Rationale: Exclusive breast-feeding ensures safe nutrition to the infant and all round development of health
Breast-milk contains all essential nutrients needed for the infant; it provides the best nutrition and protects the infant from infections. Breast-milk is a natural food and is more easily digested and absorbed by the infant as compared to formula milk prepared from other sources. Colostrum, which is the milk secreted during the first 3- 4 days after child birth, is rich in proteins, minerals, vitamins especially vitamin A and antibodies. In addition, it has a laxative effect as well. Breast-feeding helps in reducing fertility and facilitates spacing of children. Lactation provides emotional satisfaction to the mother and the infant. Recent evidence suggests that human milk may confer some long term benefits such as lower risk of certain autoimmune diseases, inflammatory bowel disease, obesity and related disorders and probably some cancers. Therefore, breast milk is the best milk for the newborn and growing infant.
In addition to providing nutrients, breast-milk has several special components such as growth factors, enzymes, hormones and anti-infective factors. The amount of milk secreted increases gradually in the first few days after delivery, reaching the peak during the second month, at which level it is maintained until about 6 months of age. An average Indian woman secretes about 750 ml of milk per day during the first 6 months and 600 ml/day subsequently up to one year. Many essential components are in concentrated amounts in colostrum as compared to mature milk, compensating for the low output during early lactation.
Breast-milk provides good quality proteins, fat, vitamins, calcium, iron and other minerals up to 4-6 months. In fact, quality of some of the nutrients can be improved by supplementing the diet of the mother with nutrients. Growth performance of majority of the breast-fed infants is satisfactory up to 6 months of age. Breast feeding is associated with better cognitive development possibly due to the high content of docosahexaeonic acid (DHA) which plays an important role in brain development.
Mother-infant contact should be established as early as possible (immediately after birth) by permitting the infant to suck at the breast. Mothers can breast-feed from as early as 30 minutes after delivery. Colostrum should be made available to the infant immediately after birth. Feeding honey, glucose, water or dilute milk formula before lactation should be avoided and the infant should be allowed to suck, which helps in establishing lactation. Colostrum should not be discarded, as is sometimes practiced.
Breast-feeding in India is common among the rural and urban poor, being less so among the urban middle and upper classes. The poorer groups continue breastfeeding for longer duration than the educated upper and middle income groups. The economically advantaged or the working mother tends to discontinue breast-feeding early. A baby should be exclusively breast-fed only up to 6 months and complementary foods should be introduced thereafter. Breast-feeding can be continued as long as possible, even up to 2 years. Demand feeding helps in maintaining lactation for a longer time. If babies are quiet or sleep for 2 hours after a feed and show adequate weight gain, feeding may be assumed as adequate. Breast-fed infants do not need additional water. Feeding water reduces the breast milk intake and increases the risk of diarrhoea and should, therefore, be avoided. Giving additional water is unnecessary even in hot climate.
Composition of breast-milk depends to some extent on maternal nutrition. In general, even the undernourished mothers can successfully breast-feed. But in the case of severe malnutrition, both the quality and quantity of breast-milk may be affected. Protein content of breast-milk appears to be much less affected as compared to fat in malnutrition. Concentration of water-soluble vitamins as well as fat soluble vitamin A (beta-carotene) is influenced by the quality of the maternal diet. Supplementation of vitamins A and B-complex to lactating mothers increases the levels of these vitamins in breast-milk. Zinc and iron from breast-milk are better absorbed than from other food sources. Trace element composition of breast-milk, however, is not affected by the mother's nutritional status.
Diseases and death among breast-fed infants are much lower than those among formula-fed infants. Breast-feeding protects against diarrhoea and upper respiratory tract infections. The bifidus factor in breast-milk promotes the natural gut flora. The gut flora and the low pH of breast-milk inhibit the growth of pathogens. Breast-milk has immunoglobulins (IgA), lactoferrin, lactoperoxidase and complements which protect the infant from several infections. Antibodies to E-coli and some viruses are found in breast milk, which protect the gut mucosa. Breast-feeding also protects infants from vulnerability to allergic reactions.
It is necessary that the woman is emotionally prepared during pregnancy for breast-feeding and is encouraged to eat a well-balanced diet. Anxiety and emotional upset must be avoided and adequate rest should be ensured. It is necessary to prepare the breast, particularly the nipple, for breast-feeding. Mother should initiate breast-feeding as early as possible after delivery and feed the child on demand. Milk production of the mother is determined by the infant’s demand. Frequent sucking by the baby and complete emptying of breast are important for sustaining adequate breast milk output. A working mother can express her breast milk and store it hygienically up to 8 hrs. This can be fed to her infant by the caretaker.
Since, drugs (antibiotics, caffeine, hormones and alcohol) are secreted into the breast-milk and could prove harmful to the breast-fed infant, caution should be exercised by the lactating mother while taking medicines.
HIV may be transmitted from mother to infant through breast milk. However, women living in the resource poor settings in developing countries may not have access to safe, hygienic and affordable replacement feeding options. Considering the important role of breast milk in child growth and development, following recommendations have been proposed by National AIDS Control Organization (NACO). When replacement feeding is not acceptable, feasible, affordable, sustainable and safe (AFASS), exclusive breast-feeding is recommended during the first months of life. Every effort should be made to promote exclusive breast-feeding for up to four months in the case of HIV positive mothers followed by weaning, and complete stoppage of breast feeding at six months in order to restrict transmission through breast feeding. However, such mothers will be informed about the risk of transmission of HIV through breast milk and its consequences. In addition, based on the principle of informed choice, HIV infected women should be counseled about the risk of HIV transmission through breast milk and the risks and benefits of each feeding method, with specific guidance in selecting the option most likely to be suitable for their situation. In any case, mixed feeding i.e. breast-feeding along with other feeds should be strictly discouraged as it increases the risk of HIV transmission.