Está en la página 1de 39

Breastfeeding

From Wikipedia, the free encyclopedia

Jump to: navigation, search

International Breastfeeding Symbol

An infant breastfeeding
Suckling and nursing are synonyms. For other uses, see Nursing (disambiguation) and Suckling
(disambiguation)

Breastfeeding is the feeding of an infant or young child with breast milk directly from female human
breasts (i.e., via lactation) rather than from a baby bottle or other container. Babies have a sucking
reflex that enables them to suck and swallow milk. Most mothers can breastfeed for six months or
more, without the addition of infant formula or solid food.
Human breast milk is the healthiest form of milk for human babies.[1] There are few exceptions, such
as when the mother is taking certain drugs or is infected with Human T-lymphotropic virus, HIV, or has
active untreated tuberculosis. Breastfeeding promotes health, helps to prevent disease, and reduces
health care and feeding costs.[2][3][4] Artificial feeding is associated with more deaths from diarrhea
in infants in both developing and developed countries.[5] Experts agree that breastfeeding is beneficial,
but may disagree about the length of breastfeeding that is most beneficial, and about the risks of using
artificial formulas.[6][7][8]
The World Health Organization (WHO) and the American Academy of Pediatrics (AAP) emphasize the
value of breastfeeding for mothers as well as children. Both recommend exclusive breastfeeding for the
first six months of life and then supplemented breastfeeding for at least one year and up to two years or
more.[9][10] While recognizing the superiority of breastfeeding, regulating authorities also work to
minimize the risks of artificial feeding.[7]
Contents
[hide]
• 1
Breast
milk
• 2
Benefit
s for
the
infant
• 2
.
1

G
r
e
a
t
e
r

i
m
m
u
n
e

h
e
a
l
t
h

• 2
.
2

F
e
w
e
r

i
[edit] Breast milk
Main article: Breast milk

Himba woman and child.


Not all the properties of breast milk are understood, but its nutrient content is relatively stable. Breast
milk is made from nutrients in the mother's bloodstream and bodily stores. Breast milk has just the
right amount of fat, sugar, water, and protein that is needed for a baby's growth and development.[11]
Because breastfeeding uses an average of 500 calories a day it helps the mother lose weight after giving
birth.[12] The composition of breast milk changes depending on how long the baby nurses at each
session, as well as on the age of the child. The quality of a mother's breast milk may be compromised
by smoking, alcoholic beverages, caffeinated drinks, marijuana, methamphetamine, heroin, and
methadone.[13]

[edit] Benefits for the infant

A woman with her child in Kabala, Sierra Leone in the 1960's.


Scientific research, such as the studies summarized in a 2007 review for the U.S. Agency for
Healthcare Research and Quality (AHRQ)[14] and a 2007 review for the WHO[15], has found many
benefits to breastfeeding for the infant. These include:

[edit] Greater immune health


During breastfeeding antibodies pass to the baby[16]. This is one of the most important features of
colostrum, the breast milk created for newborns. Breast milk contains several anti-infective factors
such as bile salt stimulated lipase (protecting against amoebic infections), lactoferrin (which binds to
iron and inhibits the growth of intestinal bacteria)[17][18] and immunoglobulin A protecting against
microorganisms.[19]

[edit] Fewer infections


Among the studies showing that breastfed infants have a lower risk of infection than non-breastfed
infants are:
• In a 1993 University of Texas Medical Branch study, a longer period of breastfeeding was
associated with a shorter duration of some middle ear infections (otitis media with effusion) in
the first two years of life.[20]
• A 1995 study of 87 infants found that breastfed babies had half the incidence of diarrheal
illness, 19% fewer cases of any otitis media infection, and 80% fewer prolonged cases of otitis
media than formula fed babies in the first twelve months of life.[21]
• Breastfeeding appeared to reduce symptoms of upper respiratory tract infections in premature
infants up to seven months after release from hospital in a 2002 study of 39 infants.[22]
• A 2004 case-control study found that breastfeeding reduced the risk of acquiring urinary tract
infections in infants up to seven months of age, with the protection strongest immediately after
birth.[23]
• The 2007 review for AHRQ found that breastfeeding reduced the risk of acute otitis media, non-
specific gastroenteritis, and severe lower respiratory tract infections.[14]

[edit] Protection from SIDS


Breastfed babies have better arousal from sleep at 2–3 months. This coincides with the peak incidence
of sudden infant death syndrome.[24] A study conducted at the University of Münster found that
breastfeeding halved the risk of sudden infant death syndrome in children up to the age of 1.[25]

[edit] Higher intelligence


Studies examining whether breastfeeding in infants is associated with higher intelligence later in life
include:
• Horwood, Darlow and Mogridge (2001) tested the intelligence quotient (IQ) scores of 280 low
birthweight children at seven or eight years of age.[26] Those who were breastfed for more than
eight months had verbal IQ scores 6 points higher (which was significantly higher) than
comparable children breastfed for less time.[26] They concluded "These findings add to a
growing body of evidence to suggest that breast milk feeding may have small long term benefits
for child cognitive development."[26]
• A 2005 study using data on 2,734 sibling pairs from the National Longitudinal Study of
Adolescent Health "provide[d] persuasive evidence of a causal connection between
breastfeeding and intelligence." The same data "also suggests that nonexperimental studies of
breastfeeding overstate some of [breastfeeding's] other long-term benefits, even if controls are
included for race, ethnicity, income, and education." [27]
• In 2006, Der and colleagues, having performed a prospective cohort study, sibling pairs
analysis, and meta-analysis, concluded that "Breast feeding has little or no effect on intelligence
in children."[28] The researchers found that "Most of the observed association between breast
feeding and cognitive development is the result of confounding by maternal intelligence."[28]
• The 2007 review for the AHRQ found "no relationship between breastfeeding in term infants
and cognitive performance."[14]
• The 2007 review for the WHO "suggests that breastfeeding is associated with increased
cognitive development in childhood." The review also states that "The issue remains of whether
the association is related to the properties of breastmilk itself, or whether breastfeeding
enhances the bonding between mother and child, and thus contributes to intellectual
development." [15]
• Two initial cohort studies published in 2007 suggest babies with a specific version of the
FADS2 gene demonstrated an IQ averaging 7 points higher if breastfed, compared with babies
with a less common version of the gene who showed no improvement when breastfed.[29]
FADS2 affects the metabolism of polyunsaturated fatty acids found in human breast milk, such
as docosahexaenoic acid and arachidonic acid, which are known to be linked to early brain
development.[29] The researchers were quoted as saying "Our findings support the idea that the
nutritional content of breast milk accounts for the differences seen in human IQ. But it's not a
simple all-or-none connection: it depends to some extent on the genetic makeup of each
infant."[30] The researchers wrote "further investigation to replicate and explain this specific
gene–environment interaction is warranted."[29]
• In "the largest randomized trial ever conducted in the area of human lactation," between 1996
and 1997 maternity hospitals and polyclinics in Belarus were randomized to receive or not
receive breastfeeding promotion modeled on the Baby Friendly Hospital Initiative.[31] Of
13,889 infants born at these hospitals and polyclinics and followed up in 2002-2005, those who
had been born in hospitals and polyclinics receiving breastfeeding promotion had IQs that were
2.9-7.5 points higher (which was significantly higher).[31] Since (among other reasons) a
randomized trial should control for maternal IQ, the authors concluded in a 2008 paper that the
data "provide strong evidence that prolonged and exclusive breastfeeding improves children's
cognitive development."[31]

[edit] Less diabetes


Infants exclusively breastfed have less chance of developing diabetes mellitus type 1 than peers with a
shorter duration of breastfeeding and an earlier exposure to cow milk and solid foods.[14][32]
Breastfeeding also appears to protect against diabetes mellitus type 2,[14][15][33][34] at least in part
due to its effects on the child's weight.[34]

[edit] Less childhood obesity


Breastfeeding appears to reduce the risk of extreme obesity in children aged 39 to 42 months.[35] The
protective effect of breastfeeding against obesity is consistent, though small, across many studies, and
appears to increase with the duration of breastfeeding.[14][15][36] A study has also shown that infants
who are bottle-fed in early infancy are more likely to empty the bottle or cup in late infancy than those
who are breastfed. "Bottle-feeding, regardless of the type of milk, is distinct from feeding at the breast
in its effect on infants' self-regulation of milk intake." According to the study, this may be due to one of
three possible factors, including that when bottle feeding, parents may encourage an infant to finish the
contents of the bottle whereas when breastfeeding, an infant naturally developes self-regulation of milk
intake.[37]

[edit] Less tendency to develop allergic diseases (atopy)


In children who are at risk for developing allergic diseases (defined as at least one parent or sibling
having atopy), atopic syndrome can be prevented or delayed through exclusive breastfeeding for four
months, though these benefits may not be present after four months of age.[38] However, the key factor
may be the age at which non-breastmilk is introduced rather than duration of breastfeeding.[39] Atopic
dermatitis, the most common form of eczema, can be reduced through exclusive breastfeeding beyond
12 weeks in individuals with a family history of atopy, but when breastfeeding beyond 12 weeks is
combined with other foods incidents of eczema rise irrespective of family history.[40]

[edit] Less necrotizing enterocolitis in premature infants


Necrotizing enterocolitis (NEC) is an acute inflammatory disease in the intestines of infants. Necrosis
or death of intestinal tissue may follow. It is mainly found in premature births. In one study of 926
preterm infants, NEC developed in 51 infants (5.5%). The death rate from necrotizing enterocolitis was
26%. NEC was found to be six to ten times more common in infants fed formula exclusively, and three
times more common in infants fed a mixture of breast milk and formula, compared with exclusive
breastfeeding. In infants born at more than 30 weeks, NEC was twenty times more common in infants
fed exclusively on formula.[41] A 2007 meta-analysis of four randomized controlled trials found "a
marginally statistically significant association" between breastfeeding and a reduction in the risk of
NEC.[14]

[edit] Other long term health effects


In one study, breastfeeding did not appear to offer protection against allergies.[42] However, another
study showed breastfeeding to have lowered the risk of asthma, protect against allergies, and provide
improved protection for babies against respiratory and intestinal infections.[43]
A review of the association between breastfeeding and celiac disease (CD) concluded that breast
feeding while introducing gluten to the diet reduced the risk of CD. The study was unable to determine
if breastfeeding merely delayed symptoms or offered life-long protection.[44]
An initial study at the University of Wisconsin found that women who were breast fed in infancy may
have a lower risk of developing breast cancer than those who were not breast fed.[45]
Breastfeeding may decrease the risk of cardiovascular disease in later life, as indicated by lower
cholesterol and C-reactive protein levels in adult women who had been breastfed as infants.[15][46]
Although a 2001 study suggested that adults who had been breastfed as infants had lower arterial
distensibility than adults who had not been breastfed as infants[47], the 2007 review for the WHO
concluded that breastfed infants "experienced lower mean blood pressure" later in life[15].
Nevertheless, the 2007 review for the AHRQ found that "the relationship between breastfeeding and
cardiovascular diseases was unclear"[14].
[edit] Benefits for mothers

Zanzibari woman breastfeeding


Breastfeeding is a cost effective way of feeding an infant, providing nourishment for a child at a small
cost to the mother. Frequent and exclusive breastfeeding can delay the return of fertility through
lactational amenorrhea, though breastfeeding is an imperfect means of birth control. During
breastfeeding beneficial hormones are released into the mother's body[16] and the maternal bond can
be strengthened.[11] Breastfeeding is possible throughout pregnancy, but generally milk production
will be reduced at some point.[48]

[edit] Bonding
Hormones released during breastfeeding help to strengthen the maternal bond.[11] Teaching partners
how to manage common difficulties is associated with higher breastfeeding rates.[49] Support for a
mother while breastfeeding can assist in familial bonds and help build a paternal bond between father
and child.[50]
If the mother is away, an alternative caregiver may be able to feed the baby with expressed breast milk.
The various breast pumps available for sale and rent help working mothers to feed their babies breast
milk for as long as they want. To be successful, the mother must produce and store enough milk to feed
the child for the time she is away, and the feeding caregiver must be comfortable in handling breast
milk.

[edit] Hormone release


Breastfeeding releases oxytocin and prolactin, hormones that relax the mother and make her feel more
nurturing toward her baby.[51] Breastfeeding soon after giving birth increases the mother's oxytocin
levels, making her uterus contract more quickly and reducing bleeding. Pitocin, a synthetic hormone
used to make the uterus contract during and after labour, is structurally modelled on oxytocin.[52]

[edit] Weight loss


As the fat accumulated during pregnancy is used to produce milk, extended breastfeeding—at least 6
months—can help mothers lose weight.[53] However, weight loss is highly variable among lactating
women; monitoring the diet and increasing the amount/intensity of exercise are more reliable ways of
losing weight.[54] The 2007 review for the AHRQ found "The effect of breastfeeding in mothers on
return-to-pre-pregnancy weight was negligible, and the effect of breastfeeding on postpartum weight
loss was unclear."[14]
[edit] Natural postpartum infertility
Breastfeeding may delay the return to fertility for some women by suppressing ovulation. A
breastfeeding woman may not ovulate, or have regular periods, during the entire lactation period. The
period in which ovulation is absent differs for each woman. This Lactational amenorrhea has been used
as an imperfect form of natural contraception, with a greater than 98% effectiveness during the first six
months after birth if specific nursing behaviors are followed.[55] It is possible for some women to
ovulate within two months after birth while fully breastfeeding.

[edit] Long-term health effects


For breastfeeding women, long-term health benefits include:
• Less risk of breast cancer, ovarian cancer, and endometrial cancer.[10][14][56][57]
• A 2009 study indicated that lactation for at least 24 months is associated with a 23% lower risk
of coronary heart disease.[58]
• Although the 2007 review for the AHRQ found "no relationship between a history of lactation
and the risk of osteoporosis"[14], mothers who breastfeed longer than eight months benefit from
bone re-mineralisation.[59]
• Breastfeeding diabetic mothers require less insulin.[60]
• Reduced risk of post-partum bleeding.[52]
• According to a Malmö University study published in 2009, women who breast fed for a longer
duration have a lower risk for contracting rheumatoid arthritis than women who breast fed for a
shorter duration or who had never breast fed.[61]

[edit] Organisational endorsements


[edit] World Health Organization
“ The vast majority of mothers can and should breastfeed, just as the vast majority of infants can
and should be breastfed. Only under exceptional circumstances can a mother’s milk be
considered unsuitable for her infant. For those few health situations where infants cannot, or
should not, be breastfed, the choice of the best alternative–expressed breast milk from an infant’s
own mother, breast milk from a healthy wet-nurse or a human-milk bank, or a breast-milk
substitute fed with a cup, which is a safer method than a feeding bottle and teat–depends on
individual circumstances.[9] ”
The WHO recommends exclusive breastfeeding for the first six months of life, after which "infants
should receive nutritionally adequate and safe complementary foods while breastfeeding continues for
up to two years of age or beyond."[9]

[edit] American Academy of Pediatrics


“ Extensive research using improved epidemiologic methods and modern laboratory techniques
documents diverse and compelling advantages for infants, mothers, families, and society from
breastfeeding and use of human milk for infant feeding. These advantages include health,
nutritional, immunologic, developmental, psychologic, social, economic, and environmental
benefits.[10] ”
The AAP recommends exclusive breastfeeding for the first six months of life.[10] Furthermore,
"breastfeeding should be continued for at least the first year of life and beyond for as long as mutually
desired by mother and child."[10]

[edit] Breastfeeding difficulties


Main article: Breastfeeding difficulties
While breastfeeding is a natural human activity, difficulties are not uncommon. Putting the baby to the
breast as soon as possible after the birth helps to avoid many problems. The AAP breastfeeding policy
says: "Delay weighing, measuring, bathing, needle-sticks, and eye prophylaxis until after the first
feeding is completed."[10] Many breastfeeding difficulties can be resolved with proper hospital
procedures, properly trained midwives, doctors and hospital staff, and lactation consultants.[62] There
are some situations in which breastfeeding may be harmful to the infant, including infection with HIV
and acute poisoning by environmental contaminants such as lead.[43] The Institute of Medicine has
reported that breast surgery, including breast implants or breast reduction surgery, reduces the chances
that a woman will have sufficient milk to breast feed.[63] Rarely, a mother may not be able to produce
breastmilk because of a prolactin deficiency. This may be caused by Sheehan's syndrome, an
uncommon result of a sudden drop in blood pressure during childbirth typically due to hemorrhaging.
In developed countries, many working mothers do not breast feed their children due to work pressures.
For example, a mother may need to schedule for frequent pumping breaks, and find a clean, private and
quiet place at work for pumping. These inconveniences may cause mothers to give up on breast feeding
and use infant formula instead.

[edit] HIV infection


As breastfeeding can transmit HIV from mother to child, UNAIDS recommends avoidance of all
breastfeeding where formula feeding is acceptable, feasible, affordable and safe.[64] The qualifications
are important. Some constituents of breast milk may protect from infection. High levels of certain
polyunsaturated fatty acids in breast milk (including eicosadienoic, arachidonic and gamma-linolenic
acids) are associated with a reduced risk of child infection when nursed by HIV-positive mothers.
Arachidonic acid and gamma-linolenic acid may also reduce viral shedding of the HIV virus in breast
milk.[65] Due to this, in underdeveloped nations infant mortality rates are lower when HIV-positive
mothers breastfeed their newborns than when they use infant formula. However, differences in infant
mortality rates have not been reported in better resourced areas.[66] Treating infants prophylactically
with lamivudine (3TC) can help to decrease the transmission of HIV from mother to child by
breastfeeding.[67] If free or subsidized formula is given to HIV-infected mothers, recommendations
have been made to minimize the drawbacks such as possible disclosure of the mother's HIV status.[68]

[edit] Infant weight gain


Breastfed infants generally gain weight according to the following guidelines:
0–4 months: 6 oz. per week†
4–6 months: 4-5 oz. per week
6–12 months: 2-4 oz. per week

† It is acceptable for some babies to gain 4–5 ounces per week. This average is taken from the lowest weight, not the
birth weight.
The average breastfed baby doubles its birth weight in 5–6 months. By one year, a typical breastfed
baby will weigh about 2½ times its birth weight. At one year, breastfed babies tend to be leaner than
bottle fed babies.[69] By two years, differences in weight gain and growth between breastfed and
formula-fed babies are no longer evident.[70]

[edit] Methods and considerations


There are many books and videos to advise mothers about breastfeeding. Lactation consultants in
hospitals or private practice, and volunteer organisations of breastfeeding mothers such as La Leche
League International also provide advice and support.

[edit] Early breastfeeding


In the half hour after birth, the baby's suckling reflex is strongest, and the baby is more alert, so it is the
ideal time to start breastfeeding.[71] Early breast-feeding is associated with fewer nighttime feeding
problems.[72]

[edit] Time and place for breastfeeding


Breastfeeding at least every two to three hours helps to maintain milk production. For most women,
eight breastfeeding or pumping sessions every 24 hours keeps their milk production high.[10][not in
citation given] Newborn babies may feed more often than this: 10 to 12 breastfeeding sessions every 24
hours is common, and some may even feed 18 times a day.[73] Feeding a baby "on demand"
(sometimes referred to as "on cue"), means feeding when the baby shows signs of hunger; feeding this
way rather than by the clock helps to maintain milk production and ensure the baby's needs for milk
and comfort are being met.[citation needed] However, it may be important to recognize whether a baby
is truly hungry, as breastfeeding too frequently may mean the child receives a disproportionately high
amount of foremilk, and not enough hindmilk.[74]
"Experienced breastfeeding mothers learn that the sucking patterns and needs of babies vary. While
some infants' sucking needs are met primarily during feedings, other babies may need additional
sucking at the breast soon after a feeding even though they are not really hungry. Babies may also nurse
when they are lonely, frightened or in pain."[75]
"Comforting and meeting sucking needs at the breast is nature's original design. Pacifiers (dummies,
soothers) are a substitute for the mother when she can't be available. Other reasons to pacify a baby
primarily at the breast include superior oral-facial development, prolonged lactational amenorrhea,
avoidance of nipple confusion and stimulation of an adequate milk supply to ensure higher rates of
breastfeeding success."[75]
Rooming-in bassinet
Most US states now have laws that allow a mother to breastfeed her baby anywhere she is allowed to
be. In hospitals, rooming-in care permits the baby to stay with the mother and improves the ease of
breastfeeding. Some commercial establishments provide breastfeeding rooms, although laws generally
specify that mothers may breastfeed anywhere, without requiring them to go to a special area.
Dedicated breastfeeding rooms are generally preferred by women who are expressing milk while away
from their baby.

[edit] Latching on, feeding and positioning


Correct positioning and technique for latching on can prevent nipple soreness and allow the baby to
obtain enough milk.[76] The "rooting reflex" is the baby's natural tendency to turn towards the breast
with the mouth open wide; mothers sometimes make use of this by gently stroking the baby's cheek or
lips with their nipple in order to induce the baby to move into position for a breastfeeding session, then
quickly moving baby onto the breast while baby's mouth is wide open.[77] In order to prevent nipple
soreness and allow the baby to get enough milk, a large part of the breast and areola need to enter the
baby's mouth.[76][78] To help the baby latch on well, tickle the baby's top lip with the nipple, wait
until the baby's mouth opens wide, then bring the baby up towards the nipple quickly, so that the baby
has a mouthful of nipple and areola. The nipple should be at the back of the baby's throat, with the
baby's tongue lying flat in its mouth. Inverted or flat nipples can be massaged so that the baby will have
more to latch onto. Resist the temptation to move towards the baby, as this can lead to poor attachment.
Pain in the nipple or breast is linked to incorrect breastfeeding techniques. Failure to latch on is one of
the main reasons for ineffective feeding and can lead to infant health concerns. A 2006 study found that
inadequate parental education, incorrect breastfeeding techniques, or both were associated with higher
rates of preventable hospital admissions in newborns.[79]
The baby may pull away from the nipple after a few minutes or after a much longer period of time.
Normal feeds at the breast can last a few sucks (newborns), from 10 to 20 minutes or even longer (on
demand). Sometimes, after the finishing of a breast, the mother may offer the other breast.
While most women breastfeed their child in the cradling position, there are many ways to hold the
feeding baby. It depends on the mother and child's comfort and the feeding preference of the baby.
Some babies prefer one breast to the other, but the mother should offer both breasts at every nursing
with her newborn.
When tandem breastfeeding, the mother is unable to move the baby from one breast to another and
comfort can be more of an issue. As tandem breastfeeding brings extra strain to the arms, especially as
the babies grow, many mothers of twins recommend the use of more supporting pillows.

[edit] Exclusive breastfeeding

Two 25ml samples of human breast milk. The sample on the left is foremilk, the watery milk coming
from a full breast. To the right is hindmilk, the creamy milk coming from a nearly empty breast.[80]
Exclusive breastfeeding is defined as "an infant's consumption of human milk with no supplementation
of any type (no water, no juice, no nonhuman milk, and no foods) except for vitamins, minerals, and
medications."[10] National and international guidelines recommend that all infants be breastfed
exclusively for the first six months of life. Breastfeeding may continue with the addition of appropriate
foods, for two years or more. Exclusive breastfeeding has dramatically reduced infant deaths in
developing countries by reducing diarrhea and infectious diseases. It has also been shown to reduce
HIV transmission from mother to child, compared to mixed feeding.[81][82][83][84]
Exclusively breastfed infants feed anywhere from 6 to 14 times a day. Newborns consume from 30 to
90 ml (1 to 3 US fluid ounces) per feed. After the age of four weeks, babies consume about 120ml (4
US fluid ounces) per feed. Each baby is different, but as it grows the amount will increase. It is
important to recognize the baby's hunger signs. It is assumed that the baby knows how much milk it
needs and it is therefore advised that the baby should dictate the number, frequency, and length of each
feed. The supply of milk from the breast is determined by the number and length of these feeds or the
amount of milk expressed. The birth weight of the baby may affect its feeding habits, and mothers may
be influenced by what they perceive its requirements to be. For example, a baby born small for
gestational age may lead a mother to believe that her child needs to feed more than if it larger; they
should, however, go by the demands of the baby rather than what they feel is necessary.
While it can be hard to measure how much food a breastfed baby consumes, babies normally feed to
meet their own requirements.[85] Babies that fail to eat enough may exhibit symptoms of failure to
thrive. If necessary, it is possible to estimate feeding from wet and soiled nappies (diapers): 8 wet cloth
or 5–6 wet disposable, and 2–5 soiled per 24 hours suggests an acceptable amount of input for
newborns older than 5–6 days old. After 2–3 months, stool frequency is a less accurate measure of
adequate input as some normal infants may go up to 10 days between stools. Babies can also be
weighed before and after feeds.

[edit] Expressing breast milk

Manual breast pump


When direct breastfeeding is not possible, a mother can express (artificially remove and store) her milk.
With manual massage or using a breast pump, a woman can express her milk and keep it in freezer
storage bags, a supplemental nursing system, or a bottle ready for use. Breast milk may be kept at room
temperature for up to six hours[citation needed], refrigerated for up to eight days or frozen for up to
four to six months. Research suggests that the antioxidant activity in expressed breast milk decreases
over time but it still remains at higher levels than in infant formula.[86]
Expressing breast milk can maintain a mother's milk supply when she and her child are apart. If a sick
baby is unable to feed, expressed milk can be fed through a nasogastric tube.
Expressed milk can also be used when a mother is having trouble breastfeeding, such as when a
newborn causes grazing and bruising. If an older baby bites the nipple, the mother's reaction - a jump
and a cry of pain - is usually enough to discourage the child from biting again.
"Exclusively expressing", "exclusively pumping" and "EPing" are terms for a mother who feeds her
baby exclusively on her breastmilk while not physically breastfeeding. This may arise because her baby
is unable or unwilling to latch on to the breast. With good pumping habits, particularly in the first 12
weeks when the milk supply is being established, it is possible to produce enough milk to feed the baby
for as long as the mother wishes.
It is generally advised to delay using a bottle to feed expressed breast milk until the baby is 4–6 weeks
old and is good at sucking directly from the breast.[87] As sucking from a bottle takes less effort,
babies can lose their desire to suck from the breast. This is called nursing strike or nipple confusion. To
avoid this when feeding expressed breast milk (EBM) before 4–6 weeks of age, it is recommended that
breast milk be given by other means such as feeding spoons or feeding cups. Also, EBM should be
given by someone other than the breastfeeding mother (or wet nurse), so that the baby can learn to
associate direct feeding with the mother (or wet nurse) and associate bottle feeding with other people.
[citation needed]
Some women donate their expressed breast milk (EBM) to others, either directly or through a milk
bank. Though historically the use of wet nurses was common, some women dislike the idea of feeding
their own child with another woman's milk; others appreciate being able to give their baby the benefits
of breast milk. Feeding expressed breast milk—either from donors or the baby's own mother—is the
feeding method of choice for premature babies.[88] The transmission of some viral diseases through
breastfeeding can be prevented by expressing breast milk and subjecting it to Holder pasteurisation.[89]

[edit] Mixed feeding

Expressed breast milk (EBM) or infant formula can be fed to an infant by bottle
Predominant or mixed breastfeeding means feeding breast milk along with infant formula, baby food
and even water, depending on the age of the child. Babies feed differently with artificial teats than from
a breast. With the breast, the infant's tongue massages the milk out rather than sucking. With an
artificial teat, an infant will suck as long as there is milk flowing and it is easy to overfeed with a bottle.
Since the flow is constant, and the baby does not have to elicit a letdown, mixing breastfeeding and
bottle-feeding (or using a pacifier) before the baby is used to feeding from its mother, can result in the
infant preferring the bottle to the breast. Some mothers supplement feed with a small syringe or flexible
cup to reduce the risk of artificial nipple preference. When using a bottle it is important to use the
slowest flow the baby will accept (and not move up to a faster flow just because the baby is getting
older) and feed in a paced manner. The baby should sit almost upright and the bottle should be only
tipped slightly to allow for a little bit of milk to pass to the baby. Bottle feeding should take as long as
breastfeeding does. Faster feeding can easily result in overfeeding.

[edit] Tandem breastfeeding


Feeding two children at the same time is called tandem breastfeeding The most common reason for
tandem breastfeeding is the birth of twins, although women with closely spaced children can and do
continue to nurse the older as well as the younger. As the appetite and feeding habits of each baby may
not be the same, this could mean feeding each according to their own individual needs, and can also
include breastfeeding them together, one on each breast.
In cases of triplets or more, it is a challenge for a mother to organize feeding around the appetites of all
the babies. While breasts can respond to the demand and produce large quantities of milk, it is common
for women to use alternatives. However, some mothers have been able to breastfeed triplets
successfully.[90][91][92]
Tandem breastfeeding may also occur when a woman has a baby while breastfeeding an older child.
During the late stages of pregnancy the milk will change to colostrum, and some older nurslings will
continue to feed even with this change, while others may wean due to the change in taste or drop in
supply. Feeding a child while being pregnant with another can also be considered a form of tandem
feeding for the nursing mother, as she also provides the nutrition for two.[93]

[edit] Duration of breastfeeding


In the United States a study published by the Center for Disease Control and Prevention found that 75
percent of mothers began breastfeeding. However, by 6 months, the rate fell to 43% and was just 22%
after a year. Breastfeeding rates vary across the country, from nearly 90 percent initiating breastfeeding
in Utah to 52.5 percent in Mississippi. The health care law now requires large employers to provide
breast-feeding mothers with breaks and a private space—not a toilet—to express milk.[94]

[edit] Extended Breast-feeding


Extended breast-feeding was at one time a very common practice worldwide [95]. Dr. Martin Stein
wrote in Parental Concerns about Extended Breastfeeding in a Toddler that “The discussion about
extended nursing is similar to that of co-sleeping. They are both characteristics of child rearing that are
closely linked to time and place. In most cultures before the 20th century, both practices were the norm.
Changes in social, economical, and sexual expectations altered our views of the meaning of
breastfeeding and bed sharing.” Extended breastfeeding was encouraged in Ancient Greek, Hebrew,
and Muslim cultures. The Koran, the Talmud, and the writings of Aristotle all recommend
breastfeeding for 2 to 3 years [96]. In Breastfeeding Beyond 6 Months: Mothers' Perceptions of the
Negative and Positive Consequences, Dr. S. B. Reamer states that “Over the past 100 years of
American history, the acceptance of unrestricted nursing decreased and the age acceptable for weaning
dropped dramatically, until the average weaning age was 3 months in the 1970's.” The current average
weaning age in America is 12 months.

[edit] Global Practices


While breastfeeding beyond 1 year of age is considered extended breastfeeding in the United States
[96], experts say that the average age of weaning worldwide is 4 to years [95]. In Guinea-Bissau, West
Africa, the average length of breastfeeding is 22.6 months [97] and in India, mothers commonly
breastfeed their children until 3 to 4 years of age. Stein says that “In India, women often wean their 3 or
4-year-old by putting the juice of a bitter gourd or melon on their nipples.” Although the American
Academy of Pediatrics stated in 1997 that “It is recommended that breastfeeding continue for at least
12 months, and thereafter as mutually desired”, the World Health Organization recommends
breastfeeding for at least 2 years.

[edit] Western Practices


Elizabeth Baldwin says in Extended Breastfeeding and the Law, that “Because our culture tends to
view the breast as sexual, it can be hard for people to realize that breastfeeding is the natural way to
nurture children.” In Western countries such as The United States of America, Canada, and Great
Britain, extended breastfeeding is a very taboo act. It is difficult to obtain accurate information and
statistics about extended breastfeeding in these countries because of the mother's embarrassment [98].
Mothers that nurse longer than the social norm sometimes hide their practices from all but very close
family members and friends. This is called “closet nursing” [98]. There are several organizations in
place to support mothers that practice extended breastfeeding. These organizations include the
International Childbirth Education Association and La Leche League International [98]. In a study
published by the Journal of Tropical Pediatrics, 24% of mothers nursing past 6 months felt social
hostility towards them. This number grew to 42% when mothers were nursing after 1 year of age. Also,
10% of mothers claimed embarrassment when more mobile, verbal toddlers made known in public the
fact that they were nursed [98].

[edit] Health Effects


Priscilla Colletto stated in Beyond Toddlerhood: The Breastfeeding Relationship Continues, “The
adverse health effects of weaning a child before or during toddlerhood are well documented for Third
World countries such as Guinea-Bissau, where children who were no longer breastfed at ages 12-35
months had a 3.5 times higher mortality rate than did their peers who continued to breastfeed.”[99] Dr.
Laurence Grummer-Strawn observed that breastfeeding is protective against diarrheal diseases and
other infections, breastfed children aged 12 to 36 months in Indonesia have much greater mid-arm
circumference than children who have been weaned, and the incidences of malnourishment in breastfed
Indonesian children are 3-5% less common than generally encountered in Indonesian clinics. Studies
suggest that extended breastfeeding may reduce the chances of otitis media allergies, leukemia, and
lymphoma for the toddler, and premenopausal breast cancer in the mother. This is attributed to the fact
that the levels of lysozyme, lactoferrin, and secretory IgA are stable and even increase in the breast
milk of mothers who are breastfeeding for over 1 year. (Stein 1507). In one study, artificially-fed
infants had 2 to 3 times as many episodes of significant illnesses (defined as “otitis media, lower
respiratory disease, significant vomiting or diarrhea, and any illness requiring hospital admission”)
[98]. However, there are also some studied risks involved in extended breastfeeding. Breastfeeding
could impair a child's growth if they are not taught to eat other foods as well. Breast milk is alone is not
enough for children over 6 months of age and some have observed that children that have been
breastfed longer than the norm have less of an appetite for added foods [100]. Stein says that “As long
as a toddler is eating a variety of grains, vegetables, fruits, and foods or supplements that provide
adequate iron and vitamin D, nutrition will be adequate and appropriate growth and development will
be ensured.”

[edit] Psychological Effects


In A Time to Wean by Katherine Dettwyler, it states that “Western, industrialized societies can
compensate for some (but not all) of the immunological benefits of breastfeeding with antibiotics,
vaccines and improved sanitation. But the physical, cognitive, and emotional needs of the young child
persist.”[101] Many children who are breast-fed into their toddler years use the milk as a comforting,
bonding moment with their mothers [98]. In a 1974 survey of 152 mothers, 17% said that the security
their toddlers obtained through extended breastfeeding helped them become more independent, 14%
said that extended breastfeeding created a strong mother-child bond, and 14.6% said that extended
breastfeeding strengthened their abilities as a mother. Four mothers said that they felt their child was
too dependent and one mother considered her child a poor eater [98]. Dr. Stein said that “A mother in
my practice who breastfed 2 children until 2 years if age explained that she would slowdown and giver
her undivided attention to her child several times each day when breastfeeding. Her children knew that
she always had time for those moments each day. This time was also important to the mother for
relaxing and unwinding....For many nursing toddlers, the breast comes to serve the same function as a
favorite blanket or stuffed animal in providing comfort and a sense of security.” One issue with
extended breastfeeding is the ability of the mother and the child to separate. Some say that the desire
for extended breastfeeding comes from the mother's inability to let go of “her baby” [96]. Baldwin
refutes this statement, saying that the child is the one who chooses when they are weaned, as it is very
difficult to force a child to breastfeed.
Legal Issues
There have been several cases where children have been taken away from their mother's care because
the courts found the mother's extended breastfeeding to be inappropriate. In 1992, a New York State
mother lost custody of her child for a year. She was still breastfeeding the child at age 3 and had
reported experiences of sexual arousal while breastfeeding the child. The authorities took the child
from the home in the fear that the mother might sexually abuse the child. Later, the social service
agency that took over the case said that there was more to the case than could be released to the press
due to confidentiality laws [95] In 2000, an Illinois child was removed from the mother's care after a
judge ruled that the child might suffer emotional damage because of not being weaned. The child was
later returned to the mother and the judge vacated the finding of neglect (Baldwin) A social service
agency in Colorado removed a 5-year-old child from the mother, because she was still breastfeeding,
but the court ordered the child returned to its family immediately [95]

[edit] Shared breastfeeding


Main article: Wet nurse
It used to be common worldwide, and still is in developing nations such as those in Africa, for more
than one woman to breastfeed a child. Shared breastfeeding is a risk factor for HIV infection in infants.
[102] A woman who is engaged to breastfeed another's baby is known as a wet nurse. Islam has
codified the relationship between this woman and the infants she nurses, and also between the infants
when they grow up, so that milk siblings are considered as blood siblings and cannot marry (mahram).
Shared breastfeeding can incur strong negative reactions in the Anglosphere;[103] American feminist
activist Jennifer Baumgardner has written about her experiences in New York with this issue.[104]
[edit] Weaning
Weaning is the process of introducing the infant to other food and reducing the supply of breast milk.
The infant is fully weaned when it no longer receives any breast milk. Most mammals stop producing
the enzyme lactase at the end of weaning, and become lactose intolerant. Humans often have a
mutation, with frequency depending primarily on ethnic background, that allows the production of
lactase throughout life and so can drink milk - usually cow or goat milk - well beyond infancy.[105] In
humans, the psychological factors involved in the weaning process are crucial for both mother and
infant as issues of closeness and separation are very prominent during this stage.[106]
In the past bromocriptine was in some countries frequently used to reduce the engorgement
experienced by many women during weaning. This is now done only in exceptional cases as it causes
frequent side effects, offers very little advantage over non-medical management and the possibility of
serious side effects can not be ruled out.[107] Other medications such as cabergoline, lisuride or birth
control pills may be occasionally used as lactation suppressants.

[edit] History of breastfeeding

Queen Marie Casimire of Poland with children by Jerzy Siemiginowski, 1684.

Famille d’un Chef Camacan se préparant pour une Fête ("Family of a Camacan chief preparing for a
celebration") by Jean-Baptiste Debret shows a woman breastfeeding a child in the background.
Main article: History of breastfeeding
For hundreds of thousands of years, humans, like all other mammals, fed their young milk. Before the
twentieth century, alternatives to breastfeeding were rare. Attempts in 15th century Europe to use cow
or goat milk were not very positive. In the 18th century, flour or cereal mixed with broth were
introduced as substitutes for breastfeeding, but this did not have a favorable outcome, either. True
commercial infant formulas appeared on the market in the mid 19th Century but their use did not
become widespread until after WWII. As the superior qualities of breast milk became better-established
in medical literature, breastfeeding rates have increased and countries have enacted measures to protect
the rights of infants and mothers to breastfeed.

[edit] Sociological factors with breastfeeding


This section does not cite any references or sources.
Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged
and removed. (June 2010)
Researchers have found several social factors that correlate with differences in initiation, frequency,
and duration of breastfeeding practices of mothers. Race, ethnic differences and socioeconomic status
and other factors have been shown to affect a mother’s choice whether or not to breastfeed and how
long she breastfeeds her child.
• Race and culture Singh et al. also found that African American women are less likely than
white women of similar socioeconomic status to breastfeed and Hispanic women are more
likely to breastfeed. The Center of Disease Control used information from the National
Immunization Survey to determine the proportion of Caucasian and African American children
that were ever breast fed. They found that 71.5% of Caucasians had breastfed their child while
only 50.1% of African Americans had. At six months of age this fell to 53.9% of Caucasian
mothers and 43.2% of African American mothers who were still breastfeeding.[citation needed]
• Income Deborah L. Dee's research found that women and children who qualify for WIC,
Special Supplemental Nutrition Program for Women, Infants, and Children were among those
who were least likely to initiate breastfeeding. Income level can also contribute to women
discontinuing breastfeeding early. More highly educated women are more likely to have access
to information regarding difficulties with breastfeeding, allowing them to continue
breastfeeding through difficulty rather than weaning early. Women in higher status jobs are
more likely to have access to a lactation room and suffer less social stigma from having to
breastfeed or express breastmilk at work. In addition, women who are unable to take an
extended leave from work following the birth of their child are less likely to continue
breastfeeding when they return to work.[citation needed]
• Other factors Other factors they found to have an effect on breastfeeding are “household
composition, metropolitan/non-metropolitan residence, parental education, household income or
poverty status, neighborhood safety, familial support, maternal physical activity, and household
smoking status.”[citation needed]

[edit] Breastfeeding in public


Main article: Breastfeeding in public

[edit] Role of marketing


Controversy has arisen over the marketing of breast milk vs. formula; particularly how it affects the
education of mothers in third world counties and their comprehension (or lack thereof) of the health
benefits of breastfeeding.[108] The most famous example being the Nestlé boycott, which arose in the
1970s and continues to be supported by high-profile stars and international groups to this day.[109]
[110]
In 1981, the World Health Assembly (WHA) adopted Resolution WHA34.22 which includes the
International Code of Marketing of Breast-milk Substitutes.

The Seven Issues that Breastfeeding Addresses:


Food
The Only Perfect Food for Infants and the only Perfect Milk for Young Children

Medicine
Immunological Properties of Breastmilk and Breastfeeding as a Healing Process

Economy
The Devastating Consequences of Formula Feeding on the Philippine Economy

Ecology
The Disastrous Consequences of Formula Feeding on the Ecology

Empowerment
Breastfeeding Propels Women and Family Empowerment

Love
Breastfeeding Strengthens Love

Faith
We are wonderfully made! Learn how the human anatomy is designed to breastfeed. It includes
excerpts from the Bible and Koran quoting verses related to breastfeeding.
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.

Up to what age can a baby stay well nourished by just being breastfed?

Q: Up to what age can a baby stay well nourished by just being breastfed?
A: Infants should be exclusively breastfed – i.e. receive only breast milk – for the first six months of
life to achieve optimal growth, development and health. "Exclusive breastfeeding" is defined as giving
no other food or drink – not even water – except breast milk. It does, however, allow the infant to
receive drops and syrups (vitamins, minerals and medicines). Breast milk is the ideal food for the
healthy growth and development of infants; breastfeeding is also an integral part of the reproductive
process with important implications for the health of mothers.
WHO recommends that infants start receiving complementary foods at six months (180 days) of age in
addition to breast milk. Complementary foods should be given 2–3 times a day between 6–8 months,
increasing to 3–4 times a day between 9–11 months. Between 12–23 months of age, 3–4 meals should
be given. In addition, depending on the child's appetite, 1–2 nutritious snacks can be offered between
meals. These 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.
The transition from exclusive breastfeeding to full use of family foods is a very vulnerable period. It is
the time when many infants become malnourished, contributing significantly to the high prevalence of
malnutrition in children under five years of age worldwide. It is essential therefore that infants receive
appropriate, adequate and safe complementary foods to ensure the right transition from the
breastfeeding period to the full use of family foods.

Amounts of foods to offer

Age Texture Frequency Amount at each meala


2–3 meals per day, plus
Start with thick porridge,
frequent breastfeeds Start with 2–3 tablespoonfuls per
6–8 well mashed foods
Depending on the child's feed, increasing gradually to ½ of a
months Continue with mashed
appetite, 1–2 snacks may 250 ml cup
family foods
be offered
3–4 meals per day, plus
Finely chopped or mashed breastfeeds
9–11
foods, and foods that baby Depending on the child's ½ of a 250 ml cup/bowl
months
can pick up appetite, 1–2 snacks may
be offered
3–4 meals per day, plus
breastfeeds
12–23 Family foods, chopped or
Depending on the child's ¾ to full 250 ml cup/bowl
months mashed if necessary
appetite, 1–2 snacks may
be offered
aNote: If baby is not breastfed, give in addition: 1–2 cups of milk per day, and 1–2 extra meals per
day.

10 facts on breastfeeding

WHO recommends
WHO strongly recommends exclusive breastfeeding for the first six months of life. At six months,
other foods should complement breastfeeding for up to two years or more. In addition:
• breastfeeding should begin within an 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 sustenance.

Benefits for mothers


Breastfeeding also benefits mothers. The practice when done exclusively often induces a lack of
menstruation, which is a natural (though not fail-safe) method of birth control. It reduces risks of breast
and ovarian cancer later in life, helps women return to their pre-pregnancy weight faster, and lowers
rates of obesity.

Long-term benefits for children


Beyond the immediate benefits for children, breastfeeding contributes to a lifetime of good health.
Adults who were breastfed as babies often have lower blood pressure and lower cholesterol, as well as
lower rates of overweight, obesity and type-2 diabetes. There is evidence that people who were
breastfed perform better in intelligence tests.

Why not infant formula?


Infant formula does not contain the antibodies found in breast milk and is linked to some risks, such as
water-borne diseases that arise from mixing powdered formula with unsafe water (many families lack
access to clean water). Malnutrition can result from over-diluting formula to "stretch" supplies. Further,
frequent feedings maintain the 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


For HIV-positive mothers, WHO recommends exclusive breastfeeding for the first six months unless
replacement feeding is:
• acceptable (socially welcome)
• feasible (facilities and help are available to prepare formula)
• affordable (formula can be purchased for six months)
• sustainable (feeding can be sustained for six months)
• safe (formula is prepared with safe water and in hygienic conditions).

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. Nipple pain,
and fear that there is not enough milk to sustain the baby are common. Health facilities that support
breastfeeding - by 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 now more than 20 000 "baby-friendly" facilities in 152 countries thanks to a WHO-UNICEF
initiative.

Work and breastfeeding


WHO recommends that a new mother should have at least 16 weeks of absence from work after
delivery, to be able to rest and breastfeed her child. Many mothers who go back to work abandon
exclusive breastfeeding before the recommended six months because they do not have sufficient time,
or an adequate place to breastfeed or express and store their milk at work. Mothers need access to a
safe, clean and private place in or near their workplaces to continue the practice.

The next step: phasing in new foods


To meet the growing needs of babies at six months of age, complementary foods should be introduced
as they continue to breastfeed. Foods for the baby can be specially prepared or modified from family
meals. WHO notes that:
• breastfeeding should not be decreased when starting complementary feeding;
• complementary foods should be given with a spoon or cup, not in a bottle;
• foods should be clean, safe and locally available; and
• ample time is needed for young children to learn to eat solid foods.
Breastfeed your baby for the first 6 to 12 months after birth. Breastfeeding is healthy for
you and your baby.
If you have a health condition or are taking any medicines, talk with your doctor or midwife about
breastfeeding before your baby is born.
To learn more:
• Learning to Breastfeed (http://www.womenshealth.gov/breastfeeding/learning-to-breastfeed/)
• Breastfeeding for African American Women and Their Families [PDF - 1.20
MB] (http://www.womenshealth.gov/pub/BF.AA.pdf)
What are the benefits of breastfeeding?
Breastfeeding is a healthy choice for both you and your baby.
Benefits for baby
Breast milk:
• Has just the right amount of protein, fat, sugar, and water to help your baby grow
• Helps protect your baby from infection and illness
• Is usually easier for babies to digest than formula
Benefits for mom
Breastfeeding:
• Gives you and your baby time to be close and bond
• Can save your family thousands of dollars
• Burns calories
• May help lower your risk of diabetes, depression, and some types of breast and ovarian
cancers
When is my baby ready to eat other foods?
• From birth to age 6 months:
• Feed your baby breast milk only (no water, no juice, no nonhuman milk, and
no foods).
• It’s okay to give your baby vitamins, minerals, and medicine that your doctor
recommends.
• From ages 6 months to 12 months:
• Keep breastfeeding your baby.
• You can start feeding your baby cereal or other baby food.
• For age 12 months and up:
• Continue to feed your baby new foods that are recommended by your doctor.
• If you can, keep breastfeeding.

Take Action!
Here are some tips for breastfeeding success.
Talk to your doctor or midwife about breastfeeding.
While you are pregnant, tell your doctor or midwife that you plan to breastfeed.
Many health centers, clinics, and hospitals have lactation counselors to answer all your questions and
help you get started. A lactation counselor (or lactation specialist) helps women learn how to
breastfeed.
After you begin breastfeeding, you may have questions about how you and your baby are doing with
breastfeeding. Talk to your doctor, nurse, or lactation counselor as often as you need to.
Make a plan for after your baby is born.
If you plan to go to work after pregnancy, a lactation counselor can help you plan to keep providing
Breastfeed Your Baby
Breastfeeding is a process that takes time to master. Babies and mothers need to practice. Keep in mind
that you make milk in response to your baby sucking at the breast. The more milk your baby removes
from the breasts, the more milk you will make.

How Breast Milk Is Made


Knowing how the
breast works to
produce milk can help
you understand the
breastfeeding process.
The breast itself is a
gland that is made up
of several parts,
including:
• Glandular
tissue – body
tissue that
makes and
releases one or
more
substances for use in the body. Some glands make fluids that affect tissues or organs. Others
make hormones or assist with blood production. In the breast, this tissue is involved in milk
production.
• Connective tissue – a type of body tissue that supports other tissues and binds them together.
This tissue provides support in the breast.
• Blood – fluid in the body made up of plasma, red and white blood cells, and platelets. Blood
carries oxygen and nutrients to and waste materials away from all body tissues. In the breast,
blood nourishes the breast tissue and provides nutrients needed for milk production.
• Lymph – the almost colorless fluid that travels through the lymphatic system and carries cells
that help fight infection and disease. Lymph tissue in the breast helps remove waste.
• Nerves – cells that are the building blocks of the nervous system (the system that records and
transmits information chemically and electrically within a person). Nerve tissue in the breast
makes breasts sensitive to touch, allowing the baby’s sucking to stimulate the let-down or milk-
ejection reflex and milk production. Learn more about let-down reflex.
• Fatty tissue – connective tissue that contains stored fat. It is also known as adipose tissue. Fatty
tissue in the breast protects the breast from injury. Fatty tissue is what mostly affects the size of
a woman’s breast. Breast size does not have an effect on the amount of milk or the quality of
milk a woman makes.
Special cells inside your breasts make milk. These cells are called alveoli (al-VEE-uh-leye). When your
breasts become fuller and tender during pregnancy, this is a sign that the alveoli are getting ready to
work. Some women do not feel these changes in their breasts. Others may sense these changes after
their baby is born.
The alveoli make milk in response to the hormone prolactin (proh-LAK-tin). Prolactin rises when the
baby suckles. Another hormone, oxytocin (oks-ee-TOH-suhn), causes small muscles around the cells to
contract and move the milk through a series of small tubes called milk ducts. This moving of the milk
is called let-down reflex. Learn more about let-down reflex.
Oxytocin also causes the muscles of the uterus to contract during and after birth. This helps the uterus
to get back to its original size. It also lessens any bleeding a woman may have after giving birth. The
release of both prolactin and oxytocin may be responsible in part for a mother’s intense feeling of
needing to be with her baby.
What is a let-down reflex?

A let-down reflex or milk ejection reflex is a conditioned reflex ejecting milk from the alveoli through
the ducts to the sinuses of the breast and the nipple. This reflex makes it easier to breastfeed your baby.
Let-down happens a few seconds to several minutes after you start breastfeeding your baby. It can
happen a few times during a feeding, too. You may feel a tingle in your breast or you may feel a little
uncomfortable. Keep in mind that some women don’t feel anything. Let-down can happen at other
times, too, such as when you hear your baby cry or when you may just be thinking about your baby. If
your milk lets down as more of a gush and it bothers your baby, try expressing some milk by hand
before you start breastfeeding.
[Return to Top]

What You Can Do Before You Give Birth


To prepare for breastfeeding, the most important thing you can do is What Dad Can Do
have confidence in yourself. Committing to breastfeeding starts with
the belief that you can do it! A woman who is thinking about
how to feed her baby values her
Other steps you can take to prepare for breastfeeding:
partner’s advice. A father’s
1. Get good prenatal care, which can help you avoid early approval and support of
delivery. Babies born too early often need special care, which breastfeeding can boost the
can make breastfeeding harder. mother’s confidence and help
2. Tell your health care provider about your plans to breastfeed, her to overcome challenges. But
and ask if the place where you plan to deliver your baby has supporting a woman’s choice to
the staff and set-up to support successful breastfeeding. Some breastfeed is not the father’s
hospitals and birth centers have taken special steps to create only role. Although the bond
the best possible environment for successful breastfeeding. between mother and baby is
They are called Baby-Friendly Hospitals and Birth Centers. important, so is the bond
Women who deliver in a baby-friendly facility are promised between father and baby. Babies
the information and support they need to breastfeed their need cuddles and hugs from
infants. their dads, too! In fact, skin-to-
3. Take a breastfeeding class. Pregnant women who learn about skin contact helps baby and
how to breastfeed are more likely to be successful than those father bond much like it does
who do not. Breastfeeding classes offer pregnant women and for mother and baby.
their partners the chance to prepare and ask questions before
the baby’s arrival.
4. Ask your health care provider to recommend a lactation consultant. You can establish a
relationship before the baby comes, or be ready if you need help after the baby is born.
5. Talk to your health care provider about your health. Discuss any breast surgery or injury you
may have had. If you have depression or are taking medications, discuss treatment options that
can work with breastfeeding.
6. Tell your health care provider that you would like to breastfeed your newborn baby as soon as
possible after delivery. The sucking instinct is very strong within the first hour of life.
7. Talk to friends who have breastfed or consider joining a breastfeeding support group.
8. Talk to fathers, partners, and other family members about how they can help. Partners and
family members can:
• Support the breastfeeding relationship by being kind and encouraging.
• Show their love and appreciation for all of the work that is put into breastfeeding.
• Be good listeners when a mother needs to talk through breastfeeding concerns.
• Make sure the mother has enough to drink and gets enough rest, help around the house,
and take care of other children at home.
• Give emotional nourishment to the child through playing and cuddling.
[Return to Top]

Tips For Getting Off to a Good Start


After you have the baby, these steps can help you get off to a great start:
• Breastfeed as soon as possible after birth.
• Ask for an on-site lactation consultant to come help you.
• Ask the staff not to give your baby other food or formula, unless it is medically necessary.
• Allow your baby to stay in your hospital room all day and night so that you can breastfeed
often. Or, ask the nurses to bring you your baby for feedings.
• Try to avoid giving your baby any pacifiers or artificial nipples so that he or she gets used to
latching onto just your breast.
[Return to Top]

Bringing Your Baby to the Breast to Latch


When awake, your baby will move his or her head back and forth, Did you know?
looking and feeling for the breast with his or her mouth and lips. The
steps below can help you get your baby to “latch” on to the breast to Some babies latch on right
start eating. Keep in mind that there is no one way to start away and for some, it takes
breastfeeding. As long as the baby is latched on well, how you get more time.
there is up to you.
• Hold your baby, wearing only a diaper, against your bare chest. Hold the baby upright with his
or her head under your chin. Your baby will be comfortable in that cozy valley between your
breasts. You can ask your partner or a nurse to place a blanket across your baby’s back and bring
your bedcovers over you both. Your skin temperature will rise to warm your baby.
• Support his or her neck and shoulders with one hand and hips with the other. He or she may
move in an effort to find your breast.
• Your baby’s head should be tilted back slightly to make it easy to suck and swallow. With his or
her head back and mouth open, the tongue is naturally down and ready for the breast to go on
top of it.
• Allow your breast to hang naturally. When your baby feels it with his or her cheek, he or she
may open his or her mouth wide and reach it up and over the nipple. You can also guide the
baby to latch on as you see in the illustrations below.
• At first, your baby’s nose will be lined up opposite your nipple. As his or her chin presses into
your breast, his or her wide, open mouth will get a large mouthful of breast for a deep latch.
Keep in mind that your baby can breathe at the breast. The nostrils flare to allow air in.
• Do not put your hands on your baby’s head. As it tilts back, support your baby’s upper back and
shoulders with the palm of your hand and pull your baby in close.

Getting your baby to latch

1. Tickle the baby’s lips to encourage 2. Pull your baby close so that the 3. Watch the lower lip and aim it as
him or her to open wide. chin and lower jaw moves into your far from base of nipple as possible, so
breast first. the baby takes a large mouthful of
breast.
Click on the start button for a demonstration

Object 1
Object 2

Text only version

Signs of a good latch


• The latch feels comfortable to you, without hurting or Did you know?
pinching. How it feels is more important than how it looks.
• Your baby’s chest is against your body and he or she does not A good latch is important for
have to turn his or her head while drinking. your baby to breastfeed
• You see little or no areola, depending on the size of your effectively and for your
areola and the size of your baby’s mouth. If areola is comfort. During the early days
showing, you will see more above your baby’s lip and less of breastfeeding, it can take
below. time and patience for your baby
• When your baby is positioned well, his or her mouth will be to latch on well.
filled with breast.
• The tongue is cupped under the breast, although you might not see it.
• You hear or see your baby swallow. Some babies swallow so quietly, a pause in their breathing
may be the only sign of swallowing.
• You see the baby’s ears “wiggle” slightly.
• Your baby’s lips turn out like fish lips, not in. You may not even be able to see the bottom lip.
• Your baby’s chin touches your breast.

Help with latch problems


Are you in pain? Many moms report that their breasts can be tender at first until both they and their
baby find comfortable breastfeeding positions and a good latch. Once you have done this, breastfeeding
should be comfortable. If it hurts, your baby may be sucking on only the nipple. Gently break your
baby’s suction to your breast by placing a clean finger in the corner of your baby’s mouth and try again.
Also, your nipple should not look flat or compressed when it comes out of your baby’s mouth. It should
look round and long, or the same shape as it was before the feeding.
Are you or your baby frustrated? Take a short break and hold your baby in an upright position. Try
holding him or her between your breasts skinto-your-skin. Talk, sing, or provide your finger for
sucking for comfort. Try to breastfeed again in a little while. Or, the baby may start moving to the
breast on his or her own from this position.
Does your baby have a weak suck, or make only tiny suckling movements? Break your baby’s
suction and try again. He or she may not have a deep enough latch to remove the milk from your breast.
Talk with a lactation consultant or pediatrician if your baby’s suck feels weak or if you are not sure he
or she is getting enough milk. Rarely, a health problem causes the weak suck.
[Return to Top]

How Often Should I Breastfeed? How Long Should Feedings


Be?
Early and often! Breastfeed as soon as possible after birth, then breastfeed at least 8 to 12 times every
24 hours to make plenty of milk for your baby. This means that in the first few days after birth, your
baby will likely need to breastfeed about every hour or two in the daytime and a couple of times at
night. Healthy babies develop their own feeding schedules. Follow your baby’s cues for when he or she
is ready to eat.
Feedings may be 15 to 20 minutes or longer per breast. But there is no set time. Your baby will let you
know when he or she is finished. If you are worried that your baby is not eating enough, talk to your
baby’s doctor. Use our Feeding Chart (PDF, 110 KB) to write down when your baby wants to eat.
[Return to Top]

Breastfeeding Holds
Some moms find that the following positions are helpful ways to get comfortable and support their
babies in finding a good latch. You also can use pillows under your arms, elbows, neck, or back to give
you added comfort and support. Keep in mind that what works well for one feeding may not work well
for the next. Keep trying different positions until you are comfortable.

Cradle hold – an easy, common hold that is comfortable for most


mothers and babies. Hold your baby with his or her head on your
forearm and his or her whole body facing yours.
Cross cradle or transitional hold – useful for premature babies or
babies with a weak suck because it gives extra head support and may
help babies stay latched. Hold your baby along the opposite arm from
the breast you are using. Support your baby’s head with the palm of
your hand at the base of his or her neck.

Clutch or “football” hold – useful for mothers who had a c-section and
mothers with large breasts, flat or inverted nipples, or a strong letdown
reflex. It is also helpful for babies who prefer to be more upright. This
hold allows you to better see and control your baby’s head, and keep the
baby away from a c-section incision. Hold your baby at your side, lying
on his or her back, with his or her head at the level of your nipple.
Support baby’s head with the palm of your hand at the base of the head.
(The baby is placed almost under the arm.)

Side-lying position – useful for mothers who had a c-section or to help


any mother get extra rest while the baby breastfeeds. Lie on your side
with your baby facing you. Pull your baby close so your baby faces
your body.

[Return to Top]

Tips For Making It Work


1. Learn your baby’s hunger signs – When babies are hungry, they become more alert and
active. They may put their hands or fists to their mouths, make sucking motions with their
mouth, or turn their heads looking for the breast. If anything touches the baby’s cheek — such
as a hand — the baby may turn towards this hand, ready to eat. This sign of hunger is called
rooting. Offer your breast when your baby shows rooting signs. Crying can be a late sign of
hunger and it may be harder to latch once the baby is upset. Over time, you will be able to learn
your baby’s cues for when to start feeding.
2. Follow your baby’s lead – Make sure you are both comfortable and follow your baby’s lead
after he or she is latched on well. Some babies take both breasts at each feeding. Other babies
only take one breast at a feeding. Help your baby finish the first breast, as long as he or she is
still sucking and swallowing. This will ensure the baby gets the “hind” milk — the fattier milk
at the end of a feeding. Your baby will let go of the breast when he or she is finished, and often
falls asleep. Offer the other breast if he or she seems to want more.
3. Keep your baby close to you – Remember that your baby is not used to this new world and
needs to be held very close to his or her mother. Being skin-to-skin helps babies cry less and
stabilizes the baby’s heart and breathing rates.
4. Avoid nipple confusion – Avoid using pacifiers, bottles, and supplements of infant formula in
the first few weeks unless there is a medical reason to do so. If supplementation is needed, try to
give expressed breast milk first. But it’s best just to feed at the breast. This will help you make
milk and keep your baby from getting confused while learning to breastfeed.
5. Sleep safely and close by – Have your baby sleep in a crib or bassinet in your room, so that you
can breastfeed more easily at night. Sharing a room with parents is linked to a lower risk of
SIDS (sudden infant death syndrome).
6. Know when to wake the baby – In the early weeks after birth, you should wake your baby to
feed if 4 hours have passed since the beginning of the last feeding. Some tips for waking the
baby include:
• Changing your baby’s diaper
• Placing your baby skin-to-skin
• Massaging your baby’s back, abdomen, and legs
If your baby is falling asleep at the breast during most feedings, talk to the baby’s doctor about a
weight check. Also, see a lactation consultant to make sure the baby is latching on well.
[Return to Top]

Making Plenty of Milk


Your breasts will easily make and supply milk directly in response to your baby’s needs. The more
often and effectively a baby breastfeeds, the more milk will be made. Babies are trying to double their
weight in a few short months, and their tummies are small, so they need many feedings to grow and to
be healthy.
Most mothers can make plenty of milk for their baby. If you think you have a low milk supply, talk to a
lactation consultant. Visit the Finding Support and Information section for other types of health
professionals who can help you.
What will happen with you, your baby, and your milk in the first few weeks
Time Milk The Baby You (Mom)
Birth Your body makes Will probably be awake in the first hour after You will be tired and
colostrum (a rich, birth. This is a good time to breastfeed your baby. excited.
thick, yellowish milk)
in small amounts. It
gives your baby a
healthy dose of early
protection against
diseases.
First Your baby will drink It is normal for the baby to sleep heavily. Labor You will be tired,
12-24 about 1 teaspoon of and delivery are hard work! Some babies like to too. Be sure to rest.
hours colostrum at each nuzzle and may be too sleepy to latch well at
feeding. You may or first. Feedings may be short and disorganized. As
may not see the your baby wakes up, take advantage of your
colostrum, but it has baby’s strong instinct to suck and feed every 1-2
what the baby needs hours. Many babies like to eat or lick, pause,
and in the right savor, doze, then eat again.
amount.
Next 3- Your white milk Your baby will feed a lot (this helps your breasts Your breasts may
5 days comes in. It is normal make plenty of milk), at least 8-12 times or more feel full and leak.
for it to have a yellow in 24 hours. Very young breastfed babies don’t (You can use
or golden tint first. eat on a schedule. Since breast milk is more disposable or cloth
Talk to a doctor and easily digested than formula, breastfed babies eat pads in your bra to
lactation consultant if more often than formula-fed babies. It is okay if help with leaking.)
your milk is not yet your baby eats every 2-3 hours for several hours,
in. then sleeps for 3-4 hours. Feedings may take
about 15-20 minutes on each side. The baby’s
sucking rhythm will be slow and long. You might
hear gulping.
The White breast milk. Your baby will likely be better at breastfeeding Your body gets used
first 4- and have a larger stomach to hold more milk. to breastfeeding so
6 Feedings may take less time and will be farther your breasts will be
weeks apart. softer and the
leaking may slow
down.

How to Know Your Baby is Getting Enough Milk


Many babies, but not all, lose a small amount of weight in the first days after birth. Your baby’s doctor
will check his or her weight at your first visit after you leave the hospital. Make sure to visit your
baby’s doctor within three to five days after birth and then again at two to three weeks of age for check-
ups.
You can tell if your baby is getting plenty of milk if he or she is mostly content and gaining weight
steadily after the first week of age. From birth to three months, typical weight gain is 2/3 to 1 ounce
each day.
Other signs that your baby is getting plenty of milk:
• He or she is passing enough clear or pale yellow urine, and it’s not deep yellow or orange (see
the chart below).
• He or she has enough bowel movements (see the chart below).
• He or she switches between short sleeping periods and wakeful, alert periods.
• He or she is satisfied and content after feedings.
• Your breasts feel softer after you feed your baby.
Talk to your baby’s doctor if you are worried that your baby is not eating enough.
How much do babies typically eat?

A newborn’s tummy is very small, especially in the early days. Once breastfeeding is established,
exclusively breastfed babies from 1 to 6 months of age take in between 19 and 30 ounces per day. If
you breastfeed 8 times per day, the baby would eat around 3 ounces per feeding. Older babies will take
less breastmilk as other food is introduced. Every baby is different, though.

The Newborn Tummy

Hazelnut Walnut

At birth, the baby’s stomach can comfortably digest what would fit in a hazelnut (about 1-2 teaspoons).
In the first week, the baby’s stomach grows to hold about 2 ounces or what would fit in a walnut.

Minimum number of wet diapers and bowel movements in a baby's first week
(it is fine if your baby has more) 1 day = 24 hours
Number of Wet Color and Texture of Bowel
Baby's Age Number of Bowel Movements
Diapers Movements
Day 1 (first 24 The first one usually occurs
1 Thick, tarry, and black
hours after birth) within 8 hours after birth
Day 2 2 3 Thick, tarry, and black
Day 3 Looser greenish to yellow
5-6 3
(color may vary)
Day 4 6 3 Yellow, soft, and watery
Day 5 6 3 Loose and seedy, yellow color
Day 6 6 3 Loose and seedy, yellow color
Day 7 Larger amounts of loose and
6 3
seedy, yellow color

Print a blank worksheet to keep track of wet diapers and bowel


movements
Diaper Checklist (PDF, 325 KB)
[Return to Top]

How Long Should I Breastfeed?


Many leading health organizations recommend that most infants breastfeed for at least 12 months, with
exclusive breastfeeding for the first 6 months. This means that babies are not given any foods or liquids
other than breast milk for the first 6 months. These recommendations are supported by organizations
including the American Academy of Pediatrics, American Academy of Family Physicians, American
Congress of Obstetricians and Gynecologists, American College of Nurse-Midwives, American
Dietetic Association, and American Public Health Association.

Re: How can I increase my milk supply?

First, consider why you feel the need to increase your milk supply. Lots of moms think they have a low
milk supply, when their milk supply is just fine. If you are exclusively breastfeeding and baby’s weight
gain is on target, there is absolutely nothing wrong with your milk supply. This holds true even if baby
is fussy, suddenly gets hungry often, will take a bottle immediately after breastfeeding, or if your
breasts are soft, and even if you aren’t able to pump any milk. If baby is gaining weight, you DO have
enough milk. To maintain a healthy milk supply, most moms don’t need to do anything (besides feed
baby when she’s hungry).
If you do have a low milk supply, you'll need to figure out why. Work with an internationally certified
lactation consultant (IBCLC) to help get to the root of your particular supply issue. If your supply is
dropping, it may mean that baby isn't effectively removing the milk from your breasts. You may need to
help baby achieve a deeper latch, or you may need to wake baby to nurse more frequently. It is very
important not to supplement as you try to build your milk supply (unless there is a clear medical
reason, like if a newborn has dropped 10 percent of his birth weight). Supplemental bottles signal your
body to make less milk. Also, using artificial nipples (aka bottles or pacifiers) can lower your milk
supply since baby can learn improper sucking techniques. Pacifiers can also lower supply by taking
away baby's cues to feed.
Once you have identified the problem and know how to solve it (or if you are trying to boost your
supply for another reason, like to increase your pumping output at work or to feed an adopted baby),
there are three main ways to increase your milk supply:
Frequent feedings
Frequent breastfeeding is the number one way to establish and/or grow your supply of breast milk. As a
general rule, the more baby nurses, the more milk your body will produce. Nursing baby every two
hours (or less) for a couple of days can be very effective in giving your supply a boost. Frequent
nursing is especially important in the first days and weeks of breastfeeding as you work to establish a
healthy supply of breast milk.
Breast pumps
If frequent nursing isn't boosting your supply enough, consider emptying your breasts with a high-
quality double-electric pump. Breastfeeding is a supply-and-demand affair: Your body makes milk
according to the amount removed from your breasts. Try pumping between feedings or pumping one
breast while baby nurses on the other. Continue to pump for five or so minutes after the milk stops
coming. The added stimulation will signal your body to produce more milk.
Galactagogues
Galactagogues are substances that increase milk supply. Fenugreek, blessed thistle, and alfalfa are
herbal galactagogues sometimes used to increase supply, and sometimes prescription medicines are
used, like Metoclopramide (Reglan), Domperidone (Motilium), and sulpiride (Eglonyl, Dolmatil,
Sulpitil, Sulparex, Equemote). The drug Domperidone isn't widely available in the United States, but it
is approved by the American Academy of Pediatrics for use in breastfeeding mothers. (The primary use
of the drug is to treat nausea and vomiting caused by other drugs; a boost in milk production is a side
effect.) You may be able to order Domperidone online from Canada or other countries. Talk to a doctor
and/or board certified lactation consultant (IBCLC) before using any galactagogue.
Rest and stress reduction may make it easier for you to make milk too. And remember to avoid
pacifiers and bottles, and give baby only breast milk. (If you have been supplementing with formula,
gradually give less and less. This should help baby suckle on your breasts more, leading to increased
milk supply.)

Successful breastfeeding in just 10 steps

INQUIRER.net
First Posted 12:03:00 08/01/2010

Filed Under: Health, Children


MANILA, Philippines—The world celebrates this year’s Breastfeeding Month by recognizing the vital
role health facilities play to help improve the rate of breastfeeding in the community. Research shows
that hospitals and maternity units can greatly influence a mother’s decision on whether or not to
breastfeed her child.

“This year, we are commemorating the 20th anniversary of the Innocenti Declaration on the Protection,
Promotion, and Support of Breastfeeding,” said Vanessa Tobin, country representative of the UN
children’s agency Unicef.

Unicef advocates for a breastfeeding culture in the Philippines. Together with other child rights actors,
it pushes for exclusive breastfeeding in the first six months of life. Exclusive breastfeeding means
feeding the child with only mother’s milk and nothing else, not even water.

Soft, semi-solid, and solid food is ideal for babies six months and beyond, while the mother continues
breastfeeding. This is called complementary feeding. Complementary feeding gives children the variety
of nutrients that they need for their age, and will help them to develop fully into healthy and active
individuals.

In response to one of the operational targets of the Innocenti Declaration, Unicef and the World Health
Organization (WHO) launched the Baby-Friendly Hospital Initiative (BFHI) in 1991. The BFHI
ensures that all free standing and hospital maternities become centers of breastfeeding support.

A maternity facility is considered “baby-friendly” when it does not accept free or low-cost breast milk
substitutes, feeding bottles or teats, and has implemented these 10 steps to support successful
breastfeeding:

1. Have a written breastfeeding policy that is routinely communicated to all health care staff. The 10
steps call for health facilities to have written policies that are displayed for all to read, indicating that
staff is committed to implementing them.

2. Train all health care staff in skills necessary to implement this policy. Training at all levels should
address the 10 steps, breastfeeding, counselling, and the International Code.

3. Inform all pregnant women about the benefits and management of breastfeeding. By the time a baby
is born, the new mother must be comfortable about breastfeeding, understand its benefits, and what she
has to do.

4. Help mothers initiate breastfeeding within one half-hour of birth. This step now means, for all
healthy newborns, skin-to-skin contact from immediately after delivery for at least one hour or until the
baby has attached and fed at the breast if this takes longer.

5. Show mothers how to breastfeed and maintain lactation, even if they should be separated from their
infants. Helping mothers to breastfeed effectively with a good technique is a vital step. If infants are
separated from their mothers, or are unable to suckle, their mothers need to express their milk. Health
workers need skills to help mothers do these things.

6. Give newborn infants no food or drink other than breast milk, unless medically indicated. Families
and health workers may believe that infants need pre-lacteal feeds of formula or glucose water or other
drinks before their mother’s milk “comes in.” This may lead to failure to breastfeed. Infant formula and
advertisements in maternities can mislead people on this important point. Breast milk is pure and
complete, while giving babies water or other liquids can pose risks due to contaminated water.

7. Practice rooming-in—that is, allow mothers and infants to remain together 24 hours a day. In many
hospitals, newborns are kept in nurseries after delivery. Rooming-in allows mothers and their babies to
stay together day and night to bond and to establish breastfeeding.

8. Encourage breastfeeding on demand. Babies should feed according to their needs, not a schedule
decided by the hospital or mother. Understanding her infant’s feeding cues improved breastfeeding and
the mother-child relationship.

9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants. During
the early weeks, the baby’s need to suckle should be satisfied at the breast. Using teats or pacifiers may
interfere with suckling and the adjustment of the breast milk supply to the baby’s requirements.

10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge
from the hospital or clinic. Breastfeeding support groups are often part of a community nutrition
strategy. Peer counsellors are women from the community who receive training in breastfeeding
support. They often contact mothers in their homes. They are very effective in increasing exclusive
breastfeeding.

Drawing attention to these 10 steps is critical in improving breastfeeding rates. More than 15,000
facilities in 134 countries have been awarded baby-friendly status since BFHI began almost 20 years
ago. In many areas where hospitals have been designated baby-friendly, more mothers are
breastfeeding their infants, and child health has improved.

BFHI is gaining ground in Asia, with Thailand being one of 12 developing countries taking the lead in
instituting the 10 steps of baby-friendly practice in as many hospitals as possible. China now has more
than 6,000 baby-friendly Hospitals and exclusive breastfeeding rose dramatically in the early 90s from
29 percent to 68 percent in the mid 90s.

“It’s a totally different scenario in the Philippines where exclusive breastfeeding for infants decreased
from 37 percent in 1998 to 34 percent in 2003. Use of milk formula and feeding bottles is still a
problem. There is much to be done to reverse the effect of bottle feeding and intensive work is
necessary to make exclusive breastfeeding the norm in the society,” said Tobin.

Health systems, health care providers, and communities must act to make breastfeeding the easy choice
for women. Breastfeeding is indeed the best start to life and mothers need everyone’s support to fully
enjoy and appreciate their breastfeeding experience.

También podría gustarte