Dr. Viraj R. Naik (Obstetrics & Gynecology) needs a second opinion on this medical case.
Hello Curofians!! I have prepared an article compiling important information on Breastfeeding awareness.
The theme of World Breastfeeding Week 2020 is “Support breastfeeding for a healthier planet”.
Under nutrition is estimated to be associated with 2.7 million child deaths annually or 45% of all child deaths. A key area to improve child survival and to promote healthy growth and development is infant and young child feeding. Particularly important are the first 2 years of child’s life, as optimal nutrition during this period lowers morbidity and mortality, reduces the risk of chronic disease and fosters a overall better development.
WHO and UNICEF recommend:
· Early initiation of breastfeeding within 1 hour of birth.
· Exclusive breastfeeding for the first 6 months of life
· Introduction of nutritionally adequate and safe complementary (solid) foods at 6 months together with continued breastfeeding upto 2 years of age or beyond.
Advantages of exclusive breastfeeding:
· The most important advantage is protection against gastrointestinal infections which is seen not only in developing but also industrialized countries. Initiating breastfeeding early, within 1 hour of birth, protects the newborn from acquiring infections and decreases newborn mortality.
· The risk of mortality because of diarrhoea and other infections can increase in infants who are either partially breastfed or not breastfed at all.
· Breast-milk forms an important source of energy and nutrients for children between 6–23 months of age.
· It can provide half or more of a child’s energy needs between the ages of 6 and 12 months, and one third of energy needs between 12 and 24 months.
· Breast-milk is also a critical source of energy and nutrients during illness, and reduces mortality among children who are malnourished.
· Children and adolescents who were breastfed as babies are less likely to be overweight or obese.
· Additionally, they perform better on intelligence tests and have higher school attendance.
· Breastfeeding is associated with higher income in adult life. Improving child development and reducing health costs results in economic gains for individual families as well as at the national level.
· Longer duration of breastfeeding also contribute to the health and well-being of mothers: it reduces the risk of ovarian and breast cancer and helps space pregnancies–exclusive breastfeeding of babies under 6 months has a hormonal effect which often induces a lack of menstruation. This is natural method of contraception called as lactational amenorrhea method.
Mothers and families need to be supported for their children to be optimally breastfed. Implementation of the "Ten Steps to Successful Breastfeeding" specified in the Baby-Friendly Hospital Initiative is essential.
*Skin-to-skin contact between mother and baby immediately after birth and initiation of breastfeeding within the first hour of life;
*Breastfeeding on demand (that is, as often as the child wants, day and night);
*Rooming-in (allowing mothers and infants to remain together 24 hours a day);
*Not giving babies additional food or drink, even water, unless medically necessary;
With regards to HIV and breastfeeding, as HIV can pass from a mother to her child during pregnancy, labour or delivery, and also through breast-milk, the evidence on HIV and infant feeding shows that giving antiretroviral treatment (ART) to mothers living with HIV significantly reduces the risk of transmission through breastfeeding and also improves her health.
Ø Major barriers for breastfeeding in public are lack of appropriate, hygienic, safe places to breastfeed and discomfort due to people staring and lack of privacy.
Ø With regards to breastfeeding in special child, there is moderate evidence to suggest that infants with cleft lip may be able to generate sufﬁcient suction, and descriptive reports suggest that these infants are often able to breastfeed successfully. There is moderate evidence that infants with cleft palate or cleft lip and palate have difﬁculty in generating sufﬁcient intraoral suction and may have inefﬁcient sucking patterns compared with non-cleft infants. Breastfeeding may also provide comfort and bonding opportunities for infants and mothers, while allowing infants to experience feeding from the breast. Evidence suggests that breastfeeding can commence/ recommence immediately after cleft lip repair. Breastfeeding can commence/recommence 1 day after cleft palate repair without complication to the wound. However, as cleft repairs do not occur immediately after birth, infants may require additional support to be taught how to breastfeed with their newly repaired clefts. Therefore, parents should be counselled that alternative means of feeding may still be required post-surgically to meet growth and nutritional goals. Parental education and supports should be provided in a timely manner. Surveys have indicated that parents of a child with cleft lip, cleft palate and cleft lip and palate desire more instructions on feeding challenges as early as possible; this commences in the antenatal period and should be ongoing. Involving partners and other caregivers in the feeding process is also recommended. Specialists can determine the feasibility of breastfeeding and advise about managing milk supply and expressing for supplemental feeds. Early advice is key, as mothers may be encouraged to initiate milk expression within the ﬁrst few hours of birth. Specialists can also assist with suitable supportive techniques
Ø As we compare mother’s milk with formula feeds, artificial formulas can be manipulated to contain higher amounts of important nutrients such as protein than maternal breast milk but newborn infants often find formula difficult to digest. Artificial formulas, furthermore, do not contain the antibodies and other substances present in breast milk that protect the immature gut of preterm or low birth weight infants and reduce the risk of infection and severe bowel problems. If preterm infants are fed with formula rather than maternal breast milk (breast-fed directly or mother's own expressed breast milk), this might increase the risk of these problems and adversely affect growth and development.
For mothers who face difficulty in breastfeeding, their concerns and issues need to be addressed well for successful breastfeeding:
*Latching pain can be tackled by making the baby’s mouth covering the areola below the nipple than above.
*For cracked nipples, breastfeeding should be done at more frequent intervals and nipples can be moistened with milk after nursing.
*In case of clogged/ plugged duct, warm compresses can applied to the breasts and breasts can be massaged and taking adequate rest can solve this problem.
*For breast engorgement, breastfeeding can be done more frequently and breast milk can be expressed.
*For cases of mastitis and thrush, medications can be timely to avoid further discomfort.
*In cases of low milk supply, mother should be psychologically supported and if required medications can be given.
*In case baby sleeps while breastfeeding, baby can be stimulated by tickling feet or burping.
*In cases of inverted nipples, pump can be used before nursing the baby.
Provision of supportive health services with infant and young child feeding counselling during all contacts with caregivers and young children, such as during antenatal and postnatal care, well-child and sick child visits, and immunization and community support, including mother support groups and community-based health promotion and education activities. Skilled counselling services can ensure that mothers and families receive this support, along with the information, the advice, and the reassurance they need to nourish their babies optimally. Breastfeeding counselling can help mothers to build confidence while respecting their individual circumstances and choices. Counselling can empower women to overcome challenges and prevent feeding and care practices that may interfere with optimal breastfeeding, such as the provision of unnecessary liquids, foods, and breast milk substitutes to infants and young children.
Skilled breastfeeding counselling can be provided by different actors including health care professionals, lactation counselors and peer support providers, and in a variety of settings– in health facilities or clinics, through home visits or community programs, in person or remotely. During the COVID-19 pandemic, it is even more important to find innovative solutions to ensure that access to these essential services is not disrupted and that families continue to receive the breastfeeding counselling they need.