BREASTFEEDING

Breastfeeding is the normal way of providing young infants with the nutrients they need for
healthy growth and development. Virtually all mothers can breastfeed, provided they have
accurate information, and the support of their family, the health care system and society at large.
Colostrum, the yellowish, sticky breast milk produced at the end of pregnancy, is recommended
by WHO as the perfect food for the newborn, and feeding should be initiated within the first hour
after birth.
Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding
along with appropriate complementary foods up to two years of age or beyond.

WHO recommends exclusive breastfeeding for the first six months of life. At six months, solid
foods, such as mashed fruits and vegetables, should be introduced to complement breastfeeding
for up to two years or more. In addition:

breastfeeding should begin within one hour of birth

breastfeeding should be "on demand", as often as the child wants day and night; and

bottles or pacifiers should be avoided.

Health benefits for infants

Breast milk is the ideal food for newborns and infants. It gives infants all the nutrients
they need for healthy development. It is safe and contains antibodies that help protect
infants from common childhood illnesses such as diarrhoea and pneumonia, the two
primary causes of child mortality worldwide. Breast milk is readily available and
affordable, which helps to ensure that infants get adequate nutrition.
Benefits for mothers

Breastfeeding also benefits mothers. Exclusive breastfeeding is associated with a natural (though
not fail-safe) method of birth control (98% protection in the first six months after birth). It
reduces risks of breast and ovarian cancer, type II diabetes, and postpartum depression.
Long-term benefits for children

Beyond the immediate benefits for children, breastfeeding contributes to a lifetime of good
health. Adolescents and adults who were breastfed as babies are less likely to be overweight or
obese. They are less likely to have type-II diabetes and perform better in intelligence tests.
differences with infant formula

Infant formula does not contain the antibodies found in breast milk. The long-term benefits of
breastfeeding for mothers and children cannot be replicated with infant formula. When infant
formula is not properly prepared, there are risks arising from the use of unsafe water and
unsterilized equipment or the potential presence of bacteria in powdered formula. Malnutrition
can result from over-diluting formula to "stretch" supplies. While frequent feeding maintains
breast milk supply, if formula is used but becomes unavailable, a return to breastfeeding may not
be an option due to diminished breast milk production.

HIV and breastfeeding

An HIV-infected mother can pass the infection to her infant during pregnancy, delivery and
through breastfeeding. However, antiretroviral (ARV) drugs given to either the mother or HIV-
exposed infant reduces the risk of transmission. Together, breastfeeding and ARVs have the
potential to significantly improve infants' chances of surviving while remaining HIV uninfected.
WHO recommends that when HIV-infected mothers breastfeed, they should receive ARVs and
follow WHO guidance for infant feeding.
Regulating breast-milk substitutes
An international code to regulate the marketing of breast-milk substitutes was adopted in 1981. It
calls for:

all formula labels and information to state the benefits of breastfeeding and the health
risks of substitutes;

no promotion of breast-milk substitutes;

no free samples of substitutes to be given to pregnant women, mothers or their families;

and

no distribution of free or subsidized substitutes to health workers or facilities.

Support for mothers is essential
Breastfeeding has to be learned and many women encounter difficulties at the beginning. Many
routine practices, such as separation of mother and baby, use of newborn nurseries, and
supplementation with infant formula, actually make it harder for mothers and babies to
breastfeed. Health facilities that support breastfeeding by avoiding these practices and making
trained breastfeeding counsellors available to new mothers encourage higher rates of the
practice. To provide this support and improve care for mothers and newborns, there are "baby-
friendly" facilities in about 152 countries thanks to the WHO-UNICEF Baby-friendly Hospital
Initiative.
Work and breastfeeding
Many mothers who return to work abandon breastfeeding partially or completely because they
do not have sufficient time, or a place to breastfeed, express and store their milk. Mothers need a
safe, clean and private place in or near their workplace to continue breastfeeding. Enabling
conditions at work, such as paid maternity leave, part-time work arrangements, on-site crches,
facilities for expressing and storing breast milk, and breastfeeding breaks, can help.
The next step: phasing in solid foods

To meet the growing needs of babies at six months of age, mashed solid foods should be
introduced as a complement to continued breastfeeding. Foods for the baby can be specially
prepared or modified from family meals. WHO notes that:

breastfeeding should not be decreased when starting on solids;

 food should be given with a spoon or cup, not in a bottle;

food should be clean and safe; and

ample time is needed for young children to learn to eat solid foods.
http://www.who.int/topics/breastfeeding/en/
http://www.who.int/features/factfiles/breastfeeding/en/
 Maternal Nutrition

Pregnant and lactating women should achieve a DHA dietary intake of at least 100-
200 mg per day, which can be easily met by consuming one to two portions of oily
fish (like herring, mackerel, salmon) per week, which is a good source of PUFA w-3
and also safer with regard to environmental contamination by methylmercury.
Proteins are the major structural component of all cells in the body, and function as
enzymes, in membranes, as transport carriers, and as some hormones.
Sources, such as meat, poultry, fish, eggs, milk, cheese, and yogurt, provide all nine indispensable amino
acids in adequate amounts, and for this reason are considered complete proteins. Proteins from plants,
legumes, grains, nuts, seeds, and vegetables tend to be deficient in one or more of the indispensable
amino acids.
Maternal nutrition during lactation
For an infant, no food is better than breast milk.
The WHO and other scientific societies promote exclusive breastfeeding as the
best source of nutrition for the baby for the first six months of life, and as the main
food until the first year of life Breastmilk, in fact, provides all the nutrients essential
for optimal growth of the baby and important protective factors against infection.
However, after the first 6 months, lactation, even if sufficient in terms of quantity, is
no longer able to meet the increased nutritional requirements of the baby, so the
progressive introduction of foods (weaning) is necessary.
The energy, protein, and other nutrients in breastmilk come from the mothers
diet and her own body stores. Milk production is determined mostly by infant
demand rather than maternal lactation capacity .This is illustrated by the ability of
mothers to successfully breastfeed twins or triplets . Factors that influence the
volume of milk consumed are the infants current weight, weight gain, birth weight,
and gender .
Virtually all mothers can produce adequate amounts of breastmilk but a
chronically deficient diet depletes maternal energy, vitamins and minerals stores.
These deficiencies can be avoided if the mother improves her diet before, during,
and between cycles of pregnancy and lactation, or takes supplements.
Moderate weight loss of the mother, typical of the post-partum period, with or
without exercise does not adversely affect lactation .
The energy cost of exclusive breastfeeding from birth to 6 months postpartum is
500 kcal/day. This estimate is based upon the average volume of milk produced
(780 ml/day) and the average energy content of milk (67 kcal/100 ml). In well-
nourished women, the energy cost of lactation is subsidized by mobilization of
tissue stores (approximately 170 kcal per day). Therefore, the recommended dietary
allowance (RDA) for energy is 330 kcal per day more than non-pregnant, non-
lactating women: from 7 to 12 months of age, based on an average milk production
of 600 ml/day and the same energy content, the additional energy required for
lactation is 400 kcal per day.
Breastfeeding increases the mothers need for water, so it is important that she
drinks enough to compensate her loss of fluids: if the adequate intake for a woman
of childbearing age is about 2,000 ml/day, during lactation an increase of about 700
ml/day is recommended .
Requirements for vitamins A, C, E, B6, B12, folate, niacin, riboflavin, and thiamine,
and the minerals iodine, selenium, and zinc are increased in lactating women. In
contrast, allowances for vitamins D and K, and the minerals calcium, fluoride,
magnesium, and phosphorus do not differ between lactating and non-lactating
states .The maternal requirement for iron is not increased during lactation, because
of post-partum amenorrhea, which prevents its loss .
The current recommendation is to provide vitamin D supplementation to all
breastfed infants rather than increase supplementation in the mother.
The vitamin K content of human milk is not affected by maternal vitamin K intake,
therefore no additional vitamin K is required during lactation .
Approximately 210 mg per day of calcium is secreted in milk. Increased bone
mobilization and decreased urinary excretion provide the calcium needed for milk
production ; intestinal calcium absorption does not appear to increase . Changes in
calcium homeostasis are independent of maternal calcium intake . As an example,
in one report, loss of bone mass during lactation was similar with calcium
supplementation (1 g per day) and placebo . Because lactation-induced bone loss is
not prevented by increased calcium intake, and bone loss is recovered after
weaning, the dietary recommendation for calcium is the same for lactating and non-
lactating women of the same age.
Fish and shellfish contribute high-quality protein and other essential nutrients
including omega-3 fatty acids to the diet. Large amounts of essential fatty acids are
beneficial to the infant for brain development. However, currently available data are
insufficient to demonstrate an association between subsequent cognition in children
and increased omega-3 fatty acid intake in their mothers during breastfeeding.
Consumption of certain fish and shellfish by breastfeeding women may increase the
newborns risk to develop nervous system alterations, since both inorganic and
organic mercury are transferred from maternal serum to human milk .
To prevent this, breastfeeding mothers should not eat shark, swordfish, king
mackerel, or tilefish because they contain high concentrations of mercury.
Breastfeeding mothers can eat up to two average servings of fish and shellfish
that have lower concentrations of mercury (shrimp, canned light tuna, salmon,
pollock, and catfish)