary foods at six months (180 days) of age in addition to breast milk. Foods should be adequate, meaning that they provide sufficient energy, protein and micronutrients to meet a growing child's nutritional needs. Foods should be prepared and given in a safe manner to minimize the risk of contamination. Feeding young infants requires active care and stimulation to encourage the child to eat.
Amounts of foods to offer| Age | Texture | Frequency | Amount at each meal |
6–8 months |
Start with thick porridge, well mashed foods,Continue with mashed family foods |
2–3 meals per day, plus frequent breastfeeds Depending on the child's appetite, 1–2 snacks may be offered |
Start with 2–3 table spoonful per feed, increasing gradually to ½ of a 250 ml cup |
9–11 months |
Finely chopped or mashed foods, and foods that baby can pick up |
3–4 meals per day, plus breastfeeds |
½ of a 250 ml cup/bowl |
12–23 months |
Family foods, chopped or mashed if necessary |
3–4 meals per day, plus breastfeeds |
¾ to full 250 ml cup/bowl |
Baby Friendly Hospital Initiative (BFHI) - TEN STEPS TO SUCCESSFUL BREASTFEEDING
Every facility providing maternity services and care for newborn infants should:
1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
2. Train all health care staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within a half-hour of birth.
5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.
6. Give newborn infants no food or drink other than breast milk unless medically indicated.
7. Practice rooming in - allow mothers and infants to remain together - 24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic
Dr Nwazor F.O. Breastfeeding. Lecture at the Family Medicine update 2011, NPMCN.